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This is a significant day. It is a day to remember those who are no longer with us; it is a day to acknowledge and pay tribute to those who have worked so hard on this issue; and, crucially, it is a day to raise awareness. On the first of those issues, the scars on those who have lost people, particularly in the early years, are clearly raw. Thankfully, I do not know anybody who has died from AIDS, but I have friends who do, and they recall the pain and suffering vividly.
It is important that we remember those who have died and acknowledge their suffering. There is a wonderful quote in the film "Philadelphia", where someone says that social death precedes physical death. That was certainly true in the early days, but I hope that things will get a lot better as time goes on. It is important, however, to look at how far we have come.
This is also a day to acknowledge those who have done so much. I pay tribute to each and every person and organisation for their work. There are too many organisations to mention, but I would like to pay tribute to the National AIDS Trust and the Terrence Higgins Trust. I would also like to mention two individuals. The first is the chief executive of the Terrence Higgins Trust, Sir Nick Partridge, who is here. He has done a tremendous amount of work over the years, and he should be acknowledged. The second is Lord Fowler, and I was pleased last night when he was acknowledged for the work that he did in the very early years.
Perhaps most importantly, today gives us an opportunity to raise awareness of HIV and AIDS here and abroad. I know that we are concentrating on the UK today, but I hope that we will have an opportunity to talk about the issues abroad, because they are significant.
The latest figures from the Health Protection Agency show that more people than ever are living with HIV. Last year, there were more than 6,000 new diagnoses, which is fewer than the year before, but only slightly. That emphasises that this is still a major problem. As many Members have mentioned, statistics also show that slightly more than half of new diagnoses are among heterosexuals, but the rate of infection in the gay community is still very high. Worryingly, there is an increase in diagnoses among those over 50, as my hon. Friend the Member for Mid Derbyshire (Pauline Latham) rightly said. We have also heard about the quarter of people with HIV who are undiagnosed. That is a huge problem, which really needs addressing.
I represent a constituency in Leeds, where the prevalence of HIV cases is average for England, with about 850 people receiving treatment and care in the city. Again, however, many of those people have been diagnosed very late, which highlights the need for early diagnosis. We also have a growing African population in the city, and there is a real link between HIV abroad and in the UK, as more and more people move around the world. In addition, we have one of the most vibrant gay scenes in Yorkshire, and I hope that we can encourage as much focus as possible on those two groups, because prevention really is the key.
It is important to mention the campaigns of the 1980s. The Conservative Government of the mid-1980s faced a massive challenge on an emerging issue, and even the best experts were learning day to day. Those campaigns were scary. I was at school at the time, but I
remember them, and they still have an impact on me. As the hon. Gentleman said, those old campaigns were not exactly targeted, but they were highly effective.
Developments in medicine these days mean that people with HIV can expect to live well into old age. This generation could be forgiven for thinking that the problem has gone away, and that is a big problem, particularly in the young, at-risk groups. In the 1980s, HIV had already taken root among gay men in this country. Meanwhile, a devastating HIV/AIDS epidemic was about to take off in Africa, with inevitable consequences for this country and others. It is now estimated that, by 2012, there could be close to 100,000 people with the virus in this country. That is a tenfold increase on the 1980s figures, so the problem has not gone away.
I pay tribute to groups such as CHAPs, which have worked with community groups all over the country, and I am lucky that we have such groups in my constituency. [Interruption.] I notice, however, that I need to get a move on, so I will get rid of some of the pages of my speech.
Let me quickly say that I am delighted that we are highlighting some of the work that has been done over the past few years, although I should emphasise that work still needs to be done to save lives. There needs to be foreign aid, education and greater testing. Let me also say how happy I am that HIV and sexual health have featured highly in the public health White Paper, and that is important. It is also important that we acknowledge the problem in socially disadvantaged cases.
Finally, there is no one silver bullet when it comes to preventing HIV transmission, but we can, through a range of interventions, start to reverse this epidemic. Like the Government of the 1980s, the coalition faces a considerable challenge in tackling HIV. Unlike that Government, however, the coalition can draw on 25 years of experience in dealing with the epidemic and in understanding what works and what does not. I wish them well.
Mr Virendra Sharma (Ealing, Southall) (Lab): I congratulate my hon. Friend the Member for Inverclyde (David Cairns) on securing a debate on such an important topic. HIV policy has long been close to my heart, and it is a pleasure to be able to speak in the debate. It is important that I can speak on an issue that affects my constituency so greatly. Although we are discussing the effects of HIV in the UK, we cannot do so in isolation; we need to discuss many global issues as well, and I am sure that we will have an opportunity to do so. Today, however, I want to address issues relating to the UK and particularly to my constituency.
Ealing primary care trust has the seventh highest prevalence of HIV in a country that has more people living with the disease than ever before. Rates of new infections in the UK remain high, and, as my hon. Friend said, the number of over-50s infected with HIV trebled between 2000 and 2009. It is obvious that a new policy has to be developed to deal with these pressing new issues.
One of the most important factors in this complex issue, which we must acknowledge straight away, is diagnosis. Roughly one in four people with HIV in
Ealing do not even know that they have it. That is roughly the same ratio as at the national level. When HIV is discovered early, people can be treated and go on to live normal lives with near-normal life expectancies. On the other hand, late diagnosis leads to more AIDS-related illnesses, increased pressure on the NHS and a higher rate of onwards transmission. We have too high a rate of diagnoses being made at a point when treatment should already have started. As hon. Members have said, in 2009, 52% of people diagnosed with HIV were diagnosed too late, and 73% of those who died were diagnosed too late as well.
What can we do to ensure early diagnosis for all cases of HIV? The Health Protection Agency believes that all new members of GP surgeries in PCTs with high prevalence rates, including Ealing, should be offered an HIV test. We need to go further, and provide incentives to GPs and other health care workers to encourage HIV testing. We also need to improve antenatal testing. We already have good provision for HIV testing of unborn babies. Even though one in 450 women who give birth is HIV-positive, only 30 babies born last year had the virus. However, we could go further.
I want to comment briefly on the growing link between HIV cases and mental health. Obviously, meeting the mental health needs of a population is important in itself, but concentrating on people with HIV can have a particularly beneficial effect, both clinically and in cost-effectiveness. People with depression have a more adverse reaction to their HIV treatment in general. It is cheaper for the NHS to invest in 10 sessions with a clinical psychologist than to pay for costly treatments further down the line because someone did not take the initial treatment properly.
Those sufferers receiving the right psychological support are less likely to miss their medication, more likely to react positively to treatment, and less likely to pass on the disease by engaging in unsafe sex; such aspects of the matter can cost more in the long run if the right support is not established immediately on diagnosis. It is therefore important for the Department of Health to integrate HIV sufferers into long-term mental health strategies.
Although I am pleased that drugs for HIV sufferers will be ring-fenced in the health budget, social care and protection for HIV sufferers, which is often provided through local authorities, will not be. Social services are hugely important for people with HIV, and a squeeze on their budget is likely to have a detrimental effect on the mental health status of many HIV sufferers and cost much more in the long term. I am aware that through the CSR an announcement was made of an increased allocation to social care for people with HIV.
I now want the Department of Health to inform local authorities of their likely budgets as soon as possible, so that councillors can start to plan a thorough care plan for people living with HIV. Only through that long-term planning for mental health cases, more social care and a greater push for early diagnosis can we really start to tackle the problem of HIV in this country, and ensure that nothing stops people with HIV living normal lives.
Pauline Latham (Mid Derbyshire) (Con):
I am delighted to be speaking under your chairmanship, Mr Leigh, and I congratulate the hon. Member for Inverclyde
(David Cairns) on obtaining this timely debate on world AIDS day. What is good about the debate is the unanimity between the parties. We often have heated debates, but we all appreciate the importance of today's debate for people suffering from HIV/AIDS.
Now that the recent tough economic choices have been laid on the table, we are able to take an opportunity to review what is and is not working in the UK and try to make improvements. HIV/AIDS is a serious virus that poses a risk not only for those who are already suffering from it but also those around them. The ease of transmission of the disease means that, if we do not bring the number who have it back down from 83,000 or so, we run the possibility of letting the virus dictate our actions, instead of taking pre-emptive measures. Unfortunately, as a member of the Select Committee on International Development, I have seen at first hand that once the virus gets into sections of society where it becomes more prevalent, it can, left unchecked, destroy countless lives and families.
Britain is a world-leader in international development, and central in the international community's voice and actions against HIV/AIDS worldwide. However, to be a credible voice and to make an inroad into the virus worldwide we need a credible tactic of beating the virus at home. Funding has been flatlining in recent years and we risk, if we are not careful, losing more than two decades of progress that has been made in fighting the epidemic.
The White Paper offers more flexibility to the health service, by offering GPs more control over the budgets that they inherit and how they spend the money allocated to them. Perhaps outlining the financial rewards of early screening will help to strengthen the argument. The Health Protection Agency recently estimated that the prevention of one new HIV infection saves the public purse between £280,000 and £360,000 in direct lifetime health care costs. That is a staggering amount per new diagnosed case. In 2008, had all of the UK's 3,550 acquired infections been prevented it would have saved approximately £1.1 billion in direct health care costs.
Alternatively, we can look at the money that could be made, not saved, by early diagnosis. People living with HIV who have an early diagnosis can contribute wealth to the nation by staying in work for longer and therefore paying more in taxes; they are able to manage their health better, which results in their taking fewer days off sick. They can plan for their financial future so as not to require incapacity benefit in such large numbers, and by having quick access to antiretroviral drugs they can ensure that they do not require full-time carers, who are often family members, for so long. Their family can therefore go out and work and contribute to the national purse.
Of course, financial reward is not the only benefit of diagnosing HIV early. The significant social benefits to early diagnosis are equally if not more important. For instance, a 35-year-old male diagnosed early with HIV, and with quick access to antiretroviral therapy, would now be expected to live to 72-only a few years less than someone who would be deemed a perfectly healthy man.
Early diagnosis enables people who are HIV-positive to take positive steps in protecting others through safe sex. A recent study of newly diagnosed HIV-positive
men who have sex with men reported that 76% had eliminated the risk of onward transmission three months after diagnosis. If the test comes back negative, of course, it allows the recipient a wake-up call and a chance to change their habits and think about the risks that they have been taking. In that way they are more than likely to help to prevent a future case of HIV in the UK.
Early diagnosis also allows the correct antiretroviral drugs to be prescribed. That in turn reduces the viral load and subsequently reduces the chances of transmitting HIV. By giving people the opportunity to take quick and effective measures against the virus we are putting them back in charge of their lives; they are not having their lives dictated by HIV. I should like the Minister to take note that women, and indeed men, who have been raped should automatically be monitored to ensure that if they suffer from HIV/AIDS it will be diagnosed extremely early; that is not something that they have chosen.
The truth of the matter is that the male gay community and the black African community are most susceptible to HIV infection owing to cultural sexual practice. There is a role for civil society in bringing UK levels of HIV down by bringing early diagnosis to those groups and deconstructing the stigma attached to screening for the virus. Everyone gets scared, intimidated and embarrassed from time to time and those natural feelings might be a barrier, preventing people in those at-risk communities from seeking early diagnosis.
Coming out of the financial turmoil of the past few years, it is important that we should take every opportunity that is given to us to make positive changes to the previous norm. We have the opportunity to put early screening at the heart of the public health White Paper and to create a social practice in which the stigma of screening is broken down through the participation of civil society. However, I believe that there is only one mention of HIV/AIDS in the White Paper. I simply ask that we do not let the opportunity slip away. Positive changes to the current HIV strategy can and should be made: most importantly, they need to be made.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab): I am pleased to have the opportunity to speak in this important debate on world AIDS day, and I congratulate my hon. Friend the Member for Inverclyde (David Cairns) on securing the debate.
Let us remember that some people who are suffering from HIV/AIDS, or suspect that they are, will have supportive partners, be in supportive communities and face the future with some positivity. Many, however, will be very frightened and very alone. It is a good thing that we in this Chamber can openly debate this issue and its ramifications, because it will reassure not just communities, activists and lobbyists but individuals who may read and see the debate this afternoon.
We must remember that we have moved some way since the early frightening adverts in the 1980s. No one who saw those adverts, with the tombstones collapsing and the voice of doom, has ever forgotten them. We should congratulate Norman Fowler on taking up the cause and using the power of his Department to put it in front of the public.
When we look at some of the indices around HIV/AIDS, we see that there has been an increase in HIV testing among gay men. Testing rose from 58% in 1997 to 72% in 2008. We have seen a plateau in new diagnoses among gay men, and we now see a consistently high rate of condom use among them-at least nine out of 10 now use condoms. The fact that we have seen such progress is partly a tribute to the people who took up the issue all those years ago. It is also a continuing tribute to the communities, activists and health providers who provide both care and commitment, and we need to acknowledge that today in this debate.
However, there is still some way to go. How we go forward on HIV/AIDS will be a test of the reorganisation of both the NHS and public health that has been announced in recent months. In principle, I do not think that anyone in this Chamber is opposed to the reorganisation, but it is just this sort of issue, which is not consistent across the country, that is not necessarily well represented in GPs' lists and has different levels of information across the country; there may not be as much information in rural areas as there is in Brighton and London. That will be a test of the reorganisation's effectiveness.
We know that AIDS can affect anyone, and that apart from the gay community the largest community affected by HIV/AIDS is that made up of black African men and women; currently, 38% of new HIV diagnosis is among that group. The stigma attached to HIV in that community cannot be overstated, and it very much hampers efforts to reach out to people and achieve early diagnosis.
The problem among black African men and women-and among other groups, as well-is that they present late and are therefore diagnosed late. That not only gives them a poor prognosis; it means that the cost of treatment is much more expensive than it need be. That is true of any individual or any group that presents late.
Another issue with black African men is that, even though they may be having sex with men, they refuse to consider themselves as gay. They think that HIV is something for the gay community and not for them, so they end up presenting very late indeed. They are more likely to be undiagnosed and to live in areas in which a relatively high proportion of the population are not on their GP's list, so they are not really interacting with the authorities.
I should like to use this debate to stress the importance of educational and informative work generally and with the black and African community in particular. We must do more with the Churches, because that is probably the most effective way to reach those groups. Any Sunday morning, there will more people in African-led churches in Hackney than at any political party meetings for 12 months of the year.
We need to normalise testing and offer it in a much wider range of settings-not just for black and African men and women, but for the population as a whole. I was routinely tested when I had my son 19 years ago and thought nothing of it. We need to make testing more routine so that people do not think, "If I go for this test, it will badge me as someone at risk." Universal testing may well be a step too far, but we need to make testing available in a wider range of contexts.
My hon. Friend the Member for Inverclyde said that he did not want to talk about international issues, but given that 38% of new HIV diagnosis is among black African men and women, I do not apologise for raising the issue of funds for the Global Fund to fight AIDS, Tuberculosis and Malaria. I know that that is not a matter for the Minister and I do not expect her to respond on the specific point. None the less, will she pass on to her colleagues the very concerning fact that the global fund is £13 billion short of what it needs? If the UK was to raise its pledged amount in line with France and other western European countries, the fund would be able to go to private sector donors such as the Gates Foundation and reach the amount of money it needs.
In that context, I should like to mention-again, I do not expect the Minister to respond on this point-that in the next few weeks we will have EU trade talks with India in Brussels. There is a great concern that as a consequence of the trade talks, India might not be able to produce the cheap generic drugs that have played such a huge role in the fight against AIDS in Africa. That would be a blow not so much for Indian industry, but for the millions of people in Africa who have benefited from access to cheap generic drugs.
HIV/AIDS is no longer a death sentence, which is good news. Thanks to new drugs, research and greater understanding, people are now living with HIV. As one of my hon. Friends said earlier, we have 65,390 people in the community living with HIV. In fact, it is increasing faster among the over-50s than among any other group, which raises new issues that were not considered in the era of the adverts with the crashing tombstones and the voice from above.
My hon. Friend the Member for Ealing, Southall (Mr Sharma) mentioned the issue of depression and how that interconnects with sufferers of HIV/AIDS and the support that they need in relation to that. There are ongoing concerns about care and support that were not an issue 20 years ago. If we are to offer sufferers from HIV/AIDS equity of health care and, as far as possible, a good quality of life, we must consider care and support, within the new health service and local authority structures, as we have not in the past.
As I said at the start of my remarks, the reorganisation of the commissioning of health care and of the public health service will be tested by this issue. Many ordinary people on the ground will judge the reorganisation by how issues such as this are dealt with. I stress, as my hon. Friends have stressed, the importance of a national strategy. We need to consider how it can go forward under the new arrangements. Will the Minister tell us who will be responsible for commissioning and funding the information work that is needed now more than ever-in particular, the specific education work that goes into the communities that I have mentioned? Who will be responsible for commissioning preventive work, care, treatment and support? I will listen with interest to the Minister's responses to those questions.
I welcome the new public health arrangements in principle. Public health has been a core activity of local government since the 19th century and so, as a former local councillor, I am glad that public health has "come home" to local authorities. However, because I know
local authorities and how they work, I want to be convinced that it is possible effectively to ring-fence the public health funds that they will receive.
I imagine that what some local authorities will do-or will be tempted to do, conceiving themselves to be under financial pressure-is to rebadge existing work in the areas of social care and environmental health as public health expenditure, and the new funds that all of us in Westminster Hall imagine are there for public health will melt away in the current climate. So this will be a test, as much as anything else, of how far it is possible effectively to ring-fence public health funds once they fall to local authorities.
Then there is GP commissioning, and the issue of HIV/AIDS will be a test of that system. The important thing with GP commissioning is that GPs should commission for their community and not for their list. As an east end Member of Parliament, I know that there are many public health issues that manifest themselves more extensively among people who are not actually on GPs' lists, for a whole number of reasons. Tuberculosis is a case in point. A disproportionately high number of people who suffer from TB are not on a GP's list, for a number of reasons. HIV will be a test of the extent to which GP commissioning consortiums will commission for the community as a whole and not just for the people who are on GPs' lists and present themselves for treatment.
It will be important to know what will happen to some of the survey work that is carried out by organisations such as the London Health Observatory; I had a meeting with representatives of that organisation this morning. That survey work is the only way of seeing what the trends are in issues such as HIV. It is easy for us to say this afternoon that 43% of HIV/AIDS sufferers are in London, many more are in Brighton and so on. However, we live in a globalised environment and there are trends and changes. Only survey work-not only national survey work, but sometimes precise survey work-can track what is really happening with HIV/AIDS.
Jim Shannon (Strangford) (DUP): I understand that some of the figures that have been released in the past year for those who have just been diagnosed with HIV show that it is not just a young person's disease any more; it also affects those who are 50-plus or 55-plus. I wonder whether the hon. Lady is aware of that. If she is, what does she feel should be done to address that issue of those in an older age bracket who are now succumbing to the disease?
In conclusion, I congratulate all those who have campaigned, worked and raised consciousness on this issue over 20-odd years. Improvements have been made, partly through the efforts of communities and campaigners and partly through the commitment
of people in the House, but we face new challenges due to the reorganisation of the NHS and the fact that a generation of people are now living with AIDS.
I look to the Minister to answer some of the questions asked in this debate, particularly about how the reorganisation will affect the treatment of HIV/AIDS, and to reassure us that the information needed in a range of communities will be publicised. I will listen with interest to her response.
The Parliamentary Under-Secretary of State for Health (Anne Milton): It is a pleasure to serve under your chairmanship, Mr Leigh; I do not believe that I have been in this position before. I am grateful to the hon. Member for Inverclyde (David Cairns) for securing this debate. I congratulate him on his chairmanship of the all-party parliamentary group on HIV and AIDS, and I congratulate the group itself on continuing to raise awareness in Parliament, in the UK and internationally.
Today, as we all know, is world AIDS day, so this debate is timely; I believe that Mr Speaker has some influence over when debates occur. It is an opportunity to reflect on what we have achieved, where we stand and the challenges ahead, many of which have been mentioned. I thank my hon. Friend the Member for Pudsey (Stuart Andrew) for his gracious comment that this is a chance for us to pay tribute to those whom we have lost along the way to the present improvements in life expectancy for those with HIV/AIDS. A dear friend, Eric, with whom I worked in the 1980s, died from AIDS; I am sure that many of us know people who lost their lives. It is so tragic when we consider the advances made.
The hon. Member for Inverclyde focused on the situation in the UK. The hon. Member for Hackney North and Stoke Newington (Ms Abbott) mentioned the global situation. It is important to note that the number of new infections decreased by 19% between 2009 and 2001. Today, more than 5 million people have access to life-saving antiretrovirals. That is more than a thirteenfold increase in five years, but significant challenges remain. More than 33 million people are living with HIV, 2.1 million children are infected and the World Health Organisation estimates that at least 10 million people still need treatment. There is a great deal more to be done, and no room for complacency.
I would like to mention my noble Friend Lord Fowler, and welcome the announcement of next year's inquiry into HIV and AIDS. Like the hon. Member for Inverclyde, I am old enough to remember when the disease came on the scene. A great friend of mine, a professor of virology who went over to the States, came back and said that it was extraordinary to see an acquired deficiency, as the disease's name suggests. He talked about a curious illness that people were getting.
At that time, a tremendous amount of work was being done by many people, not least my noble Friend, to fight HIV/AIDS. It is still a powerful model for public health campaigns; we cannot forget those tombstones. Such images enabled a lot of the preventive work from which we still benefit. I reassure the hon. Member for Inverclyde that mass communication had an effect. The rate of sexually transmitted diseases decreased across the board. However, he also mentioned targeted messages, which is where we need to focus our efforts.
Although prevalence is relatively low in the UK population as a whole, some groups are disproportionately affected, including men who have sex with men, and black African communities. In 2009, they accounted for 42% and 36% respectively of the 65,000 individuals living with diagnosed HIV infection. However, as my hon. Friend the Member for Hove (Mike Weatherley) rightly pointed out, stereotypes are dangerous, and the figures that I have quoted must be used with caution.
Anne Milton: My hon. Friend the Member for Hove also mentioned the specific problems with late diagnosis, which I shall return to. The outlook for most people with HIV in the UK is more positive than it used to be, and the vast majority can now plan for their future with a great deal more certainty, which is to be welcomed. We must not forget that we have the dedicated work of many scientists around the world to thank for that, along with action from Governments from both sides of the House.
However, challenges remain. As Members have pointed out, despite our successes, a quarter of people with HIV do not know that they are infected and so are unable to benefit from the treatment available, and they can unwittingly infect others. Around half of the newly diagnosed infections are diagnosed late, after the point at which people should have started treatment. The hon. Member for Ealing, Southall (Mr Sharma) raised that as an ongoing and growing problem, along with the fact that many of the people affected have serious mental health problems. The mental health and well-being of people with HIV and AIDS is seldom mentioned, but it is extremely important to recognise.
I share the concerns raised in the debate about the need to reduce the number of people with HIV who are undiagnosed or diagnosed late. We need to increase testing, especially in those areas that have a higher prevalence of HIV. We have seen a good uptake of HIV testing in sexual health clinics and antenatal settings, but all health care professionals need to be alert to the importance of offering appropriate HIV tests.
Anne Milton: I thank the hon. Lady for raising that point, which is important. I will return to it later in my remarks. The hon. Member for Cardiff Central (Jenny Willott) mentioned the automatic testing when she had her baby. The Department of Health has funded eight pilot projects, which have now been completed, that looked at the feasibility and, importantly, acceptability of providing an HIV test as part of routine services offered to newly registered adults. I am encouraged by the findings from those projects, which confirm that offering HIV tests in GP practices, hospitals and community settings is acceptable to patients.
The pilots picked up a significant number of previously undiagnosed people in high prevalence areas. It is good news that people are happy to be tested, because it means that we can pick up cases of HIV that would otherwise be missed. We are working on the best approaches to expand HIV testing in a variety of settings and, as the hon. Member for Hackney North and Stoke Newington said, that is really important. If a wide variety of settings was available, a GP practice is not necessarily where people would go for a test-far from it, I would say.
I am also pleased to note that, thanks to the leadership and drive of local HIV clinicians and others, findings from the pilots in Brighton, Lewisham and Leicester have now been embedded in local practice, which is to be congratulated. The Health Protection Agency will publish its final report on the pilots early next year, which many people will look forward to seeing. We need to see what we can do to put into practice what we have learnt. It is vital to increase testing for HIV, as it is for a number of sexually transmitted diseases, so we continue to fund targeted programmes for the groups most at risk from HIV in the UK. We have also funded the Medical Foundation for AIDS and Sexual Health to provide training resources for health care professionals in secondary care.
I would like to thank the hon. Member for Dudley North (Ian Austin), who kindly sent me a note to explain that he has had to leave the debate, for raising the work of Summit House Support. We will be looking at the findings of the pilots I have mentioned, and I would certainly not like to miss an opportunity to go to Dudley, should the opportunity arise, to have a look at what Summit House Support is doing.
For HIV, as for all STIs, prevention remains the most important response. In the UK, the majority of HIV infections are sexually transmitted, and the vast majority of those could have been prevented; that is a message that we really must hang on to.
I think that we also have to clamp down a bit on irresponsible marketing. I have been approached by those who are unhappy about the promotion of DVDs and other material promoting "bareback" sex. We need to address such issues and I know that a lot of people and organisations, such as the Terrence Higgins Trust, are doing all they can to stop the promotion of such material. To those who are most at risk of HIV in the UK, I say that the Government work very closely in partnership with the Terrence Higgins Trust, the African Health Network and a huge number of other voluntary and community groups.
Yesterday, we published a White Paper on public health and later this month we will publish a number of supporting documents, including a public health outcomes framework. We will be thinking about what the best outcomes might be for HIV and they will be included in
that document. I know that Members will look at that document with care and feed back to us their feelings on it. In the spring, we will publish a position paper on sexual health which will, of course, include HIV. That paper will take into account many of the issues that have emerged this afternoon.
David Cairns: I will let the Minister catch her breath and I appreciate that we are really up against the clock. She says that there will be a position paper in the spring. Does she envisage that that will lead to a full new HIV strategy, or will it just remain a position paper?
Anne Milton: No, it will be a sexual health strategy. The Government and the NHS need to play their part, and we need to support individuals to make responsible lifestyle choices. We continue to provide the very best HIV treatment services, but others have a role to play and they are often better placed than the Government to make a difference. The hon. Member for Hackney North and Stoke Newington mentioned the role of churches in that regard and they can have a significant impact.
Voluntary community groups, industry, responsible media, churches and faith groups all have a part to play. That collaboration is so important in tackling stigma and discrimination, which is still a very real issue for many people affected by HIV. That is particularly important within those communities who find sexual health issues more challenging than other communities.
Stigma means that people refuse tests, do not take precautions and do not go for treatment. I was delighted to see that the Prime Minister highlighted the issue of stigma in his world AIDS day podcast. Tackling HIV is everyone's business and we can all make a difference to reduce stigma, reduce new infections and enable people living with HIV to lead full and productive lives.
The hon. Member for Inverclyde raised issues about global funds. I am sure that he will also raise those issues with my colleagues in the Department for International Development. However, as my ministerial brief also covers EU health, it may be of note for him to realise that such issues are recognised by many people within Europe and across the world, and we continue to work both nationally-within our own member states-and internationally, because collectively we can do a great deal to help each other.
The hon. Gentleman also said that generally a one-size-fits-all approach does not work and, as my hon. Friend the Member for Hove said, anonymous testing and treatment is often crucial. We will announce our commissioning intentions soon. However, the hon. Gentleman's point is well made.
I think that it was the hon. Member for Dumfries and Galloway (Mr Brown) who mentioned the issue of commissioning services in rural areas, which poses particular challenges and very real problems. It is absolutely crucial that we get that commissioning right. We will announce our intentions soon and I hope that they will address some of the points that he raised.
We need to talk about sex. We need to talk about people's sexual health. We need to talk about people's responsibilities in looking after their sexual health, and we all have something to offer and we all have something that we can do personally, particularly those of us who are Members of Parliament. As MPs, we have unprecedented access to media, particularly in our local areas. We need to do everything that we can to express the fact that this is everybody's business and that people need to take responsibility for their sexual health. Their sexual health not only affects them; it affects the others around them and their families too. Only then will we be able to see a future for people living with HIV/AIDS that we all want to see.
Mr Tom Watson (West Bromwich East) (Lab): It is a pleasure to serve under your chairmanship, Mr Leigh. You remain the fastest voter I have ever seen, so if there is another Division I will attempt to keep up with you.
"the second biggest threat to our infrastructure after terrorism".
Those are the words that Paul Crowther, of the British Transport police, used to describe the growing problem of metal theft in the UK. It is my contention that, if al-Qaeda or militant student demonstrators perpetrated some of the attacks to critical UK infrastructure on the scale and frequency that we are currently seeing, the Home Office would be taking this matter far more seriously than it currently appears to be taking it.
Mr Watson: Whether it is copper from the side of a railway line, broadband cable, a drain gully or lead flashing from a school roof, not a day goes by when metal theft does not feature in the daily crime roster for police in the UK's towns and cities. I seek to make the case to the Minister that metal theft is a national problem needing urgent attention. It is eroding our critical infrastructure and therefore the economic capacity of the nation. After outlining the issues, I will make the case for the need to collect more accurate data on metal theft incidents, for amending the Scrap Metal Dealers Act 1964 and for protecting uniformed British Transport police. I will also make the case for new regulations to deal with the rise of unscrupulous dealers in precious metals.
The Minister has gained a reputation for being hard-working and fair-minded. I hope to convince him to focus in the coming months on the increasing problem of metal theft. Many businesses and police officers to whom I have spoken are frustrated with the progress made in the past, including-dare I say?-under my own Government. Six months into the coalition Government, I hope that he has found his feet and will be able to move up a gear in that policy area.
The Home Office line appears to be that the police have the necessary tools and powers to tackle metal theft: I will make the case that they do not. The problem is great for two important reasons: soaring commodity prices and the ineffectiveness of the Scrap Metal Dealers Act 1964. In the past two years, for example, the price of refined copper has more than doubled on international markets. Part of the problem faced by the Minister is that his Department has found it difficult to understand the scale of the problem because it has not collected the appropriate data.
Using the Freedom of Information Act, I have undertaken a comprehensive assessment into the effects of metal theft in local authorities up and down the country in 2007, 2008 and 2009. It is not an exact picture, but it provides a more comprehensive view of the scale of misery caused by metal theft throughout the country. The results are shocking, but since a number
of authorities have not responded to my FOI request, I fear that my newly compiled figures are just the tip of the iceberg.
We found 1,873 reported instances of schools being targeted by metal thieves, predominantly for the lead from their roofs. We know that 185 leisure centres and 156 community centres have been targeted, as have-shockingly-71 cemeteries and crematoriums. Thirty-three local authorities told me that metal theft has cost them more than £100,000 in insurance claims and repair costs. My borough of Sandwell has suffered the highest losses of any authority-more than £720,000. It is closely followed by Leicester, which lost £530,000, and Greenwich, which lost more than £470,000.
Last October alone, Sandwell council lost £20,000. Such thefts have cost Sandwell, and councils in Birmingham, Wolverhampton and Walsall, nearly £1.6 million over the past three years. The scale is huge and it is getting bigger. It is not taking place just in the country's metal-bashing heartlands: the London boroughs of Greenwich, Sutton, Bexley, Bromley, Barking, Dagenham, Enfield, Havering and Redbridge estimate that between them, they have lost £1.9 million as a result of metal theft.
Anything can go. Three stainless steel slides were stolen from Birmingham, and the city also lost £30,000- worth of goal posts. Durham council raised 97 repair orders for its schools, and admitted that that may not even begin to dig into the problem. Sheffield lost a swimming pool roof that cost £200,000, and Thurrock council lost the eternal flame from the East Tilbury war memorial. The cost of replacement was so great that a fibreglass replica had to be made.
More worryingly, I have uncovered an increasing problem of thieves targeting our key infrastructure networks. The most recent police estimate of the cost of such thefts to communication, energy, transport and water industries is £770 million per annum. This year alone has seen more than 5,000 reported thefts from the railway, gas and electricity networks. Such thefts have resulted not only in the loss of services to vulnerable customers, but have included attacks on 999 services and communication services that are provided to the various police forces and military establishments.
In the past six months, BT has seen more than 900 attacks on its network, which has affected more than 100,000 customers. It has lost more than £5 million in the past year, and on current trends, it looks as if it will lose £6 million in the current financial year. In one attack in Scotland last week, 32 tonnes of copper cable were stolen in a single night. Energy company E.ON faces similar problems. Last year, substation theft cost the company £1.3 million, and by the end of May it had already seen 175 reported incidents. The figures speak for themselves. It is not just the monetary cost that is worrying, but the danger in which the thieves are putting both themselves and the engineers who work for companies such as BT and E.ON, through their illegal activities.
Today, Gwent police superintendent Harry Gamlin, head of the taskforce that deals with metal theft in Wales, said that the problem is now so bad that it threatens to "fracture social cohesion." He added:
"There is a common perception of metal thieves being loveable rogues, old-man-Steptoe-type characters...People need to wake up to the fact that they are in fact highly organised and skilled gangs of criminals who more than likely have links to other forms of serious and organised crime."
It is not just the seasonal "wrong type of snow" and leaves on the track that are holding up our train network: commuters now have to contend with the regular misery of year-round signalling thefts. Network Rail tells me that commuters and operators have lost 19,417 hours in delays since 2006-07. Overall, it estimates that it has spent £35 million since then on metal theft-related crime. That includes £25 million of schedule 8 costs. That is £25 million that could have been spent on improving the railway network that has been diverted to essential maintenance because of metal theft alone.
I travel to Westminster from Sandwell and Dudley station every week. Between September 2009 and this October there have been five serious incidents of cable theft in the Tipton area alone and I have been late for meetings and nearly missed votes. These incidents in Tipton caused £485,000 worth of damage to the rail network causing hundreds of hours of delays for commuters. I find these figures staggering. Across the whole of the west midlands in the last 18 months there have been 52 cable thefts on the railway causing 1,500 trains to be cancelled. I am told by Network Rail that the route between London and Scotland up the east coast is by the far the worst affected, especially in Yorkshire and the north-east. That route has recorded days on which up to 40 thefts have taken place. Commuters and British business are the people who are really losing out as metal theft soars.
I have unearthed other examples that are shocking in their scale and audacity. There are the thieves who cut a heavy copper cable used to link an MRI scanner to the main electricity supply in Northamptonshire. Thieves stole cable twice in a week meaning 70 patients had to have their diagnostic appointments rearranged. Lives could have been lost. I have been told of the sick thieves who stole two brass plaques listing the names of the Blackley men who fell during the first world war in Manchester. The community had to unite to make sure that the 215 war heroes could be honoured on Remembrance Sunday.
Just as sickening was Linda Smith's story. Linda contacted me to tell me about the theft of metal containers for holding flowers from graves from Abney park in Stoke Newington. The Minister may not be aware that the Ecclesiastical Insurance Group, the leading church insurers, report that they have received more than 7,000 claims for metal theft since the start of 2007 at an estimated total cost of £23 million.
Councillor David Sheard of Kirklees council has been in touch. He told me about the £18,000 worth of litter bins that had been stolen from the council in a single week. The case of Tom Berge who escaped a jail sentence for stealing lead worth £100,000 from some of the most historic properties in Sutton in Croydon has also been brought to my attention. He used Google Earth to identify listed buildings, churches and schools that he could target. In Sandwell, two people have already lost their lives trying to steal cabling from a disused factory after an explosion.
Five-year-old Keanu Jones of Dudley road in Tipton could so nearly have been the third life lost last week. He fell down an exposed drain when out with his mum. The cover had been stolen. It left him shaken and covered in bruises. Keanu's case is important. It highlights
the fact that thieves do not just target high-value, precious and commodity metals. The resale value of what can be stolen can often be minimal. To quote Tony Glover, spokesman of the Energy Networks Association:
"It is pathetic, quite frankly. As a crime it is sometimes as little as £5, £10 or £20... But its impact is enormous-it's almost like an act of vandalism. Some of our equipment is oil-insulated and a £5 brass valve-that's all they stole- resulted in 30,000 litres of oil coming out of some equipment."
Just to illustrate the point, this week I was visited by my constituent Ravi Kumar who told me that thieves had stolen his old, rusty metal table from his front garden. Ravi had put the table out for collection by Sandwell council. Thieves looking to make a quick cash return made off with the table before the council van arrived. There is a black market price list for this stuff-£10 for Ravi's table, £20 for a stolen manhole cover, £80 for a catalytic converter. These items are being stolen because they are easy prey to thieves to sell on to rogue scrap metal dealers.
More worryingly, West Midlands police and the Black Country chamber of commerce continue to alert me to the rise in the number of burglary dwelling offences across the country in which the offenders are stealing the victim's gold or silver jewellery. There is currently no legislation covering the buying and selling of gold and silver by independent retailers, which are becoming increasingly common in most towns and cities. Despite some franchises still following good practice, in which no transaction can take place without a series of identity checks, some of the rogues are beginning to make an impact on communities.
I would like to see two minor changes to the law to tackle the problems that I have outlined. One change would deal with commodity metals such as copper, lead and brass, and the second change would deal with precious metals such as gold and silver. The Scrap Metal Dealers Act 1964 needs to be made fit for the modern age. It is outdated; it is not well understood, and, in its current form, it simply fails in its purpose.
Many hon. Members may not be aware of the legislation to which I refer. As it stands, the Act requires dealers to keep a simple book detailing all scrap metal received at the place of purchase. The book must also show that all scrap metal is either processed at or dispatched from that place. That is inadequate.
In the Sandwell area, and across the country, I repeatedly hear stories of some unscrupulous scrap metal dealers opening as early as 5 am. Cash in hand is given to the seller, and it is not unusual for them to turn up with a wheelie bin full of manhole covers. The unscrupulous scrap metal dealer, who does not check too closely where the metal has come from or who the seller is, then sells it on to legitimate dealers, who have no idea that they are buying stolen metal. In some cases, the metal is exported to the far east due to global demand. Some dealers will let sellers get away with giving their name as Joe Bloggs or Mr Smith. Scrap metal is big business, and the record keeping among rogue dealers can be very poor or even non-existent. One police force has told me that records kept by metal merchants do not always provide them with a good enough audit trail to track back such thieves, and I know police forces across the country feel the same.
Although I appreciate that recent dialogue between the British Metals Recycling Association and ACPO has resulted in the development of a code of practice,
which includes measures that go beyond those prescribed by the 1964 Act-including requesting proof of identity, limits on cash payments and guidance on best practice for deploying CCTV-I have real doubts that those go far enough. Unscrupulous metal dealers have already made it clear that they are unwilling to abide by good practice, and a voluntary code is extremely unlikely to change the mindsets of those people in the industry. My preferred option would be to make scrap metal dealers operate under a cashless system. If thieves cannot make a quick profit, the incentive to steal in the first place would be dramatically reduced. I draw the Minister's attention to the state of Oregon, which did that in 2009. All the signs from Oregon suggest that the beefed-up regulations have caused a drop in the number of people looking to sell stolen materials. Many police forces are also seeking powers to close down suspected rogue dealers on the spot, and they want metal users to consider embossing their metal to make it less attractive to steal. I hope that the Minister will seek ways to make that happen.
It strikes me that there is a need for precious metals, such as gold and silver, to be brought within the scope of the 1964 Act. We cannot allow the situation to continue in which there is no legislation covering the buying and selling of such metals. The Black Country chamber of commerce tells me that it would like precious metal dealers to register their business with the local authority every three years; it would like to see registered dealers required to keep a written record at each precious metal store of all items received, processed and dispatched from that store; and it would like deeper proof of identity from those who sell precious metals. I support the Black Country chamber of commerce in its call, and I hope that the Minister will take its suggestions seriously.
Based on new figures that I have made public today, I believe that the Government should arrange for data on metal theft to be better collected and to be presented in a clearer format. The failures of local authorities and police forces to accurately chronicle every incident make contributions to public policy and finding solutions on this subject more difficult for Ministers and stakeholders. It is time for the courts to get tough. The Home Office should ask the Ministry of Justice to issue specific guidance on metal theft to magistrates, as the Ministry of Justice did with home repossessions.
Analysts tell me that they expect a 62% rise in copper prices over the next few years. Coupled with the Government's announced cuts to policing budgets and the fact that the future budget of the British Transport police is in doubt, that could see a further rise in metal thefts. If the UK adopted a cashless approach to scrap metal sales, I am certain that thieves would be deterred. There would simply be no quick cash incentive for them to steal commodity metals and there would be a proper audit trail. I hope that the Minister will look seriously at the proposals of the Black Country chamber of commerce on precious metals. Metal thieves erode UK resilience. They undermine communities and threaten businesses. They have to be stopped.
Mr Edward Leigh (in the Chair): Order. This is a short Adjournment debate. Does the Second Church Estates Commissioner, the hon. Member for Banbury (Tony Baldry), have the permission of the Minister and the hon. Gentleman to speak?
Tony Baldry: I sought the permission of everyone, Mr Leigh, including Mr Speaker. The hon. Member for West Bromwich East (Mr Watson) has done the House an enormous service and what he has had to say is truly shocking. I am grateful to him and to the Minister for allowing me to intervene briefly in this debate. I do so in my capacity as the Second Church Estates Commissioner.
Lead theft is one of the most serious threats at present to the Church of England's 1,600 churches, many of them grade I listed buildings. Indeed, 45% of all grade I listed buildings are churches, and other faiths have similar concerns. Night after night, lead is being stolen from church roofs, and thieves now use Google Earth to identify targets, including church roofs.
Since 2007, the main insurer of ecclesiastical churches has received 8,000 claims for lead theft, at a cost of about £23 million. That represents only the insurance claims; the total cost, including damage to churches, is much greater. In many instances, churches that have replaced their roofs at considerable expense have been repeatedly targeted-14 times, in the case of one church. Of course, if they have had the lead stripped from their roofs, it is often difficult, if not impossible, to get re-insured. As hon. Members can imagine, the effect on the morale of parishioners and communities is devastating.
In spite of that, there have been very few prosecutions. Congregations feel that the police regard metal theft as a victimless crime and that they are reluctant to investigate or take action, even when there is an established pattern of theft taking place on consecutive nights. I understand that the Home Office does not even record the theft of lead as a separate offence. Although some of the thefts may be opportunistic, there is growing evidence that organised gangs are involved, and the graph of the incidence of theft mirrors, with remarkable consistency, the price of lead on the world metal markets. The higher the price of lead, the more churches are stripped of it.
A number of things need to be done. Scrap metal yards need to be more regularly spot-checked by local authorities and the police. Local authorities have a responsibility to inspect the registers of scrap metal yards. The hon. Gentleman's suggestion of a cashless transaction is interesting, and I hope that the Minister will take it seriously. This is a crime that has to be taken seriously. I am sure that Home Office Ministers take it seriously and that they will ensure that it is consistently taken seriously by police forces and local authorities throughout the country.
The Church of England's Church Buildings Council, chaired by Anne Sloman, has set up a working group to address the problem urgently. It is taking evidence from police, scrap metal merchants, the legal profession and other interested parties. When it reports early next year,
I hope that the Government will consider its conclusions carefully and endorse what it has to say as a way forward.
The Parliamentary Under-Secretary of State for the Home Department (James Brokenshire): May I thank you, Mr Leigh, for ensuring that this debate started promptly despite all of this afternoon's Divisions? May I also congratulate the hon. Member for West Bromwich East (Mr Watson) on securing this Adjournment debate about the important subject of preventing and tackling metal theft, and on the measured and detailed way in which he has rightly highlighted the issues? I am sure that the House will appreciate the information that the hon. Gentleman has advanced. I assure him that I regard the issue as serious. I take a personal interest in it because of my own experiences as a constituency MP. I know the impact that metal thefts can have.
May I also thank the Second Church Estates Commissioner, my hon. Friend the Member for Banbury (Tony Baldry), for his speech on churches and the challenges facing the Church community? I hope that I will be able to comment on that in the time remaining.
Metal theft is an issue about which I am concerned, and I give the assurance that the Government take it seriously. The need to reduce this crime is important, and I thank hon. Members for raising the issue. Let me be clear: we recognise the serious consequences of metal theft. It is not a victimless crime. We have seen the significant disruption that metal theft causes to critical national infrastructure throughout the United Kingdom. That includes power and transport networks, with the stealing of live copper cable, which has resulted in death and serious injury for people involved.
In addition, as hon. Members highlighted, a number of historic buildings, including churches, are being targeted for their lead roofs and damaged. Many other examples were given, but the time available means that I must try to deal with the relevant points that have been highlighted this afternoon.
I recognise that the constituency of the hon. Member for West Bromwich East has a specific issue. I was recently in Sandwell, talking to the community safety partnership and the police. They underlined to me the importance that they place on dealing with and responding to metal theft. I congratulate them on the work that they are doing in dealing with the problem.
The police, other law enforcement agencies and industry are making efforts to tackle metal theft, providing a strong foundation on which to build a future partnership approach. There are excellent examples of effective multi-agency partnerships that have come together in affected areas to tackle their local metal theft problem. I am keen to ensure that the practical impact of that work, which shows how much difference can be made by motivated and committed partnerships that take the problem seriously, is shared more widely. We need to build on it. Many scrap metal dealers are doing excellent work in supporting law enforcement activity and reporting suspicious behaviour. We need to support their efforts, while bearing down on those who operate outside the law.
At national level, the Association of Chief Police Officers metal theft working group, chaired by Deputy Chief Constable Paul Crowther, provides leadership to
police forces and a forum in which industry and the police can share information and good practice, which is extremely valuable work. I welcome the recent distribution of the ACPO tactical guidance to police forces. That provides, in clear detail, examples of effective practice in tackling metal theft.
The nature of metal theft means that joint working is just as important at national level as at local level. That is why the recent work by the telecommunications and utilities industries, in working on joint enforcement operations with local police forces, is so important.
I particularly welcome the efforts of industry in designing out this crime. For example, BT has been working to improve the protection of metal assets through improved security at storage sites. There are other examples of industry partners reviewing and tightening up their planned disposal of waste metal through the use of approved contractors and scrap metal dealers.
On the Scrap Metal Dealers Act 1964, I am grateful to the hon. Gentleman for bringing to the House's attention the issue regarding the effectiveness of the existing legislation. The Act contains a number of requirements relating to the regulation of the scrap metal dealer industry-namely, the requirement for each dealer to register with their local authority; the fact that all seller details are to be recorded; and the fact that metal cannot be accepted for sale from the under-16s. We have seen excellent examples in Avon and Somerset and elsewhere of how the existing legislation can be used.
I note and welcome the British Metals Recycling Association code of practice, which it has recently issued to its members and to which the hon. Gentleman referred. However, although we welcome such attempts at self-regulation, we are also seeking to join up the existing regulatory framework better by contributing to the Department for Environment, Food and Rural Affairs review of waste policies-due to report in the summer of next year-to see what changes, if any, need to be made to legislation in this area.
Environmental and waste regulations cover the operation of the scrap metal dealer industry, as well as the transportation and storage of waste materials. Those regulations are mostly enforced by the Environment Agency. Therefore, it is vital that the police and the Environment Agency continue to work together to ensure that all the existing legislation is used effectively.
The hon. Gentleman will no doubt appreciate that the lead on funding for the British Transport police is the Department for Transport, rather than the Home Office. I know that Westminster Hall debates are not the arena in which to make party political points about the economic situation, but I note what the hon. Gentleman said and I am sure that colleagues at the Department for Transport will note it when they refer to the report of the debate.
As the Minister responsible for crime prevention, I am determined to develop a joint plan of working with law enforcement agencies, Departments and industry to tackle metal theft at every stage, from theft to disposal. Because joint working is so important, I want the plan to be jointly owned by the Home Office and the Association of Chief Police Officers multi-agency metal theft working group. We also need to consider the intelligence arena. We are looking at how regional intelligence units can
share intelligence effectively on the more serious organised thefts of metal. That is an important subject that needs further examination.
On the cashless model, I share the concern that criminals are able to turn up at scrap-metal yards and walk away with unlimited sums of cash in exchange for metal. We will examine that in developing our work plan in this arena, including establishing a cashless model. As part of a review of the industry standards, it requires further examination.
I believe that the Church Buildings Council is producing a report on metal theft, and I would welcome sight of the report once it is complete. I hope that we will be able to incorporate its recommendations, when appropriate, in our forthcoming work plan.
I apologise that my comments have been so brief, but I reiterate the importance that I place on this matter. We are committed to preventing and tackling metal theft. I am certain that we have a real opportunity to tackle this crime by working together in partnership with law enforcement agencies and the industry. By working together and having a joint working plan, I am sure that we will be able to tackle all aspects of metal theft and provide the catalyst for a concerted effort by all agencies to reduce this crime.
More than 800,000 people are fortunate enough to live in our beautiful part of the country, the North Yorkshire and York region. It is part of God's own county, as some would say. Quality of local health care is of the utmost importance to many, if not all. Local health care provision is often viewed alongside other criteria such as employment and crime. It is a measure of the local community's economic well-being and happiness-a word that seems to be floating around in many debates at the moment.
It is in our moral and economic interests to ensure the widest availability of health services, the shortest waiting lists and the most impressive health outcomes, and they should be implemented in each and every region. Ensuring such health care standards for all is truly one of the most essential roles of Government. Indeed, I am sure that all those Members here today will agree that health-related concerns crop up frequently in our constituency mail. That is certainly so in my constituency of York Outer.
When it comes to health, I often have nothing but sympathy with the majority of my constituents who are affected. Many of them feel betrayed by the system, weighed down by the bureaucracy, frustrated by the delays and ultimately let down by those supposedly in charge. In my experience, it is easy to comprehend such frustration. After all, our national health service is a national treasure. We champion it, and rightly so. However, when patients report negative experiences and local health funding concerns, our national treasure is in danger of being tarnished, to the detriment of health care users and service deliverers. That, in my view, should not be allowed to happen.
The health service has some of the most caring, compassionate and hard-working nurses and doctors in the world. That is certainly true in North Yorkshire and York. Our health care personnel carry out tremendous work, often in tough circumstances, and they do so out of a sense of public duty, kindness and compassion. I cannot commend these individuals highly enough. However, I am concerned about health care provision in North Yorkshire and York because of the representations that I have received from NHS employees and local patients.
The region faces some real health care difficulties. In truth, extremely serious concerns are growing about the capability and performance of the region's primary care trust and related bodies. Local residents have good reason to believe that a huge range of treatments will be withdrawn, if they have not been withdrawn already. For example, I have received letters regarding the future of IVF treatments, counselling services, broken voluntary sector contracts and the withdrawal of pain relief injections. It also appears that about £2 million will be cut from GPs' budgets for prescribing medications, and that some physio services are at risk.
Julian Smith (Skipton and Ripon) (Con):
I congratulate my hon. Friend on securing this debate. He might be about to discuss this, but my experience from my
constituency is that North Yorkshire and York PCT's way of dealing with voluntary organisations in the past few months has been a disgrace, breaching the voluntary compact between those organisations and the PCT. It has caused problems for those important parts of the big society that have been operating in North Yorkshire for so long.
Julian Sturdy: Absolutely. I agree entirely with my hon. Friend. The time limit given by the PCT to those voluntary organisations is despicable, and it has caused fear and concern in the sector. Not only that, if the organisations lose funding for six months, which might be seen as only a short period, the problem is that they might not start up again. That is my concern, and I will go on to discuss it in more detail.
Local residents have good reasons to believe that a huge range of treatments will be withdrawn, as I said. If the truth be told, the status quo is not only unacceptable but frightening, particularly for the most vulnerable members of our communities. Even describing the current situation as a postcode lottery is too generous. I fear that our patch is in danger of becoming an area of health deprivation.
Several different factors require deep consideration as we piece together this somewhat depressing picture. First, we must accept that the region has to some extent been underfunded in the past. Before 2008, the North Yorkshire and York PCT did not exist. Instead, four separate PCTs covered the area. Nevertheless, for the purposes of this debate, I have amalgamated funding data to show the PCT's current funding allocation and the annual figures stretching back to 2003-04. For 2010-11, our region's PCT received just over £1.1 billion, an allocation that places it in the lowly position of 140th out of 152 PCTs. From a starting point of 127th in 2003-04, it has dropped down the funding table each year. The current funding level is the lowest allocation per head of all Yorkshire and Humber PCTs.
PCT funding is currently allocated according to a complex funding formula, often referred to as the weighted capitation formula. In essence, the formula determines the target share of resources to which PCTs should theoretically be entitled, based on a broad range of criteria including population, the local cost of health care provision and the level of need and health inequality in the area. Unfortunately, most PCTs never receive an allocation equal to their deemed target share according to the formula. Rather, they move towards it over time, some faster than others.
Personally, I am slightly critical of the current formula. It often results in greater funding disparities between different regions, which provoke a profound sense of unfairness. Less deprived areas often seem to get a certain tag as well. For example, according to the formula, North Yorkshire and York does not have adequate need for additional resources, particularly compared to the needs of more urban areas such as Hull. I am not convinced that approaching regional health funding consideration with that mentality-judging whether areas are deprived enough-is a sufficiently robust methodology in current circumstances. We must look more deeply at the funding stream.
I agree that the funding shortfall has increased the strain on our local PCT and its ability to deliver the best possible health outcomes and equity access for local
residents. I would appreciate the Minister's comments on whether the coalition Government will review the funding formula at some future date. However, I also suggest that excusing our health care failings in our region on past funding alone would be somewhat naive. Over the past few years, North Yorkshire and York PCT has accumulated an overspend of some £17.9 million. Thus, despite the coalition's welcome commitment to protect the wider health budget, services are being cut in our region to pay for the fiscal irresponsibility of the PCT. Moreover, the PCT seems to be intent on resolving this deficit immediately because the previous Government imposed a statutory obligation on all primary care trusts to break even by the beginning of 2011. Such a target-focused piece of bureaucracy has now resulted in the PCT cutting too many services too quickly, possibly leading to a diminished health care package for our local residents.
I have already listed some of the services that are under threat of withdrawal. My hon. Friend the Member for Skipton and Ripon (Julian Smith) has named the services in the voluntary sector as well. I shall expand on a few examples. First, there is the withdrawal of the pain relief injections. As Members from neighbouring constituencies know-my hon. Friend the Member for Selby and Ainsty (Nigel Adams) has campaigned with me on this-the PCT's decision to restrict the provision of back pain relief injections has provoked a huge reaction from both patients and health care professionals alike.
Nigel Adams (Selby and Ainsty) (Con): I, too, congratulate my hon. Friend on securing this debate. I am not sure whether I should declare an interest, having received several back pain relief injections in the past. The injections are a big issue in the north Yorkshire area, as evidenced by the huge postbags that my hon. Friend and I receive, and we have spoken to the Secretary of State on the matter. Can my hon. Friend recall a discussion with the Secretary of State in which he said that one of his officials would look into the York PCT's interpretation of the NICE guidelines on back pain relief injections? Has he received any notification of those discussions or heard from the Secretary of State's office?
Julian Sturdy: My hon. Friend makes a valid point. We did indeed meet, and I have not yet received a response from the Secretary of State. I hope that the Minister will hear our message here and chase up that response, because it is important that we get an answer to our question.
My hon. Friend mentioned the back pain relief injections, and the issue is causing real concern among our constituents. Members of the public came to my last surgery to discuss the matter. The PCT, as my hon. Friend said, based its decision to cut back pain injections on its interpretation of the NICE guidelines. Unfortunately, almost every other PCT interprets the same guidelines in a different way. As such, countless local people are being forced to suffer enormous and unnecessary pain.
Alongside other hon. Members from the region, I have lobbied the Secretary of State. Campaign groups such as York and District Pain Management Support Group have been leading the way on this as well. I have
also received representations from concerned health professionals. Only last week, Dr Peter Toomey, a consultant anaesthetist at York hospital wrote to me, stating:
"I consider that the PCT have made serious errors of judgement in coming to their decision to restrict access to spinal injections for the relief of pain. The PCT will not reimburse York Hospital for any injection into any part of the spine for any diagnosis unless it has been approved by the PCT's Funding Request Panel."
We know-my hon. Friend the Member for Selby and Ainsty will back me up on this-that many people are being refused by that request panel. Dr Toomey and a number of his colleagues have fought hard to challenge the PCT's policy, but-alas-their medical expertise seems to have fallen upon deaf ears.
Patients and medical professionals are united in the view that this pain relief service should not have been withdrawn. It has been taken away for the wrong reasons and should be reinstated without delay. The withdrawal of such vital services is causing me great concern, as is the withdrawal of funding for numerous voluntary services. My hon. Friend the Member for Skipton and Ripon touched on that matter earlier. The York Council for Voluntary Service has been informed of a 37% in-year cut, which has been issued by the PCT with just one month's notice. Angela Harrison, the chief executive of the YCVS, summed up the whole situation quite aptly when she said:
"These cuts have already had a disastrous effect on front-line voluntary groups who serve some of the most vulnerable members of society. At the same time, the infrastructure groups who support them have had their funds withdrawn at very short notice, reducing their capacity at a time when it is most needed."
One specific voluntary case vividly highlights the poor management of the way the PCT has handled this situation. On 19 October, Yorkshire MESMAC received a letter from the PCT, informing the organisation that its contracted health care funding was to be withdrawn within one month. Such blunt and definitive notice is absolutely outrageous. Not only has an agreement been broken, but no consultation took place with the organisation, which-knowing the PCT's overspend-would have been happy to sit down and reach a more amicable agreement. As Tom Doyle, the director of Yorkshire MESMAC, said:
"I want to express my deep frustration at how the process has been handled, which was, in my opinion, unlawful, disrespectful and showing an arrogant disregard for the PCT's own agreements and processes."
On a wider note, the voluntary services budgets are expected to lead to a saving of some £150,000 for the PCT this year. Given that that is a small drop in the £17 million overspend, I would urge the PCT to look internally for structural and efficiency savings, rather than merely reducing the funding of voluntary groups, whose work often plays such as vital role in our health service. If our voluntary health services are forced to close, I predict that far greater numbers of patients will actually require more hospitalised, long-term and expensive treatments through the NHS, thus undermining the PCT's initial savings.
Due to the overspend and service reductions, there now exists a lack of trust in the PCT and a complete absence of confidence over its future intentions, and I
fear that local people are simply paying too high a price for that. In the long term, I am more optimistic about health care provision in north Yorkshire and York, largely due to the contents of the health White Paper. The localised drive to ensure that PCTs are, at some point, abolished altogether and replaced by GP-led commissioning bodies, which are influenced by local patients, is a measure that I wholeheartedly welcome.
At long last, local patients will have a say in their local services, holding the decision makers to account and freeing up our nurses, doctors and health providers from the red-tape that so often binds them and takes them away from the front line. I hope that the Minister can reassure me that the transition from PCTs to GP-led commissioning will be carried out swiftly to ensure that the interim transitional period will not see a lack of leadership or direction for local health care services-especially in our area.
I believe that the PCT will continue to operate until 2013, and I plead with the Minister to review to the situation in north Yorkshire and York in the meantime. Our constituents simply cannot afford to wait three years for the situation to be remedied. Most specifically, I would welcome any comments from the Minister on the previous Government's imposition of a statutory obligation on PCTs to break even by the end of this year. Could that deadline be extended to soften the blow of the cuts over a greater time period?
The people of north Yorkshire and York depend upon their health care services, and many are extremely worried at present. I hope that hon. Members from the region-I was going to say "regardless of political allegiances", but as we only have coalition Members here I will not say that. To give the hon. Member for York Central (Hugh Bayley) credit, he did say that he would try to be at the debate today.
We must protect the essential health care services and funding that our region deserves. I ask and urge hon. Members to fight and to campaign for that. We must ensure that, before GP-led commissioning starts, the PCT delivers the best service that it can within its budget. It must focus on service delivery and the outlying services to our communities, rather than cutting.
I hope that the Minister will give serious consideration to the issues that I have raised. I am grateful for his time. I know that it has been a hectic day thanks to the Divisions, but I am grateful to him for giving us the time, and I hope that he will give the matter serious consideration.
Andrew Jones (Harrogate and Knaresborough) (Con): I congratulate my hon. Friend the Member for York Outer (Julian Sturdy) on securing this important debate, and I add my support to his recognition of the excellent work that the health care professionals do in our area. He has highlighted that our health grant in North Yorkshire is low, which impacts on the services that we receive.
When facing the challenge of low funding, the PCT has to look hard at its priorities, particularly with regard to mental health services. I am always concerned about mental health provision, because I think that for far too long in our country it has been a bit of a Cinderella service. In my constituency, the community
mental service has closed the Hawthorn day unit, which was extremely popular with its service users and well respected across the community. It is claimed that the closure is temporary, but the reasons for its closure run on and on, and it seems endless.
While the excuses mount up, some of the most vulnerable people in my constituency-many of whom I have met-have seen their contact time with counsellors, or their time in respite care, decrease from three or four days a week to half an hour a fortnight. I am worried about the impact of the change on some of the most vulnerable members of the community. In some cases, those constituents have severe mental health problems and can periodically be a danger to themselves. I hope that our PCT will consider that and, even at this late stage, find a way to reopen the Hawthorn day unit at the earliest opportunity.
The Minister of State, Department of Health (Paul Burstow): I congratulate my hon. Friend the Member for York Outer (Julian Sturdy) on securing this debate, and I note the cross-party support that he has gained, with the arrival of the hon. Member for York Central (Hugh Bayley). I note the presence of my hon. Friends the Members for Skipton and Ripon (Julian Smith), for Selby and Ainsty (Nigel Adams) and for Scarborough and Whitby (Robert Goodwill), and I know that they are all interested in and concerned about the issues that my hon. Friend the Member for York Outer has raised. He has made a powerful case for why we need the radical reforms across the NHS to which the Government are committed.
Before I turn to the points that my hon. Friend has raised, I join him in praising the work of NHS staff across Yorkshire. They do an excellent job, often in the most trying circumstances, and he is right that the NHS is a national treasure. Our White Paper reforms are, first and foremost, about freeing those hard-working professionals from the bureaucracy that stands in the way of good patient care.
We will be cutting management costs by a third, moving decisions closer to patients through new GP consortiums and giving local councils more responsibility for the health of their communities. All those will help to create a more flexible, efficient, interconnected and accountable health service.
We are now entering a transition to the new system, which brings its own challenges for all parts of the NHS. The descriptions that my hon. Friend has given of circumstances in his constituency demonstrate the challenge that is exacerbated by the fragile state of the local NHS finances. The Government have inherited that fragility and they will have to address it.
I understand from the strategic health authority that the North Yorkshire and York PCT is likely to end the year with a significant deficit unless it takes drastic action of the sort that my hon. Friend has described, and to which others have referred in this debate. That process clearly involves some tough decisions, which will have a distressing impact on his constituents, and I will return to those in a moment. I want to answer his concerns about funding allocations for the NHS in that part of the country.
At present, as my hon. Friend has described, the NHS uses a funding formula based on objectives set by the previous Government and developed by the independent Advisory Committee on Resource Allocation. I know that one of the big frustrations for North Yorkshire is whether its rural nature is taken fully into account in the funding formula, and my hon. Friend has alluded to that. As a Government, we have asked for that formula to be examined. The Secretary of State has asked ACRA to review how NHS resources are distributed, and has explicitly requested that consideration be given to the issues that face rural communities.
Looking ahead, from 2013-14 we will have moved to the new system of the independent NHS commissioning board allocating resources to general practice consortiums. How it does that will be up to the commissioning board itself, but we are clear that it must do it fairly and consistently across the country. For places such as his constituency, my hon. Friend the Member for York Outer is right-real pace and purpose are vital to getting the NHS on to a more stable financial footing. I can assure him that we are keen to make fast progress on GP commissioning consortiums taking on responsibilities. In that regard, shadow allocations for GP consortiums will be published late next year for 2012-13, giving the new organisations the time and space to test financial plans before the full system goes live in 2013-14.
My hon. Friend asked whether GP consortiums would have to take on PCT debt. I have heard that anxiety expressed around the country. The NHS operating framework, which we will publish in a few weeks, will set out the rules on legacy debt to ensure that no debts carry forward into the new system. That is challenging, and we are keen to work through it effectively.
I shall now come back to the present and say a few words about the current financial position in North Yorkshire and York. The strategic health authority tells me that the local PCT has had a problematic financial history stretching back many years, which may be an understatement. [Interruption.] I can see colleagues nodding.
Over the past 12 months, its situation has deteriorated due to a number of factors, including a significant overspend on community services and the fact that its QIPP-quality, innovation, productivity and prevention-programme has not delivered the expected savings. As a result, the trust is having to take radical steps to put its finances in order, including temporary reductions to some non-urgent health services. I very much regret that.
I regret that the fragility of the organisation has placed my hon. Friend the Member for York Outer's constituents in a position where they face these service changes. I hope he will understand that it is not for me to give a running commentary on every aspect of what the PCT is doing. On the issues that he highlights-particularly about the QIPP programme implementation, which I have looked at carefully-there are lessons for how we ensure that we get a proper grip on financial management in local NHS organisations.
It is striking, for instance, that the neighbouring PCTs with similar populations to North Yorkshire and York's are not facing the same financial challenge, nor are they having to resort to the desperate actions that the trust is taking. My hon. Friend is right to say that
the trust should not seek excuses in how the funding formula works. None the less, we need to look at the formula.
Equally, it is important to bear in mind that the QIPP programme in North Yorkshire and York has not delivered. I understand that it set some ambitious and challenging plans; the problem was that the implementation has not been as robust as the plans. I understand that one issue appears to be a failure to bring on board the full range of stakeholders to deliver on the improvement plans. That is a significant failing, because where the PCT is doing that, the signs are extremely positive. For instance, local GPs are working with the trust on prescribing practices-together they are looking to cut costs by more than £1 million, while protecting quality and service. I highlight that because it shows the power of GPs in managing efficiencies, and is a sign of how our reforms will help in the future.
Perhaps most troubling of all is the fact that the PCT has slammed the brakes on funding for the voluntary sector in a way that may have serious consequences for the future. The PCT may, technically, be within its rights to give the minimum of notice to providers, but pulling the plug on small organisations with just a month's notice-or in some cases, less-is alien to the spirit of collaboration and partnership that we want the NHS to cultivate. As my hon. Friend the Member for Skipton and Ripon said, it seems to be against the notion of the compact.
There is an important general point here. As we move through transition there will be difficult choices, and the NHS needs to be clear about what it needs to protect and how best to maintain vital voluntary community services. Therefore, in response to this debate, I have asked the NHS chief executive, Sir David Nicholson, to consider how to ensure that local NHS organisations act responsibly towards voluntary sector organisations during any period of retrenchment. My hon. Friend is right: we need candour and early discussions. about where the cost pressures are in the system, because, given the opportunity, the voluntary sector can contribute to managing them.
Reference has been made to the issues of pain relief injections and of treating chronic back pain. The hon. Member for Selby and Ainsty (Nigel Adams) asked a question about the discussions that he has had with the Secretary of State, as did the hon. Gentleman who secured this debate. I am not cited in regard to those discussions, but I will undertake to ensure that we look very carefully at the issue and come back to both hon. Members who raised it, to satisfy them and ourselves that NICE guidance is being followed properly.
However, I believe that the PCT understands that its decision has affected a significant number of patients with chronic back pain, and that it has written to a number of those patients, commissioned a series of initiative clinics where patients are fully assessed and given new treatment options to manage their pain.
Nigel Adams: Just on that point, it is worth remarking that the reason given by the PCT for the withdrawal of the procedure is not a financial one, which is very difficult for colleagues to comprehend. Apparently, it is based on medical advice via the NICE guidelines, but the PCT seems to be the only one in the country that has adopted that stance. Does the Minister agree that that sort of logic is a perfect reason why our reforms must come through in terms of GP commissioning, so that decisions can be made by health professionals rather than bureaucrats?
Paul Burstow: There is no doubt in my mind that getting clinicians far more engaged in commissioning will be a key driver to a significant improvement in quality and outcomes in the system in future. I certainly undertake to ensure that we have a proper look at this issue of the guidance, and I will come back to both the hon. Gentleman and his hon. Friend, the hon. Member for York Outer, on that point.
I certainly share the belief that those reforms are needed to ensure that the NHS in north Yorkshire, and Yorkshire in general, moves in the positive direction that we all want to see it move in. Our proposals will bring the right leadership and purpose to sustain and improve the services that the constituents of the hon. Member for York Outer, and those of the other hon. Members who have come to support him in this debate, expect the NHS to deliver.
Decisions that are made much closer to the patient will ensure that health care is shaped in the best interests of the community and the general population. By introducing greater transparency and democratic accountability, we will ensure that the local NHS is far more answerable to the people whom it serves and that there will be much more scrutiny and community involvement in the decisions that it takes.
That is something that I am sure all hon. Members want to see. It is how we can move our NHS forward, maintaining it as a national treasure but one that really delivers the best possible outcomes-outcomes that are among the best in the world. That is what we really want to see.