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15 Sep 2010 : Column 285WH—continued
When children are diagnosed with diabetes, it has a profound effect on their families. The parent group, Children with Diabetes, did a survey of parents, in which 85% said that their household income had gone down; 83% said that they had problems with their
marriage and family life; 84% said that their child's treatment was affected by where they lived; 71% said that they were concerned about long-term complications; 60% said that their children were most worried about being seen as different, as the hon. Member for Torbay (Mr Sanders) said; and 50% reported that their children had been bullied at school as a result of suffering from type 1 diabetes.
My right hon. Friend the Member for Knowsley (Mr Howarth) asked me to contribute to the debate because of its importance to him as an individual. That made me think about constituents I have seen and the problems that they have had. My hairdresser, who is a very important person in my life, told me that his niece, Sophia, was diagnosed with type 1 diabetes at the age of five. There was no history of diabetes in the family. The family spent ages completely terrified, wondering what the problem with their young daughter was, only to find that she had type 1 diabetes. Her mother, Nicole, tells me that she came home on the day of diagnosis with a load of equipment, not knowing what to do or understanding the consequences. She knew that she had to give up her employment, because she could not control the diabetes and did not know the consequences for her daughter. Her husband had to accept the fact that, unlike other married couples, they could not leave their daughter with other people, because those others were frightened about knowing how to care for her. Nicole was concerned about just not knowing how the family would approach routine family life, celebrations, festivals and even Christmas.
Nicole told me today that the single thing that was of benefit to her was the recently set up parent group at St. George's hospital in Tooting. The scales fell from her eyes as the clinical paediatric nurse, Richard Todd, told her how she could cope with Christmas-all the food and treats of the period-and how she could have access as a carer to discount cards, which no one had told her about in the past, although her daughter has had type 1 diabetes for seven years. She could also just meet other families and mums, and discuss the consequences, for them and their family, of their children's diabetes. If there is anything I would ask the Minister to do, it is to consider the fact that St. George's will not carry on the parent support service, because it does not feel able to keep Mr Todd's services. I am sure that there are many demands on the hospital, but that parent group-just from one parent's perspective-had an enormous impact.
The other time when a problem begins to arise in a family's life is when children transfer from primary to secondary school. While having a pacemaker, or another condition, might affect a child's school preference place, despite having type 1 diabetes Sophia did not obtain a school place in the Minister's constituency, although her mum and dad wanted her to go to school there so that they could be close at hand if anything happened and so that all the burden would not fall on the school. At the school, in turn, there was a fear about having Sophia there. Of course, with the transfer to secondary school the issue of puberty comes into play, with its impact on the treatment of type 1 diabetes, and the need to understand whether mood changes result from the illness or the normal changes that any teenager goes through.
Having a child with type 1 diabetes can also have a financial impact. I know from other families who have been to see me that that can involve simple things such as school uniforms. One mum who came to see me bought the uniform for her daughter who was going to secondary school, only for her to be diagnosed with the condition over the summer holidays; in that period she lost two or three dress sizes. Apart from the sheer fear that that must have created, the financial impact for a single mum on benefit is huge. There are implications for all the things that we would want to happen: getting mums back into work; flexible working; the need to work close to home; and the need for the wider family to understand things. I am sure that that is only a small and perhaps secondary consideration, but in the treatment of this chronic disorder, diagnosed in children so young, it has a huge impact for the wider family. The soft services of parent groups, which might be seen as less important in times of financial restraint, are crucial in enabling parents to understand the difficulties and problems, and in preventing some of the problems that other families have probably been through.
3.23 pm
Barbara Keeley (Worsley and Eccles South) (Lab): It is a great pleasure to serve under your chairmanship, Mrs Riordan, for the first time, or certainly the first time in my experience. I congratulate my right hon. Friend the Member for Knowsley (Mr Howarth) on securing the debate.
We have heard a number of telling statistics about diabetes. As has been said, of the young people and children who have diabetes in the UK, about 98.6%-a very large proportion-have type 1 diabetes. It is estimated-and it is a pity that we have to talk of estimates, and do not really know the true figures-that type 1 diabetes affects more than 25,000 children and young people. As we have heard-there are some very useful definitions-it is a chronic condition, which can be life-threatening, and which occurs when the body's immune system attacks insulin production cells in the pancreas. It is usually diagnosed in childhood, but as with most other conditions children are often kept waiting for a diagnosis. People must live with and manage the condition for the rest of their lives. Even when it is managed through regular injections, type 1 diabetes can bring long-term complications, such as heart disease, stroke or blindness, as my right hon. Friend the Member for Knowsley mentioned.
Claire Perry: On that point, a shocking statistic that I was told this morning is that the management of the disease is so sub-optimal that it is estimated that more than 80% of relevant children have blood sugar levels that are too high, despite the best efforts of their parents, the community, hospitals and support groups. That has enormous long-term health and economic consequences. Surely better management of the disease at an early stage would save the children, the family and the taxpayer enormously in the long run.
Barbara Keeley:
Indeed, and we heard earlier that the incidence of type 1 diabetes is increasing by about 4% each year. The biggest increase is in children under five. A fivefold increase in the past 20 years, as my right
hon. Friend the Member for Don Valley (Caroline Flint) said earlier, is a matter of great concern. It is important that more attention be paid to helping GPs, pharmacists, other health practitioners and teachers to identify type 1 diabetes in children and young people. As with many long-term conditions, early identification is the key, because the later the diagnosis of diabetes, the greater the impact.
My right hon. Friend the Member for Knowsley asked the Minister in an Adjournment debate on diabetes last week to introduce protocols for GPs on dealing with certain symptoms. That would ensure that GPs were better equipped to diagnose diabetes. The Minister said then that he would consider the point and would have more to say on it during today's debate. I hope that we shall hear his answer.
As we have heard, the Government's NHS White Paper proposes to give GPs the power to commission services, instead of primary care trusts, which will be abolished. I have raised on a number of occasions recently the fact that there is great concern that many GPs do not have the depth of knowledge required to commission specialist services for conditions such as diabetes. GPs may not have the skills, experience or desire to assess whole-population health care needs, to manage the market, to negotiate contracts and to monitor performance. That is becoming a key point of concern, because GPs did not necessarily come into medicine to do those things. Indeed, I understand that the Royal College of General Practitioners is urging the Secretary of State for Health to put back his plans for GP commissioning. The college's report on the Government's consultation has unearthed "major concerns". That is in line with the responses from medical charities such as Rethink and campaigns such as the Muscular Dystrophy Campaign, which also have concerns that GPs lack the skills and experience for commissioning across such a range of conditions.
There are also concerns that in taking on such a wide role, GPs' primary role of making diagnoses and providing patients with all the information and support that they need could be affected. Some of the statistics are already becoming a cause for concern. Surveys by Diabetes UK have found that 20% of young people feel that they rarely, if at all, discuss their goals for their diabetes care during check-ups. Further, only 26% have attended a course to help them learn about managing their diabetes. The essence of managing a long-term condition is recognising that people must become expert patients. If they are young, their family members must become expert carers. Will the Minister outline what steps the Government will take to make sure that GPs are better equipped to diagnose conditions such as type 1 diabetes and to continue, and improve, their support for people with the condition?
There is a clear need for people with diabetes to be given better information about how to manage their condition. The hon. Member for Torbay (Mr Sanders), who chairs the all-party group on diabetes, has tabled early-day motion 72, which notes that 65% of the 2 million people in the UK with diabetes are not taking their medication as prescribed, because two out of three do not understand what those medications are for or how to take them. We have heard from my hon. Friend the Member for Mitcham and Morden (Siobhain
McDonagh) what it is like to land at home with a host of medications, without having a real idea of what to do with them.
Mr Sanders: It is helpful that the hon. Lady has raised that point, because it is an important element of the issue. There are enormous savings to be made by preventing wastage, but we are not just talking about tablets-there is also medical equipment. Increasingly, people with chronic conditions depend on medical equipment. Being able properly to take and analyse a blood sugar reading is a very important aspect of a diabetic's ability to treat themselves.
Barbara Keeley: Indeed. I understand that the early-day motion argues that people with diabetes have a right to expect a personalised information prescription, so that they receive clear and consistent information on diabetes, which will enable them to start to understand their condition and treatment options.
Will the Minister outline what action the Government plan to take to ensure that the NHS at a local level provides diabetes care and support in line with the standards set out in the EDM? The Minister will know that I am always concerned to ensure that we consider carers' issues in the House, and my hon. Friend the Member for Mitcham and Morden has just touched on some of those issues. We should consider the effect that long-term conditions, such as type 1 diabetes, have on family members and carers. My hon. Friend described it as a soft issue, but carers are the backbone of support for children and young people in this situation, and there is an impact on them.
The Juvenile Diabetes Research Foundation states:
"Type 1 diabetes pervades every aspect of a person's life."
Of course, it also affects their family. As we have heard, everyday activities, such as eating and drinking, which are often difficult enough with children-particularly young children-involve much thought and planning on the part of carers of children and young people with type 1 diabetes.
My hon. Friend the Member for Mitcham and Morden mentioned the survey carried out by the parent group, Children with Diabetes. As she said, it found that 83% of parents said that their family life was affected by a diagnosis of type 1 diabetes-quite understandably-and 84% of parents said that the treatment that they received was affected by where they live. That should not be the case; we should not have a postcode lottery. Some 60% of parents said that their children were most worried about being seen as different-children are, of course, always worried about that-and, most worryingly, 50% reported that their children had been bullied as a result of having type 1 diabetes.
The hon. Member for Torbay talked about the stigma associated with treatment by injection. Clearly, bullying in schools can be a result of stigma and perceived difference in children. That is of great concern. Diabetes UK has found that many parents of children with diabetes are forced to give up work, for reasons outlined in today's debate. In a recent survey, half of primary school pupils with type 1 diabetes and a third of their secondary school counterparts reported that their parents had to reduce their hours or give up work to help to administer insulin injections.
The report also revealed that two thirds of primary school pupils and four fifths of secondary school pupils questioned think that school staff do not have enough training in diabetes. That is not surprising given the findings of an earlier 2008 survey of primary schools. It found that 42% of schools that had children with diabetes did not have any policy advising staff about the supervision of blood glucose monitoring by the child, 48% did not have a policy advising staff on how to help carry that out, 41% did not have a policy advising staff on how to supervise medication of any sort, and 59% did not have a policy advising staff on how to give medication. So the load is falling directly back on to the parents, because the schools do not have a policy.
When we consider type 1 diabetes, it is important to look at the people around the child or young person with the condition and to consider the level of support, information and training that is needed. The children's charter for diabetes states that discrimination in education should end and that children with diabetes should be treated with respect. I hope that the Minister agrees with that sentiment.
As I say, one of the major concerns among diabetes charities and groups, such as the Juvenile Diabetes Research Foundation, is the postcode lottery that they feel exists regarding the treatment of type 1 diabetes. We have talked a lot in this debate about insulin pump therapy, because that is rightly viewed as the gold standard of treatment for the condition. Insulin pump therapy reduces hypoglycaemia and long-term complications, and it can make life easier. As we have heard, the treatment involves a bleeper that delivers small amounts of insulin throughout the day.
Those pumps are a cost-effective treatment that can help reduce contact with primary care, reduce hospital out-patient and in-patient admissions and, most importantly for children and young people, deliver a better quality of life. As we have heard, less than 4% of the population with type 1 diabetes use a pump. As right hon. and hon. Members have said, that figure is far below the level of use in Europe, where it is at 15% to 20%, and the United States, where it is at 35%. In fact, given the number of children and young people who go on holiday to the States, it is likely that they will run into pump therapy when they are there. Of course, people also read about the therapies available in other countries on the internet.
It is clearly important that insulin pump therapy becomes available. As we have heard, it can be used by adults and children over 12 and, as my right hon. Friend the Member for Knowsley mentioned, NICE guidance also recommends that children under 12 with type 1 diabetes have access to insulin pump therapy if multiple daily injections are considered impractical or inappropriate.
The hon. Member for Torbay provided a vivid description of the stigma, bullying and other issues that arise in school. For example, he mentioned how hard it is to find a clean and private place in which to administer injections. I have touched on the difficulties of schools not having policies, and teachers not supervising the situation. Clearly, children of almost any age will almost always find it impractical in a school setting to administer injections. In those cases, insulin pump therapy will always be better for the child or young person.
As we have heard, it is worrying that there is considerable inequity in insulin pump provision across the country. My hon. Friend the Member for Mitcham and Morden talked about the figures released this month by the Medical Technology Group, which show that there is a postcode lottery, in terms of access to insulin pumps in the UK. We can compare the cost of insulin pumps, which are £3,000, with the cost of bariatric surgery for the morbidly obese, which is about £7,000. Both of those treatments have beneficial effects, save the NHS money and improve the quality of life for the patient. Bariatric surgery use has increased tenfold from 2000 to 2007 but, as we have heard, our levels of prescribing insulin pumps are only a quarter-or a fifth-of levels of usage in Europe. Given that GPs are to take on a commissioning role, will the Minister state what action the Government plan to take to ensure that insulin pumps become much more readily and evenly available across the UK?
I would like to thank the Juvenile Diabetes Research Foundation, the Eye Health Alliance, Diabetes UK and, of course, the Members' Library for their excellent briefings on the subject, which have helped us all in today's debate. I started my preparation for the debate not really understanding very much about the condition, and particularly how it affects children and young people, and I feel that I do understand it now. Given the number of people involved with the issue in every constituency and the prevalence of the condition, all hon. Members should understand it as well as I hope we will by the end of the debate; the discussion has been excellent from that point of view. I pay tribute to the children and young people who are living with this condition, and to their parents. I hope that through this debate and the questions that we are asking the Minister, we can improve the service and support that they receive from health and other services in future.
3.37 pm
The Minister of State, Department of Health (Mr Paul Burstow): I congratulate the right hon. Member for Knowsley (Mr Howarth) on securing the debate and, indeed, on taking part in last week's debate. He has brought a sharp focus to an issue that is often not debated-even when we discuss diabetes, it gets rather lost in the broader picture.
I have a constituency interest in the matter. Before the general election, a number of children in my constituency who were supported by Diabetes UK wanted to make me aware of what could be done in schools and families to support them better. There are beacons of hope and places that are doing exceptionally good things that make a huge difference. However, as has been well documented in the debate, there is clearly a lot of work to be done. I have a lot to say in response to the very many good points that have been made in the debate.
It is helpful that the debate is not just grounded in the technicalities of the issue, but grounded in the life experiences of individuals. We have heard such points made by the hon. Member for Mitcham and Morden (Siobhain McDonagh), the right hon. Member for Knowsley and, of course, my hon. Friend the Member for Torbay (Mr Sanders), who has direct experience of the matter. That is powerful because when it is done
well, it helps to give a real sense of the difference that can be made to a person's life-they no longer have to be defined by the condition; they can get on with their life. I hope we share that goal as we discuss how to shape services going forward.
I pay tribute to Diabetes UK and the Juvenile Diabetes Research Foundation, which, through the speeches of hon. Members from all parties, has contributed to the debate and does much well beyond that. This is a welcome opportunity to focus on a condition that does not get the same headlines as cancer, cardiovascular disease or, for that matter, type 2 diabetes. It presents a threat not only to children's health but, as we have heard in the debate, to their well-being and, in turn, that of their families.
The debate has rightly focused on what we can do to improve matters. The right hon. Member for Don Valley (Caroline Flint), who understandably has had to leave to attend to other business, raised a few points with a policy emphasis that were rather churlish, but I understand that they were well meant. I am sure that she and I will have an opportunity to debate those on another occasion.
Mr George Howarth: I am loth to rise to defend my right hon. Friend the Member for Don Valley (Caroline Flint), on the grounds that she is more than capable of defending herself, but the key issue that she raised was not too party political; it was about how young women are viewed and how they respond to the pressures to conform to a particular body shape.
Mr Burstow: I will come shortly to the point, which was absolutely well made, and certainly line up with the right hon. Lady's comments on that. As has been mentioned, the Minister for Equalities has done a sterling job on behalf of the Government to place the issue at the front and centre. She has not resiled from the issue and will continue to pursue it as she has done so far. I was more anxious about that concern being aligned with the Government's direction of travel on GP commissioning, which I will return to because it was raised, quite fairly, in the debate.
We have heard today about type 1 diabetes-a complex, lifelong, progressive condition that requires careful long-term management to prevent the severe and sometimes fatal complications that have been described. A 2009 survey of children with diabetes in England revealed that 23,000 children and young people currently have type 1 diabetes. There has also been a national diabetes audit, which included a separate report on paediatric diabetes that gives us a fair picture of the extent of childhood diabetes and how well it is being managed. Although Britain has one of the highest numbers of children diagnosed with diabetes in Europe, we have one of the lowest numbers of children controlling their diabetes well, and we have heard what the implications can be for those children and their families. That is extremely worrying, because poor glucose management increases the chance of the child experiencing complications. I echo the view, expressed by many Members in the debate, that that is an area where we can make significant and sustained improvements. I want to describe what we are trying to do about that.
The first question is: how can we ensure that more children receive an early and accurate diagnosis of diabetes? The challenge for GPs is that type 1 diabetes
can be difficult to spot. A child might present with the vague symptoms of extreme tiredness and weight loss, which can be mistaken for other illnesses. Type 1 diabetes is quite rare, so GPs might not come across many cases in their practice. That explains why there have been instances of the sort that have been described today: tragic cases of symptoms being overlooked and children diagnosed only after becoming seriously ill.
The National Patient Safety Agency is currently looking at a number of reports of misdiagnosis and delayed diagnosis and is working with the national clinical director for diabetes to look at what we can do to improve diagnosis rates and reduce emergency admissions. Clearly, we will have to look at protocols and how they might serve as a tool that can be used, but we need to ensure that the work is properly concluded before we decide whether that is an appropriate mechanism.
It is true that building professional awareness is key to improving diagnosis rates. We need GPs and A and E staff, in particular, to consider diabetes as a possibility when they see children with appropriate symptoms, and we must ensure that they are equipped with a range of diagnostic tools to do so. NHS Diabetes, the improvement body for diabetes care, is working with various royal colleges and other bodies to improve professional standards and ensure that best practice is reflected in their training curricula. NHS Diabetes is also working with Diabetes UK to publish best practice guides on how a child with type 1 diabetes should be cared for. Therefore, material is being generated that will help a wide range of professionals not only in the NHS, but in education and social services, to recognise the symptoms and understand what good care looks like. In addition, the Juvenile Diabetes Research Foundation has been placing posters in GPs' surgeries, highlighting the signs and symptoms to help people recognise the condition.
Once diagnosed, children need a combination of high-quality clinical care and wider support to ensure that they manage their diabetes effectively. I concede that across the NHS we have a mixed picture, as has been well described. That is the picture the Government have inherited, and we are determined to improve it. Children with diabetes often need multiple referrals to different specialist services, so well integrated multidisciplinary care is crucial to service delivery.
The right hon. Member for Knowsley broke the ground for the building of the centre in Aintree that he described, which I understand will bring diabetes clinics closer together and make it much easier to access those services. We want to see more such centres of excellence. I welcome that development but stress, rather as he did, that too often the focus is on how many hospitals, doctors and nurses there are. Beds and buildings are not as important as good services, particularly when it comes to managing long-term conditions such as diabetes, as well co-ordinated and well thought-out services that are closer to the patient and can respond to their personal circumstances and fit around their lives will meet their needs better.
Barbara Keeley:
While preparing for the debate, I noted that my right hon. Friend the Member for Knowsley (Mr Howarth) and the hon. Member for Torbay (Mr Sanders) are lucky enough to represent the two parts of the country where integrated health and social care is thought to be working the best. While talking
with the King's Fund the other day, I learned that there are only six places in the country where it is judged to be working that well. On GP commissioning-several Members touched on this point-how can the Minister ensure that that will improve, because our fear is that that major, top-down reorganisation will mean that those five or six places will be the only ones in the country?
Mr Burstow: Had I turned to the next page in my brief, I would have reached an answer to that question, so I will come back to it in a moment. My final point about care is that the latest paediatric diabetes service survey suggests that the picture is improving. It is important to stress that there is movement in the right direction, but there are still deficiencies.
On the question of GP commissioning and how we better integrate the commissioning and joining up of services, a point that the hon. Lady and others have missed in much of the commentary on the White Paper is the clear intention for local authorities to hold a new role in assessing population need. That assessment will be critical to the future of the commissioning of health and social care and to the new role of local authorities in public health, which is key to early prevention of type 2 diabetes. The notion that there is fragmentation and atomisation is far from the truth. The intention is to ensure that we have that alignment of services, which would be much better achieved through the partnership between local authorities and GP consortiums.
Mr George Howarth: I recognise the problem to which the Minister refers, but Knowsley primary care trust and Knowsley council, for example, already have a number of integrated posts; the chief executive of the PCT is also the director of social services. The process that the Minister is seeking to create through the reforms to a large extent already exists in places such as Knowsley, yet it seems that they will undo what has already been created.
Mr Burstow: As the hon. Member for Worsley and Eccles South (Barbara Keeley) has already said from the Front Bench, that is not the norm but the exception. We want that to become the norm. The point is that that has not happened everywhere. We need approaches that ensure that we design services in ways that involve all the key players, including clinicians and local authority social services, where appropriate. That is the ambition of the White Paper.
We want to unleash the potential of GPs by aligning them much more closely as commissioners with the services. I note that the Juvenile Diabetes Research Foundation supports the White Paper and sees it as a key way to lever the changes that Members have argued for in the debate. It sees the reforms as an opportunity to secure things that are not delivered under the current NHS architecture, such as insulin pumps, and I certainly wish to ensure that that happens.
Mr Howarth:
I apologise for making so many interventions, but I want to make this simple point. One of the consistent themes in this debate has been that the weakest link in the system for treating young people with diabetes is the service that GPs provide, particularly in diagnosing diabetes in the first place. I cannot see the
logic, from a diabetes point of view, in handing all the power and control to people who do not understand the disease.
Mr Burstow: The right hon. Gentleman and the Juvenile Diabetes Research Foundation seem to be in different places. The foundation takes the view that the condition is best managed through primary care. As I said, we must upskill, ensure that the signs and symptoms are better understood, and use the clinical skills of GPs more effectively.
Barbara Keeley: Will the Minister give way?
Mr Burstow: I will give way in just a moment-I want to pick up on another point. I am surprised that the hon. Lady keeps going on about GP commissioning, when it was her Government who introduced practice-based commissioning. We are building on those reforms, and see them as an essential way of ensuring that taxpayers' money is most effectively geared to delivering the best possible health outcomes for people with diabetes and other conditions.
Barbara Keeley: I do not think that Opposition Members are alone now that the Royal College of General Practitioners has expressed major concerns about GP commissioning and is pleading with the Health Secretary to put the reforms back.
I want to raise a point about local authorities and coterminosity with PCTs. We have a better coterminosity situation-and have struggled to get to it-but I know that some local authorities around Greater Manchester will be faced with having not one but two, four or five GP consortiums. As I said, health and social care integration is working in places such as Knowsley and Torbay, where great work has been done to bring things together. The fragmentation is coming out because of the nature of the reorganisation.
Mr Burstow: Again, I do not recognise that characterisation, in that coterminosity does not exist in many parts of the country under the current model. As the hon. Lady has rightly said, integrated models of care, and collaborative approaches and behaviours are not present in many places. The desire and intent behind the White Paper is to make them the norm.
I want to do justice to this debate. We could have a debate about the White Paper, and I am sure that at some point the Opposition will choose to do so. If they do that, we would be only too happy to meet them point by point, but I want to talk about some of the key developments that will bear down on this problem and really help to transform lives.
The coalition Government want to make a significant move in respect of their commitment to introducing a much stronger payment system for children's diabetes services, which will help to bring them out of the shadow of other NHS services. As a start to the process, a new mandatory tariff, which we plan to introduce in stages from April 2011, will recognise paediatric diabetes care as a clear and discrete specialism within the NHS, and will provide a clear funding stream to support such services over the long term.
At present there is a non-mandatory tariff, which was rushed in for April 2010, but it is wholly inadequate because it fails to take into account the complex nature of paediatric care, which this debate has articulated. As a result, under the current system, many paediatric diabetes services either continue to be under-resourced-we have heard about that today-or are funded through other budgets. Hence, they can sometimes be relegated to a second-class status in the NHS. The new tariff, as part of a more patient-focused funding model, will help to put us on the right track.
Mr Alan Campbell (Tynemouth) (Lab): Will the Minister give way?
Mr Burstow: I will. The hon. Gentleman has listened to the whole debate, and I appreciate the fact that he has done that.
Mr Campbell: We have reached the point about money, and I can assure the Minister that the first concern of a parent of a child diagnosed with type 1 diabetes is the health of the child, not money. My hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) discussed support for families. May I ask what representation the Minister has made to the Department for Work and Pensions on disability living allowance, which is available to many families of young people with type 1 diabetes?
Mr Burstow: I obviously have many conversations with colleagues in the DWP, but as that is the first occasion on which that matter has been raised in this debate, and as I want to do justice to other speakers, I shall move on to ensure that I answer their questions.
Let us deal with family support more generally. The hon. Member for Mitcham and Morden took us through some of the statistics; the impacts on families' lives are truly disturbing. We need to ensure that appropriate and tailored support services are in place, including the right support for carers.
I am concerned that where peer support services are provided, they are not given priority. However, not all peer support services need funding; they need willingness and support to ensure that they carry on. I would certainly commend peer support as one of the ways in which people can cope with self-care and the ongoing management of the conditions that have been discussed in this debate.
Let me deal briefly with emotional support for children in particular, and the children's charter, which has been mentioned several times. My hon. Friend the Member for Torbay spoke about the impact of a diagnosis at a young age. Part of that comes back to providing proper emotional support in formal settings-schools and other settings. We must ensure better alignment in the way that we develop our thinking around public mental health strategies, and we will be saying more about that in a cross-Government strategy on mental health later this year. I am sure we will want to pick up, at least in thematic terms, on the public health issues in the White Paper that we will publish, also later this year.
I very much welcome Diabetes UK's children's charter, which will help to establish the kind of support that children and young people need to help them cope.
Also, a guide has been developed to help commissioners ensure that children with diabetes receive the emotional and psychological care that they need.
In the last four minutes, I want to speak about insulin pumps. The right hon. Member for Knowsley rightly raised that key issue in the debate and in an article that he published today. The National Institute for Health and Clinical Excellence has clearly recommended pump therapy for children and young people if daily injections are not working. Frankly, I am disappointed and shamed that many primary care trusts are dragging their feet on making pumps available. That should have been sorted out; I should not have to come to this Chamber to explain why that has not been done, given how long the recommendations have been there. It is a pity that the delay was not challenged more in the past, and that the previous Government did not get around to sorting it out. I expect to see real improvement in this area as a result of the new funding arrangements that have been discussed in the debate.
My hon. Friend the Member for Torbay raised some important points about obstacles, and I want to ensure that, through the all-party group on diabetes, we have further conversations about what we can do to kick down those obstacles, and to ensure that the important research on artificial pancreases that is being done in this country is not undermined by the treatment not being available because there is not a route through the pumps. That point has been powerfully made in the debate, and I want to ensure that we follow through on it.
Research has been touched on in broader terms, and I want to mention a couple of examples of work that is being done at present. We are looking at how to provide better psychological support for children with diabetes, and how we can improve education and training in diabetes for children and families. We are also funding a major trial on the effectiveness of insulin infusion treatments versus standard injections. Alongside that, there is a vibrant third sector investing in research.
We have heard about work at Cambridge university to develop an artificial pancreas to reduce the risk of hypoglycaemia in children and adolescents. The link to telehealth that my hon. Friend the Member for Torbay referred to is important, and I want to ensure that the message is clearly understood and that we build it into some of the work that the Department is doing. I am about to run out of time, so I will have to write to my hon. Friend about international research.
Hon. Members raised points about schools. I shall elaborate in more detail by writing to all those who have taken part in the debate, but it is key that schools understand their responsibilities in respect of well-being and safety, and that they provide appropriate support for children who need to take medication at school.
The Government are determined to improve care for type 1 and type 2 diabetes. This is not something that we will put on the back burner. We have inherited a legacy but intend to build on and really improve those services.
Inter-city Express Programme
4 pm
Phil Wilson (Sedgefield) (Lab): I asked for the debate today to give voice to the north-east's campaign to ensure that the inter-city express programme is allowed to go ahead, due to the economic impact it would have on the region. It would have profound implications for the north-east because the investment would be the biggest in the north-east since Nissan in the 1980s. That is how important it is, not only for the north-east, but for the rail infrastructure and the UK economy at large. Hitachi has already said to me in writing that the preferred site for the factory to manufacture the trains would be in Newton Aycliffe in my constituency.
My area's involvement in the railways goes back to their beginning. Locomotion No. 1 travelled along the railway line a few hundred yards from the potential factory site on its way to Darlington in September 1825 to start the Stockton and Darlington Railway. That is how long my area has had its historic relationship with the railway. For something like 160 years, train building was a massive industry in south Durham, just a few miles away from Newton Aycliffe at Shildon wagon works, which closed in 1984 with the loss of more than 2,000 jobs. The inter-city express programme provides us with the opportunity to bring train building home.
In 2007, the Department for Transport issued an invitation to tender to transform the UK's inter-city train services and replace the outdated diesel high-speed trains that have provided the service since the 1970s. Agility Trains, a joint venture between Hitachi and John Laing, won that contract. Agility Trains will deliver state-of-the-art super-express trains based on the highly successful 395 Javelin trains in Kent, which have recently won a Passenger Focus independent survey for being the best trains. Hitachi also manufactures the bullet train in Japan.
If the programme goes ahead, Hitachi will build a purpose-built factory in my constituency alongside the second largest industrial estate in the north-east. The best way of describing the inter-city express programme is as a service and supply contract to provide new trains and a dramatic improvement to the inter-city services on the east coast main line between London, south Wales and the south-west. The contract was privately financed and managed on a pay-as-you-go basis, which means that payments are not due until the trains are delivered in 2015, after the next election. The cost of the service is spread over 27 years of operation, with payments made on a per train, per day basis. Payments depend upon delivery of a clean, reliable and fully serviceable train, thereby ensuring that the interests of the supplier-Hitachi-and the passengers are aligned.
The programme will deliver a significant increase in seating capacity, a reduction in journey times and a huge increase in reliability and comfort without need for hugely expensive track upgrades. It will also mean that passengers will be able to travel on trains that do not dump toilet waste on the track. We need to move on from the Austin Allegro era of technology.
On 26 February 2010, a written ministerial statement said that Sir Andrew Foster would subject the inter-city express scheme to a value-for-money assessment. On
6 July, the Secretary of State for Transport published the results of that assessment:
"Sir Andrew suggests that the inter-city express proposition is 'positive and attractive' in a number of ways. He suggests that the PFI-style funding arrangement is novel and well aligned in terms of financial incentives. The faster acceleration and longer carriages would have a positive impact on network and passenger capacity, and the specification has also taken network sustainability and environmental imperatives seriously."
Sir Andrew raised some technical questions about the trains, but the Secretary of State said:
"I see this as a lesser issue".-[Official Report, 6 July 2010; Vol. 513, c. 10WS.]
Hitachi has been working closely with the Department since July regarding the issues raised by Sir Andrew, and I am sure that they can be resolved. It wants to simplify the bi-modal technology for example, to bring down costs. Bearing that in mind, the economic case for the inter-city express programme to go ahead is significant.
Not only will the programme bring improved rolling stock to the railway infrastructure, which is required in the 21st century if the economy is to grow, it will also mean so much to the economic growth of the north-east. The programme helps fulfil the Government's stated aim of rebalancing the north-east economy in favour of private sector growth. Public financial input will not be needed until after the next election, and will be recouped through the innovative financial formula Hitachi has drawn up.
Some argue that it should be left to the train operators to acquire the trains they need, but, surely, economy of scale means that this proposal is the cheaper option, and it offers sufficient volume to attract a major manufacturer to the UK. Therefore, it goes some way towards meeting the Government's stated aim of growing the private sector-something we all want to see-and Hitachi will put in the investment up front. If the inter-city express programme goes ahead, and I know that the Minister cannot give an answer today, Hitachi has said that its preferred site is Newton Aycliffe. In a letter to me, it stated that, on a range of criteria, including required land size, test track availability, road access, proximity to deep sea ports, local labour availability and flexibility, and ease of business with local and regional agencies and authorities, County Durham and Newton Aycliffe scored highly. That is a tribute to the people of Newton Aycliffe, to local decision makers, and to the north-east's ability to attract foreign investors, of which there are 500, about 100 of which are in County Durham.
However, what benefits will Hitachi bring to the region? Some 800 direct jobs; up to 9,000 jobs in the supply chain, seven out of 10 of which will be in manufacturing, mainly in the region but also nationally; and for every £1 of investment there will be £48 return over 20 years. Hitachi will start building a £90 million purpose-built factory next year. Some 200 construction jobs will be generated, and private sector investment precedes any public sector investment, which will be over a 20-year-plus period. Over two decades, the region will benefit in net gross value added terms by £660 million, and Teesport will also benefit because some components will be imported from Japan.
The inter-city express programme will replace the rolling stock on the east coast main line. As someone who uses the east coast main line weekly, I know that the rolling stock needs replacing. At present, demand outstrips supply on the line. With rail travel from the north-east to London costing three times as much as flying, and as there are no longer flights from Durham Tees Valley airport to Heathrow, but only from Newcastle, there is an acute problem that needs to be remedied. The new carriages with extra passenger capacity will help to resolve the problem.
The 800 jobs will help to pump much needed expenditure into the local economy through wages. Newton Aycliffe town centre is going through a period of regeneration, and the boost to the local economy that Hitachi offers will help see the local shops boom and breathe new life into the town. Newton Aycliffe has the skills that Hitachi requires. The recent global economic downturn has seen many people with those skills put out of work. The initiative will help to put those idle hands back to work.
I have said that the initiative will match some of the Government's stated objectives-rebalancing the north-east economy in favour of the private sector and providing work to those who have skills, as well as offering apprenticeships to our young people who do not have those skills. The Government want to create 2 million private sector jobs in the next five years, and this initiative will help to do that. The programme is private-sector led. Hitachi has also committed to using local suppliers first and foremost. If it goes ahead, the investment and the presence of Hitachi will provide the north-east with the largest private sector investment since Nissan 25 years ago.
The issue has united the north-east in a campaign to ensure that the inter-city express, and Hitachi's presence in Newton Aycliffe, goes ahead, and to put the case for the region. The groups that have got together to do that include: North East chamber of commerce; Durham county council, with the support of the leaders of the Conservative and Liberal groups, as well as the controlling Labour group; the Federation of Small Businesses; the northern TUC and Unite. They have come together to promote the importance of this project to the north-east. The Northern Echo is running a "back on track" campaign because this is so important to local people. A petition launched by the partners is attracting thousands of signatures.
The Secretary of State for Transport has kindly agreed to meet a delegation of business people from the north-east next Tuesday so that we can again make the case for the opportunities that the proposal will provide for the north-east. The partnership has produced a report stating the north-east's case for the inter-city programme to go ahead, and I sent a copy to the Minister earlier today. I hope that she found it useful. The north-east has learned over the years to stand up for itself, and is saying "We're here and we can do the job." Hitachi, one of the biggest companies in the world, has faith in the region, and I hope that the Government also have faith in it.
The right hon. Member for Berwick-upon-Tweed (Sir Alan Beith) said:
"I welcome Hitachi's interest in building rolling stock in the North-East, and I very much hope the project will go ahead-it would bring enormous benefit to our region."
In a letter to me, the Minister of State, Department for Business, Innovation and Skills, the hon. Member for Hertford and Stortford (Mr Prisk) said:
"I am pleased that Hitachi has announced publicly that it intends to establish a new train assembly plant in the UK, should the Intercity Express Programme go ahead. We recognise that this would represent a significant boost to the economy in your constituency. This is to be welcome."
The Foreign Secretary said in a speech in Tokyo on 12 August:
"I am...here to announce the significant new emphasis that the British Foreign Office will give to providing direct support to the UK economy, helping British business secure new opportunities in the emerging economies and putting our diplomatic weight behind British enterprise as well as helping to bring Japanese and other investors to Britain."
"We will work alongside British businesses and the rest of Government and other Governments around the world to use our political influence to help to unblock obstacles to commercial success".
The Secretary of State for Transport met the president of Hitachi, and the Japanese ambassador, and talks have taken place between our Prime Minister and the Prime Minister of Japan because the issue is so important for bilateral relations.
I understand that a decision on the programme will be made as part of the comprehensive spending review. Will the Minister tell me whether the announcement will be part of the statement, or ancillary to it? How are the talks with Hitachi going since the Secretary of State made his written statement in July? How does the Department's position marry up with the Foreign Secretary's position that everything must be done to attract Japanese companies to Britain, and to remove any obstacles to that? What prospect does the Minister see for the north-east's economy if the proposal does not go ahead?
I am not a deficit denier, but one way of solving the problems of the deficit is to increase the economy by increasing the private sector. The inter-city express programme and the Hitachi plan for locating in the north-east would do just that. When the decision on the inter-city express programme is eventually made, I hope that those who make it know the difference between slimming and starving, because starving the north-east's economy is not the answer.
I am here today to promote the interests of my constituents and those of the north-east. There is great support in the region throughout businesses and parties. I hope that the Minister will consider these representations when her colleagues make the final decision on the inter-city express programme, and that they make the right decision. I believe she knows that that is to let the project go ahead.
4.12 pm
The Minister of State, Department for Transport (Mrs Theresa Villiers): I congratulate the hon. Member for Sedgefield (Phil Wilson) on securing this debate on this important issue.
4.13 pm
Sitting suspended for a Division in the House.
4.38 pm
Mrs Villiers: Before the interval for voting, I was congratulating the hon. Member for Sedgefield on his passionate support for the IEP. I thank him for the correspondence that he has sent to the Department, setting out a number of the points that he has raised, and for the report that I received today on the case that he has prepared for the IEP project. I am grateful for all of those. My colleagues at the Department and I will be giving serious consideration to all the points raised in the report and in today's debate.
I welcome the fact that the hon. Gentleman, alongside a delegation from his constituency and around the north-east, is due to meet my right hon. Friend the Secretary of State for Transport to put these points to him directly. The coalition Government have made it clear that rail has a key part to play in our transport strategy. Although our priority has to be tackling the deficit that we inherited, the Government fully recognise the significant economic benefits generated by investment in transport infrastructure-a point that has been explicitly acknowledged by the Chancellor of the Exchequer. Nevertheless, we must apply a rigorous cost-benefit analysis to all our planned infrastructure projects, targeting investment where it makes the most difference and where it will generate the greatest economic benefit.
That is the background against which we need to assess the future of the IEP. There can be no doubt that the project has encountered a degree of controversy since the previous Government embarked on it over half a decade ago. The objective was, as we have heard, to replace Britain's fleet of InterCity 125 trains, and to invest in capacity and passenger journey improvements on the east coast and Great Western lines. The procurement process began early in 2007, and two years later, Agility Trains was announced as the preferred bidder. An important component of Agility is Hitachi, the manufacturers of the Japanese bullet train.
As we heard from the hon. Member for Sedgefield, Hitachi simultaneously announced its plans to build the new train order in the UK. This summer, the company announced that its preferred site for a new manufacturing facility is Newton Aycliffe in the hon. Gentleman's constituency. As he has explained, that town has historic ties with the railways. As we heard today, Hitachi has said that it proposes to use the site in County Durham to bid for orders abroad, and has aspirations to export British-built trains to Europe. The parallel with the successful model used by many Japanese car manufacturers is obvious; it is a very positive example of what can be achieved. As the hon. Gentleman explained, the facility has the potential to create hundreds of new jobs, and potentially many more in supplier industries. He has put the case articulately and strongly for the economic benefit that will accrue to his constituents and the wider north-east.
Of course, such inward investment would be very welcome and entirely consistent with the Government's stated goal of rebalancing the economy and promoting manufacturing industry. I take on board the strong points that the hon. Gentleman made about the skills base in the north-east, and how appropriate it would be to support a facility of the kind that Hitachi has announced the intention to build.
However, the hon. Gentleman will, I am sure, appreciate that the decision on the IEP needs to focus on objective and established procurement principles-namely, on whether the project provides the right solution for passengers
and the railways; whether it delivers value for money, compared to the alternatives; and whether it is affordable for the taxpayer.
In its original form, the order would have been the single largest procurement of rolling stock ever, and one of the biggest private finance initiative transactions in British history. During the later part of 2008 and 2009, the capacity of the debt market contracted and the previous Government decided that it would be better to split the transaction into smaller parts.
The deteriorating state of the debt market was just one of the challenges that faced the project. A further issue arose when the previous Administration changed their mind on electrification. Having published in 2007 a long-term plan for the railways that had a limited role for electrification, the Government put out the tender for a fleet, with a significant proportion of diesel trains as part of the IEP proposal. Two years later, at the height of the contractual negotiations, the Government announced they had changed their views and proposed to electrify. That meant that the order had to be changed to an electric and bi-mode mix, which led to an increase in costs. By the time Labour left office in May, £26 million had been spent on consultancy and preparation costs, without the contractual close stage even having been reached. That has caused a degree of concern.
The project was in some difficulty when the previous Secretary of State, the noble Lord Adonis, decided to commission an independent review by Sir Andrew Foster. When it was published in July, the Foster report presented a measured and thoughtful analysis of the relevant issues. As the hon. Gentleman has correctly pointed out, Sir Andrew had some very positive things to say about the IEP. He described the proposition as "positive and attractive" in a number of ways. He described the PFI-style funding arrangements as
"novel and well-aligned in terms of financial incentives".
He concluded that faster acceleration and longer carriages would have a positive impact on network and passenger capacity. He acknowledged that the specification had also taken network sustainability and environmental imperatives seriously. Unfortunately, he also had some concerns about the project. He concluded that the previous Administration had made a number of mistakes on the programme. In particular, they did not engage the railway industry well enough and had sought to micro-manage the process. Importantly, the Foster report also highlighted that although the project has always exceeded the Department for Transport's economic thresholds, its value for money has seen a decline over time, while its costs have increased.
Mr Edward Timpson (Crewe and Nantwich) (Con): Although I acknowledge and am extremely sympathetic to the case made by the hon. Member for Sedgefield (Phil Wilson) on behalf of his constituents and the north-east, is the Minister considering carefully Sir Andrew Foster's conclusion that he is not convinced that all credible alternatives to IEP have been identified? He sets out the case in his report for a short-term IC125 refurbishment, which would be both cost-effective and technically feasible. The skills, buildings and infrastructure enabling that work to be done already exist in places such as my constituency of Crewe, where Bombardier can already carry out that work.
Mrs Villiers: My hon. Friend's intervention is timely, as I am just about to come to that point. As he rightly says, Sir Andrew did make some points about the possible alternatives to the current IEP proposition.
In response to Sir Andrew Foster's report, my right hon. Friend the Secretary of State for Transport announced that the Government would use the period up to the spending review to give further consideration to the future of the IEP. In accordance with Sir Andrew's recommendations, the Government are reviewing all the credible options in light of value for money, affordability and their compatibility with the plans for further rail electrification. That means careful consideration of how the IEP proposal could be reduced in cost, and evaluating alternative ways of addressing the problem that the IEP was designed initially to solve-that is, how to address the problems surrounding the ageing high-speed train fleet. As my hon. Friend points out, the alternatives include the possibility of refurbishing and extending the life of the existing InterCity 125 rolling stock. In that regard, compliance with disability deadlines will be an important factor to bear in mind in the assessment.
Mr Kevan Jones (North Durham) (Lab): Is the right hon. Lady suggesting that the north-east should once again get second best, while the constituency of the hon. Member for Crewe and Nantwich (Mr Timpson) is, I think, served by a line with brand new trains?
Mrs Villiers: I am saying that we have to carry out a very careful assessment of what the right outcome is for this programme, and what the right way is to address the problem of the ageing InterCity 125 fleet. That is what the Government are doing at the moment.
Ben Gummer (Ipswich) (Con): One thing was omitted from the original planned routes for the implementation of IEP, and that is the inclusion of the London-Norwich line, to the great disappointment of the people who live along it. The problem is that the rolling stock is not only ageing, as is that of the high-speed train fleet, but actually the cast-offs from the main lines to the north-east and north-west. If the routes are to be renegotiated, I hope that the line will be included, but I have to say that this is a lunatic way to procure trains. We heard about the Austin Allegro, famously specified by civil servants. I would not like this to be a similar instance of specification by civil servants that is not suitable for industry.
Mrs Villiers: Many parts of the network would like to have extra capacity, and I shall take my hon. Friend's concerns on board as a representation. Regarding additional projects of that sort, it clearly all depends on what proves to be affordable, but we intend to learn lessons for the procurement process from the experience of the IEP.
As regards reappraisal of the original IEP concept, the Department has listened with great care to the ideas put forward by Agility on how to improve the value for money of its proposition, and I would like to put on record our sincere thanks to Agility for the diligent and constructive work that it has done, in contributing to both the Foster review and the re-evaluation process that followed. I am very aware that the issue is taken seriously in Japan.
Phil Wilson: Does the right hon. Lady agree with me that the answer is not to give the existing rolling stock a lick of paint, but to invest in the infrastructure? The rolling stock has been around since the 1970s, and the technology that we have brought on board through Hitachi is cutting-edge. The trains that it uses are comparable with the Javelin ones used in Kent, which are some of the best in the country. The kind of technology that Hitachi wants to bring on board is suitable for people in the north-east of England and elsewhere who would benefit from it.
Mrs Villiers: I can assure the hon. Gentleman that the respective merits of the different options will be carefully and rigorously considered before a decision is made. This entire debate will be a helpful contribution to the decision-making process.
The hon. Gentleman mentioned that the Secretary of State for Transport has met the president of Hitachi, as has the Secretary of State for Business, Innovation and Skills. I have discussed the project with the former Japanese Minister for Transport, and the Minister of State, Foreign and Commonwealth Office, my hon. Friend the Member for Taunton Deane (Mr Browne), discussed the matter on a visit to Japan. We are taking the concerns of the Japanese Government on board in discussions on the process. Agility's proposals are due shortly, and they are likely to include plans to standardise the design of the new trains, as was recently reported in the railway press. I am also advised that Agility expects to offer a significant cost-saving, while still meeting the specification that it was originally asked to meet. We will then be able to complete our assessment of both the IEP and the credible alternatives on an equal footing.
In conclusion, I would like to assure the hon. Gentleman that the Government will take into account the representations that we have received from him today, and the representations in the report that he has submitted to us, along with those that he and colleagues have made in the past. The decision on the future of the IEP will be made on the basis of the fullest possible evaluation of all the relevant matters. I am, of course, well aware that the recent period of uncertainty has been a cause for concern to those with an interest in the project, such as the hon. Gentleman and his constituents, and the Government really appreciate the patience shown by all concerned, not least Agility Trains. However, there is a complex interaction between the IEP and other key programmes under review as part of the comprehensive spending review. In light of that inescapable fact, it seemed impossible to make a sensible and objective decision on the IEP in isolation from the conclusions that we have to reach on those other interdependent projects, and from the overall decisions on the resources available for transport infrastructure.
Although the stage that we have reached means that I cannot give the hon. Gentleman all the answers on the programme, as he has kindly acknowledged, the Government are anxious to resolve the matter, and we will convey the decision to the House as soon as we can, as part of the spending review process in October. I thank the hon. Gentleman again for his contribution, and I look forward to continuing discussions with him on the subject. As I say, we will report to the House as soon as is practical regarding this decision, which is crucial not just for the north-east but for the future of the railway network in this country.
Fresh Produce Procurement (Prisons)
4.55 pm
Gordon Henderson (Sittingbourne and Sheppey) (Con): I am really pleased to have this opportunity to highlight an issue of some concern to me and, I hope, to convince the Government to put right a couple of misguided policies introduced by the previous Administration. Ministers not only have an opportunity early next year to take action on at least one of those policies; they also have the opportunity to promote the localism agenda that is at the very heart of the coalition agreement.
Until 2007, prisons were supplied with fresh produce by local suppliers, one of which, Brambledown (Kent) Ltd, is based in my constituency of Sittingbourne and Sheppey. Indeed, Brambledown used to supply a wide range of fruit and vegetables to both the Sheppey prison cluster and a number of other Kent prisons. In 2007, the then Government changed their procurement policy for prisons. They scrapped local supply contracts and introduced a national framework contract. That contract was awarded to a company called 3663 First for Foodservice, which is part of a multinational group based in South Africa.
I would have understood the logic of the previous Government changing their procurement policy if such a move was designed to save taxpayers' money, but written answers that I have received to questions show that not to be the case. In the two years prior to the changeover, the average annual cost to the public purse for the provision of fresh produce to prisons was £8.7 million, whereas in the three years after the changeover it was just over £9 million. What those figures show is that the only people who appear to have lost out in this deal are the local suppliers who have seen their business plummet in the past four years.
To give an idea of the extent of the impact that the Government's policy had on individual companies, Brambledown (Kent) Ltd saw its annual income from the Prison Service drop from £345,000 in 2004 to just £375 in 2008. I have spoken to a number of prison governors and they have confirmed what I suspected, which is that the service and quality of food have not improved under the national procurement regime, and prisons have lost their much-valued link with local suppliers. I think that if the Minister were to ask governors, he would find that many of them would welcome the opportunity to purchase more of their fresh food locally, because it enhances their position in their local community.
Of course, one advantage of buying from local suppliers is that often much of the produce is grown locally, which leads me neatly on to another aspect of the previous Government's procurement policy: the Government's lamentable record on supporting British farmers, producers and processors. The Department for Environment, Food and Rural Affairs publishes statistics that show the proportion of domestically produced food both used by Departments and supplied to hospitals and prisons under contracts negotiated by the NHS supply chain and the National Offender Management Service. Coincidently, the latter was established in 2007, the same year as the food procurement policy for prisons was changed. Or perhaps that is not a coincidence, because the decision to change the procurement policy
and the decision to create the National Offender Management Service were, in my view, equally misconceived. Setting aside the merits of those particular policies, the statistics contained in the DEFRA document make interesting, but very depressing, reading, particularly coming as I do from a constituency in the garden of England with a sizeable farming community.
Let me quote a handful of product groups from DEFRA's statistics. Just 2% of poultry used by the Prison Service comes from British producers. A miserable 18% of pork meat is home bred. If we think that is bad, it gets worse. The proportion of orchard fruit, which includes apples, pears and plums, that the Prison Service sources from domestic producers is 0%. Not a single apple sourced by the Prison Service comes from domestic producers, and the same goes for soft fruit and bacon, which to my mind is scandalous and deeply unpatriotic.
No doubt I will be told that foreign produce is cheaper, but I do not accept that argument; cheap is not always best. It might be that buying French Golden Delicious apples instead of Braeburn apples from Kent is superficially advantageous. However, when one considers the harm being done to British farmers by this policy and the impact that transporting fruit and vegetables long distances in chilled containers has on our carbon footprint, buying local starts to make an awful lot more sense.
I hope that my hon. Friend the Member for Reigate (Mr Blunt), the new Prisons Minister, and his colleagues in other Departments will pursue a different procurement policy from that of the previous Government, who set a very bad example. How can we expect consumers to support British farmers if Ministers are not prepared to do so? Let us not forget that it is taxpayers' money that Ministers are spending. I am pretty sure that British taxpayers would much prefer their money to be spent on British food.
I urge my hon. Friend to do two things that would make him popular not only with farmers in my constituency but with the public at large. These days, being popular with anybody is a very rare thing for a politician. First, I should like the Minister to issue a guidance note to his Department officials instructing them always to purchase domestically produced goods unless doing so would place a disproportionately high burden on the taxpayer. Secondly, I should like my hon. Friend to refuse to renew the national framework contract when it comes up for renewal next May, and instead revert to a system of allowing prisons to enter into contracts with local suppliers. Pursuing such policies would help to promote the coalition Government's localism strategy, and that must be worth a brownie point to any Minister.
5.3 pm
The Parliamentary Under-Secretary of State for Justice (Mr Crispin Blunt): I congratulate my hon. Friend the Member for Sittingbourne and Sheppey (Gordon Henderson) on securing this important debate, and I am grateful to him for providing me with the opportunity to examine our strategy in this area and to see whether it should change when the contracts come up for renewal next May. There is a significant attraction in my hon. Friend's arguments. Anyone arguing for a politician to be popular is likely to be on pretty strong ground. He helpfully outlined his arguments to the Ministry of Justice, which has enabled me to provide a comprehensive answer to him.
Before I focus in depth on my hon. Friend's remarks, I should like to respond to the point he raised in a letter to me in September concerning Brambledown (Kent) Ltd. He kindly told us in private that we appeared to have missed that company off the list of contracted suppliers, which gave me the opportunity to examine the position without public embarrassment to the Ministry if we got our answer wrong. He was correct to say that Brambledown did not appear on the list of contracted food suppliers. The reason for our response, which did not mention Brambledown, is that it was not a contracted supplier to the National Offender Management Service, but it continued to supply the Sheppey cluster of prisons under existing local ad hoc arrangements. That continued until an electronic ordering system was introduced in 2007-08, which brought the transitional arrangements to an end.
Contracted suppliers are those who are awarded contracts to provide goods to prisons following a fairly contested tender process, which ensures that they meet minimum criteria and are capable of meeting the Department's requirements. The response listed 18 fresh produce suppliers who were contracted to supply prison sites.
Despite the charm and skills with which my hon. Friend made his case, there is a strong argument for the existing method of supply. Food supply contracts that are awarded by the Ministry of Justice, particularly those for prisons, are not just a straightforward matter of whether the supplier operates on a national or local basis. There are many key factors in deciding the best approach and I should like to share a few of them with the Chamber.
Operational concerns are very much at the forefront of our decision making. It is worth remembering that discontent about the quality of food, changes to menus, and failure to deliver what was previously promised have been known to be the catalyst for serious disturbances. As well as being a key issue in control, food demonstrably contributes to prisoners' overall well-being. A high proportion of prisoners are from socially excluded sections of the community, with lifestyles that are more likely to put them at risk of ill health than the rest of the population. Many have never registered with a doctor or a dentist, have drug habits and/or mental illness and live chaotic lives without a stable home. Prison gives an opportunity to improve the health and lifestyle of prisoners to the benefit of all, and diet is a major component of a healthy lifestyle.
Prisons aim to provide food that is nutritious, well prepared and served, reasonably varied and sufficient in quantity and that also meets a range of religious and cultural needs. Inadequate portion sizes, lack of variety and poorly cooked food can contribute to serious complaints and dissention. Providing prisoners with the opportunity to choose a healthy, nutritionally balanced diet, with enough knowledge to make informed choices, is important because prisoners can be in custody for long periods and are largely dependent on prison food.
Then there are the commercial and supply chain considerations. In the 2009-10 financial year, the Department spent around £60 million on food for prisoners. Although that is a big sum in itself, it amounts to an average cost of just £2.22 per prisoner per day for all food and beverages. Given that contaminated food can have disastrous consequences among a closed prison population, those costs have been achieved against a background of tight regulation and control.
I could go on with the list of factors that require consideration, and I have not even begun to touch on the environmental footprint of the vehicles that deliver food. The point is that any contractor appointed to supply food to prisons must meet all of those stringent criteria. Typically, smaller suppliers do not have the organisational infrastructure and resilience to meet the requirements day in, day out, which results in a higher proportion of contracts being awarded to larger suppliers.
Before moving on, I should also point out that the choice of a supplier that operates nationally as opposed to just locally does not mean that the produce is not sourced locally. That is an issue for our supplier-in this case it is 3663. National operators draw heavily on domestically produced food and will obviously use it when it makes commercial sense to do so. It is also not the case that our arrangements cause unnecessary mileage in delivery. National operators often have regional depots and use them to keep their mileage and costs to a minimum. Because those depots can carry the full range of products required by a prison, they are able to send just one vehicle to that prison, whereas several vehicles would be used by a number of locally based suppliers to fulfil the same overall requirement.
I will now turn to the specifics of the current food supply arrangements serving prisons. The Department uses two contractors to fulfil its requirement for food. The first of these, 3663 First for Foodservice, provides groceries, fresh produce, chilled and frozen food. The other supplier, Hovis, provides fresh bread and morning goods. Contracts with those suppliers have operated since 2007 and they offer 1,500 products for prisons to create meals with.
The delivery of products is only the beginning of the meals service. The 128 public sector prisons in England and Wales employ about 1,050 catering staff and 3,500 prisoners to prepare the food for more than 75,000 prisoners each day of the year, which amounts to more than 82 million meals a year, all served at predetermined times through 900 service points. That service is particularly challenging, given the tight financial constraints that prison kitchens must operate under.
Prisoners are provided with three meals a day, choosing from a multi-choice, pre-select menu system that is compiled to cover a minimum of four weeks. That menu format takes account of seasonal variations and prisoners' preferences, and it is capable of meeting differing dietary requirements, such as vegetarian, vegan and religious meals.
Prison governors bear the ultimate responsibility for prisoners' diets. They are required to approve food as being fit for service to prisoners and to approve local food budgets. The prison kitchens are run by catering managers, who are responsible for implementation of standards, training of staff and control of the food budget.
Gordon Henderson: I hear everything that my hon. Friend has said and it is quite logical. He says that it is the governors' responsibility to ensure that inmates receive proper food. However, why is it that the governors themselves would prefer to revert to using local suppliers?
Mr Blunt:
I heard what my hon. Friend said about that issue. I confess that, in the visits to 20 or so prisons that I have already made, I have not discussed the issue
of food supply with governors. Food supply has not been raised with me directly as an issue of concern for the governors. Following this debate, however, I will make my own inquiries on my future visits to prisons as to whether there is an issue about food supply. I am looking at all the services that are provided in prison, to see whether nationally provided services are better than locally provided services or not.
I will quite happily share my prejudice that I would prefer it if things were locally managed and locally resourced. As far as I am concerned, there needs to be a pretty high test to move to a nationally provided system. As my hon. Friend will have gathered from the tenor of my remarks, on the basis of what I have seen so far the argument that I am making is that I actually think the national food service supply chain that we have at the moment is meeting that test. However, as I get to the end of my remarks I may give him a little glimmer of hope.
More than 20,000 items of food are ordered each week across all temperature ranges. That means that the total cost of the delivery of food per day tops £230,000. To put that into perspective, it is equivalent to visiting a cash and carry warehouse to empty the shelves each day. Even if such visits were practical, there could be no guarantee of the consistency or the completeness that the prison environment demands.
The supply chain infrastructure to support this volume of food is significant and yet it also manages to deal with a wide variety of prison locations. Those locations range from Victorian prisons, which have small entry gates, low arches and limited turning space, to prisons in city centres and prisons in rural areas, which are accessed by small country lanes that vehicles have to negotiate. Few prison buildings are conducive to the delivery of the volume of food that is required and yet deliveries must be made each day, without fail, to ensure the continued running of the prison.
As I mentioned previously, food deliveries are made from a number of regional supplier depots. The deliveries are consolidated as far as possible, given the constraints that I have just outlined, so that the number of gate openings and associated security risks are minimised. Each delivery can take up to two hours to complete, depending on the security and regime of the prison. For that reason, deliveries are centrally co-ordinated to an exacting timetable. That maximises the efficiency of deliveries and minimises their impact on the prison operation.
Hovis and 3663 have introduced consistent working practices in their depots for their contracts with us. That means that each depot is easily able to support other regions in the event of a supply chain interruption. The two suppliers that are in place have been rigorously tested through open and fair competition, to ensure that they are capable of managing deliveries into prisons and can support those deliveries with robust contract management. There is little as challenging in this field as procuring food for the 82 million meals that are served in prison each year, given the limited facilities offered by prison kitchens and the tight financial constraints that they have to operate under.
The food suppliers comply with central specifications, to ensure that all food that is delivered is of good quality, safe and free from any contamination. Products are tested, where appropriate, to ensure that quality and quantity standards are met.
Reliable management information gives prisons the assurance of safety, traceability, provenance and quality that they need for the prison regime to operate with confidence. Central to that relationship between prisons and suppliers is the confidence that the suppliers can provide consistency. An undersize apple handed out at the servery will create issues of order and control, so we use suppliers that are sensitive to that need and that use their sourcing ability to maintain consistency from their supply base.
I apologise to my hon. Friend, who is a representative of the garden of England, that I used the example of an apple just now. [Laughter.]
Gordon Henderson: Will my hon. Friend say whether he feels that a Braeburn apple from Upchurch in my constituency will upset prisoners more than a French Golden Delicious apple?
Mr Blunt: Happily, the effect of this existing contract is that that is not a matter for me; it is a matter for our supplier, which is 3663. It is its responsibility to procure apples for us. I do not know the details of its apple procurement contract and I am delighted that I do not have to know them. As I say, that is a matter for 3663.
It is very proper for my hon. Friend to pursue that point with 3663 on behalf of his local orchards-to ask, "Why not? Why are these local orchards unable to compete in that way?" Like him, I have a prejudice in favour of domestically produced food and as long as the interests of the taxpayer are protected, of course we should be buying British.
Both suppliers-3663 and Hovis-are large national organisations. That is appropriate to the needs of the Ministry of Justice in terms of volume, spend and complexity. An arrangement such as the existing one exploits the capabilities of large suppliers in terms of volume leverage, sourcing capability and relationships with brand manufacturers. It provides more product choice, given that large suppliers have access to wider product ranges and have a strong capability in procuring from specialist subcontractors, hopefully including suppliers of Braeburn apples.
There are some other factors to consider in the type of supplier tiering that is being promulgated. The EU procurement directives preclude the Ministry of Justice from negotiating with suppliers on prices, but the main contractors can negotiate with subcontractors on prices and pass on the benefits. In addition, small and medium-sized enterprises are spared the costs of having to conform to onerous public procurement processes and the costs of having to interface with Government e-procurement systems, because the main contractor does it for them.
Furthermore, the supply chain risks rest with the main contractor, which allows prison caterers and governors to focus on the day-to-day operation of their prisons. The unit prices currently paid by each prison reflect that. Consequently, they are homogeneous and fully inclusive of all risks. Unit prices also cover charges for keeping vehicles waiting and they do not vary according to the actual cost of delivery or indeed the number of deliveries.
Any attempt to base prices on local circumstances would introduce complications into budget allocation. In other words, prisons that could benefit from low delivery charges would have to release part of their budget to those prisons that would have to pay more because of their remote location.
Prices are carefully managed and are determined by the price of the raw commodity, the costs of processing and packaging, transportation and distribution costs, overheads and an element of profit, which is around 1%. The cost to serve the contract is spread across the total range of products, keeping administrative and management costs to a minimum. The cost to provide meals varies from prison to prison. That is due to the differences in the prison populations and the choice of products ordered, which vary depending on the age, sex and cultural mix in the prison.
I know that my hon. Friend regards value for money as being extremely important. Value for money is tested and secured throughout the life of each contract. Prices are examined through open-book reviews and by reference to commodity indices. The Ministry of Justice undertakes monthly product reviews to determine the optimum spend profile for each product area. Each opportunity to improve on efficiency or to save money, without detriment to the quality of the product, is thoroughly explored.
I am advised that overall this national contract, which is being maintained in an era of high food price inflation-10.5% in 2009 and 4.1% for the current year so far-will deliver £5.1 million of cash savings during the period of the contract, between 2007 and 2011. When inflation is factored in, the real savings to the National Offender Management Service run to tens of millions of pounds.
However, product price is not the only driver behind contracts. Underpinning them all is the need to support prisoners and rehabilitate them back into society. When 3663 recently opened a new depot in Kent, it sought prisoners on release to form part of its new team. Subsequently, 11 ex-offenders were employed in depot operations, benefiting the supply base, the community and the Ministry of Justice.
Social sustainability is only one element of the total cost to the Department. A false choice is often posited between value for money or efficiency and sustainability. Unsustainable procurement is not good stewardship of
taxpayers' money. The Ministry of Justice is committed to reducing its impact on the environment by continuously improving the environmental performance of its operations and estate. For example, 3663 delivers virgin cooking oil to prisons. After use, the waste vegetable oil is collected by a national oil collection company and sent to a third-party operator for recycling and conversion into biodiesel, which is then returned to the 3663 depots, where it is used to fuel trucks loaded with supplies for delivery to prisons, thus completing the circle and reducing distribution costs for the Department.
The supply of food is of significant benefit in reducing risk and contributing to the overall objectives of the Ministry of Justice. Nevertheless, given the importance of food in prisons, we will re-examine how it is delivered and consider every option. If my hon. Friend, who has listened to my arguments in this debate as I have listened to his, can identify further proposals, I invite him to continue this conversation. It need not take place formally on the Floor of the House, but I am happy to listen to any further submissions that he wishes to make.
The timing of this debate is ideal, given that the current generation of contracts is due to expire in May 2011 and that planning is already under way. In considering every option, I want not just to look at the obvious but to challenge thinking on the issue. For example, most of what used to be a large network of farms and market gardens operating in prisons were closed in the past decade. There is certainly merit in revisiting the idea in order to make prisons more self-sufficient, lower costs, and get more prisoners working. About 425 prisoners already assemble some 100,000 breakfast packs every day as part of a supply chain developed with our current suppliers.
To conclude, this has been an excellent opportunity to discuss a subject that might seem uninspiring and that risks being considered simplistically. As I have outlined today, it is complex and of great importance, so I will be paying close attention to the development of policies and procurement strategies in the area. I welcome the attention that my hon. Friend has given it and the constructive contribution that he has made with this debate.
5.22 pm
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