Motion made, and Question proposed, That the sitting be now adjourned.-(Mr Vara.)
Mr Tom Clarke (Coatbridge, Chryston and Bellshill) (Lab): As always, it is an enormous pleasure to debate under your chairmanship, Mr Hood. I welcome you this morning. I also have great pleasure in welcoming the Minister. He knows that he has a very exciting portfolio, and if our extremely crowded meeting of the all-party group on learning disability yesterday is an indication-we understood that the Minister could not attend, for very good reasons-there is great public interest even in this debate. I welcome the Minister to his post.
It is a great privilege to open this debate on the hugely important issue of the treatment of people with learning disabilities in the national health service. I am well aware that the NHS in Scotland is devolved, following decisions of this House, but I declare two interests. I am a co-chair, with Lord Rix, of the all-party group, and I represent taxpayers in my constituency, who want to see best practice throughout the UK, particularly because many of the problems that will be discussed today are replicated in Scotland.
It is four years since the Disability Rights Commission published its report, "Equal Treatment: Closing the Gap", on physical health inequalities experienced by people with learning disabilities and mental health problems. It is three years since Mencap published its "Death by indifference" report, highlighting six different cases in which people with learning disabilities died unnecessarily in the NHS. Those reports helped to bring the treatment of people with learning disabilities to the fore and led to an independent inquiry chaired by Sir Jonathan Michael in 2008. In March 2009, the health service ombudsman published a report on the six deaths highlighted in "Death by indifference" and found failures of process at the heart of service provision in the NHS.
I hope that today's debate gives hon. Members the opportunity to question the Minister on progress made in the past two to three years and gives the new Government the opportunity to show their commitment to equality of health care provision for people with learning disabilities.
It is important to emphasise that the debate is not an excuse to attack the NHS. The national health service is an institution that is treasured and cherished throughout the country and of which hon. Members in all parts of the House are rightly proud. I have seen in my constituency and in constituencies throughout Britain the hard work and dedication of health care professionals-nurses, doctors, cleaners, ancillary workers and others-who are willing and able to go the extra mile for patients and are determined to help and improve the lives of people who need the support of the NHS.
A true friend of the NHS does not simply praise it unquestioningly, however. I believe that Aneurin Bevan, who died 50 years ago last week, would be delighted to see Government, politicians and voluntary organisations coming together to work with the NHS to ensure that it constantly improves its health care provision for the most vulnerable people and delivers its services with ever greater understanding and consideration. We should not forget that although the right of people with learning disabilities to experience equality in health care provision is a profoundly moral one, it is also a legal requirement under the Disability Discrimination Act 2005, the Human Rights Act 1998 and the Mental Capacity Act 2005.
It is important for us to highlight the many problems identified in some of the excellent work carried out in recent years. Sir Bert Massie, then chairman of the Disability Rights Commission, wrote in the foreword to the commission's "Closing the Gap" report that
"people with learning disabilities...are more likely to experience major illnesses, to develop them younger and die of them sooner than other citizens. They are less likely to get some of the evidence-based treatments and checks they need, and they face real barriers in accessing services...we sometimes encountered a complacent attitude that these excluded groups 'just do' die younger or 'just won't' look after their health or attend appointments."
That was a damning indictment of what many people with learning disabilities experienced when they accessed health care services. Not only were people with learning disabilities more likely to experience health problems-that inequality is due to a wide range of physical, social and cultural factors-but the treatment that they received was of a lower standard.
The same report also found that people with learning disabilities were less likely to receive checks, such as crucial screening for breast cancer. There were problems with what is called diagnostic overshadowing, whereby physical illness is viewed as part of a learning disability and therefore ignored or sidelined. Many services were found not to be making reasonable adjustments to ensure that health care information was accessible to people with a learning disability.
If the report by the Disability Rights Commission was eye-opening, Mencap's "Death by indifference" report the following year was simply shocking. It highlighted the institutional discrimination that can exist at the heart of the NHS. One family reported that when they took their daughter into hospital for treatment, they were told, "If she had been a normal young woman, we would not hesitate to treat her."
Due to time constraints, I shall highlight just one of the tragic cases included in the report. Martin was 43 years old when he died in December 2005. He had a severe learning disability and no speech. After suffering a stroke, he entered hospital, where he contracted pneumonia. He could not swallow, so was put on a drip, which he was unable to tolerate and sometimes pulled out. A speech and language specialist visited Martin and recorded that alternative feeding methods should be found, but Martin was now entering his third week in hospital, his veins had collapsed and the doctors could no longer get the glucose liquid from his drip into his body. By the time it was decided that a feeding tube needed to be inserted into his stomach, Martin had been without nutrition for 21 days. He could not undergo the operation to insert the feeding tube, and five days later he died.
The hospital's internal investigation concluded that there had been a complete breakdown of communication between the doctor and the nurses. The ombudsman went further, finding that Martin's death was avoidable and that he had been treated unfavourably because of his disability. Martin starved to death in an NHS ward because he did not receive the quality of care that he deserved and because he was failed as a result of his disability. That was certainly a shocking case, but Martin's death was more than a mere statistic. It was a human life-a life that could have been saved if he had been treated properly.
As a judicial review has been granted into an aspect of the ombudsman's findings, I will not comment in detail on the wider aspects. However, the "Death by indifference" report was possible only because of the bravery of the families who came forward to highlight the tragic and preventable loss of life that had occurred. Their bravery allowed people to see the human aspect of disability discrimination in health care and led to the creation of an independent inquiry into access to health care for people with learning disabilities, which published its conclusions in July 2008.
Sir Jonathan Michael's findings supported what people with learning disabilities and their families and carers have long said, and the points that I am about to make were overwhelmingly endorsed again and again at the all-party group's annual general meeting yesterday. People with learning disabilities find it harder to access health care services not directly related to their disability, and adjustments are not always made to allow for communication problems. Parents and carers often struggle to be heard, and there is limited knowledge among health service staff about learning disabilities.
I was pleased by the response of the previous Government, who set up the independent inquiry and unreservedly accepted its findings and recommendations. A public health observatory and a confidential inquiry into the premature deaths of people with learning disabilities have been established, and progress has been made on annual health checks, particularly in certain areas. However, more needs to be done to ensure more uniform roll-out, and questions remain about funding.
Real progress was made under the previous Government's 2009 "Valuing People Now" strategy, and I would like to hear from the Minister how the new coalition Government propose to maintain that momentum, how they will ensure that reasonable adjustments are made and how they will continue to raise awareness among health care professionals. I would also like to hear how they will move towards providing greater training in the health service-an issue that was raised again and again at yesterday afternoon's meeting-and ensure that data collection, information sharing and service co-ordination are enhanced.
As we know, the problems in the NHS are not self-contained. Discrimination, lack of awareness and a failure to understand the needs of people with learning disabilities do not exist simply in the NHS or the public sector; such attitudes percolate through all aspects of society, from education to employment to health care. If the Government are seriously committed to removing health care inequalities for people with learning disabilities, they need to do so in a wider social framework, as the "Valuing People Now" strategy clearly recognised.
I would therefore be interested to hear the Minister respond to the recent report by Professor Jim Mansell, who, incidentally, made an excellent contribution to yesterday's meeting. His report, "Raising our sights", deals with people with profound intellectual and multiple disabilities. It details the challenges, prejudice, discrimination and low expectations that many people with such profound disabilities face. It also deals with, and makes recommendations on, health care for people with profound intellectual and multiple disabilities, encouraging NHS bodies and NHS trusts to think about how adequate health provision is and to reflect again and again on how they deliver such vital services. How do the Government plan to respond to this important report? Will its extremely relevant and poignant recommendations be used as a framework for future policy making? It would be useful if the Minister could make the report available in paper form for those who do not access the internet and if the excellent accompanying DVD, which we saw yesterday, could be added to the website.
Although progress has been made, there is still plenty to do. That was highlighted recently in a poll of more than 1,000 health professionals carried out by ICM and commissioned by Mencap. The survey found that almost half of all doctors and a third of nurses said that people with a learning disability receive a poorer standard of health care than the rest of the population. Four out of 10 doctors and a third of nurses said that people with a learning disability are discriminated against in the NHS. The survey also found that a third of health care professionals have not been trained in how to make reasonable adjustments for a patient with a learning disability.
The Government need to make sure that there are accessible and open communication channels between professionals and those with learning disabilities, who rightly demand a higher standard of treatment. More than 80% of people with a learning disability have a severe communication disability, and that, alongside the prejudices and stereotypes that I have discussed, can often be at the heart of identified failures in the NHS. How will the Government continue to expand opportunities for specialist support so that two-way communication between people with learning disabilities and NHS workers can improve? I ask the Government to ensure that people with learning disabilities are guaranteed access to special communication provision and that NHS staff have appropriate communication skills.
It is vital to recognise and adapt to the challenges specific to people with a learning disability. I have recently had the pleasure of working alongside the charities SeeAbility and the Royal National Institute of Blind People, which have highlighted the prevalence of sight problems among people with a learning disability. In fact, more than a third of people with a learning disability have such a problem, and many do not realise it. Such problems can lead to behavioural change, to the undermining of quality of life and often to increased dependency. It cannot be acceptable that people with a learning disability are also least likely to get the right help and support with eye care.
In January, the all-party group co-hosted a listening event at which people with learning disabilities spoke to MPs, Members of the other House and other stakeholders about the sight problems that they had had and the lack of support available to them. As we listened to those
articulate people, it became clear that more information needs to be available and that eye care professionals need to be supported so that they can provide accessible and effective services. Eye care is one small but important part of health care provision, but it became clear, as we listened, that all people with learning disabilities want is accessible and understandable services that are adaptable to their particular needs. That is not too much to ask, I suggest, in the modern world.
The commitment to eradicating health care inequality in the NHS is shared among Members on both sides of the House, our partners in the voluntary sector and health care professionals. There are problems of discrimination, lack of understanding, communication failure, assumptions about quality of life, and inflexible service provision, which have begun to be tackled. That process needs to be continued by the new Government. I hope that they support Mencap's new initiative, the "Getting it right" campaign, which calls on health trusts to commit themselves to a charter setting out the steps necessary to ensure equality of health care in the NHS for people with a learning disability.
The charter makes reference to many of the points that are being debated this morning, including annual health checks, training, awareness, support for families and open channels of communication. Equality in treatment will be fully realised only once genuine equality for people with disabilities is achieved across society. However, the steps that have been taken to make tangible gains must continue, and must not fall by the wayside because of spending cuts or NHS reform, or for any other reason. Health care professionals need to be fully trained; specialist communications must be accessible; and services must be flexible in relation to the needs of all people with a learning disability.
The NHS succeeds because it is there for the most vulnerable. Let us hope that, with the legislative programme that has already been started, which hopefully is to continue under the current Government, we can prevent ill-treatment, discrimination and even avoidable death in that great national institution-we owe it to people with disabilities and to the vast majority of NHS staff, whose sterling commitment I again acknowledge.
Chris Skidmore (Kingswood) (Con): As the secretary of the all-party group on disability and a member of the Select Committee on Health, I have a dual interest in this debate. I am also a member of the all-party group on learning disability. I am sorry that I could not attend yesterday's AGM; it sounds as if it was a fascinating event.
I thank the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke) for calling the debate, which is clearly necessary. If I repeat any of the points that he made so eloquently, it will be only because they need to be driven home. The debate highlights some current failings in the NHS with respect to people with learning difficulties. As the right hon. Gentleman said, there have been several reports on the issue in recent years. The Disability Rights Commission's report, "Equal Treatment: Closing the Gap", published in 2006, showed that although people with learning difficulties were more likely to develop conditions such as obesity and respiratory diseases, they were less likely to receive adequate care, treatment and health checks.
In the following year, as the right hon. Gentleman also mentioned, came Mencap's report "Death by indifference". That seminal study highlighted some of the failings of the past several years and showed that six people with learning difficulties had died prematurely owing to discriminatory care. Yet after those reports were published, and despite moves towards dealing with the situation, the most recent survey by Mencap, which was released in June-again, the right hon. Gentleman referred to it-showed that half of doctors and a third of nurses had witnessed a patient with learning disabilities being treated with neglect or a lack of dignity, or receiving poor quality care. Those statistics are clearly unacceptable.
What can be done? The right hon. Gentleman has already referred to the issues that we need to address. I shall probably repeat some of what he said, and I hope that he does not mind. To my mind, the first issue is training for professionals in the NHS. There is clearly an institutional failure to make adequate provision for people with learning difficulties in the NHS, despite the fact that they receive £1.7 billion of NHS money. The Mencap survey highlighted the training issue; it found that 53% of doctors and 68% of nurses felt that they needed specific guidelines on how to care for people with learning difficulties, and how treatment should be addressed to them, to meet their needs. There is clearly a gap that we need to examine in closer detail.
I welcome the plans in the White Paper that has just been published to end the top-down managerial approach and the current centralised funding of education and training, because previously the multi-professional education and training levy was not accountable in relation to the amount of training and continuing professional development that it provided. The White Paper sets out welcome plans to give employers greater autonomy and, above all, accountability. Accountability is what we need, because training has been available but there is no way of showing that it works. We need to get back to a local level, which is what the White Paper sets out to achieve, so that there will be greater professional ownership of the quality of training. I welcome that accountability and recognise that accountability at local NHS organisational level must also ensure that people with learning difficulties are treated adequately.
The second issue that I want to mention is the broader one of communication. That is at the heart of treatment for people with learning difficulties. The question is how to cross the communication barrier between professionals-doctors and nurses-and people with learning difficulties, who often cannot express their needs, which may be very individual. One of my constituents was recently rushed to the Bristol Royal infirmary on a weekend. He had a procedure on his heart and a doctor explained his condition to him as if he were communicating with a normal member of the public. That approach was clearly inadequate for someone with learning difficulties. The nurse then presented him with some complicated leaflets, which he could not understand. There was no co-ordination with his carer at NHS level-or certainly not at the acute hospital level-and that led to a man who was already very sick being further distressed and scared.
It is in that context, to which the right hon. Member for Coatbridge, Chryston and Bellshill referred, that the role of learning disability liaison nurses is crucial, for
the support of patients, families and those who support people with learning difficulties. It is not yet clear how many such posts exist. In my area of Bristol, which has the Frenchay and Southmead hospitals, there are only two. However, I was surprised to discover that that is pretty good by national standards.
I understand that interesting new moves are under way towards developing the role of liaison nurses, and in particular that St. George's healthcare trust in south London has gone further, by appointing a nurse consultant in learning difficulties. The success of that probably says something about the need to examine the NHS staffing structure in relation to people with learning difficulties. The holder of that nurse consultant post remarked:
"This job would not have had the impact it has had if it was not at consultant level."
That shows an interesting divide, by which those with learning disabilities are often dealt with at a nursing level, when to get the impact that is needed it is necessary to go higher up the chain. Clearly, there is a need to explore the greater use of liaison nurses, the employment of a number of such nurses, and what happens at local level.
The White Paper gives us much encouragement about the personalisation of services, and, above all, the determination to put patients at the heart of the NHS. I note with interest that one of its principal aims is to ensure that shared decision making will become the norm. To use the familiar maxim that we use in the all-party group on disability, "No decision about me without me." Sadly, we know that for some with learning difficulties that will be impossible.
We already know about the difficult ethical issues, which have been reported in the national media, in respect of those with learning difficulties having treatment forced on them. For instance, a lady with cancer was forced to undergo an operation. I do not want to touch on the ethical issues today, but such cases clearly raise questions about the relationship between patients and professionals. Given the White Paper, the greater personalisation of services and putting patients at the heart of the NHS, we must ensure that patients with learning difficulties are not left behind.
Personalised care that reflects individual health care needs is just as relevant for those with learning difficulties, if not more so. If we want to realise the promise of the White Paper-I note that it is also committed to promoting equality-we must understand the importance of health outcomes for those with learning difficulties. Moving from targets towards outcomes will benefit those with learning difficulties, as some of their problems need to be considered over a greater period, and hospitals cannot always deal with them in a single session. However, those outcomes are not being met, and that reflects on society.
Above all, it is important to ensure that the most vulnerable, particularly those with learning disabilities, receive the greatest care. In that regard, the introduction last year of incentive payments for GPs to carry out annual health care checks for those with learning difficulties was welcome. However, there is clearly a problem. Take-up
has risen by about 60% between 2008-09 and 2009-10, yet still only half the money allocated for such checks by doctors is being used.
The White Paper and Government statements show that giving GPs greater control over their budgets will circumvent some of the centralised mechanisms. GPs will thus know exactly what tailored care is necessary for their patients, including those with learning difficulties. I hope that GPs will take the opportunity to expand the use of health checks within their allocated budgets. That will ensure that prevention is at the heart of treatment.
Above all, the issue is about prevention. As the right hon. Gentleman said, those with learning difficulties and disabilities are often at greater risk of illnesses that could have been prevented; they could avoid reaching the acute hospital stage, which can often be confusing and stressful, early in their treatment. Personalised care will ensure that GPs monitor patients more carefully. I hope that having annual health care checks in place will ultimately prevent people with learning difficulties from reaching the stage in the NHS that they find so disturbing-the stress of late diagnosis.
Finally, I echo the right hon. Gentleman's comments about the national health service. We are not here to criticise the institution. We share a common cause; we wish to make it better and more effective for those with learning difficulties.
Mr Gregory Campbell (East Londonderry) (DUP): I thank the hon. Gentleman for giving way. He touched on the excellence of the national health service. Does he agree that we must try to ensure best practice throughout the United Kingdom, particularly in devolved regions, and that we should not have patients in one part of the UK demanding of the health service a level of service that they see elsewhere? We should aim for equality and best practice across the UK.
Chris Skidmore: I agree with the hon. Gentleman. We are learning that health inequalities throughout our nation are extremely profound. Only by dealing with health inequalities can we raise the standard of public health in the nation as a whole-something that applies to many of our public services. Having a greater drive towards the localisation of services and the personalisation of care will get us to the stage where prevention is at the heart of NHS treatment. Through prevention, we will achieve greater equality; it will iron out some of the inequalities that we see in our most deprived communities.
The principles on which the NHS was founded are still relevant today, and we agree that that must remain so. However, although free health care at the point of access should be available to all, based on need, we must look harder at how to ensure that the needs of the most vulnerable are met. That includes those with learning difficulties. More clearly needs to be done, but I hope that we will be able to achieve it.
Barbara Keeley (Worsley and Eccles South) (Lab): It is a pleasure, Mr Hood, to serve under your chairmanship. I congratulate my right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr Clarke) on securing this debate, which is on a most important subject.
As we know, my right hon. Friend is chair of the all-party group on learning disability, and I pay tribute to his work on the matter in Parliament and with Mencap, which supports the all-party group. My right hon. Friend has highlighted a series of reports that make a compelling case for improving the treatment of people with learning disabilities, making it equal to the treatment received by others.
At the extreme, inequality of treatment in the NHS can lead to unnecessary death, as in the six cases highlighted by Mencap's report "Death by indifference". Those six cases of unnecessary death led to the health ombudsman's findings of failure in NHS service provision. Since then, Mencap has received more accounts of tragic cases from families and carers whose loved ones died because health professionals did not know how to treat, assess or care for people with learning disabilities; they did not listen to what the families and carers said about the patients' needs, and they made no effort to communicate with the patients using methods such as photo symbols.
Some time has elapsed since the "Death by indifference" report and the ombudsman's findings of failures in service provision. Will the Minister tell us what progress the Department of Health has made in achieving equality of provision in health services for people with learning disabilities? As my right hon. Friend said, there is a moral case for equal treatment but it is also a legal requirement under the Disability Discrimination Act 1995, the Human Rights Act 1998 and the Mental Capacity Acts. The cases that have been highlighted show that people with learning disabilities do not always get the right health care; failures in provision can have fatal consequences.
Given that people with learning disabilities are more likely to have major illnesses, and at a younger age, failures in provision or barriers to accessing treatments or services are more likely to lead to fatal consequences. Members may know of such things from their casework. I spent time battling for appropriate care for a young constituent with physical and learning disabilities. Her parents wanted her medical needs to be assessed alongside her physical needs, but we had a battle with the primary care trust on that. We finally won, but it was too late; my young constituent died before the improved services could be put in place.
My right hon. Friend spoke of the problem of diagnostic overshadowing, whereby physical illness is seen as part of a learning disability and is therefore ignored or sidelined. In our debate last week on mental health and autism, we said that similar difficulties resulting from mental health symptoms are being treated as if the symptoms were part of the autistic spectrum disorder and are also ignored. We need health professionals to be trained to treat, assess and care for people with disabilities or learning difficulties.
We heard earlier that a poll of more than 1,000 health professionals commissioned by Mencap found that a third of health care professionals are not trained in how to make reasonable adjustments for patients with learning disabilities. As has been said, that is no longer acceptable. The fact that more than 80% of people with a learning disability also have a severe communication disability points to the need for training and specialist support. I make no apology for repeating points made by others; we need to underline their importance.
Good communication is vital between patients with learning disabilities and health care professionals and, as we heard, that is at the heart of NHS provision. I therefore look forward to hearing the Minister's comments on access to special provision for communication within the NHS, and on appropriate communications skills training for NHS staff. The NHS White Paper says that the Department of Health will reduce its role in the education and training of staff. How will the Government ensure that professionals have proper training in providing health care for those with learning disabilities?
I turn from training to health checks for people with learning disabilities. The Labour Government's "Valuing People Now" strategy accepted a recommendation to introduce a directed enhanced service of annual health checks for people with learning disabilities who are known to local authorities. That has meant that all primary care trusts in England are under direction to commission annual health checks from GP practices in their area and to arrange appropriate training for GPs and their practice staff. Such arrangements were initially set to run until 31 March 2010, but there has been an extension until 2011.
In addition, the Department of Health planned to work with groups representing patients, families, carers and professional groups to review the effectiveness of those arrangements and consider improvements for the future. Will the Minister update us on that work and say what commitments he can make to continue annual health checks for people with learning disabilities? Will he also update us on the development of practitioners with a special interest in learning disability, as that, too, was part of the strategy? It was envisaged that such practitioners could serve as a resource to other health practitioners in their area.
Given the announcements made by the Secretary of State on Monday, will the Minister further update us on what the commissioning process will be for the directed enhanced service? Will the new NHS commissioning board require GP consortiums to provide annual health checks for people with a learning disability? What expertise in commissioning care for people with a learning disability will the Government expect GP consortiums to have? That is an important question. Will the Minister tell us whether the Government plan a wider roll-out of annual health checks for people with a learning disability, as my right hon. Friend has already asked him, and what systems will be put in place to monitor the quality of such health checks?
People with a learning disability will receive health checks only if they are known to the local authority. A further recommendation accepted in "Valuing People Now" was that the Department should ensure that it collects the data and information necessary to allow people with a learning disability to be identified by the health service and have their care pathways checked.
Will the Minister update us on the work of the NHS information centre and the public health observatory for people with learning disabilities to identify practical changes that are needed to ensure more systematic recording of learning disability within general practice? "Valuing People Now" said that the directed enhanced service for annual health checks would help GP practices ensure that the registers they maintain under the quality and outcomes framework reflect information from local authority registers of people with learning disabilities
known to those services. Will the Minister tell us whether that has been a successful way of collecting the data and information needed? Has good practice emerged on comparing data from GP practice systems with data from other NHS sources to allow better analysis of the uptake of health care interventions and health outcomes for people with learning disabilities?
Finally, "Valuing People Now" recognises the important role that carers play and the importance of working in partnership with them in the provision of treatment and care. Carers should always be included as partners in care, but the "Death by indifference" report showed that health care professionals did not listen to families and carers about patients' needs.
The hon. Member for Kingswood (Chris Skidmore) told us of a case in which the carer was not involved in any communication about the person for whom they cared. The national carers' strategy included a commitment to issue information prescriptions to carers and to enable carers to receive other appropriate information, especially in cases when mental capacity is an issue.
The national carers' strategy also recognised that the additional stress of caring may affect the carer's own health, so there is a need for annual health checks for family carers, too. We must ensure that carers get regular access to short-break services and to support.
In this time of cutbacks and austerity budgets, will the Minister assure us that he understands and prioritises work to ensure that carers are treated by the NHS as partners in care? Will he also tell us whether work on a refresh of the national carers' strategy will continue to prioritise annual health checks for carers, access to respite care and breaks for all carers, especially those who care for people with a learning disability?
The Government White Paper uses the slogan "Nothing about me, without me", which clearly owes a debt to the slogan "Nothing about us, without us", which was used for many years by disability activists. "Nothing about us, without us" was also the title of a strategy paper for learning disability produced in 2001 by the Department of Health and the service users' advisory group, which included representatives from a number of learning disability organisations.
I trust that the Minister will value the contributions and questions that have come from this debate, as Ministers have valued reports from, and the themes and slogans used by, organisations for people with disabilities and learning disabilities over the last decade.
The Minister of State, Department of Health (Mr Paul Burstow): I thank the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke) for securing this debate, because it is a timely opportunity for the new coalition Government to set out their intentions and approach to the issue. I also pay tribute to him because I know from my time in the House, over the past 13 years, that he has been a true and consistent campaigner on behalf of people with learning disabilities and their families. He has brought many issues to the attention of the House and regularly challenged Ministers of the previous Government-I am sure that he will continue to do so with this Government-to strive to achieve better outcomes for people with learning disabilities.
I made it my business to attend the first meeting of the all-party group on learning disability after the general election to signal my intention and commitment as a new Minister. Despite the fact that I could not make yesterday's meeting, I hope that my good faith and my desire to collaborate with the all-party group will be recognised. I also pay my respect to Lord Brian Rix who, along with the right hon. Gentleman, provides exceptional leadership in that area.
I also thank the hon. Member for Kingswood (Chris Skidmore) and the hon. Member for Worsley and Eccles South (Barbara Keeley), who speaks for the Opposition, for their contributions to this debate. I will clearly have ample time to respond to their many points and questions. If I miss anything out, I will write to right hon. and hon. Members later. It is right that such issues should arouse strong feelings and that they should be kept at the top of the agenda. The right hon. Member for Coatbridge, Chryston and Bellshill drew attention to the Disability Rights Commission report "Closing the gap" and the impact that it had when it came out. No one should be in any doubt of the extent to which the Mencap report "Death by indifference" provided a wake-up call to the NHS and the Government of the day. The health ombudsman's report has also been very important in alerting us to the failings in the system.
Four years on, a great deal has been written and said about this subject. None the less, despite the "Valuing People Now" strategy and the many worthy efforts to improve services, there are still some parts of the NHS that are not delivering well enough for people with learning disabilities. We have inherited that legacy and we are determined to take action on it. I welcome and support the principles set out in Mencap's "Getting it right" charter, and we will try to collaborate with the charity to ensure that we address and take forward the additional challenges. I want to work very closely with Mencap to ensure that we translate the words on the page into real change in hearts, minds and practice across the country.
The right hon. Gentleman and the hon. Member for Kingswood were right to pay tribute to the work of many dedicated NHS staff around the country. Constructive feedback also needs to be part of any good process of continuous improvement, and is certainly essential when it comes to the NHS. My hon. Friend the Member for Kingswood put his finger on the pulse when he said that one of the key things that the Government White Paper on the NHS will do is provide a far better focus on early intervention, early diagnosis and prevention. Prevention will be an important part of this Government's agenda in the delivery and improvement of health care.
I want to make it clear that this Government support "Valuing People Now" as a strategy. Our approach to it is one of continuity and change. I will not be reinventing the wheel, but I will be doing everything I can to make the wheel spin faster-if I can put it that way-because we need continuity but we also need to accelerate the pace of change on the ground.
I have listened very carefully to the points that have been made by right hon. and hon. Members during this debate and I will try to respond to those points. I will start with the point about evidence and information. Gathering evidence and information must be a key part of informing the development of practice on the ground. The right hon. Gentleman and the hon. Member for
Worsley and Eccles South, the shadow Minister, were right to say that this is an area where we must do more. Gathering better information and evidence is vital. We need better information and evidence to subject the NHS to proper scrutiny and so that the NHS can conduct proper self-appraisal; consequently, any shortcomings in care can be identified and acted on quickly, both at a local and a national level.
I can confirm that we are pressing ahead with the confidential inquiry and the public health observatory that were recommended by Sir Jonathan Michael's inquiry. The confidential inquiry will ensure that premature and avoidable deaths of people with learning disabilities are investigated and that lessons are properly learned and applied at a national level. The public health observatory will give us a much stronger evidence base about the needs of people with learning disabilities and the difficulties that they face, which in turn will inform better practice. I am particularly pleased that we will have representatives from Mencap, the National Forum for People with Learning Difficulties and the National Valuing Families Forum on the group that will scrutinise the progress of both the confidential inquiry and the public health observatory.
In addition, all areas of the country have completed, or are in the process of completing, the new health self-assessment framework. That framework brings together strategic health authorities, primary care trusts, hospital trusts and people with learning disabilities and their families. Those organisations and individuals are coming together to assess local NHS progress and to ensure that health services continue to improve for people with learning disabilities. Their work will be shared with the public health observatory to inform its work. The framework offers a strong means of ensuring accountability and it can help us to ensure that NHS services are making the right adjustments in line with their duties under the Disability Discrimination Act 2005 and other legislation, which is a point that has quite rightly been made by all right hon. and hon. Members who have contributed to this debate.
Barbara Keeley: As I think all of us who have been involved in today's debate understand, there will be a great deal of churn in the organisations that the Minister has referred to, such as the SHAs, the PCTs and the hospital trusts. Greater accountability for, and greater scrutiny of their work is clearly important, but those organisations are now threatened with closure. People will be leaving their jobs, so I want to ask the Minister if there is a follow-on plan for when those organisations expire, as it were?
The hon. Lady must have a copy of my speech in front of her, because the answer to that question is in the next paragraph. She is absolutely right. In executing the change that the White Paper sets out, which means removing the sense of central dictation and direction that we have seen in the NHS for the last 13 years, ending that sense of command and control and making the system one that is about delivering outcomes and one that is facing the patient and working alongside them to deliver those outcomes is an important transformation. Therefore we need to ensure that, in the transition planning that is now well under way for the change that will take place during the next two to three
years, the institutional knowledge and learning in the existing system properly migrate to the new system, and that best practice is firmly embedded in the front-line services. Those services will remain as they are now, but they will receive more support and investment to do even better.
Mr Tom Clarke: I welcome both the Minister's tone and his approach to the all-party group. When he considers a number of these issues, I wonder if he feels, as I do, that the importance of advocacy is underlined? Furthermore, does he believe that advocacy will become a central part of the Government's approach to these matters?
Mr Burstow: I am very grateful to the right hon. Gentleman for his intervention and his question. He raises a point that I will move on to shortly, but I certainly see advocacy as being very important in this area. Looking forward, we will need to ensure that we reflect what we are learning from the work that is going on at the moment in the new commissioning landscape and in the new frameworks for accountability at a local level.
Both the right hon. Gentleman and the shadow Minister have referred to annual health checks, so let us look at that issue. It is quite encouraging that many more people with learning disabilities are now receiving an annual health check from their GP. Last year, just over one in five people with learning disabilities received an annual health check and the latest figures show that two in five people with learning disabilities have received their annual health check within the last 12 months. However, that is clearly not good enough, as it means that three in five people with learning disabilities still do not receive an annual check. As a Government, we are determined to push that process forward to ensure that the training and development that has taken place delivers in that regard.
I have heard many stories about how those health checks have identified, for example, cataracts or cases of diabetes. Furthermore, as has already been said in this debate, if we put ourselves in the position of a person having such a health condition but being unable to communicate the symptoms, we can begin to understand the difference that these health checks can make. I am therefore certainly keen to see annual health checks continue for people with learning disabilities, and we are looking at the most cost-effective way of ensuring that.
Reference was also made to the training of staff in relation to carrying out health checks. Undertaking training is certainly part of the requirement for all the GP practices that are delivering the annual health checks for people with learning disabilities. That training is about raising awareness of people with learning disabilities and their families, and particularly about ensuring that communication issues are understood, that advocacy is provided and that there is also liaison with staff in the acute sector. So there are a number of aspects about training and I will say more about that shortly.
The right hon. Gentleman referred to the training, as did the hon. Member for Kingswood. Reference was made to the recent Mencap poll, which makes disturbing reading as it shows the number of staff who have not had training to help people to make reasonable adjustments to different situations.
The shadow Minister talked about the need to look at people in the round, so that we do not only look at either their learning disability or their physical needs but at both elements. In that way, we will not allow diagnostic overshadowing to take place. That issue must be properly addressed in training. Therefore I wanted to ensure that right hon. and hon. Members were aware that the Council for Health Regulatory Excellence is working with professional bodies to support better training and to improve professional standards. That relates to a point that the hon. Member for Kingswood made about the need for professional ownership of that training, so that it is not just something that is imposed from the top but is seen by professionals as an essential way of learning to do their job better.
As a Government, we are working with the council to reach not only doctors and nurses but the full range of health care professionals. That is clearly important when it comes to meeting the often complex needs of people with learning disabilities. For example, speech and language therapists have a key role in tackling feeding issues of the type that the right hon. Member for Coatbridge, Chryston and Bellshill talked about. However, he referred to a case that I fear I cannot talk about any further, because it is before the courts. Occupational therapists are also important in helping people to develop the skills that they need to live independently, so I am pleased that all the regulatory bodies are reporting progress on that work and I will certainly keep in touch with them to ensure that that progress is maintained. I also want to ensure that that learning is embedded as we move towards delivering the vision that is set out in the Government's health White Paper published on Monday.
Meanwhile, at a primary care level staff in all GP practices that are delivering annual health checks now have the appropriate training. The Royal College of General Practitioners is due to publish additional training materials for all GPs this summer, which are about getting health checks right for people with learning disabilities. I hope that that reassures right hon. and hon. Members that the Government are not about to shelve the issue of training but are determined to see training programmes develop.
Barbara Keeley: I think that the point about annual health checks has been emphasised. Does the Minister see those checks continuing? Will there be funding for them to continue? He has helpfully quoted some figures that show that we have moved from a situation in which one in five people with learning disabilities receive an annual health check to a situation in which two in five receive such a check. Does he know whether that gap-a gap that means that three in five people with learning disabilities do not receive an annual health check-exists because those people are not known to services or because GPs are just not carrying out those checks? In other words, is there an information gap or is there a practice or provision gap? If he does not know now, perhaps he can tell me in writing later.
Regarding the hon. Lady's point about funding, given the tone and the substantive nature of what I have said about annual health checks it would be surprising if the Government were not determined to
see those checks being continued. However, we are obviously in the middle of a spending review and therefore we must ensure that we achieve value for money in those checks. I think that this debate underscores that point only too well. I will write to the hon. Lady on the other point, because I want to get the answer absolutely right, and I will ensure that other hon. Members involved in this debate are copied in.
The hon. Lady also mentioned the value that we all rightly attach to the contribution made by family carers. I hope that she and others, while perusing the White Paper during the past two days, will have seen that one thread running through it from principles to practicalities is the value that this Government attach to the role of carers. For the first time in a Government White Paper, we have stated clearly that we see carers as partners in recovery and the provision of good care, which we want to ensure is provided appropriately in different circumstances. It is an important signal that we hope will be taken on board.
On annual health checks, the hon. Lady will know that the Government are in the midst of a series of pilots to evaluate the best way to implement health checks for carers. We will await the outcomes of the pilots before making further decisions about their wider roll-out.
On engagement, which all hon. Members have mentioned, it is crucial that patients and families are at the heart of all health care services at all levels. The White Paper makes that clear by borrowing from an important past report. We want the aspiration "No decision about me, without me" to inform how the health service develops. We need people with learning disabilities to be fully involved in the planning and design of services at a local level. If we can create an NHS that genuinely listens and responds to patients, in line with the White Paper, we will ensure that people with learning disabilities get the support and advocacy that they need to make their voices heard. That is clearly important, just as it is important to ensure that the values and principles behind the Mental Capacity Act 2005, which I supported during its passage through the House, are understood and translated into practice.
Some parts of the country are already doing great work in that area by, for example, bringing in user-led organisations to advise staff and help them offer patients the right advocacy. We want to see more of that. We will also work through the new body proposed by the White Paper, HealthWatch, which will not only handle patient complaints but be responsible for providing advocacy and support in pursuing them. HealthWatch will have a key role in ensuring that the voices of those whom we are discussing are heard fully across the NHS. It will be a powerful champion for people who are not always heard.
Hospital passports have not been mentioned, but they none the less address some issues raised in this debate. The hon. Member for Kingswood discussed, among other things, the role of liaison nurses. Hospital passports are another helpful development and were one of the top suggestions in Mencap's charter. The passports are short, accessible booklets that can be carried by people with learning disabilities to give NHS staff information about their medical history, any drugs that they are taking and their likes and dislikes. They are a low-cost but effective idea and are offered by many
hospitals throughout the country. I want to see them spread to every hospital. I suspect that the case mentioned by the hon. Gentleman involving poor communications in hospitals might have been avoided if such a passport had been available.
Clearly, acute liaison nurses also have a role to play. All strategic health authorities recently reported on the issue to the Department of Health, and all referred to the value of acute liaison nurses. The number of posts is increasing as such nurses demonstrate their value. They play a part in building capacity, training colleagues, raising awareness across the work force, improving the patient experience and, importantly, reducing length of stay and getting people back into the community appropriately.
I have mentioned commissioning structures. As we migrate from the old system to the new, we must ensure that the learning is carried over. That creates opportunities and possibilities for organisations such as Mencap and others to play their part in ensuring that they work alongside commissioners at a local level to deliver it.
Barbara Keeley: While the Minister is on that point, will he enlarge on how the commissioning of the services that we have been discussing will take place? Will they be locally commissioned, or will the NHS independent board commission them from GPs?
Mr Burstow: The NHS commissioning board will commission the family practice services that GPs provide, but the GP commissioning consortiums will be responsible for a wide range of commissioning services, some of which they may do collectively at a sub-regional or regional level, while others will be discharged by the NHS commissioning board. The important thing is the expertise available, and we say in the White Paper that GP consortiums will have access to that expertise in a number of ways. They might choose to bring it in-house, use their local authority's commissioning expertise-some local authorities have exceptional expertise-or work with third sector organisations. There are already examples of that happening, such as with Turning Point. I suggest that opportunities exist for organisations to offer commissioning expertise in order to develop services that are much more in tune with the needs of particular patient groups.
The right hon. Member for Coatbridge, Chryston and Bellshill was absolutely right to flag up the wider societal challenges of discrimination, particularly the discrimination faced by people with learning disabilities. He was therefore right to identify, as the Government do, that we must not approach the issue in a narrow, health-focused way. We need a wider social perspective in taking forward strategies on the matter, and that will be part of our thinking throughout.
The right hon. Gentleman also asked me about the Mansell report, which I know was the subject of discussion last night at the meeting of the all-party parliamentary group on learning disability. I thank Professor Mansell for his important work, not least because I understand that the work reported yesterday was commissioned by the Department of Health. It demonstrates the vital importance of improving services and outcomes for people with learning disabilities and provides important
examples of good service and good practice that we must ensure sit firmly in the strategy going forward. My officials will work further to ensure that we see how the findings fold into the ongoing work on the strategy.
The right hon. Gentleman asked about the DVD. We are happy to ensure that it can be accessed on the website and to discuss other ways we can collaborate to maximise awareness of it and the Mansell report. We are keen to ensure that people have access to it and will do what we can to achieve that.
I am told that financial matters, to which the right hon. Gentleman referred, were discussed last night at the all-party group meeting. How can we maintain and accelerate progress in the straitened financial circumstances that the Government have inherited? Part of the answer is that the NHS has benefited from this Government's commitment to real-terms growth. However, we have inherited a debt legacy that must be tackled, and we have made it clear that the sick should not have to pay the price for that, nor should people with learning disabilities. The NHS will have to be even more creative and willing to work in new ways with the third sector and other organisations to maintain and quicken the pace of reform. I am confident that we can do things differently and achieve with less, and that we can do more for people with learning disabilities.
Ultimately, we need to achieve real change to make an impact on the ground. Yes, we need better training, evidence and engagement but, ultimately, we need better services driving better outcomes for patients. We need services that are integrated-the White Paper provides a way forward on that-as well as more responsive. They must be built around the individual needs of patients and families, meet their expectations and give them a say in their treatment and ongoing care.
In conclusion, the NHS White Paper can be the catalyst that we need to drive change. The message is simple. We want an NHS that is focused on outcomes and judged by what really matters to people: the extent to which it helps them live longer and healthier lives. We will need to consider how we measure those outcomes in the right way for people with learning disabilities, and I look forward to working with the all-party group, Mencap and many other organisations on that. Reducing preventable mortality might, for example, be a helpful starting point, and we want to consult on that.
The shift away from process-led measures towards outcomes will bring a cultural shift in care and help the NHS to shake itself free of any of the lingering discrimination that has been talked about in this debate-any sense of looking at the disability rather than the individual as a whole in terms of how treatments are decided. That is the opportunity the Government's White Paper presents and I am determined to work with the right hon. Member for Coatbridge, Chryston and Bellshill, the all-party group, Mencap, families and others to ensure that we grasp that opportunity and deliver the best outcomes possible.
Mr Jim Hood (in the Chair): The sitting is suspended until 11 am.
Kate Hoey (Vauxhall) (Lab): I am grateful for the opportunity to raise this debate on the future of the south London line, which serves my constituency, and specifically the services that run through Clapham High Street and Wandsworth Road stations, which are absolutely essential in allowing many of my constituents to travel directly into central London. Although the Minister is, of course, aware of the situation and has had many briefings on it, I will set out the background, because it is by nature quite complex and his Department, ultimately, will make the final decision.
The south London line currently runs twice an hour in a loop between London Bridge and Victoria stations, stopping at South Bermondsey, Queens Road Peckham, Peckham Rye, Denmark Hill, Clapham High Street and Wandsworth Road. It serves the wide south London community by providing access to two key interchange stations, London Bridge and Victoria, which are the centres of much employment. In February 2009, Transport for London announced the funding and go-ahead for phase 2 of the East London line extension, which will supersede much of our service to the east, running to Canada Water, Shoreditch High Street and up to Dalston.
However, it is the proposals to the west that concern my constituents and me and that have worried so many of the local amenity groups, councillors and societies, such as the Clapham Society. The link to London Bridge was to be preserved by the proposed new line from Victoria to Bellingham, but Network Rail decided to axe that, on the understanding that the direct route to Victoria would be retained. We were also promised longer platforms at those stations and told that the money was available for that, so I hope that the Minister will be able to tell me about that or find out where the money that had been earmarked has gone.
Transport for London proposes that, rather than continuing to take residents into Victoria, where so many of them work, including many civil servants, those services will instead be diverted to Clapham Junction from May 2012. For those who hear the words "Clapham Junction" and immediately think, "Well, that's Clapham, so what's the difference?", I want to say that it may have the name "Clapham" but it is not Clapham. None of my constituents would consider Clapham Junction to be in Clapham. It is not convenient for them; it is not a route that they currently use to get into central London.
Clapham Junction lies further out, so passengers would have to travel further away from central London to change on to trains at Clapham Junction, which is already, as I am sure some Members know, an incredibly overcrowded station. The journey would be longer, and would mean inconvenient platform changes and even more crowded trains. It would, literally, be a backward step. As the Minister knows, Clapham Junction has been cited as the worst interchange station in London, with crowded corridors and congestion. Clapham Junction is therefore not in any way a solution, and I understand that the funding to improve the station will probably not now be available.
What is being offered, therefore, is an increased orbital service for an area that depends on its radial service to where people want to go, and for which there is increased
demand. That is demonstrated by the alternative route that people who are near enough will use: the Northern line. If the proposals go through, they will force many more people who currently use the train at Clapham High Street on to the Northern line at Clapham North and Clapham Common stations, which are dangerously overcrowded in the morning and are commonly recognised as needing reconstruction. The severe Northern line congestion suggests that there is a desperate need for alternative radial routes. If anyone ever wants to see what real crowding on a tube is, I suggest that they go to one of those Northern line stations at morning rush hour, when people sometimes have to wait for the second or third train before boarding. Cutting the alternatives into Victoria will, far from relieving congestion, have the opposite effect. People who live near Wandsworth Road are not even near a Northern line station, so they do not even have access to such an option.
What adds to the irony of the situation that has been proposed is that two trains an hour will still go to Victoria, but only at off-peak times, when commuter demand will not exist and take-up will be lowest. The outcome is that far more useful services are to be removed, and scarce money spent putting on a four-trains-per-hour service to Clapham Junction in the morning when there is no demand. I appreciate that the Minister might not yet know his London intimately, although I am sure that if he stays in his position longer he will, but this proposal is like arguing that because Richmond has orbital services it should lose all trains to Waterloo or Victoria, or that because Croydon has the East London line extension it should not have trains to London Bridge. That is really what Transport for London is proposing for Clapham High Street and Wandsworth Road.
Beyond that issue, which affects my constituents so much-although the decision has not finally been made-I have deep concerns about the process that has been followed and about how we have reached this point. The Department for Transport instructed Transport for London to work with London TravelWatch to consider the options for the future of the service, including the development of modelling to consider the future use of each option to serve my area, and many concerns have been raised about the modelling that was done to predict demand. Rather than considering consumer views data, the decisions relied on abstract projections over a 60-year period. I am not an expert, but I and many experts other than those who ordered that kind of modelling, are not convinced that it accurately reflects the desire for orbital travel, the unwillingness to interchange at Clapham Junction or the costs of the relative options.
London TravelWatch rubber-stamped the TfL proposal to end the London Bridge service, and since then there has been an ongoing discussion about the Victoria end of the service. What has emerged from the discussions is the so-called option 7, which did not exist in the previous shortlist but was brought in right at the end, although there were a number of other options. It seems to have been agreed as the way forward. This option ends peak-time access into central London and diverts people instead to Clapham Junction, forcing them on to the very overcrowded Northern line. It diverts long-distance Kent coastal services that come through to Victoria, allowing them to stop at various places-but not in my
constituency-and increasing the journey time for those commuters, without doing anything to help anyone living in the Clapham area.
London TravelWatch seems to have considered that an achievement, even though its chair, Sharon Grant, originally referred to the impact on my constituents as a "major disbenefit" with "a substantial disadvantage," and went on to talk about how terrible and overcrowded the Northern line was. Suddenly, Sharon Grant and TravelWatch seem to have decided, for whatever reason, that the Northern line is no longer overcrowded, or a problem, and that this proposal is the best option.
Option 7 brings the worst of both worlds, inconveniencing longer-distance passengers and leaving the worst-affected stations without their vital links to Victoria, forcing passengers on to the most congested part of the London underground. It is an option that, from a common-sense point of view, does not bring value for money. Even if it is cheaper at the moment, the longer-term cost makes it a clear example of false economy. London TravelWatch's remit seems strange to me. Is it not to be an advocate for the people of London? Does it actually also work for people in the wider south-east, such as Kent? It has abandoned the interests of my constituents in London. When Network Rail approved the axing of the south London line to London Bridge, TravelWatch agreed, on the condition that the Victoria link was kept.
Now TravelWatch has endorsed the axing of the Victoria link for Clapham High Street and Wandsworth Road, in a double betrayal of south London. Particularly contemptible is that TravelWatch, and everybody until early June, was reassuring all the campaigners in our area of what it called a "positive outcome." London TravelWatch is meant to be the voice of users, but it has, I believe, used its position to compromise the compromises and undermine stakeholder concerns, acting well outside its job as an advocate for users in London. It is almost like a defence barrister going into court and beginning to collaborate with the prosecution.
London TravelWatch's excuses about unaffordability and balancing the interests of Londoners do not wash. Successfully endorsing the removal of central London links is not acceptable for a watchdog whose remit is to represent commuters. There is no balance, particularly as it has reneged on categorical assurances and views about keeping Victoria links for Clapham High Street and Wandsworth Road. TravelWatch does not, in my view, interact with stakeholders, and is far too close to the rail industry to be an effective advocate, still less one that gets £1.6 million in funding from the London assembly.
I know that the London assembly is rightly considering TravelWatch's funding position. Perhaps I should not say this so bluntly, but I am fairly blunt: I slightly worry that perhaps TravelWatch's involvement with and support for TfL was something to do with its wanting to get TfL to be very much supportive of the continuation of the large amount of funding. In effect, my commuters pay to subsidise a watchdog to remove their services and make their journeys longer, more costly and more crowded. It is an irony that what we pay per year to keep TravelWatch going could give Clapham High Street and Wandsworth Road the four trains per hour service to Victoria.
This all seems to be very much a botched compromise; none of the proposed changes will benefit any of my constituents in the slightest. I believe that they would
agree with me and that they would rather keep things as they are than lose an important commuter service for the sake of four trains an hour going to Clapham Junction, which is not a station that they want to, or will, go to. We would rather hold out for future funding to lengthen the platforms, thereby allowing the introduction of the Victoria to Bellingham service, which would properly serve my constituents with four trains an hour to central London.
I am sure that the Minister will be interested to know that TfL spent £18 million on bonuses last year, up from £10 million in 2008. That suggests that it has sufficient money to keep the orbital links. As I said earlier, we should challenge why, as part of a compromise or of making it feel that it is doing something, it will put on four East London line trains to Clapham Junction when two would be enough and would release the capital and capacity for the Victoria services to carry on during the rush hour.
I do not expect the Minister to give me a detailed response on the nitty-gritty of what I have just said. He will probably give me some of the lines that have been put out by TfL, but the final decision on the matter rests with him. I am pleased that I have been granted a meeting to which I will be able to bring some of the local people who are experts on the subject. They may not work for TfL or TravelWatch and they may not earn millions a year, but they actually know what they are talking about. Frankly, they are the kind of people who I hope the Minister and the new coalition Government will start to listen to, rather than the so-called experts who are paid huge amounts of money, but, as I am sure the Minister knows, sometimes forget who they work for and who pays their salaries.
I thank Mr Speaker for giving me an opportunity to raise this matter. I am concerned that we will lose a service and that that will not be in the interests of London as a whole. It will not give value for money, and it certainly will not do anything to solve the congestion problems in south London.
Heidi Alexander (Lewisham East) (Lab): I congratulate my hon. Friend the Member for Vauxhall (Kate Hoey) on securing this debate. I was interested in her comments about the Victoria to Bellingham service, which would have four trains per hour into Victoria, and her preference for waiting for it to come in. A number of my constituents in Lewisham East rely on train services from Bellingham, which is, in effect, a public transport desert. I would very much welcome a service that ran more frequently from Bellingham into Victoria. I wonder whether the Minister, when he responds to my hon. Friend, could give me some guarantee that that option will be fully explored and investigated.
The Parliamentary Under-Secretary of State for Transport (Norman Baker): I congratulate the hon. Member for Vauxhall (Kate Hoey) on securing this debate and on providing an opportunity for hon. Members to discuss rail services in her constituency and further afield. I have always admired the hon. Lady, who is an independent person. Independence of mind is an attribute that we could do with more of in the House of Commons.
The planned changes to south London line services are a matter of concern to several Members, and officials have informed me that the Department for Transport has received significant correspondence on the matter over the past few months. I am pleased that my right hon. Friend the Minister of State, Department for Transport, will meet the hon. Lady in the coming days to discuss the issue in greater detail. Obviously, I will ensure that my right hon. Friend has access to the exchanges in this Adjournment debate.
It is probably worth starting my response by setting out the background to the proposed changes to the south London line, with some details about the existing service. The current service, provided by rail operator Southern, operates every 30 minutes in each direction between London Bridge and Victoria via Denmark Hill and Peckham Rye, including stops at Wandsworth Road and Clapham High Street. Two-car trains run for most of the day, with four-car trains provided for the morning peak. That is the only service for Wandsworth Road and Clapham High Street stations, all other stations on the route being served by other train services. I take the hon. Lady's point about the withdrawal of services to London Bridge and Victoria, and note her dramatic phrase, "a double betrayal".
It should be noted that Clapham North underground station is located some 300 yards from Clapham High Street station, and provides services to the west end, the City and Morden as well as connections to the rest of the underground network. However, I am not ignoring the points the hon. Lady rightly made about overcrowding. As an occasional commuter on the Northern line, I am well aware of the problems. It is also worth noting-I shall come back to this later-that the Northern line will benefit from enhanced capacity over the next couple of years as a result of the planned upgrade that forms part of Transport for London's investment programme.
The latest information on demand levels at these stages, which is provided by Southern, indicates that Clapham High Street is the start or end point of some 850 journeys per weekday, around a quarter of which have Victoria as their origin or destination. By comparison, Wandsworth Road is used for some 630 journeys per day, with two thirds starting or ending at Victoria.
As the hon. Lady knows, several of the planned service changes in her area of south London are required because of the start of the main works at London Bridge associated with the Thameslink upgrade programme. She will be aware that work on the Thameslink programme has already commenced across London: Blackfriars and Farringdon stations are already being rebuilt, platforms outside London are being lengthened and preparatory works at Borough market have begun. When completed, the Thameslink programme will enhance the frequency and capacity of train services throughout the centre of London, improving connectivity north to south and creating new journey opportunities while helping to relieve the Northern line north of London Bridge.
However, while works are carried out at London Bridge, the capacity of the station-the number of trains it can accommodate-will be reduced. We all recognise that any reduction in the number of services
that can go into London Bridge is not ideal, but rebuilding and enhancing a busy operational railway is not possible without some disruption.
The original plan, as consulted on by Network Rail as part of the south London route utilisation strategy document, was to divert the south London line service away from London Bridge and to create a new stopping service from Victoria to Bellingham, as the hon. Lady and the hon. Member for Lewisham East (Heidi Alexander) recognise. Bellingham is south of Catford and is a convenient location where trains can terminate. The new service would have reduced the number of train movements into London Bridge while maintaining key connections to and from London Victoria from Wandsworth Road and Clapham High Street as well as from Peckham Rye and Denmark Hill. I note Members' support for that option. It was the Department's intention to implement a Victoria to Bellingham service in place of the existing Victoria to London Bridge service while works at London Bridge were carried out, but the service changes made by TfL-I shall come to those in a second-mean that the alternative service strategy will not now be implemented.
I turn to the East London line extension phase 2 to Clapham Junction and why the proposed Victoria to Bellingham service will not now go ahead. The south London route utilisation strategy developed by Network Rail highlighted the potential benefits that the extension of the East London line would bring to the area of south London represented by the hon. Member for Vauxhall. However, in 2008, TfL and the Mayor concluded that the £75 million scheme was not affordable within the constraints of the TfL budget. Recognising the value of the extension project, the Department offered to provide an additional £15 million as grant to TfL and to support a £19 million funding application to the Office of Rail Regulation for Network Rail works to implement the project, so I think that the Department has been helpful.
As part of the funding proposal, TfL requested the withdrawal of the planned replacement south London line service to Bellingham. The money raised from that was to be diverted to the capital costs of the East London line extension-the saving is the equivalent of £24 million over 10 years. Under the devolved arrangements for London, the Mayor and TfL were, and are, fully at liberty to request such changes, given the powers granted to them over DFT-specified train services. Under the arrangements, TfL can propose, and pay for, services additional to the Department's base franchise specification. Alternatively, it is entitled to propose reductions in service levels and keep any savings made. The latter approach is what TfL proposed in respect of the Victoria to Bellingham service.
It would have been apparent that the proposed service changes would have meant that Wandsworth Road and Clapham High Street would lose all direct services to London Victoria, with passengers instead being required to travel via a change of train at Clapham Junction. However, train frequency at both locations would double from two to four trains per hour in each direction, with a far wider range of services available from Clapham Junction, including to Waterloo, stations on the west London line and the wider Southern and South West
Trains networks, although I appreciate they may not be destinations that all the hon. Lady's constituents want to reach.
Jane Ellison (Battersea) (Con): I apologise in case I have to leave before the end of the Minister's remarks, because I have to ask a question in the main Chamber at 11.30 am.
Slightly fewer of my constituents are affected than those of the hon. Member for Vauxhall (Kate Hoey), but I want to pick up on the point about Clapham Junction, because one problem is that it is not an effective interchange, despite being pretty much the busiest one in the country. I should like the Minister to recognise that the strategic long-term upgrade of Clapham Junction-I do not just mean the £20 million announced in March 2010 before the election-to reflect its status as the busiest interchange in the country is essential to making a lot more services attractive to a great many more people, irrespective of the direction from which they are coming into that station.
Norman Baker: I am grateful to the hon. Lady for her comments.
I stress that we, as a Government, are committed to devolution. We are talking about an earlier example of devolution to TfL and the Mayor, so whatever the Department for Transport thinks we live within the existing legal framework. Therefore, the Department may have fewer powers in this regard than in respect of other rail matters elsewhere in the country.
TfL made a judgment that the East London line service to Clapham Junction provided better overall benefits than the south London line to Bellingham. Clearly, Members present do not share that judgment. It is entirely appropriate that TFL, which is London's transport planning body, should make this judgment and assess the trade-offs between the different service proposals. Ministers in the previous Administration accepted the guidance provided by the Mayor on that being the best use of the limited available resources. If the Mayor and TfL make such decisions-the coalition agreement states that the Government believe that decisions should be taken at a more local level-it is important that they stand behind the consequences of such decisions when they are made, including the impacts on passengers at stations such as Wandsworth Road and Clapham High Street.
The decision not to implement the proposed London Victoria to Bellingham service was requested by TfL and the Mayor to help fund the East London line service. Implementing both the Bellingham service and the East London line would have been ideal, but both services were not affordable and TfL and the Mayor judged that the East London line extension provided more benefits than the diverted south London line. A judgment call was made by TfL in light of the financial constraints it faced. As is the case with such funding agreements, a number of conditions were attached to the funding given by the Department. TfL was fully aware of those conditions before it signed the funding offer.
Importantly, the Department was conscious of the need to keep stakeholders informed of any changes and included a requirement for TfL to inform key stakeholders about the route of the proposed changes. The Department
also included a clause stopping East London line services operating into London Victoria. If TfL decided to operate into Victoria we would need to renegotiate, and perhaps reduce, the £24 million funding offer. This may seem an odd condition, but it was put in place because other train operators would have had a claim on the Department for loss of revenue if TfL operated services into London Victoria.
The hon. Member for Vauxhall mentioned her concerns about London TravelWatch. She is aware that following the proposed changes, and significant negative public reaction, TfL and London TravelWatch undertook a further exercise to investigate what mitigation measures could be implemented to resolve some of the problems that stakeholders identified. That study recently reported and the Mayor of London wrote to the Secretary of State regarding its conclusions.
The study suggested stopping some peak-time mainline services at Peckham Rye and Denmark Hill and implementing a new off-peak Victoria to Bromley South stopping service, which would call at Wandsworth Road and Clapham High Street. However, in all its study work, TfL has not addressed the hon. Lady's key concern regarding peak period train services from Wandsworth Road and Clapham High Street to London Victoria. The study was, of course, led by TfL with London TravelWatch and they will need to answer the question about why such services cannot be accommodated, but I understand that a key constraint is the length of platforms at stations, and the costs of extending them, which limits the services that they believe can call at those stations at peak times.
Of course, we in the Department will study the conclusions of the study carefully, but I should make it clear that the Department is unlikely to be willing to fund the mitigation measures that the Mayor is proposing, given that the issues arose because the Mayor sought the withdrawal of the proposed Bellingham service.
Kate Hoey: I really appreciate what the Minister has said so far. Will he clarify something? I appreciate that how we got here is to do with TfL and the Mayor, and TravelWatch, and that it is probably more for Londoners to take up, rather than for the Minister to do so. Could he or the Department say, "No, we want you to look at this matter again", particularly the peak services between the two stations that I have mentioned and Victoria? Or is the Minister told about these things by TfL and the Mayor, with the idea being, in theory, that he is meant to say yes or no-although actually the answer is always yes?
Norman Baker: The hon. Lady makes an important point. I want my response to be exactly right because I do not want to mislead hon. Members, so I will reflect and give the hon. Lady an answer in a moment.
I understand that implementation of the proposed service is likely to cost about £1 million a year, which the Mayor is seeking from the Department. Given our current funding constraints and the likely reductions in available resources in future, an exceptional case would need to be made for any such funding to be implemented.
I note the hon. Lady's concerns about London TravelWatch, which is not the responsibility of the Department for Transport, as she is aware. London TravelWatch is an independent watchdog sponsored
and funded by the London assembly, which is part of the Greater London authority. Any comments regarding London TravelWatch, concerns about its involvement in the study, or how it functions should therefore be directed to the GLA and the Mayor as well as to its chair, Sharon Grant, whom the hon. Lady mentioned. The hon. Lady might also want to contact Passenger Focus, because although London TravelWatch is the predominant body in London-Passenger Focus tends to let it have its say and take the lead there-Passenger Focus has responsibility for rail issues nationally so it may be interested in some of her comments.
In response to the hon. Lady's earlier point, TfL made its proposals to the DFT, as I mentioned. We can ask it to look at the matter again, but doing so risks the DFT being forced to fund such a proposal. As I understand it, we have to be careful not to enter into a discussion with TfL that in any way makes us liable for the decisions of the Mayor, but I will ask my right hon. Friend the Minister of State to give the hon. Lady further clarification about that important point when they meet.
Kate Hoey: I thank the Minister for that helpful comment. It seems silly to put the matter through departmental bureaucracy if the Department can never say, "No, we don't like this." Could the Department say, "Look, actually, in the end it's probably better for this not to be changed at all," and not put in the money? Who is benefiting from the extra money that is going in?
Norman Baker: A number of factors must be taken into account, including, first, the devolved powers for the Mayor and TfL, which most Londoners would probably support-we are trying to devolve powers away from central Government; secondly, the legal restraints and legislation made in respect of the Mayor and TfL; and thirdly, the consequences for other rail operators. There is a complicated matrix to consider and I do not want to give a misleading answer today, so I will draw the hon. Lady's concerns and comments directly to the attention of my right hon. Friend the Minister of State to ensure that she gets a proper, full answer when they meet.
The East London line will bring significant benefits to the part of south London that we are talking about, providing four trains an hour regularly between Clapham Junction and Dalston seven days a week and providing connections to key interchanges to other parts of the London transport network, such as at Canada Water, for example.
On the Northern line, and crowding issues at Clapham North station, the hon. Lady will know that London Underground is planning an upgrade of the Northern line to be implemented in 2012, which will increase frequency on the southern end of the route from the current 28 trains per hour to 32. The additional capacity will help to relieve crowding issues on that section of the network. There are concerns about the spending review and funding arrangements, but we hope that the Mayor will be able to deliver the upgrade on the Northern line, as previously announced.
Members have mentioned Clapham Junction station and its use as an interchange station for London Overground services. It must be remembered that in Network Rail's plans to 2014, suburban trains through Clapham Junction to both Waterloo and Victoria will be lengthened to 10-car services. Works are also already under way to improve the interchange facilities at Clapham Junction by providing new lifts, and plans are in place to improve access to the station, for example, by providing a new entrance.
Although the changes to train services in south London are largely driven by the need to accommodate train service changes at London Bridge, the proposed Victoria to Bellingham service would have mitigated a number of the impacts of those changes. The changes to train services at Wandsworth Road and Clapham High Street and the severing of the link to London Victoria were made at the request of the Mayor of London, under the arrangements that cover rail services in London.
We will, of course, reflect on the comments made by hon. Members during this debate and consider the issues that have been raised.
Mr Mark Williams (Ceredigion) (LD): It is a pleasure to serve under your chairmanship, Mr Hood, and I am grateful to have secured this debate. Reorganisation of the Courts Service will have a significant effect on the way in which justice is provided throughout the United Kingdom. I hope that this debate will provide an opportunity for hon. Members throughout the House-there is a healthy bias from Wales in the Chamber-to reflect on facilities that may be changing in their constituencies. Notwithstanding consultations, I am sure that the Minister will take note of the points raised this afternoon. In the spirit of constituency interests, I shall concentrate on the future of the magistrates court in Cardigan, and access to justice in Ceredigion and more generally in the rural communities that many of us serve.
The consultation document usefully sets out the distances involved in closing various courts, and the public transport implications for constituents. The alternatives to the magistrates court in Cardigan are Aberystwyth in the north of Ceredigion and Haverfordwest in Pembrokeshire. The consultation document states that Cardigan is 38 miles from Aberystwyth and 29 miles from Haverfordwest. They are further away than any of the alternative courts that are proposed for closure anywhere in Wales. The distances that people will be expected to travel are longer than any others on a long list in Wales.
However, there is optimism about the public transport alternatives, although my confidence in the public transport system is not shared by many of my constituents. Someone going to court in Aberystwyth in the morning would have to catch a bus from Cardigan at 7.20 am, and then face a significant walk from the bus stop. When referring to points on a map, we are talking not about A to B or B to A, but about vast geographic areas. We are talking not just about the people of Cardigan going to Aberystwyth, but about large communities-Aberporth, Llanarth, Llandysul-and huge swathes of west Wales. We are talking not about bus services and other transport links from Cardigan, but about those from outside. Rurality and public transport has largely been ignored in the consultation document to date. Many residents of the villages in south Ceredigion are simply unable to get to Aberystwyth or Haverfordwest in the morning by public transport.
Dr Andrew Murrison (South West Wiltshire) (Con): Does the hon. Gentleman share my concern that problems with public transport bear down particularly on those who are most vulnerable and who lead the most chaotic lives in society? The previous Government were happy to close down magistrates courts, including that at Trowbridge in my constituency. That argument may apply more to magistrates courts than to county courts, but it worries many of us that those who will be most disadvantaged by the closure programme are the most vulnerable in society.
I share the hon. Gentleman's concerns. There is an underlying assumption that public transport is an add-on and that people can access court facilities in a private vehicle, but that does not apply to many of
the people to whom he referred. They are completely reliant on public transport, and all too often it does not exist.
Albert Owen (Ynys Môn) (Lab): I congratulate the hon. Gentleman on securing this important debate. He is talking about people on the periphery, and there is a double whammy because many facilities in Wales are drifting eastwards from areas such as those that he and I serve. Does he agree that the proposed local government cuts will impact on the transport system, which is already fragile in such areas, so there is a double whammy with the closure of justice centres and contraction of the transport system?
Mr Williams: I appreciate the hon. Gentleman's concern. I have tried to raise the same point over the past five years. For example, the bus subsidy grant from which many of my constituents have benefited has contracted over the past five years. Given the challenges to the public purse, that contraction looks set to continue. That is a worry, and I shall not deviate from that.
Access to justice is a key right for us all, and we will not be able to run the most economically efficient service without failing to provide the level of service required. That does not mean that we should never seek savings from the service or explore other ways of delivering a better service, but we must fully consider the impact of the loss of that service on the community.
Dr John Pugh (Southport) (LD): I congratulate my hon. Friend on securing this important debate. I agree that reducing the number of courts is all about savings, but all the research that I have looked at shows that the real waste in magistrates arises from an appreciable amount of non-attendance and people not being chased up for their fines. I do not understand how reducing the number of magistrates courts will improve non-attendance.
Mr Williams: My hon. Friend draws our attention to a practical problem. Some of us are looking further ahead to ensuring that the magistrates court system serves people. We are discussing not short-term decisions, but a longer term view of the network that we want. The issue is valid.
I note that the consultation objectives include the commendable pledge to
"ensure the estate supports the challenges of rural access".
Having looked at the documentation, I contend-I suspect that others will share my view-that that is not the case. The problem of access is not unique to rural areas, but it is a huge problem, and will be detrimental to Cardigan and the surrounding area.
Chris Bryant (Rhondda) (Lab): I am glad that the hon. Gentleman made the point about rural and non-rural areas. The Rhondda is not rural in one sense, because there is a conglomerated community and people live close to one another. However, if Llwynypia magistrates court disappears, the number of people who are unable or fail to attend court is likely to increase dramatically because they will have to travel all the way to Pontypridd. It is likely that many people, including the victims of crime, will not receive justice, and defendants may get off scot-free.
Mr Jim Hood (in the Chair): Order. We have had five interventions, each of which has been a wee bit longer than I expect interventions to be. If other hon. Members are tempted to intervene, perhaps they will be brief.
Mr Williams: Thank you, Mr Hood. I congratulate the hon. Member for Rhondda (Chris Bryant) on his early-day motion 312, and prompted by the excellent research note, I have just signed it. He is right to make the point, but he will forgive me if I focus on the rural challenges. I am sure that he will make the point about urban communities. The problem involves the practicalities of living in rural communities and accessing services, but access to justice as a right is a much bigger picture. He mentions in his early-day motion victim support and the implications for that.
A constituent of mine, who is a justice of the peace, acknowledges that usage of Cardigan court is low, and that that is largely due to the facilities not being good enough to accommodate many cases because of under-investment over the years rather than lack of need. Custody cases cannot be heard because of a lack of suitable cells; special measures trials are difficult because of a lack of facilities; and the court is not compliant with disability discrimination legislation. If the villages south of Ceredigion and north of Pembrokeshire are included, he estimates a catchment area of nearly 40,000 people, which should surely be enough to justify a modern court building with the necessary facilities to hold a wide range of cases.
It is also crucial to remember that the closure will not only affect those individuals who will be denied convenient access to justice. Legal providers and witnesses will be forced to travel extra distances, which might be an added deterrent. If police officers are required to give evidence, those based in Cardigan will have an additional distance to travel. There is pressure on neighbourhood policing in rural areas. The areas are vast and, as the hon. Member for Ynys Môn (Albert Owen) will agree, there is a problem of resources. The pressures on police forces in rural areas look set to continue.
A concentration of court services away from rural areas could lead to the same trend in the availability of legal advice. People will have to travel to Aberystwyth to attend court, and they may have to travel to access legal advice. Even if that doomsday scenario is not reached, the closure will certainly have an impact on local providers of legal services.
I welcome the fact that the documentation contains a section on rural-proofing, but I fear that Cardigan is a long way from being rural-proofed. The standard of public transport is not adequate for the purposes suggested in the proposals. During a debate on court closures in Yorkshire that took place in Westminster Hall last week, the Minister stated:
"Recent improvements in transport and communication links mean that people can travel further in less time if they need to."-[Official Report, 7 July 2010; Vol. 513, c. 131WH.]
I am sure that that is true in many parts of the country, but it is not the case in west Wales where public transport has suffered over the past few years and, if anything, we have a less comprehensive service than that of several years ago.
I accept that there will always be local opposition to any change in the service, but I have been struck by how strongly people in Cardigan feel about this proposal,
and the impact that it will have on the community both because of difficulties with public transport, and because of straightforward concern about lack of access to justice.
Albert Owen: There is also an economic argument. Many of the court areas have solicitors' offices built around them. That is certainly the case in Llangefni in Anglesey. Does the hon. Gentleman recognise that and does he agree that measures have already been put in place for legal providers to move to other courts, as has been highlighted?
Mr Williams: I agree with the first point, which was the concern I raised earlier. Legal providers will move to the destination of the court, and that will leave a vacuum elsewhere. Many people will be concerned about the impact on areas that have high levels of deprivation. Cardigan contains the two most deprived wards in Ceredigion, Teifi and Rhydyfuwch, which are in the top 20% most deprived wards in Wales. In the community safety domain of the Wales index of multiple deprivation, which covers recorded crime, youth offenders, adult offenders and fire incidence, Cardigan's Teifi ward is in the top 5% of the most deprived wards in Wales. Consequently, Cardigan town council has written to me and to the Secretary of State expressing its concern at the proposals and raising many of the points that I have mentioned. The council was grateful and pleased that Cardigan has acquired a new police station with eight cells, but it feels that there should be a new court building adjacent to that police station.
There has been some suggestion that we should move towards a model that has group facilities and can achieve swift, community-based justice and make operational savings. The combination of facilities on a single site has many advantages, but I fear that sometimes the understandable drive for efficiency has clouded the vision of the best way to provide justice. Although we are not in a position to build many new facilities across the country, if we lose locations that provide a greater function to the justice system, there is a danger that we will never be able to implement that vision.
It has been suggested that Aberystwyth-38 miles north of Cardigan-is capable of taking on the extra work that would be necessitated by the closure of the court at Cardigan. The consultation points to the construction of a new justice centre in Aberystwyth, which I welcome, but the Minister will be well aware of the delays in that project after the collapse of the developers involved. Originally, the project was to have included a Crown court, with Aberystwyth serving as a mid-Wales hub for justice. Currently, the nearest Crown courts are in Carmarthen, Swansea and Welshpool.
Mr Elfyn Llwyd (Dwyfor Meirionnydd) (PC): And Dolgellau.
Mr Williams: And Dolgellau-I thank the hon. Gentleman for adding that to my list. There remains a case for a Crown court in Aberystwyth, even if the money is not currently available.
I have written to the Minister and his predecessor, Bridget Prentice, who I met. However, there is as yet little concrete information to report. As such, the closure of a magistrates court in Cardigan is predicated on a
project that we hope will happen, but for which we have no time scale. I hope that that concern will be noted in the consultation.
The Cardigan and Tivyside Advertiser, which serves Cardigan and the surrounding area, has launched a campaign to save the court. One of its concerns is about the continuation of court reporting which, as I am sure the Minister will agree, is vital to our democracy. The newspaper does not have the resources to send reporters to Haverfordwest or Aberystwyth, and if the court closes, it will have to end its reports on Cardigan cases. That is not a justification for keeping the court, but it is an important point none the less.
Concerns have been raised about the decline of court reporting and the impact that that has on transparency. By and large that decline has been the result of newspapers deciding that it was not in their economic interest to cover court cases, but if the Government take decisions that will impact on public access to information about court proceedings, that factor should be considered.
Under the proposals, Ceredigion and Pembrokeshire local justice areas are to be merged. I do not oppose that, as it seems to be a sensible extension of the collaborative work that is already taking place. However, I seek clarification from the Minister that justices of the peace would not be required to be on the bench for all courts within that larger area, as that could become unmanageable. The principle of the merger, however, has been accepted, and I hope that any issues of practicality can be resolved.
One of the justifications for the proposals is the cost. The reorganisation is expected to save about £15.3 million a year, and make a one-off saving of £21 million from backlog maintenance. Closing the court at Cardigan means a saving of £88,000 a year, as well as a saving of £85,000 from backlog maintenance. Although all savings are to be welcomed, those figures are relatively small-perhaps they will multiply as we hear from other hon. Members about their own areas. We must consider whether the savings provide value, and Ministers will have to decide whether the loss of the service is worth the savings that will be made. In Cardigan, I do not think that that is the case.
The Magistrates Association has noted that while the consultations are carried out, an advertisement has been placed for 30 district judges. That has caused understandable concern to lay magistrates. I would be grateful if the Minister would address that point and provide some reassurance to lay magistrates that their role in the justice system remains valued.
I appreciate that money can be saved from the Courts Service, and I appreciate the need to find savings across the Government. However, this decision is not about cutting budgets for a few years, but about depriving communities of a service for a generation if not longer. The Minister has rightly stated that the Government will be judged not on the amount of money spent but on the quality of justice provided. That is a fundamental principle. On that basis, has he considered the suggestion by the Magistrates Association to allow magistrates courts to do more, thereby ensuring that our courts are properly used and provide local access to justice?
The Government must make their decision based on the need for the service. There is good reason to reorganise the Courts Service, and consider which courts we want
and need and which ones we do not. However, that must not be obscured by the search for savings in which all Ministers participate. These are crucial decisions that will shape the nature of justice in Ceredigion and the rest of the UK for many years. This service should not be decided on the basis of the bottom line.
Jonathan Edwards (Carmarthen East and Dinefwr) (PC): It is an honour to serve under your chairmanship, Mr Hood, and may I begin by congratulating the hon. Member for Ceredigion (Mr Williams) on securing this vitally important debate? As many hon. Members will testify, the issue will have a major impact on a great number of our constituents. In my constituency, the proposed closures will be a hammer blow to the local area, eroding the connection between the local community and justice provided through the magistrates system. I have spoken to local residents and solicitors, and there is great concern. If the proposals go ahead, and the notion of justice being directly linked to the communities in which the crimes took place is lost, the entire ideal of fairness in our society is put at risk.
Looking at the detail of the proposals, I can only assume that the courts facing closure have been chosen completely at random. Any examination of the impact of the closures makes it clear that the suggestions are not practical, especially in my part of the world. One of the courts down for closure in my constituency is Llandovery. That certainly highlights the off-the-cuff approach that the UK Government have taken. Anyone with knowledge of the provision would have pointed out that the Llandovery service has been closed for some time. I can only hope that it was not the Ministry of Justice's intention to shut the town's library, which has been operating from the site for the past few years. [Interruption.] Well,I hope not.
However, what is deeply concerning is the lack of attention given to the impact of closing the main service in my constituency: Ammanford magistrates court. One justification given for shutting the court services in Llandovery, in the north of Carmarthenshire, was that people there could make the long journey to Ammanford. As someone who makes that journey by private means as part of my job as a Member of Parliament, I can attest to the fact that it can take close to an hour, even though the route is serviced by the main Swansea to Manchester trunk road.
The most recent round of closures will require people from the Llandovery, Cilycwm and Rhandirmwyn areas-some of the most isolated parts of Wales-to make an extended trip out of the constituency to Llanelli. For people who can call on private transport, that is difficult at the best of times, but for those who cannot, and with such poor public transport services in the county, it will be almost impossible for many people. We must also remember that the Government will be asking people to take on the additional expense of public transport or added petrol costs at a time when families are already making very difficult choices as a result of tightening family budgets.
The north of Carmarthenshire to Llanelli is not a natural public transport route, with only the Heart of Wales rail line providing a direct service. Those who have travelled on that beautiful rail track will know that
the services are not regular enough to allow convenient travel to Llanelli. Trains run on the line at four-hour intervals, if my memory serves me correctly. In my constituency, that has an impact not only on those travelling great distances to Ammanford, but even on people in the surrounding Amman valley area. Closing Ammanford court will result in people in areas such as Brynamman, Garnant and Glanamman in the upper Amman valley having to catch several different buses, often with long waiting times between connections. The first direct bus from Ammanford to Llanelli does not arrive until 10.30 in the morning. My constituency would also be left without a single court.
I recently spoke to someone who plays an active role in the Courts Service in Carmarthenshire, who explained how one defendant had asked to be sent to jail as they did not consider it financially or physically possible to undertake community service in another part of the county due to the limited availability of public transport. There is certainly a strong case to be made that by closing those sites and expecting defendants, witnesses and court employees to travel further at great personal cost, we will inevitably end up with a situation in which the amount of time and effort spent on chasing individuals who do not turn up to court will rocket. That point echoes one made earlier. It could be counter-productive with regard to saving the public money. There is also the cost of the police having to go further to obtain warrants, leaving their beat, which would be a big blow for the town of Ammanford.
It is evident when considering Ammanford court in my constituency that the decision was made without evaluating the individual merits of the court. Over the past few years, £59,000 has been spent refurbishing the facility. It seems extraordinary that such a large amount of public money could be spent improving the court to make it-as I am told-a good-quality building and a state-of-the-art magistrates court, only for it to be closed without a second thought. That totally contradicts the mantra of value for money that is supposed to be at the heart of the proposals and the consultation.
This is not the first time that Ammanford court has faced the threat of closure. In the last round of closures, Ammanford was also on the hit list. Local magistrates and the local legal community believed that the recent investment in the court would safeguard its future and were very disappointed to see Ammanford in the consultation document. They are clearly very concerned about the Government's proposals. The hon. Member for Ynys Môn (Albert Owen) made an excellent point in that respect. The legal community in the town has set itself up around the court and there would be an effect on the economy if the court were to move.
The proposals would also create just one Carmarthenshire bench. The Dinefwr bench, which currently serves my constituency, covers one of the most concentrated areas of Welsh speakers in Wales and provides a fully bilingual service. Justice is therefore delivered in the language of choice of defendants. People are especially proud of the bilingual scheme; it is one of the foremost schemes in Wales. There are concerns that the loss of the Dinefwr bench could dilute that service. I seek assurances from the Minister today that if there is
to be a unified Carmarthenshire bench, he will do his utmost to ensure that the bilingual service is fully maintained.
I strongly oppose the proposals, as they will have a hugely detrimental impact on community-based justice delivered by local magistrates. I urge the Minister to reconsider his proposals, especially in Carmarthenshire, where the negative impact of the closures will be felt throughout the county, especially among the most vulnerable in society. Diolch yn fawr iawn.
Andrew Percy (Brigg and Goole) (Con): I do not intend to take too long today, because I introduced a debate last week on the proposed closure of Goole and other courts, but there are one or two issues that I was not able to bring out in that debate that I would like to cover now.
I agree with the point repeated by the hon. Member for Carmarthen East and Dinefwr (Jonathan Edwards) and originally made by the hon. Member for Ynys Môn (Albert Owen). The legal community is often set up around the courts. The situation is exactly the same in Goole, where solicitors firms and the police station are attached to the court, to the point that there is a connecting tunnel and the services available in the police station are also available to the magistrates court. We have a legal quarter in Goole that is obviously threatened by the proposals.
Like some hon. Members who have spoken, I represent a largely rural constituency. The East Riding of Yorkshire council is the largest unitary authority in England, covering 1,000 square miles. The point I made last week was that we went through a reorganisation 10 years ago in the East Riding, which left us with four courts, including the one in the city of Hull: two in the centre of the East Riding and two at either extreme of the area, one in Goole and one in Bridlington. We are now in the strange situation that the court furthest away, in Goole, is the one under threat.
There has been an attempt to achieve efficiencies because the back-office functions are already centralised with Beverley. The biggest concern for me is that a large proportion of defendants who are dealt with in Goole are from the local area. We now have the strange situation-I repeat this point because it is important-in which defendants from the Goole area will have to travel to Beverley to access justice.
Research shows that it will take most people who want to travel by bus up to two hours to get to Beverley, involving a change of bus in Hull. Depending on the route that people follow, the least time that they can take is one hour and 25 minutes, but the more likely time, given how the timetables work, is one hour and 56 minutes to travel by public transport from Goole to Beverley. It is important to point out that there is no direct bus service. Services from other parts of the East Riding are unaffected by the proposals, but people in Goole who want to get to Beverley will have to travel via Hull, where there is already a magistrates court. I referred to that last week. We will have the strange situation of people who want to take the bus to Beverley magistrates court sitting on the bus, travelling past another magistrates court, in Hull, getting off the bus,
waiting for a connection and then getting on a bus to Beverley. They will have to travel some 39 miles to access local justice.
That is a huge concern for the magistrates and for people in the Goole area. The risk, of course, is that people simply will not turn up. I would like to see some assessment from my hon. Friend the Minister and from the Ministry of Justice of how many cases or how many defendants or witnesses they expect to be affected by this move. In particular, how many are likely to choose not to attend?
I touched on the issue of the utilisation rate in my debate, but was not able to go into great detail. I followed it up with a written question to the Minister, which on the face of it may not have been particularly useful to my argument. That is perhaps a lesson learned for the future. I went back to the magistrates and asked for more clarification of the issue. There is quite a low utilisation rate for the courts in Goole, but that is because we have two courts-court 1 and court 2, which are taken together. Actually, the utilisation rate for court 1 is exceptionally high. The magistrates inform me that it is upwards of 70%-probably nearer 80%. We have a low utilisation rate for court 2 because not taken into account in that figure is the fact that the room is used for other meetings. It is a resource that supports the work in court 1. However, that does not come across in the utilisation rate. In the past, court 2 has been used by the commissioner for taxes, the Department for Transport and others.
I did not go into politics just to be against things; I also want to suggest possible solutions. One solution that I would like considered is bringing other services to Goole, possibly tribunals, so that we can make the system sustainable as we move forward.
I mentioned briefly last week the matter of deprivation. On some measures Goole is among the 10% most deprived areas of the country. We have the strange situation of people in the most deprived parts of the East Riding, which includes Goole, facing the longest trek to access justice and the most expense.
Chris Ruane (Vale of Clwyd) (Lab): Is the hon. Gentleman aware that two courts in my constituency will be closed? The one in Rhyll covers the first, fourth and fifth most deprived wards of the 1,900 wards in Wales. Does that make sense?
Andrew Percy: The hon. Gentleman makes a good point; that is where the biggest impact would be felt. I am sure he will make that clear during the consultation process, because it is a huge concern that the most deprived should feel the greatest impact.
I was about to say that despite the best efforts of the dynamic Conservative-run East Riding of Yorkshire council, Beverley still has some of the highest parking charges in the region. Even if people are fortunate enough to be able to get there by their own means, they will be faced with the prospect of having to pay significant parking charges.
I did not get the chance last week to talk about the county court that operates outside Goole. That, too, is proposed for closure, and its services are to be transferred to Doncaster. Yes, we have reasonable transport links with Doncaster, with direct bus or train services. However,
no figures are given in the document on how much will be saved by closing Goole court. Although it operates as a courthouse for only one day a month, it provides a vital service. Once we lose it, people will be forced to travel to Doncaster. We will have people heading to Doncaster in south Yorkshire, and others having to travel 40 miles by public transport to Beverley.
Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab): Another aspect of the transport difficulties is the cost. It is proposed that a magistrates court in Guisborough in my constituency should be closed. The transport links go through the same villages, and it is highly likely that witnesses, defendants and plaintiffs will all be getting on the same bus when going to court, once it is moved to Middlesbrough or Darlington. Without a local court service, which they already have, that will happen more often.
Andrew Percy: The hon. Gentleman makes an important point. The situation could be the same in many of our constituencies, and it is a matter for concern. Sadly, it is not dealt with in the consultation document.
I said that my area could be left with a justice black hole, as we will also be losing Selby magistrates court under the proposals. We should be genuine about wanting to see justice being delivered, but to some concern among Conservative Members the Justice Secretary has spoken of the need for more community sentencing. If we are trying to bring justice to the community, we will need local courts so that people can access it.
I do not wish to say much more, but one point that I made last week is worth making again. It falls outside the consultation criteria, but I make it with as much passion as I can. Despite Goole's history of being knocked for many things, over the past few years we have been trying to do something with our heritage. The courthouse at Goole, which is part of the police station next door, is a Victorian building. It is a fantastic building, and it forms a huge part of our local heritage. We are trying to preserve that heritage to draw people into Goole. We have more than the docks; we have some interesting heritage and history, but one of our oldest and best-maintained buildings faces an uncertain future. I know that will not be factored into the decision-making process, but it is important. We are keen to preserve our heritage, on which note I shall resume my seat.
Mr Jim Hood (in the Chair): Order. The Members who wrote to Mr Speaker requesting to speak in this debate have all spoken. Other Members have indicated to me that, if possible, they would like to speak. We have some time, but I intend to start the Front-Bench speeches at 3.30 pm. If the Members I call use their time wisely, we may be able to accommodate everyone who is interested in making a contribution.
Chris Ruane (Vale of Clwyd) (Lab): I congratulate the hon. Member for Ceredigion (Mr Williams) on securing this important debate. It is pleasing to see so many Members here, and many of them-I think six-are from Wales.
Two of the 156 courts to be closed are in my constituency-a county court in Rhyll and a magistrates court in Denby. I have been to a briefing with the Public
and Commercial Services Union, which has given me an excellent note. I want to tease out some of the points it mentions as they relate to my constituency, and I have some specific questions for the Minister. However, my questions about the courts in my constituency apply to all the courts under threat of closure.
I said in an intervention that the court in Rhyll is located in the heart of the poorest ward of the 1,900 wards in Wales. Two other wards there are fourth and fifth in the league table of deprivation in Wales. The pre-consultation and consultation period for the closures is not sufficient; it finishes in September and most of it will take place over the holiday period. Will the Minister extend it so that full consultation can take place in those communities? I hope he will write to me, giving answers to my specific questions. I intend putting that information out in the community, giving people a reasonable time to give me feedback and for me to pass it on to the Minister. Will he review the time scale?
I have other specific questions. How many cases have been moved from the Rhyll and Denby courts to other courts over the past two or three years, and to which courts were they moved? The equality impact assessment in the public consultation document provides no assessment of the potential impact on users broken down by disability, gender, ethnicity, impact on families and-dare I say it?-social class. Who will be affected, and who will be adversely affected?
Will the Minister provide me with the number of cases heard annually in the last three financial years and how it compares to the national average? Will he provide me with the projections made by Her Majesty's Courts Service for the future caseload of those courts, and the utilisation figures for each court affected and each of the courtrooms in them? How many courtrooms are there in each of those courts, and how many courtrooms are currently in use?
Will the Minister tell me the number of cases disposed of in chambers over the last three years, and the breakdown of the number of staff in each of the courts affected by grade, by full and part-time working, and by disability, gender and race? Is it possible to have the court user surveys for the two courts affected in my constituency?
Has the maintenance backlog been included in the savings? If so, has finance been set aside, or is it merely sleight of hand? What were the maintenance costs for the buildings in Rhyll and Denby over the last three years, and has there been any refurbishment in the past 15 years? If work is to be transferred, what are the estimated refurbishment costs at the receiving courts? Which will be the receiving courts in my constituency? If the reason for closure is the state of the accommodation, has alternative accommodation been sought in Rhyll or Denby? If not, why not?
Those are the questions that I would like the Minister to answer, and I would appreciate him doing so as soon as possible. I can then pass the answers on to my constituents so that we can have full, proper and meaningful consultation about the proposed closures.
Mr Elfyn Llwyd (Dwyfor Meirionnydd) (PC):
May I declare an interest as a former solicitor and a member of the Bar? I have practised in every one of the courts
that are under threat in mid and north Wales and I can speak about the quality of those buildings and of the service available in them. I congratulate the hon. Member for Ceredigion (Mr Williams) on securing the debate, and I share the concerns of my hon. Friend the Member for Carmarthen East and Dinefwr (Jonathan Edwards) and others who have spoken.
My theme is access to local justice. I am concerned about the proposed closure of Pwllheli magistrates court. I have the honour to represent one of the two largest constituencies in Wales in terms of geography; indeed, it is probably among the top five or 10 in the whole UK, stretching 100 miles from north to south and 90 miles from east to west. It currently has two magistrates courts, one of which is under threat, and that is an abysmal prospect for those with any notion of local justice.
I heard what the hon. Member for Ceredigion said about amalgamating magistrates court areas. I can assure him that people from Pembrokeshire will be required to travel all the way up to north Ceredigion; indeed, people are already doing that in the area that I represent. Consequently, justices of the peace are not putting their names forward for appointment, and good people who could do a decent, good job for their communities are not doing so. It is not a coincidence that we have an advert for 30 district judges. It is disturbing but true that the proposals will be one of the nails in the coffin of the lay magistracy, and we should not run away from that fact.
One thing about being in the House for a while is that one sometimes has a feeling of déjà vu. In the 1992 Parliament, the Blaenau Ffestiniog court in my constituency was threatened. We appealed, but, fortunately, a general election intervened, and there was then a new Minister. What came out of that process, however, was that closing the court offered a marginal saving of £11,000, but that did not take into account the added travelling time for solicitors, barristers, police, JPs, probation officers and, in youth cases, social service workers. When that was taken into account, there was no saving. What makes all this worse is that about £10,000 or £15,000 was spent on the building a few months ago to make it DDA-compliant, but it is now being shut down.
I hope that we have a proper consultation, and I echo all the questions that the hon. Member for Vale of Clwyd (Chris Ruane) has just asked. I also ask the Minister to tell me how many cases have been moved from Pwllheli magistrates in the past three years, where they ended up and how many hearings were involved. Why is it considered appropriate for one of the largest constituencies in Wales to have one magistrates court? For heaven's sake, it is ridiculous.
When I qualified back in the mists of time-in the mid-70s-there were six magistrates courts in Meirionnydd. Arguably, that might have been too many, but we now face the prospect of having just one magistrates court in a far larger area than the whole of Meirionnydd. I am deeply concerned.
Stephen Barclay (North East Cambridgeshire) (Con):
Like me, the hon. Gentleman represents a large rural constituency. Does he find it paradoxical that new housing developments take place in rural constituencies such as ours, but that services are centralised in the
cities and moved away from rural areas, with a total disregard for long-term population growth? That is the same long-term plan on which the consultation is premised.
Mr Llwyd: That is absolutely right. That is contributing to rural poverty and to difficulties in obtaining services in rural areas, and we are talking in this debate about a service.
I am also concerned about the notion that somebody from Aberdaron in the west of my constituency can get to the proposed centre in Caernarfon by bus by 10 o'clock in the morning. I doubt whether that is possible, but if it were, there is the likely and plausible scenario that they will meet witnesses on that same bus. What happens next? Interference with justice, and perhaps even violence-I do not know. I am concerned about that. I hope that this is meant to be a proper consultation, but I have my doubts.
The hon. Member for Ynys Môn (Albert Owen) made a few points. It is proposed to close Llangefni magistrates court and Llangefni county court and to move things to Holyhead. The consultation document says that Holyhead is 20 miles away by bus. Curiously, although the magistrates court in Llangefni is opposite the county court-they are within yards of each other-the document tells us that it is 20.6 miles from the magistrates in Llangefni to the magistrates in Holyhead and that that costs £2.60 on the bus, but that it is 20 miles to Holyhead from across the road and costs 60p less on the same bus. I do not think that the documents are at all robust. We want proper, robust figures; we want the justification for these damaging closures. However, I end by saying that in my nearly 20 years in this place, I have not yet seen a serious consultation take place in August.
Dr Andrew Murrison (South West Wiltshire) (Con): I congratulate the hon. Member for Ceredigion (Mr Williams) on securing this important debate. Unlike the hon. Member for Dwyfor Meirionnydd (Mr Llwyd), I believe that the consultation will be conducted in the right spirit. I am also sure that my hon. Friend the Minister will be open to reasonable persuasion, and I make my remarks in that context. Equally, I understand that he, like all Ministers, needs to effect savings in the extremely difficult financial circumstances that we have inherited. Nevertheless, it is an important principle of law in this country that there should be equality before the law and that people should have equal access to justice, and it is access that chiefly concerns me.
In Trowbridge, the county town of Wiltshire, which is a very rural area, we have experience of court closures. Under the previous Administration, we had the closure of Trowbridge magistrates court, and I have to tell the Minister that that has not improved access to justice one bit. Although I fully accept that vulnerable groups are perhaps likely to be more disadvantaged in magistrates courts than in the county court system, because of the kinds of case that are heard in them, the same argument nevertheless applies to county courts. Some hon. Members will be surprised to learn that there are a large number of vulnerable and disadvantaged people in my constituency, and they will be disadvantaged by the closure of Trowbridge county court. I am concerned about them above all
because they will be relatively disadvantaged in accessing justice, while others will have an advantage over them, which cannot be right.
The consultation document describes Trowbridge county court as underused, but that is not so. It is open five days a week, which is not necessarily the case for many of the courts under consideration. For example, it is used more than Bath, which is 12 miles away, and Salisbury, which is 30 miles away.
The proposals seem to rely on assumptions about the utility of video links, telephones and online services. I would counsel a bit of caution, however, because I have great experience of the health service, where plans have historically been put in place that rely on assumptions about developments and innovations that are, in fact, several years down the line. If the current proposals take effect, and we close court houses on the assumption that innovation would take up the slack in some way, we might be a little premature.
The proposals are driven by a need to update premises and to ensure that we comply with domestic and European legislation. That is all very well, but there is a dynamic between the need to upgrade and the need to maintain equal access to justice. We note that Lord Young is reviewing the impact of health and safety legislation, and many of his findings may be relevant to the debate. We have some experience in Wiltshire of the need to upgrade court houses. In Salisbury, a great palace of justice has been created, and its case was based on the need to upgrade premises. As a result, we lost Trowbridge magistrates court, disadvantaging my most disadvantaged constituents.
I genuinely hope that the consultation will be conducted with an open mind. Indeed, under the stewardship of my hon. Friend the Minister, I am confident that it will be. I am equally confident that he will see good sense and make sure that Trowbridge county court is removed from the list of the vulnerable.
Chris Bryant (Rhondda) (Lab): I, too, congratulate the hon. Member for Ceredigion (Mr Williams) on securing the debate, and on signing my early-day motion. Many hon. Members have specific concerns and have rightly advanced arguments about equality of access to justice in rural areas. As I was pointing out, my constituency in the Rhondda is not, properly speaking, rural, although we still have sheep parading down the streets most days of the week-mostly in an inconvenient way-and nearly every house is within half a mile of a farm. Those are very different farms from the ones in Surrey and other parts of the country, but nevertheless it feels to many people as if they need only lift their eyes to see the hills. The Rhondda feels like a rural community. More importantly, the communities there are valley communities, and the further one goes up the valley the less access there tends to be to larger shops or, for that matter, the services provided by national Government, the Welsh Assembly Government or local government. That is one of the problems driving depopulation at the top ends of some valleys, which may be very beautiful but none the less have economic problems. People rightly ask themselves, "Is someone just choosing to close us down?"
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