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Westminster Hall

Wednesday 30 November 2011

[Mr David Crausby in the Chair]

Organ Donation

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

9.30 am

Glyn Davies (Montgomeryshire) (Con): This is the first time I have served under your chairmanship, Mr Crausby, and it is a pleasure to do so.

I have several brief comments to make before I start on the substance of my speech. First, I must declare an interest, although not a pecuniary one. I am a member of the Kidney Wales Foundation and it is important that I make that clear at the start. I have been interested in this subject for many years because a very dear friend of mine was one of the first to receive a heart and lung transplant at Papworth. She died about two months ago, but for 20 years we discussed the subject on a monthly basis. We did not agree, but our discussions inspired my interest in transplantation as a whole. In particular, we worked on local dialysis provision in Montgomeryshire.

I thought very carefully about becoming involved in a high-profile way because most of my friends and colleagues in the Kidney Wales Foundation take a different view from me. I am not in favour of presumed consent, whereas nearly all of them are. In my view, the way forward is to ensure that everyone knows about the issue so that people’s views are known when they die. Having a public debate is in itself a very good thing to help to achieve the objectives I want.

I think we all agree about the need to increase the availability of organ donors—those who are in favour of presumed consent and those who want to retain the informed consent system. The difference is that I do not believe that presumed consent will deliver an increase in organs for transplant. The evidence tells me that it makes no difference. The reason I sought this debate is that the Government in Wales have proposed to opt for presumed consent, which would inevitably have an impact on the rest of the United Kingdom and makes this a very proper debate for this Chamber.

I must make it clear that my opposition to presumed consent has nothing to do with ethics or morality, though I believe that there is a strong ethical case for opposition to it. Others, including the Archbishop of Wales, have articulated the ethical arguments much better than I can. It cannot be right to interpret the absence of an objection as a considered declaration of support. They cannot be seen as the same thing. Changing the system from an act of giving by the citizen to an act of taking by the state is a genuine ethical consideration, but my opposition to presumed consent is based not on ethics but on efficacy. There is simply no firm evidence that it will deliver any more organs for transplant.

In the final years of the previous Labour Government, the then Prime Minister, the right hon. Member for Kirkcaldy and Cowdenbeath (Mr Brown), began advocating

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presumed consent, as some hon. Members here may remember. He established a Department of Health organ donation taskforce. I believe that the chief medical officer at the time also supported a change to presumed consent. The taskforce was instructed to examine presumed consent in detail and to provide a report for the Government. The taskforce consisted of a large committee of specialists under the chairmanship of Dame Elisabeth Buggins, with several sub-committees to consider particular issues. Its report, published in 2008, made it absolutely clear that presumed consent was unlikely to increase organ donation rates in the UK and risked diverting substantial resources—it would cost £45 million to establish and several million pounds a year thereafter—from effective solutions. The report is the most comprehensive analysis of presumed consent ever carried out. It runs to several hundred pages.

Jonathan Evans (Cardiff North) (Con): I have a copy of the Buggins report here. Did my hon. Friend take from his reading of it the fact that at the beginning of the process many of the people who were part of the taskforce were strongly in favour of presumed consent, and it was as a result of the detailed work undertaken that their viewpoint came to be changed? That was a crucial part of what emerged from the report and is highlighted in the conclusions.

Glyn Davies: My hon. Friend makes a good point. Because of the brief that the British Medical Association has circulated to Members, I want to quote the report’s conclusions so that we know what the taskforce actually said. One of the main recommendations states:

“The Taskforce’s members came to this review of presumed consent with an open mind, with many sympathetic”

to presumed consent. It went on:

“the more the Taskforce examined the evidence, the less obvious the benefit, and the more multifaceted and multidimensional the issue of increasing donor numbers was revealed to be…The Taskforce reached a clear consensus…that an opt out system should not be introduced”

as it could impact negatively on organ donation.

I was quite shocked to receive the BMA parliamentary brief because it sets out without the slightest doubt to give the impression that the taskforce recommended the opposite of what it did recommend. That is verging on a lack of professionalism. I have huge respect for the BMA and I was very disappointed to receive its parliamentary brief. It will seriously damage my confidence in such briefs in the future, whereas I depended on them in the past.

Nia Griffith (Llanelli) (Lab): When someone dies it can be very difficult for doctors to talk about organ donation at that time. Does the hon. Gentleman agree that what we need is a huge drive to get families to talk about consent well in advance? We must be honest and acknowledge that organs that are fresh from healthy bodies are the most desired, and it is often the tragic deaths that lead to organ donation. We need to get as many people as possible signed up, other than those with strong religious objections. If people are signed up, doctors can have an informed discussion with them.

Glyn Davies: I absolutely agree, but I do not necessarily agree with having a list identifying people. I hope to cover that point. Having people’s views identified outside the traumatic circumstances that surround a death is

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absolutely key if we are to increase the number of organ donations in this country. That is what the evidence in other countries tells us.

When the taskforce was set up, the Prime Minister of the day expected it to support a transplant revolution, but of course it did not. A similar conclusion was arrived at by a cross-party group of Assembly Members who looked at the same issue. The Members I talked to went into that committee expecting to support presumed consent, but they said in the Assembly that it should not be presumed. They did not think it would deliver the increase in organ donation levels that was generally anticipated.

The second report of the organ donation taskforce in 20008 recommended an improvement in transplant co-ordination, and that is being implemented. The number of organ donors in the UK has risen from just over 800 in 2008 to more than 1,000 last year. That is an extraordinary and dramatic improvement that has saved hundreds of lives. I have searched pretty hard, and the evidence I found is that the way forward is to look at the problem logically and in depth, conduct serious research and then take well-considered action.

Many people support presumed consent because they intuitively feel that it must make a difference. Opinion polls show support, and it is not surprising that they do. When people are going around saying that the change to presumed consent will increase the number of organs available, others will automatically say that they are in favour, but the reality is not what they think. There is a misconception that, if a citizen does not put their name on a centralised, opt-out register, their organs can be used for transplantation. This is a half-consent system, and it is not the presumed consent system that is being proposed. With soft opt-out, or presumed consent with safeguards—these are the phrases used—the actual decision to donate still rests with potential donor’s family, as happens under the current system. The key issue—the point raised earlier by my hon. Friend the Member for Cardiff North (Mr Evans)—is that the donor’s wishes are known by his or her next of kin.

It is always dangerous to draw conclusions from international examples but, for many years, Spain was presented by those who support presumed consent as proof of the effectiveness of that system. Since the late 1980s, Spain has had the best rate of organ donation in the world and has rightly been recognised as a model for other countries. Because Spain legalised presumed consent in 1979, it has been assumed that this played a key part in its success. However, the 1979 legislation to introduce presumed consent had no impact whatsoever on Spanish donation rates. Key organisational changes introduced 10 years later, in 1989, delivered the success of which Spain is so rightly proud. Spain does not have, and has never had, an opt-out register.

The director of the Spanish organ donation body, Dr Rafael Matesanz, has said that the 1979 legislation is dormant and plays no role in Spain’s outstanding organ donation rates, but this fact does not deter the supporters of presumed consent. They now ignore Spain, citing cultural differences to explain why Spain is not a good example to follow. They also ignore the fact that the United States has one of the best organ donation rates in the world, despite there being no presumed consent

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there. In fact, civil liberties issues in the States would almost certainly prevent presumed consent being introduced there.

The focus now has moved to Belgium and to studies performed in Belgium 25 years ago, between 1984 and 1987. I tried to discover what happened, because I want to see more organs donated. If a system works, and there is evidence to show that it works, it is important that we study to such examples, so I have gone to a lot of trouble to find out what happened in Belgium.

Belgium introduced presumed consent legislation in 1986. The key result was that the rate of kidney transplantation in Belgium rose from 200 per annum in 1984-85 to 300 per annum in 1987. Again, under more detailed examination, the claim that this is the consequence of presumed consent just does not stand up to scrutiny. The results of these studies were published, as a page and a half meeting report, in 1990, by L Roels and co-workers, Transplantation Proceedings, volume 22, pages 2078 to 2079. The authors state clearly that the presumed consent legislation

“was consolidated by a nationwide information campaign about the benefits of organ donation…and is being maintained by continuous efforts to inform healthcare professionals about the modalities of organ procurement procedures.”

More importantly—crucially—the authors go on to say:

“Whereas before 1986 most smaller non-university hospitals were reluctant to participate in organ donation activities, by lack of any legal security in the absences of an adequate legislation. The majority of organs harvested” —

I do not like that word; I prefer “donated” —

“during the last 3 years were performed in this particular group of hospitals.”

Presumed consent was clearly a major factor in increasing organ donation in Belgium in the 1980s, but it is irrelevant to the current position in the UK because the legal certainties have never been an issue. It may have had some influence in Belgium but it is clear that Belgium is a very weak example of evidence on which to base a major change in UK policy.

Kevin Brennan (Cardiff West) (Lab): As I understand his argument, the hon. Gentlemen is saying that in other countries other measures have worked to increase the level of donation, but he also seemed to be arguing that presumed consent would make matters worse, and reduce the number of organs donated. Can he explain how that mechanism would work?

Glyn Davies: I thank the hon. Gentleman for that intervention, because I would not want there to be a misunderstanding. I gave a direct quote from the organ donation taskforce set up by the previous Government, which said that there was no evidence of an increase, and indeed some danger that there might be a negative effect. I used that quote as a challenge to those who are suggesting that the taskforce report shows positive support. I did not suggest that presumed consent will decrease the level of donation.

Susan Elan Jones (Clwyd South) (Lab): It strikes me that the hon. Gentleman is saying that we have a choice – either presumed consent and no awareness-raising, or awareness-raising in the hope that that will generate more organ donation. From our nation of Wales, in the

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UK, we know that one person a week dies because they cannot have a transplant. I was on the Welsh radio programme “Dau o’r Bae” recently when one of the hon. Gentleman’s colleagues, the Rev. Felix Aubel, was adamantly in favour of presumed consent, and felt that there were very few ethical considerations against. There is quite a diversity of views, but I would contend that there is not the polarity that the hon. Gentleman suggests.

Glyn Davies: I thank the hon. Lady for her contribution, but I have not thought of this as being in any way a political issue. I know that there will be members of my party who will take a different view. For me, this is an issue purely outside party politics.

Paul Flynn (Newport West) (Lab): Of the people who died last year waiting for organs, 50 died in Wales, and the evidence from the world experience is that the system being proposed by the Welsh Assembly will reduce that number of deaths. The hon. Gentleman has produced nothing to suggest that that is not the case.

Glyn Davies: I thank the hon. Gentleman for his intervention, but I simply do not accept that. The evidence actually shows the opposite of what he has just said, and he is ignoring that evidence. This is an issue of such importance to me—probably the most important issue to me since I have been a Member of Parliament—that I have looked carefully at the evidence. I do not want to be advocating a course of action that in some way negates that evidence, and I do not think that that is what I have been doing.

Mr Mark Williams (Ceredigion) (LD): The hon. Gentlemen has been very careful. He has cited the experience of Belgium and Spain. Would he also cite the experience of the survey held by the Kidney Wales Foundation, looking at 22 different countries, comparing the rates of donation and concluding that presumed consent would increase the rate of donation by up to 30%?

Glyn Davies: I thank the hon. Gentleman for that intervention. I referred to Spain because that is the example that all those who seek presumed consent have quoted for many years. I then referred to Belgium because when it was shown that the evidence from Spain did not support that argument, the example then used was Belgium. If there is evidence from 22 more countries, then I will have to see the results from them as well. I just do not accept that the international evidence supports the move to presumed consent at all.

Jonathan Evans: I would like to explore this issue for slightly longer. The evidence indicates that what is important is the awareness, not the presumed consent. The Minister, on a point that I hope to raise with her later, wrote to me to indicate that awareness-raising, from just undertaking the taskforce report, has resulted in donation rates increasing by 28% over the last three years. Nobody could say that that is because of the system – it is because of communication and information.

Glyn Davies: I am hoping to come to this issue if I have time at the end of my speech. It is a crucial issue. I value the help that the British Medical Association has given me over the years. However, the Parliamentary

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brief from the BMA, which I referred to before, shocked me a bit; so I have gone to some trouble to understand its position. The BMA agrees with the move to presumed consent, and has done for many years. The position of the BMA is of great interest. It has been a vocal supporter of presumed consent since it adopted the policy in 1998, long before the report of the organ donation taskforce, which was a comprehensive study into the issue.

The BMA’s current position was overwhelmingly endorsed a few months ago at its annual representatives meeting, a very important meeting which was held in Cardiff and attended by hundreds of doctors representing regional groups throughout the United Kingdom and some special interest groups. Many dozens of motions were discussed over three days and votes are taken. A vote of 51% of those in the hall makes what is being discussed policy for the BMA. It seems scarcely credible that an important organisation can make policy on a complex issue in this way—as a sort of public speaking competition, rather than on the basis of detailed research. I do not accept that the BMA’s position on presumed consent can be treated seriously until it reforms the way it makes policy on complex issues. Given the influence of the BMA on public opinion, and that patients’ lives are at stake, there is a powerful moral obligation for it to undertake substantial research into this position before it continues to carry forward an issue that in my view damages the cause that it purportedly supports.

What is the way forward for patients who are at the heart of the debate? I want to come to the positive way forward. We know that the rate of organ donation is influenced by three crucial factors. The first is the number of potential donors. With rare exceptions, potential donors are comatose patients on life support machines in intensive care units. Inevitably, the level of intensive care provision is a crucial aspect of organ donation, and it is relatively poor in the United Kingdom.

That is one factor. Identification of all potential donors is another. Every patient who is a potential donor should be given the opportunity to become a donor, by early identification and discussion with his or her family. The Spanish have an extensive system of transplant co-ordinators, involving mainly part-time intensive care physicians. There is a lesson there for the UK.

Consent from the patient’s family is also key. This is influenced by background knowledge of transplantation and organ donation; the professionalism of timing, as to when we approach the family; trust in the medical profession and knowledge of their loved one’s wishes. Spain has a national training programme for its co-ordinators and a 24-hour information helpline open to the press and public, and places a high priority on public relations.

Consent cannot be legislated for. In 1990, the refusal rates in the UK and in Spain were the same, at about 40%. Over the last 20 years, the refusal rate in the UK has stayed roughly the same. In Spain, it has fallen gradually to the current level of 15%. There is a dramatic difference in what has happened in Spain, as a result of the systems outside presumed consent. That is the example that we should be following.

The second report of the organ donation taskforce recommended improvement in transplant co-ordination, which is being implemented. This is where the numbers

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I referred to earlier become apparent: the huge 25% rise in the UK and the 60% rise in Wales. It is a fantastic achievement. This is the approach we should be taking forward, which leads me to the final part of my speech this morning.

Jessica Morden (Newport East) (Lab): Does the hon. Gentleman agree that there is a particular problem with organ donation in black and minority ethnic communities? What does he think we ought to do, if we are not aiming for a soft opt-out, to raise the profile of organ donation to tackle health inequalities in these communities?

Glyn Davies: The figures that I have seen show that the refusal rate in those communities is much higher in Britain. The rate of allowing organs to be donated by the next of kin is actually reducing among the non-BME population in Britain. So there is a lot of work. I do not know the answer to that. I do not want to make suggestions that I have not researched. I am trying to stick to the research, and I have not done research into that, although it is clearly an issue. It was a specific part of a debate here about two months ago and it is an issue we must tackle.

Finally, those of us who disagree with the proposals being put forward by the Welsh Government and advocated by my friends at Kidney Wales Foundation and the BMA have a responsibility to engage seriously with what is a genuine attempt to increase the availability of organs for transplant. It is a worthy objective. It is accompanied by a commitment to invest considerable sums of public money to achieve it. It has led to a lot of debate already, particularly in Wales, to this debate today, and will lead to much more. Many hon. Members are interested in the debate. If Wales and the Welsh Government seek to introduce the legislation, there will be huge debate across the UK. The debate itself is hugely helpful.

The final point I want to make this morning is that we should build on what is so obviously working. There is currently a national transplant week and a national donor day. However, these do not impinge as much on the national consciousness as we would like them to in the UK. I admit that I did not know that they occurred. If part of the extensive resources which would be used to implement the presumed consent legislation were to be used to create a national donor and transplantation day in Wales, what a difference that could make. It could have real impact. The resources could be used to celebrate the donors and their families of the preceding year on television, radio and the newspapers. The success stories of the recipients of new organs who are living a full life would be inspirational as examples and would help discussion about this issue, so that next of kin would know what their families’ wishes were.

Nia Griffith: Would the hon. Gentleman consider the advantages of trying to have specific points in people’s lives when they are asked about organ donation, such as when they get their driving licence or their national insurance number, or something like that, so that there is a methodical way of asking people to sign up?

Glyn Davies: I thank the hon. Lady for raising the point. That is not directly related to the debate today, but the point raised would support and strengthen the

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current system of an opt-in card, and it is a good idea. I have thought about it a lot and most people would accept that that is a reasonable way forward. It asks people their opinion and requires them to think about the issue. As long as we can extend that—having them tell their next of kin what their position is—it could be very successful.

We could learn from what has happened in Spain: Spain is the most successful country in the world. We also could establish a 24-hour information telephone line, with many more lines available on the national organ donor and transplantation day, if it were set up. On that day the people of Wales could be encouraged at every opportunity to tell their loved ones and their next of kin what their wishes are regarding organ donation. Husbands, wives and children will always be asked their permission. If you are ever unfortunate enough to be a potential donor, you need to have your next of kin know your wishes, so that they will be implemented. Telling them your wishes is much simpler, hugely cheaper, more effective and far more flexible than presumed consent legislation. Establishing a national database is expensive; overseas experience suggests that only 1% or perhaps 2% of the population are likely to use it. We know that it is more probably some 10% of people who do not want their organs to be donated; those are the figures we get—that about 90% of people are content.

This is a poor substitute. We all need more organs available for transplant. There is no dispute about that—it is a worthy objective that nearly everybody signs up to. Building on the success that we are achieving, involvement in a transplant co-ordination system is the way to go. Building on the evidence and on our experience, we know that that is what works; not creating a bureaucratic, superficially attractive, presumed consent system that simply will not deliver what we all want.

Several hon. Members rose

Mr David Crausby (in the Chair): As so many Members wish to speak, I will call the two Front Benchers at 10.40 am, giving them 10 minutes apiece, but I would appreciate short contributions in order to get as many people in as possible.

10 am

Paul Flynn (Newport West) (Lab): This debate reinforces the view that Assembly Members never actually leave the Assembly, but continue their debates here in Westminster. This morning’s debate is not for us. The Government have 400 commitments in the coalition agreement; if they have 401 commitments then there is even less chance that they will deliver on this. There is no likelihood of change.

Glyn Davies: I reassure the hon. Member that this issue was never raised during the eight years I served as a member of the Welsh Assembly.

Paul Flynn: It is now a live issue in the Assembly. We are not the Assembly, we are a British Parliament, and I question whether this is an issue of primary concern. Of course we should talk about it, but sadly any possibility of reform is remote in this Parliament, although it is a live issue in Wales. This debate has been called in order to influence the debate in Wales and it is questionable whether it is a legitimate use of parliamentary time.

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Guto Bebb (Aberconwy) (Con): I congratulate my hon. Friend the Member for Montgomeryshire (Glyn Davies) on securing this debate. On whether this is an issue to be debated in Westminster or in the Welsh Assembly, is the hon. Member for Newport West (Paul Flynn) implying that no contribution to the debate can be made in a Westminster context? There is a real question mark as to whether the Assembly has the legislative competence to deal with the issue.

Paul Flynn: I served in Parliament before there was a Welsh Assembly, unlike the two hon. Gentlemen. Since it has come into being I have absolutely never, at any time, become involved with, made speeches on, or interfered in those responsibilities of education and health in Wales, which are the responsibility of the Welsh Assembly. We have to accept that and realise that there are Welsh Assembly responsibilities and other responsibilities here. I do not want to labour that point, however, because there is a more important point to be made—

Guto Bebb: Will the hon. Gentleman give way?

Paul Flynn: No, I will not. I have been asked to be brief. We must get away from what we are hearing from prattling prelates and procrastinating politicians and look at the real issue. We cannot talk about a system that is working well, as was suggested this morning, when 1,000 families were bereaved last year in the UK and 50 families were bereaved in Wales. I will not talk about one family in my constituency where a young woman died waiting for an organ transplant because it is too heartbreaking a story, but I want to say something about the reality. Despite all the fine theories and words ahead, what is happening to real people in our constituencies?

Some of us listened to the testimony of Matthew Lomas and his mother when they came to Parliament a month ago. It was a dreadful story of suffering that moved us all. Matthew and his brother were born with congenital heart defects and they both had pacemakers. Matthew was suddenly getting a great deal of pain and discomfort and was taken to the hospital, where the diagnosis was a sombre one. His heart was growing and he would eventually die. He was told that on a scale of one to 10 his chance of surviving was at 9.9, and the family prepared for Matthew’s death. They were told that a heart transplant was a possibility, so they arranged for him to go to Birmingham’s Queen Elizabeth hospital, where he had a series of assessments. When the doctor told them that he would have to have a transplant, his mother said:

“Matt and I stared at each other it was so surreal. Had we both heard the same thing? We didn’t talk. Matt may have wept, I can’t be sure. I felt numb and could only think about my son who I had just been told was dying.

The sister came back in. ‘Had you been expecting to hear that?’ she asked gently. ‘No!’ we said together. It was the first thing we had said since hearing the awful news. ‘I thought Matt would need a new pacemaker.’ I said.”

She told the story—which some hon. Members will have heard—of the dreadful things that happened from then on. There were false alarms; a call from Birmingham came at 2 o’clock in the morning. They prepared themselves and started to drive up the motorway, only to be told when they were halfway there that the heart was not suitable. There were many other false alarms along the

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way. Eventually the transplant did occur—I find it difficult to read the whole story so I will cut it short. The family went through agony as the young man approached death. He was fitted with a device that would keep him alive for 28 days, but death was a certainty at the end. By good fortune—not from the wisdom of politicians or prelates—he survived. He is at home now and has a life expectancy of five years.

Another constituent of mine, a young woman the same age as Matt, died last year because there was no heart available. I believe we must say—because the overwhelming evidence is there in spite of what the hon. Member for Montgomeryshire (Glyn Davies) said this morning—that the weight of the medical evidence shows the best way forward, and that is the decision that the Welsh Assembly is about to take. For goodness sake, instead of going along as we are—particularly today—serving the few rather than the many and talking about our various political differences, let us realise that this is an area in which we politicians can save lives and lift the burden of anxiety from families waiting for organs. We know that all of the evidence—the fair evidence, not the procrastinating evidence we have heard this morning—shows that there will be more organs available. For goodness sake, let us allow the Welsh Assembly a free run to get on with it and lead the country as it has in the past with other reforms. We hope that England and the rest of the United Kingdom will follow suit when the reforms produced by the Welsh Assembly are proved to be a great success.

10.7 am

Mr Mark Williams (Ceredigion) (LD): Thank you, Mr Crausby. It is a pleasure to serve under your chairmanship this morning and I will be as brief as I can. I must congratulate my hon. Friend the Member for Montgomeryshire (Mr Davies) on securing this debate. I know that he has taken a keen interest in this matter over many years and he spoke with customary conviction while presenting his case. I do not agree with his case, but nonetheless I respect his conviction.

Guto Bebb: Does my hon. Friend agree that there is a way in which we can present this argument that has been made by my hon. Friend the Member for Montgomeryshire, and to the contrary by the hon. Member for Newport West (Paul Flynn)?

Mr Williams: The hon. Member for Newport West (Paul Flynn) also spoke with characteristic passion, and he spoke with passion about constituents, which is an important point to make. Another important point to acknowledge is that this is not a partisan issue. I happen to support the stance taken by the Welsh Assembly Government. It is not a Government that my party is part of, but I support the initiative of both Health Ministers in the Assembly, who happen to be Labour Members.

I will briefly explore the Assembly Government case and endorse the work of the British Medical Association. I will also highlight the work of the Kidney Wales Foundation, the British Heart Foundation, Diabetes UK Wales, the British Lung Foundation and the Kidney Welsh Patients Association.

Glyn Davies: Will the hon. Gentleman give way?

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Mr Williams: I am not going to give way to the hon. Gentleman. I will proceed because many others want to speak.

Members of the Select Committee on Welsh Affairs received the request for legislative competence on this matter, although mercifully that was superseded by the referendum result, which conveyed greater powers to the Welsh Assembly. That is why it is now able to proceed in the legislative way that it is. The debate has, of course, been triggered by the publication of the White Paper by the Assembly Government on 8 November, which proposes a soft opt-out organ donation scheme for Wales, with a view to that becoming fully operational in Wales in 2015. Both contributions we have heard this morning have acknowledged the tragically large waiting lists for donors: 10,000 people UK-wide, 500 in Wales. The wider public support was acknowledged by the hon. Member for Montgomeryshire.

It was also acknowledged that earlier committee work had been undertaken in the National Assembly, and the committee was not exactly ringing in its endorsement of a soft opt-out proposal, although it did not rule that out. The then Health Minister opened the matter to public consultation, and some 81% of respondents in 2009 indicated that they were supportive of a soft opt-out scheme.

Despite those statistics and the overwhelming public approval for a scheme, tragically only 29% of us have signed up for organ donation. There has been much mention of the international comparisons. I will not dwell on them, other than to cite again the comparison highlighted by the Kidney Wales Foundation. It looked at 22 different countries with opt-out schemes—not just Belgium or Spain—and found that over 10 years there was a 25% to 30% higher donation rate than for informed consent schemes. I appreciate what has been said about an evidence-based scheme, but we must not be selective in the evidence used. That is critical—we need to look at the whole picture.

I strongly contend that a soft opt-out approach must not be seen in isolation. The Assembly Government is not arguing that a soft opt-out scheme alone will work and do the job that we all wish to see. As the hon. Member for Llanelli (Nia Griffith) said in her intervention, we need to heighten publicity, which is absolutely critical. Initiatives such as the use of the Driver and Vehicle Licensing Agency, so that when people apply for a driving licence they are asked whether they wish to join a scheme, would play an implicit part in a soft opt-out scheme.

Jonathan Evans: Will the hon. Gentleman give way?

Mr Williams: I will carry on, because I am conscious of time.

Critically, the Assembly Government has also responded to the need to increase infrastructure to cope with transplants. It is clearly developing that: the transplant directorate of the University hospital of Wales in Cardiff is the only transplant organisation responsible for kidney and pancreas transplantation in south and mid-Wales. In March, £2.4 million was spent on the Cardiff transplant unit, which has been opened with a dedicated transplant team and with new recruits of surgical and nursing staff. The Assembly Government also committed £1.5 million to implement the recommendations of the organ donor taskforce. Infrastructure and public information, coupled with a soft opt-out scheme, is the key.

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Finally, and critically, we need to address the ethical issue. The soft opt-out scheme has been described as somehow being ethically improper. I think that is probably the view—I hope I do not do him a disservice—of my hon. Friend the Member for Montgomeryshire. That view has certainly been expressed by the Archbishop of Wales. I would not dare to describe him in the glowing way that the hon. Member for Newport West did; I am a member of his Church, and I deeply respect the Archbishop of Wales. He has highlighted the issue of the relative power of the state and the individual.

As a Liberal—call me an old-fashioned liberal—I very much want to see the emphasis on individual choice. The hon. Member for Clwyd South (Susan Elan Jones) alluded to that point in her intervention. There will still be choice—the choice to opt into a scheme is still there. The archbishop’s article in the Western Mail stated:

“Organ donation…ought to be a matter of gift. If one takes organs without consent, on the assumption that a person is tacitly assenting by not opting out, then that is no longer a free gift to others. An organ donation ought to be precisely that…an act of love and generosity.”

I agree with those sentiments, but I do not accept that opting out in any way conspires against the spirit of generosity. That is where public information and the awareness issue are so important.

What we need to do, which is what the Assembly Government seek to do, is to extend that spirit of generosity so that it becomes the norm and so that the discussions that every family will have to have throughout people’s life about such matters are very much the reality. That puts the onus on the individual to make informed choices, and that should be highlighted. A point has been made about relatives and members of families. The soft opt-out option means—this has been made open to consultation by the Welsh Government—that there is a specific role for members of bereaved families, whose views will be taken into consideration.

I perhaps started this process as an intuitive supporter of soft opt-out. I remember going to a meeting organised by the hon. Member for Cardiff West (Kevin Brennan) earlier this year, when we met people who were waiting for transplant operations. There is a healthy impatience, certainly in the Assembly Government and among others of us, to see the issue resolved.

The hon. Member for Newport West talked about his constituency cases. One benefit of the House rising early yesterday was that I was able to watch a little more television than usual. I watched an excellent documentary last night about a young couple from Exeter: 21-year-old Kirstie has been waiting several years for a lung transplant. She struggled through her teenage years, and she even struggled through her wedding day while being unclear whether she could actually survive the day. The highs and the lows—the highs were that on two occasions she received telephone calls saying that a donor was available; the lows were realising that the donor was not appropriate. Miraculously, as she reached the end of her life, a suitable donor was found, and Kirstie is now recovering and enjoying an increasingly full life. Sadly, many of our constituents are not so lucky, which is why many of us are very impatient and why the National Assembly Government have taken the lead in pushing for a soft opt-out option.

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10.17 am

Jim Shannon (Strangford) (DUP): I thought that I should speak, and it is a pleasure to do so, on this matter, which is one of some importance to me. Every person in this House agrees that something must happen. It is the strategy or the policy for the way forward that is the issue. I have to say that I totally support the point of view of the hon. Member for Newport West (Paul Flynn).

I have carried a donor card—it is a bit faded, but it is still a donor card—for more than 20 years. This is the second or third one. If this body that I stand in today should be in an accident, and there is an opportunity for donations, I would like my body to be used for that purpose to give life to others. That is a personal opinion. There will be others in this House who carry donor cards, and they will be of the same opinion.

My nephew Peter is a recipient of an organ donation. He received a kidney. I can well remember the day he was born—he is a year younger than my elder son—and he was a wee boy. He was born with about half a kidney, and it was touch and go the whole way through his life. The result of it all was that he received a donor kidney, and today his whole life has changed. Today he races motor bikes—a bit of a tradition in our family—and he has a job and a full-quality and normal life. That is good news.

In my constituency of Strangford, we had the opportunity to have a memorial garden. That was an initiative that came from local people, who worked with the Ards borough council and ensured that a portion of land was set aside earlier on this year—in May or June—for a memorial garden so that those who are recipients of donor organs and those families whose loved ones have passed on have somewhere where they can go to have a moment of quietness or of contemplation.

Some eight years ago, just a mile from the location of that garden, an accident took place in which one person was killed instantly and another survived for a few days. Months afterwards, the father of one of them came to see me. He was still heartbroken, but he told me that his son had managed, as a result of his death, to pass on organ donations, and the gift of life, to five families. That is another illustration of the quality of life that can arise out of such events.

I am conscious of time, but I shall make three quick points. Just four weeks ago, I put down an early-day motion for the House to consider. Through that, I became conscious that we need to do something better, because the system we have today is not working. Organ donations are not coming through and we must do something about that. We need to think outside the box, if I may use that terminology—it is used often about many things. People of the vintage of 70 to 80 years old should not be excluded from organ donation. If their bodies or organs are healthy, why not use donations from people of that age? Perhaps the Minister can give us an idea about that in her response.

The hon. Member for Ceredigion (Mr Williams) mentioned the TV programme, which I had actually seen the night before, although it was the same one. It very clearly illustrated the highs and lows of people who are waiting on organ donation—the highs when they think it is their turn and the lows when they find out that it is not suitable. It charted the life of one

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person through her youth, her marriage and the countdown of days after the marriage until she was on a life-support machine and had only three days to live, and then the organ donation came through. Again, that illustrates very clearly the things that we need to do.

I have been contacted by many constituents who are aware of the issue, of the need for organ donations and of the need for that to happen quickly. My last point is in relation to those who need a transplant, but—nobody has yet mentioned this—have a rare blood group. What are the chances of someone with a rare blood group receiving an organ donation from someone of that particularly group? It is one of those 100 to one or 1,000 to one chances. We therefore have to do something different. Whether that means a pilot scheme, so that people are automatically organ donors unless they say otherwise, which is what I believe we need; I would go a stage further, although I am not sure that everyone would agree.

Unless we have a system in place that gives the individual an option and ensures that organ donations can come through, we are not serving our people or our country well. I urge hon. Members to think very honestly about the issue and to move forward in a positive fashion. We need organ donation, we need it on a different system and we need it now.

10.21 am

Mr Philip Hollobone (Kettering) (Con): In October 2006, my constituent Mrs Jeanette Crizzle very sadly died from acute myeloid leukaemia. Her husband Adam decided to set up the Jeanette Crizzle Trust, of which I have the privilege to be a trustee, to promote what has become NHS Blood and Transplant’s give and let live education programme for schools. At that time, we went to see the then Health Minister—she is now the Labour Chief Whip—and she kindly agreed to get the programme under way. Young people are the donors of the future and it is vital that we reach them. They are the ones who will keep future blood stocks healthy and provide life-saving organs in years to come.

The significance of that for this debate is that my constituent Mr Adam Crizzle, once his wife had very sadly passed away, did not leap to the conclusion that we should have a system of presumed consent; he leaped to the conclusion that we should increase awareness to encourage people to become donors in the future. That is something that I am very happy to support.

I am sure that we can all agree with the comments made by the hon. Member for Strangford (Jim Shannon) showing that the present system is not working well enough. Where we might disagree is how to make it work better. I come down firmly on the side of arguing that there is plenty more opportunity to increase the awareness and to encourage people to become donors.

I take this opportunity to praise NHS Blood and Transplant for the give and let live donor education programme. I am pleased that the Health Minister has agreed to meet Mr Adam Crizzle next month to explore ways in which that programme can be further advanced and improved. Some three quarters of schools are involved in the programme, which is targeted at 14 to 16-year-olds. However, many schools have not yet been reached, and I am sure that the Department of Health can build on the initial successes in the early years of the programme to ensure that it is extended even further.

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I apologise to you, Mr Crausby, for not being able to stay to the end of the debate to hear the Minister’s remarks. However, I praise my hon. Friend the Member for Montgomeryshire (Glyn Davies) for securing this debate and for highlighting this important issue, and I pay tribute to all hon. Members who have contributed their passionate views to the debate.

10.24 am

Kevin Brennan (Cardiff West) (Lab): This is a political issue. It may not be a purely party political issue, but it is a political issue, because ultimately it is decided by politicians. If a similar proposal were introduced for other parts of the United Kingdom in this House, it would probably be whipped by the Government, who I imagine would take a political position on the issue. That may or may not be the case, but whether or not the issue is party political, it is political because it is about life-and-death matters affecting our constituents, matters that are ultimately decided by politicians. That is our duty and we should not give politics a dirty name by saying it is not a political issue, because politics is important—often, it is a life-and-death matter—and this is one example.

I listened carefully to the arguments of the hon. Member for Montgomeryshire (Glyn Davies). I absolutely accept that he is entirely sincere in making those arguments and that he has considered the matter very seriously. I know that, through a close friend, he has personal experience of the issues involved. I also know of his work with the Kidney Wales Foundation, a charity that is located in my constituency and has done such sterling work to move the issue up the agenda in Wales and to help develop the proposal brought forward by the Welsh Assembly Government.

However, I struggle to understand the logic of the hon. Gentleman’s position. He appeared to be saying something with which we can all agree—that increasing the levels of organ donation will not simply happen through a proposal such as soft presumed consent and that other things could and should be done to increase organ donation. As he rightly said, the very fact that the previous Prime Minister raised this matter from the top and generated a taskforce and a debate has helped to improve organ donation, in the same way that the Alder Hey scandal had the opposite effect on rates of organ donation in the past decade.

There are things that can be done. One study cited in the science section of the Library’s note, which hon. Members may have read, stated that the four main factors for high donation rates are “an opt-out policy”, which we are here to debate, and

“a large number of transplant centres…a high percentage of the population enrolled in university education…and a high percentage of Roman Catholics”.

That may explain the sanctimonious hyperbole of the Archbishop of Wales on the issue. He may want to reconsider the position that he has taken and to consult some of his ecumenical colleagues in other parts of the Christian faith.

The reason why I struggle with the logic of the hon. Member for Montgomeryshire is that he said that his objection was not ethical. We do not therefore have to

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deal with the issue of whether the proposal is an imposition by the state, which should not in any way presume anything about what should happen to the organs of someone who has died. He said at the outset of the debate that his objection was not on such grounds; he said that he wanted to cite the evidence. When I asked him whether he thought such a soft organ donation proposal would make matters worse, he said that a line in the taskforce report stated that that was a possibility, but that that was not his position and that he was not arguing that a proposal for soft organ donation would make matters worse. At the very least, all the proposal would do, according to his own argument, is make things no better. Yet he accepts that, by raising the debate and the issue, organ donation rates are likely to increase.

My argument is that the proposal is not a significant imposition on the individual human rights of people, because it is soft organ donation. In practice, what would happen is that, when an organ becomes available, it will be presumed that the donor had consented but there is still the safeguard that the relatives of that donor have to be consulted. All that would change would be the nature of the question. It would no longer be, “Your loved one did not carry a donor card and did not indicate consent before this misfortune befell them, would you agree to their organs being donated?” Instead, the question would be, “As you know, in this jurisdiction it is presumed that consent is given unless somebody opts out, and therefore we intend to proceed unless you decide to veto that process.” That is the difference. In my view, logic tells us that, in those circumstances, it is likely that more organs will be donated. Even if that was not the case, and even if, as has been said, it made no difference whatever, are we not right to try?

I believe that the proposal will be a success, and we should try it. This is the advantage of devolution: it is possible for the proposal to be tried in one part of the United Kingdom just as the smoking ban was tried despite massive objections from all sorts of people. That proved a huge success and the ban was adopted in other parts of the United Kingdom. I think the same will happen in this instance.

Glyn Davies: I accepted in my speech that the proposal in Wales may have triggered my debate in some way, but this is an issue for the United Kingdom. We have all spoken about a situation that needs to be improved, and that needs to happen across the United Kingdom. That is what today’s debate is about.

Kevin Brennan: Indeed, and I accept that. As I just said, I believe that the proposal in Wales will, eventually, lead to an improvement right across the United Kingdom.

On the constitutional point, the Welsh Government have taken legal advice and believe that they have the necessary jurisdiction to undertake the reform. If the United Kingdom Government and their legal advisers do not believe that to be the case, how should the Welsh Government react? I will tell you, Mr Crausby: they should react by making sure that they make any necessary changes to ensure that it is absolutely clear that the Welsh Government have the necessary jurisdiction to make that reform. Otherwise, we are heading for an unnecessary constitutional crisis. I hope that the Under-Secretary of State for Health will make the issue clear when she replies to the debate.

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10.31 am

Jonathan Evans (Cardiff North) (Con): I am grateful to be called, Mr Crausby, and I shall be brief.

First, I should like to place on record my thanks to Mr Max Gabe Wilkinson, my former neighbour, who was the founder of the Kidney Research Foundation in Wales. More than 30 years ago, he signed me up to a donor card. I can say to the hon. Member for Newport West (Paul Flynn) that, as the vice-president of the Catholic Union of Great Britain, I have been a declared donor ever since, and therefore this is no prelatory speech.

My concern is to maintain the integrity of organ donation, and confidence and trust in the system. In context of UK policy and its impact on what is happening in Wales, my remarks today will be limited to what has happened in trying to promote more organ donation through the DVLA website. As part of a policy that applies to all of the United Kingdom—the Minister is aware of my concerns because I have written to her—it is legitimate to say to people, “Do you wish to opt into organ donation?” That new system has been in operation since 1 August, but in Wales, there is no capacity to say no. My hon. Friend the Member for Ceredigion (Mr Williams) put his finger on it when he said that there should be the option to say no. The Minister has helpfully written to me to say that there does not need to such an option because people can change their minds and decide to opt in later on. But if we are to have two separate systems, the option in Wales, as one of my constituents has written to me to point out, is that one cannot opt out if one is proceeding to declare a viewpoint on the DVLA website. Therefore, ultimately, if legislation is introduced in Wales—I am not expressing an opinion as to whether that legislation should be passed or not—there would have to be a different approach. Otherwise, one fundamentally undermines people’s ability to be confident that if they want to opt out, they can say so. They cannot exercise that choice on the current DVLA website.

Why is that important? It is important because we need to maintain that trust, and at the same time maintain the legal integrity of the system. Although it has been said that everything will be fine, and never mind about the legal competence, the issue relates to the position of the European Court of Human Rights. In the event of something going wrong, heaven forbid, we could end up with a negative situation in which the process that is adopted in Wales fundamentally undermines confidence in organ donation altogether. Those factors need to be in Ministers’ minds, and that is why I wanted to make a brief contribution to the debate.

Several hon. Members rose

Mr David Crausby (in the Chair): Order. I am going to ask the Front-Bench spokesmen to speak at 10.40, so I ask for a short contribution from David Simpson.

10.34 am

David Simpson (Upper Bann) (DUP): I appreciate the opportunity to speak, and I will be very brief.

I congratulate the hon. Member for Montgomeryshire (Glyn Davies) on his passionate speech, and I understand how he feels. If we put ourselves in the position of those

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who are waiting on transplants, the picture is entirely different. If any one of us sitting in this room were waiting on a liver transplant, a lung transplant or whatever, we would do anything to cling on to life for our families and our children.

I accept the moral and ethical issues, and personally I might have issues about the moral aspect, but would it really matter to one of us in this room whether it was an opt out, opt in, moral or ethical choice? If you had to grasp on to life, you would do anything. Having said that, I understand that there is wealth of different arguments and opinions in this room, but life is life, and we must try to help those who are waiting on organ transplants.

Between April 2010 and March 2011, more than 1,000 lives were saved in the United Kingdom from lung, heart, liver or combined transplants. As has already been said, those people would be dead today without those transplants. That represents 1,000 families who still have their loved ones with them. When we look at the percentages, transplants are now so successful in the United Kingdom that, a year after surgery, 94% of live donor transplant kidneys are still functioning well; 88% of kidneys from people who have died are still functioning well, as are 86% of liver transplants, 84% of heart transplants and 77 % of lung transplants. That is a fantastic achievement for the medical profession.

Although there are moral and ethical issues, I believe that we should try to find some way around them. Not only should this argument be debated in this Chamber, but it should be debated in the main Chamber. We should find some resolution to it, because life is precious to no matter who it is. Perhaps a pilot scheme launched by the Welsh Assembly is the way forward, but I believe we must find a resolution. The hon. Member for Kettering (Mr Hollobone) congratulated the give and let live campaign and that campaign should be extended. Primary schools were also mentioned in this respect. We hope and trust that a resolution can be found.

Mr David Crausby (in the Chair): An even shorter contribution from Duncan Hames.

10.39 am

Duncan Hames (Chippenham) (LD): Genuinely held views have been expressed by Members in this debate. We heard from Members who are proud of their donor cards, but I would ask Members when they last saw an organ donor registration form. When was the last time that those Members were asked whether they would donate their organs when they die by those who do not know that those Members hold such donor cards? I agree with the hon. Member for Llanelli (Nia Griffith) that we need a methodical way in which people can sign up to the organ donor register. My hon. Friend the Member for Ceredigion (Mr Williams) referred to the success of measures in terms of driving licence applications, but they have only got us so far. We must go further.

The hon. Member for Kettering (Mr Hollobone) put his finger on it when he spoke about the importance of attracting young donors to the organ donor register. Later on today, I will meet the Minister in the company of young campaigners, Abby Thackray and Hope Milne, whose sign up, speak up, save lives campaign featured on Channel 4’s “Battlefront” programme. While the

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debate continues in Wales, we have a suggestion that gives us something to proceed with in the meantime, on which we could make progress in the rest of the Union. With the introduction of individual voter registration, I believe that there is a fresh opportunity to use a paper-based, individual process to invite every adult, as part of a canvass, to be a new organ donor. I hope that the Minister will embrace that opportunity when we meet her and the Minister with responsibility for constitutional reform later today.

10.40 am

Andrew Gwynne (Denton and Reddish) (Lab): Thank you, Mr. Crausby. It is a pleasure to serve under your chairmanship. I congratulate the hon. Member for Montgomeryshire (Glyn Davies) on securing this debate. I also pay tribute to the hon. Member for Chippenham (Duncan Hames) for his sterling effort in squeezing a whole speech into a minute and a half—he did very well.

The system of opt-in for organ donation has been the subject for debate for many years because of the serious shortage of organ donors and consequent waiting lists for transplant operations which has led to suggestions from a number of stakeholders that a review of the current approach to organ donation is long overdue. In the United Kingdom, the number of people awaiting transplant operations greatly exceeds the number of organs available. This shortage of organ donors means that some 400 patients, mainly those waiting for life-saving heart, liver or lung transplants, die each year before a suitable donor can be found. As we have heard during the course of this debate, the BMA, many transplant surgeons, patient groups and many hon. Members in both Houses would like the UK to adopt a system of presumed consent where it is assumed that an individual wishes to be a donor unless they have opted out by registering their objection to donation after death. I recognise that there are strong feelings on both sides of the debate, as we have heard today—not least those put so eloquently by the hon. Member for Montgomeryshire.

Hon. Members who have served in this House for some time will be aware that the former Health Secretary, my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson), asked the organ donation taskforce to assess the possible impact of a change to presumed consent and the acceptability of such a change for the United Kingdom. By doing this, the previous Government recognised the complexity of the issues and widely differing viewpoints surrounding systems of consent to organ donation.

We know that the taskforce examined the complex moral and medical issues around presumed consent, including giving the family of the deceased a final say on the donation of any organs. It also looked at the views of the public, health organisations and other clinical, ethical, legal and social issues raised by a wide range of stakeholders, while at the same time establishing a series of expert working groups to help gather the relevant evidence. The Minister will be aware that the resulting report, entitled “The Potential Impact of an Opt Out System for Organ Donation in the UK” was published in November 2008, recommending that the current system of opt-in be retained and the

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recommendations of the taskforce’s earlier report on organs for transplant, produced in January 2008, be implemented. However, in July 2007, the chief medical officer supported the idea of an opt-out system with proper safeguards and good public information. My right hon. Friend the Member for Kirkcaldy and Cowdenbeath (Mr Brown) also called for a public debate on the issue of presumed consent when he was Prime Minister and did not rule out changing the law to an opt-out system.

So what would actually happen under a system of opting out? It proposes that every person living in the country in which it is introduced is deemed to have given their consent to organ donation unless they have specifically opted out by recording in writing their unwillingness to give organs. Supporters of the introduction of such a system in the United Kingdom believe that establishing an automatic right to take organs when the donor has not expressed wishes to the contrary would lead to a significant increase in the number of potential donors. They also conclude that the relatives of, or those close to, a person who has not expressed a wish to donate would be relieved of the burden of making that decision at such a traumatic time.

However, one fear with presumed consent is that people will not get round to registering an objection and the subsequent expectation that organ donation should take place could lead to unnecessary distress for relatives and widespread adverse publicity. Many transplant recipients add that a donated organ is more easily accepted because they know that it has been positively given by the deceased whereas presuming consent would turn donation into an action by default.

Other concerns surround the potential medical risks involved in removing organs without full discussion with relatives. Families are a valuable source of information about their loved one’s previous health and relatives are questioned as part of the screening process. If an individual does not register an objection, it is possible that their silence may indicate a lack of understanding rather than agreement with the policy. It is because of these concerns that, in the majority of countries operating an opt-out system, health care professionals still consult the family to establish consent.

While always looking closely at both the pros and cons of the system of presumed consent, there is recognition across the health care profession and more widely that there is a crisis which leads to tragic loss of life—in the UK, at least one patient a day dies waiting for a transplant.

The former chief medical officer, Sir Liam Donaldson, was an enthusiastic supporter of presumed consent. He told The Guardian in 2007:

“We have something of a crisis in this country. Every day at least one patient dies while on the transplant waiting list. There are something like 7,000 people on the waiting list at any one time. There is a shortage of organs in this country and the situation is getting worse.”

A team at the centre for reviews and dissemination at the university of York focused on 13 studies and found strong links between presumed consent and increased donation rates. One of the studies found that donation rates were 25% to 30% with presumed consent. However, researchers also said that it was unlikely that presumed consent alone accounted for all of the effect as one study found that the number of transplant centres had a

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greater effect than an opt-out system. Other factors that had an effect on donation rates were death from road traffic accidents, health spending, public awareness and religion.

Support for presumed consent in the UK, as we have already heard, has grown steadily since 2000 and, in a survey carried out in 2007, 64% of respondents were in favour of moving to presumed consent. The BMA’s own figures are even more favourable, showing that around 70% to 90% of the population would be willing to donate their organs after death.

As I said earlier, when my party was in government, the then Health Secretary asked the organ donation taskforce to make specific recommendations to improve the infrastructure within which donation takes place and, since those were made, improvements have been achieved, with a 28% increase in donation rates over three years. The changes proposed by the taskforce include a wide range of measures designed to make the offer of donation a standard part of the care provided to dying patients—in the words of the taskforce, to make donation a

“usual and not an unusual event”.

As we have heard today, the Minister will be aware that this issue is being pursued in Wales with the National Assembly for Wales and the Welsh Assembly Government recently publishing a White Paper on an organ donation Bill for Wales which suggests an opt-out system with safeguards. As we have heard today, the moral and ethical arguments continue. It is right that we have this debate and have it in the United Kingdom Parliament as well as in the Assembly and that we raise awareness of this issue and help to educate people.

I share the concerns expressed today about the insufficient organs donated in the United Kingdom. There is no doubt that we need more people to realise that organ donation saves lives. We know that, in future, organ shortages—particularly for kidneys—are likely to increase. I congratulate the hon. Member for Montgomeryshire on securing this important debate, thank all hon. Members for their contribution and look forward to hearing from the Minister how the Government propose to resolve the crisis, what their position is on a presumed consent system and what action the Department of Health is taking to carry forward the work done by the previous Government on this issue.

10.49 am

The Parliamentary Under-Secretary of State for Health (Anne Milton): Thank you Mr. Crausby. It is a pleasure to serve under you today. I congratulate my hon. Friend the Member for Montgomeryshire (Glyn Davies) on securing this debate on presumed consent. I also thank him for his thoughtful contribution. Like him, I am fixed only on the evidence. I do not have an ethical position on this—I will act on the medical evidence in front of me. Sometimes, with an issue like this, there is a huge danger that the plight of those waiting to have a transplant clouds the ability for some to consider the evidence clearly. What matters is what actually works. The hon. Member for Denton and Reddish (Andrew Gwynne), the shadow health spokesman, outlined some of the complex issues around presumed consent and what faces the public.

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This is not a party political issue. It is an issue decided on by politicians, but I would be saddened if it became a party political issue. It is also not an opportunity to exchange insults. Rather, it is an opportunity to make a difference. So, if nothing else, I would urge hon. Members to leave the Chamber today, and call their local press to see whether. together, they can start a campaign to raise awareness and to begin a conversation in their constituencies. Politicians generally have considerable access to the press. On the whole, we are not averse to having the odd photo of ourselves. I am sure that we have opportunities to raise awareness of this important subject.

There are now about 10,000 people requiring a transplant. Three of them die every day waiting for a transplant or after they are taken off the list because, tragically, they are too ill. Research shows that the majority of people in the UK support transplantation. Extensive reference has been made to Wales, and we shall study those proposals carefully before we respond. But I want to make it clear that the Government do not believe that the introduction of presumed consent, by itself, will necessarily lead to an increase in donor rates. It is important that any Government keep the evidence under review.

As many hon. Members have said, the organ donation taskforce considered the issue of presumed consent in great detail. As my hon. Friend the Member for Cardiff North (Jonathan Evans) said, many of those involved in the taskforce changed their minds, and that is an important point to make. In its second report, published in 2008, the taskforce did not recommend introducing an opt-out system. It felt that an opt-out system would have the potential to deliver benefits but, as my hon. Friend said, it would also present significant challenges that would need to be overcome. Instead, the taskforce believed then, and believes now, that a significant increase in donor rates can be achieved by acting on the recommendations in the first report.

The UK needs to maximise its potential for donation and make organ donation a usual part of health care. We still believe that the implementation of those recommendations will result in an increase in organ donation rates at least 50% by 2013, and that is still on track. Through NHS Blood and Transplant, the number of specialist nurses, clinical leads, donation committees and donation chairs in acute trusts have all increased, and that has borne considerable fruit—since 2008, an increase of 31%, up from 28% —those are the most recent figures.

Some studies suggest a link between presumed consent and higher donor rates, but closer examination shows the picture to be very much more complex—my hon. Friend the Member for Kettering (Mr Hollobone) was so right. Spain has been quoted at length. It has a donor rate of 32 per million of population, compared to the UK’s 16 per million. They have presumed consent, but the architect of the “Spanish model” has repeatedly stated that the legal basis of consent is irrelevant to organ donation. What is critical is the organ donation and retrieval system in place, with highly trained staff and a well-designed donation framework, supported by high public awareness of the issues and benefits. We need awareness and a conversation with our families. In

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practice, I doubt whether there is a surgeon anywhere who would take an organ from somebody without the consent of their family.

I am pleased to report that organ donor rates have increased by around 31% since 2008 and we are on track to meet the 50% improvement. On top of that, over 18 million people, some 29% of the United Kingdom population, have added their name to the organ donor register. In 2010-11, there was a record number of deceased organ donors—1,010 donors compared with 745 in 2001-02. That year also saw a record number of transplants from deceased and living owners—3,740 transplants were carried out in the UK, compared with 2,600-odd in 2001-02. However, despite the progress, there is still a shortage of organs and I am surprised that more has not been made of the inequalities that surround this issue.

The situation is very serious for people from African-Caribbean and Asian backgrounds, who are three to five times more likely to need a kidney transplant. Almost a quarter, 23%, of patients waiting for a kidney are from black or minority ethnic groups but they make up only 8% of the UK population. Three quarters of people from a BME background refuse organ donation when asked, compared with an average figure of 40%. There is particular and specific issue, which we need to address, but it is not insurmountable. We need more people from BME communities to register to donate their organs and, more widely, there needs to be a greater understanding in BME communities of the problems that they face—a greater need for kidney transplants, longer waits and less well-matched organs being donated for their communities.

We cannot be complacent and must carry on the work of the previous Government through schemes such as the give and let live initiative; requiring people to answer a question on organ donation when applying

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for a driving licence on-line; signing on the organ donor register when applying for a European health insurance card or a Boots advantage card; and specific initiatives within the black and minority ethnic populations, like working with faith organisations, radio stations, charities and community groups. What we really need is for people to sign up to having a conversation with their families. That is what really matters.

Work continues at every level on referring and procuring organ donors. We are also trying to make organ donation a usual part of end-of-life care. I hope hon. Members will think on that for a moment. When we think about making organ donation a part of end-of-life care, one realises what a complex, emotional and sensitive issue this. The hon. Member for Llanelli (Nia Griffith) mentioned families talking about this matter. That is so critical, so that when tragedy comes, the transition to donation is simple.

We have set up a transitional steering group, and it will focus on six key areas: increasing consent rates; brain stem death testing in all appropriate cases; donation after circulatory death to be considered in all circumstances; increasing donation from emergency medicine; referral of potential donors; and improving donor management.

I thank hon. Members for their thoughtful contributions. I know that this is an emotive issue that raises strong feelings. We need an evidence-based approach. I thank all those in this country who have donated the organs of family members in the midst of the turmoil of death. That death has and does give life to others—not just one person, but often two, three or four people. Nothing can ever relieve the burden of grief or loss, but nothing can replace the gift of life that organ donation represents. We have to use every tool at our disposal to increase those donation rates. We have to remind people, at every opportunity, that this is about a gift of life and in particular focus on those communities that are more disadvantaged than others.

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Water Bills (South West)

10.59 am

Dan Rogerson (North Cornwall) (LD): It is a pleasure to serve under your chairmanship this morning, Mr Crausby, and I am very grateful for the opportunity to cover this particular topic. It will not be for the first time, I must say. Those who have sat in your position over the years have seen many debates secured by Members from our part of the world on this huge issue for our constituents: very high water bills.

We have moved on a little since we last met. I recall being here in March for a debate secured my hon. Friend the Member for Torbay (Mr Sanders), at which point we were still looking at how the responses to the Walker review of 2009 would come forward. We now have a concrete response from the coalition Government, about which I am delighted. Politicians are always looking out for our constituents, so there are one or two things I want to ask the Minister later, particularly about social tariffs and WaterSure, but I would like to start off the debate by congratulating the Department and the Minister’s colleagues across Government for the contributions they have made.

It bears repeating why we are in this situation and what the experience of our constituents has been in Devon, Cornwall and the west of Somerset and Dorset over the past couple of decades since privatisation. At the time of privatisation, there was an aspiration on the part of the Conservative Government to see private investment coming in to develop infrastructure that had been neglected. There is no doubt that it had been neglected for decades, but there was huge concern at the time from those who could not see how competition could work in a sector where there was one main supplier and one main company dealing with waste. That has been an issue, in that no sort of market emerged, unlike in other privatised industries.

The key question for us in the South West Water area was one of infrastructure. The company was able to do a huge amount, both to deal with the environmental legacy that it was left and to meet the requirements set by the Government and the European Union. We welcome that, of course. Organisations such as Surfers Against Sewage, which has been around and done fantastic environmental work over the years, were at the forefront of holding Government and industry to account to deliver on their commitments and obligations. While we have seen progress, investment can only be secured against an income stream. The company had to seek that investment—get investment from shareholders and go to the markets for money—on the basis of an income stream.

In Cornwall and south-west England, we have seen a huge legacy of environmental works that need to be carried out, to a far greater degree than any other part of the country. I refer to the fact that the population of Cornwall accounts for 3% of the population of England, but we have 30% of the coastline. That is an easy way to illustrate the scale of the problem; we have a large amount of work to do, but a relatively small population to pay for it, despite the fact that the coastline is a national treasure, if you like. It is enjoyed by people from across the country who come to take advantage of it. We have the south-west coast path and all sorts of

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attractions for people to come to enjoy the beaches and countryside of Cornwall and Devon, but we have not had a way to capture a contribution from those people towards the maintenance of infrastructure. It falls to people living closer to that national asset to pay for the whole lot.

There has been some concern in the press recently about the policy of contribution outlined in the Budget and referred to in the autumn statement, and the money set aside to help in this regard. There was an article in The Times last week, in which there were rumblings from other parts of the country about how unfair this was. I do not think that that unfairness exists; this is a much fairer solution to a problem that people in my constituency and those neighbouring it have experienced for a couple of decades. There is still, however, a lack of understanding. We have perhaps not made a big enough effort at national level to get across to those who are concerned in other parts of the country just why there is a desperate need.

Andrew George (St Ives) (LD): First, I congratulate my hon. Friend on having secured this important debate. I would like to congratulate the Government and welcome the announcement in the autumn statement yesterday, although I have to say that it was a 20-year ask. My hon. Friend referred to WaterSure and the social tariff. Does he agree that the statement yesterday does not mean that we should not also make a strong case for an equitable outcome with regard to the future statement on WaterSure and the social tariff when the water White Paper comes out next week?

Dan Rogerson: My hon. Friend is absolutely right. Earlier, I hinted that I would return to that, and of course he understands that further questions remain, which, if settled fairly and equitably, could ensure that the contribution set aside in the Budget has the maximum impact, and that none of its benefits are lost through unintended consequences with regard to tariff schemes.

Anne Marie Morris (Newton Abbot) (Con): I am grateful to the hon. Gentleman for giving way and would like to add my thanks to the Government for what is undoubtedly a great contribution to our household bills. Is my hon. Friend expressing concern that, while that is a good first step, we want to ensure that the benefit is not eroded by future changes? There is the prospect of further EU directives impacting on the cost of preserving our beaches.

Dan Rogerson: We must always have an eye on those sorts of costs and look at any other measures that the Government introduce to deal with the emerging issue of water poverty, which is unfortunately catching up in other parts of England and Wales. Any measures to tackle that should not undermine the good done in the recent announcement.

The time of privatisation in the late 1980s was particularly fraught in my constituency, because it coincided with a water poisoning incident at the Lowermoor treatment works, which is still controversial today. A link was drawn between the fact that there was no inquiry into the incident at the time and the fact that privatisation was under way. I must say that that feeling still exists in the minds of many who feel that they may have been

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affected by that incident. There is an ongoing inquest in Taunton that is finally getting to the bottom of some of those questions. I pay tribute to Doug Cross for all the work that he and his fellow campaigners have done on that issue over the years.

We then moved into the period when it became apparent that all of this work needed to be done. It was done, and there have been huge improvements in water quality, with benefits to the local community and people from further afield who can come and enjoy our wonderful environment. After the departure of the last Conservative Government, we moved into the period of the Labour Government. I pay tribute to Linda Gilroy, a former Member who campaigned a lot on this issue. It was very helpful to have one Member on the Labour side—they were few and far between, and it is even further between in the south-west now—and she very much engaged with this, and was seeking a response.

Right at the end of the previous Government we had the Walker review. At the last gasp of their term in office, they finally had that review. I must say, however, that we had the feeling at the time that there was not going to be the kind of response that we wanted to hear, in terms of national recognition of this problem. We wanted the recognition that it needed to be handled at that level rather than by the relatively small population in the area. I was frustrated by the attitude of Ofwat in all of this. They could have played a much stronger role in advocating to the Government on the issue of unfairness and the problems it causes for bill payers and the industry in the south-west.

We move on, however, and we now have a coalition Government who put their determination to do something about this in the coalition agreement. I pay tribute to the Chief Secretary to the Treasury on the Liberal Democrat side, and to the right hon. Member for West Dorset (Mr Letwin) on the Conservative side. I know that both of them are determined to work with DEFRA to deliver on this and ensure that that commitment is met. However, with the very welcome £50 contribution towards each household’s domestic bills in the South West Water area, there are further decisions to be taken around WaterSure, which is a scheme that helps people who are in the most need with their bills. It is funded by a form of cross-subsidy from billpayers. The crucial question is whether that subsidy is a within-region subsidy, or whether it is a national one.

I have heard the view that it should just be within the water company’s area. However, that is a dangerous road to go down, for the following reasons. First, I believe that it should be about meeting need, wherever that need may be. Even after this £50 contribution to high water bills per household in the south-west, we will still have the highest water bills in the country, by some way. If we compare the average £517 annual charge in the south-west—and that is the average, of course; those who are unmetered will have a much higher charge—with the Thames Water figure of £319, we see that there is a £219 difference. The £50 will close that gap a bit, but it will still be considerable.

I accept that that is as far as the Government could go with that measure of financial support in the Budget. However, for customers still struggling with those high

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water charges, WaterSure is a lifeline. For those who are just above that threshold, as always, we have this issue. It would be unjust, having at last secured recognition and support from the Government, to see some of that £50 clawed back in a significant way to fund WaterSure, and also further in regional social tariffs, which is something that water companies are exploring.

South West Water have really engaged in this process. As a private company, it is a tricky thing for it to do; confronting the fact that it has the highest bills is perhaps something it does not want to talk about. However, I pay tribute to Chris Loughlin and the management of the company, who have been absolutely straightforward about the fact that this is the problem they are facing. They want a solution, and they want to play their part in driving forward efficiencies in the business. They were honest about the situation that we face.

South West Water also want to do more with social tariffs. However, the issue for the company is that if we were to have WaterSure funded only within the South West Water area, that would mean that every bill payer who is not on WaterSure would be paying approximately £3.41 towards those who are, whereas across the country the average funding for WaterSure on bills—I am sure the Minister will correct me if I get this wrong—is 30p to 40p. That is a far fairer way of dealing with the issue. Just because someone happens to live in the south-west, they should not be affected by these social tariffs to a greater degree than people elsewhere. The need for people to be on social tariffs in the South West Water area is much higher than in other parts of the country, because the bills are higher, but also because, despite what some might feel about the leafy south-west, it is an area of great poverty. My own region of Cornwall is in receipt of convergence money from the European Union in recognition of the fact that, sadly, our economy still has some way to go to catch up with the wider UK economy.

Another parallel that could be drawn is the issue of additionality. It was always a battle under the previous regional development agency regime to say that, just because we are getting the convergence money, we should not miss out on our fair share of the regional development agency’s money as well. It is supposed to be additional, to help us get to parity with everybody else. This £50, welcome though it is and a tribute to how the coalition Government is tackling these problems, should be in addition to WaterSure and social tariffs that come along. It is not a replacement for them. While the Minister’s Department is looking further at how these social tariffs could play a role in meeting that need, my key point today, in thanking the Minister and the Government for what they have done for our constituents with this £50 assistance, is to ask that when we return to the issue of WaterSure and social tariffs, we should, as far as possible, make them fair and focused on individuals, no matter where they are in the country, rather than being in some kind of fortress south-west, because we would then be taking a step back, having made a step forward. I would hate the Government to be doing that when they are at last making great progress on an issue which has been a huge problem for us over the past two decades.

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11.15 am

The Parliamentary Under-Secretary of State for Environment, Food and Rural Affairs (Richard Benyon): First, may I congratulate my hon. Friend the Member for North Cornwall (Dan Rogerson) on introducing this debate in an extremely timely manner. Perhaps if it was this time yesterday he would have been extolling the Government to take yet more action, and I am very glad that we were able to deliver. It has been a feature of Parliamentary life that when two or more south-west MPs are gathered together, the issue of water charges is raised, and as the Minister responsible, I am well aware of its importance to a huge number of his and other hon. Friends’ constituents in various constituencies across the south-west.

This is a really important issue for those people, and I recognise the important point that my hon. Friend made at the end: welcome as the measure is, he and other Members from all parts of the House will continue to push on this issue until they feel that greater parity has been achieved in water charges. As he knows, the average water and sewerage bill for household customers across England and Wales is £356, but the average for South West Water, before we implement these changes, is £517. He and other hon. Members will have dealt with cases of constituents, many of them in extremely straitened circumstances, whose bills are considerably higher. I recognise that this is an ongoing discussion and one that I am keen to continue to have with hon. Members across the south-west.

I am delighted that the Government were able to announce details of support for customers of South West Water in the autumn statement yesterday. Every South West Water household bill, as my hon. Friend says, will be reduced by £50 a year. That follows the commitment made in the Budget earlier this year to use public expenditure to support households facing high bills. The Government had to act. In her review, Anna Walker identified the fact that households in the south-west of England faced the highest water bills in the country, because at the time of privatisation, South West Water had the lowest levels of infrastructure required to protect drinking water quality and safeguard the wonderful environment that my hon. Friend so accurately described. This was the biggest challenge facing any water company at privatisation and in the 20 years that have elapsed since then, South West Water has invested around £2 billion to raise sewerage standards to the same level as elsewhere.

Local people have benefited though improved water quality, reduced leakage, cleaner beaches and bathing water, but—and it is a very big but—the cost has been met by those customers. The Government recognise that circumstances faced by customers of South West Water are exceptional and unfair. We are now addressing this historic issue and will contribute to the cost of reducing bills. We looked very closely at Anna Walker’s recommendations, and that was a feature of the debate that my hon. Friend secured some months ago in this Chamber. We decided that each household customer should receive an annual discount on their water bill. I am very grateful to all the south-west MPs who have doggedly raised this issue and demanded action. It is in the hon. Gentleman’s character to be big enough to

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recognise the input from Members of all parties and, of course, to Linda Gilroy, who raised this question in her time in the House.

This is a fairness measure: a payment to all South West Water household customers to redress an historic unfairness. This debate comes just ahead of the water White Paper, of which a key theme is affordability. South-west MPs have often raised with me and my predecessors individual cases of people in their constituencies who really struggle to afford their bills. Thankfully, even before yesterday’s announcement, South West Water had taken action to address the region’s particular set of circumstances and to tackle affordability problems. The company has a free debt helpline that helps customers to set up payment plans, it offers water metering and water conservation advice, and it recognises that many people are able to reduce their bills and to use water more efficiently by having a water meter.

I echo the words of my hon. Friend the Member for North Cornwall about Chris Loughlin and his team. I have worked closely with them, and they have an absolute and genuine determination to address the issues. South West Water works with local citizens advice bureaux and other experts, and it has introduced a range of initiatives to help those who find it difficult to pay their bills. It has established an advice gateway with south-west citizens advice bureaux and it trains and sponsors CAB debt advisers. Advice agencies such as the CAB can refer struggling customers to the company’s water care scheme and can obtain benefit entitlement checks, tariff checks, water efficiency advice and free efficiency devices.

South West Water also has a scheme for customers who are in debt, and I am very impressed by that work. I have been into households with advisers and seen the impact that they can have on the bills paid by people on low incomes just by installing a very few items or by changing those people’s behaviour, including what they do and how they use water throughout the day. That can have an enormous effect on household bills, but I recognise that, in this context, it might still be only a relatively small proportion of bills. In doing that, South West Water and companies with similar schemes have recognised the benefits to customers, and also to the company. I applaud such schemes, which are designed by water companies to tackle local problems in their region. Many companies in other Members’ constituencies have similar excellent schemes.

Water affordability problems are not confined to the south-west. Across England and Wales, 23% of households spend more than 3% of their disposable income on water and sewerage charges. Some 2.5 million households are spending more than 5% of their disposable income on water. That is a very important issue and one that the Government take very seriously. That is why water affordability will be a key theme in the upcoming water White Paper. We will commit ourselves to a long-term and a short-term set of actions to ensure that water bills are affordable.

WaterSure, to which my hon. Friend the Member for North Cornwall referred, will continue. It will be supported by social tariffs, which will enable water companies to design locally appropriate schemes. We believe WaterSure is really important, but we recognise that its criteria mean that it deals only with families who have a relatively large number of children—three or more—or with elderly or infirm people who require more water because of

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their circumstances. I have been persuaded by the many moving cases that have been put to me by colleagues about the circumstances of particular constituents.

I recognise the importance of WaterSure in addressing the concerns of those individuals, but I also recognise that about 50,000 people are currently claiming. WaterSure can therefore only ever help a small group of people in water need. That is why company social tariffs, on which we are consulting, are so important. When the consultation ends in January, we will quickly announce the guidelines for those enormously important tariffs.

Dan Rogerson: The Minister is being very helpful. On the groups who are covered by WaterSure, the south-west not only has many people on low incomes, but it has an ageing demographic because of the huge inward migration of older people and the outward migration of younger people. If WaterSure could be established with a national coverage, it would ensure that when people spend their active working life in another water region of the country and then end up in the south-west—I hope, to live a happy and long life in retirement—we had a fairer distribution of the cost. Otherwise, that will all have to be funded within the region.

Richard Benyon: My hon. Friend makes a very good point. However, the other important point to note is that the fact that the south-west has a much higher percentage of households on meters is good for those particular people, because they very often use much less water than larger families or households in multiple occupancy. That offers a really effective way not only of paying proportionally lower bills, but of managing problems—for example, they will know much sooner, if they are on a meter, if there is a leak. I applaud the work done by the company. We want to see such work developed not only in the south-west but elsewhere, and we will encourage that.

Andrew George: The Minister is speaking about the crux of what will no doubt appear in the water White Paper next year. The impact of the flat £50 per household

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reduction is welcome. It will apply irrespective of whether households are wealthy second home owners on water meters who therefore have relatively low bills or the large number of local families in straitened circumstances. It is those families for whom a nationally equitable solution is required because, despite the £50 reduction, they will still face considerable bills.

Richard Benyon: First, I can say to my hon. Friend that he will not have to wait until next year for the water White Paper, which is much more imminent. I cannot tell him precisely when, but it will be very soon. Secondly, the White Paper will examine the whole range of affordability issues and solutions. I hope that the package we introduce will make a real difference.

My hon. Friend and all Members who represent the south-west will recognise that that will require legislation, which is why I cannot promise that it will be delivered before April 2013. I wish it could, but we are convinced that primary legislation is required, although we hope to deliver it in time for the start of the financial year in April 2013.

Company social tariffs will allow water companies everywhere to reduce the bills of those who would otherwise be unable to afford them in full. In conjunction with the excellent existing support schemes and advice, companies will be able to design the right tariffs for their region. We want all companies to introduce social tariffs as part of a package of advice and support for customers about affordability and efficiency. I hope that hon. Members, advice organisations and environmental organisations will work with water companies to design the best schemes for their regions.

Before I conclude, I just want to express again my appreciation to hon. Members across the south-west for their efforts in bringing forward this matter, and my determination to continue this discussion in the future.

11.28 am

Sitting suspended.

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Scotland (Poverty)

[Mr John Robertson in the Chair]

2.30 pm

Sandra Osborne (Ayr, Carrick and Cumnock) (Lab): I am grateful for having been able to secure this debate on poverty in Scotland on 30 November, St. Andrew’s day, which is also the day of industrial action in support of public sector workers and their pensions. Nothing could be more relevant to the working people of Scotland today than highlighting the threat of the growing poverty in our nation and the attack on workers’ rights by this ideologically driven, right-wing coalition Government. As I describe the Scotland I know, the reality of poverty and the threatened growth in poverty which is facing Scotland, I hope that the Minister will reflect and respond from his perspective of Scotland—although I have my doubts that there will be a shared perspective.

We Scots are often portrayed as a bit sentimental about Scotland, especially on occasions like Burns night or St. Andrew’s day. I want to talk about the reality of poverty in Scotland today. I do not think that the Minister will want to use any notes from my speech at whatever St. Andrew’s night bash he graces this evening. The national heroes and heroines to whom I would like to pay tribute are the anti-poverty organisations such as the Child Poverty Action Group in Scotland, the Poverty Alliance, the churches and other umbrella groups, bringing together those committed to seeing a fairer, more equal Scotland. The heroes and heroines to whom I would like to pay tribute are those in the unions and the Scottish Trades Union Congress who stand up for people’s rights at work and who fight the scourge of unemployment and the attack on working conditions. That is the Scotland to which we should pay tribute today.

I would like to acknowledge the excellent work done by John Dickie, head of CPAG Scotland, particularly for producing the book “Poverty in Scotland”, which contains some relevant facts and figures to which I shall refer. How do we measure poverty? People are considered as living in poverty if they live in households with less than 60% of median household income. That is the key measure used by the UK and Scottish Governments and by the European Union. Using that measure, and after housing costs are taken into account, the latest official data show that a single person is in poverty if he or she is living on less than £124 a week. A lone-parent family with two children aged five and 14 are in poverty if they are living on less than £256 a week, as is a couple with two children aged five and 14 on less than £346 a week—which is just over £12 a day, and not a lot to cover food, fuel bills, household goods and transport, never mind school trips, family visits and leisure activities. About 970,000 people in Scotland live in poverty—19% of the population. About 250,000 children live in poverty—25% of all children. Poverty in Scotland and across the UK is significantly higher than in many other European countries. In Denmark and Norway fewer than 10% of children live in poverty, while Germany has a poverty rate of 15%.

One would have thought that poverty levels in this day and age should be falling, but not any more. Yes, real progress had been made specifically among children—the numbers went down by 100,000 between 1996-97 and 2004-05. The number of pensioners in poverty has

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decreased by nearly two thirds since 1996-97. However, since 2007 there has been no overall reduction in child poverty or in poverty among adults of working age.

Mark Lazarowicz (Edinburgh North and Leith) (Lab/Co-op): I am grateful to my hon. Friend for giving way and I congratulate her on securing this debate. Given her comments, does she share my disappointment and anger at the fact that 10,000 children in Scotland are likely to be forced into poverty as a result of the tax and benefit decisions made by the Government yesterday?

Sandra Osborne: Absolutely. I will come to that point later.

These trends follow dramatic increases in poverty between 1979 and the mid-1990s. Perhaps, like me, the Minister remembers those years and can offer a view on what caused that to happen and on whether we are heading back in that direction, thanks to his Government’s policy. That is exactly the direction in which the Government are taking Scotland. Cuts and reforms currently in train will have a significant negative impact on individuals and communities across Scotland and on devolved issues such as housing, child care, health, social care, equality and anti-poverty policy as a whole.

In June 2010 the Chancellor promised a Budget that would be tough, but fair. He announced an increase in VAT to 20%, a two-year pay freeze for public sector workers, a three-year freeze in child benefit and a tightening of housing benefit entitlements and eligibility for child tax credits, among other austerity measures. Coupled with the comprehensive spending review last October, those measures represent some of the most regressive in living memory. Yet, in the same breath, the Government claim that we are all in this together.

Fiona Bruce (Congleton) (Con): I thank the hon. Lady for giving way. Does she not recognise that if the Government had not had to make these difficult decisions, the position for children growing up in Scotland—and, indeed, their children for generations to come—could have been far worse?

Sandra Osborne: My point is that the cuts have not been made in a fair and even manner, as the Government promised. I will develop that point later.

It is all too evident that the impact will fall disproportionately on vulnerable groups and on those who deliver the services on which those groups depend. Those are not just my views; there has been widespread condemnation from campaigning groups and third-sector organisations in Scotland that the budget and austerity measures will further increase poverty and inequality.

As my hon. Friend the Member for Edinburgh North and Leith (Mark Lazarowicz) said, in yesterday’s autumn statement we heard of further measures. The Chancellor announced the expansion of free nursery places for two-year-olds, helping 260,000 children. But, alongside that, he announced that he would be taking more than £1.3 billion a year from families by failing to go ahead with the planned additional £110 rise in child tax credits and by freezing working tax credits.

Dr Eilidh Whiteford (Banff and Buchan) (SNP): I congratulate the hon. Lady on securing today’s debate. This is a very important subject to discuss on St. Andrew’s day. Does the hon. Lady share my concern that the

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poorest families will suffer a disproportionate impact from these cuts, and that the 20% of the poorest families in Scotland will bear the brunt?

Sandra Osborne: That is the whole point of raising this debate today.

All this has happened despite the fact that when the Chancellor announced the rise in tax credits he said that it would support 4 million lower-income families, helping to ensure that there would be no adverse impact on child poverty. As the Minister knows, there is now a law relating to child poverty. The Chancellor has now taken that extra support away from the 4 million families. In its distributional analysis of yesterday’s measures, the Treasury has admitted that, as a result of the decisions taken by the Government, the number of children living in households with incomes below 60% of the median will increase by 100,000 in 2012-13—which will mean more children living in poverty.

Cathy Jamieson (Kilmarnock and Loudoun) (Lab/Co-op): I thank my hon. Friend for giving way and for securing this debate. When we talk about big numbers, medians and so on, it can sometimes be difficult for people to understand how changes impact on their lives. Is my hon. Friend aware of research done by the Union of Shop, Distributive and Allied Workers which shows that, already, some £989 has been taken from a low to middle-income family as a result of changes to tax credits? That is even before this latest broken promise, with £110 being taken from child credits.

Sandra Osborne: My hon. Friend is absolutely right. We are concerned about the impact on ordinary people. The quicker they realise exactly what this Government are up to, the better.

Who are these people? Alongside children, certain groups are at particular risk of poverty. They include lone parents, women, people who are not working, people affected by disability and people from ethnic minorities.

Mr Brian H. Donohoe (Central Ayrshire) (Lab): I congratulate my hon. Friend on securing this debate. As one of my neighbouring colleagues, she knows full well the problems of unemployment, particularly among young people. Is that not one of the main areas that should be tackled at an early stage—earlier than this Government intend?

Sandra Osborne: Absolutely. I will refer to that later. To say that it is too little, too late would put it very mildly.

Poverty is most prevalent in urban areas, yet there are almost 100,000 income-deprived people in rural areas in Scotland. I would be interested to hear the Minister’s views on what he thinks causes poverty. The Tories are quick to identify individual behaviour as a cause of most social ills, but individual behaviour is of limited value in explaining the extent of poverty in Scotland. The key drivers are inequality, low pay, inadequate benefits, poor-quality work opportunities and lack of support for those with caring responsibilities, ill health

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or those affected by disability. A lack of money leads to the threat of falling into debt, choosing between necessities, going without basics, frequently being caught up in a cycle of dead-end jobs and being unable to save. For children, it means, for example, having less access to safe play spaces and being less likely to participate in arts and drama, sport or other outdoor activities.

While financial inclusion policies have led to significant improvements since 2007 and access to basic financial products, one third of households with incomes of less than £20,000 still have no savings. Those households are also less likely to have the means to participate fully in society more generally. Over half, for example, still have no internet access or car available to them. What is more, they are far more likely to be living in fuel poverty, spending a disproportionate level of already inadequate income on basic— [Interruption.]

John Robertson (in the Chair): Order. There is a vote in the Chamber. The sitting will be suspended for 15 minutes.

Mr Tom Clarke (Coatbridge, Chryston and Bellshill) (Lab): On a point of order, Mr. Robertson. How does this affect the timing of the sitting?

John Robertson (in the Chair): The sitting will be delayed for 15 minutes. Extra time will be added, and the debate will still have its full time.

2.41 pm

Sitting suspended for a Division in the House.

2.52 pm

On resuming

Sandra Osborne: I was about to talk about people who are living in fuel poverty who are spending a disproportionate level of already inadequate income on basic energy bills. Almost 1 million households, more than one in three Scots, now struggle to heat their homes. However, the SNP has cut the budget to help tackle fuel poverty by almost a third, down from £70.9 million in 2010-11 to £48 million in 2011-12. Dr Brenda Boardman from Oxford university, previously lauded by First Minister Alex Salmond, has said that Scotland has some of the worst fuel poverty in the UK. She describes the SNP’s cut in the fuel poverty fund as a real slap in the face for the fuel poor.

Dr Whiteford: I know that fuel poverty is something that is also taken extremely seriously in my constituency, partly because people do not have access to social tariffs on low incomes. They also often have trouble accessing broadband. But will the hon. Lady accept that the SNP Government have done more than previous Labour Governments ever did to address fuel poverty in Scotland, and are making record levels of investment in their energy assistance package and with other measures?

Sandra Osborne: I think that they flatter to deceive. Measures have been cut, including what I have just described. As I say, it is not just from me, it is from a very eminent professional who is an expert in the field. At the end of the day the Scottish Government will decide how to implement the budget in Scotland.

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Not surprisingly, poverty means lower levels of mental wellbeing, shorter lifespans and more ill health. Those in the lowest 20% of household incomes, particularly women, are far more likely to suffer from depression, anxiety and attempted suicide, while men living in the most deprived areas have a life expectancy of more than 11 years shorter than those in the 20% least deprived areas of Scotland. The situation in Scotland is very serious. Here I would like to pay tribute to Campbell Christie, the former STUC leader and another truly great Scot, who recently passed away but who chaired the Scottish Commission on Public Services. Its report said:

“Members of the commission have been struck by just how much public spending is skewed by that bottom 20% in terms of poverty, unemployment, health and all the factors that go with it—and how little progress has been made on that bottom 20%.

If you are going to do anything, you should relentlessly target resources at the bottom 20%. That would bring Scotland up overall: it's not just a moral case for social justice; there's a strong economic argument too.”

A recent national survey revealed that six of the 10 worst areas of Britain are on the west coast of Scotland, including areas of Glasgow.

In any debate on poverty, certain key assertions must be made. First, income and material conditions remain the most fundamental determining dimensions of poverty. Political and policy emphasis on non-income dimensions of poverty must not be used to draw attention away from the fundamental causes of poverty—lack of money.

The policy can work. The Labour Government's commitments and policy action that boosted pensions, benefits, tax credits and wages and removed some of the barriers to work have had an impact, with child and pensioner poverty significantly lower than in 1997. Other policy interventions that should be welcomed include a focus on more equal health outcomes and commitment to the idea of a living wage, although when that was put forward in South Ayrshire by Labour, the SNP Tory administration voted it down. We need more investment and income maximisation, statutory commitments to tackle child poverty and improved access to debt solutions.

Labour made huge strides in government, both in Westminster and at Holyrood, to tackle youth unemployment in Scotland. Again, the clock has been turned back. Youth unemployment is rising fast. Behind these figures is a generation of young Scots, rich in talent, full of potential, with a hunger to work. Yesterday’s announcement in the autumn statement was too little, too late. It will be next April before it even kicks in, which has meant two years of inaction, and equates to £121 million a year, a fraction of the £600 million this year alone which Labour would spend on a youth jobs fund through repeating the bank bonus levy.

Dr Whiteford: Will the hon. Lady join me in welcoming the initiatives of the Scottish Government to ensure that every 16 to 19-year-old in Scotland who is not in full-time education will have a training place or an apprenticeship or a job?

Sandra Osborne: I would very much welcome any measures that are taken in Scotland on youth unemployment, but it does not help when the SNP Government choke off opportunity by cutting funding for the country’s colleges. I attended the graduation

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ceremony at Ayr college the other week and I was very impressed by the students’ achievements, but the level of cuts that the college was facing—10% this year and 20% over the next two years—was very depressing. There have already been job losses and the college has been told to concentrate on 16 to 19-year-olds. That is fine, except that it takes places away from adult learners.

I received all my education, such as it is, as an adult, and I want young people as they grow older to have cradle-to-grave education, not just between the ages of 16 and 19. That is also needed for the economy.

I refer now to research from the Centre for Regional Economic and Social Research at Sheffield university. It calculates that the headline total of 2.6 million men and women on incapacity benefits is set to be cut by nearly 1 million by 2014. Most of these will be existing claimants who will lose their entitlement. The report shows that, because of the reforms, 600,000 are set to be pushed out of the benefits system altogether, forcing a big increase in reliance on other household members for financial support.

The researchers also show that by far the largest impact will fall on the older industrial areas of the north, Scotland and Wales, where local economies have been struggling for years to cope with job loss and where the prospects of former claimants finding work are weakest. Glasgow looks set to be hit 10 times harder than, for example, Kingston upon Thames. In common with many of my colleagues here, these are just the types of areas that we represent where it has been very difficult to recover from industrial decline in the past. This is not going to help.

Mrs Anne McGuire (Stirling) (Lab): Does my hon. Friend accept that it is not just the loss of individual or family income, but the loss of a significant amount of spending power within already deprived communities which will have an impact on the wider community and not just on the individual family?

Sandra Osborne: These issues affect the whole community, which is why in many ways high unemployment is a false economy. It would be far better invested in the communities. Professor Steve Fothergill, who co-authored the report, said:

“The large numbers that will be pushed off incapacity benefits over the next two to three years are entirely the result of changes in benefit rules. The reduction does not mean that there is currently widespread fraud, or that the health problems and disabilities are anything less than real.”

He then goes on to say that

“the estimates show that the Coalition Government is presiding over a national welfare reform that will impact principally on individuals and communities outside its own political heartlands.”

The Minister will be painfully aware that Scotland certainly meets that description.

I do not have time this afternoon to go into the detail of the Government’s Welfare Reform Bill, but behind the stated intention of rolling up most means-tested benefits into a universal credit and making work pay, there are significant increases in the conditions attached to entitlement, and draconian sanctions for those who fail to meet these conditions. Welfare benefits cuts of £18 billion over the next three years, in conjunction with the proposals in the Welfare Reform Bill, will have

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a hugely negative effect on Scotland’s poorest communities, families and individuals. These measures will be across the whole of the UK, but will also cut across a whole raft of devolved responsibilities. They deserve the united resistance of Scottish MPs and MSPs.

Attention must be refocused on to the privileges and lifestyles of the affluent and rich as much as the more disadvantaged. The Government must tackle the banks and fuel companies rather than focus on hitting public sector pensions.

Recently my constituency Labour party launched a plan locally at a public meeting in Ayr: Labour’s five-point plan for jobs. We heard a compelling argument for why this is needed from STUC deputy Stephen Boyd. He said that in Scotland we have a huge full-time employment deficit; that is the deficit that the Tories do not want to talk about. There are more than 150,000 people who want to work in full-time jobs but are currently unemployed. There are also the underemployed, and the economically inactive but wanting to work. There is a total of almost half a million Scots who want to be in full-time employment but are not. Jobseeker’s allowance claimants in East Ayrshire are up 86% on last year, and they are up 65% in South Ayrshire. These are frightening figures. The number of claimants in the last six months in these areas is up 300% and 400%.

Mr Alan Reid (Argyll and Bute) (LD): I am grateful to the hon. Lady for giving way. I sat through her speech, which contained a lot of criticism of the Government, expecting her to come forward with solutions, but they have been lacking. For all of these spending projects that she has talked about, will she tell us by how much she wants to increase Government spending? What taxes will she put up to find the money? The only source of revenue she indicated was a bankers’ levy bonus tax; will she tell us how much that would raise and the rate at which it would be set?

Sandra Osborne: I do not have the figures to hand, but I actually referred to a number of policy initiatives that could be taken and were taken by the last Labour Government. I could go back into my speech and read out Labour’s five point plan for jobs, but I am aware that other Members would like to speak and I was genuinely trying to curtail my remarks. I will let the hon. Member know about it later.

I firmly believe that there is more than one Scotland, just as there is more than one Britain. In the end, how you see Scotland depends on your perspective, your politics and your priorities. To paraphrase Nye Bevan, socialism is a language of priorities, just a very different set of priorities. The trouble with the SNP is that, for all its rhetorical nationalism, there remains a single priority: independence. Today should be a day for getting away from the tired, endless wrangling over constitutional issues and the protracted debate over the long-time-coming independence referendum. It should be a day for getting away from the SNP’s dangerous lottery, playing with people’s jobs, incomes and life chances, ignoring all of the warnings, crossing their fingers and hoping for the best. Today is a day for concentrating on the real Scotland—a country of huge achievement and potential, and a country rich in diverse cultures, but a country that also knows the reality of poverty and the risk of

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increased poverty to come unless it gets the political leadership and policies it needs for a better way forward.

3.5 pm

Ann McKechin (Glasgow North) (Lab): It is a great pleasure to serve under your chairmanship this afternoon, Mr Robertson, and may I congratulate my hon. Friend the Member for Ayr, Carrick and Cumnock (Sandra Osborne) on securing this important debate and providing an opportunity for all of us to reflect that the scale of the problem of poverty in our own country deserves much more time and attention than it receives. In a month when it was reported that the number of pauper funerals in Scotland exceeded 5,500 in the past year, and when a report from the university of Sheffield Hallam stated that Glasgow was the worst area in the United Kingdom for incidences of hunger, it is truly remarkable that we have not one but two Administrations who barely feel able to mention the subject in any of their pronouncements—one largely because of their indifference, and the other in sole pursuit of their one goal, so that if anyone dares make a critical reflection they are talking Scotland down. I do not believe that either serves our country well. Only when we start to talk openly again about poverty will we be able to rise to the challenge.

I would like to focus my remarks today on a couple of points that I believe must be urgently reconsidered by the Government if we do not wish the poverty figures to rise even further. I will start on housing, and in particular the impending changes in housing benefit. The majority on this form of benefit are not on unemployment benefit, but they do represent fairly accurately those who are on the lowest level of income. Shelter Scotland reports that this year only one in eight of all housing benefit claimants is unemployed. The rest includes pensioners, carers and disabled people unable to work. In Scotland, about 19% of people in receipt of local housing allowance are in employment.

The vast majority of those in receipt of the benefit in Scotland are living in rented social housing, and a good percentage of those who are renting privately are occupying former social housing. Prior to introducing the new regulations, which will commence in stages from this year until 2013, the UK Government conducted absolutely no evaluation of the rented housing sector in Scotland, be it the availability in each local authority area of multi-occupancy property or the availability of one- bedroom houses. If I asked anyone living in Scotland, however, to take even a wild guess about what may or may not be available I would imagine just about everyone could anticipate that, outside the major cities, there would be very little multi-occupancy households and that most social housing in Scotland consisted of houses with two bedrooms or more.

Lord Freud in the other place apparently believes in some imaginary world where suitable property will spring from the bowels of the earth in a wonderful free market to allow housing benefit recipients to comply with the new regime rather than live in what he believes is “luxury”. Unfortunately, I remain unconvinced, and so do the Convention of Scottish Local Authorities; the Scottish Federation of Housing Associations; Shelter; the Scottish Government; and many other informed groups who I have met over the last year to discuss this issue.

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If I take just the change in the age threshold for claiming the single room rate, which will be increased from 25 to 35 in April next year, according to figures I requested from the House of Commons Library in January, there are only, for example, 20 multi-occupancy registered homes in the entire Angus council area, but, according to an official answer from the Scottish Government, as of last year there were 100 single people aged 25 to 34 years in receipt of local housing allowance in that area. In North Ayrshire the figures are even worse. There are seven houses of multiple occupancy and 280 people aged 25 to 34 years in receipt of LHA. Where are these people—about 7,500 throughout Scotland—expected to stay?

Mrs McGuire: Does my hon. Friend also accept that the pressure on multiple-occupancy housing is even greater in a city such as Stirling that has a university population? Those who look to conform to the new housing regulations will find themselves in even worse straits than she has indicated in other areas.

Ann McKechin: My right hon. Friend is absolutely correct—that is a point I am about to make. I, too, represent an area that has a university community, and we continually have difficulties about multi-occupancy. Again, the UK Government have completely failed to consider new regulations put in place as a result of legislation that has gone through the Scottish Parliament.

Many local authorities and social landlords have progressively moved away from multi-occupancy lets due to problems with management and its unpopularity with other tenants and communities. In Angus, the difference between the rental level for a one-bedroom home and a shared home rate is £20.77 a week. For people who are unlucky enough to live in rural Aberdeenshire, it is £49.61 a week, because they are sitting in the midst of an oil economy, with rentals to match. Inevitably, people will be pushed into our cities, regardless of where their job is, in a desperate effort to find accommodation.

As I have mentioned, the UK Government have given no thought as to how local communities may feel about the expansion of multi-occupancy housing in their areas. I know from experience in my constituency that there have been examples of the dumping of people in bed-and-breakfast accommodation from other local authority areas, because those areas had no or very few such places available. I can only imagine where all those hundreds of people in north Ayrshire, for example, will have to go—I think that most of them will end up in Glasgow.

Dr Whiteford: The hon. Lady is making some important points about the housing situation. Will she reflect on the situation for pensioners who might also be affected by the under-occupancy rules that are coming in and the fact that suitable one-bedroom properties are simply not available, particularly those on a flat level for people with mobility issues?

Ann McKechin: The hon. Lady makes a good point. I know that that matter is not currently covered in the regulations proposed by the Government. However, should there be any further expansion, we would be looking at something close to a total collapse of social

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housing, because of the sheer numbers of people, particularly pensioners, who are living alone in properties with two or more bedrooms.

One change due in 2013 is that housing benefit will be restricted for working-age claimants in the social rented sector to those who are occupying a larger property than their household size. Do the Government know how many will be impacted by that change? Why do I bother to ask them, because they have no desire to find out?

It has been estimated from the family resources survey that Scotland-wide there are approximately 100,000 households in the social rented sector in receipt of housing benefit where the accommodation is currently under-occupied. We do not, however, know how many of those are rented to retired tenants compared with those of working age. Glasgow Housing Association, which is Scotland’s largest social landlord, has estimated that roughly 13% of their entire housing stock will be affected by just that one change alone. That represents thousands of tenants in just one city in our country.

Such a change may occur simply because an adult child leaves home, even if the family still have children of school age. A family may be forced to move out of a property that they have lived in for many years and in some instances to move many miles from the community in which they are settled—or they might fall into rent arrears, or they could just eat less, or they could not heat their home. That is the reality of the real choices that thousands of low-income families will now face.

Mr Reid: I share some of the concerns that the hon. Lady is voicing. However, it is important to point out that the regulations have not yet been drawn up, so she cannot predict that such things will happen until we see the regulations. I certainly hope that they will be framed sensibly to take into account the issues that she is raising.

Ann McKechin: The proposals are currently in the Welfare Reform Bill. I hope that he and the Minister will think again and will persuade their colleagues in the Department for Work and Pensions and Lord Freud in the other place, who seems to be utterly resistant to making any changes to the clauses relating to those draconian measures. Hon. Members will remember the chaos caused by the implementation of the poll tax, and the consequences we faced for many years due to the scale of the arrears that built up and the misery that was heaped on our poorest communities. Perhaps the Minister will explain why his party has never learned the lesson of what occurs when a Government implement unplanned, arbitrary hits on those with the least resources to cope.

Coming back to my comments about this month’s report on hunger in the city that I am proud to represent, Paul Mosley, professor of economics at Sheffield university, said that the number of people using the Scotcash community bank service who struggled to buy food in the previous week was far higher in Scotland than in any other area of the UK. He said:

“In other cities outside of Glasgow the figure was 1% to 2%... In other words, there were some people whose poverty was so bad they were also in food poverty and sometimes didn’t have enough food to give to the children to eat. But in Glasgow the proportion was something like 10%.”

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Mosley said that the findings supported suggestions that areas of Glasgow suffered a depth of poverty that

“you don’t encounter in other parts of the UK”.

That depth of poverty is no surprise to me, and I am sure it will be no surprise to you either, Mr Robertson. No other part of western Europe witnessed such an intense and rapid deindustrialisation in the 1970s and 1980s, in a city that already had a long history of poverty. I am in no doubt that it will take many years to reverse, but I have always believed that it is possible, if we are prepared to put in the necessary commitment and resources. In recent years, figures on absolute and relative poverty in Scotland have flatlined, but we now face a really tough challenge. Are we prepared to witness the reversal of the advances made during the first years of this century or are we willing to organise our priorities so that we can protect the poorest and do more to improve their lives? That is the real challenge that we face in our country—not the endless debates on constitutional niceties, but what kind of country do we actually want to be.

Just yesterday, as my hon. Friend the Member for Ayr, Carrick and Cumnock correctly mentioned, it was calculated that the Government’s freeze on tax credits and related benefits will put a further 100,000 children throughout the UK below the poverty line. I look forward to hearing the Minister explain in detail how his Government will now meet their legally binding targets on child poverty reduction. I am also interested to know when he last discussed poverty or any related issues with his counterparts in the Scottish Government. If that was not recently, perhaps he could undertake to make a real St Andrew’s day pledge to make the eradication of poverty his priority.