“The workload net balance has now been negative for thirteen consecutive quarters, which means more construction businesses are reporting a decline in workloads than are reporting any increase.

The latest results from the FMB’s State of Trade survey showed that construction workloads continued to fall at the start of 2011, and around 35% of respondents anticipated lower workloads in the second quarter of the year.

Employment conditions also deteriorated in the first quarter of 2011. When members responded to our last survey in March 43% had reduced employment levels in the first three months of the year, compared with 32% in the last quarter of 2010. Figures recently released by the Office for National Statistics showed a total of 24,000 construction job losses in the first quarter of 2011.”

The situation is very serious indeed. The FMB also points out that the pressure on small construction businesses in particular is intense. Their output decreased by more than twice as much as that of bigger companies, which is very worrying, considering that 93.5% of Britain’s private contractors employ fewer than 14 people.

When the UK economy contracted by 0.5% in the last quarter of 2010, the fall in construction output was 3.3%. Responding to that drop, the Construction Products Association’s economics director, Noble Francis, said:

“Although the poor weather in December inevitably had an adverse effect on construction work, it also did one year earlier. It is clear that the recovery in construction during the middle of 2010 has now ended abruptly and that private sector work is not coming through strongly enough to sustain growth.”

He predicted a 2% decline in construction in 2011.

We have heard the key statistic that every £1 spent on construction generates a total of £2.84 in economic activity. We need, desperately and urgently, to generate economic activity, which is the exact opposite of what the Government are doing. For smaller construction firms in particular, a lack of available work is being caused by the deliberate decisions of this Government to withdraw investment from projects such as Building Schools for the Future. The interlink between the public and private sectors in construction is of huge importance. We lack work in the construction sector, but, at the same time, there are also increases in prices for construction companies. The Specialist Engineering Contractors’ Group tells me that the price of copper has risen by 275% in the past two years, and that the price of iron ore has more than doubled to $200 per metric tonne since last summer.

Some good work is going on in relation to project bank accounts. It was initiated by the previous Government and has been taken forward by this Government, but even that is under threat.

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Gordon Banks: On the issue of price increases, my hon. Friend is right to highlight international commodity prices, but price increases are also being forced by the economic conditions delivered by this Government. Production capabilities are being closed down and jobs are being lost, so the price of the finished product is being driven up.

Ian Lucas: Absolutely. The other key point is that this Government increased VAT at the beginning of this year. They have increased the price of any business that offers goods for sale and services within the construction sector. The FMB says:

“The situation for small construction firms has been made more perilous by the VAT increase at the start of the year.”

A deliberate decision and act of Government policy is making the position of construction companies more perilous. That is a damning statement.

The Minister of State, Department for Business, Innovation and Skills (Mr Mark Prisk): The hon. Gentleman has rightly cited the concerns of the FMB. Does he support its call for a 5% cut in VAT, over and above the claims of the shadow Chancellor, the right hon. Member for Morley and Outwood (Ed Balls)? Is that what the Labour party would do?

Ian Lucas: If the Minister listens to the rest of my speech, he will hear me address that particular point. The increase was wrong-headed, the wrong policy and an example of the Government being wrong again. They are beginning to look increasingly like Herbert Hoover, rather than Franklin D. Roosevelt. That is why we are saying that we need to look at alternatives to the policy that is being pursued at present. If we continue with the policy that the Government are doggedly pursuing, it will be disastrous for the construction industry. That is why the Labour party will propose reductions in VAT when we next discuss the Finance (No. 3) Bill. My right hon. Friend the shadow Chancellor has already proposed an emergency reduction in VAT. The Government make complacent observations on the matter, but the situation is urgent. Not only is the construction sector under massive threat, but it is not able to provide the number of apprentices needed within the sector to maintain it. Businesses have no confidence in offering any jobs to people, let alone in taking on employment. The Government simply have to recognise that sort of reduction in confidence in the sector.

The FMB has made various proposals, as the Minister has mentioned. Our shadow Treasury team has made proposals in relation to the Finance (No. 3) Bill, and I hope that the Minister and the Government will start listening. If they do not, all of the rhetoric about growth and rebalancing the economy that we hear coming out of No. 1 Victoria street will be recognised for what it is, which is rhetoric alone. The Government are being hounded by the Treasury, and the Department for Business, Innovation and Skills is being sidelined. It is a Department with no influence in a Government who are pursuing a bankrupt economic policy that is leading to more bankrupt companies. Such companies are increasing in number, as shown by the figures that I quoted earlier. That is the reality of what is happening on the ground.

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I pay tribute to the good work that the Minister is trying to do in areas such as the development of a low-carbon economy, the green investment bank and the green deal, but they are chugging along and are nowhere near arriving yet. The position is urgent. The Government need to contribute a positive answer to the crisis facing the construction industry. We need action, not words, and we need it now.

12.19 pm

The Minister of State, Department for Business, Innovation and Skills (Mr Mark Prisk): I congratulate the hon. Member for Liverpool, Walton (Steve Rotheram) on securing the debate. It is great that we have among our specialist crafts and trades two bricklayers who have been in the business. I am a mere surveyor, but I hope that I am trusted to at least get the pricing right. I am pleased to say that we have had a very constructive discussion, albeit with a fair degree of partisanship. I was glad to hear the hon. Member for Wrexham (Ian Lucas), who speaks for the Opposition, say that he is fond of me. It would be slightly worrying if he were not—I am not sure what we would have had at the end in terms of just how fond he is.

Let us consider some of the facts and see whether I can respond to some of the key points raised. The debate has been very wide. We have covered skills, access to finance, the importance of the green economy and of apprenticeships, as well as the planning regime system and how that works. I suspect that hon. Members from all parties would share the view that the construction sector is crucial, as is shown by the numbers. It makes up 6.8% of the total economy and directly employs around 2 million people.

As we have heard in the debate, we recognise that construction and housing related to construction have been through a tumultuous time—a savage period—since 2007. Over the two or three years during and through the recession and, yes, into difficult times now, many businesses have faced a real rollercoaster. Good firms have gone and firms that, frankly, were struggling anyway have gone. There has been a headcount loss, which we note and regret, but we should not simply paint a wholly gloomy picture. Some months the figures go up and some months they go down, but if we consider the most recent output figures that have been published on the three months to the end of April, there has been a 6.2% increase in output, which is about £16.7 billion. So it is not a wholly gloomy picture.

Gordon Banks: On that point, I take it that the Minister is referring to ONS statistics. Does he have any concerns about how the ONS gathers statistics on the construction industry?

Mr Prisk: Concerns have been raised. The Construction Products Association, which has been mentioned, has asked whether the strength of the sector is in fact underplayed. That issue is being considered by the ONS.

The hon. Member for Liverpool, Walton will not agree on this analysis, but I did not hear from him any recognition of the enormous financial deficit that we inherited and therefore the tough decisions that we had to take. What I heard from him was the suggestion that we are not investing at all. I do not accept that. Let me highlight how, despite those difficulties, we have set out

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the first national infrastructure plan and shown how £200 billion of public and private funding will be put into the sector—into infrastructure and construction—over the next five years.

The spending review has started to spell out how that will work. There will be £10 billion additional funding for roads and maintenance, which is crucial, and £14 billion additional funding for rail. Of course, Crossrail is going ahead and we intend to proceed with High Speed 2. That is crucial for the overall sector. In the hon. Gentleman’s area, the Mersey Gateway is a £600 million project that will create 460 direct jobs. The project should open some important opportunities in the area and generate around 4,500 jobs. In difficult circumstances, we are making an investment that could help.

Several hon. Members mentioned the question of how we can help the economy and the construction sector more broadly. The Government can do a number of things. My hon. Friend the Member for Peterborough (Mr Jackson), the hon. Member for Derby North (Chris Williamson) and others talked about the planning system, which is a sclerotic system that needs to change. That is why we are progressing with a presumption in favour of sustainable development, so that the default answer is yes and the burden of proof is moved to those who seek to oppose development. We are streamlining the planning process and the consents that go with it and stripping back the 3,250 additional pages of planning guidance of the past five years to around 100.

We want to speed up the system and to get developments under way by setting a time limit. That important issue has not been raised in the debate. If we establish a clear 12-month deadline, including appeals, it will give business, construction and corporate clients the certainty of knowing that there is a timeline within which planning will progress. That is a vital part of the process.

Susan Elan Jones: Will the Minister give way?

Mr Prisk: I am not going to give way because, with respect, the hon. Lady did not make a speech and I am trying to respond to those who have.

The construction strategy is important because it provides certainty about the future pipeline of public projects. Several hon. Members said, “Let’s have some action, not talk.” I agree. That is why, from this autumn, we are rolling out a two-year programme of pipeline projects that are funded. Therefore, the industry—infrastructure and construction projects—will know what is coming, can plan for it, invest for it and put money into the skills. That is crucial. We have never had that before. It seems painfully obvious now that that is what the industry wants. We are doing that, and we are doing it for the first time. Such an approach will make an important shift.

That brings me to the question of public procurement. We recognise that many public procurement costs have been way over what they should be, which is why we have set a target of a 20% reduction. I pay tribute to the industry because it is great that it has stepped up to the plate and said, “Yes, we agree. We want to be part of this.” We have set out a clear process of how we are going to eliminate waste and duplication, and introduce a whole new way of procurement that will not only reduce the costs, waste and duplication, but open the market to newer entrants—small and medium-sized enterprises—who perhaps in the past have felt shut out.

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Gordon Banks: Does the Minister not agree that for that to happen there must be a constructive programme—to use an appropriate word—of varying sized contracts throughout the UK? Crossrail is fine, but a small SME will not be involved in that and certainly will not make any money from it.

Mr Prisk: Absolutely. That is why our approach is not just about one part of central Government; it is about the whole of government. The hon. Gentleman is right. We need to ensure that the package sizes are varied sufficiently, so that SMEs can participate.

On skills and apprenticeships, first, we are ensuring that young people can at an earlier age—14 onwards—get their hands dirty and start to learn good trades and crafts. We are expanding the university technology colleges—there will be 24 of them—so that we can ensure that, yes, young people get their basic English, maths and so on, but that from 14 onwards they can start to learn a trade and a craft. That is important. Secondly, we have rightly heard a lot about apprenticeships. That is why, over the coming four years, we are putting £250 million of extra money in to deliver 250,000 additional apprenticeship places. Concerns have been raised about whether we are making enough progress and whether there are enough places. In this first year, the evidence is that the take-up has been 100,000 places. That is double the number originally expected and is an encouraging sign.

Ian Lucas: Is the Minister not concerned that, according to figures released yesterday, the proportion of apprentices in construction has fallen? Is that not a matter of real concern? Places are not available within the industry because there is not enough work.

Mr Prisk: I do not deny that there is a challenge in construction. We cannot force that number. The point is to ensure that we put the funding in place, so that

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businesses who wish to do so can participate. In that first year, we have seen a good picture overall.

The important issue of green skills was mentioned. For the record, we have agreed a clear strategy with the sector skills councils and established a programme to create an additional 1,000 apprenticeship slots for green skills. Last week the “Low Carbon Construction Action Plan” was published. That document sets out our response to the industry’s programme in terms of 65 specific tasks, including skills and investment. We do not simply want to set out what we might do in five, six or seven years’ time; there is a programme for what happens now, through the next four or five years. The programme is specific in that context.

I shall turn briefly to Building Schools for the Future. The reality is that it was a hideously complex programme with an overrunning budget, an incredible duplication of processes and wasteful outcomes. It has been suggested that Building Schools for the Future is the end of school building. It is not. The Department for Education has spelt out clearly that we intend to ensure that £15.8 billion is available for schools spending over the four-year comprehensive spending review period. Clearly, we need to get value for money and to strip away what the industry has told us are some of the processes that block the system and do not deliver the calibre of buildings that our children deserve. That is why the Department will be responding to the independent James review. I am mindful of the time, so I will respond in writing to the point that the hon. Member for Wrexham made on low carbon.

Let me draw my thoughts to a conclusion. I come from the sector, so I recognise that these have been tough times and that the industry is not out of the woods yet. There are glimmers of opportunity, but there are challenges as well. For the first time, we have an infrastructure plan in place and a rolling programme for the funding of infrastructure and construction schemes—

Mr Charles Walker (in the Chair): Order. Time is up.

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End-of-Life Care

12.30 pm

Brandon Lewis (Great Yarmouth) (Con): It is a pleasure, Mr Walker, to serve under your chairmanship. The aim of this debate on end-of-life care in Great Yarmouth and Waveney has two key elements: to highlight the great deal of work being undertaken locally by a wide range of people for end-of-life care through the primary care trust, the James Paget hospital and the East Coast hospice; and to outline where we need further Government support, because more support is needed for end-of-life care in our area.

For many years, patient choice has been the buzz phrase used by all Governments in relation to the provision of health services. However, patients and their families in Great Yarmouth and Waveney, and in parts of the east coast more generally, live in one of the few places in the country where full patient choice of end-of-life care is simply not available. This debate will highlight the work that is already being done to provide end-of-life care, and outline the need for a full range of options.

The World Health Organisation defines end-of-life care as:

“The active, total care of patients whose disease is not responsive to curative treatment”.

Palliative and end-of-life care needs to provide dignity, respect and privacy for both patients and their families. There is an opportunity for a range of providers—hospitals, community hospitals, care homes, hospices and hospices at home—to be part of that provision. The aim is to provide a holistic approach to end-of-life care, in order to limit distress for both the patient and their families through the right type of support.

Let me first turn to current provision. It is disappointing that, at the moment, Norfolk has no in-patient hospice provision outside of Norwich. Other counties in the eastern region have much better provision. For example, neighbouring Suffolk has two hospices, in Bury St Edmunds and Ipswich. With a population of approximately 230,000, the Great Yarmouth and Waveney PCT area is significant in not having a hospice. I will return to some worrying figures relating to that shortly. There is a lack of choice. Great Yarmouth and Waveney is one of only two areas in the country with no in-patient hospice. If the Government wish to provide the widest choice, which I believe they do, then different solutions for different patients are required. There is no full range of options for end-of-life care. At the moment in Great Yarmouth and Waveney, end-of-life care is only available in a hospital, community hospital or at home. A hospice would extend that choice, and provide a midway option between dying in hospital and at home.

One project currently underway is Palliative Care East, which is part of the James Paget hospital. Funding has been secured to establish this superb project, which will be a day care centre at the hospital. There will be a resource centre and an outreach service with out-patient care for terminally ill patients, providing practical help and support, along with advice and information. Many people support the project—I have taken up the challenge of a triathlon to raise money for it. The date is 7 August, if anybody would still like to donate some money, through JustGiving, for Palliative Care East. In the past

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few weeks, some ladies raised £65,000 by climbing to the top of Ben Nevis—a great example of fundraising by a local community, which is not affluent, in order to deliver something that it needs very much. The hospital is to be congratulated on pulling that organisation together, and the project is just about ready to be delivered.

It is, however, important to provide additional services. Currently, that facility has no plans for in-patient beds. That is where another organisation, East Coast Hospice, comes on to the radar. It is a local charity, which I and my hon. Friend the Member for Waveney (Peter Aldous) have supported all the way through, which wishes to build and operate a 10-bed, in-patient hospice, alongside a day care unit, to provide a safe haven for patients and their families. So far, it is half way to raising enough money to acquire a five-acre site in Gorleston, which is close to the hospital, through various fundraising activities, including four fundraising shops that are now open. There is a lot of work being done. The charity requires several million pounds to commence building work on the hospice.

One issue that has arisen, with Palliative Care East and East Coast Hospice working at the same time to raise funds for two much-needed facilities, is the confusion in the local community about what they are. One challenge facing end-of-life care is how various providers can work together and access funding. It is important to avoid duplication, so that voluntary services can run alongside the NHS provision and for neither to be seen as a threat to the other, or duplicating costs, particularly administration costs. One aim of the debate is to highlight how different organisations need to work together, and how they can work together to provide real choice in an open, transparent dialogue that is required to achieve that. There has been some confusion, even among people in the public sector, and among councillors. We have had to have meetings to bring people together to explain the difference between what Palliative Care East will provide as an out-patient facility, and what a hospice provides as a non-hospital based facility for people at the end of life.

Historically, there seems to have been an institutional block to the provision of a hospice, particularly because of the stance of the local hospital. That has nothing to do with the current administration; it appears to go back to 1982, when there were arguments from the hospital that there was no local need for a hospice. That has been, and currently is, at odds with strong indications of support from patients, residents and GPs. The Marie Curie Cancer Care “Delivering Choice” programme notes the need for a hospice. Perceived local hostility towards the establishment of a hospice has, at times, directly prevented the project from moving forward. The PCT has not always been able to provide the necessary and helpful letters of support to allow the hospice to gain access to funding.

One worrying issue is that in our PCT area, Great Yarmouth and Waveney, £2.62 per head is spent on end-of-life care. Out of 151 PCTS, Great Yarmouth and Waveney is ranked 142nd for patient spending—the lowest in the east of England, and nearly half the national average expenditure. Even now, we are somewhat unclear as to what the current spending on end-of-life care is for the PCT, as there are no published figures for 2008, or indeed 2010. Research shows that the Great

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Yarmouth and Waveney PCT has the lowest spend per capita, despite having the highest relative need. With an ageing population, that will continue to put pressure on our local area.

During a debate recently secured by my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow) said:

“We want to ensure that these institutions grow and flourish as part of a more personalised approach to end-of-life care.”—[Official Report, 2 February 2011; Vol. 522, c. 1007.]

During the debate, three principles for hospices were set out: to get the funding right for hospices; that there should be a clearer understanding of the role of hospices in end-of-life care, and that that should be recognised in the commissioning process; and that end-of-life care is a priority for improvement across the NHS. What will the Minister do to help us to persuade PCTs, such as Great Yarmouth and Waveney, to look at hospice provision as a core part of end-of-life care strategy?

The principles of the Health and Social Care Bill will allow GPs a central role in commissioning services and providing choice for patients. I very much welcome that, as do GPs in our area, with their pathfinder. At the moment, however, that choice will not be able to be fully exercised because no real choice exists in our area for end-of-life care. GP commissioning can help the establishment of a hospice in this area because of the broad support of GPs, as outlined in the Marie Curie “Delivering Choice” programme.

In last year’s end-of-life care strategy, the Government announced a £40 million capital scheme for hospices. That fund is allocated directly to PCTs, with the Department of Health not being prescriptive about how it is spent. In addition, Help the Hospices also receives funding directly from the Government to help support its network. That funding is only available, however, to hospices with established facilities. That excludes charities, such as East Coast Hospice, that want to build a hospice. I have two questions for the Minister. Will the Minister consider allowing opening access to funding, so that charitable organisations can access funding where there is a need for hospice provision, and where no current provision is available? Secondly, what can the Minister do to allow organisations that want to establish a new hospice to access capital funding from the Government, which is clearly needed in Great Yarmouth and Waveney?

The phase 1 report of the Marie Curie “Delivering Choice” programme made various recommendations about hospice provision and in-patient care in the area, which we have so far failed to deal with properly. The report highlighted widespread support among GP respondents, who identified hospice provision and palliative care services as key themes for health care in our area. They were particularly critical of the difficulty in accessing the 12 beds available at Northgate hospital in Great Yarmouth, underlining the need for additional in-patient beds, which a hospice could provide. GPs recognise the need for access to a hospice with specialist provision of enhanced symptom control, respite care to support families and emotional support for patients and their

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families. Of 45 respondents to the questionnaire, 38 considered the development of a hospice for vulnerable patients a necessity.

Most GPs recognise that the James Paget hospital is not suitable for end-of-life care. In fact, the whole point of a hospice is that it is not in a hospital but that it is an alternative. The James Paget is also a busy acute hospital, which adds extra pressures to make end-of-life care more difficult. The community hospital has limited access to its provision and has a shortage of side rooms allowing for privacy and respect. Although the PCT’s commitment to new palliative care facilities exists, the trust has not yet been able to do anything about the need for a hospice.

We now have the palliative care funding review, which is chaired by Tom Hughes-Hallett, the chief executive of Marie Curie Cancer Care. When launching the review, the Secretary of State said:

“This will better enable patients to choose how and from whom they receive their end-of-life care”—

something I fully applaud. After the debate, I hope that we can ensure that such a choice becomes available to the residents of Great Yarmouth and Waveney, as it currently is not. We do not even have access to the £40 million of hospice funding via the local primary care trust, as I noted a few minutes ago, because we do not currently have a hospice. We have, however, the need to build one.

The interim report published by the review committee in December 2010 states that

“we need...A reduction of inequities in the system; be they geographical…or access to services for patients with different diagnoses.”

The committee also comments that affluent areas tend to be able to offer a more diverse range of services owing to increased charitable funding. Poorer areas offer poorer levels of choice, a point highlighted in an area with deprivation, such as Great Yarmouth and Waveney. The interim report emphasises that the majority of patients have a preferred place of care when they die: at home. The second choice is a hospice, with almost 25% preferring that option, although at the moment only 5.2% can achieve that aim. Most deaths in England—about 55%—occur in NHS hospitals. That is exacerbated in areas such as Great Yarmouth where a full range of end-of-life care options is not available.

Can we find a way in Great Yarmouth and Waveney for the PCT, the hospital and East Coast Hospice to work together? Primarily, can the Government allow us to develop a hospice in Great Yarmouth by ensuring fair access to infrastructure capital funding? Organisations such as East Coast Hospice are working hard to raise the necessary funds to buy the land and to run the service, but they need help with the infrastructure, with the capital investment to make the potential building a reality.

12.43 pm

Peter Aldous (Waveney) (Con): It is a pleasure to speak under your chairmanship, Mr Walker. I am grateful to my hon. Friend the Member for Great Yarmouth (Brandon Lewis) for securing this debate on a topic of such importance to our two constituencies, and to the northern part of the constituency of my hon. Friend the Member for Suffolk Coastal (Dr Coffey).

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My hon. Friend the Member for Great Yarmouth has set the scene admirably. I shall make a few observations based on my own finding and experiences in the past year representing Waveney and over the past 40 years as a resident of the area. I will outline five distinctive health features in the area that place a burden on the NHS generally and on end-of-life care more specifically.

First, Lowestoft and Great Yarmouth include pockets of extreme deprivation which are not immediately apparent to those with only a passing knowledge of Suffolk and Norfolk. Secondly, a high percentage of the population is elderly; the East Anglian coast has long been a popular retirement area. I do not begrudge people moving into the area—in fact, I welcome them—but the Government must recognise that they are an added financial cost for those providing health services, and that must be reflected in the funds made available. Thirdly, the influx of holidaymakers in the summer months is an added pressure. I well remember visiting my father in James Paget hospital some 10 years ago and observing that many of those in his ward were not local to the area.

My fourth point, with regard to where people die in the Great Yarmouth and Waveney area, is the limited hospice provision. In England as a whole, 5.2% of people die in a hospice, but in our area only 0.1% do. In the west of the Waveney constituency, those in the Bungay area are well served by the excellent All Hallows hospital at Ditchingham, but there is a glaring lack of a similar facility in the Great Yarmouth and Lowestoft area. East Coast Hospice, of which my hon. Friend the Member for Great Yarmouth and I are both patrons, is determined to redress the balance, as he said. It has a lot of work to do, however, and it is vital for the Government to ensure an environment and climate giving it every assistance and encouragement as it sets about its task.

Finally, despite the lack of facilities in the area, we have a tremendous community spirit, with many voluntary groups and charities doing all that they can to provide services and to raise funds. As well as All Hallows and East Coast Hospice, we have Waveney Hospice Care, which is merging with the St Elizabeth hospice, and does great work providing day care. Palliative Care East has reached its target for providing day care and support for those using the James Paget hospital, and East Coast Truckers continues its sterling efforts to raise funds for East Anglian Children’s Hospices.

Moving on, I will outline three areas of end-of-life care in which we must do better. First, as I mentioned, more hospice care is needed—my hon. Friend set that out clearly. Secondly, linked to that, is the urgent requirement for more respite beds, so that carers can get away for a much-needed break. Last Friday, I was with Crossroads Care, which reinforced that point.

Dr Thérèse Coffey (Suffolk Coastal) (Con): I congratulate my hon. Friend the Member for Great Yarmouth on securing the debate and my hon. Friend the Member for Waveney (Peter Aldous) on his contribution. Does he agree that, although we do not have the range of choice, we ought to pay tribute to places such as Patrick Stead hospital in Halesworth, which manages to provide some respite care but could easily provide more if the funding were available?

Peter Aldous: I agree entirely. The Patrick Stead is my local hospital, so I also endorse its excellent work.

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The third area is the need for the provision of 24/7, around-the-clock community care, which must be a priority. It could provide people with the option to spend their last days in their own homes, with their families and friends, which so many people wish to do. My father, who died last year, died in hospital and not at home. For my mother, who cared for him in the last few months of his life, the availability of such a service would have made her job as a carer that much easier.

In conclusion, what am I looking for from the Government? I want two things: first, a fairer funding settlement, to address the needs that I have outlined briefly; and, secondly, a system or framework that enables the voluntary and charitable sector to work with and flourish alongside the NHS. The Department of Health tends to distinguish only between the NHS and private providers, but the third sector must not be forgotten and it must be set free to flourish without the bureaucracy that currently bears down on hospices and carers.

12.48 pm

The Parliamentary Under-Secretary of State for Health (Anne Milton): As ever, it is a pleasure to serve under your chairmanship, Mr Walker. I congratulate my hon. Friend the Member for Great Yarmouth (Brandon Lewis) on securing this debate. He is closely involved with charities in his constituency, and the issue is close to his heart, as it is to mine, having worked in the NHS for 25 years before entering this place. I congratulate him and all the local people who have worked tirelessly to raise funds in his area.

Many people receive excellent care at the end of life, but not everyone does. Services in some parts of the country are not as good as services in other parts, and people with some diagnoses are more likely to get good, high-quality, end-of-life care than others. My hon. Friend is right that choice is absolutely central. Choice is about where one is cared for and where one dies. The end-of-life care strategy, published under the previous Government in 2008, aimed to improve care for people approaching the end of life, whatever their diagnosis, wherever they were, including enabling more people to be cared for and die at home, if they wish. It is worth noting that the figures indicate that 17% of people, when asked where they would like to die, reply that it depends. That depends largely on the sort of support that they feel that they might get. My hon. Friend the Member for Waveney (Peter Aldous) mentioned respite care, which is an important element. People feel they might like to die at home if their family could get some respite from their responsibilities.

The end-of-life care strategy covers all adults with advanced progressive illness, and care given in all settings. We know people want choice about where they die. Some want to die at home, but not everybody. Some people are happy to die in a care home, where that has become somebody’s home, which we must not forget. However, we know that most people die in hospital; the figure is about 57%.

We want to ensure that the services are there to help people die and live the end of their lives in a comfortable setting. For choice to become a reality, we need commissioners and providers to ensure that the right services—including community-based services, such as 24/7 care, as mentioned by my hon. Friend the Member

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for Waveney—are available to support people at home. Ensuring that those services are available cannot be done overnight. We have said that we will review the progress we have made in developing and improving services in 2013; that will be an audit of where we have reached.

We also want to review the payment system to support end-of-life care, including exploring options for per patient funding. The funding has to be right to provide the incentives to commissioners to purchase the care that we want to see. We have set up an independent palliative care funding review to look at the matter, as mentioned by my hon. Friend the Member for Great Yarmouth. The review, covering both adult and children’s services, has been looking at options to ensure that the funding for palliative care providers is fair and encourages the development of community-based services. As I said, it is important to get the levers and incentives in the right place. We hope to be able to respond formally to the report by the end of the year.

Of course, hospices and the important role that they play are in the mix of care facilities that need to be provided. When I worked in this area of nursing there were very few hospices in the country. One cannot talk about end-of-life care without mentioning people such as Colin Murray Parkes who spearheaded the hospice movement. We want to see hospices flourish, develop and continue the expansion of their remit for caring for those with illness other than cancer, and into community-based support for patients, their families and their carers.

Only a comparatively small number of people die in a hospice, but a great many more benefit from their services and expertise in other ways, such as day therapy or hospice at home. My hon. Friend the Member for Great Yarmouth mentioned the £40 million capital grant for hospices, but that an area must have a hospice to get the grant. His point is well made. The one-off grant allowed us to fund 123 projects in 116 hospices, which is quite a far reach. For the longer term, the palliative care funding review will help us move towards a fairer funding system that puts the levers in the right place.

However, it remains for local NHS commissioners to determine what services should be provided locally. I urge all hon. Members to ensure that they work closely with the local NHS. I understand that the estimated need for palliative care is higher in Great Yarmouth and Waveney than in any other PCT. NHS Great Yarmouth and Waveney, together with Norfolk and Suffolk county councils, have commissioned the Marie Curie “Delivering Choice” programme, one of the first to be established in the east of England. That programme brings together local organisations, patients and carers. I can assure my hon. Friend the Member for Great Yarmouth that the Department of Health never forgets the third sector. The third sector is a very important part of the mix of

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health care providers. We never forget it because there are people around the country who work tirelessly in the third sector, not just to support people who are ill or at the end of their lives, but their families and carers.

My hon. Friend the Member for Great Yarmouth is right that hospice provision is part of the mix of care. Ideally, no care setting should have priority over any other. The settings are like the pieces of a jigsaw: the picture is not complete until all the pieces are in place. The choice is not there until all the choices are available locally. Many care homes have developed a lot of expertise in the area and are now delivering excellent end-of-life care. The knowledge and expertise owned by the professionals in end-of-life and palliative care are what matters.

I will return to the subject of the local area. NHS Great Yarmouth and Waveney have put together this programme, and a new end-of-life pathway has been defined and specifications written for the services required to deliver it. The new services that have been commissioned are specialist palliative in-patient services; a care resource and outreach service; and a nursing end-of-life care facilitator.

I fully understand the concerns that prompted my hon. Friend to secure the debate, and it wonderful that he has the support of other hon. Members. I am sure that working together with the local NHS, they will move the programme forward. I applaud his commitment to the campaign for the best-quality end-of-life care for his constituents. I believe that the initiatives and steps that the Government are taking will help improve this important area of health care. We look forward to continuing to work with everybody, including those in the hospice movement, to achieve that aim.

I would like to finish by mentioning the incredible efforts, not just of those in the east of England but around the country, who are tireless in their efforts to raise money, to support those at the end of their lives, and to support the families who are looking after them.

Dr Coffey: I welcome the Minister’s warm words for actions already undertaken by my hon. Friends the Members for Great Yarmouth (Brandon Lewis) and for Waveney (Peter Aldous). At some point, would she come to our part of the world, to meet people who are actively involved, and to hear about other aspects such as the community nursing care fund, which, as long as she helps us get a hospice, may provide a good role model for elsewhere in the country?

Anne Milton: I would be delighted to visit the east of England. The hon. Lady has struck a good deal. I am always interested to see progress made. As she says, it is important to spread good practice. For anybody who is in need of NHS services or care, nothing but the best will do. We should never lower our standards in trying to achieve that aim. Nothing but the best will do on the day one is born; and nothing but the best will do on the day one dies.

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Edale Unit (Manchester)

12.58 pm

Tony Lloyd (Manchester Central) (Lab): It is a pleasure to have this debate under your chairmanship, Mr Walker. I am delighted to see the Minister here. However, I express regret on her behalf, as the debate would not have been necessary, had the Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow), who is responsible for care services, had the courtesy to meet me some weeks ago. I asked to meet him to discuss an important issue, not simply a local one, regarding how decisions are made in the NHS.

The subject of the debate is a mental health facility in Manchester. The Edale unit was a custom-built facility for in-patient mental health services, for people with acute mental health problems who need that type of dedicated care. It was built as part of the private finance initiative that totally transformed central Manchester hospital facilities in my constituency. The Edale unit opened only four or five years ago, and offers five wards and single rooms, many of which are en-suite. It has gyms, therapy rooms, quiet rooms and other facilities that, even now, are pretty much state of the art. It is therefore astonishing that some time last year—I do not know when because the mental health trust did not have the courtesy to inform me as the local MP—plans were made to close the unit and relocate it to a refurbished unit some miles away.

The first I knew about those plans was when the Manchester Users Network for those who use mental health services wrote to me, and to others, stating that it regarded the proposed relocation as deleterious. The group pointed out that it would be difficult for people to travel from central Manchester to the relocated site, that patient recovery is clearly helped by contact and support from networks, families and friends, and that it would be more difficult for some people to receive that support if the unit were located away from the centre at a site in north Manchester. The Manchester Users Network raised a number of other issues, and I am grateful to its chairman, Alan Hartman, and to others, for making me aware of what had been proposed. At that point I was fairly neutral about the proposals and wanted simply to be persuaded. I began to ask questions about the changes but, quite frankly, it is difficult because I have not received answers to the important questions.

One might think that a brand new facility, built to precise designs by the mental health trust, would be worth keeping. The trust said, however, that on cost grounds it made sense to close the facility. It claims that it will make savings of £1.7 million a year in running costs, which may be true, although it is not clear how such savings will be achieved. Nevertheless, even if we accept that figure as part of the basic argument, that does not justify the closure of a unit that the trust was so recently involved in designing.

The situation becomes even more bizarre when we learn that some £2.3 million of non-recoverable fixed costs will fall on the central Manchester health trust as a result of the closure of the Edale facility. In other words, there will be a loss of £600,000. That does

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not make accounting or economic sense, and even if it narrowly makes sense for the mental health trust, it does not make sense for the taxpayer.

I have never received answers as to whether the figures that I have cited on different occasions are right or wrong. If that imbalance exists and it will cost the NHS and the taxpayer more to close the facility than to keep it open, it will be a scandal to allow the relocation to go ahead. In any case, nearly £5 million worth of new capital costs will be needed to refurbish the old facility to which the mental health trust wants to move the present unit. A huge argument needs to be made to justify the cost equation, and Ministers, the strategic health authority, the mental health trust and the primary care trust have not yet provided answers to that.

Perhaps the cost will be balanced out if we have a much better facility for users of mental health facilities and their families in Manchester. The difficulty with that argument is that those groups who have been in touch with me feel as one that the proposed move will be a bad thing—I say as one, although in fairness one or two senior consultants from the mental health trust have told me that they are in favour of the move.

I have also received a letter which, although sadly anonymous, no one would dispute comes from clinicians. The letter is about the proposed changes, and warns that the transfer of the Edale unit to Park house in north Manchester would be a move to an

“overcrowded, predominantly dormitory set up. This will predictably increase violence and morbidity on the ward.”

The letter goes on to say, among other things, that the move will

“hinder the contact of the patient with their family—”

—again, a point made by the Manchester Users Network. The letter rails against the fact that there are already numerous transfers to Edale house from the facility in north Manchester for reasons of privacy and space, and states:

“Most senior clinicians of the Trust are very cynical and disillusioned with this plan and appalled that the Strategic Health Authority has not put a stop to this.”

That is quite strong language from the clinicians, although I admit that it is an anonymous letter, which makes it difficult to validate.

When the mental health trust, and others, were scoping possible changes, they came up with a number of options. From all those available, the option that scored the lowest was that now adopted by the mental health trust. The weighted benefit score was a combination of inputs from clinical leaders, service users, carers and the wider community, and using those scores, the proposed relocation to Park house not only received the lowest mark but was deemed far worse than the “do nothing” option—in other words, to keep the Edale unit open. That assessment was not made by anonymous clinicians or users; it is the in-house weighted benefits score that was used to determine how to proceed. On that basis, I am at a loss to know the clinical justification behind the move. It is not necessarily that there is no case to be made, but the case has not been made to the wider public and it seems that for the mental health trust, cost is still the dominant issue.

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More recently, a minute from the board meeting papers of the strategic health authority seemed to attempt to undermine the validity of the Edale unit. It stated:

“The Trust has indicated that any option to retain the Edale Unit is deemed to be unviable given their severe concerns regarding the design of the Edale Unit which include multiple ligature points, unsecured windows, dangerous balcony, lack of access to outside space. The Trust does not feel the faults are rectifiable.”

That seems to be a damning critique of the unit. Catalyst, the PFI partner that developed the whole of the central Manchester site, was so concerned that it attempted to engage with the mental health trust. A letter sent to Mark Ogden, the chief executive of the strategic health authority, stated:

“Following our contact with the staff at Edale we had a telephone call from a Mr Paul Fitzpatrick who introduced himself as the lead for health & safety for the Manchester Mental Health and Social Care Trust. His manner was extremely abrupt; despite repeatedly requesting details of the alleged breaches to health and safety in order for us to address them, Mr Fitzpatrick hung up the telephone on us without divulging any details of the alleged breaches.”

That would be farcical if it were not so serious. A paid operative of the mental health trust refused to discuss with the developer the problems that were minuted in the strategic health authority’s board meeting. It gets slightly easier because Catalyst sensibly went out of its way to see whether there was any validity in the allegations. It commissioned a health and safety report and looked at whether anything needed rectifying. It replied to the strategic health authority:

“We are sure that you will be pleased to see that the allegations were groundless and we would like to agree a mutually acceptable amendment to the minutes of your meeting”.

I think that Catalyst has every right to ask for that retraction if the allegations cannot be made to stand up, not because I want to defend Catalyst—it is up to Catalyst to defend itself—but because it has been used as part of the polemic about the unit’s closure.

We are now in very serious territory, because the point that I am making to the Minister is this. On cost grounds, the closure does not add up. On quality-of-service grounds, it is a very uncertain case. I have had a reply from the chief executive of the mental health trust, who goes through a number of things that she says are improvements in the move from Edale to Park house. However, none of those supposed improvements is location-specific. They could be achieved—if they need to be achieved—either at the Edale unit or at Park house.

The physical environment that the mental health trust proposes to move to is certainly inferior. The facility has been refurbished, but not, I am told, to an amazingly high standard, although that has to be proved. It is certainly the case that, instead of offering the single rooms that the Edale unit offers, that facility will have dormitory accommodation, and one of the concerns that people involved with the treatment of mental illness have put to me is that, with that type of dormitory accommodation, when more than one person in the dormitory is in a very distressed condition, that is a combination that is simply not acceptable in terms of the best possible type of treatment. There are real doubts even about the capacity of the proposed alternative if it is brought to fruition.

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I cannot quote Greater Manchester police officially on this matter, but I have talked to individual police officers. It will perhaps be difficult for the Minister to know the physical geography of Manchester—why should she?—but the Edale unit is very close to the city centre. Crumpsall hospital in north Manchester is a considerable way from the city centre. One of the realities of policing in a city such as Manchester is that there are times when people who are severely distressed during bouts of mental illness and mental health breakdown are taken to the accident and emergency unit at the Manchester Royal infirmary, which is close to the city centre and part of the central Manchester site. When the clinicians recognise that the people brought in need mental health treatment—mental illness treatment—they can be transferred across the hospital site to the Edale unit.

I know from talking to police officers that exactly that happens regularly. Their concern has been expressed to me in this way—again, I point out that this is not GMP force policy. If they take people to the A and E unit at the central Manchester site and are told that the people need treatment in a mental health unit, they will have to transfer them physically, with all the use of police time at busy times of the week—on a Friday night or Saturday night—from the centre of Manchester up to the new unit in north Manchester. I say to the Minister that I fail to understand why the police were not a formal consultee in this process, because that seems a fairly obvious thing to have asked about.

The location matters in its own right. This is not a location-free decision. There are better locations in central Manchester than the north Manchester site. That is not to say that there should be nothing in north Manchester. I represent constituents across the north and the centre of the city. What I am asking the Minister for is some sense that the decisions really have been thought through and that there are proper answers to the very serious doubts that have been raised. As yet, I have not heard those answers.

I come finally to what may be the most important issue of all. I have been very concerned for a long time about the governance of the mental health trust in Manchester. I have met representatives of the strategic health authority. I have had many meetings over the years about the situation there. Most recently, there was an inquest into the death of Peter Thompson, a man who was certainly an alcoholic, who died outside the Edale unit. The coroner and the jury involved made quite hard-hitting reports on his death. The coroner issued a report under rule 43 of the Coroners Rules 1984. He says in his letter to the mental health trust:

“This rule provides that where the evidence at an inquest gives rise to a concern that circumstances creating a risk of other deaths will occur or will continue to exist in the future, and in the coroner’s opinion, action should be taken to prevent the occurrence or continuation of such circumstances, or to eliminate or reduce the risk of death created by such circumstances, the coroner may report the circumstances to a person who may have power to take such action.”

This is quite a strong thing for the coroner to have done: he has reported to the mental health trust that it needs to take action.

Section 8 of the conclusions of the report of the inquest said:

“The court received independent expert evidence from a Professor of mental health nursing, who identified and confirmed several failures in management and planning.”

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In relation to the actions that the coroner urged should be taken, he said:

“It was noted that there seemed to be a general lack of appropriate management and control of the ward staff…The court was concerned about the general competence and professionalism of the staff and their actual ability to do the job…What is required is effective leadership and management. This appeared to be absent.”

This matter is not sub judice, Mr Walker—I must make that point in case it is of concern to you. It is already in the public domain. The coroner sent the rule 43 letter to the mental health trust and to other interested parties. I will not argue about the nature of cuts in modern Britain—that is a fallacious argument. I believe that the mental health trust in the city of Manchester has been underfunded for many years. I believe that, in the desperate need to find cost savings, the mental health trust has come up with a scheme that will save the mental health trust money. However, it does not deal with the real issues of a mental health trust that is not managing its affairs properly, which is putting—in this case, literally—the life of someone at risk.

We must do better. Frankly, it is not good enough for the Minister responsible for care services to refuse a meeting with me to talk about these issues. I would not have been raising them today in this public forum had I had a private meeting with him. I invite this Minister to say that there will now be a proper investigation of the way in which the decision was made, to satisfy not just me but the public that on cost grounds and on care grounds, the decision is optimal. Most importantly, we must now begin to get to grips with the management malaise that the coroner identified and that other people have raised as a concern. If we do not do that, we not only let down those who are mentally ill; we may put them at the most serious risk.

1.17 pm

The Parliamentary Under-Secretary of State for Health (Anne Milton): Still we are here, Mr Walker—how lovely!

I congratulate the hon. Member for Manchester Central (Tony Lloyd) on securing the debate. I would join him, I am sure, in paying tribute to the skills and dedication of mental health professionals not just in Manchester, but throughout the country. They do a fine job, often in very difficult circumstances. However, he was right to say at the end of his speech that we must do better. Mental health services have often been the Cinderella services. It has been extremely difficult to get them the priority that they deserve. From my perspective as a Minister responsible for public health, I see the prevention of poor mental health as being as much a priority as the prevention of poor physical health. I know that the hon. Gentleman has campaigned locally on health issues in his constituency and is a very strong supporter of all that goes on. Unfortunately, my hon. Friend the Minister of State, Department of Health, who has responsibility for care services, is tied up with the Health and Social Care Bill today. However, I am sure that he will read the record of this debate with interest.

I cannot unravel this story in the time available to me, so I hope that the hon. Gentleman will bear with me when I raise a number of issues that are pertinent. I shall come in my conclusion to what I feel is the best way forward. There is no doubt that any change brings uncertainty. I can well understand how plans to transfer

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local mental health in-patient beds naturally provoke concern. I understand the hon. Gentleman’s surprise at the relocation of beds from a newly built facility. He particularly mentioned the central location of Edale as important, and the views of the police not having been sought. I cannot comment on that, but his point is well made.

Let me give a little background on where we are with mental health services. We have launched “No health without mental health: a cross-Government mental health outcomes strategy for people of all ages”, which has two aims: improving the population’s mental health and improving services. The mental health strategy takes a life-course approach and sends a clear message that prevention, early diagnosis and early intervention are key priorities.

We would expect the bulk of the strategy to be delivered locally by experts on the ground working with services users, their families and carers, and, in some circumstances, the local police. Through the Cabinet Sub-Committee on Public Health and the ministerial advisory group, Ministers will continue to pay close attention to the delivery of the improvements set out in the strategy. There is no doubt that services in the community and closer to patients’ homes are better for recovery and encourage independence, although in-patient beds are needed at times.

The ministerial advisory group will bring together the new NHS commissioning board, Public Health England and a range of stakeholders, including clinical commissioning groups, the voluntary and community sectors and local authorities—one cannot underestimate the role that local authorities have to play in providing services for people with mental illness. Once the proposed NHS commissioning board and Public Health England are fully operational, we anticipate that they will become the focus for all stakeholders to lead the implementation of the mental health strategy and to review its progress.

The NHS in Manchester is working to strengthen its community-based services and to reduce reliance on acute care for those with a mental illness. That should be about improving quality, not introducing cost-saving measures. That follows the strategy set out in the national service framework for mental health services, which the Labour party introduced when it was in government. Indeed, there is cross-party consensus that investing more in community-based support benefits patients, and there is a growing body of evidence to support that. What people are fearful of is that such support is a cost-cutting measure.

I am told that Manchester Mental Health and Social Care Trust has worked closely with staff, service users, carers and other stakeholders, including the Manchester local involvement network and the Manchester carers forum, to develop proposals for rationalising its in-patient services for adults and older adults with mental health problems. The hon. Gentleman might not feel that that work has been sufficient, but it is important to put on the record what the local NHS feels it has done, which, as he rightly said, involves reducing the number of in-patient sites

The proposals will maintain the same number of beds, and I am told that only one in 17 mental health service users requiring in-patient services in Manchester will be affected. Service users who are in receipt of community support from adult and later life community

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teams at the nearby Rawnsley building and those who attend out-patient appointments will not notice any changes to services as a result of the relocation of beds. Alternative accommodation for the non-in-patient services based at Edale house is being sought in more appropriate community settings. I do not know Manchester well, but I am sure that there are other community settings in which such services can be provided.

The trust expects to achieve a number of clinical benefits, although the hon. Gentleman is perhaps somewhat cynical about that. It feels that those benefits will include a greater concentration of staffing expertise, an improved level of support on wards, a reduction in delays for treatment and the development of specialist services. We probably need to concentrate specialist services ever more to get the expertise we need.

Tony Lloyd: I am genuinely sympathetic to the Minister, who has been given her briefing. I mean no disrespect to her or her speech, but the problem is that such claims are easy to make; indeed, the 100-bed Edale unit could deliver concentration in exactly the same way. It is just not obvious that the mental health trust is doing anything more than providing words as a façade for its decision. It has given no explanation of why the change is better, or why the present situation is worse, other than this fallacious nonsense about the Edale unit not being up to standard.

Anne Milton: I thank the hon. Gentleman for his intervention. I should probably have started with the end of my speech, but I will come to the direction I feel he should move in.

The Government have pledged that all service changes must in future be led by clinicians and patients, and not driven from the top. The Department has outlined and strengthened the criteria that any decisions on NHS service changes are expected to meet. Decisions must focus on improving patient outcomes, and the hon. Gentleman mentioned quality, although the issue is obviously open to debate locally. Decisions must also consider patient choice, have support from GP commissioners and be based on sound evidence.

I must stress that the NHS is not run from Whitehall, and a lot of local issues need to be looked at locally. The overview and scrutiny committee has confirmed that it is satisfied that appropriate involvement has taken place. The mental health trust is exploring the feasibility of

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introducing a defined transport system at the committee’s request to ensure that service users and their families have suitable access.

The hon. Gentleman mentioned the tragic case of Peter Thompson, and my sympathies are always with the friends and families involved in such situations. The case has clearly raised significant issues, not least that of good leadership, which is critical to ensuring that good services are available. I would expect the local NHS to learn from this tragic incident and to ensure that it does not happen again.

The chief executive of the mental health trust has written to the hon. Gentleman and offered him a meeting on three occasions—28 February, 25 May and more recently. I urge the hon. Gentleman to have that meeting, because he is clearly unhappy about a lot of issues. He mentioned the anonymous letter he had received, and if its authors get sight of this debate, I hope they will come to see him in confidence—like all Members, I know that he would keep their identities confidential. The letter has raised some concern, but it is difficult to do anything about it while it is anonymous. I am sure that the hon. Gentleman’s assurance that it is from clinicians would hold up.

I urge the hon. Gentleman to meet the chief executive. He clearly remains open-minded, but he is anxious to be convinced. He describes a complex story, in the middle of which we have a tragic death and the coroner highlighting some important issues. I am sorry that I cannot give the hon. Gentleman more in the debate, but the best way forward would be for him to meet the chief executive.

Tony Lloyd: I would, of course, be happy to meet the chief executive, but what I have really been offered is a meeting to tell me why the trust is going ahead with the decision that it has already made. I want explanations, and that is what the public and the taxpayer are entitled to. If I do not get that explanation, can I come back to the Minister and her colleagues and at least get some sense that they are engaged in dealing with what could be a scandal?

Anne Milton: I thank the hon. Gentleman for that intervention. That is absolutely right: he should see the chief executive and ask for an explanation. As he rightly says, he is open-minded and wants to be convinced. If he still does not get an explanation that satisfies him that things are being done to improve patients’ quality of care, I am sure that my hon. Friend the Minister of State would meet him. He would be welcome to come back to us with any issues, but I urge him to have a meeting with the chief executive first.

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Rural Bus Services (South Devon)

1.29 pm

Dr Sarah Wollaston (Totnes) (Con): I thank you, Mr Walker, for chairing this debate on the important issue of rural bus services in south Devon, and I thank the Minister for his continuing interest in sustainable transport. I want to cover the three areas of the scale of rural transport poverty, the current reductions to services in Devon and, perhaps more importantly, the threats on the horizon: there is a perfect storm brewing for rural transport in my constituency. Finally, I have some proposals, put forward by my constituents as well as by people with transport expertise. I hope to persuade the Minister that doing nothing will be to abandon the transport poor at the roadside. I hope that he will accept an invitation to Townstal in my constituency to meet those who have been hardest hit by cuts to services.

Citizens Advice has found that many low-income families spend as much as 25% of their income on owning and maintaining a car; not through choice but through necessity. In addition, south Devon is one of the most expensive areas of the country, with high housing costs and low earnings, and employment that is often unreliable and seasonal. It has one of the highest insolvency rates in the country, and a high percentage of retired people, who are more likely to be dependent on public transport. It is not only the work that is seasonal; we also have a seasonal population. In summer our population expands dramatically, putting a further strain on services.

It is notable that the more rural an area is, the greater the number of cars and vans per household. Our services have become so infrequent and inconvenient that anyone who can use a car will do so, and those who have no access to a car cannot afford the full fare that is needed for the services to be run on a stand-alone commercial basis. South Hams, for example, has more than 12,000 more cars than households, which only underlines the relative transport poverty of the have-nots. Those have-nots are 14% of rural households in Devon—55,000 people who have no access to a car. Without transport, those people cannot gain access to hospitals, employment, education or even employment agencies or citizens advice bureaux.

The reason for that is clear. Under the comprehensive spending review, the Government grant to Devon county was cut by £54 million in 2011-12. Like all councils, Devon has statutory obligations, so it held a good public consultation exercise. However, unfortunately, people who never need to use public transport do not see it as a priority, so it emerged as a relatively low priority.

Anne Marie Morris (Newton Abbot) (Con): Similar cuts have been suffered in my constituency, in Dawlish, on the 178 Newton Abbot to Okehampton service, and on the 361 Bridford to Newton Abbot service. Does my hon. Friend agree that one of the problems is that Devon’s settlement from central Government was in a sense not appropriate, because rurality was not taken into account? Therefore there was a particular challenge in funding the bus service.

Dr Wollaston: My hon. Friend makes an excellent point. Devon county council reduced its public transport support budget by £1.35 million out of a total spend of

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£7.75 million. My hon. Friend makes a good point in noting that that did not recognise the particular challenges of rurality.

As I have said, the real problem is the perfect storm that is brewing, with ever-increasing costs and further reductions in revenue. From April 2012 there will be a 20% reduction in the bus service operators grant which will increase operator costs by 1.5% to 2%. When we consider that our fares are already among the highest in the country, if that were passed on to passengers it could result in a further abandonment of bus transport.

The reduction in operator reimbursement for pensioners’ bus passes is also creating a particular problem in Devon, because in Devon 56% of all bus journeys after 9.30 in the morning are made by concessionary travel scheme passengers, which amounts to 30% of operator income. Local experts tell me that a reduction of the reimbursement to operators of 15% translates into a 4% to 5% loss of income; but for more rural operators such as those that are found in Devon it could be as much as 30%, which would be devastating. To those figures must be added the cost of administering the scheme. Devon must spend £12 million on that, which ironically is twice as much as it must spend on supporting bus services to ensure that people can travel in the first place. Devon county council estimates that it has been underfunded by approximately £5 million in the current year on that scheme alone. Many of my constituents wonder whether the ability of some people to travel free is more important than the ability to travel at all for many people of all ages.

On top of those reducing subsidies comes the blow of passenger transport inflation, which the Minister knows outstrips the retail prices index, as a result of increased insurance premiums, increasing staff costs as a result of legislation on part-time workers, increased training requirements and bus adaptations. That is before factoring in the runaway costs of fuel. Seventy bus routes have been affected in Devon. Hon. Members will be relieved to hear that I am not going to name them all, but I should like to mention service 111, which illustrates several points.

The 111 was a lifeline in my constituency, running from Dartmouth via Totnes station, stopping off at the Torbay shopping area and taking passengers directly to the door of the local hospital. It ran via several villages and was a reliable service. Crucially, it also allowed parents to exercise choice in the matter of their children’s school. The loss of the 111 has been devastating. Last week I met Freda Morgan, who, despite being in her eighties, made the trip from Dartmouth to visit her 91-year-old sister in hospital. Previously she would have been able to travel door to door. This time, on the way out she needed two changes of bus and a very long walk up a steep hill—trust me, people in Devon are used to hills, but this was a very long one from the main road. On the way home she needed to take a completely different operator’s buses and a different set of routes, including a ferry crossing. The round trip lasted a total of 10 hours. She managed to get only an hour with her sister, and she arrived home completely exhausted.

Mrs Morgan is not alone. I have had similar emails and letters from many other constituents: patients and visitors, parents who now cannot get their children to school—of course we cannot think it is an option to change a child’s school half way through their education—and a flood of people who feel trapped in their homes.

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Mr Adrian Sanders (Torbay) (LD): One of the answers is to get more people using the buses, so that they become more viable. Surely one of the best ways to make buses more viable is to get them to run on time. Reducing congestion between the hon. Lady’s constituency and mine—I am thinking of the Kingskerswell bypass—would have an enormous impact on bus use throughout Torbay and south Devon, because buses would be more likely to run to timetable.

Dr Wollaston: That is an excellent point. Reliability is a key issue—both reliability in timetabling, and the reliability that means a child who starts at a particular school will continue to be able to get there in the long term.

Another of my constituents, Richard Parnell, made the excellent point with reference to seasonal employment that he has been unable to get to many places because of the changes. Even when he was recently called to do jury service he found it very difficult to attend.

I mentioned bus 111 because it was, in a way, a victim of its own success, showing that the issue is not only cuts to rural subsidies; there is also the perverse impact of the way it has been possible to apply competition to the routes in question, since deregulation under the Transport Act 1985. Some 76 per cent. of bus journeys in Devon are on commercial services and, crucially, Devon county council is unable to consult on changes to commercial services. There have recently been 200 to 300 service changes each year, with only 56 days notice. That leaves little time for those affected to make alternative plans.

Service 111 was operated by Stagecoach under a tender paid for by Devon county council, which allowed Devon to specify the timetable, fares and bus specification. When the tender was due to expire, another operator declared the section between Dartmouth and Paignton to be commercial. To cut a long story short, the unviable parts of the route were cut out, and Devon was left to pick up the sections covering a number of villages, which are now cut off, with an inadequate service, the 149. Stagecoach registered its own commercial service 111, but because Devon withdrew the funding to students whose parents exercised choice to send them to an out-of-area school, it was left unviable, and the service folded. Now all the communities have been left with a woefully inadequate service, as a result of the combination of grant cuts and the inappropriate application of competition.

Many communities in my constituency have been badly affected. They include Kingsbridge, with the loss of the X64, and Dittisham, Blackawton and Marldon. The county maintains that no community has been cut off—I acknowledge that it has tried hard to prevent that—but if a service no longer allows people access to employment, medical appointments or school, they might as well be cut off.

We have some wonderful community bus services in Devon. I am sure that my hon. Friends will join me in paying tribute to them and their volunteers; I think of services such as the Coleridge community bus and “Bob the Bus” in Totnes. Devon has also led the way in demand-led bus services such as the fare car scheme, but it would be a mistake to think that they reduce costs, as some are even more expensive.

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Mr Gary Streeter (South West Devon) (Con): I congratulate my hon. Friend on securing this important debate and on making such a powerful speech. Given that we cannot anticipate much more Government subsidy over the next two or three years, and given that bus companies understandably do not want to operate unprofitably, does she believe that some improvement could be made if the bus companies, the county council and—as important—parish councils and communities were much more involved in consultation about which routes were necessary and which timetables would suit best? Does my hon. Friend believe that there is enough engagement with local people?

Dr Wollaston: My hon. Friend makes an excellent point. As I said earlier, there is no opportunity for such engagement because of changes in legislation after deregulation. I would like it to be restored and I would like to see an obligation to consult more widely. I would also like to see more sensible ticketing arrangements, so that constituents who have to take different routes there and back are able to use a smart card.

I am surprised by the number of pass holders in Devon who say that they would rather pay a small amount per journey, or even pay an annual administration fee, than suffer reduced services. They understand the financial realities to which my hon. Friend the Member for South West Devon (Mr Streeter) refers. Experts in local transport tell me that an annual fee of around £30 would cover the administration costs—the £12 million that I spoke of earlier—which is twice as much as Devon is spending on subsidising the extra costs. Such a fee would still represent outstanding value for money. I hope that my hon. Friend the Minister will consider it.

Another excellent question is why foreign vehicles can use our motorways for free when we pay so much to use theirs. Why cannot we have a system like that in Switzerland, where vehicles have to pay for and display a motorway pass even if they use the motorway for only one weekend? Could we not do likewise? The equivalent for British nationals would be the tax disc; we could ask all foreign trucks and cars to pay a smaller amount for the pleasure of using our lovely motorways. Others have suggested increasing vehicle excise duty for high-emission vehicles to subsidise public transport. However, we know that such measures would not directly benefit local rural services unless the increased income were directly allocated to councils and ring-fenced for sustainable transport.

My own suggestion would be to consider giving councils greater powers to require out-of-town supermarket users to pay to park. The money could be reimbursed in store if necessary, but the levy could be used to subsidise local rural services if it was appropriate for the area. It would be a form of localism to allow local people to decide on the matter. It would also help redress the imbalance that blights our rural high streets, which are often subject to high parking charges.

I hope that the Minister will think again about the cuts to bus service operator grants. However, I make a special plea on behalf of community buses: could they use red diesel? I hope, too, that the Minister will reconsider the unforeseen consequences of deregulation, referred to earlier, particularly the impact that it has had; on top of the cuts, it has devastated rural services. I also hope he will meet me to discuss some of the red tape and

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additional costs faced by community buses, which provide an invaluable service. I have already referred to smart cards. Again, that would make a huge difference. I stress that none of us feels that doing nothing should be an option.

Finally, as a small plea to another cyclist, may I ask the Minister to consider amending the legislation to allow buses to have bike racks? It happens in European countries but not here; that is another example of UK legislation exceeding that of the EU. I understand that regulations prevent buses from carrying front bike racks—that is what local operators tell me—but if we allowed rural buses to carry bike racks, the services could become more commercially viable in the summer. We all know that there is not an endless pot of money, and that would make a big difference to areas such as mine, which are trying to introduce green transport.

1.45 pm

The Parliamentary Under-Secretary of State for Transport (Norman Baker): I thank my hon. Friend the Member for Totnes (Dr Wollaston) for arranging this debate and for packing a great deal into 16 minutes. I thank our quartet of Devon MPs for saying roughly the same thing about their bus services.

I know well from my constituency that buses are a lifeline for many people in rural areas, providing access to jobs, schools, health care and social activities and the rest. Good bus services contribute to the Government’s key transport priorities of cutting carbon and creating growth, not least by allowing access to employment opportunities. Other benefits of removing car traffic from our towns would include reduced noise pollution and improved air quality.

Because of the value that the Government attach to bus services, we are committed under the comprehensive spending review to continuing our financial subsidy of bus operators. It is worth pointing out that the many newspaper stories suggesting that the bus service operators grant would be cut altogether proved to be erroneous. We value the support that we give to bus companies and bus operators.

The bus service operators grant—the BSOG—remains untouched for this financial year. However, as my hon. Friend the Member for Totnes said, it will be cut by 20% from next April, thereby giving bus companies about 18 months notice of the change. Department for Transport calculations suggest that will bring about a change in fares of about 1%. Bus operators are on record as saying that the scale of changes and the notice that they have been given make them hopeful of being able to incorporate the change to the BSOG without affecting fares.

Dr Wollaston: Given the rurality of services in Devon, local experts in the county council estimate that for us the change would be between 1.5% and 2%.

Norman Baker: I hear what my hon. Friend says. The Confederation of Passenger Transport UK said that it was hopeful of incorporating the change without affecting fares or services; I hope that reassures her on that point. I shall deal in a moment with local tendered services, which I suspect are more of a problem for my hon. Friend’s constituents.

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The Government are committed to reducing the budget deficit that we inherited, and every sector has to play its part in that. However, the Transport Secretary and I are determined that buses should continue to receive their fair share of funding. We want to encourage more people to use buses, and to make bus travel more attractive in whatever way we can, given the financial envelope within which we have to work.

The Government spend more than £1.2 billion a year on concessionary travel and bus subsidy in England, outside London, of which £15 million or thereabouts is spent in Devon. We remain particularly committed to the concessionary travel entitlement in England for the 11.5 million eligible older and disabled people. I hear my hon. Friend’s suggestion of introducing a small charge to help finances. I can only say that the Prime Minister has made plain the importance that he attaches to the present arrangements—that the concessionary travel arrangements continue to be free for those entitled to them. That obviously remains the Government’s policy.

My Department recently issued new guidance to local transport authorities to help them ensure that bus operators are reimbursed for carrying eligible passengers on a “no better off, no worse off” basis. My hon. Friend referred to the concessionary travel reimbursement arrangements, but the essential legislative requirement that bus companies should be no better off or no worse off has not changed. All that has happened is that the Department has issued new guidance to enable local authorities better to deliver the requirement. They are not obliged to follow that guidance, although they may do so if they wish; but they are obliged to comply with the legislation, which has not changed.

Mr Sanders: I raised this matter under the previous Government and suggested, through parliamentary questions, that the cost of a national scheme would be less than lots of local schemes. Will the Minister consider that as a way in which we can reduce the costs overall? It seems crazy that different local authorities pay different rates for the same service.

Norman Baker: There is a national arrangement in place in Scotland, which was considered. Responsibility was moved from district councils to county councils, which helped to bring some consistency to services and reduce some of the overheads. However, we have to balance that with our need to pursue a localism agenda, which both coalition parties firmly support. To have a national scheme would counter that and go against our direction of travel.

When the Department was considering the new guidance for the concessionary travel scheme, we took representations from the bus operators and local councils. I then personally amended the guidance to ensure that it reflected the particular challenges of operating in a rural area.

I recognise that the recent local authority funding settlement has been challenging and that in some areas, local councils have responded by taking the axe to local bus services. That badly hits rural areas such as Devon where supported services make up a much higher share of the total than in metropolitan areas. The formula of the Department for Communities and Local Government, which allocates money to local councils, incorporates a sparsity factor, which should help areas such as Devon.

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The Department is also committed, through the local government resource review, to looking at the entire way in which funding takes place and local moneys are raised from the local taxpayer, and that process is ongoing.

I am naturally concerned when I hear that vulnerable people with few other transport choices have lost their only bus service, or that children have reduced public transport access to the school of their choice. Those are serious and unwelcome developments. As my hon. Friend says, fewer than a quarter of all journeys in Devon are made on supported services. That means that more than three quarters are made on commercial services, which are unaffected by changes to council income or changes in council policy.

When difficult decisions are to be made on local bus services, I am clear that they should be made at a local level and not in Whitehall. The Government set out in the local transport White Paper their commitment to ending top-down decision making and one size fits all solutions. That means that we will see different decisions made in different places across the country depending on the priorities given by elected local members in those areas.

Some councils have taken an almost slash and burn approach to bus services, while others such as East Riding have percentage cuts in single figures. They have been more careful about making decisions that affect bus users. I note that Devon county council has cut its budget for supported bus services by 17% this year. In a consultation that it held called “tough choices”, which I welcomed, savings on bus services were one of the top three areas that were identified by 60% of those who responded. I accept the point that my hon. Friend makes that those who do not use buses will be more likely to identify them for cuts than those who use them. Nevertheless, it was an attempt by the county council to validate the decisions that we are taking, and that is entirely helpful. Other areas have consulted and reached different conclusions. Cornwall, for example, has chosen to keep its morning peak-time concessionary travel entitlement on a countywide basis.

It is up to Devon to prioritise its spending as it sees fit, and it is not for central Government to intervene in that matter. How much it spends on buses, roads and libraries is ultimately a matter for Devon county council. Rather than telling councils what to do, my focus instead is on encouraging bus companies and local transport authorities to work together to deliver improvements that make the bus a more attractive option. They need to improve reliability and produce smarter and more integrated ticketing—to which my hon. Friend referred—reasonable fares and understandable timetables. She will be aware that an application has been made to the local sustainable transport fund in respect of smart ticketing. Decisions on the outcome of that particular application will be made shortly.

I am also keen that local authorities make the most efficient use of their resources. It is a good idea that there is a maximum efficient use of the vehicles that a council may have. We still have cases in which there are adult social care vehicles in one box, public transport vehicles in another box and school buses in a third box, and they are all run by different departments of the council. These days, councils, which need to make efficiency

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savings, should eliminate those sorts of duplications and that silo mentality. I am not clear what the position is in Devon. I hope that it has identified savings such as that to be made. None the less, those sorts of practices can still be found in local councils up and down the country. Therefore, local councils have a job to do to ensure that they get the best value for money.

My hon. Friend also mentioned community transport. I accept that that is not a panacea for any reduction in bus services, but it can be a useful facility for particular individuals with special needs or for small communities where a bus service would not be practical. We are keen to build up the capacity of community transport organisations, which is why I recently provided local authorities with £10 million of extra funding. Devon county council was given a grant of £425,000 for that purpose. I was pleased to learn that the council has maintained its community transport budget in recognition of the important work that such organisations do at a local level.

I pay tribute to Devon Wheels 2 Work scheme. It is an excellent example of a not-for-profit organisation that provides vital links to education, work and training by loaning motorbikes and scooters at subsidised rates. Other examples can be found across England, and it is exactly the sort of grassroots activity that I would like to see more of and to encourage.

Let me now pick up on some of the points that were made. My hon. Friend made reference to route 111. As she will understand, I am not familiar with that route. However, it is a matter for Devon county council to judge whether or not it is one of the routes that it should support. It is sometimes the case that routes to hospitals are difficult to justify commercially. As people move in and out of hospital, it is difficult to build up a regular clientele for that particular service. It certainly seems that some people have been significantly inconvenienced by the withdrawal of that route, and I hope that she and her colleagues will be able to persuade Devon county council to think again.

As for the integration between the transport authority, Devon county council and the bus operators, I have noted my hon. Friend’s point about 56 days’ notice for changes. That is something that I am currently looking at. No decisions have been made, but it is something that is on the radar. It is up to Devon to decide whether it takes advantage of the terms of the Local Transport Act 2008, which facilitates quality partnerships or even quality contracts. If Devon wants to get more of a handle on bus services, there are powers in legislation available to use should it wish to do so.

My hon. Friend raised other matters that do not fall under the Department for Transport. She will be interested to know that the Under-Secretary of State for Transport, my hon. Friend the Member for Hemel Hempstead (Mike Penning) is introducing proposals for HGV charging, which will, for the first time, capture foreign lorries in terms of what they have to pay to use our motorway network.

My hon. Friend seemed to want to go wider into road charging and almost edged into the Lib Dem manifesto from the last general election, but that is not currently Government policy. She also came up with some interesting ideas on red diesel and hypothecation, which are matters for the Treasury and not the DFT. However, her comments have been noted and I will ensure that they are passed on to the relevant officials at the Treasury.

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My hon. Friend also raised an interesting idea, which has been around for some time, about out-of-town supermarkets. I can see why she has raised that matter, and I will make sure that her comments are passed on to colleagues at the Department for Communities and Local Government, who have the lead responsibility for that matter.

I do not have an answer on buses with bike racks, but I will drop her a line to let her know what the legal position is and how we view the matter. Finally, if my

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hon. Friend wants to bring up some of her constituents to discuss matters, I will ensure that a slot is made available in my diary for her to do that.

Question put and agreed to .

1.59 pm

Sitting adjourned.