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9 Feb 2011 : Column 77WH

Westminster Hall

Wednesday 9 February 2011

[Philip Davies in the Chair]

Neuromuscular Care (North-West)

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

9.30 am

Graham Evans (Weaver Vale) (Con): I thank Mr Speaker for allocating time for this important subject. I pay tribute to the excellent Muscular Dystrophy Campaign, which does such brilliant work in this field and has assisted me in preparing for the debate. This morning, I will bring to the attention of the Minister the significant gaps in specialist neuromuscular care services in the north-west region that many people living with muscular dystrophy and related neuromuscular conditions currently experience. Vital review work undertaken by the NHS North West specialised commissioning group in the past six months is encouraging, but families need to see it translated into real improvements to services. It also provides an opportunity to improve patient outcomes and to reduce the amount of money spent on unplanned emergency admissions to hospital for people in the north-west with neuromuscular conditions.

Let me briefly outline my personal connection to muscular dystrophy. I am 47 years old, and I had a cousin, Stephen Payne, who, if he was still alive today, would be of the same age. He was diagnosed with Duchenne muscular dystrophy at the age of six, and I remember the devastating effects that it had on our family. This was in the late 1960s, when not a lot was known about the condition. I remember my uncle, Mr Barrie Payne, taking his son to Harley street for a diagnosis. I am afraid to say that it was not good. None the less, Mr Barrie Payne is a fighter and a campaigner and he threw all his energies into fundraising to see if a cure could be found for Duchenne.

My very earliest memories, therefore, are of a family fighting and campaigning for a cure for that dreadful disease. I also have very early memories of politicians getting involved in this vital subject. I pay tribute to Lord Alf Morris of Manchester, who, at the time, was the MP for Wythenshawe. Coincidentally, Lord Morris's sister lived on my council estate, and I remember him driving to our estate in his Wolseley car. At the time, those cars were for very special people. He came to see my family when he visited his sister and I remember thinking at the time what a special man he was. In those days, in the '60s and '70s, it was thought that politicians could help ordinary people from working-class backgrounds such as mine. I remember so well the work that my family and Mr Morris did to get a change in legislation. I am pleased to say that Alf Morris was behind the Chronically Sick and Disabled Persons Act 1970, which was the first Act in the world to give rights to people with disabilities.

I did my best to raise money for the muscular dystrophy charity. I used to sell pens, pencils, rulers and pencil cases in my school yard at primary school. Imagine a
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head teacher allowing a child to go into school with a bag full of goods to sell for cash in these politically correct times. Coincidentally, my head teacher lived next door to my cousin, Stephen Payne, and at school fairs he used every opportunity to raise money for muscular dystrophy.

My uncle continued to campaign to raise money and awareness. People in wheelchairs were often not allowed access to places such as airports and museums, which led to considerable arguments. My uncle rightly felt that people with disabilities should be allowed in. I am glad to say that in the 21st century, things are a lot different.

Stephen was a bright and articulate individual, and he was always forthright in his opinions. He was a Manchester City fan, while I was a Manchester United fan. When Manchester United got relegated in 1973, he certainly let it be known how pleased he was about that. Stephen died in California when he was 21. His peers died when they were in their very early teens, which just goes to show that palliative care and hydrotherapy can extend the lives of people with Duchenne.

The Muscular Dystrophy Campaign is the leading UK charity and focuses on all neuromuscular conditions. It is dedicated to improving the lives of all people with such conditions. Founded in 1959, the Muscular Dystrophy Campaign funds vital research, provides and supports care services and gives information, advice and direct help to individuals living with neuromuscular conditions. I am honoured to be a member of the all-party parliamentary group for muscular dystrophy, which has highlighted shocking gaps in service across the UK and continues to call for improvements in access to specialist neuromuscular care to follow up recommendations in the Walton report.

There are more than 60 types of muscular dystrophy and related neuromuscular conditions. It is estimated that more than 1,000 children and adults in every million of the population are affected by muscle-wasting neuromuscular diseases-in the north-west around 8,000 people in total. Such disorders can be genetic or acquired. A number of conditions, such as Duchenne muscular dystrophy, are particularly aggressive. They cause progressive muscle wasting, weakness, orthopaedic deformity and cardiac and respiratory compromise, and result in premature death. Many young boys in the UK with Duchenne muscular dystrophy are dying before they get beyond their teens; that is unacceptable.

Specialist multidisciplinary care has been developed by leading clinicians as the best model for delivering effective care for such complex multi-system diseases. The provision of expert orthopaedics and early cardiac monitoring and intervention has been shown to improve muscle function and maintain independent mobility. People with neuromuscular conditions, therefore, need specialist multidisciplinary care, support and intervention from a range of professionals and specialists. That was recognised as part of the specialised services national definitions set. Leading neuromuscular clinicians fought hard to get those services recognised as specialist by the Department of Health.

Specialised services are defined in law as services with a planning population of more than 1 million people, which means that a specialised service is not provided by every hospital in England. The SSNDS describes the services in more detail. The definitions provide a helpful basis for service reviews and strategic planning, which
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enables commissioners to make comparisons of activity levels and spend. They help with the identification of activity that should be regarded as specialised and therefore subject to collaborative commissioning arrangements. The 10 specialised commissioning groups, acting on behalf of the members of primary care trusts, are responsible for the commissioning arrangements for specialised services.

Neuromuscular conditions come under the auspices of a number of specialities; they are genetic conditions, so geneticists sometimes deal with patients. The conditions sometimes affect children, so paediatricians are involved. A number of the adult forms come under the heading of neurology. Some of the conditions require respiratory care, which is provided by a respiratory practitioner, and some are metabolic conditions such as Pompe, and patients are treated by specialists for metabolic disorders. Therefore, health care for people is quite fragmented, and that clouds professional responsibility. "Neuromuscular" must be recognised as a speciality along with neurology.

Dr Ros Quinlivan, a leading consultant in paediatrics and neuromuscular disorders, has outlined the effects of neuromuscular conditions and how they need to be managed:

It is now felt by the clinical community that it is time to make a neuromuscular curriculum part of the medical career, to establish the neuromuscular field in its own right. The conditions have a lot in common, so it makes sense that they are treated by the same person. For example, some forms of limb-girdle muscular dystrophy exhibit similar symptoms to some forms of spinal muscular atrophy, but one is a muscle disease and the other more a neurological disease. They are long-term rare conditions, which makes them quite different from neurological diseases such as Alzheimer's and Parkinson's.

Neuromuscular services need to be commissioned on a regional basis. Currently they are commissioned by the 10 regional NHS specialised commissioning groups, with top-slicing of PCTs. That method of commissioning services for these rare and very rare conditions has been endorsed by a new body of experts, the British Myology Society. It makes no sense for one PCT to commission specialised services. Unlike conditions such as Parkinson's or multiple sclerosis, there are no guidelines from the
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National Institute for Health and Clinical Excellence for these neuromuscular conditions, which presents real difficulties when trying to set standards of care across the country.

That situation has been a contributing factor to the postcode lottery that has arisen, and which was highlighted in the all-party group on muscular dystrophy's Walton report, published in August 2009. That followed reports by the Muscular Dystrophy Campaign, as part of the charity's "Building on the Foundations" campaign, which revealed the shocking lack of specialist care in many parts of the country. The lack of knowledge, training and skills in the sector is a significant concern. For example, there is no specific training or curriculum for neuromuscular services in the neurological field.

I am sure that hon. Members will share my concerns and the frustrations of people living with neuromuscular conditions in the north-west, as expressed in the Muscular Dystrophy Campaign's patient survey in 2010. Deborah Hurst from Liverpool is affected by facioscapulohumeral-FSH-muscular dystrophy. However, she was not diagnosed with it until she was in her late thirties. She is now 47. Her two daughters were born before she was correctly diagnosed and one of them, who is now aged 25, has inherited the condition. Deborah says:

Mrs H from Lancashire has a son affected by a neuromuscular condition. She says that in her experience, GPs do not understand such conditions:

Elaine Sands from Stockport is also affected by FSH muscular dystrophy. She does not receive any specialist care, but she would value the support of a neuromuscular care adviser. She says:

However, the situation is different for Joanne Ashton. She has a five-year-old son, Liam, who has Duchenne muscular dystrophy. Through the specialist neuromuscular service at Alder Hey hospital, Joanne and her family have access to a specialist consultant, Dr Stefan Spinty, and to a full multidisciplinary service, including a neuromuscular care adviser. Joanne says:

The Muscular Dystrophy Campaign's clinician-led report, "Building on the Foundations in the North West", which was published in June 2009, made a number of findings about neuromuscular services in the north-west.

Mr Gregory Campbell (East Londonderry) (DUP): I thank the hon. Gentleman for giving way and I congratulate him on securing this debate. He has rightly referred to the issue of care advisers. Obviously I understand that
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the north-west of England is his particular concern, but does he agree that if more emphasis were put on having excellent care advisers right across the UK, like the adviser who he has just referred to, that would help those who suffer from this condition immensely in trying to come to terms with it?

Graham Evans: I thank the hon. Gentleman for that intervention. I wholeheartedly agree. When someone is suffering from a condition, there is nothing quite like having people trying to help who understand what they are going through, both physically and mentally. So I wholeheartedly agree.

As I was saying, the "Building on the Foundations in the North West" report found that three out of four neuromuscular patients and their families have no access to a key worker or a care co-ordinator. About 6.5 regional care advisers are needed to serve the estimated 8,000 people -which is up from an earlier estimate of 6,500 people-in the north-west area who have a neuromuscular condition. Many of those people are simply not known to providers of health services.

The report also found that neuromuscular patients have very limited access to treatment, in particular to ongoing physiotherapy. Specialist physiotherapists are required to support outreach clinics and to provide training and professional development for community physiotherapists. In the north-west, two fifths of neuromuscular patients said that they do not receive enough physiotherapy.

Another finding of the report was that there is no dedicated physiological service for neuromuscular patients, despite the importance of such a service as part of multidisciplinary care for that patient group, who have rare and very progressive conditions. Those conditions are often genetic, there are no known cures and there are only limited treatments available. Greater support at the transition from paediatric services to adult services is needed, given the evidence that services are removed or greatly reduced when patients leave paediatric services, even though their needs may well increase given the progressive nature of many of these conditions.

John Pugh (Southport) (LD): I thank the hon. Gentleman for giving way and I congratulate him on raising an important subject. In fact, he highlights a very significant problem. If I understand him correctly, he is saying that we need an adequate clinical network for the rare disease that he is speaking about and a range of providers need to be joined seamlessly, as it were, in some way for the good of the patient. Normally, we expect the strategic health authority to identify the failures to provide such a seamless service and to somehow levy the PCTs to deliver it, which the patients expect and deserve. Is he saying that the central problem is how such a service will progress under the new arrangements, when PCTs, SHAs and other such organisations, which are mandated to resolve these problems, no longer exist?

Graham Evans: I thank my hon. Friend for that intervention. He makes a very good point. The new arrangements are a threat, but they are also an opportunity, because services are currently provided by the PCTs but not all of them understand these neuromuscular conditions. The new arrangements are a real opportunity for the Muscular Dystrophy Campaign to get its point across,
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so that we get off on the right foot when the changes come in. However the GP-led consortia really need to understand and appreciate what is required. It is about having a holistic approach. Shortly I will discuss an excellent neuromuscular centre in Cheshire, which makes a huge difference to patients. It encompasses physiotherapy and the other aspects of care that make life so much more comfortable for those people who have muscular dystrophy.

John Pugh: I apologise to the hon. Gentleman and to you, Mr Davies, because I will not be able to stay for the duration of the debate. Consequently, I will not find the answer to the problem that I have just referred to.

Graham Evans: Okay. I thank the hon. Gentleman.

George Hollingbery (Meon Valley) (Con): I apologise to my hon. Friend for intervening immediately after another intervention. He has just raised an interesting point about the transition from paediatric services to adult services. In my own area of the south-central region, which is clearly outside the geographical area that is the focus of this debate, we have recently managed to secure at least an advertisement for a new care adviser in the area. However, I understand that that care adviser will not be able to advise on paediatric conditions but only on transition and adult services. Is it not the case that we need a full range of services for all sufferers of this disease and a proper range of advice across all ages?

Graham Evans: My hon. Friend makes a very good point and I totally agree. A holistic approach is needed and there should be a seamless transition from being a young person and receiving paediatric services to receiving adult services. However, this point does not just apply to muscular dystrophy. For example, lots of mental health care services suffer from similar problems. Nevertheless, my hon. Friend is quite right. There should be a seamless transition from one service to another.

Greater support at transition from paediatric to adult services is necessary to provide evidence of services being removed or greatly reduced when patients leave paediatric services, even though, as I have said, their needs may well increase given the progressive nature of many of these neuromuscular conditions. There is a three-monthly transitional clinic in Manchester and a monthly transitional clinic that alternates between Alder Hey children's hospital and the Walton centre, which are both in Liverpool. Both those services-in Manchester and Liverpool-are extremely vulnerable and entirely dependent on the availability of their respective consultants. A transitional clinic at Preston is evolving, but it is not formally funded and is based on the good will of the clinicians. The transitional clinic at Alder Hey children's hospital is the only one that is attended by the required multidisciplinary team. None of the transitional services in the region is funded or appropriately staffed.

The Walton report, published in August 2009, expressed the concerns that the all-party group on muscular dystrophy developed as a result of its inquiry into access to specialist neuromuscular care. Martyn Blenkharn, chair of the Muscular Dystrophy Campaign's North West
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Muscle Group, expressed in written evidence to the all-party group his frustrations about attempts to access NHS physiotherapy:

The all-party group concluded in its regional summary about the NHS North West region:

The NHS North West specialised commissioning group has taken significant steps forward since those findings, and I will outline them shortly.

The North West Muscle Group raises awareness of neuromuscular conditions and provides a forum for people living with the condition to share experiences and advice about access to local and regional services. Since its launch in June 2009, the group has been actively campaigning to improve access to neuromuscular services in the region, engaging with MPs and with the NHS North West specialised commissioning group. Pressure from the North West Muscle Group, alongside the Muscular Dystrophy Campaign and the all-party group, was instrumental in ensuring that the NHS North West specialised commissioning group conducted a thorough review of neuromuscular services.

Joanne Ashton, a member of the North West Muscle Group, commented:

The campaign in the north-west was further spurred on by a comment made by Mike Farrar, NHS North West's chief executive, to Lord Walton of Detchant at an event in Parliament in November 2009. Having referred to the review of neuromuscular services in the south-west, which Sir Ian Carruthers, NHS South West's chief executive pushed through, Mike Farrar commented:


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As a result of lobbying by the Muscular Dystrophy Campaign, a review of services was set up in the NHS South West specialised commissioning group in February 2008. In February 2009, local primary care trusts approved a new £1 million neuromuscular strategy to reduce the £6.9 million spent in the region on unplanned emergency admissions to hospital for people with neuromuscular conditions.

I am fully aware, as are several hon. Friends, of the excellent work by the NeuroMuscular Centre in Winsford, Cheshire, which is in the constituency of my hon. Friend the Member for Eddisbury (Mr O'Brien). That centre provides ongoing specialist physiotherapy, which reduces the number of falls among people with neuromuscular conditions, and it also offers social enterprise opportunities. However, although the physiotherapy provision is regarded as excellent by those who go to the centre, difficulties are encountered with PCTs and funding, as reported in the Muscular Dystrophy Campaign's patient survey 2010. Mr A from Cheshire has Charcot-Marie-Tooth disease and travels to the centre for specialist physiotherapy and hydrotherapy, but his local PCT is unwilling to pay, despite not offering him any alternative physiotherapy or hydrotherapy provision. Following concerted pressure by the Muscular Dystrophy Campaign, the North West Muscle Group and the all-party group, Jon Develing, chief officer of the NHS North West specialised commissioning team, made a personal commitment to the all-party group in January to recommend that the NHS North West specialised commissioning group undertake a review of neuromuscular services.

The review was set up by the commissioning group in May 2010, and the steering group set up an effective model for the NHS working with the Muscular Dystrophy Campaign, patients and expert clinicians from the region. To further involve people living with neuromuscular conditions, a stakeholder day was held in September 2010, which represented a vital opportunity for people to have their say about the services that are crucial for an acceptable standard of specialist neuromuscular care in the region. That led to a gap analysis and a report with recommendations for service improvements- the first time ever that neuromuscular services have been looked at in this way, across the whole region.

The recommendations are currently being put to local primary care trusts to approve new investment for a neuromuscular strategy. The proposed minimal required investment to reduce the £13.6 million spent on unplanned emergency admissions to hospital for neuromuscular conditions and to sustain neuromuscular services across the north-west includes 2.5 new fully NHS-funded care advisers, 2.5 specialist consultants, two to three specialist physiotherapists and one specialist neuromuscular nurse.

Will the Minister agree to write to the specialised commissioning group and to PCTs, endorsing the recommendations as necessary steps to save money and reduce unplanned emergency admissions? Will he ensure that a named individual in the NHS in the north-west will take the work forward once the specialised commissioning groups disappear? The neuromuscular network approach is hugely important to ensure the co-ordination of neuromuscular services in specialist multidisciplinary teams, as demonstrated in the south-west of England and by the Scottish Muscle Network, and
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to ensure links to the primary and secondary care that plays a crucial part in the management of neuromuscular conditions.

Dr Stefan Spinty, consultant paediatric neurologist at Alder Hey children's hospital, who played a leading role in the north-west neuromuscular service review, said:

Christine Ogden, a campaigner and fundraiser from Bolton, whose grandson has Duchenne muscular dystrophy, said:

Beryl Swords from Liverpool, whose son John has FSH muscular dystrophy, has commented on the provision of physiotherapy for adults with neuromuscular conditions:

The urgency of improving neuromuscular services in the north-west is encapsulated in the following comments by Nicci Geraghty, a north-west campaigner and fundraiser:

The evidence provided makes a compelling case for the urgent necessity of developing and improving neuromuscular services in the north-west in order to save money. Will the Minister write to NICE stressing the importance of a NICE quality standard for Duchenne muscular dystrophy, as well as one on home ventilation and respiratory support? Will he attend the next meeting of the all-party group on muscular dystrophy on Wednesday 9 March to update the group on progress, and will he agree to meet clinicians who have been developing a neuromuscular curriculum with the Association of British Neurologists? Thank you for calling me, Mr Davies.

10 am

Mark Durkan (Foyle) (SDLP): It is a pleasure to serve under your chairmanship, Mr Davies. I congratulate the hon. Member for Weaver Vale (Graham Evans) on securing this debate, which is important to many people. Although the title of the debate refers to neuromuscular services in the north-west, my constituency neighbour the hon. Member for East Londonderry (Mr Campbell) and I come from the north-west of a different island. This is not revenge for the map-reading errors that many of us would have heard excuses for over the years in border areas in Northern Ireland, nor is it an attempt
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to hijack this debate. I want to give positive support to the articulate efforts of the hon. Member for Weaver Vale, who spoke compellingly about what muscular dystrophy can mean for the individuals affected and their families.

Unlike the hon. Gentleman, I do not have a relative who suffers from muscular dystrophy, but I remember being particularly impressed by a young constituent of mine and his family. My constituent, who unfortunately died a couple of years ago, was named Donovan McKeever. When his parents, Brendan and Teresa, heard Donovan's diagnosis, they were confounded by the degree to which nobody knew what to say to them or what they were talking about, asking about or looking for. Donovan's father Brendan wrote a small book about his experience, titled "It Shouldn't Have to Be Like This".

Unfortunately, when a child is diagnosed with muscular dystrophy-this also happens with many other conditions, such as autism-parents often have to navigate systems and negotiate between services as though they were the first to find themselves in that situation. The hon. Gentleman's speech reflected such frustrations. Because people know the good work of the Muscular Dystrophy Campaign and know that it is a recognised disease, they assume that care services are in place and that the system kicks in and knows what to do, how to pass people on and how to connect services. They assume that key workers exist to ensure that needs are met, whether that involves a disabled facilities grant for adapting housing, or assistance deciding which school environment will be most conducive or accessible. Families need support, and they expect the system to provide it. For people with muscular dystrophy-Donovan had Duchenne muscular dystrophy-that does not always happen.

The hon. Gentleman mentioned the importance of care advisers, as did the hon. Member for East Londonderry in his intervention. Northern Ireland has a muscular dystrophy care adviser, but unfortunately the funding for that care adviser is committed only until the end of March, and no long-term funding is in place. Not only are things not as they should be, but the existing service and the commitments that have been made may well disappear in the context of budget squeezes and other changes.

We should use this occasion to call for better services, planning and support, not just in the interest of individuals with such conditions and their families but in the interest of providing well-managed public services and savings. The hon. Member for Weaver Vale mentioned unplanned emergency admissions. Some 2,000 people in Northern Ireland suffer from muscular disease, and their unplanned emergency admissions cost at least £2.25 million a year. Better and more appropriate and available services would lead to savings. Making people present themselves in a less appropriate context puts pressure on other services and adds to costs, which is not efficient. Cutting corners in such areas in the name of efficiency savings is wrong, and some of the cuts and squeezes taking place are counter-efficient.

I know that the Minister is particularly concerned about the health services that the hon. Gentleman and I have mentioned. The issues on which patients need to engage the public policy system are not confined to clinical presentations. In the context of some other changes that the Government are introducing, such as
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changes to disability living allowance and medical assessments, I would hope that the Minister acts as an advocate for patients with muscular dystrophy to ensure that they are not overburdened by medical assessments. They find it difficult enough to navigate the system and get the services that they expect; it should not be made harder for them to get support such as disability living allowance and the mobility component.

On the intended removal of the mobility component of DLA from people in residential care, many young adults with muscular dystrophy choose to live in a residential care setting because of their situation. Their parents may have passed on, and other family members may have moved on. It is nonsense for people who have made that choice to lose the mobility component, with all the social support, access, personal outlets and socialising that it allows. I hope that this debate is not purely about the important issue of clinical and medical services for those with muscular dystrophy; I hope that we will take a holistic approach to people's particular needs.

The hon. Member for Weaver Vale mentioned specialist multidisciplinary care. If we break the issue down to our different locations, whether we are talking about the new single commissioner for Northern Ireland, the Health and Social Care Board-

Philip Davies (in the Chair): Order. I do not wish to interrupt the hon. Gentleman's flow, but I hope that he appreciates that the terms of the debate relate specifically to the north-west. Although his comments on Northern Ireland are interesting, I hope that he will tie them in to the situation in the north-west, as that is the title of the debate.

Mark Durkan: I fully accept your admonition, Mr Davies. I made that point at the start.

If we consider specialist multidisciplinary care in relation only to different localities-whether primary care trusts and GP-led commissioning in the north-west of England or purely within the devolved regions of Scotland or Northern Ireland-we might miss a point. In the case of rarer diseases and conditions, a bigger commitment and wider consideration at a UK level provides a better context of scale. As we have heard, individual GPs sometimes are not good at responding to particular needs or realising the importance of a condition because they do not see enough instances of it. That problem applies not only to GPs but, more broadly, to other services and public management bodies.

I hope that, during the Minister's tenure, the Joint Ministerial Committee, which brings together Ministers from the devolved entities as well as those from Whitehall, and the British-Irish Council will undertake initiatives to examine whether we can learn lessons from one another. When I was a Minister in the Northern Ireland Assembly, I was privileged to attend the council's very first meeting. I remember the late Donald Dewar saying that one of the most undervalued art forms was plagiarism and that we needed a vehicle to bring together public policy planners and overseers, such as Ministers, from different parts of these islands. We need that not just in order to see who is doing well at what and to copy them, but in order to be honest and admit what we are all
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doing badly; to discuss the serious issues that we are not doing enough about; and to constantly agree, as public representatives, that more should be done and that there should be better laws, better services and better funding. If we cannot do enough of that in relation to our own individual pressures, perhaps the British-Irish Council and the Joint Ministerial Committee can together ask some of the fundamental questions, at the heart of government, that were raised by the hon. Member for Weaver Vale.

10.11 am

John Pugh (Southport) (LD): I have the temerity to believe, Mr Davies, that this debate might finish early, so I will make a brief contribution. I congratulate the hon. Member for Weaver Vale (Graham Evans) on introducing the topic. His preamble was very touching-I have a vision of him as an enormously public-spirited child, raising money for charity. He has clearly carried that public-spiritedness into later life and into politics. I disagree with him, however, about the poshness of Wolseley cars-there were certainly some fairly ordinary Wolseley cars in my day.

I want to elaborate on my intervention on the hon. Gentleman. He explicitly said in his articulate presentation that he has some concerns about the abolition of the specialist commissioning bodies that were set up by the strategic health authorities. Such concerns have been generally well recorded by a number of people with an interest in a variety of rare diseases, not just those of a muscular kind. Although renal problems are not particularly rare, the SHA in my constituency has dealt with the huge problem of elderly people needing renal services by saying that those services need to be in Southport where the demand is. A facility has been produced that is beyond the cost limits of the primary care trust: in fact, it is a regional facility and has been established on the basis of a regional strategy.

The case has been well made across the piece that we need specialist commissioning groups. They have been necessary to deal with rare diseases and to construct the necessary clinical networks. Often, people need not a specialist secondary care facility, but adequate facilities and therapies in the primary care setting. Moreover, those facilities need to somehow integrate, talk to one another and form a clinical network.

What will happen when the SHAs and, presumably, the commissioning units that they set up go? I hope that the Minister will solve that problem. There are two possible answers to the question. The first is that we do not know. The other answer-the Minister may wish to enlarge upon this-is that we will get outposts of the national commissioning board that will do very much the same job as the SHAs. If we have regional commissioning groups, which are generally aware of what is required in the region, we replicate the existing solution, which may be perfected and improved in the process. Few would have problems with that. Some would question the necessity to deconstruct then reconstruct everything, but such a solution is acceptable to many who are concerned about a range of rare diseases, including those that the hon. Gentleman has spoken about. Therefore, my single, simple contribution to this debate is to pose the Minister a question: is that the solution to the problem and, if not, what is?


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10.14 am

Emily Thornberry (Islington South and Finsbury) (Lab): It is a pleasure to serve under your chairmanship, Mr Davies. It is also a pleasure to take part in Westminster Hall debates, which I usually find to be of much higher quality than those in the main Chamber. It is a shame that so few people attend these debates, because they can be outstanding.

I found today's contribution by the hon. Member for Weaver Vale (Graham Evans) profoundly moving, and I am grateful to have had the opportunity to listen to him. The image of him selling rulers in the playground will stay with me, and those with muscular dystrophy are lucky to have such a passionate and committed campaigner on their side and in their corner. I too shall always remember to plagiarise Donald Dewar, but in a much less generous way than the hon. Member for Foyle (Mark Durkan). He attributed to Donald Dewar the phrase that plagiarism was undervalued, but I fear that I will simply use it as my own from now on.

Joking aside, this is a serious issue. I was not aware that there are 60 types of muscular dystrophy and that 1,000 children and adults in every 1 million of the population are affected by the disease. It is hugely important to learn such things in my job. It is unfortunate that so few people know about them and that I have to be in this position to learn about them. It is also of great interest that 8,000 people are affected by the condition in the north-west region. We have heard how aggressive Duchenne muscular dystrophy is, and the effect that it has on young boys is a great worry. I have also learned about the stupendous work of Stefan Spinty; it is important to remind the Department of Health that he is trying to run his network without any funding.

In broader terms, treatment for muscular dystrophy in the north-west faces two challenges. The hon. Member for Foyle touched on the first, which is the challenge of cutbacks to services in general. We heard of the cutbacks to special assistance for those with muscular dystrophy in the hon. Gentleman's area. The cutbacks to mobility and adaptation in relation to people's homes are larger concerns. Those things are very worrying.

The other challenge relates to the changes in GP commissioning coming at us if the Health and Social Care Bill is passed. We heard this morning that GPs often do not have a great deal of expertise in relation to muscular dystrophy. One could quote statistics that GPs will come across the condition only once or twice a year, but the stories we have heard from the hon. Member for Weaver Vale are more important. He talked about the woman with muscular dystrophy whose daughter clearly had the same condition, but when she told a doctor that there was something wrong with the child, she was told that she was fussing and silly. On the back of that, we heard that doctors have only about two hours of teaching on the condition, so we should all be worried about exactly what will happen to its treatment when GPs take over commissioning. The Government must reassure us about what the specific commissioning pathways will be for this condition, and what the role of the national board will be in relation to muscular dystrophy. It is only right that people with muscular dystrophy, their families and those who represent them are reassured that they will be treated properly and that their particular condition will be treated.


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John Pugh: The hon. Lady's point seems slightly tangential. If her argument is that what is wrong with the arrangements is the current ignorance of GPs about referral pathways, that situation has pre-existed these arrangements and may succeed them. It is an independent issue, is it not? It is not about structures.

Emily Thornberry: As the structures currently stand, it is understood by GPs that they can receive back-up, through the specialised services national definition set, from the various networks that have already been established. If the national health service is to be grabbed by the ankles, turned upside down and shaken hard, the problem is that in the ensuing chaos, GPs will be distracted and, in the short term, people with muscular dystrophy might not get the services that they deserve. That is a legitimate concern, which it is only right to lay at the Minister's door, because it is this Government who will be putting the national health service through that process.

As I have already asked, will the Minister confirm that specialist neuromuscular services will fall under the remit of the national commissioning board? How will the board work with other services, such as community nursing, speech and language therapy, and continuing care and physiotherapy, which I understand will be commissioned by GPs? How will that work, and how will people with muscular dystrophy not fall between the gaps? Will the Minister provide more information about regional commissioning-already mentioned during the debate-which might arise under the national commissioning board? It would be reassuring for many to learn that the national commissioning board might have regional hubs, but we have yet to hear that stated specifically. If it were to be stated this morning, it would be good news for many people.

The other issue that I know the Minister shares my great passion for and interest in is the importance of increasing integration of services. People with the conditions we are discussing are clearly exactly the sort of people who need integrated services, so that they can have assistance in hospital-hopefully as an out-patient-and care in the community. There is a continuing disconnect between social care and health care. We all know that when those services do not connect properly, people end up as an emergency admission. We have already heard that £68.5 million is spent across England on unpaid emergency hospital admissions for people with muscle disease.

It is clear that savings can be made, and the holy grail for all of us is to ensure that there is better integration between the various services-both between primary and secondary care, and social care and health care. The challenge in the near future is to consider exactly how the Health and Social Care Bill will help with that integration. There is concern that, in fact, it will do the opposite.

It is important that the legacy is protected. The Muscular Dystrophy Campaign has been working constructively with the 10 NHS specialised commissioning groups across England, and significant progress has been made on improvements to neuromuscular services and on an increase in the number of muscular dystrophy care advisers. In the context of the changes to the national health service and the cutbacks in funding, there is concern that a lot of that good work may fall by the wayside. This morning would be a timely moment
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for the Minister to reassure us that the legacy will not be lost. Will he reassure me that the work being carried out by the regional specialised commissioning groups will not be put in jeopardy following the proposed reforms for their abolition?

10.22 am

The Minister of State, Department of Health (Paul Burstow): I congratulate the hon. Member for Weaver Vale (Graham Evans) on the passionate and powerful way in which he clearly set out the case. He has done a great service to the interests of those who suffer from muscular dystrophy and their families. I thank him for securing the debate. I also congratulate him on the work he has done in his role as a member of the all-party group on muscular dystrophy, not only for his region but in raising the issue more thoroughly around the country. I join him in paying tribute to the work of the Muscular Dystrophy Campaign and the North West Muscle Group. Both those organisations operate as powerful advocates for people affected by these lifelong and life-limiting conditions.

It is 18 months since the all-party group published the Walton report, which showed how far we had to go-as the hon. Gentleman has described only too clearly- to improve the care of those with muscular dystrophy and other neuromuscular conditions. There are historic weaknesses. The intervention of my hon. Friend the Member for Southport (John Pugh) just now underscored that point. There are weaknesses in the current system and in how we organise the things that have rightly been highlighted by today's debate.

There is a real sense of urgency for change, not least because of the simple fact that we know about the huge personal and family costs of this condition and how it impacts upon people's lives. Unless care is properly co-ordinated and well conducted, NHS resources will be wasted. They will be invested in the wrong places and will not deliver good outcomes. That cannot be acceptable in our modern health care system. Several colleagues alluded to the costs. The figure of £13.6 million was mentioned as the overall cost of unplanned hospital admissions for those with neuromuscular conditions in the north-west. If we analyse the journeys that people make through our health care system, that shows the actual cost.

Some hospital admissions are necessary and unavoidable. A person who contracts a respiratory infection is a good example of where there is an unavoidable need. However, if we consider the figures in greater detail, the number of people admitted for non-invasive, elective care, shows that there are many preventable costs in the system. That amounts to just under £5 million in the north-west alone. Those costs could be avoided and the money could be spent better. That has to be a key message. It is not just about spending more; it is also about spending better in our system. We need to ensure that we consider the economic case for investing wisely in services that can, in fact, provide a better quality of life. We must also ensure that we avoid unnecessary admissions in the first place.

Positive steps have been taken in the north-west. That progress has been hard fought, and it deserves to be recognised and applauded. Indeed, the strategic health
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authority has told me that £4.2 million has been spent on developing neuromuscular services over the past four years. As mentioned, a dedicated neuromuscular service at Alder Hey has been set up to provide excellent care for children. Out of that £4.2 million, £289,000 was invested as a commitment to the service provided and led by Dr Spinty. There appear to be some grounds for dispute over whether such services are funded or unfunded. However, we certainly need to keep ensuring that resources go in. There is a case to be made for ensuring that resources are well spent. Paediatric critical care services have improved with a dedicated paediatric intensive care transport team. There are additional beds at Alder Hey and the Royal Manchester for ventilation services, with similar investment in both invasive and non-invasive respiratory services for adults, too.

Although those developments are welcome, the local NHS accepts that many issues still have to be addressed, many of which have been aired today. The specialised commissioning group is responding to the Walton review by reviewing the region's neuromuscular services. In essence, that review group-made up of clinicians, commissioners, patients and families-is aiming to address exactly the issues aired today: how to improve the poor support available to those diagnosed with neuromuscular conditions in adulthood; how to address the variability and patchiness in the availability of specialised neuro-rehab and wheelchair services; and how to improve transitional arrangements to help young people to move from paediatric to adult services. That is an absolutely key issue that comes up time and again in relation to rarer conditions when considering how well or how poorly the NHS manages those vital transitions from child and adolescent services to adult services.

The review group has updated the all-party group on muscular dystrophy on the review's progress. On the kind invitation that has been extended to me to attend the meeting of the all-party group, I do not know whether I can attend on the specific date mentioned. However, I will certainly undertake to attend a meeting of the group as soon as I can and take questions from the group's members.

I understand that the NHS North West specialised commissioning group will consider the review's recommendations in March, and that the full report will be published shortly after. Clearly, I do not wish to pre-empt that report in any way but, based on the conversations I have been having in preparation for the debate, I think that the review team is asking some important and necessary questions. Those questions are on sharing best practice to ensure greater consistency, on work force planning, so that there is better co-ordination and leadership across care pathways, and on finding efficiencies across the system in line with the region's quality, innovation, prevention and productivity plans.

The key to all of this is to have a much clearer split of responsibility-a sense of joined-up access across the care pathways to deliver a less fragmented and more person-centred approach to planning. I will say a bit more about the point that the hon. Member for Islington South and Finsbury (Emily Thornberry) raised on that in a moment. For me, the greatest challenge for the modern NHS is how to make sure that we have much more joined-up delivery. We have to accept that care and support for those with long-term conditions is a particular area where we do not get it right often
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enough, and it is unfinished business. There is too often a disconnect between what is commissioned at a regional level by specialised commissioning groups and what is available at a local level as commissioned by primary care trusts. It not only confuses patients and compromises both their care and quality of life; it also leads to inefficiency and duplication within the system.

Putting that right means thinking radically. It means putting greater emphasis on managing pain and helping people with multiple conditions. It means finally developing a personalised system to end the attachment to bricks and mortar institutions and to reinvent health care in a modern context-a health system that is much more about what can be delivered in the home and in the community, than it is about clinics and consulting groups.

When it comes to long-term conditions such as muscular dystrophy, attention tends to fall on specialised commissioning groups, and that is what has been rightly talked about today-the response in terms of tertiary care. Tertiary care is clearly important. We can see, from the important work at Alder Hey and Royal Manchester children's hospital, the difference that such specialist centres can make. However, there also needs to be an equal onus on community-based support-the ongoing day-to-day care that is so important to support quality of life and to keep people out of hospital in the first place.

Primary care trusts and in the future GP commissioning consortia and health and well-being boards, not the specialised commissioning teams, will be responsible for that. They will shape the services that clinicians and social care need to provide to meet the needs of patients, such as hydrotherapy, wheelchair services, speech and language therapy, respiratory support and help with swallowing. It is therefore essential to have better co-ordination, a better link-up between commissioning teams across health and social care and beyond, and, rather than individual bits, a person-centred approach to planning across the whole care pathway. That needs a whole life course approach, which is why I return to the point that we need a focus on transitions between childhood services and adult services. The review's recommendations will help to bring that about in the north-west. I look forward, as I am sure the hon. Member for Weaver Vale does, to its publication and to it being put into effect.

To take the case of specialist physiotherapy, the SHA recognises that there is pressure on tertiary centres, which is something that the hon. Gentleman talked about. The challenge must be met by a whole system approach that makes full use of the available resources. NHS North West tells me that it is already mapping out in more detail what neurophysiotherapy services are available across the north-west. The current specialist physiotherapists are being encouraged to work with community physiotherapy to improve their skills and to help them to offer appropriate services at a local level. That outreach to upskill other parts of the work force will be a key way to improve delivery. I understand that Manchester PCT is also doing some exciting work in piloting a neuro-rehab service that treats people at home or in the community, rather than in a clinic. That brings into relief the potential benefits of integrating tertiary and community-based services-of how, by doing things differently, we can improve services for patients.


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The hon. Gentleman talked about the NICE guidelines. He is absolutely correct, as are other hon. Members who have spoken in the debate: we need greater consistency, and being more consistent means being clear about what "good" looks like. I have already mentioned NHS North West's neuromuscular services framework, which is a helpful starting point for bringing different organisations together. My hon. Friend the Member for Southport also raised the issue of the need for clinical networks, and I will say a bit more about that in a moment. The review group is also making the case for the clinical networks and clinical network managers to provide leadership, to share best practice, and to provide challenge to commissioners. Again, that would seem to be a sensible approach not just in the north-west, but around the country. I would expect the NHS commissioning board to help to take that forward when it takes up the reins of specialist commissioning.

Of course, another issue mentioned by hon. Members is the need for clear guidelines and quality standards from NICE to cover muscular dystrophy and various aspects of the delivery of care and treatment for people with the condition. I hope that Members understand that it is not for me to direct NICE. Its strength as an organisation rests on its independence from Government, and therefore I will not compromise that. What I will do, and which is important to do, is ensure that it is made aware of today's debate, so that it can take it into account in its deliberations. The East of England specialised commissioning group is leading on quality standards work and service specifications, so there is work to help influence that going forward.

Another influence on NICE are the conversations with the leadership group of the Neurological Alliance on how it can develop stronger clinical advice for a range of rare neurological conditions. I strongly urge the Muscular Dystrophy Campaign to actively engage with that leadership group, so that it is also at the table with NICE. NICE is part of that forum, which presents an important opportunity to achieve faster progress and effective action. We are also, in the context of the work of health and well-being boards and GP commissioning consortia, looking at how to update the guidance for joint strategic needs assessments. I urge the Muscular Dystrophy Campaign to have an input, through the Neurological Alliance, on that work, too.

Equally, the National Quality Board is working on a broad library of quality standards to cover all areas of NHS care. Again, there will be opportunities for the Muscular Dystrophy Campaign and others to feed into that process. Input through the leadership group of the Neurological Alliance would be a very effective way of getting its voice heard.

Careers and training have been referred to in the debate. I suggest that, rather than a Minister trying to dare to dictate the curricula of the medical professions, it might be more prudent to ensure that they are also aware of this debate, with a covering letter from me to draw it to their attention so that they can take it into account as they reflect on future curricula.

On the issue of advice and support for patients, a strong case has been made for the case-management approach. It is important that we look outwards to patients and their families. At the moment, people with long-term conditions can feel disempowered and frustrated by the complexity of the system. It can be a fight, as the
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hon. Member for Weaver Vale has described, to understand what is available. As the hon. Member for Foyle (Mark Durkan) rightly said, it should not be the case that every time someone enters the system it feels like they are navigating it for the first time, as if no one else has ever gone through that before. That is a perfect way of describing how the system should not feel and how it must not feel as we go forward. The hon. Member for Weaver Vale described the example of Liam. That example makes a very strong case for increasing the number of neuromuscular care co-ordinators, who are known to be extremely helpful in improving patient care and outcomes. I understand that that is something that the review group is exploring and it will, through its contracting arrangements that go beyond that, help to drive that forward. I have no doubt in my mind that there is a strong economic case for the co-ordinators.

I am also pleased that the Manchester PCT is looking at how personal budgets can be used to help people with neuromuscular conditions to get the help they need. Personal budgets are more than a lever to give patients more control. They can be a catalyst for bringing services together around the needs of the individual-another way in which we can integrate at an individual level. In fact, a number of the pilots that are testing personal health budgets are actively involved people with neuromuscular conditions.

The final question, asked by both my hon. Friend the Member for Southport and the hon. Member for Islington South and Finsbury, is how do we maintain continuity during the transition period? The Health and Social Care Bill is clear that highly specialised services would, in future, be commissioned by the NHS commissioning board. I can confirm that this condition is included among them, as it is already designated as a specialist commissioning area. The board will decide how best to organise itself to deliver, on a case-by-case basis, different commissioning activities on different specialist conditions. It would be wrong, when the Government are saying in the Bill that we are giving autonomy to an NHS commissioning board, for the Minister to then specify, in an Adjournment debate, to the nth degree precisely how the NHS commissioning board should discharge that function.

The NHS commissioning board has that responsibility, and that comes with a responsibility on patient and public engagement as well. It is important that lessons from existing experience of specialised commissioning are drawn together to inform the way in which those responsibilities are discharged in the new system. I will undertake to ensure that this debate is drawn to the attention of those who are doing that work at the moment. Again, I think that the Specialised Healthcare Alliance provides the Muscular Dystrophy Campaign with a way in to influence and shape those opportunities. I note from comments to the Health Committee before the general election that there was a recognition that
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we could do much more by moving to a national commissioning board that can streamline, simplify and ensure greater consistency around contracting for these services.

That brings me to the other element of the new architecture, which is general practitioner commissioning consortia. Clearly, integrated planning between consortia and the NHS commissioning board will be essential, just as joint working between primary care trusts and specialised commissioning groups is at present. I am keen that strategic health authorities will encourage GP pathfinders, along with the early implementers of health and well-being boards, to work with the specialised commissioning groups to explore how the relationship can work best on the ground so that we develop the best case examples to inform the system as we move to the new arrangements.

As the hon. Member for Weaver Vale rightly highlighted, GP consortia will need advice and guidance as they take up the reins. There will be a great opportunity for patient groups to step in and provide support in that way, and I would certainly encourage that kind of active engagement. Also, health and well-being boards will have a key role as system integrators-they will have a major part to play in developing the more joined-up system. We will consider whether that is enough or whether we need to do more as we scrutinise the Health and Social Care Bill clause by clause in the coming weeks. The most effective way of operating will be through the regional networks that the Neurological Alliance is setting up. Again, I hope that the Muscular Dystrophy Campaign will be part of that.

Yes, we have to ensure that we get specialist commissioning right, but we also have to ensure that we get commissioning for long-term conditions in general right, and we have to do that at a local level.

I thank the hon. Gentleman for securing this debate and for setting out the issues so clearly, and I thank other hon. Members for their contributions. We know that there is much to do to improve the care of those with neuromuscular conditions, and that we are not doing enough yet. We know that the system that we inherited has not delivered uniform and consistent access to services-we must do more. We also know that financial pressures should not block progress because, all too often, action here saves money that can then be better spent on improving the quality of services.

I look forward to reading the final report of the north-west review group-and, indeed, the other reviews that are taking place-and I hope that it can be a catalyst for real improvements in the years ahead. The hon. Gentleman is right to say that we have to translate the intentions behind the review into tangible actions that transform the lives of his and many other hon. Members' constituents up and down the land.

10.42 am

Sitting suspended.


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Unscrupulous Builders

10.58 am

Stephen Lloyd (Eastbourne) (LD): Thank you, Mr Davies, for giving me the opportunity to speak in the debate. I welcome the Minister, and look forward to his response after we have all spoken.

As an officer of the all-party groups on ageing and older people and on consumer affairs and trading standards, I feel that the issue of unscrupulous builders is of the utmost importance and warrants the thorough consideration it will be given now. I come from a business background-I run a small company and have worked as a business development director in the corporate sector-so I am not a politician whose default position is, "Let's have more regulation." However, in the building and renovation trade, many rogue builders across the UK have been ripping people off for far too long.

In my judgment, something must be done, and the Government must take steps to protect vulnerable people from cowboy builders. There are three core issues to address: first, the routine targeting of the most vulnerable people in our society; secondly, the way that unscrupulous traders create an unfair marketplace and plague the legitimate building industry; and thirdly, how we can act to stop the proliferation of fraudulent work.

Recently, a rogue trader was convicted in my constituency. That was a good result considering how difficult it is to prosecute such criminals under current legislation. During the proceedings, it came to light that he had accepted cash and cheques from customers in Eastbourne for sums of up to £23,000. One of the victims was an elderly widower, which is not uncommon. He received redress from the television show "Cowboy Builders." The programme surprised my constituent by fixing the damage done to his property while he was in hospital recovering from a heart attack. That was a good deed and much appreciated, even if it was for the purposes of entertainment. Although we can take comfort from the happy ending to my constituent's ordeal, it is unacceptable that he felt compelled to turn to a television show rather than to the authorities. However, given the lack of adequate, robust legislation to protect citizens from such criminals, his decision is easily understood and was, frankly, wholly rational.

We have a duty to those whom we serve to do something about the weakness of the current legislation, and I hope that colleagues will join me in calling for a formal consultation into the merits of a compulsory licensing system for the construction industry. Gangs such as the group of Gloucestershire scam builders convicted and jailed in January for defrauding householders of nearly £1 million cannot be allowed to continue unabated. The three men involved conned more than 50 people in 14 counties, and I extend my sincere appreciation to Gloucestershire police, who worked tirelessly and diligently throughout the three-year investigation to bring the fraudsters to justice. I echo the sentiments of the detective chief inspector who led the investigation. He characterised the perpetrators as, "Criminals, pure and simple."

Such unlawful behaviour must be taken seriously. Consumer rights experts report an average of 100,000 complaints about rogue builders each year, and trading standards organisations reveal that £170 million is stolen
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from UK home owners by cowboy builders every year. We are told that 2.4 million people have had problems with cold-calling property repairers; it is imperative that we take action.

Mr Mark Williams (Ceredigion) (LD): I congratulate my hon. Friend on securing the debate, and support the clarity that he seeks through a licensing regime. Does he agree that one of the strongest arguments in favour of that is the frustration shared by many of our constituents? One of my constituents, in pursuit of justice after an experience with a cowboy builder, has written to the Royal Institution of Chartered Surveyors, the Insolvency Service, the Property Ombudsman, the Legal Complaints Service and the Trading Standards Institute, but so far to no avail. I welcome my hon. Friend's attempts to bring some clarity to this area of concern.

Stephen Lloyd: I thank my hon. Friend for his extremely well-made intervention. I have heard about such cases again and again both in my constituency and as an officer of the all-party group for consumer affairs and trading standards. We are in a ludicrous position where criminals are ripping off people, often elderly people, up and down the country. However, because they are clever at using-or abusing-the law, it is almost impossible to pin them down and seek redress. That is an absurdity, and times need to change.

The issue is not simply about providing adequate protection to the public; the trouble caused by such activities is far-reaching and widespread. I know some tremendous local builders in Eastbourne, but the actions of the cowboy builders impede legitimate businesses and create an unfair marketplace for the many-the vast majority of builders, renovation companies and tradespeople who are wholly legitimate. The problem causes particular difficulty for the small firms that we are counting on to help bring us out of recession. Because the unscrupulous individuals who prey on the public operate outside the law, they often do not pay VAT. That gives cowboy builders an illegitimate financial advantage by enabling them to charge much lower prices-20% lower-than responsible legitimate companies, thereby distorting the marketplace and creating unfair competition.

That practice results in a significant loss of tax revenue, because much of the work that would be invoiced is currently paid cash in hand and is off the books, resulting in an enormous revenue loss to the Exchequer. Given the current economic situation, it would be foolish to pass up the opportunity to clamp down on such behaviour. It is deeply unfair to law-abiding citizens who pay their taxes to continue allowing fraudsters and charlatan building companies not to contribute their fair share. Beyond that, a further worry must be addressed. Around 80% of the informal economy-sometimes known as the black economy-is work undertaken by companies that are completely outside the tax system. I have already mentioned VAT, but such evaders are much more likely to avoid other key legal obligations, such as health and safety legislation. That puts their customers not only at a financial, pecuniary risk, but at physical risk.

Jim Shannon (Strangford) (DUP): Everyone has seen the programme, "Cowboy Builders", that the hon. Gentleman referred to. It illustrates that a small number
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of people will take advantage of vulnerable people. Does the hon. Gentleman feel that one way of monitoring and keeping an eye on things and regulating the system would be to use local government to oversee work and say whether it should be passed? Perhaps that would be one way of resolving the situation.

Stephen Lloyd: That is a good point. It is not the conclusion that I have reached, but it is a strong point. The challenge with local government oversight is that it varies a lot around the country. Some local authorities would make it a high priority, while others would not. It is an option, but the conclusion I have drawn is that the Government must start taking steps to look at a licensing proposal.

I am aware that there are already programmes to help regulate the construction industry and mitigate fears, and I do not wish to undermine the valuable work of organisations such as TrustMark and the National House-Building Council. However, those schemes are taken up mainly by large companies that operate at national or regional level, and they are not the problem. The administration and cost involved in registering with such schemes is a natural deterrent to the individuals and small firms that I, and many of my colleagues, want to help. Because the vast majority of substandard work is carried out by individuals or small gangs of rogue builders, the current measures are inadequate.

According to Local Authority Building Control, TrustMark has insufficient funding to deal with the problem. Therefore, we need serious consideration about how to proceed with more effective methods of regulation. The seriousness of the matter is heightened by the well-known target of the illegitimate traders-older people, who are often the most vulnerable in our society. An ageing population coupled with increased home ownership necessitates a Government response.

Between 1981 and 2001, the proportion of the population over 75 years old increased by more than 30%. The number of pensioners living alone increased by 150,000 between 1991 and 2002, and now accounts for 14.4% of all households. That means that there are now more than 5 million pensioner-only households. Let me be clear: MPs in the House know that unscrupulous builders target vulnerable, often elderly, people. That is a growing market, and unless something is done, those builders will have ever more opportunities to rip people off.

Numerous investigations have shown that unscrupulous builders are taking full advantage of the gaps in our legislation and our rising pensioner population. Crooked salespeople are commonly overbearing, persistent and totally unscrupulous. That is a particular problem for older people, as they often live alone and are trapped by such intrusive door-to-door sales techniques. Once a salesperson is in their home, a vulnerable individual has limited means by which to end the transaction. The option of asking someone to leave is not always available to them because many home owners feel too intimidated in that situation to broach things so directly. That may sound absurd, but our experience as Members of Parliament, dealing with a large amount of casework and listening to constituents, who are often elderly, means that we know that they will be too frightened to ask the cowboy builder to leave.


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When hard-sell tactics are used, many individuals feel trapped in their homes and have nowhere to retreat, leading to increased pressure and a desire to rid their home of the unwanted guests as quickly as possible, often-crucially-by accepting the service being offered. In fact, there are even reports of people being driven to their bank immediately to draw out large sums of money when faced with threatening demands.

Stephen Gilbert (St Austell and Newquay) (LD): I am grateful to my hon. Friend for securing a debate that is important to constituents from throughout the country and represented by hon. Members on both sides of the Chamber. Does he agree that one way in which we could consider regulating the sector is by extending what we have done with the gas industry to the building industry? The Gas Safe register gives older people confidence that the engineers coming into their home are qualified and professional.

Stephen Lloyd: I thank my hon. Friend for his intervention. That is a good idea as long as it is managed properly. My concern is that it might end up a bit like TrustMark. Many people do not know about that scheme and even among those who do know about it, there is some concern that it is not robustly policed. I like the idea, but we have come to the point when we need to introduce licensing. I will explain how I propose that we fund it.

In my judgment and that of many others, none of the current legislation is able sufficiently to protect the public from such threats. I hope that hon. Members will forgive me because I am going to give them a bit of a history lesson. The Pedlars Act 1871-that is a wonderful phrase; "the Pedlars Act"-excludes virtually all callers involving property maintenance and repairs. The cancellation of contract concluded away from business premises section of the consumer protection regulations is an important statutory consumer measure, but it will generally offer little or no protection from criminal practices when the traders' names and addresses are not known. Large amounts of cash change hands, yet there is no intention of operating in a fair manner. That is absolutely appalling. It is systemic and we simply cannot let it continue. Section 16 of the Theft Act 1968 has left a loophole in legislation, as its definition of theft covers only actions when a person, by deception, dishonestly obtains property belonging to another with the intention of permanently depriving the other of it.

Cowboy builders are fully aware of the flaw in consumer protection and know that as long as they carry out at least some activity, the incident will be classified as a contractual disagreement and therefore not a criminal offence. Prosecution of those perpetrators is very tough, as the necessary evidence is often very difficult to obtain; I could go on and on. That is why the market has been expanding and the actions of those deplorable individuals have got bigger every year. They know the law is an ass.

There is a logistical problem for any witnesses asked to stand up in court and face those who wronged them. That is a particular concern when the victims are already among the most vulnerable. It is another reason why action must be taken to halt the spread of these fraudulent criminals.

I am coming to the end of my speech because I want to give the Minister plenty of time to reply. In raising these issues, I make it absolutely clear that I do not want
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to cast aspersions on the legitimate business men and women who provide an important and welcome buildings and renovation service to many people up and down the country. In my constituency, a noted builder, Ellis Builders, has given me advice on how I can present and pitch a proposal in a way that will work for legitimate builders. I appreciate the support that its managing director, Derek Godfrey, gave me.

We must consider the possible courses of action open to us and the ways in which we can aid genuine tradesmen and end the scourge of rogue builders. Naturally, a central aspect of any reform would have to be an increase in public awareness. The public must know how to confirm whether the workers being hired are legitimate. One reason why the current voluntary schemes are ineffectual is the lack of public knowledge surrounding programmes such as TrustMark. I believe that to make any significant advance in protecting the well-being of individuals, it is critical that we provide one clear method for assessing the competence of a building tradesman. On that point, I agree with the National Federation of Roofing Contractors and join it in advocating a means of appraisal that will provide confidence that the tradesman or woman in someone's home is competent, trustworthy and reliable.

There are many ways in which that may be achieved. Successful licensing schemes already operating in Australia and the US could provide a useful starting point for the consultation that surely must follow this debate. However, at such a difficult time for our economy, I appreciate that we must be extremely careful not to overburden a crucial sector of that economy-construction. It is necessary to strike a careful balance. We need to provide regulation and protection for the consumer on the one hand without disproportionately increasing costs or deterring compliance on the other.

It is time to consider seriously a national licensing scheme. The fee need not be too expensive. It could be £500 per annum and tiered, with smaller companies paying less and larger ones more. Any legitimate builder would see that as a worthwhile investment in their business. It would give the public the security of knowing that a builder was licensed. They could say to someone, "Do you have a licence?" If the answer was no, they could say, "You won't be doing any work in my home." If the answer was yes, they could open the door. In my judgment, that sum, if it was tiered as well, would be sufficient to fund a licensing body.

We cannot keep sweeping this issue under the carpet. The legitimate building trade-companies of all sizes-deserves more. The public deserve more. We can do more. To misquote the great and one and only Gary Cooper, "It is time to run the cowboys out of town."

11.17 am

The Parliamentary Under-Secretary of State for Business, Innovation and Skills (Mr Edward Davey): I congratulate my hon. Friend the Member for Eastbourne (Stephen Lloyd) on securing the debate. I thank all hon. Members for contributing. Listening to my hon. Friends the Members for Ceredigion (Mr Williams) and for St Austell and Newquay (Stephen Gilbert) in particular, it was clear that this issue affects many of our constituents. I can confirm that it has affected my constituents. I represented one of my own members of staff on this issue. She ended up having to use the TV programme
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dealing with cowboy builders to sort out the problem. Through dealing with that, I understood how difficult these problems can be. My hon. Friend the Member for Eastbourne was therefore right to bring the issue to the House. Although I do not agree with his proposal for a compulsory licensing scheme, let me say up front that I hope that when he hears some of my other remarks, he will know that the Government take the issue seriously, along with many other consumer affairs where there is consumer detriment. Some of the general reforms that we want to make and the general research that we are undertaking will help to ensure that this issue and others like it can be better dealt with in future.

Let me say for the record, and so that my hon. Friend understands why I am less attracted by his proposal, that there are issues of practicality and proportionality, which I know that he, as a small business person, will be very mindful of. Many people are employed in the construction industry. The UK construction industry is one of the largest in Europe, with more than 2 million people employed and 200,000 businesses. That gives a sense of what a compulsory licensing scheme would have to do and the sheer scale and size of it. That would bring with it costs and complexity.

As my hon. Friend rightly said, some rogue, cowboy builders behave appallingly, but we must balance a number of issues as we put together our measures, and I hope to reassure him about those measures in the course of my speech. I am sure that he will agree that the vast majority of people operating in the construction industry do good jobs, work hard and perform well. We are talking about a relatively small number of rogue traders, and the question, therefore, is whether we put huge cost and complexity on 2 million people and 200,000 businesses to target that tiny minority. I say that not least because it is unclear whether a compulsory licence scheme would deal with the rogues who tend to work outside the system. One would have to be sure, even under my hon. Friend's proposals, that the enforcement measures were such that one could catch these people. I have some concerns about such issues, not least when they are married to the costs and complexities that would come about under such a scheme.

Let me reassure my hon. Friend about one or two points that came up in the debate. We want a proportionate scheme. Through licensing and regulation, we want to target those trades where there is a high risk to public safety, and my hon. Friend's points about health and safety were extremely well made. That is why the gas safe register scheme, which used to be known as the CORGI scheme, is important. It deals with the technical competence of people who ply their trade. There is also the competent persons scheme for electrical work. Clearly, gas and electricity raise other issues, and we need to ensure that they are properly regulated. However, it would be disproportionate to have similar schemes for the work done by painters, decorators and others.

I hope my hon. Friend realises that we are trying to take a proportionate approach that ensures that while legitimate businesses doing a fantastic job are not penalised with costs, measures are targeted on the real cowboys. If my hon. Friend looks at the legislative framework, he will see that it is designed to clamp down on underhand practices. The Supply of Goods and Services Act 1982 requires traders to provide a service with reasonable care and skill, in a timely manner and at a reasonable
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cost. The Government are examining how the Act might be modernised and simplified so that consumers have a clearer understanding of their rights, including their rights to redress when they have experienced shoddy workmanship or paid for goods that turn out to be defective. I hope that that work will lead to ideas that improve the situation.

The general consumer rights set out in the Act are accompanied by specific legislation to protect consumers from unfair selling in their own home. Builders, of course, fall within the scope of those provisions. The Cancellation of Contracts made in a Consumer's Home or Place of Work etc. Regulations 2008-I am sure my hon. Friend is familiar with them-give consumers the right to cancel a contract they have signed without penalty within seven days. That cooling-off period is a valuable protection, especially for those who may have felt pressurised into agreeing to have work done as a result of the tactics of an unscrupulous builder. My hon. Friend will note that those regulations came in in 2008, and they are still being rolled out, so an understanding of them is still developing among many trading standards officers and the wider public. Those measures are in place, however, and I think that they will be increasingly effective.

As regards other protections given to consumers, it is important to ensure that the enforcers-at national level, it is the Office of Fair Trading, but there are also local authority trading standards officers-have the right tools at their disposal to deal with dodgy builders. The Consumer Protection from Unfair Trading Regulations 2008-again, they are relatively recent-give the enforcement bodies more effective means of tackling unscrupulous practices and rogue traders. Indeed, they ban traders in all sectors from unfair commercial practices against consumers, particularly in relation to the sale and marketing of services. They set out broad rules, which enforcers can use to determine whether a practice is unfair. As I said about the other set of regulations from 2008, these regulations are still relatively new. Trading standards officers are beginning to use them and beginning to understand their use. The regulations are spreading best practice. These tools have come into the toolkit relatively recently, and they will help. They also ban any commercial practices that use harassment, coercion or undue influence that is likely significantly to impair the average consumer's freedom of choice in relation to goods or services.

If we take those various measures together, it is clear that the legislative framework is quite robust, but I would not claim that it is perfect, and we always need to think about how it could be improved. That is why the Government support a project being undertaken jointly by the Law Commission and the Scottish Law Commission to examine how private law might be reformed to provide consumers with a clear, simple right of redress when they are victims of misleading or aggressive selling. My hon. Friend may be aware of that because it comes from a Liberal Democrat consumer document called "Are you being served?", which he may have read before the election.

In addition to providing effective remedies for people who have suffered at the hands of rip-off builders, it is important that we put resources into preventing problems from occurring in the first place. At the end of last year,
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we announced £3.2 million of funding for scambuster teams so that they can continue the fight against rogue traders and builders who deliberately set out to defraud consumers. The fact that we have been able to continue this important work, despite the tough choices that we have had to make elsewhere, is a clear sign of how important we think this issue is. Rogue builders and others who prey on vulnerable and elderly people will not be tolerated, and scambuster teams will lead the fight against them. My hon. Friend valiantly champions the needs of elderly people in all areas of public policy, and I hope that he will talk to scambuster teams in his area to ensure that constituents who are occasionally preyed on by rogue builders are aware of the teams' work.

I appreciate that it can be difficult for consumers to judge whether a builder is genuine. For extra peace of mind, therefore, they can look for tradespeople who belong to approved traders schemes. This is where the TrustMark scheme, which has been mentioned, comes in. TrustMark is an easy way for consumers to identify a builder who has agreed to abide by industry standards of competence and fair trading and to be independently inspected to ensure that they are meeting those standards-the point my hon. Friend made about enforcement. Those in the industry who are approved by one of the operators of the TrustMark scheme are independently inspected, which can give people reassurance. This is a free service to the consumer. Last year, there were 3.5 million inquiries, with people checking out builders and other tradespeople. My hon. Friend is right that we need to raise awareness of the scheme, but the 3.5 million inquiries last year suggest that an awful lot of people are aware of it. That awareness is growing, and we need to continue to help it grow. In addition to the TrustMark scheme, many local authorities run assured trader schemes in their areas to help residents find trustworthy local builders. Again, I would encourage consumers to use those schemes wherever they exist.

The debate is timely because we need to ensure that colleagues across the House and others who are interested in this issue know that the Government take it seriously. As we look at general consumer legislation and do a lot of detailed work on it and the consumer landscape, we will be thinking about the difficult cases that have been mentioned. In the back of our minds, we will be thinking about how provisions will apply to cases in which constituents have been very badly done by. I give my hon. Friend my assurance as consumer affairs Minister that the Government will bear such cases in mind as we review the legislation- indeed, we are doing that very actively.

I reassure my hon. Friend that regulations are now in force-I admit that they are very recent-and that they will assist our work. I assure him that TrustMark is a very good scheme, and I would encourage hon. Members to promulgate it, and local authority trader schemes, when they talk to constituents.

I thank my hon. Friend once again for bringing this matter to the House. Although I have not been tempted by the compulsory license scheme that he so eloquently proposed, I hope that I have reassured him that many other measures that are in place, or which we are considering, will have a good effect on the problems that he raised.

11.29 am

Sitting suspended.


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Flood Risk Management

[Jim Sheridan in the Chair]

2.30 pm

Hugh Bayley (York Central) (Lab): There is a contradiction at the heart of the Government's policy on flood alleviation. In answer to a parliamentary question about flood risk, the Minister told me that

He said that the Environment Agency suggests that river flows may increase by 20% by later this century.

On the same day but in answer to another question, the Minister said that the flood risk management budget, paid by the Department for Environment, Food and Rural Affairs to the Environment Agency, would fall from £354 million this financial year-the Government inherited that figure from the former Labour Administration-to £259 million next year. That is a reduction of 27%. It does not make sense to reduce public investment in flood risk management when those risks, and the costs that flow from those risks, are increasing.

Capital funding in Yorkshire has been hit harder than in any other region. According to a letter from the deputy chairman of the Environment Agency to the Yorkshire regional flood defence committee, funding has fallen by more than 50% compared with last year. Why has my region suffered a larger cut in Government funding than all the others?

The consequences for Yorkshire have been blunt. Three schemes in the Environment Agency's programme were to have gone ahead in 2011-12. All three have been axed. The York scheme would have provided improved flood defences for the Water End and Leeman road areas of the city. There was a scheme for Thirsk. There was a large scheme to protect Leeds city centre, and York still needs flood defences to be provided in the Clementhorpe area, but that was not included in the original programme.

The Environment Agency tells me that those schemes have been deferred indefinitely, but I was pleased to hear the Minister saying in response to an urgent question in the House earlier today that the schemes have not been cancelled. Will he explain to my constituents the exact status of those schemes? If they have not been cancelled, I presume that it is envisaged that they will go ahead. Will he give us a time scale for when those schemes are to go ahead?

Fabian Hamilton (Leeds North East) (Lab): Does my hon. Friend not agree that there is considerable urgency for flood schemes in the city of York? I shall be talking about Leeds later, but when I lived in the city of York the Kings Arms was flooded almost to extinction almost every other year. Does he not agree that we badly need these schemes, especially those for York and Leeds?

Hugh Bayley: The River Ouse, which flows through the centre of York, drains water from about 3,000 sq km of the Pennines. When there is heavy rainfall, the river rises enormously. At the moment, York has severe floods; the river has risen by about
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15 feet above its summer level. When that happens, the Kings Arms public house gets flooded. I am sorry to say that there is no defence in the world that will stop it being flooded several times a year. It almost trades on the novelty of being built in such a way that people can simply hose down the mess and get on with the drinking.

Hundreds of private homes in York-and hundreds of businesses in York; I shall say more about them later-suffer catastrophically when the river rises. In 2000, when the River Ouse rose to its highest recorded level in 400 years, some 350 homes were flooded, and hundreds more came within a whisker of devastation. I left my job as a junior Minister then and went back to York to join Silver Command, which managed the crisis. I remember clearly the November night when hundreds of local residents and 500 soldiers from the 2nd Signal Regiment were sandbagging the Leeman road and Water End area, putting sandbags on top of the existing flood defences to protect the homes behind. Those homes came within a centimetre of being inundated. About 380 homes most certainly would have been inundated, and perhaps another 120 were at risk. Indeed, the leader of York city council was evacuated from his home; he lived in the area at the time.

I shall quote from a statement prepared for this debate by York city council's chief engineer:

I remember preparing evacuation plans 10 years ago. Our fear was not that we would have seepage and slowly rising water levels in people's homes, but that the flood defences might collapse. The engineers believed that that was a real danger, so much so that we tipped thousands of tons of sand and gravel behind the built flood defences to strengthen them. If they had collapsed, we could have had a wall of water running through the centre of York, which would have caused absolute devastation.

The City of York council received advice from the Association of British Insurers about the cost of repairs if the Leeman road and Water End flood defences were overtopped. The calculations were based on 382 homes being inundated. ABI's advice was that the cost of repairing each of those homes would be between £20,000 and £40,000. The total cost of repairs for one flooding event would be £11.5 million, almost twice the cost of the flood defence scheme that the Environment Agency has deferred. The community largely consists of two-bedroom Victorian railway cottages. Many of them are privately rented, and others are owned by people on low to modest incomes-the priority group that the Government say should be helped by the new flood defence plans.

Ten years ago, 100 or so homes in the Clementhorpe area of York were inundated. It received a lot of attention because one of the streets involved is called River street. The papers all carried pictures of firemen evacuating people by boat. That area, too, needs protection. A temporary scheme has been provided by a private benefactor, but it does not work as the council would like, so it is not being used at the moment. Before this debate, I asked the Association of British Insurers and individual insurers, and I am grateful for their advice. For obvious reasons, insurers are always cautious about
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telling the public how much they pay out in claims. One told me that in York it has paid out £12.5 million in claims for flood damage-800 claims in all-over the past decade. The claims peaked in 2000 when it paid out in respect of 286 properties, and again in 2007 when it paid out in respect of 247 properties. The average claim per property flooded was £25,000.

When we debate the problems and risks of flooding, we often talk about home owners and households. It is quite right that individual people-our constituents-should be at the front of our minds, but we must not forget that businesses are very seriously affected, too. I see that my hon. Friend the Member for Workington (Tony Cunningham) is nodding his head. He has had a much more recent experience of flooding than, thankfully, we have had in York.

In response to the Government cuts in capital flood defence schemes, Gary Williamson, the chief executive of the Leeds, York and North Yorkshire chamber of commerce said:

The impact of the floods in 2000 on businesses in York was catastrophic. Visits to main attractions, such as York Minster and the Jorvik Viking Centre, dropped by 94%, from 5,425 in November 1999 to 356 in November 2000. Once the flood had gone, the number of visits was down by 86%. Bed occupancy in hotels was down by a third. Retail business was down between 30% and 50%-it varied from shop to shop-in the busy pre-Christmas shopping period. The York Minster shop suffered a 72% fall in sales. Overall, as a result of the floods in 2000, there were 200,000 fewer visitors to the city, costing something in the region of £10 million, and that ignores all the other business and commerce in the city that suffered as a result of the flood and the subsequent severing of a railway line. The railway is an extremely important commercial highway, pipeline or communication link for York. When the line just south of York in Selby was severed by the flooding, it cost the city far, far more.

What will the Minister do to get the Leeman road and Water End scheme back on track, working with me, as MP for the city, and the local authority, the City of York council? Like all hon. Members, I understand that the country's macro-economic position is weak. In the last published quarterly figures, we learned that the economy had contracted by 0.5%. Economists are now asking what the Chancellor's plan B is should the country fall back into recession; in other words, two consecutive quarters of contraction of the national economy. Of course Labour has argued that the deficit must be brought under control, but the way in which the Chancellor is doing that is too fast and the cuts that he is implementing are too deep. In the run-up to the Budget, the Chancellor will obviously be considering his options. He may not announce it in the Budget, but it is perfectly obvious to all of us in this Chamber that the Treasury is considering a plan B. If the Chancellor were to respond to the worsening economic situation by relaxing the pace of public expenditure cuts, the most obvious place to provide an expansion-or perhaps a lesser contraction-of
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public expenditure would be in relation to capital schemes. We know that there is a current account deficit, but even when Governments are running a current account deficit, they continue to invest over the long term, and rightly so. When someone buys a house, they take out a mortgage for 25 years. When the Government invest in flood defences, they also need to borrow and pay back over a long period of time and pay back, because flood risk is a long-term risk and the flood defence will be there for 50 or 100 years and the capital scheme needs to be financed over that period.

Tony Cunningham (Workington) (Lab): Perhaps the best example that I can give my hon. Friend is Carlisle in Cumbria, which was flooded a number of years ago. In 2009, as a result of a £35 million investment in flood defences, Carlisle did not flood. As a Government, we spent £35 million to prevent flooding. If we had not spent that amount and Carlisle had been flooded, it is estimated that it would have cost between £70 million and £80 million to clean up and repair the damage. Surely that is a good example of how we need to spend in the short term to ensure that we are not stacking up long-term problems.

Hugh Bayley: My hon. Friend gives an extremely good example. The Environment Agency says that the cost-benefit ratio of its schemes in the pipeline are 8:1, which was confirmed by the Environment, Food and Rural Affairs Committee's recent excellent report on flood and water management legislation. That means that we get back much more than we pay. If we leave it to each individual to try to insure themselves-if they are able to insure themselves-the cost to them and the private insurance companies will be much greater than the cost of investing in flood protection. Moreover, if we were to relax the squeeze on publicly funded capital schemes, the jobs that would be created would be in the private sector, precisely where we need to create jobs to pull the economy back on track and to get the Government's fiscal position looking better than it does now.

I ask the Minister to talk this matter through with the Treasury in the run-up to the Budget. I do not expect any feedback in the purdah period before the Budget. None the less, I hope that his Department will make representations, so that if the Chancellor is talking about relaxing the squeeze on public expenditure, he looks at capital works, particularly the cost-effective investments in flood alleviation.

I will try to be brief because I know many Members want to speak. The City of York council and the Yorkshire regional flood defence committee are considering alternative sources of funding for the Leeman road and Water End scheme, including the possibility of funding from the European Union, which is available to support businesses. I have talked earlier about the enormous impact that flooding can have on commerce. Is the Minister prepared to work with the council and the Environment Agency to try to get support for such a scheme?

Consultation documents from the Minister's Department reveal that the Government are seeking to transfer part of the cost of providing flood defences from central Government budgets to local communities. I am not making a particular point about that, but I hope that the Minister will listen and focus on what I am saying.
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He can describe it slightly differently if he wants. It would be a mistake to have a flood tax added to local authority taxation because the boundaries of local authorities do not match the boundaries of river catchment areas. If we are planning to deal with flood waters, we need to plan for the river catchment as a whole.

When York floods, we provide a service for places upstream, because we take the water away from them and prevent them from flooding. Equally, when Selby floods it does a service for the city of York, as it takes our water away and saves us from flooding. That is precisely what Selby is doing at the moment and hopefully it will not flood as a consequence. We are interdependent-that is how nature works-and the funding response needs to take account of how nature works and be based on river catchments rather than local authority areas.

One way in which we might do that is through giving responsibility, in part or in whole, to water and sewage management companies, which of course have been set up to follow river catchment areas. We talk about the "Severn Trent" region. Why is that a region? It is a region because anyone extracting water needs to follow the river courses. Equally, anyone dealing with flood water needs to follow the river courses.

It would be wholly unfair if people in York had to pay for draining water away from upland areas on the east side of the Pennines-the 300,000 square kilometres of land that York drains-or if Leeds city centre had to pay for draining water away from people living upstream in the Wharfe valley. Yet it would be fair for people living in those valley catchments to work out collectively how to deal with the water as a whole. That is what the Environment Agency says they need to do.

Neil Carmichael (Stroud) (Con): Will the hon. Gentleman give way?

Hugh Bayley: I will give way in just a moment.

I see excellent work that the Environment Agency has done upstream from York, creating small ponds on agricultural land, planting trees and building dams that can be closed at times when there is a lot of water, so that water can be stored. If we can slow the run-off, we can convert an 18-foot flood over 24 hours in York, which would be catastrophic, into a 15-foot flood over three days in York, which would be quite manageable. The Minister will have seen such schemes. They exist because we cannot expect small communities-working village by village, town by town, city by city-to protect themselves without a scheme being worked out for the catchment area as a whole.

I ask the Minister to consider an interesting proposal that has been put to me by Yorkshire Water that the company could perhaps buy flood defence infrastructure from the Environment Agency, which would give the Government a capital receipt. Yorkshire Water would be able to do so because it can go to equity markets, which a Government cannot do. Of course such a scheme would increase the cost of water, because the company would have to repay the cost of managing floods more effectively. However, it would mean that those increased charges were spread across the river catchment area as a whole-upstream and downstream communities-rather than on downstream communities exclusively.


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Neil Carmichael: Will the hon. Gentleman give way?

Hugh Bayley: I said that I would give way to the hon. Gentleman. I will do so, then I will give way to the right hon. Member for Berwick-upon-Tweed (Sir Alan Beith) and then I will sit down.

Neil Carmichael: I just want to support what the hon. Gentleman has been saying about the need to think strategically. In my constituency of Stroud we have the Slad valley, which is a relatively small valley. However, if we had a co-operative Environment Agency, a less rigorous interpretation of the water directive and a general willingness to allow local people to do what they think should be done we would solve a huge number of problems for Stroud, which has nearly 5,000 houses in total that are vulnerable to flooding. My appeal is for more local flexibility, so that we can take action and implement flood alleviation measures.

Hugh Bayley: I am glad to receive support from the hon. Gentleman. However, I hope that he will join me in saying that these risks, which people in both our constituencies face, are present and real risks now and that we need Government funding now to address them. I say that because by the time that we work out a new system in five years' time, our constituencies might have flooded.

In fairness to everyone else who wants to speak, I will take an intervention from the right hon. Member for Berwick-upon-Tweed and then I will draw my remarks to a close.

Sir Alan Beith (Berwick-upon-Tweed) (LD): I just want to make the point that upstream flooding, which the hon. Gentleman describes as a form of alleviation in main urban centres, has a cost for the agricultural communities in the areas concerned. Even as far away as Northumberland, we were aware that in east Yorkshire there was considerable resistance to such schemes, but they are an essential part of flood management. Nevertheless, it requires a lot of co-operation and discussion with the farming community, to ensure that a proper balance of interests is recognised.

Hugh Bayley: That is obviously right and it is a very important contribution. We cannot get flood risk management for free, whether it involves building flood defences in York city centre or paying farmers to let their winter cropping fields flood at a time when they would otherwise be planting root vegetables or some other crop. However, it might be both cheaper and more environmentally sustainable to pay the farmers to grow more trees, create ponds and use other measures to retain some of the water long enough to protect downstream areas from inundation.

I could say much more about the consultation documents, about what the insurers are telling me or about the Environment, Food and Rural Affairs Committee report, but I will sit down now so that other Members can have their say.

2.55 pm

Dr Thérèse Coffey (Suffolk Coastal) (Con): Thank you, Mr Sheridan. It is a pleasure to serve under your chairmanship. I am somewhat nervous, because I have
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known the gentleman sitting to the left of you-the Clerk, Mr Hennessy-for 30 years and I have never spoken in front of him before. It is a new experience for me.

I congratulate the hon. Member for York Central (Hugh Bayley) on securing the debate. As Members may know, I will bore for Britain on the topic of coastal defences and, of course, river defences too. I mentioned the issue of flood defences in my maiden speech and in recent debates on shoreline management plans, and I will continue to do so because it is absolutely the No. 1 defining issue in my constituency of Suffolk Coastal.

I pay tribute to the Minister who is here today. He is actually very popular in our constituency, not only because he yet again confirmed the situation regarding Felixstowe's flood defences in the main Chamber earlier today but because he visited my constituency. When he did so, people liked the fact that he listened, reflected on the facts and actually did something about them. We have seen that in some of the thinking expressed in the consultation paper and also in his encouragement of officials at the Environment Agency and Natural England to do the right thing by working with local people and landowners, to get more for less out of the budget. Sadly, due to the economic legacy that we inherited, that budget is slightly reduced from what we would of course like it to be.

In fact, I will go further and say that the Minister has been so successful that the risk is that he will get promoted, but we desperately do not want that to happen because we need him to sort out the fish problem too. Having said that, I will move on to other issues.

I generally welcome the change in thinking on flood defences. For me, there is an incentive, as that change in thinking will help people and communities who help themselves. It is that partnership model that I recognise, but it is a model that still provides protection, within the funding formula, so that where there are wards of deprivation the formula acknowledges that deprivation and will work towards alleviating it.

That gives a fresh element of hope to my constituents who, under the shoreline management plans, were told, "You're on your own". Actually, this new model is a way forward. The Minister has already seen some of the schemes in my area that I want to commend to the House. For example, at Bawdsey there was a situation whereby the economic benefits under the calculations did not derive any financing in particular. What happened was that some local farmers came together and offered up land for development. The local council agreed to grant planning permission for houses to be built on that land. Together the council and the farmers put the money from that development into a trust, which has now paid for coastal defences to protect the area around Bawdsey for some time to come.

More recently, in Thorpeness local home owners came together-I must admit that not all of them did so; one or two decided not to put their hands in their pockets. However, the rest came together and said, "We want to protect our shoreline along here", and the Environment Agency, working with Suffolk Coastal district council, came up with a scheme that will make a difference to people's lives.


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There are ideas for future schemes. I am hesitant to speak about them, but one can see other opportunities whereby communities decide to have infrastructure development. I say that I am hesitant to speak about them, because I do not want my constituents to write in and say, "Thérèse Coffey demands turbine be placed in Felixstowe"; nor do I want my local paper to get the wrong end of the stick. However, there is an opportunity for communities around the country to come up with imaginative ideas for possible schemes.

For example, if we had a wind turbine in Felixstowe, that would work in a high wind when the port itself, down the road, is closed, because the cranes there cannot operate in high winds. That would contribute to the local economy, and the income could be ring-fenced and put into future sustainable defences, not only for Felixstowe itself but for areas, such as Felixstowe Ferry, at the mouth of the River Deben, that face particular difficulties at the moment. The Environment Agency is being very kind at the moment, but I recognise that that kindness cannot go on for ever with our future policy.

I am also interested to learn from the Minister how the pathfinder evaluations might fit into the consultation on the future of funding for flood defences and whether any element of that evaluation process will be incorporated in the consultation.

In Happisburgh, people are very excited because they have been offered some compensation for their houses that are about to fall into the sea. I mentioned that in the shoreline management plans debate, but unfortunately the Minister was in Brussels at the time, trying to do his best for us on fish. Although flooding is terribly disruptive to home owners in places such as York, the water normally goes away, and repairs are needed, but the risk with erosion is that it is terminal. Once someone's house has gone into the sea, it has gone; not only that, the owner is liable for its safe disposal. With a '60s or '70s house with lots of asbestos in it, the owner might be able to apply for a grant of up to £5,000, but that might not cover the costs. The Pitt review constantly referred to in the consultation is based on fluvial flooding rather than on coastal erosion, which has been an add-on.

One thing that is mentioned in the document is that with homes built since 2009 it is the developers who are supposed to take on the flood risk. That is a reasonable suggestion, and I hope that anyone who has bought a house in a flood-risk area since 2009 realises that. With good design, housing can be a lot more resilient to flooding.

Under OM1 in the consultation, I am slightly disappointed to note that the agricultural land value estimate has not been updated or upgraded since the 2007 comprehensive spending review, despite in the other part of the Department for Environment, Food and Rural Affairs there being thoughts on food security and about ensuring that we have that element. It would have been nice to see a slightly more generous value attributed to agricultural land.

Under OM5 to OM7, a lot of money is set aside per acre and per hectare for the recreation or preservation of habitats, to comply with the European habitats and water directives, and that, I am afraid, reinforces the view held by some that nature is more important than people. OM3 gives the figure of £3,050 rental income per year for properties at risk of coastal erosion. In my constituency, trying to rent a coastal property for £3,050 a
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year simply would not happen-a beach hut, perhaps, would be about it. The figure is probably more generous than it has been previously, but I urge the Department to think again on that.

I have to hold my hand up: I have not yet gone through the document with a fine-toothed comb, but will be working on that to ensure that I get my consultation response in by 16 February. However, the document contains some very encouraging phrases that reinforce the principle of partnership and give an opportunity to constituents who are being told that there is no public funding available for them.

I shall finish on two issues, one of which is the cost of delivery. There is an element of red tape in councils, with planning permission, and there are the aspects of the costliness of permits and studies for Natural England, and the consents from the Environment Agency. I know that the Minister has already taken action, and is committed to removing as many blocks as possible to make it as easy and cheap as possible for land owners to protect their defences-all force to his elbow. The Environment Agency told me a couple of weeks ago that it would not prevent land owners in "no active intervention" areas under the shoreline management plans from defending their property. That came as a bit of a surprise yesterday to some of the people at the all-party coastal and marine parliamentary group, and it was thrown up- perhaps anecdotally; I do not have enough evidence-that the Environment Agency might say that but Natural England will stop us anyway.

Sir Alan Beith: There is a tendency for one agency to say that the other agency will not allow it to do something, but in my experience getting them all together in the same room-ideally on site-means that some of that starts to fall away. Fruitful co-operation between agencies is the way forward, instead of blaming someone else for not doing something.

Dr Coffey: My right hon. Friend is absolutely right. I am relaying some of the anecdotes about the frustrations of landowners, but I agree that getting people in the same room to talk things through leads to constructive solutions, once the initial hurdles have been surmounted.

On the funding process, one of my local Suffolk Coastal councillors, Andy Smith, who is a lead council member on coastal matters, has raised with me the annual allocation of funding process. Some schemes take more than a year, and things are unclear or uncertain. There could be a project that was agreed a couple of years previously but which constantly comes up for review regarding the annual allocation of cash. There is something not quite right with that process, and I hope that we can get it right.

Finally, I am encouraging internal drainage boards to participate in the consultation because they could be effective delivery partners for a lot of the work that we want to do. IDBs are not the only solution, but they are a good one. They combine local landowners and councillors, and have an element of democratic authority. The future is quite bright, and could be very bright for coastal and river defences, but I urge the Minister to ensure that the policies of the previous Government, of making 100-year decisions on the basis of three years' funding, are a thing of the past. There are many generations of families in Suffolk who have done their bit for their bit of land
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over the years, passing it on from generation to generation. Let us not kill off the chances of this generation for the sake of 100-year hindsight.

3.6 pm

Fabian Hamilton (Leeds North East) (Lab): I am very grateful to my hon. Friend the Member for York Central (Hugh Bayley) for initiating the debate this afternoon.

After the then Secretary of State for Environment, Food and Rural Affairs, my right hon. Friend the Member for Leeds Central (Hilary Benn), had made a statement to the House on flooding on 17 December 2008, I asked him a question about his proposed trial areas for surface water management in Leeds. My question was about an area in the Roundhay ward of my constituency called the Wellhouses-a series of residential streets through the middle of which runs Gledhow beck. I had been approached by local residents who were concerned that they had the responsibility for maintaining the banks of the beck, which frequently overflows during heavy rain, exacerbated by the excessive outflows of water from the balancing lake in Roundhay park. As always, my right hon. Friend was courteous and helpful in his reply, and promised to let me know whether Gledhow beck would come under his plans to transfer surface water management to local authorities such as Leeds-one of his trial areas-in 2011. The subsequent answer was that it would.

Surface water management might appear to many to be a rather dry and uninteresting issue until their homes are flooded by exceptional rainfall or overflowing balancing lakes. I took up the issue affecting the residents of the Wellhouses because I was shown first hand the appalling damage that could be done in an instant to the homes of people I am privileged to represent. Most people never give a moment's thought to the merest possibility of their homes being flooded, until it happens.

It is true that many parts of the hilly city of Leeds will never be in danger of flooding. Where I am fortunate to live-in Pudsey to the west of the city, between Leeds and Bradford-we are more than 650 feet above sea level and can be complacent. However, much of Leeds is built around the River Aire, and is therefore susceptible to flooding. On 15 June 2007, Leeds city centre came very close indeed to being overwhelmed by water, after days of appalling weather when a whole month's rainfall fell in 24 hours-Leeds was not unique in that, that summer. Many city centre roads were under water, and the city almost came to a juddering, squelchy halt. On 27 June 2007, the Yorkshire Evening Post reported that more than 6 cm of rain had fallen during the previous nine hours,

Suzanne McTaggart's report added:

On its excellent website, the Environment Agency says of its proposed Leeds River Aire flood alleviation scheme:


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The Environment Agency's latest briefing on the Leeds scheme tells us that the agency is now working closely with Leeds city council to come up with an affordable scheme. It estimates that the current comprehensive scheme would cost about £190 million and would involve building raised defences on the River Aire, thus directly protecting 255 residential and 495 commercial properties and indirectly helping to avoid the flooding of 3,800 residential and commercial properties. The briefing suggests that if the city of Leeds were inundated by floodwater, the damage would total at least £480 million -several times the cost of the flood defences. DEFRA has asked the Environment Agency to continue working with Leeds city council to secure alternative sources of funding or to find ways to reduce the costs of the project, but initial indications from DEFRA, which I understand have now been confirmed, show that sufficient funding will not be available in 2011-12 to proceed to detailed design.

I intend no disrespect to my good friends who represent the great Yorkshire cities of Hull, Bradford and Sheffield, or, of course, to the wonderful people who live in those cities, when I say that Leeds is without doubt the engine of the whole Yorkshire regional economy. Like every other city in the UK, with the possible exception of London, Leeds has been badly hit by the economic downturn, but it still draws in tens of thousands of commuters every day, who come to work in the many businesses, legal practices and financial institutions that operate from Leeds city centre. Leeds is still the largest financial centre in England outside London-hon. Members can forget about Manchester. Imagine what would happen if the "relatively small" floods in 2007 became a much larger flood, as the Environment Agency fears they might, swamping the centre of Leeds, its wealth-generating businesses and its newly built apartments and homes.

Spending a relatively small amount now could, however, help to prevent catastrophe in the future. With climate change making rainfall in these islands ever more unpredictable, the River Aire will burst its banks sooner or later and drown our city. Not only will thousands of homes be affected, but millions, if not billions, of pounds of business activity will be halted, and thousands of hard-working citizens will have their jobs or their lives ruined-all for the want of the flood defences that could have been built, but which the Government cut because the deficit simply had to be repaid in four years, rather than five, six or even seven. [Interruption.] Sorry, does the hon. Member for Shrewsbury and Atcham (Daniel Kawczynski) want to intervene?

Daniel Kawczynski (Shrewsbury and Atcham) (Con): I am not allowed.

Fabian Hamilton: In the summer of 2009, I was approached by the residents of Valley terrace, which is in an area of housing just off the Leeds outer ring road, in the Roundhay ward. They were upset that woodland between their homes and the noisy, busy dual-carriageway ring road was to be destroyed and built on by developers.


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Geoffrey Clifton-Brown (The Cotswolds) (Con): I assume that the hon. Gentleman's city, like my constituency, suffered bad floods in 2007. If it did, he should surely attach some of the blame for the lack of action on building flood defences to the Labour Government, rather than blaming this Government, who have had only six months to do anything about this.

Fabian Hamilton: I strongly disagree with the hon. Gentleman.

Hugh Bayley: I have fought hard for 10 years for flood defences to be improved in York and I would accept-

Geoffrey Clifton-Brown: Why did the Labour Government not do anything about it?

Hugh Bayley: Will the hon. Gentleman listen for a minute? I accept that the Labour Government, who put in millions of pounds and improved many flood defences, protecting some areas of the city, did not finish the job. However, I should tell the hon. Gentleman, who I hope will have the opportunity to speak, that while Labour was in power, we increased Government funding to the Environment Agency for flood risk management from £249 million in 2000 to more than £500 million in 2008-09-in other words, we more than doubled it. We provided funding for more flood management and protection schemes than was the case before. Our concern is that this Government are reducing funding.

Jim Sheridan (in the Chair): Order. Interventions are getting a bit long.

Fabian Hamilton: I thank my hon. Friend for that timely intervention. I was going to respond simply by saying that we cannot design flood defences in two or three years; it takes a long time to make sure that we have the protection that is appropriate to the environment and needs of a particular area to ensure that the system will work. A great deal of research has to go into these issues, from not only the Environment Agency, but every other agency involved. That is why these things were not done instantly after the 2007 floods.

Let me return to the points I was trying to make about the little piece of land between the ring road and Valley terrace. Some may accuse my constituents there of being no more than nimbys-that stands for "not in my back yard"-who do not want any further development now that they have their homes in such a lovely area. However, I supported their bid to stop the planning application, which would have destroyed that small area of woodland, because the woodland soaks up rainwater coming down from the hills into the valley where the ring road is situated. I am increasingly concerned-I would be interested in the Minister's response-that planning authorities are allowing more homes to be built on woodland with no regard to the excessive surface water drainage problems that might occur as a result. I am delighted to say that planning permission was refused on this occasion-whether that was to do with my intervention, I simply cannot say.

That brings me back to the Wellhouses. June 2008 saw the publication of a not very entertaining, but very important DEFRA report, entitled "The West Garforth
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Integrated Urban Drainage Pilot Study"-hon. Members should try saying that when they have had a few drinks. Among its many conclusions was:

I am grateful to the Environment Agency, the leader of Leeds city council-Councillor Keith Wakefield-the Leeds, York and North Yorkshire chamber of commerce and my friend and constituent, Chris Say, for all their help in getting me the information, facts and figures on which I have based my contribution. This is an important issue for every resident of Leeds and has an impact on a much wider population. I therefore hope the Government are listening and will make our flood defences a priority at a time when money is in short supply-the futures of so many, and the economy of a whole region, depend on it.

3.17 pm

Mr George Mudie (Leeds East) (Lab): It would be unfair of those of us from Leeds to take up all the time, because flooding is such an important matter, which affects people directly and in such a traumatic way, and other hon. Members must have their opportunity. I will therefore be very quick.

I had the opportunity to raise a question about this issue with the Minister on the Floor of the House earlier this afternoon. I should say that I am not making a political point. I will certainly not get involved in any political nonsense about which Government spent more. We are where we are, and we can settle political differences and arguments elsewhere. We are talking about flooding, which, as we all know, affects people in a very personal way. I say that in my defence. What I would also say, however, in what I hope will be a brief speech is that one difficulty with flooding assistance is that it seems to relate, on a cost-benefit basis, to the number of households. That is where the Minister and I were at cross purposes earlier this afternoon.

To illustrate what my hon. Friend the Member for Leeds North East (Fabian Hamilton) was saying, let me use the words of the flood risk manager in Leeds, who puts the case better than I could:

which is fine; we would expect him to say that. He continued by saying that

My hon. Friend the Member for Leeds North East mentioned the £500 million of damage that could be done. I do not know whether the Minister has been to Leeds, but the river runs through the business and retail centre-the river and the canal run below the main train station-and it is a compact city centre, which flooding would damage tremendously.

The Environment Agency brief-when I mentioned it previously, the Secretary of State was talking to the Minister and seemed to disagree-stated:


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I simply make the point to the Minister that the major economic centre and engine for growth for millions of people in west Yorkshire is the Leeds centre, and it has come disastrously near being put out of operation in a major way. The train station is built over the rivers. The 2000 flood threatened electricity supply in the city centre, which, in turn, threatened the major Leeds general infirmary. This is a question of a major catastrophe. The Minister will not think I am doing him any favours, but I do not want him to be on world or national television in his wellies standing looking at a flooded national city-the largest in the north. I do not want that to happen, for the sake of the city and its people and the surrounding towns and cities. That is how close we are, if the matter is judged on number of households and cost.

We are where we are. It is accepted that any Government would have to pull back the deficit, whatever the time scale. These are difficult times and priorities must be set. I understand the situation. I even offer something additional-without being patronising. I shall say this so that the Minister can use it against me-and the city-but I think that the scheme was designed in slightly better times. I question the £190 million scheme, especially given the number of schemes lining up throughout the city. In the Chamber, the Minister offered a meeting. I should welcome one, but its outcome would be to make it clear to the Environment Agency and the city, within agreed parameters, if possible, what type of scheme and expenditure are realistic in this day and age. We would say "Go away and if you can get something within those parameters we will look at the design work." We are not speaking about this year or next year. The design work would be started on a more modest, but realistic, scheme. That would help.

There is an additional way in which it would help. The Minister will appreciate the problems. Quite rightly the previous and present Governments have told the city to get private involvement. Businesses and houses are being saved, and there is development, so they have told it to put some funding in and it has found, it thinks, £20 million. That is a lot of money but when it is compared with a £190 million scheme one might say, "I think you'll have to do better," and that causes problems. What if we were all to meet in a room and say, "Let's get real with one another; let's get this scheme down"? The city centre must be protected and we cannot have a national economic asset knocked out-but the work should not be at any price. We should get a realistic price and a realistic public contribution, and all agree to do the work as quickly as possible.

As I am chairing a Committee upstairs at a quarter to 4, I shall have to leave the debate, and I give my apologies now-I am not leaving out of disrespect. However, I should hope that the Minister would see my remarks as helpful. They are heartfelt on behalf of the city of Leeds, and west Yorkshire.

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