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Westminster Hall

Tuesday 12 October 2010

[Mr Gary Streeter in the Chair]

Epilepsy Services

Motion made, and Question proposed, That the sitting be now adjourned.-(Mr Dunne.)

9.30 am

Paul Maynard (Blackpool North and Cleveleys) (Con): It is a pleasure to serve under your chairmanship today, Mr Streeter. It is also a pleasure to see so many Members in Westminster Hall, which shows how important the topic is to so many people.

I am very pleased to have secured this debate at what is a crucial time for people with epilepsy-crucial because of the uncertainty about how the Government intend to deal with the condition in the future. We are going through a period of structural reform in the NHS, which I strongly believe will lead to substantial benefits for many patients, but there may well be a temptation during this period of reform for the Department of Health to concentrate more on structural reform than on individual conditions such as epilepsy. I want to use this debate to try to explain to the Minister why he should focus on particular chronic conditions and not just on the bigger picture of structural reform. In particular, I want to explain why I think that epilepsy is quite different from many other chronic conditions.

I have epilepsy myself, as well as another chronic condition, cerebral palsy. The cerebral palsy is part of my life, day in and day out; it never goes away, it is always there and I know that it is there. Epilepsy is qualitatively different. I often liken it to a thief in the night, because it creeps up unexpectedly. I have nocturnal epilepsy, so epilepsy affects me when I fall asleep and the chemicals in my brain do whatever they do such that a fit occurs. In my case, fits are triggered by alcohol, so I now have to avoid alcohol continually everywhere I go.

What is important to stress, and what many people without epilepsy may not realise, is the fear that accompanies epilepsy. I do not fear my cerebral palsy, because it is predictable; I know that it is there and I know what is occurring as a result of it. With the epilepsy, however, when I wake up the morning after a fit, I do not know who I am, or even necessarily where I am. My short-term memory has gone and I cannot quite put together what I did the day before, including where I was. Even now, when I have a fit I am not really sure where I am in the country and I fear what has happened to me overnight. Have I soiled myself? Is there a mess on the floor? Will I have to call for help and have to deal with the embarrassment that that might cause? It is therefore very important to stress to those who do not have epilepsy the fear that accompanies a fit, or rather the fear that accompanies the aftermath of a fit. It is not the fit itself that is the unpleasant experience for those of us with epilepsy, because we do not experience it; we are not there during a fit. It is the aftermath-dealing with the consequences of a fit-that is often the problem.

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For many people with nocturnal epilepsy, perhaps the biggest fear is something called SUDEP. Those without much familiarity of epilepsy may not be aware of SUDEP, but it stands for sudden unexpected death in epilepsy. Almost 1,000 people die from epilepsy every year, many of them in the younger age groups, and two thirds of those deaths are avoidable. As I say, SUDEP particularly affects young people, yet one survey by Epilepsy Action found that 33% of primary care trusts lack a transition plan for the transition of individuals from childhood to adult care. I think that such a plan is vital, because when an individual moves from childhood to adult care, that is their period of greatest vulnerability. Many of the tragic cases that I have received letters about-I know that many other Members here today have also received such letters-involve young people who one minute were living a happy, normal life, and then suddenly one night they went to sleep and did not wake up. To me, such cases are great tragedies. A focus on the provision of better-quality data on children's epilepsy and transition care is needed, to see whether we can prevent such cases from occurring. If we could only match the median death rate for the 15 original EU member states, for example, we would prevent a quarter of the current deaths from SUDEP in Britain. If that number of deaths was caused by a single transport accident, we would have a public inquiry tomorrow. These days, calling for a public inquiry has become something of a cliché, but I am talking about a substantial number of deaths, and I believe that we can make progress in reducing it.

The issue is not only the human cost, but the financial cost. In particular, I want to focus on misdiagnosis. Epilepsy Action says that between 20% and 30% of cases of epilepsy are misdiagnosed, at a cost of £140 million to the NHS. I know from personal experience that misdiagnosis happens. When I first started having fits at night, when I moved down to London in my early 20s, I did not really know what was happening to me. I just thought that I was falling out of bed, but there was blood everywhere and I could not quite put two and two together. One evening, I threw myself out of bed sufficiently hard that I banged my head against my bedside table and had quite a deep cut between my eyebrow and one eye, missing taking my eye out by the narrowest of margins. My next door neighbour said, "I really think that you ought to go and get that seen to." I did not want to get it seen to, because I could not really explain to the nurse what had happened. Nevertheless, I pootled down to the hospital, where the attitude of the nurse was to say, "You've been drinking, haven't you?" To my mind, that is a classic example of misdiagnosis. A chance to diagnose me with epilepsy and to start me on a treatment plan was missed because there was a presumption that I had been drinking and that the cut I had suffered was caused by drunkenness.

Misdiagnosis affects the treatment of epilepsy at every stage of the process. Apparently, some 74,000 people who are diagnosed with epilepsy do not actually have it. Not only does that misdiagnosis have a cost in terms of the cost of the drugs that those people are put on, but it has a human cost in terms of the stigma that those people feel that they have to bear and the worry that they face in their daily lives. If they could only be diagnosed with what they actually have, rather than with what they do not have, that would improve their lives.

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There are also 69,000 people who have the wrong type of epilepsy diagnosed. I have gone into quite some detail about the type of epileptic fits that I have. I gather that there are some 40 varieties of epileptic fit that can affect an individual and they all require slightly different treatments, so it is important that people are given the right diagnosis. That is why specialisms matter. Epilepsy is special and I want the Minister to regard it as a special type of chronic condition. That is not to say that other chronic conditions do not matter or are unimportant, but epilepsy is quite different from many other chronic conditions and it needs to be treated in a special way.

That special treatment means having special GPs to deal with epilepsy. I was fortunate that, when I was first diagnosed with epilepsy, I had a GP who was interested in the condition. When I moved house, my next GP was not quite so interested in epilepsy, so the nature and quality of my treatment and care changed. With the formation of local commissioning groups, I hope that we will have the opportunity for GPs to develop those specialisms and to build on those interests, not just in the treatment of epilepsy but in the treatment of the other special conditions that people regularly go to their GP about. I think that local commissioning groups offer an opportunity to advance that agenda and I urge the Minister to explain to us how he thinks the groups can help GPs to develop those specialisms.

It is worth highlighting a report by the all-party group on epilepsy back in 2007-three years ago now-which contained a fantastic quote from Dr Hannah Cock, a senior lecturer at St George's hospital, who said

That is a very important point. People should not have to wait for a crisis to occur before they get the treatment that they most need. I know that President Obama's recently retired chief of staff is known for saying, "Never let a good crisis go to waste," but when it comes to epilepsy care, we do not want to get to that crisis point. We want to have consistency of care and that consistency of care is itself very important.

In particular, I want to raise the issue of generic substitution, which again might sound rather arcane to those who are not familiar with it. Like many other people, I take a regular dose of medicines and tablets. I go down to my pharmacy every six or eight weeks to pick up my new set of prescriptions. I have no problem with the idea of substituting generic medicines-it is important that we get value for money and effective medicine. What I am concerned about and what I ask the Minister for reassurance on is consistency of supply. Although the name on the packet might be the same, if the drug comes from a different manufacturer that uses a slightly different compound-if it is altered in ever so tiny a way-it can have a massive impact on how my brain reacts when various things occur in it that might lead to fits. Consistency of supply, not generic substitution itself, is my concern. I know that the Department has engaged in a consultation on the matter, but for the sake of the many people like me who are worried about it, I ask for some reassurance.

The other issue involving consistency on which the Minister can offer some comfort is specialist nurses. They are a wonderful idea. Epilepsy Action has been
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campaigning to promote their virtues, referring to them as "sapphires", and they have an important role to play. We have about 250 at the moment, but the best estimate of how many we need is 1,100. There is clearly a gap, and those who are retiring or leaving are not being replaced, so the shortage will continue to worsen. The previous Government recognised the importance of sapphire nurses and was going to study their effectiveness. Will the Minister reassure me that the current Government will proceed with that study and recognise the importance of such nurses? Specialist nurses are a cost-effective means of providing consistent low-cost care that monitors a patient's condition over time, ensuring that any blips on the radar are picked up early and preventing the need for costlier intervention further down the line.

That is the crucial point: better care and treatment are more cost-effective. We are all, I hope, looking for ways to save money, and that is one way to do so. We do not want inadequate care at the primary care stage to lead to more expensive tertiary care later. We do not want crises to occur. Cheaper care occurs in a primary setting and helps individuals to manage their condition, putting the patient in charge. However, to use the word "special" again, we need more specialism at the tertiary level as well. Neurological consultants are thin on the ground, but neurological consultants with an interest in epilepsy are even scarcer. They offer one way to help to prevent and correct misdiagnoses and to get it right the first time, but I gather from another Epilepsy Action survey that 90% of primary care trusts are not meeting the recommended two-week deadline for seeing a consultant.

I say that with a degree of caution, because I am no fan of two-week deadlines. They can be artificial, lack clinical sophistication and rob clinicians of their own clinical judgment. I have never been a fan of the two-week deadline. However, in my view, it has slightly more than a decorative role, if only because a lot of people present to their GP when the sort of crisis that I mentioned has occurred. Some degree of urgency in referral is needed, particularly because I hear many stories of cases where patients have died after referral but before having seen a consultant. That is an avoidable tragedy. We do not need artificial deadlines or targets, but there needs to be some way to ensure that urgent cases are referred promptly and reasonable confidence that they will see a consultant within a reasonable period.

I also ask for a bit of special treatment on the national level. I would be interested to hear whether the Minister might consider creating the post of national clinical director for epilepsy, which has been a long-term demand of many organisations in the Joint Epilepsy Council. One can commission successfully at regional level-it has been done in many parts of the country for many chronic conditions-but a degree of national oversight is needed to ensure that standards are set and adhered to. I realise that the National Institute for Health and Clinical Excellence has set clinical guidelines, but I have concerns.

In 2005, I was fortunate enough to be the parliamentary candidate for Twickenham, not far from the Minister's constituency. I wrote a letter to the local paper during national epilepsy week because I wanted to highlight the issues, and someone wrote in the next week to say that clearly I was possessed by evil spirits. I had thought that Twickenham and south-west London were a
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particularly liberal, enlightened part of the world. That is what I was always told; they were so sophisticated that they had discovered liberal democracy a few years earlier than the rest of us. Blaming evil spirits was perhaps a bit unfair to me, but for many patients, NICE clinical guidelines are a bit like spirits. They have no real substance or tangible meaning, because they are not mandatory.

I know that there is always a big discussion about whether clinical guidelines should be mandatory if we do not want to take clinical power away from consultants, but clinicians are frustrated that they cannot implement the guidelines, and patients are equally disappointed that the guidelines do not mean anything in reality. There is a perhaps more philosophical question to be dealt with. If we are to have clinical guidelines for any condition, how can we deal with the fact that clinicians need to be reasonably confident that they are supposed to implement them and patients need to be confident that they will mean something? There is no point having clinical guidelines as decorative features. They are not Christmas trees; they are meant to help clinicians give better treatment.

The last Government met the Joint Epilepsy Council. I pay immense tribute to the then Opposition spokesman, Earl Howe. I know how much he has done on epilepsy and I have worked with him for many years. He is a good man, and I more than anyone am delighted to see him a Minister at last. He told the conference of NHS commissioners to go away and make a difference. How, specifically, does the present Minister think that NHS commissioners are making a difference? In particular, I make a plea to him to meet with me and representatives of the epilepsy charities-the Joint Epilepsy Council, Epilepsy Bereaved, Epilepsy Action-and senior clinicians to discuss some of the sector's fundamental concerns. As I said, better treatment and better care will lead to bigger cost savings for the Department, but more importantly, they will improve quality of life of the 400,000 people in this country who have epilepsy.

I was surprised to read that the primary care trust for my Blackpool constituency has the highest incidence of epilepsy in the country. I had not realised that. We are talking not about a small group but of a large group of people who must deal with an immense stigma in their lives, as I know some of my hon. Friends will describe. We must deal with it day in, day out. Epilepsy is unlike any other chronic condition. I thank the Minister for listening and my colleagues for attending. Can we please hear some good, positive news about how the Minister intends to take the agenda forward?

9.48 am

Dr John Pugh (Southport) (LD): I congratulate the hon. Member for Blackpool North and Cleveleys (Paul Maynard) on speaking in such a personal and informed way. With your indulgence, Mr Streeter, I welcome the new shadow Health Secretary, the right hon. Member for Wentworth and Dearne (John Healey), to our midst. I congratulate him on his party's endorsement of him. Achieving such a position in the rankings can only be a reward for the competence and ability shown over a sustained period.

Flattery aside, epilepsy is one of the oldest diseases known to man. It has affected many celebrated and distinguished people-not only the hon. Member for
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Blackpool North and Cleveleys but Julius Caesar and Dostoevsky, whose book "The Idiot" contains the best literary encapsulation of what it is like subjectively to experience the condition. However, for many people, it is a profoundly socially debilitating experience. My first encounter with it as a fact of life was when I was a child in primary school in Maghull. On my way to school, I walked past what was in those days called an epileptic home, where it was not uncommon to see the rather distressing sight of a man-he seemed quite elderly, but was presumably younger than I am now-lying on the floor while his workmates gathered around him, spoon in hand to stop him swallowing his tongue.

The presumption in those days was that epilepsy debarred people from a range of activities. Those men were obviously considered suitable only for farm labour and lived, as I said, in what was then called an epileptic home. It is now a nice flat development; care has moved on. Things have improved enormously, largely due to the intervention of drugs, better neurological understanding and the involvement of patients and patients' groups-I think the hon. Member for Blackpool North and Cleveleys alluded to the expert patient programme. People have become better at controlling the condition and, indeed, at preventing seizures within the condition. These days, many people who have epilepsy do not actually have seizures.

However, when we consider the provision available for the condition, it is manifest that we need centres of special excellence, such as the Chalfont Centre and the Walton Centre for Neurology and Neurosurgery NHS. There is a high rate of misdiagnosis and epilepsy is not a subject on which even an acute hospital always has the relevant or best expertise. It is also clear that the prevalence of the condition means that specialist support has to be available locally in the acute environment and in the community. Nurses need to be able to give the patient the support that they need. That is particularly the case for children who, of course, are not expert in their condition. Such general provision is needed to improve diagnosis and treatment, to control symptoms and to provide advice. As well as doctors and specialists, nurses are clearly crucial, and that was, in fact, the theme of the hon. Gentleman's comments.

My research on the subject so far has clearly shown that treatment is a lottery for patients across the country and that access to centres of excellence varies. Appointment times, local commissioning and support differ from primary care trust to primary care trust. Such is the variation that the Minister of Health in the previous Government suggested that strategic health authorities should be asked to review their provision because the statistics were showing that 64% of PCTs had no specialist nurses, and there was a 20% to 30% misdiagnosis element in treatment. It was also said that there were 400 avoidable deaths. I am not sure how that figure was established, but appreciable costs are obviously involved in suing-I have seen £138 million and £183 million mentioned. There are different figures given on that, but clearly the amount concerned is substantial and we need to take the issue seriously, particularly in a time of austerity when resources are perforce stretched.

I hope-the hon. Gentleman certainly shares this hope-that, as we gravitate towards GP-led commissioning, some of those ills will abate and the situation will improve. Presumably, specialist neurological services
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will be a matter not for local PCT commissioning, but the national commissioning body. However, it is not entirely clear how good or able such a body will be-whether it will be in a strong or weak position-to deal with the matter.

In terms of tracking parliamentary answers, many of which have been provided by the Minister or his officers, no information is collected centrally on specialist appointments or on readmission rates. There is also no information available on the destiny of specialist nurses-how much time they spend performing their specialist function and to what extent they get drafted into other work. There may be enough evidence for a national commissioning body to do a good job and produce the right kind of service across the country to the satisfaction of the hon. Gentleman and all other epilepsy sufferers, but it is not currently apparent that the data are there to allow that to be done.

In addition, it cannot be assumed that all GP commissioners would be able and willing to commission well. I was interested in what the hon. Gentleman said about his journey of moving from one doctor to another, and the expertise being available in one practice as opposed to another. There are quite good reasons why GP commissioners and GPs themselves might not be able to field every episode of epilepsy to everybody's satisfaction-for example, they might have limited clinical experience or be new to the profession. On the basis of the statistics I have seen-I have put them to some use and come up with a figure-I calculate that most GPs probably have on average around 10 patients who suffer from an epileptic-like condition. GPs might not see many people with such a condition very often at all.

So how do we ensure that GP commissioning is, as we all hope, better and not worse than PCT commissioning? I think we all recognise-indeed, the previous Government recognised-that PCT commissioning was by no means perfect. Monitoring GP performance is particularly difficult because epilepsy sufferers are very much a minority. It is not clear who will monitor how well GPs are dealing with the matter. After all, GP performance monitoring is currently done by PCTs and, clearly, GP monitoring that is done by GPs might not be as good as GP monitoring done by others. The legislation does not make it entirely clear how big GP commissioning bodies will be, but presumably they will be on a smaller scale and have fewer resources than the PCTs that they will replace. That is an issue.

When the new regime appears, how will we get improved commissioning, so that there is not a repetition of the problem of a minority condition not being treated particularly well? The Department of Health has a mantra that goes something like this: commissioning is a matter for local decision making and the Department will not tell local commissioners how to do it. However, it will judge them against a quality framework and assess how well they are doing it. I think that the expression is that GP commissioners will be "held to account" on how well they deal with epilepsy as a condition.

That is fine by me. I am very comfortable with that being done-it certainly should be done and I think that the hon. Gentleman will be very comfortable if that is done-but what does the expression "holding to
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account" mean? The phrase is relatively undefined and I can think of about three different meanings I could give it. The Minister can perhaps tell me which definition is right. If a GP commissioning body fails to perform well in dealing with this chronic complaint, does "holding to account" mean that they will simply be named and shamed? Does such an expression mean GP commissioning bodies will be financially penalised, which is another way of being held to account-if someone does not do the job they are supposed to, they will lose resources as a result; or does the phrase mean-this is the third definition-that GP commissioning bodies will be overruled? The actual task of holding to account is important and it is vital we are precise about what we mean by that. Unless we get the right profile locally, talking a good game here will not make much difference.

In holding GP commissioning bodies to account, we must ask ourselves not only how the issue is examined, who examines it and what they then do, but from where the information comes for such an examination. In other words, five, six or seven years down the line, if we have to examine how one local commissioning body performs compared with another, will the only way to do that be by asking that commissioning body to mark its own papers and provide data of its own choosing? Clearly, that would not be adequate or satisfactory. Those are fair questions.

I think that the Minister and all hon. Members here want progress in dealing with this chronic condition. We do not simply want frameworks, guidance and detail here and there of what should be in place-the hon. Member for Blackpool North and Cleveleys used the phrase "decorative features"-without there being a hard-edged attempt to ensure that what we believe should be in place actually is in place. I conclude by simply pressing the Minister to say what will happen when a GP commissioning body performs less than adequately. Who will do what, when and with which data? That is not a trivial question; it is important to all epilepsy sufferers.

9.59 am

Nic Dakin (Scunthorpe) (Lab): I congratulate the hon. Member for Blackpool North and Cleveleys (Paul Maynard) on securing the debate and on speaking so eloquently, which focused our minds from the start. I am pleased to have the opportunity to say a few words on the impact of NHS treatment on the education of children with epilepsy. The hon. Gentleman mentioned misdiagnosis and the impact it can have on children and on adults, and he mentioned the impact of transition, with 33% of transition plans not being what they should be. That has a negative impact on not only children's health, but, crucially, their education. I am pleased that some students have attended the debate to listen to what we have to say.

There is some very good practice in parts of the NHS, but it is not consistent across the whole health service, and schools and colleges could do much more to support children with epilepsy. I am pleased that the Minister of State, Department for Education, the hon. Member for Brent Central (Sarah Teather), is planning to meet the Joint Epilepsy Council later this month and I hope that she will pick up the matter with the same interest as her predecessor, my hon. Friend the Member for Kingston upon Hull North (Diana R. Johnson).

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The education system must learn from best practice so that it can ensure that the education of young people with epilepsy does not suffer as a result of the wrong support in schools. Children experience particular problems in mainstream schools because of the NHS's occasional failure to get their treatment right. I urge the Minister to work with his colleagues in the Department for Education to ensure that minds are brought together on that to get the best deal for children.

As the hon. Members for Blackpool North and Cleveleys and for Southport (Dr Pugh) noted, the move to GP commissioning offers opportunities, but it also offers risks. Whatever changes are made, it is crucial that young people with epilepsy do not suffer further because of increased instances of misdiagnosis and a lack of appropriate support. I hope that the Minister, with his colleagues in the Department for Education, will bring sufficient analysis to bear to ensure that that can be better dealt with in the education system.

We should look at the commitment that is in place in Wales to have a school nurse in every school and consider whether we should have something similar in England to ensure consistency of support for young people with epilepsy and other conditions so that their education is not negatively affected. There is a double disbenefit with epilepsy: there are the health issues, which were explained so excellently earlier; and there are the knock-on effects on children's education. That is what concerns me and why I have spoken in the debate.

10.3 am

Laura Sandys (South Thanet) (Con): I thank my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard) for securing the debate, as it is important that the matter is brought to the fore. I am lucky and privileged to be the chairman of the all-party group on epilepsy, and I am pleased that we are joined today by many young epileptic people who are taking their education forward and have a bright future ahead of them. We must ensure that we give them the same future in employment that we give other young people, and that future is about controlling a chronic condition.

Like my hon. Friend, I am epileptic, though I am lucky to have had very few seizures-I have had five in my life and no incident in the past seven years. There is a wide range of conditions-40, as my hon. Friend mentioned. Some people, like me, sometimes forget that they are epileptic, while others have seizures regularly, sometimes daily. The issue we all share is stigma. As soon as one mentions the word "epilepsy", all sorts of extraordinary ideas come into people's minds, and there can be an assumption that we might need constant attention.

Children with epilepsy have a particularly difficult time in school, because even if they do not have any seizures they can be wrapped in cotton wool and stopped from participating in outdoor sports. A child with epilepsy of course needs attention, and my hon. Friend is right that nurses and teachers need to understand that seizures might occur, but we must start to relax about this. We must focus on epilepsy from a medical point of view, but we must not stop young people participating and being part of a life when, with proper diagnosis and the right medication, they can make an important contribution in school and in employment.

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I do not know whether other hon. Members know this, but my hon. Friend and I, as epileptics, are not allowed to walk up the stairs to the top of Big Ben. There are many things that we cannot do, such as recreational diving; epileptics cannot go diving unless they have been seizure free for five years and have not been taking medication for that time. I would have thought that it was probably quite useful to take medication, and I have done quite a bit of scuba diving without knowing about those regulations. We are creating barriers because we do not understand the variations in epilepsy. There is extreme epilepsy, mild epilepsy and seizure-free epilepsy, and we have an opportunity to ensure that more people are seizure free and making a contribution to society. I would like the Minister to join us, with the Joint Epilepsy Council, to ensure that we start to make the authorities, teachers and the medical profession understand more about the variations and the opportunities available to people with epilepsy who have been properly diagnosed and are properly medicated.

My chairmanship of the all-party group on epilepsy is concerned with stigma and with those who have severe epilepsy, but also with liberation for those who have controlled epilepsy. When I became chairman, I was contacted immediately by a local GP, who happens to be one of the best in the country specialising in epilepsy. Over the past five years, with seven GPs specialising in epilepsy, we have reduced related A and E admissions in South Thanet by 60%. That is most certainly a cost saving, but also a life liberator. We are reducing seizures for patients across the area, and I would like the Minister to look at what we have done. Patients are getting that primary attention and are not having to wait for months for appointments with consultants. They have ongoing care with specialist nurses.

What we have achieved in South Thanet is a model that could be rolled out over many other specialisms, where GPs who are passionate about a subject can make the difference and ensure that we have a more effective and responsive service. Hopefully we will reach the target for epilepsy, which is for 72% of sufferers to be seizure free. I would welcome the opportunity to meet the Minister and to discuss our services in South Thanet further.

10.9 am

Owen Smith (Pontypridd) (Lab): I thank the hon. Member for Blackpool North and Cleveleys (Paul Maynard) for securing this debate, and for speaking so eloquently and passionately. I do not hope to speak with his expertise, but I do have some expertise, inasmuch as I have a close family member-a brother-who has suffered with epilepsy over the past 15 years. I have some insight into the nature of the difficulties that he has encountered, the problems in the current NHS system, and the issues that emerge in dealing with this chronic but particular condition in that system.

My brother is one of the 500,000 people in this country who have epilepsy. They are a minority, but a significant one-that is a lot of people. He is also one of the 50% of the 500,000 who are not seizure free: he has had a seizure every month, if not every week, for all of the past 15 years. That has had a dramatic impact on his life in terms of what work he is able to do, the energy he has, and the fear that he lives with, which the hon.
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Gentleman described so eloquently and which all people who have epilepsy have to contend with on a daily basis, of sudden unexplained death as a result of the condition.

That is my interest. It has given me an insight into issues that have already been raised today about the postcode provision, to use the vernacular, that exists across the NHS. We have a fragmented NHS, particularly in respect of epilepsy. That is the case for many other conditions, but it is particularly true for epilepsy. The phrase "Cinderella condition" is rather overused in the press these days, but epilepsy is one of those conditions. We can genuinely say that it does not have the high profile that it ought to have and therefore does not receive the concentration that it should.

There is clearly fragmented, unequal distribution of expertise in the NHS in terms of general practitioners, who, as the first point of call for anyone suffering with epilepsy, are critical, and nurse specialists. I believe that that is widely recognised. Like the previous Government, the current Government recognise that specialist nursing for epilepsy is under-resourced in this country and, equally, that it is an extremely important means of redressing the problem of insufficient provision of expert GPs.

It is clear that there are few centres of excellence for epilepsy in this country, and, therefore, that people such as my brother, who lives in Wales, have to travel long distances to hospitals or other centres of excellence for prolonged examinations to monitor brain patterns. He, too, suffers from nocturnal epilepsy, and therefore needs to be studied in clinical conditions in hospital to try to determine the nature of his condition and what resources might be brought to bear to alleviate it.

I, too, have some fears about the extent to which the creation of the new GP consortiums will exacerbate the problem of fragmentation and inequality of provision across the country. I can accept that, in areas where there are GPs with a special interest or particularly strong centres of excellence, there may be a beneficial effect in massing GPs together and spreading their expertise through a wider network. Equally, I can see significant potential for unintended dangers if we do not have GPs in those consortiums and we have a diminution of control over, and certainly insight into, their activities. It is unclear what the sources of commissioning will be, and who exactly will be commissioning specialist services. That has yet to be clarified, and I look forward to the Minister's giving us some greater insight into that.

Another thing that I worry about in respect of consortiums is data. We have poor data on epilepsy: how many people suffer, the nature of their condition, how often they attend hospital, how often they are treated for acute episodes. Perhaps if their condition had been managed more effectively, it would not have reached that point. I have tabled numerous parliamentary questions about that recently, and all the answers confirm that we do not gather enough data.

There will be a further danger that we will not gather data if we fragment the NHS to the extent that is proposed with the creation of the consortiums. I hope that the Minister will give us some reassurance that information gathering will be a priority, whatever the structural make-up of the NHS, and that we will continue
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to see that critical piece of the jigsaw applied in respect of epilepsy care. In recent years, we have seen data gathering become an important tool for tackling other chronic conditions, notably cancer.

I worked in bioscience before coming to this House, and therefore have some insight into the science around epilepsy and the economics around the production of medicines. Prescribing of epilepsy medicines seems to involve a form of Russian roulette because our understanding of this neurological condition is deeply imperfect. For example, my brother has been through 11 or 12 medicines and combinations of medicines. Doctors still employ what is pretty much a hit and hope strategy. Perhaps I am being slightly unfair, but I believe that many epilepsy experts recognise that they do not really know which medicine will work, and therefore they try various drugs until they find the one that works for their patient. In my brother's case, and in the case of 50% of sufferers, they often do not find the one that works, and we get into the more complicated issues around whether surgery is required.

Generic substitution is clearly an issue. We all understand that we need to make savings, and the importance of substituting generic medicines for the original brands when they are available.

Dr Pugh: The hon. Gentleman made a good point about data, which is worth repeating. However, there must be data on every episode dealt with through acute hospital care. His Government introduced the tariff system. Therefore, in some shape or form, the data are there-they just do not appear to be available for clinical purposes.

Owen Smith: The hon. Gentleman is absolutely right, and I have recently had answers from the Government about that. It is not simply a question of gathering the data. The NHS is a wonderful sponge, soaking up data. The critical thing is wringing it out and employing data to improve services. Epilepsy is a condition that has not been concentrated on, and therefore there is no emphasis on garnering data.

We must be careful about generic substitution of epilepsy drugs. I know that many sufferers agree with that. Another point is that genericisation of a market in medicines leads to changes in the economic incentives for research and development companies to produce them. There clearly are not incentives for companies to produce new epilepsy drugs. That is inevitable because of the large number of epilepsy medicines, many of which are effective, and many of which have been genericised.

Part of the answer in fixing markets that are not working has to be Government intervention to try to improve incentives. The previous Government were making effective inroads through the innovation fund and the innovation pass that they were negotiating with the pharmaceutical and biotechnology industries, which would have encouraged and incentivised further R and D into more recondite diseases and the production of medicines where there is not an immediate economic incentive.

I was therefore discouraged to hear that the innovation pass is being abandoned by the Government-it will not be taken forward. I would like to hear some reassurance from the Minister that he is aware of the issue and
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interested in looking at how he can work with the pharmaceutical industry to incentivise further R and D into those areas where this country does not perform well. Epilepsy is one of them. We have a higher incidence of unnecessary death from epilepsy, and, bluntly, we do not prescribe terribly well for it. It is an area where we could produce more and take advantage of the great skills in the pharmaceutical industry, and where the Government could have a positive impact.

10.19 am

Priti Patel (Witham) (Con): I pay tribute to my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard) for securing this debate, and for his tremendous personal account of the condition of epilepsy, and how it has impacted on his life and his journey to Westminster and becoming a Member. I thank my hon. Friend the Member for South Thanet (Laura Sandys) for being frank and for providing powerful insights into the work and role of general practitioners in her constituency. Clearly, they are making a difference.

My contribution to this debate is about the structure of the NHS, especially in the light of the fact that significant and welcome Government reforms are coming soon. In Witham, the number of administrators and bureaucrats in the local primary care trust-Mid Essex PCT-has increased fourfold in the past 10 years. In this debate, we are talking about general practitioners, commissioning, the postcode lottery in terms of services, nurses, access to care, real care provision on site and the ability to deal with epilepsy. I am sure that the Minister agrees that epilepsy services could be served so much better by getting rid of a lot of the waste and bureaucracy. This is an opportunity to redirect the resources to ensure that epilepsy is given the right kind of local care provision and to ensure that GPs who are commissioning services are dedicated the right kind of resources and professional expertise that are so desperately needed out there.

One of my constituents is here listening to the debate. It is self-evident, from looking at my local PCT, that provision is hit and miss. It comes back to data, which we have heard a great deal about this morning. There is not enough data out there. I struggle with that notion when I hear locally about the bureaucracy in my PCT, which has been so vast that one wonders what it has been doing to secure data in the past decade. I plead with the Minister to ensure that all the resources out there are redirected to the right purposes to serve local epilepsy sufferers in the right way.

My hon. Friend the Member for South Thanet mentioned stigma, but I should like to talk about quality of life and referrals to specialists. I have heard from my constituent who is here this morning about how epilepsy can prevent people from getting back into work. In respect of anybody who is up and able and wants to be an active citizen and contribute to their local economy, or even make a difference in some service, it seems self-evident that we desperately need local services and agencies working together to break down the barriers of stigma; to work constructively to enhance the quality of life of epilepsy sufferers; and to be more accommodating and understanding of the needs of people going into the workplace, without being patronising, enabling them and supporting them perhaps even to develop careers in the field or profession in which they choose to work.

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The Government have an opportunity to consider generic substitution in the round, without coming to any rash conclusions. We are talking about savings, in this era of the comprehensive spending review, but this is about understanding that epilepsy is a subjective condition that affects individuals differently, not about a one-size-fits-all approach in respect of the drugs and prescribing regimes. This is a plea to the Minister to ensure that the right decision is made on behalf of sufferers.

10.23 am

Mr David Amess (Southend West) (Con): It is always compelling when colleagues speak from personal experience. That has certainly been the case today. I congratulate my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard) on the way in which he introduced the debate. Indeed, his speech was so comprehensive that he has left little for other hon. Members to say. But being a Member of Parliament I will try to find something to add to this debate. I congratulate my hon. Friend on sharing his experience with us this morning. I am certain that he is still reflecting on what the history of this country would have been like if he had been elected as MP for Twickenham.

Colleagues have spoken about their personal experiences, so perhaps I could share some of mine. A number of my family members have suffered with epilepsy, although I will not name any of them because they do not want to be the subject of any intrusion whatsoever. All I will say is that it is scary when people are not prepared for what happens when someone has a fit. When a baby suddenly stops breathing it is stressful for parents who have not been warned about such a situation.

My hon. Friend mentioned people suffering from epilepsy perhaps being thought to have had a bit too much to drink. I am ashamed to say that I am guilty of having made that misdiagnosis myself and coming to the wrong conclusion. I am glad that he mentioned that.

The Minister and I were colleagues on the Health Committee. Throughout that time it occurred to me that, although it would have been a new contribution to the debate, we never had an inquiry into epilepsy. Now that my right hon. Friend the Member for Charnwood (Mr Dorrell) is chairman of that Committee, perhaps the Minister might like to consider that matter, together with my hon. Friend the Member for South Thanet (Laura Sandys), who is chair of the all-party group on epilepsy. That would be a good subject for a Health Committee inquiry.

Sudden unexpected death in epilepsy accounts for more than half of all epilepsy-related deaths in the United Kingdom. We know that with a clear understanding of epilepsy and good management of seizures, the risk can be minimised, as hon. Members have already said. The National Institute for Health and Clinical Excellence guidelines recommend that information about the problem should be provided to patients following a diagnosis of epilepsy. There is clear evidence that that does not appear to be happening. Perhaps all colleagues would be diligent about this situation and inquire about what exactly is happening. People who are diagnosed with diabetes or heart problems, for example, are made aware
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of the risk of death if their condition is not well managed. Epilepsy should be in that category and dealt with in the same way.

There is no national monitoring of epilepsy deaths. However, the Coroners and Justice Act 2009 highlighted epilepsy as one area in which standards could be developed. There continues to be an urgent need for research into the cause and prevention of the problem. Eight years on from the national sentinel audit that established the level of avoidable deaths, our understanding of sudden death in epilepsy is greater, but we still need to reduce the number of such deaths, as my hon. Friend the hon. Member for Blackpool North and Cleveleys said. We need more research into this neglected medical syndrome.

The White Paper reforms may offer a significant opportunity for some of the more neglected conditions in health care. It has been acknowledged that national targets, which I have deplored, ignored some conditions. Now the White Paper promises a relaxation in the use of targets and puts patient safety at the heart of the NHS.

In conclusion, if primary care practitioners are to be responsible for commissioning epilepsy services, they will need to be well informed on these issues, as my hon. Friend has made clear. They will need to move beyond the dreadful tick-box exercise for epilepsy in the GP contract and look seriously at the potential for achieving more positive outcomes for patients and a more cost-effective health service.

I ask the Minister to bring these issues to the forefront as we build on our excellent national health service.

10.29 am

Liz Kendall (Leicester West) (Lab): It is a pleasure to serve under your chairmanship, Mr Streeter. I congratulate the hon. Member for Blackpool North and Cleveleys (Paul Maynard) on securing the debate. I particularly thank him and the hon. Member for South Thanet (Laura Sandys) for their brave, personal speeches, delivered with a frankness and honesty that is not always the hallmark of politics or politicians. Just by speaking about their conditions, they will have given strength and courage to thousands of people with epilepsy throughout the country. I am grateful to them for that.

Hon. Members have powerfully set out the scale of the problem and highlighted three key issues. The first is misdiagnosis: around 150,000 people are wrongly diagnosed with epilepsy or are diagnosed with the wrong sort of epilepsy. The second is poor quality treatment: patients may not see a specialist quickly enough and, because of the problems of misdiagnosis, thousands of patients take powerful drugs that are unnecessary or do not work effectively, and they must make repeated visits to their GP or go into hospital. Thirdly, because of poor diagnosis and treatment, there are unacceptably poor outcomes for individuals with epilepsy and for society as a whole. Only half of those with epilepsy live seizure-free, when the estimate is that 70% could do so. Of the almost 1,000 deaths from epilepsy every year, approximately 400 are avoidable-that is at least one unnecessary death from epilepsy every day of the year.

The estimated financial cost of that poor-quality care includes more than £20 million a year spent on incorrect drugs, and rises to more than £130 million if unnecessary
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GP appointments and hospital admissions are taken into account. That does not include the far greater costs to individuals and society as a whole for the thousands of people with epilepsy who cannot play a full role in their families, at work or in the community because they do not receive the care and support they need.

Following the efforts of patients and voluntary groups, many of whom are here today, understanding of epilepsy has increased in recent years. Last year, the all-party group on epilepsy met the then Health Minister, Ann Keen, for discussions, including on the findings from Epilepsy Action's 2009 report, "Epilepsy in England: time for change" that NICE's 2004 guidelines on epilepsy treatment are not being properly implemented in an estimated 90% of PCTs.

At a one-day conference for NHS commissioners in January, the then Minister spoke specifically about how to improve epilepsy services. She met specialist epilepsy nurses at the National Society for Epilepsy, and wrote to strategic health authorities asking them to consider how to improve services, including by increasing the number of specialist nurses. I understand that she intended to ask the Care Quality Commission to undertake a review of epilepsy services in the NHS. My first question to the Minister here today is: what plans do his Government have to increase the number of specialist epilepsy nurses and will they ask the commission to conduct that review into epilepsy services? My experience is that the commission's reviews can make a real difference in raising awareness of such issues.

The key question today is whether the Government's plans for the NHS will make the improvements that epilepsy patients desperately need. The key concern that we have heard about today is the future of commissioning. Clearly, PCTs have struggled to deliver high-quality care for patients with epilepsy, as they have with many less common conditions. That is and always has been a real problem in the NHS. How can the highest possible standards of care for less common conditions be delivered in every part of the country? If there have been difficulties in ensuring sufficient knowledge and expertise in 150 PCTs, that challenge will be even greater in the 500 commissioning consortiums that the Government want to establish.

The key issue that has been raised today is whether GPs have the necessary skills, awareness and interest in epilepsy services. Some do, and there are some good, expert GPs, such as those to whom the hon. Member for South Thanet referred, but many do not have the same skills and experience, and that is of great concern to patients with epilepsy. The expertise that does exist in PCTs is in grave danger of being lost. Many PCT staff who have been involved in commissioning are, understandably, looking for other jobs outside commissioning or outside the NHS. Will the Minister explain how he will ensure that GPs have the necessary skills and experience to identify and then correctly to refer patients to specialists? How will he ensure that GP commissioning consortiums have the necessary skills and expertise to commission high-quality epilepsy services?

My hon. Friend the Member for Scunthorpe (Nic Dakin) raised an important question. How will the Minister ensure that GP commissioning consortiums work with schools, local authorities and other care services? My local authority in Leicester has worked
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hard to build up relationships with the PCT, but that has been thrown up in the air and it must now develop relationships with individual GPs. That is a big challenge.

I want to make it clear that GPs must be more effectively involved in shaping NHS services. They are the first port of call for patients and their decisions affect 90% of spending in the NHS. Yet many GPs do not want and do not currently have the skills necessary to take on responsibility for commissioning £80 billion of NHS services. Despite claiming that they will end top-down reorganisation in the NHS, the Government continue to insist that all GPs must take on that role, and within a short time scale, but anyone who has been involved with the Government or the NHS knows that it takes a long time to change things in the NHS. PCTs are spending a huge amount of time trying to persuade GPs to become involved and to ensure that they have the right skills and expertise. Many people are worried, rightly, about whether PCT staff who are about to lose their jobs will want to put in that time and effort and, if they do, whether that time and effort would be better spent on improving patient care.

The financial costs of the Government's reforms are also significant. They have said that they will protect NHS funding in the comprehensive spending review, but the ageing population, increases in long-term conditions, and ever more expensive drugs mean that the NHS is still facing what the King's Fund and the NHS Confederation have called the biggest financial challenge of its life. Its overall budget may be protected, but it must make savings of £15 billion to £20 billion, and it has never before achieved that. Despite the Government's claims that management will be cut by 45%, the King's Fund estimates that the Government's reorganisation will cost £3 billion. Will the Minister explain why his Government believe that yet another major, structural reorganisation is the best use of time and resources in the NHS, particularly in such financially challenging times?

Ultimately, what matters to patients and the public is that they get the best health care and the best value for money. The Government have said that outcomes in the NHS will be set out in the new NHS outcomes framework, and that the new national NHS commissioning board will be held to account for delivering those outcomes. The board will also take direct responsibility for commissioning some specialist services that used to be commissioned at regional level. The board will have a budget of more than £100 billion a year, but it is unclear how it will be held to account by Ministers or Parliament, who are responsible to the public for improving the NHS.

My final questions are as follows. Will the NHS outcomes framework include outcomes for epilepsy? Will the NHS commissioning board commission specialist epilepsy services, and will it draw on the expertise that was developed at regional level to do so? Will the Minister explain how the Government will ensure that the commissioning board has the necessary expertise on epilepsy services? Will patients be involved in determining outcomes and the commissioning board's work? How will Ministers and Parliament hold the board to account? For example, if the board fails to include outcomes for services such as epilepsy, will the Government or Parliament be able to require the board to take action, or to remove individual members or the board as a whole?

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Our debate today on epilepsy services will be mirrored in relation to a huge number of other conditions. People want to know how their condition will be improved by the planned changes. I am privileged that my first debate as a shadow Health Minister has been on this important subject, and I thank all hon. Members and the patients and patient groups who have come here today.

10.39 am

The Minister of State, Department of Health (Paul Burstow): I start by congratulating the hon. Member for Blackpool North and Cleveleys (Paul Maynard) on securing this debate and on the remarkable way in which he outlined a compelling personal case and posed some important challenges for the Government.

Before I respond to the hon. Gentleman's points and to contributions made by other hon. Members, I would like to correct an error that I made in a debate on diabetes on 15 September. During that debate, I mistakenly stated that the Juvenile Diabetes Research Foundation supports the NHS White Paper. In fact, it has not taken a position either way, and I am happy to correct the record on that point at the earliest opportunity.

In introducing the debate, the hon. Gentleman gave a powerful account of why we must do better for the 450,000 people with epilepsy in the UK. He painted a compelling picture of the fear that the condition provokes and the fear of the aftermath-the "thief in the night", as he put it. Many hon. Members have made powerful testimonies in this debate, and that is to be commended.

I also congratulate the hon. Gentleman on his recent appointment as vice-chair of the all-party group on muscular dystrophy and as vice-president of Epilepsy Action, an organisation that does excellent work to support and advise people with epilepsy. He asked me if I will meet him and other colleagues from the sector, and I would be happy to do that, together with his colleague, the hon. Member for South Thanet (Laura Sandys), who is chair of the all-party group on epilepsy. I hope that we can have further discussions about that.

I also welcome the hon. Member for Leicester West (Liz Kendall) to her new role. I understand that, in a previous incarnation, she worked as a special adviser to a former Secretary of State. I look forward to our exchanges in Westminster Hall and the main Chamber over the years to come. I hope that she will find the role as enjoyable and fulfilling as I do.

The debate has highlighted the many failings of the current arrangements for the design and delivery of epilepsy services. Those failings have been clearly articulated by many people, and in particular, the issue of stigma was raised by the hon. Members for Scunthorpe (Nic Dakin) and for South Thanet. I undertake to take that issue back to the Minister of State, Department for Education, my hon. Friend the Member for Brent Central (Sarah Teather), who is to meet colleagues in the sector soon, so that we can look at how to tackle that problem. It is not a matter solely for the Department of Health, but rather a wider societal issue and a challenge for the Government. We will discuss and look further at how to ensure clarity and proportionality in the regulatory burden.

Hon. Members have referred to the various statistics that make up part of the picture: 69,000 people are living with unnecessary seizures, and 74,000 people
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are taking drugs that they do not need. Nearly £200 million is needlessly spent each year on hospital admissions linked to poorly managed epilepsy. The 400 avoidable deaths per year-a tragic number-are largely the result of poorly controlled epilepsy.

The previous Government produced a string of policy documents designed to improve services and support patients with neurological conditions. The national service framework for long-term neurological conditions, and the NICE clinical guidelines on epilepsy, are both strong statements that the Government support. Plenty of sensible work has been done to improve support for people with all kinds of long-term conditions, such as setting out the need to have a more patient-centred approach to their care. The problem, which has been made clear in today's debate, is that the words in those statements have often not been translated into practice. The failing is not of our shared intent, but of implementation. The previous Government's top-down approach created a culture where only what gets measured gets done. That distorts priorities and, as the debate has demonstrated, leaves gaping holes in provision and lets people down in the ways that have been described.

The solution is not to publish more strategies or add more to the list of things that the NHS has to measure and account for. Instead, we should change the system entirely and record and value what really matters. That is what our proposed NHS reforms are about, and I welcome the opportunity to outline how those reforms will have an impact on epilepsy. We want to strip out unnecessary targets and bureaucracy and replace them with a system that recognises and rewards quality and overall patient outcomes.

We have already held a consultation on the new outcomes framework. I am pleased that a number of neurological organisations contributed to that process, including the Joint Epilepsy Council and Epilepsy Action. The framework will drive a better approach to service design and performance management across the NHS, including on issues of speed and accuracy of diagnosis. It will be the engine of change, giving us clear and coherent structures of accountability to drive radical improvements in standards from the bottom up, not the top down. My hon. Friend the Member for Southport (Dr Pugh) spoke about accountability, and I will say more on that later.

I am determined that specific issues to do with neurological conditions, and epilepsy in particular, should be appropriately reflected in the composition of the outcomes framework, and I will make that point to the NHS medical director, Bruce Keogh. I encourage other hon. Members who are concerned about this matter to ensure that they also make such representations. I undertake to look at precisely what contribution the Care Quality Commission can make; clearly there are potentially many thematic reviews that it could undertake-far more than it could carry out in any one year. It is a powerful tool for levering-up quality.

In his opening remarks, the hon. Member for Blackpool North and Cleveleys mentioned transition care. There must be significant improvement in that, because the transition from care in childhood to adult care is currently not good enough. We must ensure that we pick up and learn from the work carried out by the national director
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for children's services, who has published guidance on improving the transition between child and adult services to ensure that everything possible is done to maintain people's health and well-being. The subject of transition comes up more often that anything else, and we must ensure that we have a better, clearer focus on the transition between children's services and adult services, and between primary and secondary care.

Mr Sam Gyimah (East Surrey) (Con): The National Centre for Young People with Epilepsy is in my constituency and it is interesting to hear the Minister mention transition care. Would he be open to considering a clinical standard for paediatric epilepsy?

Paul Burstow: The Government proposals include a national quality board that will be responsible for considering potential areas for quality standards, and NICE will take that work forward. There is already a number of standards in the national service framework, but I will certainly give further thought to the hon. Gentleman's point.

A number of hon. Members have mentioned information, and the Government want to give patients and the public all the information that they need to make informed choices and hold the NHS to account. We will shortly be launching a new information strategy to improve radically the range and quality of information available to patients, professionals and the public, so that there is increased transparency and strengthened accountability in the system.

Teresa Pearce (Erith and Thamesmead) (Lab): The Minister mentioned information for patients, but one area of concern that has not been mentioned today is that involving women of child-bearing age. Currently, such women are meant to be counselled by their GPs, but sometimes that counselling is patchy or non-existent. One successful drug creates a significant increase in baby malformations, so a woman who finds herself pregnant must decide whether to carry on taking the drug with a risk to the baby, or stop taking the drug with a risk to herself. The risk of maternal death is almost 10 times higher for women with epilepsy. What can be done to make GPs take seriously the role they have when women are facing that terrible decision?

Paul Burstow: I am grateful to the hon. Lady for raising that point. In the proposed quality and outcomes framework for 2011-12, NICE has recommended a new indicator to encourage more GPs to talk to women with epilepsy about the drug risk during pregnancy. I hope that that will focus on the point that the hon. Lady has rightly raised.

Patients should be able to check up on local services right down to the performance of individual consultant teams, so that they can, if necessary, vote with their feet. That not only gives patients more control, but it exerts pressure on different parts of the NHS to make continuous improvements. On a professional level, it is important to ensure that there is better recording and sharing of information about services.

My hon. Friend the Member for Southport and the hon. Member for Pontypridd (Owen Smith) talked about the lack of information about neurological services at local level. I can tell them that the Department has
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developed a reference data set for local commissioners to use. That will give them a standard set of information to request from local providers about the different stages of care for someone with a neurological condition. Reference has been made to a dearth of data. I can tell hon. Members that there are data relating to the primary reasons for hospital admissions, readmission rates, average lengths of stay, out-patients, first to review rates and programme spend for neurology through the payment by result rates. All that information is on NHS Comparators, which is part of the NHS website. It is an online tool that presents all that information in a way that is accessible not just to professionals, but to the third sector. One of the challenges that I pose to hon. Members and to organisations with an interest in this field is to make more use of NHS Comparators, because it is a valuable tool for challenging commissioners and holding them to account and for ensuring that there is competitive localism-a real sense of comparing one area to another to ensure that we drive up standards and learn from the best.

Priti Patel: We have heard in the debate that epilepsy is a very subjective condition-it affects people in many different ways. We have also heard about the data challenges, and the Minister has kindly given us some insight into what comparators are out there. The fact is, though, that if someone is a sufferer, is on their own and is in desperate need of care and access to information, hearing about data comparisons is not necessarily of practical help. What practical measures exist for sufferers and for organisations that can give genuine support and guidance to epilepsy sufferers?

Paul Burstow: The hon. Lady makes a very important point. I was talking about using the data to improve standards, but we also need to ensure that, through NHS information prescriptions, we provide better and more timely information to people. Further work is also necessary in that area.

A message that comes through strongly is that commissioning is key to better epilepsy care. We believe that placing decision making much closer to the patient through general practice consortiums will unlock new opportunities and lead to more sensitive and responsive decision making about care and treatment pathways. Some patient groups and some hon. Members in this debate have expressed concern about the experience and knowledge of GP commissioners in designing epilepsy services. Let me say a little more about that.

The NHS commissioning board will have a vital role to play in supporting consortiums. It will set commissioning guidelines based on clinically approved standards developed by the National Institute for Health and Clinical Excellence. In addition, the long-term conditions delivery support team will work closely with new directors of commissioning, their commissioning boards and GP consortiums to build skills and awareness. For example, the team has already developed a new commissioning pack, bringing together information that commissioners will need to design good epilepsy services.

My hon. Friend the Member for Southport has asked me, within about four days of the close of consultation on the White Paper, to describe in full and complete detail every aspect of the new accountability regime for the new system. I will not do that in the debate today,
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because that would not do justice to the 5,000 respondents to the consultation. The Department is in the process of properly considering the responses to the consultation and we shall give a considered and proper response. What we have done so far is set out clearly the direction of travel and reform. I think that my hon. Friend has conflated two or three things in his test of accountability: professional accountability, accountability to the public and accountability to other organisations. We will make clear, when we set out the next steps to the reforms that we have proposed in the White Paper, precisely how each part of the accountability conundrum that he posed is properly addressed.

Dr Pugh: I thank the Minister for that response. He has spoken about frameworks and about commissioning standards. I hope that he will go on to speak about what happens when the frameworks are not in application and when the commissioning standards are not observed, for whatever reason. The only thing that I have heard him say so far is, "We're going to have a competitive local environment. People can vote with their feet." That is an awfully London-centric view, because in many areas of the country, that is not a realistic option.

Paul Burstow: I think that my hon. Friend perhaps needs to reflect a little further on the White Paper proposals and what I have said in the debate, because what we are actually talking about is not competition in terms of people always choosing to go somewhere else, but in terms of the ability to see what somewhere else looks like and make a comparison and to ask commissioners locally why they are not commissioning to the same standard. It is as much about that as about being able to move around the country, and certainly that is what we are determined to deliver.

Mr Gyimah: Will the Minister give way?

Paul Burstow: Only one more time, because I want to ensure that I have done full justice to the debate.

Mr Gyimah: I thank the Minister for his comments on commissioning. In that context, I understand that there will be 150 clinical standards against which commissioning will be judged. It would be helpful for people who suffer from epilepsy to know what weighting and priority will be given to those clinical standards as GPs deal with commissioning.

Paul Burstow: The 150 quality standards that NICE will be responsible for producing will make up a key document that the NHS commissioning board will use to draw up the clinical standards that it will use to drive commissioning activity and hold GP consortiums to account for delivery. They will be rewarded against the outcomes that they achieve. That is an important part of the accountability mechanisms that will be in place.

Hon. Members on both sides of the Chamber talked about the need for early diagnosis and correct diagnosis. Where epilepsy is suspected or where there are issues about the management of the condition, patients should be swiftly referred to specialists to confirm the diagnosis and agree treatment options. I am very sympathetic to the calls made today for more specialists and good access to appropriate diagnostic equipment.

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A number of hon. Members rightly mentioned specialist epilepsy nurses, who are particularly vital to providing patients with a stable presence in their treatment and ongoing care. I pay tribute to their work in supporting and advising patients and helping them to manage their condition effectively. However, it is not for me, as a Minister, to make decisions on how local NHS organisations spend their money. I hope that I have satisfied my hon. Friend the Member for Southport, who thought that I might say that. Centralised, top-down management is the problem, not the solution. The new system is quite clear. GP consortiums and NHS trusts will have outcomes to meet for their patients. They must consider, in the light of their own circumstances, whether recruiting more specialist staff or investing in new equipment is the best way to achieve those outcomes.

However, on the question of research and whether we need to test whether the evidence is robust, the evidence is clear, and it is clear in the guidance from NICE itself, that specialist nurses are important for helping people living with epilepsy. The guidance is clear and should be taken into account by those commissioning services. The long-term conditions delivery support team has developed a guide to help commissioners to make the strong business case for the very important investment in specialist epilepsy nurses.

I want to say something about innovation and efficiency, because that is not just about how many consultants and nurses are in a hospital; it is also about how well they are used to support people in the community. The best neurology departments are adapting, evolving and improving their working practices to meet their populations' needs in the context of financial constraints and the need to increase productivity. There is a particular role for neuroscience networks in bringing specialist teams together with general practice and wider sources of support. A lot of work is under way in relation to, for example, the QIPP-quality, innovation, productivity
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and prevention-programme, whereby teams of clinicians are working together to promote innovation and drive out inefficiencies.

I shall give a couple of examples of where things are changing on the ground. In Dorset, there is a county-wide service whereby a consultant neurologist and specialist epilepsy nurses work with GPs and community teams across the region to give better support. In east Kent, networks of GPs with a special interest are joining forces with specialist nurses and local neurology services to deliver community-based epilepsy care. Those are highly effective models and they are the type of models that should be followed in the rest of the country; I certainly question why they are not.

Generic substitution was raised by the hon. Member for Witham (Priti Patel), the hon. Member for Pontypridd and others. As has been said, that is subject to consultation at the moment and I cannot pre-announce the conclusions, but I certainly share the concerns about consistency of supply that the hon. Member for Blackpool North and Cleveleys expressed.

Appointing a national clinical director is certainly something that we need to consider, particularly in the context of the implications of the reforms that the White Paper proposed, and we will consider that carefully.

Our proposals for the NHS will create the building blocks for real and positive change: a new transparency and consistency of purpose, built around an outcomes framework; a more responsive approach to commissioning led by GPs and local government; and much greater influence for patients through better information and choice and control over their care. I look forward to discussing these matters further with hon. Members through the all-party group and with the various organisations that represent the interests of people with epilepsy. I also look forward to taking the White Paper proposals forward, because I genuinely believe that they will transform services from the bottom up, making a real difference to the quality of life of people with epilepsy.

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Human Trafficking

11 am

Emma Reynolds (Wolverhampton North East) (Lab): I applied for this debate as a Back Bencher, but I have since been promoted to the Front Bench. In these unusual circumstances, I will be brief to let Back-Bench colleagues have time to debate the issue properly. However, I want to set out why I called for the debate in the first place, even if I cannot do justice to my original speech.

In opening the debate, I want to applaud in particular the work of Members on both sides of House in championing the fight against human trafficking. Members from each of the main three political parties have deep concerns about that modern form of slavery and have kept the pressure on successive Governments to tackle this egregious human right abuse. Today is an opportunity to continue to do that. In particular, we should recognise the tireless work of the all-party group on human trafficking, as well as the inquiries and reports in the previous Parliament of the Joint Committee on Human Rights and the Select Committee on Home Affairs.

Over 200 years ago, the slave trade was abolished, but another form of slavery has taken its place, one which is more clandestine, underground and hidden, but which is still insidious and brutal. It is one of the most virulent crimes in today's society, one of the most prevalent forms of violence against women and a grave human rights abuse. There are thousands of vulnerable people, mostly women and children, being trafficked into and within our country. They are suffering at the hands of criminal gangs and pimps and enslaved by their keepers; they are abused, raped, violently and sexually exploited, and forced into prostitution, slave labour and domestic servitude. With our country's pitiful rate of conviction for trafficking, all too often such gangs and pimps enjoy impunity. There is still not enough being done to help and to protect the victims of trafficking and to prevent them from becoming victims in the first place.

The victims of trafficking are diverse. Some come from beyond the European Union and some from neighbouring countries at the eastern border of the EU, such as Moldova and Ukraine. Others come from countries further away, such as Nigeria and China. Victims also come from EU countries, and it is often overlooked that women and children are being trafficked within our country. There are indications that the Olympics will increase the demand for prostitution in particular, and, as a result, there will be human trafficking into London from other parts of the United Kingdom and beyond our borders.

Some victims of human trafficking are kidnapped from their families and some are sold by relatives. Tragically, some come of their own accord having been deceived into thinking that they are being helped into the UK on the promise of a better life, only to find when they get here that they are literally imprisoned, kept like slaves and forced into prostitution or forced labour. They are traded by criminal gangs or pimps who treat them like second-hand cars-the more profit, the better for their keepers. Each sex trafficker is estimated to earn, on average, £500 to £1,000 per woman per week. According to their evil and depraved view of the world, the younger the girl, the better, as their value decreases the older they get. Of the 8,000 women who
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work in off-street prostitution in London, it is estimated that 80% are foreign nationals and many are forced into prostitution while they are still children.

Wherever the victims of trafficking come from-whether within our country or beyond-they have one thing in common: they suffer the worst human rights abuses at the hands of their captors, keepers and pimps, and each have an unequivocal, equal and universal right to be helped and protected. I urge the Government not to be complacent in tackling this egregious human rights abuse. I am confident that colleagues will be more specific about what needs to be done and I look forward to listening to the debate. I hope to do all that I can to contribute to finding a solution to this problem in my new position on the Opposition Front Bench.

11.4 am

Mr Peter Bone (Wellingborough) (Con): It is a great pleasure to serve under your chairmanship, Mr Streeter. I start by congratulating the hon. Member for Wolverhampton North East (Emma Reynolds) on leading this debate. Unfortunately she has almost had her hands tied; she was allowed to speak for only a short time because she has just been appointed to the shadow Cabinet. I congratulate her on that. It will be a loss to the Back Benches, but may I say in all honesty that I wish her very very many years-and I mean very very many-in the shadow Cabinet? I would also like to welcome the Minister for Immigration, because in him we have a Member of Parliament renowned for his care and humanity, and his understanding of the issue. I say that not only because it is true, but because I want him to do things. I notice that in the Chamber today Members from all parties are present, which is a sign that this is a cross-party concern.

At the outset I want to pay tribute to my predecessor, Anthony Steen, formerly MP for Totnes. As the first chairman of the all-party group against trafficking of women and children, he pioneered an approach to human trafficking, which I, as the new chairman, am happy to follow. Quite simply, he put human trafficking or modern day slavery on the parliamentary map. I pay tribute to him and to his current work to establish the human trafficking foundation, together with Clare Short and my co-chairman of the all-party group, Baroness Elizabeth Butler-Sloss.

At the end of their 13-year term, the previous Administration could be given only a B for their work on human trafficking. The acid test has to be, were there more apprehensions of traffickers year-by-year? The answer is no. Were the police filing more charges and did more convictions take place? The answer, sadly, is no. Instead, the number of victims rose and rose. However, the previous Government did take two major initiatives, which were welcome. The two operations to deal with trafficking were Pentameter 1 and 2, and they involved every police force in the land. They did not just raid brothels, massage parlours and saunas, but went into private homes-wherever they thought there were traffickers. New initiatives such as those are urgently needed, and the House would like to know what plans the Government have. The Minister may not be able to say too much about that today and may be holding back for anti- slavery day next Monday, but we would like to know if new announcements and initiatives are on the way.

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New initiatives are needed because a number of operations are being disbanded, such as the UK Human Trafficking Centre, a £2 million initiative in Sheffield that was absorbed by the Serious Organised Crime Agency. In itself, that might not have been a problem but now SOCA is also being wound down. We need a Pentameter 3, so that traffickers realise that we are on their case and that this Government will be tougher than the previous one. Is that planned?

We all know that it takes several years for new projects to be effective. What will happen to human trafficking during the apparent lull in the prosecution and harassment of traffickers? It took the previous Administration two years to implement the Council of Europe convention on action against human trafficking after they signed it, and it has never been fully implemented. Operation Golf at the Met has been a remarkable and successful operation. Superintendent Bernie Gravett and Chief Inspector Colin Carswell deserve the gratitude of the whole House for their single-mindedness in tackling child trafficking.

The traffickers will be breathing a sigh of relief that the superintendent's team will be disbanded shortly, just as the human trafficking unit in the Met was disbanded nine months ago. Therefore, although the previous Administration pressed the right buttons, the reality is now coming home to roost: by the beginning of next year there will be precious few specific operational units in the UK specifically tackling human trafficking. Here is a great opportunity for the coalition Government to make some real changes and improvements to tackle this appalling crime, which should have disappeared when slavery was abolished 200 years ago, but is flourishing worldwide.

What is needed is a more robust Crown Prosecution Service that does not make deals with defence counsels on behalf of traffickers. We secure too few convictions, and those that we do secure are the result of plea bargaining, resulting in a lesser crime being admitted and a lesser sentence being given by Crown court judges, many of whom need better training about the nature and extent of human trafficking.

Our track record on dealing with foreign children, particularly from the far east, is lamentable. We need to ensure that the hundreds of children who are discovered here each year, and who are acknowledged as trafficked by the national referral mechanism, are treated more compassionately. Such children should have a guardian, and I am told by a legal friend that we need a guardian ad litem, which, as I understand it, means someone who will act as their parent and look after them, particularly in the court situation. These children are both victims and witnesses, and it is wrong to expect them to go through the system without help when we would not necessarily expect an adult to do so. The European convention on action against trafficking in human beings proposes such a guardian and so, too, does the new European directive.

Let me briefly say something about the directive. At the last Prime Minister's questions, there was a lot of argument between the Prime Minister and the now deputy leader of the Labour party, the right hon. and learned Member for Camberwell and Peckham (Ms Harman), over whether we should opt into the
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European directive. As someone with some reservations about the European Union, I do not really think that it is necessary to opt in, but we do need to do everything-and more-to help children, and the Prime Minister is more than open to suggestions that will help us to achieve that.

Sadly, domestic slavery exists in Britain and is another concern. Some foreign embassies and their officials, who have diplomatic immunity, are, sadly, the worst abusers, and that should worry us all. Currently, the visa for someone who comes here to work for a diplomat is very restrictive, and they can work only for the embassy. They really should come in on a normal domestic visa, which would allow them to go somewhere else if they were being abused.

The issue was well illustrated in the exhibition that the now Prime Minister visited in the Committee corridor last March. The event was sponsored by the all-party group, in conjunction with the Bromley Trust and the Tudor Trust. I pay special tribute to the work of Kalayaan in Notting Hill Gate, which supports victims and campaigns for the merger of diplomatic and ordinary domestic visas, 16,000 of which are issued each year. Such a step would allow diplomatic workers the same freedom as domestic workers with annual domestic visas.

Let me say a word about sex trafficking. We are fortunate in London to have the POPPY project, which, linked with Eaves housing, offers more than 50 units of accommodation to trafficked women. However, POPPY offers more than just accommodation; it offers social, psychological and medical support. Many girls have been viciously treated for many years and need not just a bed, but friends they can trust. That is what POPPY offers, and it does a professional, top-class job.

Although POPPY is technically allowed to accommodate women only for a 42-day period of reflection while they contemplate their future and whether they can assist the authorities, many women need a much longer period of sanctuary. In that respect, the current situation is absurd, although I do not have time to go into it today. Adults who are trafficked into this country are looked after better than children, because while adults will go into something such as the POPPY project, children will be lost in the local authority system-many of them will disappear and be re-trafficked.

POPPY not only provides a lifeline for 42 days, but forms many women's futures, and it has developed its experience and knowledge over the past decade. There is no one quite in POPPY's league. Other shelter projects around the country-in Bristol, Sheffield and Dover-do valuable work, but they are small, have few facilities and, sadly, no Government funding. Trafficking covers the country-not just the south-east and the cities. Caring for victims initially is important, but what happens to them afterwards? Who helps them? Who integrates them back into society? How many return to their home country and at what risk to them and their families? What is the number of deportations?

Human trafficking is the fastest growing business in the world. With increasing demand, the speed of growth is terrifying. Today, 27 million people worldwide are in slavery, with 300,000 in Haiti alone. Trafficking is the fastest growing illegal industry and, according to the United Nations, nets more than $32 billion a year-that would almost help us to overcome our deficit. Hon. Members should just think about that: criminal gangs
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make $32 billion out of trafficking. The punchline is that the growth of human trafficking is fuelled by the ease of access, anonymity and secrecy provided by the internet, and that is why we do not see trafficking in our daily lives. That is the difference between slavery in Wilberforce's time, which was highly visible, and modern slavery, which is underground and hidden..

My request is that our Government should take the lead and, while establishing a national border police force, which is a welcome move, do something specific to help victims of trafficking. There should be more compassion for victims who arrive from all over the world, and that could involve a range of different means. I doubt whether things will change overnight, but I hope that compassion will increase. There are also the victims from EU countries who travel here on legal passports. How, I wonder, will the border police stop those people being trafficked?

For all those reasons, anti-slavery day is very important. On the whole, people are just not aware of modern slavery; they do not realise that it exists around the comer from where they live. They cannot see it, so they do not believe that it exists. What we do know is that the numbers overall are increasing. Sadly, people are recyclable. Unlike arms or drugs, which the criminal gang can trade only once, human beings can be recycled and sold again.

As I said, there is interest across the House in the idea that Britain should lead the way and be known throughout the world for its effective and compassionate approach. In that respect, I am glad to see three Members from Northern Ireland, who represent the political divide there. We must congratulate the Assembly on passing a resolution last week making Northern Ireland

That is what we need to do in the rest of the country. If we make the United Kingdom a place traffickers do not want to come to and where they do not believe that they can make money, we will stop trafficking. Congratulations to Northern Ireland on leading the way.

We are tolerating the closure of some of the most innovative initiatives, and I wonder how that squares with the Home Secretary's statement in the House on 22 July, when she said:

Perhaps, on anti-slavery day, and in the spirit of the big society, we could involve and support non-governmental organisations such as ECPAT-End Child Prostitution, Child Pornography and the Trafficking of Children-POPPY, Kalayaan and the Helen Bamber Foundation, which have an enviable record, but which receive little or no Government funding. Those are exactly the organisations that the Prime Minister has in mind when he talks about the big society. The Minister may delight us all on anti-slavery day by announcing some real progress on beginning to tackle the problem of human trafficking with a vengeance.

11.19 am

Ann Coffey (Stockport) (Lab): I welcome you to the Chair, Mr Streeter, and I congratulate my hon. Friend the Member for Wolverhampton North East (Emma
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Reynolds) both on securing this valuable debate and on her promotion to the Front Bench.

I chair the all-party group on runaway and missing children and adults and I would like to raise some issues on its behalf. The group is very concerned about what happens to vulnerable children and adults when they go missing. Many get hurt in some way. They can fall into drugs and crime or fall prey to abusive adults, and can also get caught up in trafficking and prostitution. Our aim is to try to keep young people as safe as possible.

I want to take this opportunity to highlight and praise the work of the UK Missing Persons Bureau, which is part of the National Policing Improvement Agency. The bureau does some excellent work and is the UK national and international point of contact for all "missing" and "unidentified" cases. It is also the centre for information exchange and expertise on missing children and adults. The bureau has developed substantial knowledge on the issue of missing trafficked children and missing asylum-seeking children and works closely with police forces across the country. It has a valuable database, which stores data on missing people and unidentified bodies. It is an essential tool for the monitoring of missing people as it provides a national picture.

Missing trafficked victims are part of that database. Incidents-particularly repeated incidents-of children going missing are often an indicator of other problems for the child and can be an indicator of trafficking. The nature of trafficking means that children are often moved across force boundaries and therefore may be reported missing in more than one force area. On some occasions the same child may be reported missing to numerous forces under different names. A national database of those incidents is the only way in which links between cases can be identified. Following the reported incidents of potentially trafficked children going missing from local authority care in 2009, there has been understandable concern about and interest in the measures that are being put in place to ensure that those vulnerable children are adequately safeguarded and that steps are taken to prevent them from going missing from care.

I want to draw to hon. Members' attention two major operations that are currently going on to try to tackle the trafficking of children. The first is called Operation Paladin, which is a Metropolitan police-led operation involving immigration officers and social workers. It is based at Heathrow airport and the United Kingdom Border Agency asylum screening unit in Croydon. It also works at the St Pancras Eurostar terminal. The team specialises in identifying and safeguarding vulnerable children who are suspected of being trafficked. It also investigates specific trafficking and migration offences as well as advising other police force child abuse investigation teams on child trafficking issues.

The second operation is Operation Newbridge, under which Sussex police and West Sussex county council drew up an inter-agency protocol for managing potential child trafficking victims taken into social services care. That allows the sharing of information with a view to tracing young people from abroad who have disappeared from care. Since the operation started there has been a significant drop in the number of children suspected of having been trafficked into Gatwick airport and a reduction in the number of such children going missing from local authority care.

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The two operations have two different approaches. Operation Paladin covers investigative and interview support while Newbridge focuses on multi-agency work. The bureau believes that we should now merge the two operations under one new name so that we have a co-ordinated response using both types of operation across the UK as a strong and effective example of inter-agency working to safeguard trafficking victims and prevent further trafficking. That makes perfect sense to me and to the all-party group and I urge the Minister to examine the proposal from the bureau as a way forward. I also urge the Minister to recognise, in any future organisation of police services, the valuable work that the UK Missing Persons Bureau does in a number of areas, and to safeguard that valuable resource.

11.24 am

Fiona Bruce (Congleton) (Con): I congratulate the hon. Member for Wolverhampton North East (Emma Reynolds) on securing this timely and important debate on the trafficking of human beings, and forced prostitution. I can see that it is an issue that she cares about deeply, and I share that with her. We need to recognise the fact that human trafficking, and, by extension, the exploitation of vulnerable women and children through prostitution, happens in the UK, and is something we should continue to fight. I am pleased that the coalition Government have agreed to tackle human trafficking as a priority.

I also want to highlight the fact that the issue could affect any of our constituencies. Early last year, as part of the nationwide Operation Pentameter, which my hon. Friend the Member for Wellingborough (Mr Bone) referred to, and which was aimed at tackling human trafficking and raising awareness of modern-day slavery, the Cheshire police-who oversee my constituency among others-arrested a woman in a constituency near mine who had trafficked human beings for sexual exploitation. That woman had managed brothels and trafficked women, and was also in possession of drugs. She was given a custodial sentence, and rightly so.

We also know that what is happening is bigger than just a couple of cases. According to research published in August for the Association of Chief Police Officers, there are at least 2,600 women in prostitution who have been trafficked into the UK, and at least 9,200 who are considered to be vulnerable, whose situation is more complicated and who might be considered to have been trafficked within the UK, or who are controlled in some other way, such as through drug dependency. Those are large and distressing numbers and they do not include victims of trafficking and forced labour.

As I have said, I am pleased that the coalition is committed to tackling human trafficking as a priority. However, without wanting to go into the reasons for the Government's decision to opt out of the EU directive on human trafficking, I want to ask the Minister to consider a concern that was put to me in a letter, which I am sure many colleagues have received, from a social policy charity that works with non-governmental organisations on the ground to help women exit prostitution. Its concern is that victims of trafficking who have undergone some of the most severe human degradation, often having been raped or forced to take drugs, may still face the trauma of prosecution. That needs to be reviewed.

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The "Human Trafficking and Smuggling" legal guidance advises prosecutors who review cases in which a trafficked victim may have committed a criminal offence while in a situation of coercion that, where there is clear evidence that the suspect has a credible defence of duress, the case should be discontinued on evidential grounds. However, there is information to suggest that that approach is not being practised as robustly as it perhaps could be. For example, a prosecutor can take such steps to discontinue a case only if they have information from the police or other sources that the suspect might be a victim of trafficking; and that is relevant only where the criminality is a direct consequence of the trafficking situation.

In another case that has been brought to my attention an unopposed appeal against conviction was brought before the court, and was granted by Mr. Justice Cox on 26 June 2008. That is admittedly some time ago, but the case was brought to me by the POPPY project, which has already been referred to with applause during the debate. On 17 March 2008 the appellant had pleaded guilty at Canterbury Crown court to an offence of using a false identity card with the intention of using it as her own and was sentenced to eight months imprisonment, less 16 days spent on remand. Research by the POPPY project subsequently showed that the woman was the victim of trafficking into England for prostitution. I believe that the case may be one among many, but one is enough to require me, and the Minister, to look into the matter, and find out whether our current processes are sufficiently robust to protect such victims-for indeed they are victims, not offenders, and should be treated as such.

11.29 am

David Simpson (Upper Bann) (DUP): I welcome you to the Chair, Mr Streeter. I congratulate the hon. Member for Wolverhampton North East (Emma Reynolds) on initiating this important debate on human trafficking, which is a particularly brutal form of organised crime.

The hon. Member for Wellingborough (Mr Bone) reminds us that next Monday is anti-slavery day. Mankind has been guilty of many atrocities and crimes down the centuries, but I believe that one of the biggest travesties is slavery. Nothing is more degrading or humiliating for individuals than to have to live such lives. Human trafficking is a modern form of slavery, victims often being forced to work in the illegal sex industry.

As has been mentioned, this obscene trade was recently debated by the Northern Ireland Assembly. One thing that featured in that debate was the fact that, in many areas, people have suspicions about particular dwellings or establishments that they suspect are being used as illegal brothels. They report their suspicions to the authorities, but little action seems to be taken. That is a major concern. All parties in the Northern Ireland Assembly endorsed the proposal that Northern Ireland should be an unwelcome place for traffickers, but we need more than that. Although such matters are passed by our legislative chambers, we need to see action-and a large number of convictions.

Dr William McCrea (South Antrim) (DUP): Over the years countless initiatives have been taken by various Governments, but initiatives of themselves are not sufficient. Surely the courts should allow the sentence to fit the crime. We must have sentencing that will stop this terrible and despicable abuse.

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David Simpson: I agree with my hon. Friend the Member for South Antrim (Dr McCrea). He is absolutely right. The judiciary has a lot to answer for. The police continually brought individuals before the Craigavon courts in my constituency, but I remember that one judge was nicknamed Father Christmas because every time those guys were brought before the courts they were let off. The onus is on the legal establishment to convict. I would be interested to know whether other hon. Members find the same situation in their constituencies as I and other Northern Ireland Members do.

This particularly vile trade often involves forced sexual slavery, predominantly of women but also of men-and, indeed, of children-into a nightmare world. There they are treated as commodities to be traded and sold in order to gratify people willing to pay so that they can prey upon them.

Mr Denis MacShane (Rotherham) (Lab): I am grateful to the hon. Gentleman for giving way. When the hon. Member for Wellingborough (Mr Bone) mentioned the Northern Ireland Assembly initiative to make Northern Ireland a trafficking-free zone my heart leapt with joy. However, I wonder what specifically is being done. Is there a new law? Is there a law to prevent demand? Thirty years ago, Ken Livingstone declared London to be a nuclear-free zone; it is true that no nuclear bombs have fallen on London since then. Without being trite, what is the Assembly's legal proposal?

David Simpson: I agree with the hon. Gentleman. Indeed, I have made the same point. Whether the matter is being debated here or in the main Chamber or in any of the regional assemblies, it may get all-party approval but it does not necessarily achieve anything. The Northern Ireland Assembly has taken the first step to bringing the matter to a final conclusion. We need to move quickly.

People are persuaded by these unscrupulous individuals that they will be helped to obtain a better life, but we know that the reality proves to be very different. They are tortured, trapped and treated as little more than pieces of meat. The hon. Member for Wellingborough brought to our attention debates in this Chamber on domestic slavery, which is another travesty, which arises through diplomatic immunity or other loopholes. It is a disgrace and should not be allowed.

As I said earlier, this is a modern form of slavery. It happens on a large scale. The United Kingdom Human Trafficking Centre reports that between April and December 2009, 527 potential victims of trafficking of 61 nationalities were referred to the national referral mechanism. However, that covers only what is known; I fear that it happens on a much larger scale than many imagine.

I am also concerned that good police work does not always lead to successful prosecutions, and I have mentioned the role of the judiciary in that respect. However, I congratulate the police on the successes that have resulted from the recent UK-wide Operation Apsis. We need many more such successes. I emphasise that although we might debate such an horrific way of life, we need to see those people brought before the courts and given the sentence that goes with the crime.

Mr Gary Streeter (in the Chair): Order. I remind the House that wind-ups will begin at 12.10 pm. Four Members seek to catch my eye. First, I call Tom Brake.

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11.37 pm

Tom Brake (Carshalton and Wallington) (LD): It is a pleasure, Mr Streeter, to see you in the Chair this morning. I congratulate the hon. Member for Wolverhampton North East (Emma Reynolds) on securing this important debate.

I echo what the hon. Member for Wellingborough (Mr Bone) said about the excellent work done on human trafficking by the now retired Member for Totnes, Sir Anthony Steen. He was, it will be agreed, a colourful figure-he was often frank and occasionally unguarded in his comments-but he deserves to be remembered for his excellent work on raising the profile of the matter and for establishing the Human Trafficking Foundation. I also support what the hon. Gentleman said about the need for better training for officers and others engaged in dealing with the problem, and the need for guardians to support children through the unpleasant and doubtless un-nerving process of going through the courts.

We know that human trafficking is a big problem, but it is fair to say that the scale of it is a little hard to determine. The United Nations estimates that 70,000 new victims arrive in Europe each year and stay a couple of years; that compares with a total population working in the sex industry of something in the order of 140,000. The market as a whole is said to be worth €2.4 billion a year. A substantial amount of money is being spent on this horrific trade-or service, if I can put it that way. The Association of Chief Police Officers estimates that an estimated 30,000 sex workers in the UK have been trafficked into the country, coming principally from China, Thailand and other parts of south-east Asia, and from eastern Europe.

That report was fairly controversial in that it extrapolated from interviews with women who were working in brothels in London a national figure of 2,600 victims of sex trafficking. All one can know for certain is that those women would have been under huge pressure not to confirm the way in which they had arrived in the UK, which makes it difficult to establish how many victims there are other than it is a very large number. What is certain, however, is the number of convictions. Since the Sexual Offences Act 2003 came into force in January 2004, 46 men and women have been convicted and jailed for transporting willing sex workers-I am sure that we could argue about what constitutes a willing sex worker and discuss the economic pressure that they may have been under to come willingly to the UK for such a purpose-and 59 people have been convicted of transporting women who were forced to work in the sex industry. What is also clear is the excellent work that the POPPY project is doing and the number of women that it has been able to help. In the past six and a half years, it has helped and supported around 500 women.

Hon. Members who have local newspapers-as Members of Parliament, we all follow our local newspapers carefully-will be aware that the newspaper group, Newsquest, has been actively trying to ensure that no local papers carry ads publicising such services, and I commend such work.

What makes this issue even harder to resolve is the conflict that exists between trying to establish whether someone has been trafficked here or whether they have come here of their own volition. Hon. Members will be familiar with the research that was published by
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Dr. Nick Mai of London Metropolitan university-again, we have to read between the lines of the responses that were given-in which he conducted detailed interviews with 100 migrant sex workers in the UK. He astonishingly states that for the majority of people, working in the industry was a way to avoid the exploitative working conditions that they had experienced in their previous non-sexual jobs. I take that with a pinch of salt because such people are working in an industry that is illegal and on the margins, and their status in the country is uncertain. The suggestion that they come here to work in such an industry because it provides better working conditions than the ones that they might have experienced before requires some scrutiny, but that is what his research apparently found. That makes it harder for authorities such as the UK Border Agency to err on the side of thinking that people have made a conscious choice to come to the UK for this purpose rather than erring on the side of assuming that people have been trafficked, which is what we want. Such an attitude is also adopted in relation to children who are, all too often, treated as criminals rather than people who have fallen foul of trafficking.

Members will be familiar with the concerns expressed by the anti-trafficking monitoring group about trafficked children who have gone into care and subsequently gone missing. The review into 390 cases of suspected trafficked victims handled by the UK authorities gave some quite alarming statistics about how many of those victims subsequently disappeared.

In theory, the national referral mechanism, to which other hon. Members have referred, allows the police and social workers to refer suspected cases to the appropriate authorities, but again there is legitimate concern that the people who are being referred are being treated as part of an immigration issue rather than as a crime issue, or as victims of trafficking who require support. If the police are succeeding in identifying people who are responsible for human trafficking, it is not being followed through in terms of the number of convictions. For example, only five people were convicted of human trafficking for sexual exploitation in the first six months of this year compared with a figure in the low 30s in previous years. Therefore, we are not seeing many successful prosecutions.

Will the Minister give us an update-I know that this is not his brief-on what the Crown Prosecution Service is doing to improve its prosecution policy in relation to these cases, and does he believe that it will be successful?

In conclusion, I will refer to the UK opt out of the EU directive, which was clearly a controversial decision by the coalition. The coalition has been criticised by many campaigning groups for not signing up to the directive, and I must say that I have some sympathy with the concerns that have been expressed. I know that the Government will consider the impact of the directive, and I strongly hope that if they decide that the directive will help to address the issue of human trafficking, they will not be put off adopting it simply because it is prefixed with the word "EU". If the directive is effective at tackling the issue, it is incumbent on us as a Government to support it.

Mr Bone: Will my hon. Friend give way on that point?

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Tom Brake: I have one more sentence, so I will not give way. Perhaps the hon. Gentleman will get another opportunity to speak. I just wanted to conclude my remarks by saying that we have an anti-slavery debate on Monday and a debate on the issue on Thursday. Regrettably, it is clear that slavery is alive and well in our society today and it is something that all parties here this morning want to address, and I certainly want to play a role in doing that.

11.47 am

Michael Connarty (Linlithgow and East Falkirk) (Lab): I congratulate my hon. Friend the Member for Wolverhampton North East (Emma Reynolds) on securing this very important debate. There is no doubt that a modern day slavery exists in many forms. I liked most of the speech of the hon. Member for Wellingborough (Mr Bone) but I was rather disappointed by his limited UK-centric views and ambitions. He seems to feel that we can stop human trafficking by throwing up gates around the UK. However, it is not a UK phenomenon, but a worldwide one. There is no doubt that trafficking can be for sexual exploitation. In many cases, it exists down our street. In the Falkirk and West Lothian areas of my constituency, brothels have been broken up and trafficked women have been found. At Prime Minister's questions in September, the deputy leader of the Labour party raised a scandalous case in London in which some of the organisers were Iranian who lived in London. They were not necessarily UK citizens, but people who were habitually in the UK. If they had not been captured in the UK, we would not have been able to pursue them outside the country. Under the present law, if they had gone to any other EU country, we would not have had the right to pursue them.

Mr Bone: Will the hon. Gentleman give way?

Michael Connarty: I will continue for a while, but the hon. Gentleman can intervene later. That is the problem that we need to address. Many people are trafficked not just for sexual exploitation, but for domestic exploitation. They think that they are coming here for good, well-paid jobs, and they end up being handed over as domestic servants. They are paid a low wage, trapped in the house, have their passport taken off them, and told that if they go out they will be reported and sent back to wherever they have come from. There are thousands of people in this city who are living like that. We had the scandalous case of the Saudi Arabian prince who murdered a domestic slave in his household in London, and that happens in large homes in this city. It is a scandal and something that we should be worried about.

Many other people are in poverty-wage jobs. For example, someone came to see me recently who, over nine and a half years, had basically been moved from Chinese restaurant to Chinese restaurant around the UK. They were told that if they ever went to see anyone, they would be exposed and sent back home to China where, for various reasons, they do not want to return. They came to see me because I had spoken at the annual general meeting of an organisation that deals with such people in Glasgow, which of course is the only city in Scotland that takes people who are asylum seekers who have been dispersed from London. So human trafficking is a very big trade that, in fact, has sexual exploitation
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at one end, but, as has already been said, that sexual exploitation is not necessarily the biggest part of the trade.

Many people are trafficked with the promise of a good job or a better life. When I spoke at the AGM that I just referred to, a young man also spoke who had been here in the UK for 10 years. He was the last remaining member of his family, having escaped from a violent situation in Africa. He was told that he was going to a better life and was dumped in Glasgow. Quite frankly, being dumped in Glasgow would be a frightening experience for some English people, on the basis that they cannot always understand the language. [Laughter.] That young man was dumped in Glasgow and was totally impoverished. Thank goodness that there was an organisation in Glasgow, called Positive Action in Housing, which deals with such people. It has now been going for 15 years and I pay tribute to Robina Qureshi, its director and the person who set it up. It rescues people from exactly that kind of domestic slavery and exploitation, whereby people pay to be trafficked. Indeed, sometimes their families gather large amounts of money to pay for them to be sent through human trafficking routes run by gangs in Europe and elsewhere in order to get a better life, only for them to end up being dumped on the streets of the UK or other EU countries. So it is a much bigger issue that we are talking about. There are two parts to the issue-one is about people trafficking and the other is about enforced prostitution-and we must focus on both parts.

The reference to Anthony Steen was very timeous. He was the former MP for Totnes and a member of the European Scrutiny Committee. He did an excellent job in setting up and becoming the chairman of the all-party group on human trafficking and then in setting up and chairing the Human Trafficking Foundation.

I think that the way that Anthony Steen worked was a key to how we should go on as a Government, regardless of which party is in power. He used his travels as part of the European Scrutiny Committee to go round Europe trying to convince every Parliament in Europe to have an all-party group against human trafficking. I am sorry, but we cannot set up a ring around Northern Ireland, Scotland, Wales or the UK as a whole-it cannot be done. We have to work with everyone across all the countries involved.

No doubt Anthony Steen aspires to do things beyond the EU, but when I talked to him he said that basically it was the countries that were used as transit countries, or the countries of departure, that had to be focused on. It was the countries where the criminal organisations exist; those organisations do not necessarily exist in the countries that were targeted for trafficking people into. It was not just the reception countries, such as the UK, that should be focused on. Therefore, it was important to Anthony Steen that the UK Government should sign up to and opt into the EU directive on human trafficking because that directive is necessary, so that we can have bigger and more useful powers than we have at the moment.

Mr Bone: The hon. Gentleman is making a very powerful speech. Regarding the opt-in to the EU directive, I just wanted to say that what concerns me as chairman of the all-party group is that, if we opt in, we are saying, "That's it". I do not think that the EU directive goes far enough and I do not want signing up to it to be an excuse for not doing more.

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Michael Connarty: That is a wonderful ambition and if that is the case then I will now give the hon. Gentleman some reasons why we should do what is necessary now and take the first step by signing up to that directive.

During Prime Minister's questions on 15 September, when the issue of human trafficking was raised, the Prime Minister invited me to write to him and I wrote to him, to explain why the powers that we have at the moment are not good enough. What powers do we have? We have the Sexual Offences Act 2003; that is the power that we have to deal with these matters. We have heard from the hon. Member for Carshalton and Wallington (Tom Brake), a Liberal Member, that there have been 46 convictions under the 2003 Act of people who were willingly trafficked, which is not a great record.

Under section 57 of the 2003 Act, basically we can take action against anyone who is outside the UK and trafficking people into the UK, if they are UK citizens. Under sections 58 and 59 of the Act, anyone who is in the UK and planning to traffic people out of the UK can also be taken to court. The other actions that can be taken, regarding brothels and all the rest of it, are contained within that same Act. But those three sections-57, 58 and 59-are the sections that cover what I believe is identified as being the "outside" problem of what is happening outside the UK.

What does the EU directive bring, in terms of the powers that we require? It actually requires member states to assert jurisdiction on their own nationals. In other words, under the directive the UK could and should prosecute any UK national involved in human trafficking anywhere in the EU. It also gives the power, but not necessarily the obligation, for member states to take jurisdiction-that is, the power of prosecution-of a habitual resident in the UK who commits these crimes anywhere in the world. So, if they go anywhere in the UK, we can pursue them.

The EU directive also gives a power regarding a victim who was a UK national or a habitual resident in the UK who was trafficked anywhere in the EU. In fact, that gives the UK the power to protect a young woman who is working around the EU. There are now many young women who work around the EU, who do not necessarily live in the UK any longer, but who end up getting trafficked by, for example, a Bulgarian gang. Do we really think that the Bulgarian legal system will protect that young woman? However, the British jurisdiction given under the EU directive would give us the power to pursue that gang.

I want to end by saying that I want to hear why the Government are not signing up to the EU directive. Let me be quite frank. If Madeleine McCann had been an adult-a young woman-and had been trafficked out of Portugal to somewhere else by someone who was not a UK citizen, we would have no jurisdiction. Under the directive, we would have that jurisdiction, so why are the Government not signing up to it?

11.55 am

Mr Denis MacShane (Rotherham) (Lab): Thank you very much, Mr Streeter, for calling me. I offer my congratulations to my hon. Friend the Member for Wolverhampton North East (Emma Reynolds), both on securing this debate and on her promotion to the Front Bench.

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I do not disagree with much of what has been said. I am here simply to assert that we can do something. Wilberforce should be living at this hour. We have slavery, but it is not known. Slavery in the late 18th century was not much known about; it was incorporated into people's conservative traditional thinking. It has required strong individuals such as Sir Anthony Steen, who is no longer with us in this House, and other colleagues to take up the campaign against it.

I must place on record my immense disappointment that one specific measure that was put to the new Government shortly after the coalition was formed-namely, a very sensible and practical EU directive-has been spurned. As we honour William Wilberforce, I cannot honour his biographer, the Secretary of State for Foreign and Commonwealth Affairs. He made a most eloquent speech at the Upper Waiting Hall exhibition that the hon. Member for Wellingborough (Mr Bone) mentioned, yet as the steward of our European policy he is not prepared to put his ministerial tick where his mouth was just a few months ago.

[Mrs Anne Main in the Chair]

I want to make one small point. The Government and some hon. Members have referred to a report published in August by the Association of Chief Police Officers that talked about 2,600 prostituted sex slaves. I dislike the term "sex worker"-it has an ideological loading. The vast majority of women and girls involved this area are there because of debt or drugs; they are under the coerced control of their pimps. The image of the "happy hooker" sex worker-the "Belle de Jour" sex worker-might apply to a tiny, tiny minority, but this is one of the most disgusting forms of exploitation in our society, whereby a young girl or woman is obliged to take 10 or 12 penises into her orifices each day in order to make money for her pimps and traffickers. So we should have no more nonsense about "sex workers"-these are prostituted women who are suffering horribly.

However, regarding that figure of 2,600 prostituted sex slaves that is quoted in the ACPO report, that report was shredded almost before it was published by the Eaves organisation and other investigators, who noted that it was based on police officers in full uniform going into massage parlours and other brothels and, within sight of the pimps and other controllers of these women and girls, saying, "Excuse me, love, are you trafficked?" and then coming up with that figure of 2,600. It is nonsense, given the world statistics about the level of sex slave trafficking, which are quite reliable. Even if Britain has a smaller share of that trade than other countries, we are still certainly talking about a five-figure number of prostituted sex slaves, at the very least.

There is an important mechanism to deal with this problem of sex slavery, which is tackling the demand side. I will not enter into that debate today; there is some division across the House about it. Nevertheless, until we put the responsibility on the men who pay for sex with coerced and trafficked women, I am afraid that the hope that we will find every pimp and put him behind bars is not a very realistic one.

I pray in aid the Archbishop of York, Dr John Sentamu, who wrote a marvellous article in the Yorkshire Post about a month ago saying:

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-that might incorporate the views of the hon. Members for the hon. Member for Wellingborough and for Congleton (Fiona Bruce)-

The Archbishop of York is right, and I deeply regret the fact that the Liberal Democrat spokesman in this debate has not been able to back him fully and wholeheartedly. On the whole, those who lie down with Eurosceptic Tories get up with opt-outs.

We will keep pressing the Government on the issue. It is simply not good enough to say, as the Prime Minister said to the then Leader of the Opposition on 15 September, that the directive

I am happy to say that the Prime Minister misled the House inadvertently, but he did mislead the House, and that cannot stand. It is clear to anyone who has read the directive, as I have, that the UK is not in compliance. Article 2 deals with offences concerning trafficking in human beings. According to CARE, a Christian organisation working on the issue, the UK Government are only semi-compliant. Article 7 deals with the non-prosecution or non-application of penalties to the victim, a point made strongly by other hon. Members. Again, the UK is only semi-compliant. There is no requirement in UK law not to prosecute victims, even though the Council of Europe convention explicitly states that there should be.

As a delegate to the Council of Europe, I was part of a campaign to get the UK first to sign and then to ratify the convention. The Home Office was utterly resistant, as it is today, to the EU directive. It required the Prime Minister's personal intervention to get the convention signed and ratified, but we are not yet applying its articles fully. We are certainly not applying the proposed articles of the EU directive.

Article 8 of the EU directive deals with investigation and prosecution. We are not compliant. No specific legislation addresses any of the requirements. The Crown Prosecution Service is currently consulting on its policy on prosecuting cases of human trafficking. Frankly, if the CPS had been around at the beginning of the 19th century, it would have taken until the 20th century to finish its consultation. Parliament itself must get to grips with the issue.

The UK is only semi-compliant with the directive's article on assistance and support for victims of trafficking in human beings. On the general provision of support for child victims, one of the worst aspects of sex slave trafficking, the UK is, again, only semi-compliant.

Mr Bone: Will the right hon. Gentleman give way?

Mr MacShane: I really do not have time. Forgive me; this is a short debate.

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On one important measure in the directive-that there should be national rapporteurs on the issue-the UK is wholly non-compliant. The Prime Minister misled the House on 15 September. I hope that the Minister is willing to accept that and move forward.

The UK Human Trafficking Centre is being abolished. There will be no Operation Pentameter 3, which the hon. Member for Wellingborough rightly demanded. We are shutting down the initial steps taken by the last Government, who were working against "Whitehall knows best" syndrome and much of the mass media. Papers such as The Guardian and shows such as "Newsnight" have constantly downplayed the number of sex slaves and trafficked and prostituted women in our country. It is up to this House alone to persuade the Government.

I make no protest against the Minister who is replying to this debate-he is a sincere and serious Minister on this subject-but he has got it wrong. It is not just about UK law versus Brussels-the Foreign Secretary, in his speech to the Conservative party conference in Birmingham, was pandering to the latent Euroscepticism of his Back Benchers-but about sending a signal to every other EU member state that Britain is part of the joint European campaign. It is also about sending a signal elsewhere in the world that we are prepared to change our law to conform fully to the EU directives, as have all the other EU member states that have signed up, and take the campaign forward internationally.

I know that the Minister will have to read out his brief today, but I say to him that the campaign will go on until we are prepared to support the victims of sex slave trafficking instead of saying, by opting out of the EU directive, that the pimps and traffickers have one or two people on their side in Whitehall.

Mrs Anne Main (in the Chair): Before I call the next speaker, I remind hon. Members that I will start calling the Front-Bench speakers to respond at 10 past 12.

12.5 pm

Mark Durkan (Foyle) (SDLP): It is a privilege to serve under you, Mrs Main. I congratulate the hon. Member for Wolverhampton North East (Emma Reynolds) on securing this important debate and on her promotion to the Front Bench. I join other hon. Members in commending the long good work of Sir Anthony Steen, the former Member for Totnes, on this issue. I also commend his successor to the chair of the all-party group on human trafficking, the hon. Member for Wellingborough (Mr Bone), who is an able and active campaigner on the issue at many levels.

Unfortunately, I differ with the hon. Member for Wellingborough on the EU directive and the question of the opt-out. I note that he said in an intervention that he did not object to the directive in principle but was concerned that if we opt in, we will say that that is enough. Reference was made earlier to the resolution recently passed in the Northern Ireland Assembly. There is a serious danger that if we opt in, we may adopt resolutions that become a badge for the system without being a shield for the citizen, so that caution was well stated. However, it applies equally to the Government, whose line is "We don't need to opt in because we're doing everything it requires anyway." Surely there is a
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danger that people will say that they are already doing enough. As we have heard from other hon. Members, particularly the right hon. Member for Rotherham (Mr MacShane), it is not the case that the UK is doing everything required in the EU directive within its various jurisdictions.

Opting into the EU directive would give us much needed greater reach against human trafficking and its perpetrators and users. More action is needed on both the control and demand sides. I know that other hon. Members do not want to go too far into that debate today, but it is one issue that featured in the recent debate in the Northern Ireland Assembly.

We must recognise that we need to act not only at EU and the wider international level, as hon. Members have said, but within these islands. We must recognise that there is a corrupt carousel of seedy exploitation that uses various jurisdictional anomalies within these islands. We see it happening not just between Northern Ireland and the south, where there are activities in the border areas. As was mentioned in the Assembly debate, a victim uncovered recently in Stranraer was on her way to Northern Ireland, not to be exploited there but because that was her transit route to the south. We know from talking to the Police Service of Northern Ireland and people in Women's Aid who work on such issues in the north and south that people border-hop not just within the island of Ireland but between islands in this country.

I hope that the Minister will consider taking a strong initiative at the level of the British-Irish Council as well as in Europe. There are eight jurisdictions within these islands. Not all of them have a role in prosecution and pursuit, but many can play a role in supporting victims and those who assist them. Action at the British-Irish Council level, as well as at the EU level, would show that the various Chambers around these islands that are passing resolutions want such resolve to add up to effective action against this very cruel, criminal trade.

12.9 pm

Diana R. Johnson (Kingston upon Hull North) (Lab): It is a privilege to serve under your chairmanship today, Mrs Main. I congratulate my hon. Friend the Member for Wolverhampton North East (Emma Reynolds) on securing this important debate and on making a strong opening statement about why she secured it. I also congratulate her on her new role on the Front Bench; I wish her every success with it.

The contributions of hon. Members from all parties have clearly shown that there is cross-party support on the issue and that there is a resolve across all parties to tackle it. I pay tribute to all of this morning's contributions, including that of my hon. Friend the Member for Stockport (Ann Coffey) on the role she plays in the all-party group on runaway and missing children and adults. She considered the issue of runaway children and how that impacts on the matter.

I also pay tribute to my hon. Friend the Member for Linlithgow and East Falkirk (Michael Connarty), who mentioned important transnational issues, and my right hon. Friend the Member for Rotherham (Mr MacShane), who, as usual, made a compelling case for why we should sign up to the EU directive on human trafficking. The hon. Member for Wellingborough (Mr Bone) made
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a well informed and strong case for why the issue needs to be high up on the agenda. The hon. Members for Congleton (Fiona Bruce), for Upper Bann (David Simpson), for Foyle (Mark Durkan) and for Carshalton and Wallington (Tom Brake) also spoke eloquently.

This is my first opportunity to speak as a member of the shadow Home Affairs team. I was delighted to be given this debate to answer for the Opposition because I am the Member of Parliament for Kingston upon Hull North. One of Hull's famous sons is William Wilberforce, who played an important part in starting the debate on the slave trade so many years ago, so I am particularly pleased to have the opportunity to speak on this matter today.

I also pay tribute to Anthony Steen, the former Member of Parliament for Totnes. When he contributed to debates on the issue, he would invariably pay tribute to the previous Government's role in making sure that the matter was properly addressed. Ministers in the previous Labour Government always paid tribute to Anthony Steen and the role he played in ensuring that the issues of slavery and trafficking were considered fully and properly by the House.

I was interested to hear that it was mooted at one point that Anthony Steen should be the adviser on human trafficking to the then Leader of the Opposition, now the Prime Minister. I wondered whether Anthony Steen's advice had been sought on the EU directive and what he might say to the Prime Minister about the Government's stated positions on the directive. I use the word "positions" because the Government's positions are very unclear. The Home Secretary has said that signing up to a particular directive had to be in the interests of the UK and, of course, we would all agree with that. However, she went to say that the UK is already achieving much of what is contained in the draft EU directive. A Home Office statement went further and stated that signing up would make very little difference to the way in which the UK tackles the problem and that there would be no operational benefits. On the other hand, the Prime Minister offered to go away and think again about the directive and said that there would be opportunities to opt in at any time.

The Minister's first job this afternoon is to clear up the confusion. Is the directive in or is it out? If it is a maybe, how much of a maybe is it, and what will swing the argument either way? The Government say that the UK already complies with most of what is required under the draft EU directive but, as we have heard from various hon. Members today, there are key areas with which we do not comply. For example, paragraph 5 of the explanatory memorandum extends the definition of trafficking and inherent within that is recognition that exploitation takes many forms and that one form of exploitation, such as labour exploitation, often leads to another, such as sexual exploitation.

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