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Westminster Hall

Tuesday 29 November 2011

[Mr Lee Scott in the Chair]


Motion made, and Question proposed, That the sitting be now adjourned.—(Stephen Crabb.)

9.30 am

Steve McCabe (Birmingham, Selly Oak) (Lab): Good morning, Mr Scott. It is a pleasure to serve under your chairmanship.

I am very pleased to have secured this debate. To be honest, it is so long since I began trying to secure it that I cannot entirely remember all the motivations for doing so. Recently I have had two different groups claiming ownership of the idea for it, and I am quite happy to accept that they are both right. I do not regard myself as an expert on epilepsy and I am not particularly motivated by self-interest or by the experience of relatives or close friends. Like many other MPs, I am motivated by constituents who have come to me to talk about their own experiences of epilepsy and by the interest of the various groups and charities that set out to help people with epilepsy. Consequently, any mistakes and omissions in my contribution this morning are entirely my fault, but I am extremely grateful to various groups for the facts in my speech and the good advice that I have received. They include Epilepsy Action, the Joint Epilepsy Council, Epilepsy Bereaved, the National Centre for Young People With Epilepsy, which is now called Young Epilepsy, and of course the all-party group on epilepsy—whose secretary in 2007 was, I note, the MP for Witney, who is now the Prime Minister.

Mr Jim Cunningham (Coventry South) (Lab): Like my hon. Friend, I have a number of constituents who are affected by epilepsy. The Dattani family lost their son, Ravin, in February because of epilepsy, and with the help of others, in particular the local newspaper, the Coventry Telegraph, they have raised about £19,000. They point out that epilepsy causes more than 500 deaths each year in the UK, and one of the issues they have raised in correspondence with me is that often parents do not know the right questions to ask a doctor. That view is reflected in other correspondence that I have received on this subject, and it is a point that we should look into. In addition, the majority of people do not realise that epilepsy can end in death. Will my hon. Friend congratulate the Dattani family on their efforts to do something about epilepsy after the loss of their son, and particularly on raising about £19,000 with the help of our local newspaper?

Steve McCabe: I certainly congratulate the family on that fundraising, and the point about lack of information on epilepsy is crucial. The full title of the debate is “Prevention of avoidable deaths from epilepsy”, but given the nature of the subject I may occasionally stray into more general territory; I hope that you will forgive me for doing so, Mr Scott.

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Epilepsy is defined as a tendency to have recurrent seizures, when a sudden burst of excess electrical activity in the brain causes a temporary disruption in the normal message-passing between brain cells. Epilepsy is not one condition but a composite of about 40 different types of seizures and up to 50 different syndromes. It affects about 600,000 people in the UK, which is one in every 103 people or about 930 people in each parliamentary constituency. It is estimated that about 69,000 people with epilepsy could have their seizures controlled with good treatment; about 74,000 people are taking aggressive drugs unnecessarily, because of misdiagnosis; a quarter of people who are known to learning disability services have epilepsy; half of the 60,000 young people with epilepsy are estimated to be underachieving academically relative to their intellectual capacity; and people with epilepsy have been shown to be twice as likely as those without epilepsy to be at risk of being unemployed.

Some studies suggest that the likelihood of early death in people with epilepsy is two or three times higher than in people without epilepsy. As my hon. Friend the Member for Coventry South (Mr Cunningham) indicated, the biggest risk appears to be poor seizure control, with the risk of early death increasing as the number of seizures that an individual suffers increases. A phenomenon that people are now starting to come to terms with is sudden unexpected death in epilepsy, or SUDEP. I understand that in 2009 about 1,150 people in the UK died of epilepsy-related causes. That means that, each day in the UK, approximately three people with epilepsy die, and at least a third of those deaths—one death each day—are potentially avoidable.

I am very grateful to Lucy Kinton, a consultant neurologist at Basingstoke and North Hampshire NHS Foundation Trust, who says that there is not enough research into SUDEP, which frequently affects young people who otherwise could be expected to have a fairly normal life. Indeed, she points out that our investment in research into epilepsy is much lower than our investment in research into other frequently occurring conditions, such as diabetes.

Nia Griffith (Llanelli) (Lab): As a child, I lived on what was called an epilepsy centre—my mother was the resident doctor there—in the middle of the countryside. Does my hon. Friend agree that although we have made huge progress since those days in terms of changing social attitudes and raising awareness, research into epilepsy is still very much underfunded? Is there not a huge need to make research into epilepsy an urgent priority, so that we can gain some of the knowledge that could prevent some of the future deaths from epilepsy?

Steve McCabe: I certainly agree that there have been considerable strides and we should not dismiss them, but there is an overwhelming need for further research and for improvements in specialist care and treatment. That is one of the points that I hope the Minister will comment on later this morning.

SUDEP accounts for nearly half of all epilepsy-related deaths. Research suggests that the seizure activity in the brain may sometimes cause changes in the person’s heartbeat or breathing, very occasionally causing the person to stop breathing completely. The single most important risk factor appears to be uncontrolled generalised tonic-clonic seizures, which, I understand, are the type

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of seizure that causes a person to lose consciousness, while their body becomes stiff and then starts to jerk. Such seizures can lead to sudden unexpected death.

It is estimated that there are about 500 cases of SUDEP every year, and a further 500 deaths every year due to other epilepsy-related causes. About 39% of adult deaths from epilepsy were considered to be potentially or probably avoidable. The main problems or deficiencies that cause these deaths include inadequate drug management; lack of appropriate investigations; inadequate recording of patients’ histories; adults with learning disabilities being lost in the transfer from child services to adult services; and one or more major clinical management errors being made. The absence of evidence of a package of care for those suffering from epilepsy is also a cause of rising concern. In primary care management, the main problems identified include sparse evidence of structured management plans, missed triggers for referral and professional communication failures.

For women with epilepsy, the risk of sudden death in pregnancy remains higher for those with other long-term conditions. The risk of maternal death is an estimated 10 times higher for women with epilepsy than for women in the general population. It is probably fair to say, however, that the risk is still low overall.

I am very grateful to Young Epilepsy, formerly known as the National Centre for Young People with Epilepsy, which works on behalf of about 112,000 children with epilepsy.

Jim Shannon (Strangford) (DUP): I congratulate the hon. Gentleman on bringing this matter to Westminster Hall for debate. I went to school with a young fellow who had epilepsy. I well recall how scary my first encounter with the condition was, because I did not know what was happening. Does the hon. Gentleman agree that there is a need for better awareness in schools? If there are pupils with epilepsy in a school, the school needs to know that, so that it can react in a positive way rather than with the fear that comes from not knowing how to deal with it.

Steve McCabe: Absolutely. Young Epilepsy is very effectively carrying out a pilot project, with more than 20 schools, to develop and test a model of best practice that can be replicated in any school. Although there might well be the usual problems of time and finance, I understand that the pilot is now at a stage where it could be rolled out across the country. That would go some way to addressing fellow pupils’ concerns and to preparing staff much better in what to do in particular situations. I am extremely grateful to Young Epilepsy for its work in that area.

The figures suggest that there has been a general increase in epilepsy, but that could be due to better diagnosis. There certainly seems to be a suggestion that greater attention to the recording and monitoring of people with the condition has been a factor, due to the GP outcomes framework and the introduction of the National Institute for Health and Clinical Excellence guidelines, and similar ones for Scotland. Misdiagnosis remains a significant problem: a rate of between 20% and 30% of people being misdiagnosed could equate to

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something like 138,000 people without the condition receiving anti-epilepsy drugs, at a cost of about £220 million a year.

There is evidence that epilepsy is more prevalent in the most socially deprived parts of the country than in the better-off ones. There is a particular problem, with which the Minister will be familiar, in the allocation of residential care for some people who suffer from epilepsy, with the local authority describing epilepsy as a health condition, but most other people saying that a combination of health and social factors are involved. A particular group to mention in that respect is prisoners. A number of studies have been done, not least by the all-party group, that show that the NICE guidelines are not followed in the vast majority of prisoner cases, and that there are problems with prisoners having access to the proper drugs and, significantly, with diagnosis. There also seems to be a problem with how some PCTs determine access to services, with some using referral and funding panels rather than relying solely on clinical judgment. I would have thought that that is not necessarily in people’s interests.

All of that leads to a picture of a treatment gap. About 70% of the population with epilepsy in this country could be seizure-free if they received optimal treatment, but only about 52% are seizure-free. Too few children are offered or referred early enough for surgery that could cure their epilepsy or at least significantly reduce seizures. I understand that there is a backlog of more than 2,000 children who could benefit from such surgery.

The Prime Minister himself has acknowledged that there is a need for improved services. More than 10 years have passed since the then chief medical officer, Sir Liam Donaldson, said in his annual report that epilepsy services suffered from a lack of interest compared with the management of other chronic conditions such as asthma. Although national initiatives such as the NICE guidelines and inclusion in the GP contract have raised awareness of epilepsy, and although there are patches of excellence across the country, overall service provision in most communities has not translated into sufficient effective interventions. One purpose of today’s debate is to ask the Minister to meet with some of the epilepsy organisations, particularly Epilepsy Bereaved, to discuss what else we can do to prevent avoidable deaths.

I do not want to take too long because I want to let other people speak, but I should mention that there are recurring stories about the deaths of young people. A young boy of nine who experienced frequent seizures had benefited from excellent care from his paediatricians, but he died following a transfer of care during an overnight stay in hospital when his history was not adequately updated. In another case, a young woman died suddenly in her sleep, leaving behind two sons. She had had infrequent seizures but had never been given adequate advice. Some five years ago, two famous cases, those of Erin Casey and Christina Ilia, led to a fatal accident inquiry in Scotland, with which the Minister might be familiar. In summarising, the sheriff was absolutely clear that the risk of sudden death might have been reduced by access to a night monitor or much better information about the particular risk at that point in the evening.

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I will not dwell on the number of things we need to do. I take the view that there has been progress in our understanding of epilepsy and that there is probably less stigma attached to the condition these days. I think that the previous Government and the present one have made efforts to improve the quality of care, but we know that significant problems remain. We need to think about whether we can set up a dedicated research fund to look much more closely at epilepsy. General practice needs to be much clearer about risk management, about the potential benefits of technology—for example night monitors—and the need to flag up injuries, A and E visits and missed prescriptions. Good medicines management is needed because, as I said earlier, about 70% of people could be seizure-free if prescribed the right medicine. Much more active monitoring of epilepsy deaths is also needed, so that we know what is happening and can draw up plans to help people to manage the condition.

The depth of the subject tempts me speak for much longer, but as I said at the outset, my purpose is to flag up some of the central issues involved in avoidable deaths and the actions that could be taken to help people who suffer from epilepsy. I will allow sufficient time for other colleagues to contribute and for the Minister to reply to the debate.

Mr Lee Scott (in the Chair): Before I call the next speaker, let me say that I intend to start the winding-up speeches at approximately 10.40.

9.50 am

Paul Maynard (Blackpool North and Cleveleys) (Con): It is a pleasure to serve under your chairmanship, Mr Scott. I congratulate the hon. Member for Birmingham, Selly Oak (Steve McCabe) on securing this important debate.

I am epileptic. I have nocturnal epilepsy. I have tonic-clonic seizures, which, as the hon. Gentleman explained, are the severest form of epilepsy and the form that we all associate with the condition. I am, at least for another fortnight, between the ages of 20 and 35. I am single and, for the avoidance of doubt, I should make it clear that I sleep alone. I am also male, for the avoidance of any further doubt, and it might surprise people outside this Chamber to learn that I work long hours in a stressful occupation—at least I think it is stressful. I therefore tick every box for being at risk of sudden unexpected death due to epilepsy. I go to bed every night knowing that there is an infinitesimally small chance that I might not wake up again. That is, of course, a great concern.

I realise that anyone with epilepsy has a 24 times greater chance of sudden death than the normal population. Those particularly at risk of SUDEP are 23 times more likely again to experience sudden death. That understandably preys on the mind, but what concerns me more than anything else is the fact that I did not learn of all the risks at the time of my diagnosis; I discovered them because I happened to Google my condition. I sat at my computer with a chill going over me, thinking, “My goodness, I never knew any of this could possibly occur.”

I know that that is a wider concern from meeting many people, including a constituent of mine, Avril Walker, who lost her son Christopher to SUDEP when he was aged 19. I have also met many families through

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Epilepsy Bereaved and Jane Hanna. They all say the same: they have a sense of anguish at the loss of a loved one, which is natural and entirely understandable, but many of them have a much greater sense of frustration that at the time of diagnosis no one explained the risks of SUDEP to them. If they had known, they could at least have sought to undertake mitigating activities to reduce their risk.

I know what those activities can involve. Before my diagnosis, when my epilepsy was not controlled, I managed to throw myself down the stairs. I woke up with my head in a fridge, a washing machine and an oven, which thankfully was not turned on. I threw myself out of bed and hit my head on my bedside cabinet, making a large gash only just above my eye. When I went to accident and emergency, I was told, “Oh, you’ve just been drinking too much.” The irony, of course, is that the treatment for my epilepsy involves the avoidance of any alcohol. That is what makes it so difficult to control: if any alcohol is used in any food that I inadvertently eat, I will have a seizure in the night.

Thankfully, I adhere to my medicine. The diagnosis is so important because there is no greater impetus to adhere to medication than the knowledge of what might happen if one does not. The most sacrosanct thing in my life is ensuring that I have my medicine. I live what is essentially a double life—I am down here half the week and up in Blackpool the other half—so it can be quite difficult to ensure that I have the little packet of pills that I usually carry around with me. If I am without them, panic ensues and I have to rush down to the Victoria walk-in centre to get an extra prescription. May I complain to the Government about its being shut in a month’s time?

Ms Diane Abbott (Hackney North and Stoke Newington) (Lab): I am listening with great interest to the hon. Gentleman’s personal experience; our debates are always enhanced by such contributions. Does he think that there is any particular reason why doctors are unwilling to tell people diagnosed with epilepsy about the risk of sudden death?

Paul Maynard: I thank the hon. Lady for that pertinent intervention. I was intending to come to that. I think that all doctors dislike dispensing bad news. It is perhaps the least fulfilling part of the job. I am sure that some of the doctors to whom I have spoken think that the moment of diagnosis is not necessarily the appropriate moment for a detailed discussion starting, “Oh, and by the way, you’re 23 times more likely to die now, so you need to do this, this and this.” However, it underlines the importance of epilepsy specialist nurses, who can have a more structured conversation one or two weeks later, after people have got over the shock of the diagnosis.

The diagnosis is a shock. When I was diagnosed in my early 20s, I had no idea when I went to the doctor’s that morning that he would tell me that I had epilepsy. I was stunned by the news. That might not have been the most appropriate time to say, “And by the way, you’ve got all this to deal with as well.” None the less, it is vital that that structured conversation occurs at some point soon after diagnosis, because it is possible to do things to mitigate the condition, even if it is just blunting the sharp corners of one’s bedside cabinet, lowering the

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height of the bed or fitting a child gate above the stairs. If one knows what is likely to occur, one can at least try to mitigate it.

It also underlines the dramatic importance of adhering to medication. Many of the young people who are most susceptible live what one might call chaotic lives. They do not always pick up their medication. If they are away at university, they are not under parental control and one cannot monitor their medicinal intake precisely. If they are aware of the risks, a degree of self-discipline might be brought into play to ensure that they stick to their medication regime. I have heard time and again that sudden deaths seem to occur particularly in a university setting. That concerns me. Self-discipline is necessary as early as possible, and the diagnosis and explanation process are fundamental.

When the worst occurs—tragically, it will occur, because one can never iron out the risks entirely—a much better post-death process is needed. It is natural for the family to be shocked, particularly if they were not expecting it and had not been made aware of the risk factors. There is a lack of awareness in the coroner service and among the police. There can be nothing worse than finding one’s child’s bedroom turned into a crime scene because police are not aware of the potential for sudden death from epilepsy. All that could be much better handled with instructions from on high. The coroner service in particular needs to make a list of national charities dealing with sudden death to which families can turn for help. That would be of great assistance, because many people simply do not know where to turn.

I beg the Minister to encourage the medical profession to ensure that some medical professional has a conversation either at diagnosis, if they feel it appropriate, or within a fortnight or so, to explain the risks. That alone would make a difference, rather than a conspiracy of silence that leaves those with epilepsy to find out about it for themselves. If that conversation occurs, at least people can try to take the actions necessary to protect themselves. That would make the most difference.

9.59 am

Paul Flynn (Newport West) (Lab): It is a pleasure to serve under your chairmanship for the first time, Mr Scott. I warmly congratulate my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe) on obtaining this debate and on his splendid contribution, which covered the ground of all the campaigning groups working on behalf of those with epilepsy.

It is a great pleasure to follow the most important and worthwhile speech that will have been made in the House today, whatever happens in the Chamber. It is enriching for us to have the hon. Member for Blackpool North and Cleveleys (Paul Maynard) in Parliament. We are not members of the same party, but I will happily embrace him as a friend and call him such. Hearing at first hand from those who suffer from illnesses or disabilities is of enormous value to us. There is nothing better than to hear from the hon. Gentleman about the simple changes that might be necessary, such as blunting sharp corners and taking simple precautions, to avoid the tragedies that occur all the time. I welcome his presence in the House. If this House is to restore our greatly damaged reputation—it is of profound importance to us all that we win back the trust and confidence of this

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country—we need more Members such as the hon. Gentleman with experience that can give us diversity. The House must become more representative of the nation in every way.

My reason for speaking in this debate relates to a matter involving two constituents and lifelong friends of mine, Gwyn and Gill Thomas. I knew one of their daughters, Rhian, throughout her brief, radiant life. Her parents were devoted to her. On a visit to Florida, the place where Rhian was happiest, she died suddenly during the night. There was no warning or expectation, and Gwyn and Gill were left shocked, as would we all at the untimely death of one of our children, and bewildered by what had happened. As in many cases when a family experiences terrible grief, they have become enthusiastic campaigners to ensure that no one else suffers in the same way as they have suffered. They wish to avoid this being repeated in other families—a strong and understandable reaction. My hon. Friend the Member for Birmingham, Selly Oak has mentioned the concerns, and I have heard about them first-hand in the House from other parents who have lost young people in similar circumstances.

Channel 4 covered the case of the Casey and Ilia fatalities, which involved two families who suffered in a similar way. Erin Casey was aged 19 and Christina Ilia was aged 15—one a university student and the other a schoolgirl. The sheriff concluded that, had Erin been told of the risk of sudden unexpected death in epilepsy, she might have picked up her prescriptions and complied more with her medication—she might not have died. Had there been supervision in the form of nocturnal devices, which have been discussed, Erin might have wanted them and might not have died. On the death of Christina, the sheriff found that, had she and her parents been told of the risk, they would have discussed and considered the possibility of providing night supervision, possibly by use of alarm. If Christina had had such supervision, she might not have died during the night. The judge recommended that there should be a discussion of SUDEP in order to reduce the risk at diagnosis, unless there was serious harm to the patient. The timing of the discussion should be deferred, but needs to be planned. The role of a specialist epilepsy nurse is vital, and the failure of the authority to provide a specialist nurse service was viewed as contributing to the death. Those points were well made in the television programme and must be of concern to us all.

My hon. Friend has given a list of the possible remedies—drugs and how they should be used, and the existing advice—that appear to be available. Part of my constituents’ additional agony as a result of their bereavement is that they were not informed of many of the things that they have heard about since Rhian’s death. They want to go out and make sure that everyone else is aware of the possible remedies that could avoid such tragedies in the future. As with many other subjects discussed in the House, my views on this issue are the result of constituents’ problems. I thank the persistence of the campaigning of my constituents and all others who are determined that everything possible is done to avoid these unnecessary deaths.

10.5 am

Ms Diane Abbott (Hackney North and Stoke Newington) (Lab): It is a pleasure to serve under your chairmanship for the first time, Mr Scott. I congratulate my hon.

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Friend the Member for Birmingham, Selly Oak (Steve McCabe) on securing this debate and on the work that he and the all-party group on epilepsy are doing to spread awareness in Parliament of the nature of epilepsy and to raise the profile of epilepsy and its related problems.

As we have heard, epilepsy currently affects almost 500,000 people in the UK. It is one of those conditions that, I think, excite a certain fear among people who are not familiar with it. One of the important aspects of the all-party group’s work is to get past that fear barrier, so that people understand and the climate is created in which services can be commissioned properly.

We have heard about the danger of sudden unexpected death in epilepsy and that it affects the younger age demographic in particular. I understand that an information resource has been issued in Wales and Scotland on the risks and prevention of SUDEP. Is such a resource currently available in England?

Certain factors can increase the risk of SUDEP, and hon. Members have referred to them, drawing on their personal experience. The total number of people dying needlessly of epilepsy each and every year is more than the total of AIDS-related deaths and cot deaths combined, yet for some reason SUDEP deaths have never had the same prominence in the public imagination and public debate as issues such as cot death and AIDS. It is also most unfortunate that the death rate in Britain for SUDEP is 25% higher than the average for the European Union. This is a difficult topic and I understand that doctors may have a certain reticence about discussing the risk with young people at the point of diagnosis, but if our death rate is 25% higher than that of the EU, it shows that more can be done.

A straightforward and important suggestion has been made that medical practitioners should be required to have that discussion with people soon after diagnosis. As we have heard, it is young people between the ages of 16 and 35 who are at greatest risk. That is the age, certainly if my life between 16 and 35 is any example, at which people are least inclined to listen, behave sensibly or take advice. That makes it doubly important that there is a formal requirement for a medical practitioner to sit with young people and explain exactly what the risks are.

In preparing for this debate, I looked at the National Institute for Health and Clinical Excellence guidelines on epilepsy. They recommend that all people with suspected epilepsy should be seen by a specialist, but I understand that half of acute trusts—49%—do not employ one. NICE guidelines also state that people with suspected epilepsy should be seen urgently within two weeks, but I understand that the waiting lists of most trusts—more than 90%—are longer than that. Will the Minister comment on what action his Department is taking to ensure that people diagnosed with epilepsy are seen more promptly in the future?

A further recommendation from NICE relates to epilepsy specialist nurses. NICE guidelines state that they should be an integral part of the medical team providing care to people with epilepsy, but more than half of acute trusts and PCTs in England do not have one. How will the Minister ensure that trusts in England and, of course, clinical commissioning groups use NICE guidelines to plan and commission epilepsy services? Will the Department of Health agree to treat the matter

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as a priority and put an end to the current situation, where people with epilepsy continue not only to have a poorer quality of life, but to face a greater risk of dying? As I have said, there is a 25% higher death rate here than in the rest of the European Union.

We know and respect the fact that the Prime Minister has personally pledged to raise the profile of epilepsy and to tackle the stigma that surrounds the condition, to which I referred earlier. I understand that the Prime Minister has met my hon. Friend the Member for Walsall South (Valerie Vaz) to discuss her ten-minute rule Bill on epilepsy. We know from the Epilepsy Society that, during the meeting, the Prime Minister agreed to consider the Bill and look at improving health and education services for people with the condition. In a letter to Lord Howe dated 16 May 2011, the Prime Minister acknowledged that

“there are historic weaknesses in the commissioning of services”

and that there is an urgency for change

“because these failures carry huge costs as well as having a massive impact on the lives of people with epilepsy”.

The Prime Minister concluded that there are

“potentially very significant savings from unplanned emergency admissions to be made by getting this right, which goes hand-in-hand with improvements in outcomes, including life expectancy and a reduction in the number of tragic sudden deaths in epilepsy”.

Labour Members respect the Prime Minister’s genuine concern about this condition, but I think the Minister would agree that we need to move on to action. The Epilepsy Society was very encouraged by what the Prime Minister had to say. He said that he would get back to Epilepsy Action but, to this day, he has not made any specific commitments. Does the Minister know whether the Prime Minister has had a chance to consider the points put to him by my hon. Friend the Member for Walsall South, representatives of the Joint Epilepsy Council and the hon. Member for South Thanet (Laura Sandys), who chairs the all-party group on epilepsy?

The Minister will also be aware that, during the last year of the Labour Government, the Joint Epilepsy Council won the support of the then Health Minister, Ann Keen, who so recently suffered a sad bereavement. She initiated a conference of epilepsy commissioners, which took place in January 2010. That was branded as jointly organised by the Department of Health and the Joint Epilepsy Council—a true partnership. Will the Minister tell hon. Members what discussions he and his colleagues have had with stakeholders and whether he is working with the Joint Epilepsy Council to address the shortfalls in service provision for people with epilepsy in England?

As I am sure that the Minister is aware, Epilepsy Action has carried out a study that revealed the variations in service provision, data collection, evaluation and quality of care. In the course of its study, it became apparent how many of NICE’s recommendations are still not being met, particularly in terms of access to specialist consultants and nurses, as I said earlier. Taken together, the facts from the survey do not paint a picture that is wholly encouraging. Some epilepsy sufferers and their families feel that it is a forgotten condition, which is why this debate is so important.

As the Minister will be aware, Epilepsy Action has called on the Government to take a lead in driving improvements to epilepsy service provision. Among other things, Epilepsy Action is calling for a national

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clinical director for epilepsy to ensure that local commissioners carry out a review of the implementation of the NICE guidelines, NHS work force planning to focus on the recruitment and training of sufficient epilepsy specialist consultants and nurses, commissioners to build a clearer picture of the epilepsy population in their area, a commitment to ensuring that all patients with suspected epilepsy see a specialist within two weeks, all acute trusts to have adequate diagnosis equipment in line with the patient population they serve and all patients to receive an annual review of their epilepsy. That would particularly help younger patients, who would be reminded, if they have forgotten, of the seriousness of their condition and of the things that they should be doing to help themselves.

Epilepsy Action is also calling for the introduction of effective transition services for children moving into adult epilepsy. Again, that is particularly important to the younger cohort. Finally, Epilepsy Action wants the Minister to consider ensuring that all patients with epilepsy who want a comprehensive care plan can get one. The Minister will be aware of those recommendations, and hon. Members want to hear how he plans to respond.

As I said at the beginning of my remarks, this condition excites a certain fear and, even today in 2011, a touch of stigma. Particularly for younger people—I consider people under the age of 35 to be young—the condition poses a risk of sudden death. That risk is higher than in other European countries, which suggests that there is something we can do. We know—the whole House knows—that the health service is going through a period of transition and change. I will not use this debate to challenge the changes that are going to happen, but because we are going through a period of change, it is very important that the measures are in place to ensure that the care people receive for such a condition is as good as it has ever been, particularly in relation to commissioning services locally. It is also important that we move forward with the improvements and pay attention to the quality of life of epilepsy sufferers that people campaigning on epilepsy have sought for many years. I await with interest the Minister’s response to the points that I have raised.

10.17 am

The Minister of State, Department of Health (Paul Burstow): I, too, am pleased to serve under your chairmanship, Mr Scott. I congratulate the hon. Member for Birmingham, Selly Oak (Steve McCabe) on securing the debate and on being so persistent in applying for it week after week until, finally, being successfully in the ballot for Adjournment debates. The hon. Gentleman is right to bring the matter back to the House for a debate and I am grateful to all hon. Members who have contributed. The personal testimony and the testimonies we have heard on behalf of constituents speak to the devastation that the condition can bring to families and the people who suffer from it.

A lot of statistics have rightly been rehearsed to illustrate those points as part of today’s debate. They are undoubtedly very compelling and, as has rightly been said, quite depressing. They show that although we have known for a long time what needs to be done, it

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does not appear to be implemented as consistently as it should be across the country. There are places that follow the NICE guidelines and consequently make a difference, but over many years other areas have failed to invest or see the matter as an area of priority. That is not a comment on previous Governments’ records, but an acknowledgement of the difficulty in an organisation as large as the NHS of ensuring sufficient focus on something as important as this.

The hon. Member for Hackney North and Stoke Newington (Ms Abbott) paid tribute to the work of the all-party group on epilepsy. I come across many APPGs in pursuing my ministerial responsibilities; they are, truly, an important part of how this Parliament makes sure that the voices of many seldom-heard groups—or groups certainly not heard often enough—are heard by Ministers and the Government.

I will try to ensure that I respond to all the points that have been made. I have been encouraged to speak for as long as is necessary to do just that.

Paul Flynn: Will the Minister give way?

Paul Burstow: There is an objection to that point. I give way.

Paul Flynn: Members have, very generously, given the Minister 40 minutes to reply to the debate, which is rather longer than Ministers usually have. Will he find time in that 40 minutes to commit to the practical, affordable remedies that have been urged on him by the many charities involved in SUDEP?

Paul Burstow: I hope to do just that, and I hope to do justice to the points that the hon. Gentleman and other hon. Members made in the debate.

At least one hon. Member—my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard), who initiated the debate we had about a year ago—has contributed to the debate on this issue again. The message I took from last year’s debate was clear, and I take it again today. There is a real sense that we need change in the system. We need change that delivers a real focus on issues such as epilepsy to ensure that clinicians and the service respond properly to the evidence, act on the evidence, and translate it into services that are fit for purpose. At the moment, the service continues to fail hundreds of thousands of people living with epilepsy, at a huge cost to them personally and to their families. When we debated these issues a year ago, there was some uncertainty about how the Government’s plans for reform would deliver improvements. I would like to spend a little time today setting some of them out.

Ms Abbott: Will the Minister give way?

Paul Burstow: In a moment, if I may. We have plenty of time. I just want to say something about the voluntary sector, and then I will happily give way to the hon. Lady.

The outlook for most patients with epilepsy is good—it is important to acknowledge that—but we know that more than 1,000 people die of epilepsy-related causes each year. Many of those deaths are due to accidents or status epilepticus, but a significant number of them are attributable to SUDEP—sudden unexpected death in

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epilepsy. The devastating effect of any epilepsy death cannot be overestimated and cannot be understated. I pay tribute to the many voluntary sector organisations that have been referred to in this debate. They work hard to highlight the challenge, and to ensure that the failings that have been described are identified and tackled.

Ms Abbott: In preparing for the debate, I was struck by how much higher our rate of sudden unexpected death in epilepsy is, compared with that in the rest of Europe. Do Ministers have any analysis of why that might be?

Paul Burstow: I will come on to outcomes and information in a moment. Understanding the performance of our health economies, compared with that of other systems around the world, is an important part of how to ensure that we focus on what matters most to deliver change and improvement. I will talk about outcomes, data and variation in a moment, if I may.

I particularly want to acknowledge the work of Epilepsy Bereaved, which since its foundation in 1995 has led cutting-edge work to establish major risk factors and ways to reduce risks and prevent deaths. The charity provides very well-regarded bereavement support, which helps to break the isolation that people experience following SUDEP, or other seizure-related deaths. I acknowledge the organisation’s concerns that failings in care and the commissioning of services have led to many avoidable deaths from SUDEP.

In the 12 months since we last debated epilepsy services in Westminster Hall, we have made significant strides in putting in place the necessary arrangements to level the playing field in commissioning epilepsy services relative to other services.

That leads me on to the NHS outcomes framework. The hon. Member for Hackney North and Stoke Newington referred to the NICE guidelines and the role of specialists. One role that the NHS outcomes framework can play is to ensure that commissioners, providers and others are better able to identify those things that can drive up performance in the NHS. The publication of the first NHS outcomes framework marks the start of a journey for greater transparency and accountability for the outcomes that the NHS achieves for patients. It demonstrates a move from traditional input and output targets towards a focus on delivering better health outcomes for all. The framework includes a focused set of national outcome goals and supporting indicators that patients, the public and Parliament will be able to use to judge the overall progress of the NHS. A number of those goals and indicators are relevant to epilepsy. They will, of course, inform the Secretary of State’s mandate to the NHS commissioning board and, in turn, to the NHS commissioning framework.

Let me give a few examples of the relevant indicators. In domain 1 of the NHS outcomes framework—preventing people from dying prematurely—the overarching indicator is about mortality from causes considered amenable to health care. This debate demonstrates graphically that epilepsy is one of the conditions where there is plenty of room for significant progress. The hon. Member for Hackney North and Stoke Newington rehearsed the statistics, which are compelling. They point, very powerfully, to commissioners having to look at this if they are to deliver measurable improvement against that indicator.

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Domain 2, enhancing quality of life for people with long-term conditions, speaks directly to the issues addressed in this debate. The overarching indicator is health-related quality of life for people with long-term conditions. It addresses such specific issues as the proportion of people feeling supported to manage their conditions. That speaks directly to issues such as care planning and case management. That indicator is not just in the NHS outcomes framework; it also sits within the adult social care outcomes framework, to try to align more joined-up thinking and commissioning on these issues. Improving functional ability in people with long-term conditions relates to ensuring that more people are able to stay in employment.

There are many other indicators. The aim of domain 3 —helping people to recover from episodes of ill health or following injury—is to capture information on patients’ journeys through the system. Domain 4—positive experiences of health care—will look at such things as patients’ experiences of primary care. My hon. Friend the Member for Blackpool North and Cleveleys described the conversations that should happen, and they should be captured.

The emerging commissioning landscape will contribute to improving not just epilepsy outcomes but outcomes across the board. In the past, commissioning has been too remote from the patients it is intended to serve. Commissioning decisions made by clinical commissioning groups will ensure that they are underpinned by clinical insight and knowledge of local health care needs, and, importantly, the perspective of the patient and family carers. Clinical commissioning at its best is a collaboration of professionals. The NHS commissioning board and clinical commissioning groups will be required to obtain clinical advice from a broad range of professionals with expertise in the

“prevention, diagnosis or treatment of illness”—

and in the—

“protection or improvement of public health”.

There is a real pull in the framework that we are putting in place to make sure that that happens. As well as promoting effective clinical leadership and multi-professional collaboration around specific conditions and pathways, we expect doctors, nurses and other professionals to come together in clinical senates to give expert advice from a variety of health and social care perspectives.

NICE has rightly been alluded to a lot. The Government intend to build on its strong track record by re-establishing it as a statutory body. It will continue to play a key role in the NHS through the production of robust, evidence-based advice and quality standards. I will address the issue of quality standards specifically. The hon. Member for Birmingham, Selly Oak asked about surgical interventions in the context of the work being done to produce quality standards covering epilepsy services. They have already been commissioned by NICE and will cover children and adults separately. I will pass on the point that was made about the need to address issues of transition, so that that is not overlooked in producing two separate quality standards. In the children’s quality standard, there is a specific need to address access to surgical interventions, and it will be addressed.

HealthWatch has its part to play, and will better enable people to help shape health and social care services, at both a local and national level, by providing

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a strong forum where the views and experiences of patients, carers and the public can influence the commissioning process and improve the quality of health and social care services. There must be a clearer split of responsibility—a sense of joined-up access across the care pathway to deliver a less fragmented and more person-centred approach to planning. We accept that care and support for those with long-term conditions is a particular area where we do not get it right often enough. Not only are patients confused but their care and quality of life are compromised, and it leads to inefficiencies and duplications in the system.

The hon. Member for Birmingham, Selly Oak asked me specifically about prisoner health. One of the opportunities that arises from the establishment of the NHS Commissioning Board is that it will be the commissioner of prisoner health. With it leading on such work, we are in a much better place to assure ourselves that the NICE guidance on prisoner health and epilepsy is properly and consistently applied throughout the prison estate. I shall certainly pass on any further information that I can to the hon. Gentleman.

Ms Abbott: I have listened with great attention to the Minister and, naturally enough, he has started with generalities, but the nature of Westminster Hall debates lies in the opportunity for Members to get replies to specifics, so I have three questions arising from the speeches today. First, do the Government intend to appoint a national clinical director for epilepsy? The hon. Member for Blackpool North and Cleveleys (Paul Maynard) asked specifically about people being able to talk about sudden unexpected death within a couple of weeks of diagnosis, but am I to take it that the Minister has no means to direct that and will leave it to commissioning groups to decide what is appropriate? Finally, are the Government prepared to commit to the explicit inclusion of epilepsy mortality in the outcomes frameworks?

Paul Burstow: The hon. Lady needs to be patient, because I still have quite a lot of sheets of paper and quite a lot of answers to give. Before I took her intervention, I had answered a specific question on prisoner health from the hon. Member for Birmingham, Selly Oak. I am trying my best to cover the ground.

I will deal with the national clinical director proposition. As part of the transition—the hon. Lady alluded to this—from a command-and-control system in which the NHS is directed from the Department of Health to a model in which the service is at arm’s length and directed through goals and objectives set to a mandate, the NHS commissioning board will be where national clinical directors sit. The national commissioning board will make the decisions on the precise configuration of those appointments. Clearly, that will be modelled on the approach taken on an outcomes framework, so that there is proper coverage of all its domains. That is as much as I can say today, and perhaps we need to have a further debate, but if she wants more information, I will happily write to her with more detail. I cannot say today, however, that there will be a DH-appointed epilepsy national clinical director, because that is the old world and we are moving to a new world, whether

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we agree about that or not, and in that new world the responsibility for making choices about the appointment of national clinical directors will sit with the NHS commissioning board. That is as clear an answer as I can give to her question. I will answer the others as we move on.

Assessment of need was mentioned in the debate and goes to the heart of a challenge for the charities. My experience over the past 12 months of talking to many non-governmental organisations that advocate on behalf of patient groups is that some see huge opportunities in reorganising themselves to get much closer to the new commissioners and to those who will shape priorities for local services at a local level, and they are looking to organise themselves accordingly. Others are finding it more difficult to think through how to organise themselves to do that, and are therefore looking to how they can use the old levers, encouraging the Department of Health to proceed through central fiat and direction. My job is to say that that is not how it will work and, if they expect that that is how things will happen, they will be sadly disappointed. The Department and I as a Minister are only too pleased to work with organisations to ensure that they can realise and exploit the full potential of the new arrangements such as the health and wellbeing boards, the clinical commissioning groups and their duty to engage with their public, their patients and carers. Organisations, including some of the epilepsy charities, need to think that through carefully.

Health and wellbeing boards will be the local system leaders and will drive joined-up health and social care services. They have a key role, with joint strategic needs assessment and joint health and well-being strategies, in which they understand the population need and future population need, and that in turn drives commissioning for populations and outcomes. Simply said, to ensure that those joint strategic needs assessments are rich and informed, charities in the sector have a part to play in the conversation, to ensure that their input is not lost. NICE clinical guidance and quality standards play their part as well.

The hon. Member for Birmingham, Selly Oak asked about research. Who could disagree—I certainly do not—that the case for more research is strong? Again, however, directing more research through ministerial instruction is not how we should proceed. That might get more research but it does not guarantee quality, which is why we have for a long time had the Medical Research Council leading, with independent peer review as the process for allocating research resources. As in many other spheres, the key is to ensure the crucial infrastructure to support quality bids in the first place—the better the quality, the better the chances of an increase in the resources. We saw that with dementia; the Government had a priority to invest more but did not achieve that simply by putting up a quantum and stating that “This is what we must now spend.” Simply, it is about putting in place the steps to ensure quality research bids in the first place.

The information revolution is another important part of delivering the agenda. Today’s challenge in providing high-quality care services cannot be met without effective use of information. At present, many people who use our health and care services do not get the information that they need and expect as part of the care process, which we have heard described graphically. We sometimes

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fail to meet the information needs of our clinicians and care professionals, so information is critical to our ambition to put people in the driving seat of their services and their care. Through the work of the NHS Future Forum so far, we are examining how to ensure that the information strategy that will be published fully reflects the various concerns expressed.

The hon. Member for Hackney North and Stoke Newington asked a specific question about whether the information provided in Scotland and Wales is available. The answer is yes. There are comprehensive information sources available on NHS Choices, including a guide to epilepsy that contains information about SUDEP and minimising risk. The use of things such as NHS information prescriptions and, as we develop more of them, tools to help patients and clinicians make decisions are ways of further strengthening that important notion of “no decision about me without me”.

The hon. Member for Newport West (Paul Flynn) talked about his constituents Gwyn and Gill Thomas, the tragic death of their daughter from SUDEP and how they felt bewildered and, I suspect, outraged that they did not get information on which they could have acted at the time. That has spurred them on, and we can probably find echoes of that in every constituency surgery throughout the country—people motivated by personal experience to ensure that it happens to no one else. The hon. Gentleman’s example of the case of Christina and the lack of knowledge of risk underscored the as-ever exceptional contribution of my hon. Friend the Member for Blackpool North and Cleveleys to today’s debate. By talking about his own experience, he illuminates a much wider and more important picture about the frailty of human beings and their reluctance sometimes, even when professionally trained, to engage in the conversation that they are paid to have, which ultimately is a conversation about life or death. We know that NICE has set out clear guidance on care planning and case management, which provides good evidence of how they can make a difference.

The guidance also talks about the role of epilepsy nurses, and the hon. Member for Hackney North and Stoke Newington asked how the Department helps with their availability. One of the ways we help is by ensuring that good tools are available for local business cases to be put to commissioners locally. We do not mandate from the centre a certain number of such members of staff, but we make it clear through the regulatory framework and other ways that the skill and staff mix of organisations has to be appropriate to the services that they are providing. There is as well a strong economic case for epilepsy nurses to be commissioned, because of how they can have that honest conversation with the individual concerned.

Another way we can play our part at national level in raising the profile of these issues and making commissioners think through how they commission services effectively is through the development of outcome strategies. We have outcome strategies for respiratory and mental health conditions, and I recently announced the Government’s intention to develop a cross-Government outcome strategy for long-term conditions. The purpose of the strategy is to take a life-course approach. It will draw on the Government’s approach in developing our mental health strategy. Shaping it will involve a wide range of stakeholders beyond the Government.

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The hon. Lady rightly rehearsed the Prime Minister’s enduring interest in these issues, which spans the whole health sphere. That is why he continues to pursue and to follow closely the key work of Health Ministers in taking forward the legislation to reform the NHS. I will inquire about the correspondence and find out what has happened about that.

Reference was made to the Joint Epilepsy Council and its activities. I applaud its work, but I must make it clear that the future of our public services is in a local rather than a national context. For the NHS, it is not about running commissioning services for specific conditions from the Department of Health; it is about local clinical commissioning groups working locally with patient groups and others better to understand local needs and to ensure that they structure services with those in mind.

Steve McCabe: I accept the case that the Minister is trying to make for the new commissioning arrangements, but, like many of us, charities and help groups that work with epilepsy are not entirely clear about how the new arrangements will work. Does he have any plans to meet the epilepsy groups so that he can better explain his ambitions and how those groups will be able to play a central role in the new world that he envisages?

Paul Burstow: It was kind of the hon. Gentleman to intervene, because it allows me to answer his final question. The Department continues to work with the charities and to discuss their concerns, and I am happy to arrange a meeting to have such discussions.

Paul Flynn rose—

Ms Abbott rose—

Paul Burstow: I will give way to the hon. Gentleman while the hon. Lady frames her questions—she clearly has one or two—and I will then give way to her.

Paul Flynn: I have listened with great attention to the Minister. I am aware of his record in opposition as a doughty campaigner for many causes. The Government are obsessed with change and upheaval in health service structures. Can he provide some practical assurance that by the end of their term of office, if they go to 2015, there will be fewer sudden unexpected epilepsy deaths?

Paul Burstow: I have referred to the focus on outcomes and the establishment of an outcomes approach not just to commissioning services, but to how we measure the performance of services. That provides hope of an improvement. The issue is not just a high-level one. I have not talked about specific statistics today, but sitting behind each and every indicator in the outcomes framework for the NHS are hard metrics that are being used to identify variations between parts of the country. We have seen in other services—for example, cancer services—how powerful the publication of atlas data, which shows performance in different localities, is at challenging clinical teams and challenging commissioners to commission differently and better. I genuinely believe that that approach and the focus on outcomes and data are key drivers to improving future performance.

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Ms Abbott: I have listened with great care to the Minister, who has been at pains to outline that we are moving from a world of command and control health provision to a world in which individual clinical commissioning groups will make decisions for their locality. Should the groups that are lobbying on epilepsy take from this debate a message that the days of lobbying at national level are effectively over, and that they must mobilise themselves to lobby commissioning group by commissioning group?

Paul Burstow: They must certainly be prepared to engage a lot more at local level. That is an important part of commissioning to fit the needs of postcodes rather than by prescribing from the centre and having postcode lotteries. It is not possible from so far away to be clear about the specific needs of a population. That is why the change is so important. However, the Department of Health expects and Ministers want to have a relationship with those organisations, because they can inform the shape of the mandate that the Secretary of State will set for the NHS. They can inform the way in which NHS outcomes framework, the adult social care outcomes framework and the public health outcomes framework operate, and their priorities. There will still be a rich conversation at national level about action, but there will be an even richer conversation about outcomes, performance and commissioning, which need to be local.

In conclusion, I am grateful to the hon. Member for Birmingham, Selly Oak for calling this debate and his perseverance in applying for it. He has rightly rehearsed a matter that has been neglected for too long. I believe that the Government’s changes, particularly our focus on outcomes and greater respect for clinical judgment at local level, will deliver improvements in services and quality of life, and indeed will save lives through improved commissioning at local level.

10.46 am

Sitting suspended.

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HGV Wheels (Safety)

11 am

Paul Goggins (Wythenshawe and Sale East) (Lab): It is good to see you in the Chair, Mr Scott. I am not sure whether I have served under your chairmanship before, but I look forward to it.

I regret having had to apply for this debate, and believe that the exchange that will take place over the next half hour could just as easily have taken place in the Minister’s office. Indeed, such an exchange might have benefited from a more informal setting, and we could have heard from industry experts who would have had much to offer.

I applied for this debate because I received a letter from the Minister on 11 November. The letter, which was dated 9 November, stated:

“Unfortunately, I am sorry to say that due to pressures on my diary I will not be available in the near future to meet with you.”

I was surprised to receive such a letter from the Minister, because I have always found him approachable and responsive, particularly on the important issue of HGV wheel safety. I know that he takes his responsibilities seriously, so I was extremely disappointed.

I was also shocked to receive such a letter because it was written on 9 November, less than a week after the tragic crash on the M5 in which seven people lost their lives and in which I know the Minister took a close personal interest. That the Minister should send such a letter at a time when the issue of road safety was so high in his mind and in that of the public and Parliament, and refuse to meet me and those expressing concern about the issue, was disappointing and shocking. We are, however, having our meeting in the Chamber this morning, and Hansard will write the report rather than someone from the Minister’s private office.

I first raised the issue of HGV wheel safety in June 2010 in a letter to the then Secretary of State. It followed my visit to Motor Wheel Service, a company based in my constituency that is the largest distributor of HGV wheels in the United Kingdom and across Europe. I remain grateful to the managing director of MWS, John Ellis, and to Matthew Wells who kept me briefed on issues that have concerned them for a considerable time. He also ensured that I was briefed for today’s debate, and both he and John Ellis remain vigilant and active across the industry on issues of wheel safety.

On 9 November last year—just over a year ago—we had a constructive meeting with the Minister in his office at which he willingly agreed to review the data available in his Department concerning accidents, failures and defects involving HGV wheels. We parted company after that meeting on agreeable and friendly terms, and we returned to the issue on 29 March this year in the first Westminster Hall debate on HGV wheel safety at which I made two suggestions to the Minister. My first suggestion was that he should consider holding a year-long trial in one region of the country, so that enhanced testing of HGVs could take place with particular emphasis on wheel safety. The Minister listened carefully, attentively and thoughtfully to my comments, but the answer was no at the end of the debate.

The Minister was slightly more encouraging about my second suggestion, which was that he should identify a senior official in his Department to be a point of contact between the Department and the wheel supply

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industry. If people in the industry had specific concerns or evidence about faulty wheels, they could report it to that named individual, who could then investigate and produce any necessary report. That would be an inexpensive way of dealing with any concerns raised, and it would help the Minister to separate speculation from facts—I accept that there may be speculation in this area, and it is important to establish the facts precisely. If only a few faults were discovered through such a reporting mechanism, confidence would be maintained and that would be good. If, however, faults were discovered, the Minister and representatives from the industry could sit down together and work out an appropriate way to ensure proper checks and reports on wheel safety.

Following that debate, there was a bit of a delay before the Minister got back to me, although he did reply in a letter dated 3 June. He thanked me for my e-mails of 15 April, 10 May and 27 May, in which I asked for further information, and crucially he confirmed that the Vehicle and Operator Services Agency has a specific team, the vehicle safety branch, that is responsible for HGV wheel safety. He also gave me the name and contact details of the head of the vehicle safety branch, who was clearly the senior official I hoped would be nominated. So far, so good. However, the Minister went on:

“The vehicle safety branch looks at issues of design or construction…and will request the manufacturer, producer or supplier to start an inquiry if there is evidence that a design and construction defect exists.”

That rather limited approach adopted by the Minister caused me some concern, so I sought clarification. The Minister wrote back to confirm that the vehicle safety branch

“will not investigate faults that have arisen due to the use of the product, for example poor maintenance or accident damage.”

The quality of wheel design and construction was never a problem for me or those in the industry who raised the issue. The United Kingdom has a high standard of HGV wheel manufacturing, and it is no surprise that few faults have been reported. My concern, which I raised in the earlier debate and raise again today, is the 10,000 second-hand HGV wheels that enter the UK market every year. The Minister has never disputed that figure, and the industry certainly believes it to be true. Some of those second-hand wheels may be damaged as a result of various incidents, and I will come on to that point in a moment. My principal concern, however, is the 10,000 second-hand wheels that enter circulation every year in the UK.

An HGV wheel can be damaged in several ways. Dents and cracks can be caused by over-tightening the wheel nuts or by any collisions in which the vehicle has been involved—road traffic accidents are an obvious example, but vehicles can also hit kerbs or potholes, which is sadly becoming more frequent given the condition of some of our roads. Damage can also be caused by rust, general wear and tear due to the weather, road surface conditions or age, or if the wrong tyre is fitted to a wheel. There are, therefore, various ways in which wheels can be damaged, and 10,000 second-hand wheels are in circulation and not being properly checked. That is my central concern.

Clearly, there is a lack of confidence across the wheel-supply industry concerning the checks carried out by VOSA. The VOSA inspection manual, which covers

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inspections carried out as part of an MOT and more random roadside checks, indicates that an inspector should look for missing wheel nuts and ensure that the wheel is appropriate for the load being carried. It is, however, of concern to me and the industry that insufficient emphasis and detail has been placed on the search for cracks and other damage.

You and I, Mr Scott, can only imagine the damage that would be caused by a 45-tonne truck travelling at 55 mph should there be a major tyre blow-out. It could cause a catastrophe, which is why we have a stringent system for checking and monitoring the tyres on all vehicles—cars as well as HGVs. Catastrophic wheel failure would produce exactly the same impact as a tyre blow-out, yet the Government seem unmoved by the concerns being raised by me and the industry.

Where is the evidence? As I have made clear, part of the problem is that the evidence is not being gathered as systematically as it should be. That is why I suggested in the first Westminster Hall debate both a year-long pilot project in one region of the country where more stringent tests could be carried out and a named official to be the point of contact between the Department for Transport and the industry.

Today, I shall give the Minister three recent examples that should concern him. The first is the evidence that I saw with my own eyes on a recent visit to MWS in my constituency. I do not pretend to be an expert on wheel safety, but it seemed to me, as I examined with my own eyes the wheel that was shown to me, that there was clearly a crack in the wheel. As an amateur—a non-professional—I would certainly want and expect a wheel damaged in that way to be thoroughly checked and examined. I sent a photograph of that wheel to the Minister. In the rather short reply in which he refused to meet me, he did not refer to that evidence, although he might want to comment on it today. I hope that he will recognise that if a wheel is damaged and is in the hands of people who are less reputable than the company in my constituency, it could be attached to a lorry in a hazardous way that could cause a catastrophe.

The second piece of evidence is an October 2011 press report in Truckstop News. It raises concerns that the Minister must respond to this morning. The headline was “Killer Wheels”. The article stated that

“wheel manufacturer Alcoa has warned there are fake wheels on the market that are failing early. Cracked wheels were sent to Alcoa’s distribution network by end users trying to have them replaced under the Alcoa wheel five-year warranty agreement. Alcoa says the imitation wheels are a good copy, making it difficult to see the difference between these and the genuine article. The manufacturer wants to ensure customers are not fooled and end up with worthless and potentially dangerous forgeries.”

Counterfeit items across the whole of society can cause great damage. That is the case whether it is counterfeit cigarettes damaging people’s health or counterfeit wheels. If counterfeit wheels were fitted to a lorry, they could have catastrophic results if they failed, and they almost certainly would fail if they were not built to stringent design and manufacture standards. I would like to know what the Minister makes of the report to which I have referred. If he has not had a chance to see it yet, he should check it and come back to me and others with his observations.

My third piece of evidence is an ITV news report from last Friday, which the Minister may have seen. The

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report was on the impact of potholes and said that there is an average of 15 potholes in every neighbourhood. I do not know about your constituency, Mr Scott, but that figure seems on the low side to me. Anyway, that is what the report said. The camera crew went to a tyre fitter in Gateshead, who showed them the impact on a wheel of a major tyre blow-out that had resulted from a collision. As viewers saw the picture of the wheel and compared it with how a wheel should be, coming from the manufacturer, they could certainly see the difference. They could see very clearly the damage that had been done. Again, I refer the Minister to that evidence, if he has not yet had the chance to see it.

The Minister has a choice this morning. He can tell me once again that the failure rate is 0.0006% and that if anyone supplies defective or faulty items to be fitted to a vehicle, they can be prosecuted; or he can take a rather more engaging approach—as I hope he will, even at this stage—and meet me and representatives of the industry to consider the need for more rigorous checks. The Minister may have gathered from the fact that he is here this morning—I am grateful to him for being here—that I am certainly not going away on this issue. There have recently been a number of presentations on the issue to important industry bodies. ATS Euromaster has had a presentation, as have the National Tyre Distributors Association, the Northwest Automotive Alliance and the Society of Motor Manufacturers and Traders. I can tell the Minister that further discussions are planned with those bodies about these concerns, which I can attest are growing concerns in the industry.

Indeed, such is the level of anxiety in the industry that when the Minister wrote to me to say that he was not prepared to go beyond the very limited offer that he had made, the industry was prepared to put in place its own reporting mechanism, so that it could say to companies throughout the wheel supply industry that if they had evidence of any wheel failure, they could report it through a specially designed industry reporting system and it could be passed on to the Department for Transport. That was the request that I made of the Minister: given that the industry was prepared to put in place its own self-reporting system, could we have a meeting to discuss how best to make the arrangements for that industry reporting structure to link to his Department? He has made it clear up to now that he is not engaging with the industry in relation to that question, but I urge him to reconsider that position and to be prepared to have a meeting or at the very least to be prepared to talk to the industry about its own ideas for self-reporting and how that could be linked to and engage properly with officials in his Department. As I have said, I hope that the Minister will reconsider. I am pleased to see him in his place today and I look forward very much to listening to what he has to say.

11.16 am

The Parliamentary Under-Secretary of State for Transport (Mike Penning): It is a pleasure to speak under your chairmanship on this important day, Mr Scott. I congratulate the right hon. Member for Wythenshawe and Sale East (Paul Goggins) on securing the debate, although I am slightly disappointed by his saying that I have not engaged. We had the previous debate in this

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Chamber, but before the debate we had meetings in my office; I think that that is engagement. I have said throughout that as the Minister—the right hon. Gentleman used to be a Minister himself—I have to have an evidence base to go forward. In the letter to him, I was trying to be as honest as possible: I did not have a slot in my diary between now and Christmas, and that is why I said that at this stage I cannot see him; I could have given him a date after Christmas, but I thought that such a long delay would have been an insult to him. However, like any other colleague, he can stop me at any time and I will engage at any time. My officials are also engaging.

It is important to talk about who is representing whom in the very important UK logistics industry. The Freight Transport Association and the Road Haulage Association, whose representatives I meet very regularly and with whom I have a very good rapport, have not raised this issue with me once. I was at a major haulier’s yesterday—in fact, I was going along the A13 in Essex in a 38-tonne articulated truck. I make those visits so that I can engage with the industry. I was feeling slightly jealous yesterday because I have only a class 2 licence, not a class 1. I have been very close to this issue for most of my career, especially when I had a licence in operation myself.

The right hon. Gentleman is absolutely right. I am going to quote the 0.0006% figure. I will answer the specific points he raised, but if anything has changed the position since the previous Adjournment debate—if more evidence has emerged—of course we will look at it and at the specific details to which we have alluded.

The right hon. Gentleman sent me a photograph of a damaged wheel. One of the facts I wanted to ascertain was when that vehicle was last tested, because the crack should and would have been brought up in the test. It is illegal to have that sort of damage on a vehicle, as he knows, and it is illegal to run the vehicle with it. The operator’s licence would be affected should they run a damaged vehicle; it is an offence under the Road Traffic Act 1988 as well as under the operator’s licence. However, the crack would have been picked up at the annual check. Unlike cars—we are to review the situation of cars in relation to MOTs—lorries are checked annually from when they are new.

I would like to know, and I would have hoped that the right hon. Gentleman might have told me because he was using this as evidence today, what vehicle the wheel came off and when the vehicle last had a check. It could have been the case that the damaged wheel on that vehicle was picked up and then removed, as we would all expect—so that it was not on the road at all.

Killer wheels are an interesting topic. The question of copies or snides has been around for a long time, particularly regarding aluminium wheels on cars. The failure rate for aluminium wheels, if they are not constructed right, has worried me for many years. The focus is often on design rather than function—people want them to look flash. That is something that we are looking at robustly, but legislation already exists to make sure that that sort of thing does not happen again. If the manufacturers are picking up copies being brought into the country, I assure the right hon. Gentleman that we will work with the Department for Business, Innovation and Skills on that.

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The ITV report on potholes was interesting, because there are myriad reasons why a wheel could fail. Those who follow Formula 1 will know that during the race before last, a wheel failed on the first corner; there was an instantaneous puncture. Central Government have invested a huge amount of money in repairing potholes, which is why the number of potholes is as low as the report suggested. The right hon. Gentleman will have to wait until later today for further announcements on road infrastructure. It is absolutely right to say that failures take place when vehicles hit potholes or hit the kerb. I had a failure in an aluminium wheel when I attempted a U-turn, misjudged it and caught the wheel wrongly on the kerb. Not only did the tyre give way but the aluminium wheel broke.

Paul Goggins: During the first five minutes of the Minister’s speech he has not even glanced at his folder, which demonstrates both his enthusiasm for road safety and the fact that he is completely on top of his brief. He has responded to the three pieces of evidence that I gave him without looking at a note, so he clearly has the information at his fingertips.

If the hon. Gentleman had written to me on 9 November to say that he was dealing with a lot of pressing matters and would not be able to meet me until the new year, I would have understood and accepted that. I would have done so reluctantly, because before Christmas would have been better, but if he makes that offer again this morning I will be happy to accept.

Mike Penning: I apologise for the fact that I am not reading the speech that was written for me—I rarely do—but I hope that I am on top of my brief. Road safety is paramount for me, especially as I come from a fire service background. While I was in the fire service, I attended road traffic collisions regularly as the driver of a rescue vehicle. I never once encountered an incident in which the wheel had failed, although there were lots of other problems, particularly on some older cars where the hub structure had failed. In the evidence that we have looked at, which I will not read out, there were 23 failures over a 15-year period, but such problems were often due partly to accidents where wheels had been struck and damaged.

I will write to the right hon. Gentleman in the very near future and offer him a slot after Christmas. I think that something positive has come out not only of today’s debate but of my saying no the last time we met in this Chamber, because the trade associations have stepped up to the plate. Rather than Ministers telling people what to do, the right approach is often for the industry to realise that it has a responsibility as well and that reform is needed.

There might be a certain amount of semantics on the part of both myself and the right hon. Gentleman about the wording of the letter and who the official responsible for these issues is, but the simple answer is that the buck stops with me. If the trade associations want to present evidence to me, rather than an official within VOSA, they can do so and I will be more than happy to provide that point of contact. This is not only about the manufacturer; if the failure rates are increasing, and that is what this is all about—I am not disputing that one way or the other because, frankly, we do not know, and there is no point disputing something that is

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not disputable—do I still want there to be a second-hand market? I do, because that is important for people who cannot afford to buy brand-new wheels every time, but those wheels must be safe. The operators have a responsibility to make sure that that happens, and I do not want to take that responsibility away from them.

When I was in that truck yesterday, I felt comfortable not because it was brand spanking new—it was not; it was about 18 months old—but because of the robustness of the legislation governing VOSA and its testing regimes. I have been at the side of many a road with the new VOSA testing and enforcement officers, and I know how remarkable the current equipment is. We can estimate the weight on an axle while the vehicle is travelling at 56 mph down the motorway; we can pull it over and put it on a weighbridge, and we know accurately what the result will be. When inspections take place, on overseas vehicles as well as our own, checks on wheels and brakes are carried out, there and then, to the best of the officers’ ability. Obviously, most of the weigh stations do not have a pit facility.

If the right hon. Gentleman—let me call him my right hon. Friend—has called this debate as a direct reaction to my letter, he should have pulled me over in the Tea Room, where I would have addressed the matter straight away and we would have had a meeting after Christmas. He will understand, because he was a Minister himself, why I do not like making appointments way into the future. Events take over and I might not even be at the Department any more; someone else may be doing this job if we go too far past Christmas, or even before Christmas.

Paul Goggins: I sincerely hope that the Minister is still in his position in the new year, not only because he has now promised me a meeting, but because he is clearly on top of his brief and doing a good job. I commend him for that. He has mentioned twice that I was a Minister, which I was for seven years, and I never, ever refused a meeting with a Member of Parliament. The message that I am sending to the Minister and the Government is that when Members of Parliament are pursuing issues that concern them and their constituents and they want to meet Ministers, it should be an absolute given that those meetings take place. Of course Ministers are always busy, but their busy diaries must not get in the way of their fundamental accountability to MPs and to Parliament.

Mike Penning: I have a reputation in the House for being approachable, and this is the first time that I have ever been reprimanded by a senior Member. My letter was written in the best possible faith; a series of events to do with lots of things, which I will not go into now, meant that I could not guarantee a slot that I would be able to hold on to. The worst thing in the world is to make an appointment and cancel it, but that is what tends to happen. When I was in opposition, promises were made to me and they were not kept. If I make a promise, wherever possible and subject to business, I keep it, so the right hon. Gentleman and I will meet. I hope that the trade associations will do what they said they will do—that they will get the submissions together and come as a united body to present their evidence. That will allow me to go away and ask why we have certain failure rates coming from all the different expert

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bodies mentioned in the speech that I have not used, and to compare that with what is happening on the front line.

Whatever happens, I will not increase the burden on businesses. I think that the haulage industry, with the margins that it works on, is already heavily burdened, and I am trying to take some of that burden away. Road safety is paramount for me, but operators have responsibilities, which they must never forget.

11.28 am

Sitting suspended.

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Girls (Educational Development)

[Mrs Anne Main in the Chair]

2.30 pm

Esther McVey (Wirral West) (Con): It is a pleasure to serve under your chairmanship today, Mrs Main, in this important debate on the development of confidence for girls in school and the importance of role models to the future career paths of young girls. The debate is important to every schoolgirl in the country. The outcome and agreed actions need to take effect to ensure that girls achieve their full potential. As Mrs Robinson, the headmistress of West Kirby grammar school, has said, we have to encourage girls to have a can-do attitude from as young as possible, perhaps from year 7. Many schoolgirls lack confidence in themselves and their ability, and while boys think that they can, girls think that they cannot.

I have worked in the area for the past decade with schoolgirls, women-in-business organisations and through academic study and research. Today, I hope to bring to the debate not only my experiences, but those of my colleagues, renowned academics, Girlguiding UK, which, with more than 500,000 members aged four to 25, is the biggest voluntary girls’ organisation in the country, teaching professionals and business women who mentor other business women and schoolgirls. I will also talk about the findings from a recent Ofsted report titled, “Girls’ careers aspirations”.

My personal journey resulted in my writing a careers guide for girls called, “If Chloe Can”. The book was written to help provide an array of role models for girls, showing them examples of inspiring women from different backgrounds who all excelled in their careers. The book has now become a play to inspire girls and to show them what they are capable of achieving with hard work and determination. The play is now being done with the National Youth Theatre, which found a young writer, Karla Crome. She is only 23 and was delighted to write the play, which helped her along her playwriting path. There is also a group of young female actresses, who are also gaining experience to help launch their careers. All that is consistent with the theme of building confidence through doing and achieving in a supportive environment, while being helped by role models.

The female role models who took part in the play and the career book totalled some 100 women, who are some of the most successful women in the UK and the world.

Karen Lumley (Redditch) (Con): Does my hon. Friend agree that we, as Members of Parliament, also have a great deal to offer as role models? I am mentoring six young girls in Redditch, and I learn a great deal more from them than they learn from me.

Esther McVey: My hon. Friend has an excellent point. As female MPs, we are role models. To become an MP, someone has to be one in 100,000 people, and there are so few of us here, which relates to the cycle of learning that she has discussed. Knowledge from one generation can be passed to the next.

I was impressed by how openly and honestly the 100 successful women that I have mentioned talked about confidence, the need to develop it and how important it

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was for them in achieving in life. They compared confidence to a muscle that needed to be worked out through repetition of small, ever-increasing achievements. From those accomplishments, they developed a mental power—a power based on ability, achievement and a track record, further enabling them to strive for success.

Confidence can be difficult to describe. Helen Fraser, chief executive of the Girls’ Day School Trust groups of schools, past managing director of Penguin Books and two-time winner of “Publisher of the Year”, explained it as follows:

“There are many interrelated aspects to confidence, but there are two I would highlight as particularly important for girls, and which schools can help girls develop. The first is having the confidence to take risks, to ‘feel the fear and do it anyway’. Schools can nurture this by encouraging girls to take small risks—to stand up in front of a crowd and make a speech”—

like I am doing today—

to direct and produce plays, to take part in debates, to take on challenges like the Duke of Edinburgh’s award. These kinds of experiences make girls much more confident about risk, and risk is absolutely essential in working life.”

Pauline Latham (Mid Derbyshire) (Con) rose—

Mrs Helen Grant (Maidstone and The Weald) (Con) rose

Esther McVey: I will give way first to my hon. Friend the Member for Mid Derbyshire (Pauline Latham) and then to my hon. Friend the Member for Maidstone and The Weald (Mrs Grant).

Pauline Latham: My hon. Friend says that confidence can be difficult to describe, but we know exactly what it is when we see it. Does she agree that girls often do much better in a single-sex environment in schools, even if it is only in a single-sex class in a co-educational comprehensive? They are not having to live up to a stereotype in front of their colleagues and friends, the boys—

Mrs Anne Main (in the Chair): Order. I remind the hon. Lady that interventions should be short.

Pauline Latham: Thank you, Mrs Main. Does my hon. Friend agree that girls do much better if they are not threatened by apparently more confident boys?

Esther McVey: My hon. Friend raises a point about girls being taught in a single-sex environment. Obviously, parents know best whether they want their children to be taught in single-sex environments. Whether there is stereotyping, whether girls are living up to stereotypes and whether they have the ability to speak freely within their peer groups can affect their confidence.

Mrs Grant: Although academic subjects are important, does my hon. Friend agree that confidence-building subjects such as music, drama, the arts, sports and reading out loud in class are also important? Some children may not flower academically at a particular moment, and those subjects can boost their self-confidence and self-esteem.

Esther McVey: I totally concur. That is what Helen Fraser was talking about—little bits that people can do to build up confidence. As we know, some of us flourish and blossom at different times in life. Therefore, someone has to feel confident in what they have done when they do it.

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The second aspect that Helen Fraser raised is

“the confidence to be yourself, not to feel you have to conform to everyone’s expectations. This includes the confidence to stand up for yourself, to disagree with the group consensus if you believe they’re wrong and you’re right. Even if it is just speaking up at a meeting, or daring to have an opinion that isn’t the same as everyone else’s, it’s important to have the confidence that your…opinions and beliefs matter just as much as any other woman’s or man’s.”

Heather Wheeler (South Derbyshire) (Con): An interesting thing that I found in business clubs, particularly in girls-only schools, is that when girls set up and run companies—the companies are sort of junior social enterprises—it builds their confidence and helps them break out from ordinary school. Will my hon. Friend comment on that?

Esther McVey: I will indeed. I will talk about work experience and employing other styles of developing confidence later on. My hon. Friend has certainly touched on an important subject.

The aspects that I have talked about make up confidence. They are important throughout life, and girls lack them. Quantitative studies over many years have shown that levels of self-confidence in girls and young women are much lower than those in boys—Hisrich and Bowen in 1986, Hollenstead and Wilt in 2000 and Kickul, Wilson, Marlino and Barbosa in 2008. Such issues need to be addressed, because they have lifelong implications.

Today’s debate centres on the key ingredients that assist in life fulfilment and in achieving personal potential, which need to be nurtured especially in girls far more than boys. Broadbridge noted that a lack of confidence resulted in girls being far more critical of themselves and their abilities. That can become self-doubt later in life, preventing them from applying for promotion and bringing attention to their own achievements, as Singh, Vinnicombe, James said in 2006.

That stands the test from a recruitment point of view. Having conducted informal quantitative studies, recruiters will say that they can probably check a woman’s CV in 20 minutes, because a woman usually underestimates her ability, whereas they might need up to two hours to check a bloke’s CV, because he is convinced that he can do something, even if he has not necessarily done it yet.

In Carol Gilligan’s book, “In A Different Voice”, she explained how male and female traits develop differently from birth through parental guidance. Boys strive to be independent by, for example, playing competitive games, whereas girls stay close to their mother and their games are dominated by “sharing” and “playing together”. That means that men can put “winning” ahead of relationships and that women value co-operation and do not like the quest for victory, if it threatens the harmony of a group. The academic Albert Bandura noted that

“confidence in our ability to perform”

is developed in four key ways—social persuasions, mastery of experience, modelling and judgment of our own psychological state. Social persuasions and stereotyping, as identified by Bandura, are a huge concern when considering girls in school.

Girlguiding UK’s 2009 girls’ attitudes survey showed that girls aspire, stereotypically, to female careers. Hairdressing was the No.1 choice for under-16s; teaching was the No.1 choice for 16 to 21-year-olds; and only 1% of those surveyed said that they wanted to work in

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science or engineering. In the same survey in 2011, when the girls were asked why so many of them aspired to be hairdressers and so few to be engineers, more than half those surveyed—57%—said that hairdressing is what girls are interested in, while they veer away from engineering because of a lack of interest, as expressed by 51%, and a significant lack of female role models, as expressed by 60%. It was also perceived that girls “don’t do that sort of job”, as expressed by 47%, and that they did not know enough about it anyway, as expressed by 43%.

As demonstrated by those figures, there is a confidence issue when we explore areas of work that are outside the stereotypical areas of female work, which often limits the job prospects, wages and promotion of women. In turn, that often leaves women in much more vulnerable jobs later in life, such as “the five Cs”—cleaning, catering, caring, cashiering and clerical work. The widening of girls’ horizons from a young age is vital, especially as there is a constant battle with the daily barrage of media sexualisation and stereotyping of girls. Studies over the past 30 years—from McArthur and Resko, to Manstead and McCulloch, to Hyde—have constantly found that, overall, men and women in the media and advertisements differed in terms of credibility, with men being portrayed as authorities and women as users, and women in terms of relationships and men as independent. Given the daily amount of television alone that we consume—on average, four hours a day—and how highly we regard TV as our major source of entertainment and our most important news medium, we can realise how important that constant barrage of TV images is when it comes to fixing our views and adding to existing stereotypes.

Many girls tend to be seen, and see themselves, as the nurturers, which is reflected in their choice of occupation. The recent Ofsted report, “Girls’ Aspirations”, showed that the sort of fixed views exhibited by girls in the Girlguiding UK report are being maintained, because girls are sticking to strict, old-fashioned stereotyping. The Ofsted report also found a lack of knowledge among girls about what careers are available and about progression and promotion in careers in general, which highlights concerns about the careers system and careers advice.

What are the Government doing? They have taken some important steps. I welcome the introduction of the E-bac, or English baccalaureate, which is one of the Government’s most recent initiatives. It is a new performance measure for schools and is designed to give children a more rounded education, encouraging more students to take traditional academic subjects, including English, maths, history, geography, the sciences and a language. It was reported in August that the E-bac is steering twice as many pupils in England’s secondary schools towards core academic subjects. A Government-commissioned survey showed that 33% of pupils will take E-bac subjects in 2012 and 47% in 2013 compared with only 22% in 2010.

Kevin Brennan (Cardiff West) (Lab): Further to the point made in an earlier intervention, will the hon. Lady tell us what the impact of the introduction of the E-bac has been on the study of music?

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Esther McVey: I must admit that I do not know what the impact of the E-bac has been on the study of music, but hopefully the Minister can answer the hon. Gentleman’s question.

I am working with the 30% Club, which is a group of women aiming to increase the percentage of women on top company boards to 30%. One member of the 30% Club, Katushka Giltsoff, a partner at the Miles Partnership, said that knowledge is key and that the most important thing that girls can do is study serious, mainstream subjects and obtain an all-round education, so that they can do what is best for them later in life. It is also important that we do not limit girls’ choice of subject early on, because limiting subject choice early on ultimately limits career choice later.

Where could we be doing more? We need to ensure that girls have a better understanding about career choice and its impact on their long-term earnings. We also need to develop better and more carefully planned opportunities for girls to meet female professionals who are working in non-stereotypical roles, so that they gain a better understanding of what a job entails and how they can follow a career path. That process could even be extended so that female professionals could act as mentors to guide girls into careers that they are interested in. Everywoman has begun the Modern Muse project, which tries to link business women with schoolgirls. Claire Young of Girls Out Loud is piloting Big Sister. That project is very much like the American model of Big Brothers and Big Sisters, which bring mentors and business professionals into schools so that children can have a selection of role models. Similarly, Etta Cohen, who is the founder of the biggest women’s network in the north-west and an ex-teacher herself, has said that schools and teachers in particular have a big role to play in getting real role models into schools and in getting schools to engage more closely with the business world. The Government could address that issue by preparing more girls to become women entrepreneurs, which we know is important. At the moment, 150,000 fewer women than men are setting up in business. If we had 150,000 more women in business, they would be fulfilling their potential and paying into the economy. Moderate estimates are that they would pay in £9 billion, but it could be as much as £30 billion.

There are various routes to follow. The other thing that the Government are doing, and need to do, is link up what is already out there. We should not reinvent the wheel but encourage organisations to do more together, whether that involves MerseySTEM promoting the study of science to girls, the Chemical Industries Association and the Royal Society of Chemistry encouraging girls to study chemistry or—if I can mention it again—the National Youth Theatre producing the play based on my book, which will be seen by 1,000 schoolgirls at a time. All those organisations can give girls an array of role models.

All this activity is vital for future generations of girls, and we are looking at this issue at a very important time. Lots of changes are going on, but the progress of girls has not improved in the past 30 years. The progress of girls has been glacial, and whatever has happened in the past 30 years has not helped girls. That is why today I have specifically cited academic studies from the past 30 years, as well as very practical studies and reports by business groups. I have done so to say, “We must do

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more.” The help and support is out there, and I know, from working within our Government, that we have a will to improve things.

I have a question for the Minister, who I know has done so much to change the landscape of apprenticeships and expand their availability and take-up by both companies and individuals. I hope that he can shine his spotlight on this area and achieve similarly successful results. To do so, he must encourage confidence-building measures for girls, through the types of activities that I have discussed, beginning with girls in year 7 or younger, and he must actively encourage girls in the pursuit of the Duke of Edinburgh award in performance, arts and music.

I welcome the Government’s national citizenship service, which was piloted in the summer. On Wirral, it brought children together from all kinds of backgrounds and at the end of the two-week project the children said it had pushed them, allowed them to engage in activities that they had never done before, including team play, and built their confidence. They said that it had been life-changing and transformational. If we could build on that success in one way or another and encourage more children, particularly girls, to participate in those projects in their summer holidays, it would be a giant step forward.

The Government should develop work experience links during summer holidays. I wonder whether the Government’s plans, for 5,000 women mentors over the next three years to inspire female entrepreneurs, could be extended into schools to help with initiatives such as Modern Muse and Big Sister. As John Asgian, a teacher at St George’s school in Maida Vale, puts it:

“Self-confidence is a function of self-identity. It is not always about ‘feeling good about yourself’, it is about doing well for yourself and doing good for others.”

If we want a generation who are doing well for themselves and good for others, it is time we helped them build the ability to do it, and we can do just that by building self-confidence for girls.

2.50 pm

Amber Rudd (Hastings and Rye) (Con): The Government are right to put so much emphasis on qualifications and on raising school standards. Every time our excellent Secretary of State for Education gets up and raises the flag for higher standards in schools, I want to cheer him, and as a parent I harass my children regularly, with mixed results, but I must confess that there is perhaps one thing more important than qualifications and that is, of course, confidence. If you have confidence and qualifications you are king and are likely to become a Member of Parliament—

Mrs Anne Main (in the Chair): Order. Could you not say “you”? I have masses of confidence and qualifications, but I am sure that the hon. Lady is not referring to me. I have noticed other hon. Members doing the same. I do not wish to stop the flow of the debate, but if speakers could not refer to me, I would be grateful.

Amber Rudd: Of course, Mrs Main. I will adhere to that, confidently. With qualifications and confidence—king. Without qualifications—trouble, absolutely. But anyone who is brimming with confidence can get on and make the right choices.

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It is very important that, along with studying for their qualifications, young people learn confidence at school, but why is it particularly necessary for girls? We so often see girls outperforming boys in qualifications, so why is it that when I go, as I often do, to the mixed schools, particularly the secondaries, in my constituency and get up and talk to the pupils, I get many questions, but very rarely from the young women? They seem to think that they have to sit quietly, and that worries me. It worries me that the next generation of young women are not confident enough in the classroom, and that will have an impact on their future lives. We know what low confidence is about; it is about low self-esteem, and in areas of high deprivation, such as the ones I have in Hastings, we are more likely to get the low self-esteem that goes with lower family expectations and unwise choices.

The topic I want to address today is teenage pregnancy. The UK has the highest rate of teen pregnancy in Europe and the developed world, and one of the highest in the whole world. The previous Government made strong efforts to tackle the problem. In 1999 they put together a 10-year strategy to reduce the number of teen pregnancies, and a lot of money was spent on it. The different impacts and influences on the young women making the choices were analysed, and we found out a lot about the effects of welfare, of access to employment and housing, and of confidence, but unfortunately the strategy did not have a tremendous impact. Over those 10 years, the number of teen pregnancies fell by only 13%; the goal had been 50%. Any decrease is of course good, because having such high levels is an unacceptable way for communities to operate, but we could do more, by boosting confidence in schools. We must have a platform that addresses how we can influence young women so that they make smart choices.

Claire Perry (Devizes) (Con): Does my hon. Friend agree that one of the best ways of influencing young women to make smart choices is to show them role models? All too often the role models in the media are about make-up and singing as career success. Does she agree that a great advantage of the initiative taken by my hon. Friend the Member for Wirral West (Esther McVey) is that it shows young women that there is a huge multiplicity of female role models out there who can inspire them?

Amber Rudd: I agree. It is incredibly important that young women realise that there are other women out there who can help them to make smart choices. We need to reduce the impact of all the advertising and television that seems to suggest to them that celebrity and early parenthood are a way forward. It is well known that these young women sometimes make what we call a choice to go ahead and have a baby at a young age. They think it is a smart choice—they see the welfare benefits—but in the vast majority of cases it is not a smart choice, and it has unhealthy outcomes for the young woman and the baby.

In schools, we can do two things. We can raise educational standards, of course. In some cases, it is hardly fair to say that young women with no qualifications make choices. They do not make choices, because they are left with no qualifications. Having qualifications is incredibly important, and I hope that this Government raise standards.

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We also need to help young women with their self-esteem, so that they have, quite simply, the confidence to make choices—to say “No” when they want to, and to ask for birth control so that they do not end up having babies quite so young.

Last week I saw Hilary Pannack of Straight Talking, a leading UK charity, which was set up in 1998 to combat the high levels of teenage pregnancy. The charity does an extraordinary thing, delivering peer-to-peer education in schools. It employs young mothers who have had babies as teenagers to go into schools and make clear the sort of life that lies ahead. They do not say, “This is a disastrous thing to do,” because no life is a disastrous thing, but they do explain the hardships of young motherhood and the lack of choice about their own lives. The organisation is very successful. It told me that it tries to explain why not to get pregnant:

“The approach is centred on the belief that young people might know how not to get pregnant”—

this is not pure sex education; they understand the facts—

“but they also need to know why not to get pregnant.”

My experience of talking to young women in Hastings is that that would be a very useful guide.

Coming back to the impact of deprivation, in 2007-09 the teenage conception rate in Hastings was, unfortunately —

Mrs Anne Main (in the Chair): Order. I am trying to give some latitude to the Member, but somewhat tangentially some of her comments range rather wide of the debate on confidence. If she could keep bringing her comments back to confidence, I should be grateful.

Amber Rudd: Okay. I am interested in talking about this topic because confidence is probably the single most important element in a young woman’s life choices. One of the most destructive factors is a young woman not having the confidence to be able to make the choice to get her qualifications and develop her career, and instead making what is effectively a choice to have a baby very young. That is why this is absolutely about confidence. It is about having the ability to make that choice.

I encourage the Department for Education to engage with the charity Straight Talking so that we have more representations from women who have been in that situation and can deliver peer-to-peer advice in schools, so that young women can focus on that choice. I welcome the fact that the Department is consulting on the subject--if any Members would like to input into it, the consultation closes on 30 November. If we are going to reduce the rate of teenage pregnancy, which is a casualty of lack of confidence, addressing confidence is absolutely paramount.

2.59 pm

Chris Ruane (Vale of Clwyd) (Lab): For 14 years before becoming an MP, I was a primary schoolteacher. I ended up as deputy head of the primary school that I went to when I was three—Billy Backwater, perhaps, and some might say that I have swapped one set of bells and playground humour for another. While I was a teacher, I taught eight, nine and 10-year-olds. The young

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girls had confidence, dynamism and enthusiasm—I could see it in their body language, their movement, their facial expressions and how they interacted with boys, teachers and each other. Something happens around the age of 13 or 14 that turns girls from dynamic people to not-so-dynamic ones who adopt the role of second-class people in school.

I congratulate the hon. Member for Wirral West (Esther McVey) on securing this debate on a subject that is rarely debated. The briefing pack from the House of Commons Library concentrates on jobs and not on the essence of the debate, which, as you have said, Mrs Main, is girls’ confidence.

The hon. Member for Wirral West mentioned many research documents and books. I draw hon. Members’ attention to Mary Pipher’s book “Reviving Ophelia”. Ophelia, as hon. Members will know, determined her own value by how she was perceived by her father and Hamlet, and ended up dying, drowned in a beautiful dress that made her look ever so pretty but dragged her down and kept her underwater, surrounded by flowers.

At the crucial age of 13 and 14, in early adolescence and puberty, the battle for self is won or lost. Much is made of qualifications such as GCSEs and A-levels, but only 18% of a person’s success, measured over a lifetime, is down to qualifications. We focus attention and funnel billions of pounds of funding into education, but is that the wisest use of our public funds? Are there other ways we could try? Could we divert some of it into confidence-building measures such as mentors and role models?

Bob Stewart (Beckenham) (Con): If what the hon. Gentleman says about early puberty and age 13 and 14 is correct, should we not concentrate all our efforts on that age group? If we have to take resources away, we should take them and concentrate them on that age group, in order to give them the confidence to shoot through and go on to do GCSEs, A-levels and so on.

Chris Ruane: I agree that it is a crucial age, but as another hon. Member mentioned in an intervention, the most crucial age is probably nought to three, when children are dressed up in pink or blue and told to be active or passive. For me, though the thrust of this debate is that 13 and 14 are a critical age.

Other factors that determine success are emotional intelligence and confidence. Luck, as everyone within this room will know, provides a great deal, as do social connections and networks. Some people are well connected—I would say that most of us here are—but in places such as the constituency of the hon. Member for Hastings and Rye (Amber Rudd), a seaside constituency like my own, social networks and networking opportunities for jobs, placements and internships are minimal.

During the period when girls are aged 13 to 14, smartness is seen as a liability. There is pressure to be popular rather than honest with themselves, and young girls are taught to be feminine rather than a whole person, as that might be slightly unfeminine—“She’s a bit tomboyish. She’s a bit too big for her boots. Get down.” Many young girls spend more time on make-up than on developing value systems. We could do a lot to teach young girls to develop their own value systems.

I mentioned the education budget, but there are also consequences for the health budget. Mental illness among

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children is running at 25%, and obesity in young children at 29%. We are following the American model, although we are 10 years behind, so we have a lot worse to look forward to. Binge drinking is on the rise, and smoking has decreased in virtually every sector of society save for one group: 15-year-old white working-class girls. What is going on? Why is that group the worst affected? Incidences of bulimia, anorexia nervosa, loneliness and self-harm are on the increase and need to be tackled. Not only do they have an economic consequence, they have a human consequence. Girls’ complicated lives are often reduced to one thing by the media: weight. “If you’re thin, you’re okay. If you’re not, you’re not okay.”

Mary Pipher’s book outlines some practical tools, one of which involves centring oneself on a regular basis. We are all on the hedonic treadmill. As MPs, we get up at 6 or 7 o’clock in the morning and get home at 11 o’clock at night; often, we find little time for our spouses, parents and children. We are not alone; other people out there are in the same position. We pass on those values to our children, and they do not have time to reflect. Reflection and centring are key, especially for young girls, but perhaps for all of us here.

Mary Pipher says that a distinction should be made between thinking and feeling. Girls should not just follow their emotions; they should slow down and think. Is that feeling intelligent? They should check with reality. Girls need to develop personal value systems, which she describes as a north star, by asking, “Who am I? What is important to me?” and holding it up so that when advertisers try to throw them this way or that, they say, “No, I’m going that way. I’m following my star.”

Mary Pipher says that we should take time for the important decisions in life. Teenage pregnancy has been mentioned. Deciding who their first boyfriend will be is a big step for girls, as is how that relationship unfolds. Who are their friends? Are they the right friends and not just the popular ones? Do they have the right values that fit with a girl’s own personal values? Mary Pipher also says that young girls, like all of us, should try to manage pain. Pain can be a good thing if we handle it right: if we feel under threat and get on top of that threat, we become stronger people; if we fold under it, we become weaker. It is a dangerous game. Pain is all around, and to overcome that pain, proper support is needed, as is time to talk with family, friends, trusted mentors and role models. Organisation of a young person’s life is also important. We should help them manage their busy schedules and be there when they need help.

Other hon. Members mentioned providing the right activities, although it sounds a bit old-fashioned, a bit big society and a bit like the right hon. Member for Witney (Mr Cameron)—perish the thought. The right activities, such as exercise, reading, hobbies and meditation are all old-fashioned but good stuff, as opposed to the wrong activities, which are thrown at kids in every advert. We witness something like 1,400 adverts a day. They are full of promotions of drinking, eating and overeating, sex, drugs and smoking. The advertising industry is a multi-billion-pound industry that tells us to consume, consume, consume and not to bear in mind its effect on individuals and families.

Developing the right activities is important. As was mentioned, we need to recognise, record and celebrate successes, whether in sports or other activities. That

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becomes a virtuous circle, as a girl gains confidence in one activity such as singing or dancing and becomes a bigger person for it. Again, it is big society-ish, but we need to develop altruism and volunteering to get away from the self-absorption forced on us by the media, and to use skills such as humour and to develop a thick skin against our peers when they say, “Your values are wrong and ours are right.”

In his book “Affluenza”, Oliver James calculates the amount spent on advertising in America to be 2% of GDP. In the UK, it is 1.5%, and it is 1% in mainland Europe. The purpose of advertisers is to sow discontent and make people think that their life is not quite right, but that it would be right if they had this or that. Some of us can say, “No, I don’t want that,” but young girls are especially vulnerable to advertising and that state of permanent dissatisfaction. Advertising comes through the TV, the radio and, increasingly, through the internet. It comes especially through girls’ magazines, which have been described as the work of the devil. Considering the values that they communicate to young girls, should such magazines be regulated? I know that we are not in favour of press censorship, but let us at least have an assessment of the harm that they are doing to young women.

Mrs Anne Main (in the Chair): Order. I am sure that the hon. Gentleman will bring the word “confidence” into his discussion of all these activities.

Chris Ruane: With respect, Mrs Main, every single point I have made is about confidence. This is about someone creating their own value system rather than having the media’s values rammed down their throat, and it is about developing as a person with individual confidence. Another way people can combat such pressure and develop confidence is to check the messages that enter their ears and eyes daily. Hon. Members may laugh at the concept of media studies, but when we became a literate society 600 years ago, literacy flourished and people studied it. Now we are in the age of the moving image, but we do not study the moving image. It is pooh-poohed, because the owners of the media do not want us to understand it or to appreciate the control that they have over our lives.

Bob Stewart: I stand as a father of four daughters, grossly over-confident—

Chris Ruane: You or the daughters?

Bob Stewart: I am overawed by them. The hon. Gentleman mentioned literacy. I also have two sons, and I have found that the daughters spend so much time reading compared with the boys. That is absolutely fabulous, and we should use it somehow to develop confidence among our children.

Chris Ruane: They obviously have a very good father.

Bob Stewart: They have a very good mother.

Chris Ruane: In conclusion—I realise that others want to speak—there is a number of positive actions I hope the Minister will take. Much of the research that was done for Mary Pipher is American, and although there is a direct correlation with this country, we need

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British research to find out what is going on in our society. We must not leave such research on dusty shelves, but use it to create practical activities in the classroom and in the home for young women. We need a curriculum that includes properly structured confidence building, which is measured over time to ensure continual improvement. Dare I say it, we may even need regulation. I know that the Government are loth to regulate, but we need an assessment of the damage advertising causes to specific groups, especially young, vulnerable women and children, and if regulation is needed, we should implement it.

3.12 pm

Caroline Dinenage (Gosport) (Con): Thank you, Mrs Main, for allowing me to take part in this incredibly valuable debate.

I commend my hon. Friend the Member for Wirral West (Esther McVey) for the huge contribution she has made to tackling the lack of confidence among girls by securing this debate and by working over many years to bring this issue to the public consciousness. It must have taken some confidence to stand up today and speak about this issue, because confidence among young women seems for some to be a marginal issue that is worthy of comment but always plays second fiddle to the goals of academic success, sporting achievement and extra-curricular excellence in schools. I believe, however, that the most important thing we can take from today’s debate is the understanding that confidence is absolutely pivotal to a girl’s success. That confidence and self-belief, which eludes so many girls in our schools, is the foundation of their achievement throughout life.

At senior levels across the sectors women remain a rare breed. FTSE 100 boards are plagued by a chronic under-representation of women, and only one of the 12 Supreme Court judges is female. However, the commendable aim of getting more women on the boards of top companies or to the heights of the professions is entirely alien to many girls in my constituency. The worlds of business, law or science are a million miles away from where some of the young women in Gosport believe they can take their lives, because of their persistent lack of confidence and aspiration. One teacher told me quite bluntly that many girls will get pregnant because they see having a baby as the one thing they are capable of achieving. As a primary school teacher, she sees first hand that from a tragically young age girls allow themselves to be shouted down by boys in class, as they mimic the lack of confidence, attainment and ambition they see in their own mothers and other female role models.

As children grow, so does the gender gap. National statistics show that girls are more than capable of outperforming boys throughout school. I could mention as anecdotal evidence the fact that, on the school run on Monday morning, my nine-year-old son bemoaned the fact that the two most brilliant children in his class were both girls and asked at what age girls stop being better than boys at everything. Despite the statistics, however, many girls are falling behind in the most deprived areas of Gosport. A teacher told me about one girl whose ability in maths far outstretched what she was actually achieving. At a certain point the girl started to believe that doing well in maths or in science was in some way not cool or attractive.

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My hon. Friend the Member for Wirral West mentioned a survey by Girlguiding UK, which found that being a hairdresser or beautician is the top career goal for many secondary school girls. Although, God knows, I appreciate the work of beauticians and hairdressers as much as the next woman, more work is needed to ensure that careers advice and work experience opportunities highlight the hugely diverse avenues that are open to women.

Jessica Lee (Erewash) (Con): I apologise for not being here earlier for the debate; I was detained in the main Chamber. Does my hon. Friend agree that we have an opportunity to advance the possibility of careers in science and engineering, and to show how attractive they can be for girls and how much opportunity there is?

Caroline Dinenage: That is absolutely correct. Raising aspiration for girls is about not only showing them opportunities but convincing them that those opportunities are within their reach. More than half the girls questioned eschewed science and engineering, because they believed that careers in them would be too difficult. From a very early age, our schools must convince girls of the simple truth that they are capable of achieving a great deal. One pioneering primary school in my constituency has launched a children’s university, which runs every Friday. The children’s university empowers kids as young as five to chose their own courses in subjects as diverse as microbiology, woodwork and Spanish. For a girl who has never seen a woman in her family go to university, or indeed even hold down a job, the impact is immense. The role that our schools play—through careers advice, the introduction of positive role models or innovative projects such as the children’s university—is central to raising the confidence and aspiration of girls.

Finally, we must accept that promoting confidence in young women requires a holistic approach. Other Members have said that eating disorders, mental health issues and self-harming all greatly undermine what girls can, and believe they can, achieve. We need to encourage more joined-up thinking between schools, training providers, and other youth and health services, rather than just seeing academic failings in isolation. Nurturing confidence in young women will ultimately rest on seeing the whole person; it will involve seeing the lack of ambition they experience at home, the insecurities that are re-confirmed by their peers and the emotional challenges that young girls will always endure. Only then can we ensure that young women will reach the great heights that we know they are capable of in their chosen career.

3.18 pm

Tracey Crouch (Chatham and Aylesford) (Con): It is a pleasure to follow my hon. Friend the Member for Gosport (Caroline Dinenage) and other hon. Friends who have spoken thus far. I congratulate my hon. Friend the Member for Wirral West (Esther McVey) on securing the debate. I went to an all-girls school, and I look forward to going back shortly to do its prize-giving. I have a suspicion that confidence will be a key part of any speech I make, so this debate will be not only important but incredibly timely. For that, I thank my hon. Friend.

Everyone has approached the debate so far from completely different directions, which is interesting. The hon. Member for Vale of Clwyd (Chris Ruane) mentioned the importance of literacy and education, which is

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telling when we look at other countries across the world that ban women from reading books because the regimes are frightened of the information and education that women can gain from them.

Chris Ruane: One quote, which I did not use before, is: “The less a woman has in her head, the easier she is to carry.” What does the hon. Lady think of that?

Tracey Crouch: It is interesting how in the past certain comedians have mocked women’s education, to try to belittle women. Some dictatorships have banned women from being educated, which makes the point.

In my short remarks I want to mention the importance of sport and physical activity in building girls’ confidence. I am interested and active in sport, and am pleased to say I have just been appointed parliamentary ambassador to Us Girls, a lottery-funded project within 50 areas of high disadvantage, spread throughout England. It is tied in with the hugely successful StreetGames. I am also the manager of a girls football team in Chatham. I have been with the girls since they were nine and 10 years old, and now they are 13 and 14—the key age group we have been talking about this afternoon. They have gone from timid little girls to strong, confident and often cheeky teenagers. It has been very interesting to see them grow up, and I am proud to have played a small part in their lives thus far.

I am pleased to be involved in youth sport, not least because a quick search on the internet shows that there has been much scientific research into how sport can help to build confidence in girls. In addition, it has been proved that girls who do sports do better in school, because exercise improves learning, memory and concentration. It can also help to reduce stress and make people feel a lot happier, not just about their physical self but about their mental ability. What is fantastic about some of the recent initiatives to get youngsters—boys and girls—active in sport is the fact that there has been much more innovative thinking about the type of sport or physical activity that is offered. In my day—without meaning to sound as if I am 100 years old—the only opportunities for sport we had were netball and hockey in the winter and athletics and tennis in the summer. We were very lucky to have the playing fields so we could do those activities, but not everyone wanted to do competitive team or field sports. Now there is much more to do, ranging from dance and trampolining to Zumba, which is apparently the latest craze.

Kevin Brennan: Will the hon. Lady give way?

Chris Ruane: On Zumba? Kevin, please!

Kevin Brennan: I am not an expert on Zumba, I am afraid, so it was not on that matter.

The hon. Lady is making an interesting point about choice and diversity for girls in PE and games in school, and physical activities. In her role as an ambassador will she emphasise that to Ministers, too? An emphasis on competitive sports between schools is right, but for some girls the physical activities that will get them to participate, and increase their confidence, are not necessarily the traditional games she mentioned.

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Tracey Crouch: I agree. Competitive sport is important as it builds team spirit and confidence in many different ways, but other sports build personal confidence. I am thinking of dance and the advent of “Strictly Come Dancing”, which has inspired many more young people to get involved and interested in dance. We should try to maintain as much variety as possible in the range of sports available to young girls.

Esther McVey: That reminds me of Debbie Moore, the first lady to set up a public limited company. She did not like sport, but wanted physical exercise, team play, confidence building and to go before an audience, and dance was how she found those things. That is not sport, but the encouragement of other active pursuits.

Tracey Crouch: I completely agree with my hon. Friend, and have been careful not to talk just about sport, because physical activity is incredibly important.

Getting people involved in sport or physical activity is one thing; keeping them involved as they get older is a very different problem, and all clubs or organisations involved in providing sports opportunities are finding it difficult. In my field, football, girls drop out more as they get older. The Football Association and other organisations that are looking at sport for women are trying to deal with that. Interestingly, when girls start to drop out of sport their confidence often drops, partly because when they are participating they become more confident about their weight and body shape, so it follows that they get less confident if they drop out.

Access is one way of keeping girls involved, and that is a debate for another day, but confidence can be instilled by others, which is why media portrayal and positive role models are important factors. So far, every Member has mentioned those two elements. I hope that I am a positive role model for my girls football team and indeed for local schoolgirls, who may or may not be interested in politics, but see a female politician in the local area. There are only three female MPs in Kent, and I think it is important for me to go out to schools in my area. We have a few single-sex schools in Medway, and I visit them to show them that women locally can achieve.

I am merely one woman in their lives, and television and local newspapers are often shaping influences. The shape, size and style of women on our TV screens or in magazines is often commented on. I applauded loudly when in the current series of “The X Factor” talented but not stereotypically size 8 beauty-queen participants were put through to the later stages. From an early age girls see what happens, and they go from wanting to be the Disney Princess to wanting to be a slimline pop star. The irony is that often the bigger girls are better singers. What we do to encourage diversity of representation in the sector is important.

Chris Ruane: Will the hon. Lady congratulate Sami, from Rhyl, my home town, who, when pressured by the judges to lose weight, said, “No, I am happy the way I am”?