Will the Minister elucidate how the NHS constitution requirement will make a difference? Procedures are already in place, yet 50% of patients on the pathway were not informed, or their families were not consulted. It is time that the soundbite, “No decision about me

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without me” became a principle and a value, rather than the vacuous phrase that it currently is. There is no politics in that—it is really important; it is the core of everything.

Through Lord Alton of Liverpool, I am aware that Liverpool medical school requires all its students to undertake one month’s training in the care pathway, working in a hospice during their fourth year. Such good practice should surely be a core component nationwide, and in the light of a recent study, there is perhaps an argument for making it mandatory across the country. That kind of training needs to be given to those already qualified and working on our wards—not just doctors, but nurses and all members of the multidisciplinary team who are called on to make decisions. If there have to be financial incentives, they should follow the training to ensure that all those who care for the terminally ill and dying are properly equipped with the skills that they need, in what for all concerned are traumatic and often complex situations. Good training costs money and must be externally validated, and I invite the Minister to respond specifically about that need.

I see merits in a system that manages end-of-life care effectively—it is a measure of our humanity that we seek ways to ease suffering—but my concerns about the application of the Liverpool care pathway remain. There is far too little reassurance in the system, which has allowed the pathway to move from an end-of-life care system to one that is held up as hastening death. We can talk about the theory of how the LCP should be followed, but the fact remains that, in practice, it is not always implemented as intended. It should never be seen as a conveyor belt to the cemetery. Some 80,000 patients are supported by—not put on—the Liverpool care pathway, and many receive the finest care, but many is not good enough. It is said that about 1% of cases go badly wrong, but just one case—never mind 1% of cases—is one too many. Those who founded the pathway did so because of their respect for the dignity of patients; those who implement it need to understand and share that view or face the legal consequences and their own consciences.

2.59 pm

Sir Tony Baldry (Banbury) (Con): When I first entered the House of Commons some 30 years ago, I became the founder secretary of the all-party hospice support group, and Jack Ashley was the founder chairman. I am glad to say that that group has now become the all-party parliamentary group on hospice and palliative care. During those 30 years, an enormous amount of work has been done on enhancing palliative care in hospitals. We are fortunate in this country in having an outstanding hospice movement. Part of the purpose of the Liverpool care pathway was to ensure that the good practice of palliative care, which had been developed in hospices, could be spread to other health care settings, such as hospitals and care homes. Extending it to people’s own homes was also important because if people are asked where they would like to die, most say at home. The reality for each one of us is that we will die.

The Liverpool care pathway requires staff to ensure that all decisions to continue or to stop treatment are taken in the best interests of each patient, and emphasises that patients should be involved in decisions about their

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care and that carers and families should always be included in the decision-making process. An evaluation in 2011 showed that in 94% of cases, there had been such involvement. The idea of documenting conversations, which the hon. Member for West Lancashire (Rosie Cooper) mentioned, is sensible. In our own professional lives, and, indeed, as Members of Parliament, we all know that people, especially family members, do not always take on board news that may be distressing. Often it is quite a shock to be told that a loved one is near to death. Very often, the instinctive reaction is to want to ensure that life can be preserved for as long as possible, but we also have a duty of care to ensure that in people’s last days and hours they die well and painlessly and with as much dignity as possible.

I was very struck by two contributions in the Library briefing. One was a brave article by a specialist registrar who herself is a terminally ill cancer patient. Of the Liverpool care pathway, she said:

“It prompts us to have open discussions with relatives, and, if possible, patients, to stop unnecessary medication, to discontinue futile medical interventions, and to shift our focus of care to symptom-control, comfort and dignity… Most patients on the LCP, in my experience, are too poorly to eat or drink, but where a patient is alert enough to swallow we certainly continue to offer them food and fluids in my hospital. They are not ‘starved to death’. The problem with intravenous fluids is that cannulae need to be inserted to administer them. This is painful, often very difficult and sometimes near impossible in patients who have been in hospital for a number of weeks.”

Jim Shannon (Strangford) (DUP): Although the hon. Gentleman makes a pertinent point, surely the issue must also be about those people who are not convinced about the system and who are suspicious and worried about what they have been told. There are people who have been denied fluids, and also drink and food. Does the hon. Gentleman think that there should be some protection in the system for such families so that they can feel assured that there is care? The point I am trying to make is that this should be about care and not killing, but many of us suspect that there is more emphasis on the killing than on the care.

Sir Tony Baldry: Very few of us can have the confidence of Cardinal Basil Hume who, in his book “The Mystery of the Cross”, observed:

“Death is a formidable foe until we learn to make it a friend. Death is to be feared if we do not learn to welcome it. Death is the ultimate absurdity if we do not see it as fulfilment. Death haunts us when viewed as a journey into nothingness rather than a pilgrimage to a place where true happiness is found . . . Death is not the end of the road, but a gateway to a better place.”

Few of us, irrespective of our faith, have that clear courage and confidence, but we all recognise that we will die. There is nothing about 21st century medicine that is going to keep the hon. Gentleman or myself, or any of us, alive for ever. Death, and the process of death, can be extremely painful, and it is our collective duty and responsibility to try to ensure that people die as painlessly as possible and with as much dignity as possible.

I can assure the hon. Gentleman that people do not go into the medical profession to kill. My father became a doctor and my mother a nurse to ensure that they could give people the best quality of care. Although the

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press have published a number of stories about relatives who have expressed concern about how the local care pathway has been used, there is no systemic evidence to suggest that the policy is being abused. A consensus statement was published last year by several non-governmental organisations and charities, all of which are much respected in this House, supporting the Liverpool care pathway. They include Age UK, the Alzheimer’s Society, the British Heart Foundation, Help the Hospices, Macmillan Cancer Support, Marie Curie Cancer Care, the Royal College of General Practitioners, the Royal College of Nursing, the Multiple Sclerosis Society and the Royal College of Physicians.

Jim Shannon rose

Sir Tony Baldry: No, I will not give way because others want to speak. This is an important issue, but we must ensure that we put it in perspective. If we are not careful, all the work that has been done over the past 30 years by a whole number of organisations, including those that I have just mentioned, to enhance and improve palliative care could be undone. Sadly, people die every day; that is the reality. It is not a failure of the NHS that people die. It is only a failure of the NHS if people do not die well. We need to ensure that all improvements, whether they be to records or to communication with patients and their families, are undertaken, but nothing should deter us from trying to ensure that everyone in this country gets the best possible end of life and the best possible palliative care.

3.7 pm

Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op): I am pleased to serve under your chairmanship, Mr Weir. I congratulate the hon. Member for Montgomeryshire (Glyn Davies) on securing this debate on such an important issue.

I represent St Joseph’s hospice on Mare street in Hackney, which is a beacon of good practice in end-of-life care. Under the expert leadership of its chief executive, Michael Kerin, its medical director, Dr Anjali Mullick, and the Sisters of Charity, who founded it more than 100 years ago, the hospice ensures that people in their last stages of life receive care and die with the respect and dignity that they deserve, and that is what we are talking about today.

It is worth reiterating here what end-of-life care should offer. It is about treating someone who is dying as a person, and not as a number or a patient, and about looking at that individual’s needs in the round. It is not about giving a mechanistic response. As my hon. Friend the Member for West Lancashire (Rosie Cooper) said, surely once a clinical decision has been made about someone’s life chances, we, as a compassionate society, should try to ease suffering and support them to die well. The Liverpool care pathway, which is used only when someone is in the last hours or, in some circumstances, the last days of their life, aims to provide the tools to enable rest and care rather than making active interventions that would cause a person to die less well.

Those fine principles are great, although they may not always be adhered to fully. Good leadership and training of staff are vital, and that is one of the issues I want to address in the short time I have to speak.

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We face an important challenge as a society as we consider the end-of-life care we aspire to. Most of us want a choice of where we die. If we had a free choice, most of us would choose to die at home, supported by organisations such as Marie Curie or hospices such as St Joseph’s, whose nurses go out and care for people in the community. Where individual practitioners are out and about and are not being overseen, that will create greater challenges in the future for regimes such as the Liverpool care pathway, but that is no reason to dismiss it or not to see it as an important way of helping and supporting people as they die.

That raises an important issue for us as a society. If we agree that dying well is important, we need to recognise that practical and policy issues need to be addressed. Patient and family choice about where to die works only if proper 24/7 care is provided, whether in the home, the hospice, the hospital or another setting, and we need to make sure that proper resources and support are available. Often, that is about training practitioners in general so that they know what best practice is. If we look to our inner humanity, we all know what we would want, leaving aside all the medical trappings, if we were dying: we would not want to be poked and prodded in the last hours of our lives; we would want to have a good, well-supported death.

Training and development are vital, and I welcome the work done by trainee doctors in Liverpool, which my hon. Friend mentioned. When the hospice movement started, it was rare for doctors to get proper training; indeed, I think they spent about a day on the bedside manner for dealing with a dying patient and speaking to their family. Things have moved on a lot since then, and it is vital that, in the debate about the Liverpool care pathway, we do not throw out the baby with the bathwater. The LCP has done good things, although improvements could probably be made at any point to any such approach. None the less, it is vital that we maintain the approach that dying well is important and should be available to all in every setting.

3.12 pm

Fiona Bruce (Congleton) (Con): I congratulate my hon. Friend the Member for Montgomeryshire (Glyn Davies) not only on securing the debate but on the calm and measured way in which he introduced it—his was exactly the constructive tone in which we should discuss this concerning issue.

Last year, an 83-year-old widower was taken into hospital feeling very unwell. His eldest daughter visited him every day. No particular illness was diagnosed, but he was certainly weak and frail. After a few days, the daughter asked a nurse in the corridor, “How is he today?” Almost casually, the nurse said, “Oh, he’s not very well at all. He has not long to live. We are putting him on the Liverpool care pathway.” There was no discussion, no explanation, no consultation—just an announcement, a statement of fact, almost in passing. The daughter was shocked. As his eldest child, she thought, “Surely there should be more formality, more dignity, more of a clear process.” What gave her particular cause for concern was that her mother had become frail just two or so years earlier—admittedly after a brain tumour operation—and had been put on a regime of limited food and fluids. It had taken her weeks to pass away, which was agonising for her and heart-rending for

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the members of her family, as they waited and waited for their wife and mother to die. Again, there was no discussion or consultation with the daughter, although perhaps there was with the father. He was an elderly man in his 80s, and he was now lying in bed himself, about to be put on a similar regime.

After her mother died, the daughter felt a terrible guilt. Perhaps it had taken too long for her mother to die. Perhaps the daughter should have asked more questions. Perhaps she should not have let her mother suffer so much. With no medical background, however, she was left rather sad and confused. When the nurse announced that the hospital was putting her father on the Liverpool care pathway, the daughter, knowing a little more about it by this time, immediately contacted her sister, and the next day their father was moved to a nursing home. There, his needs were attended to in a positive and caring way. There, he did not die; in fact, he got better.

Now, well over six months later, that elderly man is very much alive. He is still being cared for. He is eating well, getting up when he wants to and resting when he does not want to get up. He enjoys visits from his family, although he does not enjoy it when his favourite football team loses in the last minute or so of a match, as happened last Saturday. He is listening to tapes of Sadler’s Wells opera company singing Gilbert and Sullivan, and he is joining in with “Songs of Praise”. He is having intelligent and considered discussions about his finances and looking forward to his 85th birthday. It is not a fantastic quality of life, but it is a life, and as he told his doctor in the nursing home, “I want to live.”

Minister, Mr Weir, concerned Members, I know all that is true, because the lady who passed away so distressingly was my mother, and the elderly man I have described is my father. I, their daughter, witnessed all those events first hand. In one sense, I am not sure I need to say much else to support the points that have been made, but the application of the LCP needs to be looked into.

John Glen (Salisbury) (Con): My hon. Friend is making a powerful case, and it is obviously painful for her. Does she agree that there is a distinction between accepting the notion that a life must end and accepting that there is an inevitable time frame in which that life must end? We must not make premature assumptions about that period, so it is critical that there is a clear understanding of what the Liverpool pathway means and how it can affect the timings of an event we do not know the actual trajectory of.

Fiona Bruce: I thank my hon. Friend for that intelligent comment, and I will talk further about that.

I want to speak now as a vice-chair of the all-party group on dying well and the all-party pro-life group. Despite my personal experiences, I believe the main intent of the Liverpool care pathway is compassionate and good. It is fundamentally aimed at what is increasingly called a good death. When correctly administered, the principles behind it are those of good palliative care, and they are fully in accordance with the view, which I hold, that all life is God-given and should be allowed to run its course, without death being hastened through unnatural intervention.

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Jim Shannon: I congratulate the hon. Lady on the passionate way in which she has dealt with this issue. Does she agree that it is important that those who work in the Liverpool pathway are highly skilled? If such care is left in the hands of those who are less skilled, there is a possibility that what could be termed voluntary euthanasia will take place. Does she agree that only highly skilled people should be involved in the Liverpool care pathway?

Fiona Bruce: I do, and this is where training is so important. Without the proper application of the Liverpool care pathway, death can be hastened, and that is not the intent of the pathway. Occasionally, even with correct application, it can be the unintended consequence—for example, through the use of narcotics to alleviate severe discomfort and facilitate a more peaceful passing.

I wholeheartedly welcome the Minister’s decision to hold an independent public inquiry into the LCP. I have met him, and I thank him for his open-minded, calm and reasoned approach and for the fact that he has had ears to hear concerns about the LCP. Without wishing to prejudge the terms of the inquiry, may I make the following suggestions for it to consider?

First, a number of pressures might subvert the proper implementation of the LCP, and I am grateful to Professor David Albert Jones of Oxford, who is an authority on this topic, for highlighting them. He says they are:

“the subjective character of judgments about how soon someone is going to die…the fact that the LCP may be initiated by people who are not senior clinicians familiar with the individual patient’s case and have not consulted with palliative care physicians… the influence of managerial pressures to reduce bed occupancy …reluctance to face the difficulties of continuing care of certain difficult patients…the euthanasiast outlook of some clinicians…the possibility of doctors or nurses regarding the LCP as a set of ‘tick boxes’…rather than assessing the needs of the patient…Other NHS organizational/staffing procedures or constraints”.

He adds:

“Research shows that care of the dying is poorest in the hospital setting”

in contrast to care in hospices, which I believe we all admire.

I also urge that the inquiry consider the following measures: that no patient should be placed on the LCP unless they are imminently, irreversibly and inevitably dying, which I understand to mean perhaps within 36 hours; no one should be placed on the LCP without its being discussed with a designated relative or carer; every patient placed on the LCP must be continuously monitored and reviewed by a multi-disciplinary team; documentation must be simplified and standardised, so that those implementing the LCP can easily follow the guidelines; training and supervision should be mandatory, as well as standardised and improved; non-clinical priorities in the use of the pathway must be eradicated and every patient must be treated solely according to their needs; payment for such care must be reconsidered; and the communication to relatives should be substantially improved.

I believe that, if it is well used, the LCP can improve standards of end-of-life care, especially in hospitals. It should promote better palliative care and support the kind of good death that we would all wish for ourselves and our loved ones. I sincerely hope that the independent inquiry will be a major step in facilitating that.

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3.20 pm

John Pugh (Southport) (LD): I also congratulate the hon. Member for Montgomeryshire (Glyn Davies) on introducing this important debate in such a measured and sympathetic way. It was effective indeed.

I do not like the term “Liverpool care pathway”; I prefer talking about guidelines for palliative care. That is probably a less contentious way of discussing it. The Liverpool care pathway was developed in Broadgreen, and I was born in Broadgreen. More importantly, my grandmother died there, having been readmitted several times. The last time she was admitted she had declined somewhat at home and I can remember the expression of horror on her face indicating that that was not the right way to treat her. She knew that she was going to die and she wanted to die at home, and she was being admitted unnecessarily to hospital. I regret that we arranged for that to happen. It is very important to get the last years, months and weeks of people’s lives correct and we certainly did not; hence there is a need for things such as the Liverpool care pathway and a more understanding, measured and sensible approach to affairs.

There is a need for the hospice movement, but the reality is that most people do not die in hospices; they die in the NHS and there is a need for the NHS to have some clinical guidelines to follow. That is particularly the case for those in their last hours, day, weeks and months, whose death is imminent and who cannot have that death prevented or, realistically, postponed. That is quite a high threshold to be met, and finance should in no way come into meeting that threshold. When finance does come into it, it can only corrupt the process. The Liverpool care pathway guidelines imply constant review and no one wants that coloured by financial incentives. After all, there is always the remote possibility of people getting the diagnosis wrong.

That is not a case against having guidelines at all or against thinking that we sometimes need to opt for a palliative choice rather than a remedial one, if there is no realistic remedial choice available. If that choice has to be made, there is no in-principle case for involving relatives and the patient in it, with the important caveat that what is done should be in the patient’s interest. I am not always sure there is an obligation to clarify the situation for the patient or their relatives, if they prefer to die in hope or expectation of recovery and find the thought of their inevitable demise insupportable, particularly if it will not change clinical behaviour and the only option is palliative care for that person. That is a difficult issue, which every clinician needs to face and be guided on in facing it.

There is certainly a need to inform the patient and/or relatives if expectations about care are starting to differ, or if the nature of the palliative care offered is unclear. That might be the case if a patient is wrongly categorised, or if there is a debate about the palliative care itself, and it is seen as substandard. Some of the episodes of dehydration that have been described in the national newspapers have seemed to me to be substandard palliative care. The bottom line is that palliative care should not worsen the condition or augment the suffering of somebody who inevitably will die, unless the patient chooses it. In certain circumstances, I can imagine somebody trading pain for more life.

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Care can be worsened in two quite different ways: it can be worsened by disruptive, painful, pointless, futile interventions, and it can equally be worsened by neglect, and indifference to people’s symptoms and the manner of their decline. My aunt recently died in the Royal Liverpool, which has taken over Broadgreen. I remember going to her bedside and seeing the signs that said, “Nil by mouth”, and wondering whether we should offer her a drink while we sat there and talked. We never managed to get round to having a sensible conversation about that with the medical staff. I was never sure what I was confronted with. It might have been wise care; there may have been a genuine risk of choking, which I believe is one of the reasons why people are not given liquids at that stage. It might just have been neglect or absence of thought. What did not happen—and should have—was a discussion about treatment: a sort of negotiation.

If palliative care is the path chosen—it should only be chosen when it is, in a sense, the only path—there needs to be a negotiation. It is the trick of getting that negotiation right that is the difficult thing. We need to respect the rights of all people concerned, and the patient’s rights sometimes differ slightly from the family’s rights. The family fearing bereavement can only wish the patient to live at all costs. That may not always be the patient’s aspiration in that circumstance. The hon. Member for Montgomeryshire has started us along the path of having a measured discussion and review of these matters and I hope it continues.

Mr David Burrowes (Enfield, Southgate) (Con): I respect what my hon. Friend says on communication with the patient, but I would like to clarify something. A survey by the Marie Curie Palliative Care Institute Liverpool and the Royal College of Physicians said that half of those on the LCP are never told that they are on such a pathway. Also, the LCP is not just a framework of good practice but a pathway, taking the patient towards the presumed outcome of death. Surely, therefore, it is important to make it clear that there should be communication with the patient; it should not be only the best half who know.

John Pugh: That in part is the dilemma. I know that the saying is “No treatment about me, without me”, but there are certain circumstances that we will all be aware of where the patient is dying and the clinician is in an acute moral dilemma over whether to inform them that that is the case—that there is no hope and that they will be given purely palliative treatment. I am fairly confident that a good number of people will die in our hospitals for years to come, despite the Liverpool care pathway or any other guidelines that we put in place, who will, until the moment of their decease, expect recovery.

Mr Mike Weir (in the Chair): We have just under 12 minutes left and two speakers to go. I ask that they bear that in mind.

3.28 pm

Mr Edward Leigh (Gainsborough) (Con): I am glad to have this opportunity and I thank my hon. Friend the Member for Montgomeryshire (Glyn Davies) for raising this important subject. We all know that the Liverpool care pathway was devised with the best of intentions. I assure my hon. Friend the Member for Banbury (Sir Tony Baldry) that none of us wants to end

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or take away palliative care. We all want to relieve pain and we all want people to die with dignity, but there are serious concerns about the Liverpool care pathway and that is why this debate is so important. Those concerns have been expressed by physicians. It was physicians—ethicists—who started this debate, not the newspapers. The newspapers did not start the ball rolling and we should be aware of that. Professor Peter Millard, emeritus professor of geriatrics at the university of London, and Dr Peter Hargreaves, palliative care consultant at St Luke’s cancer centre in Guildford, have warned of the risk of “backdoor euthanasia”—their words—and that economic factors are being included when treatment is considered. We must be aware of these concerns, which were originally expressed by clinicians. However, I believe that it is one of the chief duties of those of us in this House who are not clinicians to speak up in defence of the vulnerable, the voiceless and those who are sometimes forgotten.

It is simply unacceptable that vulnerable people, including the poor, the elderly and those who do not have close friends and family to look after them, come to a premature death—an unnecessarily early death. As my hon. Friend the Member for Congleton (Fiona Bruce) and others have said, in numerous cases, even friends and family caring for a loved one have not been informed that they have been put on the LCP. May I say that my hon. Friend’s speech was a wonderful speech? It drew on her personal experience and was one of the most moving speeches that I have heard in this place over many years.

I sat with my best friend, Piers Merchant, as he was dying; he was a former MP and my hon. Friend the Member for Banbury (Sir Tony Baldry) will remember him well. I saw the morphine being pumped through his body. I am sure that he died early—perhaps a few hours or even a few days early, I do not know—from the morphine. Those of us who loved him wanted him to be cared for properly, but we also did not want him, or any of our loved ones, to be put on an irreversible path to death where that was avoidable.

I welcome the statement by the Department of Health that it

“has consistently made clear that care provision, including for people at the end of life, should be based on need.”

But the question that we need to ask in this debate is this: how are the Department’s intentions implemented on the front line of medicine and hospital care? No doubt there is wonderful care being given in many hospices, but is that gold standard being replicated in all our hospitals?

It is undoubtedly true that the LCP has led to the premature death—it may not be premature by much, but it is still a premature death—of as many as 130,000 hospital patients each year. This is a vital issue that we must address in this House; with 450,000 hospital deaths in Britain each year, that figure of 130,000 is about 29% of the total number of hospital deaths. In fact, this is a frightfully serious issue.

Robert Flello: Will the hon. Gentleman give way?

Mr Leigh: Does the hon. Gentleman mind if I do not give way? I just want to make my speech and give my hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) a chance to speak too.

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Professor Pullicino, who was quoted earlier, has himself personally intervened to have a patient taken off the LCP who went on to be successfully treated. So, despite the fact that we must listen to clinicians, it is simply impossible to determine satisfactorily that a patient has hours or days left to live, which is one of the worrying flaws of the LCP.

In November, an independent inquiry into the LCP was announced, and I welcome that announcement. My hon. Friend the Minister is doing his job extremely well in this regard, and we respect him as somebody who will genuinely try to get to the truth. He himself has said that there have been too many cases of patients dying on the pathway while their families were not informed, so he is quite right to zero in on that issue. He has said, “This is simply unacceptable.” I echo those words and I hope that he will repeat them when he winds up the debate.

Of course there are people who speak on both sides of this issue, but I believe that any inquiry must be conducted by a suitable variety of individuals and not just by supporters of the LCP. It is not good enough to state, as the Department of Health sometimes does, that the LCP is not euthanasia. It might not be euthanasia and, of course, if it is implemented properly it is not euthanasia. However, it has become obvious to many people that the LCP can be employed, and indeed has been employed, in cases that are highly questionable.

I say to those who have spoken today that what worries me is this: why is it that the average time to death on the LCP is 33 hours? An identical figure for average time to death was found in two consecutive national audits that were conducted two years apart. In the view of many people, that shows that the LCP has a machine-like efficiency in producing death within 33 hours, and that is why some people say that the LCP is in effect a “lethal care pathway”. Statistics suggest that fewer than 5% of patients put on the LCP are taken off it. Why only 5%? There is something wrong here, and the inquiry needs to get to the bottom of it.

I believe that we should appoint a member of the judiciary rather than a medical expert, to carry out the inquiry. Of course, they will have medical advisers, but we should appoint a member of the judiciary rather than just a medical expert to lead the inquiry, so that they can look at this complicated issue with a fresh perspective and a judicial mind.

Thank you for calling me to speak, Mr Weir. In conclusion, I believe that we have a duty to instil confidence in each of the citizens and residents of this country that they live in a society that believes in their inviolable dignity as human beings, and that takes the necessary steps to ensure that they are cared for and looked after when they are ill, especially in the closing moments of their life.

3.35 pm

Oliver Colvile (Plymouth, Sutton and Devonport) (Con): Thank you very much indeed, Mr Weir, for calling me to speak. It is a pleasure to serve under you.

I congratulate my hon. Friend the Member for Montgomeryshire (Glyn Davies) on securing this important debate. I suspect that I am not particularly well qualified

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to speak about the Liverpool care pathway, but neither are an awful lot of my constituents. Therefore, it is very important that what we talk about today is how we can look after their interests, and the interests of others, in this regard.

I am very aware of what kind of death I want to end up having. Some six years ago, my father died while driving his car. He came out of his office, at the age of 89, to go and have lunch with the Archdeacon of Canterbury. My father had a massive heart attack, pulled over to the side of the road—thank goodness he did not take anyone with him—and duly died. It was just yards away from the church and I know very well that God decided, probably in his infinite wisdom, that the one thing that he was not going to do was allow my father, a former naval commander, to give the archdeacon a difficult time. However, I am very aware that—frankly—an awful lot of us do not have that kind of option about how we end up dying, if we have an option at all. Many people find themselves having to go into hospital, and dying there.

Many of us have a great deal of notice about dying. So, in the next few minutes, I want to talk about an individual constituency case that I had—an appalling story about the death of the father of one of my constituents in the Derriford hospital in Plymouth. In doing so, I want to ensure that the public are aware of the controversial approach to ending life and that we have a discussion about it.

My constituent’s father went to Derriford hospital from Mount Gould hospital, which is also in Plymouth, in April 2011 because he had become bedridden. He was put on the Liverpool care pathway without any food and water. That was supposed to last for up to two days, but he lived for 12 more days, finally dying on 8 May 2011. My constituent claims that during the time that her father was on the LCP, he perked up and was even watching television. Despite that, he remained on the LCP.

My constituent’s family feel, and I rather agree with them, that giving someone 12 days to die is not what this system should be about. Although Derriford hospital claims that staff spoke to the family on the ward, my constituent and her siblings dispute that. They claim that they did not know that their father was on the LCP until the car park attendant told them.

To give Derriford hospital its due, the chief executive—who is new to the job and was not at the hospital when this case happened—has dealt with the case subsequently, recognising that the clinical teams may not have explained fully to my constituent’s family what was going to happen and what was actually involved in the LCP. The family feel that they were forced to watch their father die under very distressing circumstances. Despite having his food, water and medication withdrawn, the family were horrified to see him biting the sponge that was being used to wipe his lips, because he was so hungry and thirsty.

Unfortunately, my constituent has also had a subsequent —and completely different—experience of the LCP when her brother-in-law died at a hospice. It must be remembered that hospice staff are specialists in helping patients at the end of their lives, and the more that we can encourage people who are suffering in that situation to be dealt with by hospices, the better. Certainly a lot

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of hospitals are very busy indeed and their staff do not necessarily have the time to carry out the kind of checking that we feel they should do.

I am very aware that the death of a close relative is a traumatic time. One should remember that patients’ relatives do not always take in the full story that they are being told and that they can become confused about what they are being told. However, we must ensure that a system is in place that avoids those kind of complications.

I am very aware that the Government are taking this whole matter very seriously and I am grateful to them for that. I thank my hon. Friend the Minister and his colleagues for the review, about which he wrote to me just today, and their proposal to produce a new pledge on care planning. To help my constituent, and many other people like her, we need to ensure that we have a timetable for that.

I pay tribute to bereavement charities, such as Cruse Bereavement Care. They do an enormously good job in helping families through the whole grieving process. I ask for more training, and for more information for families so that they can be assured that their relatives will get the best care possible. By giving detail to the Government’s proposals, the Minister would be giving certainty to Benjamin Franklin. Members might remember that he wrote, in a letter to Jean-Baptiste Le Roy in 1789, that the only things we can be certain of are birth, death and taxes.

3.40 pm

Liz Kendall (Leicester West) (Lab): It is a pleasure to serve under your chairmanship, Mr Weir. I congratulate the hon. Member for Montgomeryshire (Glyn Davies) on securing this extremely important debate and on his heartfelt but calm and thoughtful opening speech, which set exactly the right tone. How we care for the dying is a measure of how we care for all sick and vulnerable people. It is a litmus test not only for the NHS and the wider care system but for society as whole.

This debate comes at an important time because, as the hon. Gentleman said, in recent months growing media attention has been paid to the Liverpool care pathway. Several Members have talked about the misconceptions and the inaccurate information that has been published about it. I have read the recent consensus statement from 22 patient and professional organisations and also the full care pathway documentation, and it is clear to me that the Liverpool care pathway is not in any way about ending someone’s life but about supporting the delivery of excellent end-of-life care.

The pathway does not seek to replace clinical judgment; it is not a treatment but a framework for good practice. It does not seek to hasten or indeed delay death, but to ensure that the right type of care is available for people in the last days or hours of life, when all the reversible possibilities for their condition have been considered. I do not believe that it is a deadly or lethal one-way street. Precisely because it is not always easy to tell whether someone is very close to death, the pathway emphasises the need for constant and regular review, and if a patient’s prognosis changes, their care needs should be reassessed and, if appropriate, the use of the pathway stopped.

The pathway does not preclude the use of clinically assisted nutrition or hydration; in fact, it explicitly states that patients will be supported to eat and drink

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for as long as possible. It absolutely emphasises that wherever possible patients must be involved in decisions about their care, and that carers and families should always be included in decision making. Such involvement of patients and families is enshrined at the very heart of the Liverpool care pathway.

Robert Flello: Does my hon. Friend agree that if there is no consultation, and there is denial of care and of treatment that eases pain, it is not the Liverpool care pathway?

Liz Kendall: I absolutely agree. The issue we face is less about the pathway itself and absolutely about how it is implemented in practice. The pathway document states on its very first page that the pathway is only as good as the teams who use it.

There has clearly been an issue about taking a pathway that was developed by experts in one part of the country over several years, with regular training and audit, and trying to implement it across the wider NHS. Individual patients and families—as we have heard—and also the national audit of the Liverpool care pathway, suggest that there are genuine problems with communication. Too many patients and families are not properly informed about what the pathway is and how it works, and they are not effectively involved and their consent not sought at every stage and on all the necessary decisions. One incident in which patients and families are not fully and sensitively involved is one too many. It is not acceptable, and it directly contradicts the very essence of the Liverpool care pathway and its key principles and values.

Rosie Cooper: Will my hon. Friend give way?

Liz Kendall: If my hon. Friend does not mind, I will not give way as I do not have much time.

I welcome the fact that the issues are now being looked into. I understand that three separate reviews are being undertaken. The national end-of-life care programme is doing a short, snapshot review of complaints about the use of the Liverpool care pathway, the Dying Matters coalition is working with families whose loved ones have been on the pathway, to see what worked well and what did not, and the Association for Palliative Medicine and a range of other national organisations are talking to clinicians, to get their opinions regarding integrated care pathways in the last days of life, of which the Liverpool care pathway is one.

In November, the Minister said he would appoint an independent chair to co-ordinate the work of the different reviews, so I ask him: has a chair now been appointed? Will the chair, the Department of Health or any other organisations consider any additional issues, alongside the work that is under way? For example, will the way in which the Liverpool care pathway is paid for be reviewed? It is important that hospitals receive proper payment for the care they give and for any associated training, but any evidence that patients are being put on a pathway for financial reasons is a serious matter and is totally unacceptable.

Will there also be a review of the education and training in end-of-life care for new and existing staff, in particular training in how to discuss difficult, complex and emotional issues with patients and their families? One of the real challenges is that the process of death

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and dying is so uncertain. A patient’s prognosis is not always clear; the situation changes. Doctors are used to treating and curing, giving clear evidence, treatment and advice—or they are trained to do so—but it is not always possible.

I want to finish on a broader point, which is important for us in this House. The difficulty that NHS and care staff, the media, families and the public have in discussing end-of-life care reflects wider society’s lack of familiarity with death and dying, which was not the case 100 years ago. Age, cause and place of death are generally very different now from what they were at the beginning of the last century, when a far greater proportion of deaths occurred in childhood or early adult life, often from acute infections, with most people dying at home. Now, more than two thirds of the 500,000 deaths a year are among people aged over 75, most of them following a long-term illness such as heart disease, cancer, stroke, chronic respiratory disease or dementia, and most are in hospitals and care homes.

Many people do not, therefore, experience the death of a loved one until they are well into mid-life. We do not see dying people and dead bodies—not for real. We see them on television and in computer games but not in real life, and we do not talk openly in society about death. I know that in all our families it is difficult to discuss death, but in the century of the ageing society, with chronic conditions as the major cause of death and disease, that must change.

As the hon. Member for Banbury (Sir Tony Baldry) said, death comes to us all, and we should strive for as good a death as possible. That will, of course, mean different things to different people—I would like to go quickly, and I hope that the people I love go quickly, too, and do not have a long, slow death.

Rosie Cooper: We will not be bumped off.

Liz Kendall: Indeed, or have a premature death. For many of us, a good death means being treated as an individual with dignity and respect, without pain and suffering wherever possible, and in a familiar environment surrounded by the people we love. We need a full and frank debate about these difficult issues, handled calmly and sensitively and based on evidence and fact rather than on myths and misconceptions. Dying matters, not just to the NHS and the wider care system but to us all, and for that reason I am grateful to the hon. Member for Montgomeryshire for securing the debate.

3.48 pm

The Minister of State, Department of Health (Norman Lamb): I do not have a Parliamentary Private Secretary sitting behind me, and I am most grateful therefore to you, Mr Weir, for your assistance with some Members’ constituencies.

I congratulate the hon. Member for Montgomeryshire (Glyn Davies) on securing the debate, and on the sober, serious and rational tone he deployed in his contribution. The whole debate, in fact, has been exemplary in that regard. I suspect that all of us in this room are after the same thing; it is how we secure it that matters so much. I have just over 11 minutes, which is not really enough to

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do justice to every contribution, so as soon as I possibly can, I will write to all the Members who have taken part, to update them.

I take the Liverpool care pathway extremely seriously. It has been much discussed recently: many hon. Members and members of the public have written to the Department of Health expressing their concerns, and there have been numerous parliamentary questions, too, all of which stems from a lot of media interest over the past few months. Several stories have appeared discussing the ways in which the LCP is used and what it is for. In particular, there have been a number of reports in the media alleging that patients are being placed on the LCP secretly, with no consultation with them or their relatives. It has been suggested that the LCP routinely involves medical staff withdrawing treatment, including food and fluids, from patients. Perhaps most seriously, the LCP has been accused of being a way to kill patients to save the NHS money. There have been suggestions that the Department of Health bribes hospitals with extra money for every patient placed on the pathway.

Those accusations paint a misleading picture of the purpose of the Liverpool care pathway, yet I take seriously the concerns raised by the families of patients who have experienced extremely poor end-of-life care. I am horrified by some of the stories that people have told me about the withdrawal of food and fluids from sick relatives in hospital and about the failure to inform loved ones that the patient has been placed on the pathway.

The hon. Member for Congleton (Fiona Bruce) spoke movingly of her experience, and I am pleased that she came to the round table that I held to discuss those concerns. As the hon. Member for Gainsborough (Mr Leigh) made clear, the concerns are legitimate and should be taken seriously, not dismissed because of exaggerated reporting. What happens on the front line and how we translate theory into practice are so important.

I agree with my hon. Friend the Member for Southport (John Pugh). I dislike the jargon: what on earth does “Liverpool care pathway” mean to patients and their families? We must use language that ordinary people understand, particularly at a most traumatic time for all involved. That is one thing we need to address.

One aspect of care that receives almost universal praise, as the hon. Members for Banbury (Sir Tony Baldry) and for Hackney South and Shoreditch (Meg Hillier) have made clear, is the hospice movement, which grew from Dame Cicely Saunders’s belief that, however ill, people matter at the end of their life and should never be abandoned. That is why the Marie Curie Palliative Care Institute Liverpool, led by Professor John Ellershaw, developed the Liverpool care pathway in the late 1990s. The pathway was designed to transfer the principles of hospice care—the shadow Minister, the hon. Member for Leicester West (Liz Kendall), made this point—so that terminally ill patients always get the best treatment, even if they do not receive specialist palliative care.

The Liverpool care pathway is not a treatment but a framework for managing treatments, which is important to understand. As the hon. Member for Montgomeryshire made clear, the LCP, when used correctly, is one way to ensure that the last hours or days of a patient’s life are as comfortable as possible. The guidance for using the LCP makes it clear that the aim is to support, not

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replace, clinical judgment. Sometimes there are questions about clinical judgment, but not about the pathway itself.

The Liverpool care pathway guidance sets out the following objectives and considerations for taking care of patients: determining whether any further medications and tests would be helpful; ensuring that the patient is as comfortable as possible—surely we all agree with that; helping the patient to take on food and drink for as long as possible, which means not denying them food and drink, as we sometimes hear; and taking care of the patient’s spiritual and religious needs, which is of acute importance to many people. The guidance reminds clinicians that unnecessary treatment or tests may cause harm rather than good.

The guidance states that regular review is acutely important. If their condition improves, the patient should be taken off the pathway. The 5% figure to which the hon. Member for Gainsborough referred is of concern and should be considered; it is essential that the medical team discusses the pathway with the patient, their family or their carers. Those people need to be fully involved in decisions about end-of-life care, even though those discussions may be very difficult. Obviously, those conversations need to happen as quickly as possible.

The Liverpool care pathway can work as intended only if each patient is fully consulted, unless that is not possible. Even then, the family must be fully involved. Through his interventions, the hon. Member for Stoke-on-Trent South (Robert Flello) made that point strongly. The opening section of the information sheet that comes with the pathway cites the absolute importance of discussion with the family. Staff must talk to the patient and their family as much as they need and want, to explain what is happening and why. That is non-negotiable. Any failure to do so is completely unacceptable.

The hon. Member for West Lancashire (Rosie Cooper) mentioned documentation, which is best practice and should always happen so that everyone can see what has been discussed. She also mentioned the constitution, and we are considering how we can give it greater traction. There is a sense that everyone agrees with the constitution, but what value is it? How can we make the constitution provide real power to patients in the NHS?

I agree with the shadow Minister’s concerns about translating across the whole system something that has been designed by experts. Such translation can be problematic and needs further attention.

Rosie Cooper rose

Norman Lamb: I am conscious that time is tight. I will write to the hon. Lady. If she wants to raise issues with me later, I will be happy to address them, but I need to respond to the debate.

From what people have said, it is clear that there are too many cases where patients have been put on the pathway without proper explanation, without the

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involvement of their family and sometimes without any notification, which is totally unacceptable. Yet again, we see how right Dame Cicely Saunders was when she said:

“How people die remains in the memory of those who live on”.

The impact is profound. My wife works for Cruse Bereavement Care, which does magnificent work helping people who have suffered bereavement. We have a duty to give such people the best possible experience as they lose a loved one.

On 26 November, I hosted a round-table meeting with patients, families and professionals—both supporters and critics of the pathway were represented—and at that meeting I announced that we will appoint an independent chair to consider how the LCP is used and experienced and to examine the accusations made in the press. We expect to announce the chair of that review very soon, and we expect that the chair will want to identify a small panel of independent experts from a range of backgrounds, including representatives from faith groups, which is important. I reassure hon. Members that the review will be independent.

The Liverpool care pathway is internationally recognised as good practice, and it is widely supported by organisations involved in end-of-life care. If people do not feel that they have received the best care or, worse, if patients cease to trust the pathway, that is a problem that needs to be addressed.

Training is fundamental, as the hon. Members for Hackney South and Shoreditch and for Congleton and the shadow Minister said, and it will be considered as part of the review. The review will systematically examine the experience of the Liverpool care pathway by patients, families and health professionals, and it will seek evidence to support or refute the accusations and to see where improvements might be needed. The review will hear directly from families. There will be a session dedicated to families so that they can tell the panel about their experiences.

The review will also consider the role of financial incentives in the use of the LCP. Like my hon. Friend the Member for Southport, the hon. Member for West Lancashire and others, I have concerns about the use of financial incentives. The review will report both to the Department of Health and to the NHS Commissioning Board by the summer.

Everyone wants their loved ones’ final hours to be as pain-free and dignified as possible. Used as intended, the Liverpool care pathway can help achieve that. The pathway prioritises comfort, dignity and appropriate care, but all that is undermined if the public distrust the pathway and if clinicians do not apply it properly. We do not dismiss people’s concerns, which I take extremely seriously. Instead, we have to ensure that care in the last few days and hours of life is always of the highest standard. Reinforcing the absolute importance of involving patients and their families in discussions on their care and treatment is essential.

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Education Funding (Cambridgeshire)

4 pm

Dr Julian Huppert (Cambridge) (LD): It is a pleasure to serve under your chairmanship, Mr Weir. I am delighted to have secured this debate on an issue affecting every pupil in Cambridgeshire.

Educating our young people to the highest possible standard is vital for a fair and stable society. Every child should be given an equal and fair opportunity and educated to the best of their ability, no matter what their skills. Education should be the priority. Whatever financial situation that we find ourselves in, we must never bankrupt our children’s future. They get only one shot.

The pupil premium was on the front page of the Liberal Democrat manifesto, and we are now delivering it in government. In Cambridgeshire, our schools are getting £1.8 million to help 2,100 children from poorer backgrounds get a good start in school, with critical flexibility for heads to work out how best to spend it for their pupils. Every child deserves a fair start in life. However, Cambridgeshire has a systematic problem with basic funding for pupils.

Ever since the Tory county council under Baroness Blatch cut funding for schools in the 1980s, Cambridgeshire schools have been consistently under-resourced. Her cuts have been perpetuated, as central funding for schools has been based on previous years’ funding, with no opportunity to close the gaps that have grown. The Tory cuts have been perpetuated by the Labour Government and this Government so far. Children now are paying for poor decisions made in the ’80s.

Pupils in Cambridgeshire get far less funding than pupils almost anywhere else in the country. In 2009-10, Cambridgeshire got £34 million less funding than the English average, and that trend has continued. For the financial year 2012-13, the dedicated schools grant placed Cambridgeshire 143rd in funding out of 151 local authorities. That funding covers nursery provision, mainstream schools, special schools and all high-needs pupils.

The Government’s new approach makes the problem even more obvious. Basic school funding is, reasonably and sensibly, being separated out from early years and high-needs funding, so that people can see what is happening. The schools element of the funding for 2013-14 gives Cambridgeshire the least of any of the 151 local authorities, at £3,950 per pupil per year. The English average is £4,550.

What possible reason can the Government give for why pupils in Cambridgeshire deserve 13% less funding than the rest of the country? Other than historical accident—I hope that the Minister agrees that it is wholly wrong to punish kids now for political decisions made in the ’80s—why do pupils in Surrey, Buckinghamshire, Essex, Bedfordshire, Hertfordshire and Peterborough deserve more cash?

Of course schools serving more challenging communities should receive more funding, but that is supposed to be addressed, at least in part, by the pupil premium, and Cambridgeshire has challenging communities. Educational attainment in the north of Cambridge and the north of the county, in the fenland area, is significantly lower

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than it ought to be. I can see why people in expensive areas could argue for more funding—teachers must be paid enough to be able to afford to live near their schools—but Cambridge is a very expensive area. The Cambridgeshire Schools Forum has been campaigning for a number of years to narrow the funding gap between the higher and lower-funded local authorities. I have been delighted to support it over many years, both when I served on Cambridgeshire county council and now as MP for Cambridge.

Two years ago, on 7 February 2011, I raised the issue in education questions:

“Cambridgeshire gets less school funding per pupil than almost anywhere in the country. If we received the per pupil average across England, we would have some £34 million more for education. Can the Secretary of State explain why pupils in Cambridgeshire deserve so much less money, and will he review that?”

The Secretary of State for Education replied:

“They deserve to be treated like every other student. We are reviewing funding and will be publishing a paper in the spring to try to ensure greater equity in the allocation of schools funding.”—[Official Report, 7 February 2011; Vol. 523, c. 19.]

I agree with everything that he said. Pupils in Cambridgeshire deserve to be treated like every other student. That is all we ask.

The Cambridgeshire Schools Forum and I, and many others, were delighted by the promise of greater equity in the allocation of schools funding. We know that it takes time, and we know that we may not end up exactly at the English average, but a commitment to greater equity was what we wanted.

Instead, the gap has widened. We receive £600 less per pupil than the English average for schools block funding, and with 73,800 pupils, according to the Department for Education’s figures, so we are now short by £44.3 million across the county, compared with the English average. For an average two-form entry primary school, that is a difference of £250,000 a year in funding—enough for seven teachers on average pay. Alternatively, the money could be spent on more teaching assistants, better teaching materials, more activities or better school buildings; there are so many options. Yes, the national budget is limited, but Cambridgeshire kids deserve what everyone else gets.

We had hoped that the national funding reforms might start to address those inequalities. However, it now appears that the earliest any such change might be possible is 2015-16. That is having a real effect on children’s lives. Philip Hodgson is chair of the Cambridgeshire Schools Forum, and I served with him as a governor. He says that

“standards in Cambridgeshire are slipping in some areas or not improving at the same rate as better-funded local authorities. Cambridgeshire schoolchildren will suffer from the underfunding for even longer unless action is taken now to begin the introduction of fair funding”.

The gap in Cambridgeshire is widening because there is not enough resource to close it.

I have been in contact with my local head teachers to ask them about their individual situations. They are positive about the pupil premium. Many heads have said that it allows them to do things they had never been able to do before. At Chesterton community college, for example, the principal, Mark Patterson, has been able to fund specialist reading teachers to deal with the handful of pupils who reach secondary school every

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year unable to read at an appropriate level. Rather than having them continue to fall behind, he can give them the right support to keep up, which is fantastic. However, all the heads are concerned about the tightness of the funding that they in Cambridgeshire face.

Chris Beddow of Abbey Meadows says:

“As a school serving a challenging demographic area, we receive a considerable amount of extra funding. However, when compared to a school of similar size in Peterborough, we receive £80,000 less, due to funding differentials between authorities. How is this justifiable as our costs are the same? Cambridge is growing and as a school we are building extra capacity and growing. This year will see our numbers grow by 10%; however, our funding will only grow by 6%. Again, I fail to see how this gap is justifiable.”

To give another example, I recently heard from Steve Jordan, the head teacher of St Paul’s primary school in my constituency. The school, which is small, has been working on an extremely tight budget. Although it has been just about able to stay in the black, it has had to keep eroding its reserves to do so. It has a capital budget of about £7,000 a year. The school’s management cannot maintain the standard of the school site as they wish. The school field needs replacing. It is becoming a health and safety hazard, with rubble beneath the soil gradually working through, and drainage is being affected by tree roots in the pipe work, which the school cannot afford to repair. It is shocking that schools such as St Paul’s are so stretched that they cannot carry out small but necessary repairs. It is not a new problem; it has happened because decades of under-investment have compounded it in those schools.

I welcome the Government support for new school buildings. Cambridgeshire has a demographic bulge at the moment, and the county is frantically opening new primary school places to cope. The bulge will then move on to secondary school, and we will then need financial support to deal with that. I specifically welcome the inclusion of the Manor school in the Government’s priority school building programme. It will make a huge difference to the school, which was visited by the Minister’s predecessor, and the services that it can provide. It is especially welcome because it will be a grant, not tied to any PFI constraints. While I am mentioning the Manor, I pay tribute to Ben Slade, the school’s former principal, who was energetic and inspirational to many pupils and others.

Our problem with schools is that the deal is simply unfair. In Cambridge, there is a range of 16-to-19 education providers, including the excellent Cambridge regional college, which will sponsor the new university technical college in Cambridge, and two sixth-form colleges, Hills Road and Long Road, which educate thousands of 16 to 19-year-olds to a consistently high standard. I have spoken to both principals, Linda Sinclair and Chris Sherwin. They describe a funding situation in which they are struggling to keep their heads above water.

The problem is not unique to Cambridgeshire. Sixth form colleges across the country are suffering from the same problems. Although there are only 94 sixth- form colleges in England, they educate more than 150,000 16 to 19-year-olds and send more people to higher education than independent schools, with almost a third of those young people coming from the least

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advantaged areas of the country. Almost three quarters of those colleges are rated as either good or outstanding by Ofsted.

Hills Road sixth form college does phenomenally well at getting pupils into Oxbridge, beating every school in the country, other than Westminster and Eton, which is a great achievement for a state-funded school. The state sector can work wonders at much lower cost than any private education, but it needs appropriate funding and does not get that.

Sixth-form colleges face particular inequity. They have to pay VAT on goods and services, with a couple of exemptions, whereas schools and academies are reimbursed for those costs. That costs the sixth-form college sector some £30 million per year—about £320,000 per college—which could be spent on education. Can the Minister try to persuade the Treasury to fix that bizarre discrepancy, which also applies to regional colleges? Anne Constantine of Cambridge regional college highlights that

“The VAT bill on revenue spend at this college in the last financial year was £1.2 million of non-recoverable VAT, most of which was incurred in relation to 16-18 learners, a sum”

that could be reinvested in learning if they were treated the same as schools.

Pupils at sixth-form colleges are ineligible for free school meals. Will the Minister support the Association of Colleges “No free lunch” campaign to ensure that students in sixth-form colleges get the same as they would at a maintained school sixth form, an academy, a free school, a university or a technical college?

Sixth-form colleges are funded less than the alternative providers, and that funding is also being reduced. Hills Road sixth-form college, for example, devised a plan to cope with average funding of £4,500 per student—a fairly small amount, compared with what is available at key stage 4 in a number of other providers—but the more recent announcement of a simplified pro-rata funding scheme from 2016-17, at a rate of £3,900 per student, means a further 13% budget cut. That pro-rata funding system is a redistribution of funding between 16-to-19 institutions and not a national cut—it does not save money for the national purse—but it means that sixth-form colleges, such as Hills Road, that deliver large programmes with high success rates will lose heavily. They will no longer be able to act as an exemplar in the state system.

The new figure of £3,900 per pupil per year is less than is available at key stage 4, but must be used for the much wider aspirations of those aged 16 to 19. It does not allow for enrichment activities and does not cover extra costs of subjects, such as experimental sciences, and does not allow pupils to have funding to study a fourth A-level, which is particularly important for those who want to do double maths and go on to study sciences at a number of universities. A particular problem is that sixth-form colleges cannot cross-subsidise between different age groups, because they have only a narrow intake.

A particular issue affects Long Road sixth-form college. There is large growth in sixth-form places, as schools and academies expand into sixth-form provision, benefited by their financial advantages over sixth-form colleges, but without the matching increase in the numbers seeking to go on to sixth form. That makes the financial pressures far worse at Long Road, for example, and both Hills

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Road and Long Road colleges are facing serious cuts to their budgets. That will affect their ability to provide the quality of education that their students deserve.

It is not even clear how these changes will affect those colleges. Institutions that currently deliver larger than average-sized programmes, such as Hills Road, will have to reduce them by 2016-17 to match the new funded level. That will have to be managed gradually over the next three years, because the prospect of doing it all at once in 2016, as they face the cliff edge, would be too painful to contemplate. Can the Minister confirm whether institutions that reduce their programme sizes gradually over three years will be fully protected until 2015-16, in terms of funding per learner, by the formula protection mechanism, or will they be penalised for trying to avoid a cliff edge? Can he confirm—this is an issue for Long Road in particular—whether guided learning hours that are focused on enrichment, rather than specifically on qualifications, will also be included in that protection? If the Minister needs further details, I am sure that the principals will be delighted to talk to him.

Sixth-form colleges are not clear how their funding will operate. They need certainty. They are also concerned about the combined impact of all the changes happening at once. The decrease in income due to the decrease in student numbers as a result of expanded post-16 provision without demographic growth, the continued removal of entitlement funding and the decrease in income as a result of the new funding methodology will all hit at the same time, and they are already being hit. The 2011-12 funding impact survey of sixth-form colleges showed that almost half of sixth-form colleges have already had to drop courses. Several reported that science, technology, engineering and mathematics courses were removed from the curriculum, and a quarter indicated that at least one modern foreign language had been dropped. They are also having to reduce or remove enrichment activities, such as sport, music and drama and careers guidance.

Schools and sixth-form colleges in Cambridgeshire do a good job on limited resources. I am not asking for favours or special treatment. I simply ask for fairness: fair funding for Cambridgeshire pupils, so that they no longer get the least per pupil in the country, and fair treatment for sixth-form colleges, so they no longer face lower funding and higher costs than other providers. If we are to build a strong economy and a fair society, we must ensure that everyone can get on in life.

4.15 pm

The Minister for Schools (Mr David Laws): It is a pleasure to serve under your chairmanship again, Mr Weir. I congratulate my hon. Friend the Member for Cambridge (Dr Huppert) on securing this important debate, which will be of great interest in his constituency and in the county that he represents. I am grateful for the opportunity to address a number of issues that he has raised.

The Department accepts that Cambridgeshire is, on our latest figures, the 143rd lowest-funded authority in England. My hon. Friend knows that the Government are determined to address the injustices in our funding system and to seek, over time, to introduce a fairer

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national funding formula. We are still committed to doing that. I will explain later precisely how we will deliver that in the years ahead.

I am happy to meet my hon. Friend, head teachers and college principals from his constituency in the weeks ahead if he feels that there are further points to be made about funding fairness for Cambridgeshire and the other issues that he has mentioned, and should he want the opportunity for head teachers and principals to put those points directly to me.

I am grateful for the opportunity to address the important concerns that were raised today, which will be of interest to many families in Cambridge and Cambridgeshire and many of the people who work in the educational establishments that my hon. Friend mentioned.

We intend to move to a fairer funding formula across the country, and I will explain how we will do so. Our aim is for every child to be able to succeed at school, regardless of their background and where they live. That is why the Government, despite having to make difficult decisions on public spending since we took power in May 2010, have protected pre-16 school funding in real terms over the spending review period. As part of that, we introduced the pupil premium, which we advocated in our general election manifesto and which, by the end of this Parliament, will have targeted an additional £2.5 billion per year to disadvantaged pupils.

My hon. Friend mentioned how much additional money his county—his constituency—is receiving. He will be pleased to know that the per-pupil amount of the pupil premium will be rising from some £623 per pupil in the current recent educational year to £900 per pupil in the year that we are heading into, which will be a big help to many educational institutions with a large number of disadvantaged youngsters. However, we need an underlying system to support that investment and to ensure that pupils are not disadvantaged as a result of a national school funding system that, frankly, does not distribute funding fairly.

My hon. Friend has highlighted some reasons why the current system for funding schools is in desperate need of reform. It is based on an assessment of need that dates back to at least 2005-06 and it has not kept pace with the changing demographics and needs of pupils. It is also complicated, so head teachers, governors and parents are unable, usually, to understand how their school budgets have been calculated and what the justification is. In addition, the current system is not designed to support the successful expansion of academies. Therefore, it is difficult to demonstrate that schools maintained by local authorities and academies are being funded equitably, which is the Government’s intention.

For the lowest-funded authorities, such as Cambridge, that outdated system may well mean an allocation that does not reflect the current needs of schools in the county. It is not right that schools with similar circumstances in different areas of the country can receive vastly different funding for no clearly identifiable reason. That is why, on 26 March 2012, my right hon. Friend the Secretary of State for Education announced our intention to introduce a new national funding formula during the next spending review period. That formula would distribute money fairly across the country, targeting need and getting rid of some of the anomalies that make the current system so unfair and irrational. However, reforming

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such a complex system—particularly in an environment where, for understandable reasons, all Departments’ budgets are so constrained—is far from easy, and it is important that we do it at a pace that schools can manage, including schools in parts of the country that have been better funded in the past. The last thing that we want is to cause destabilising changes to school budgets, which cause anxiety and distract schools from delivering high educational standards for their pupils.

We are moving gradually towards introducing a new funding system at a pace that gives us sufficient time to agree to the construction of a new formula and that allows schools enough time to adjust to changes in their funding arrangements. At present, we are planning to introduce the national funding formula in the next spending review period. In the meantime, from April, the local system will be simpler and more transparent, meaning far less complexity for us to untangle when we come to address the national system.

Our first step is to ensure greater transparency and consistency in the allocation of funding locally. For 2013-14, the dedicated schools grant has been allocated in three clearly identifiable spending blocks: schools, early years education and high-needs pupils. We set each block for each local authority using details of its spending in 2012-13 and then agreed the blocks with each authority. The spending blocks provide greater transparency over how much has been spent in each of those areas.

We are also making changes to how funding is allocated to schools, so that, within local areas, pupils to the age of 16 begin to attract similar funding regardless of where they go to school. Moving to a more consistent way of funding schools may mean that local authorities and their schools forums have to think radically about how they distribute money to their schools, and a new local formula will inevitably generate shifts in school budgets. That may be uncomfortable, but if we can start to iron out some of the inconsistencies and unfairness that pupils and schools currently experience, that will ultimately help to pave the way towards a fairer, more pupil-led system.

Local authorities have worked hard under the new arrangements to build new formulae that adequately reflect the needs of their schools. However, for some areas, particularly Cambridge, that has proved problematic, and some schools are facing considerable budget changes. I also understand why in Cambridge, as a lower-funded authority, my hon. Friend is worried about how the changes will be managed. Although the budget changes are necessary to reflect a new system, we are clear that they should not be unmanageable, not least in areas such as his. That is why the Secretary of State announced in June that schools will continue to have planning certainty through the minimum funding guarantee. Therefore, in most cases, schools will not lose more than 1.5% of their budget per pupil in 2013-14 and 2014-15, and many schools will gain. In addition, the Secretary of State and I confirmed in October last year that we will continue to operate a minimum funding guarantee beyond 2014-15. We cannot confirm its exact value until the new spending review period, but we are absolutely committed to protecting school budgets from unmanageable changes.

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I reassure my hon. Friend that we will carry out a thorough review this year of the impact of the new simpler formula on pre-16 funding, making any necessary changes based on that evidence in 2014-15. Over the coming weeks, we will start to work with local authorities to explore the effects of different factors, such as the lump sum and deprivation factors, so that we can ensure that a robust system is in place for 2014.

The Secretary of State announced on 2 July 2012 that, from April 2013, we are introducing a new national funding formula for 16 to 19-year-olds in education and training. That new formula will be based on the principle of funding per student, rather than the existing system of funding per qualification, which my hon. Friend mentioned. That will allow sufficient income for each student to undertake a full programme of study, whether vocational or academic.

Our objective is to introduce a system of fair funding that will provide a place in education or training for every young person who wants one and will support full participation by 16 and 17-year-olds by 2015. The new formula will give many benefits, including taking into account the needs of the disadvantaged, implementing the recommendations of the Wolf report and supporting the envisaged A-level reforms. The new formula will fund full-time students for an average of 600 teaching hours, which will be sufficient to offer a significant programme of study. The formula will mean that all students aged 16 to 19 will be funded using the same formula, removing the historical differences between schools and academies and sixth-form colleges.

I understand that some school sixth forms and sixth-form colleges that offer a predominately academic programme to their students, such as Hills Road in my hon. Friend’s constituency, are concerned about their funding under the new 16-to-19 funding formula. I am aware of that institution’s reputation, not only in Cambridge, but across the country. In response to my hon. Friend’s question, I confirm that we will provide at least three years of full funding protection from the formula changes, while we continue our reform of qualifications, including the forthcoming A-level reforms. I also confirm that the 30 hours currently focused on enrichment activities are included in that protection. Detailed allocations of funding for 2013-14 will be announced in March. Arrangements beyond 2014-15 will not be announced until the next spending review has been completed. As part of the process, we have established a ministerial working group with key sector representatives to consider the best way to implement the reforms to programmes of study and associated funding changes, as well as to help us to ensure that the reforms work in the best interests of all young people.

My hon. Friend mentioned VAT, and I am sympathetic to the concerns expressed about the different VAT treatment that sixth-form colleges receive from the Government. I have asked officials to raise the matter with the Treasury and Her Majesty’s Revenue and Customs and to report back to me.

On free school meals, it is only the entitlement to a free meal that is different for schools and academies compared with colleges. There is no actual funding given by the Department for free school meals for sixth- form pupils, even in the school and academy sector,

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which complicates dealing with the injustice in entitlement. We are currently looking at options for extending eligibility further across the 16-to-19 sector.

We also seek to address concerns around capital funding, which my hon. Friend mentioned. We have more than doubled the capital funding that will be made available in this spending review period to support specifically the provision of additional places to those made available in the same period by the previous Administration. We have made £2.8 billion available for basic needs in this spending review. Most recently, in last year’s autumn statement, the Chancellor announced £980 million of additional capital funding for basic needs over the next two years. That will help us to expand good and outstanding schools where there are shortages of places and to establish new academies and free schools where there is that basic need.

I am grateful to my hon. Friend for drawing attention in this relatively short debate to the funding issues faced by schools and sixth-form colleges in Cambridgeshire. I hope that I have provided some reassurance that our aim in making these reforms is ultimately to ensure that England has a fair and transparent funding system precisely to deal with some of the injustices that areas such as Cambridgeshire may have suffered in the past. A new national funding formula will reassess need across the country and will allocate funding accordingly. A refreshed distribution of funding will renew confidence in the system, but only if we put the right formula in place. The Department is working actively on the issues now in the run up to the spending review that will happen before the summer, and it is a preoccupation of mine. I am happy to meet my hon. Friend and any representatives from the education sector in his constituency to discuss this further.

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Charities (Donations)

4.30 pm

John Robertson (Glasgow North West) (Lab): It is a pleasure, Mr Weir, to serve under your chairmanship in this important debate. Towards the end of last year, charity donations had dropped by 20%, and one in six charities said that they face closure in 2013. We rely on charities to support some of the most vulnerable people in our society, and when 73% believe that they are unable to fulfil their philanthropic goals because of lack of funding, there is real cause for concern.

In May 2010, the Government launched their big society idea. The Prime Minister said that it was about allowing charities, social enterprises and companies to provide public services, devolving power to neighbourhoods, and making government more accountable. We are now relying on charities to provide much needed support, but only yesterday Sir Stephen Bubb, head of the Association of Chief Executives of Voluntary Organisations, said:

“The reality many charities now face is crippling spending cuts”.

The Government would like us to rely on charities, but they have neglected to support them in their time of need. What we need now is a Government initiative to support, not one led by charities. In recent years, the public have become increasingly wary of giving to charities following reports of aggressive campaigning. That may be going too far, so we need innovative solutions to access gift aid money, instead of pestering people to give more than they can afford.

Some charities are the only providers for many people, and sometimes they provide niche services to the most vulnerable people in communities. The Marie Collins Foundation provides support for children who have suffered sexual abuse via the internet or mobile technology and has unique expertise in this area. The One in Four charity supports people who were sexually abused as children and is facing an unprecedented amount of work following recent media attention. It relies on donations and volunteers, yet 80% of its clients are referred by the NHS. It is clear that those charities play a role that is genuinely needed in our society.

The problem lies in the reduction of grants and funding available to charities. The SHARE Community says:

“There’s less money available from charitable trusts, and more competition for what there is.”

This debate is not about the fundamental structural changes needed in Government financing to give better support to our charities, although I am sure that an assessment of how that works would be appreciated by many. It is about how to harness the British public’s generosity into a more successful donation record for charities, big and small.

Chris White (Warwick and Leamington) (Con): Will the hon. Gentleman give way?

John Robertson: I am sorry, but the hon. Gentleman did not come to me before the debate, so I will not give way.

People want to give, but they simply cannot afford to give as much as they used to. The problem is reaching breaking point. With the recent child benefit reductions and welfare reform at the forefront of hundreds of

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thousands of people’s minds, charities are being stretched in two directions. For many families, the reduction in income will mean they simply cannot afford to give as much as they used to, leading to reduced budgets for charities. We recently had a debate in the Chamber on food banks, which are classic examples of the strain facing charities during the financial crisis. For example, in the last year, the Trussell Trust almost doubled the number of food banks it oversees from 149 to 293. The BBC recently ran a report about a mother who is a full-time carer to one of her children and is relying on that charity for emergency food parcels. Her words echoed those of many people throughout the country:

“I choose between whether to pay my electricity company...or feed my kids”.

I am sure that the Minister is aware that I often criticise energy companies for their selfishness when raising their prices, and that should be addressed, but we can help to ease the burden in the face of corporate greed by making it easier for charities, such as the Trussell Trust, to secure donations. Similarly, the homelessness charity, Shelter, has seen an 80% increase in demand for homelessness services in the last three years. Additional funding is needed immediately to support its work, and as we enter the coldest part of the year more will be needed.

Elderly people—I have many in my constituency—are also struggling with cuts and rising living costs. In Glasgow, there are now more senior citizens than 16-year-olds. That is a growing trend, and the growing proportion of elderly people will put more strain on our resources. Charities such as the excellent Glasgow Old People’s Welfare Association face rising demands on their resources and rely heavily on increased donations. We must support their work so that they can support elderly people. Demand on such charities will only increase as people start to feel the pinch of years of austerity policies.

Last week, there were reports that a triple dip recession is feared, so 2013 will be a difficult year for many. More and more people will turn to charities for support in their time of need. The Margaret Carey Foundation says:

“Were the charity sector to go into steep decline, the state would have to step in or…just stand by and watch people suffer as a consequence of not having a support system.”

Due to the enormity of Government cuts, I fear it would be the latter. Supporting our charities is an absolute priority, but 20% say they fear they may close this year. We must do something urgently to secure their financing structures.

Unlike many businesses, charities do not have the luxury of reserves to cover income shortfalls, and this year will be a breaking point. The Charities Aid Foundation reports a £300 million deficit in the funds of more than 90% of small and medium-sized charities, and those not facing closure will reduce services.

A key aspect of harnessing donations is to make them more secure and effective, especially with the 20% drop in the last year. It is increasingly difficult to get the other 80%. Cystic Fibrosis Dream Holidays says:

“It is becoming more and more difficult to raise the funds we need. We seem to be doing twice the work to raise half the income!”

The Refugee Youth Project, a charity that provides support to young people who have fled to the UK, relies

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heavily on donations. Some significant costs on charities are not covered by project budgets, so they desperately need unrestricted funding, primarily from donations, to stay alive. Funding from donations is also used to develop research and to pilot new initiatives with young people, allowing the charity to grow and to increase its effectiveness. Project budgets may be financed by Government grants, but that is no good if the backbone of the charity is not supported by donations.

Many charities also rely on the selling of unwanted goods in shops around the country, but Age UK has noted a 20% drop in doorstep donations of unwanted goods, and I am worried that that will only increase as the world moves to online shopping. Online marketplaces, such as Amazon, make it easier and quicker to sell unwanted items, and that is increasing. The British people are finding that they cannot get such books, CDs and other items in charity shops, and the number of those shops will decline. Comic Relief and Sport Relief are doing an excellent job, but we cannot rely all the time on the money that they are raising. It is easier for them to do so, but the lifeline and money that are needed are not there. The fact that charities now have to consider UK problems as a more pressing priority means that international charities will get less, so there will be a reduction in money to developing countries. Donations from UK residents are dropping, and I suggest that, if that trend continues, donations to charities that distribute in the UK will be given priority by donors. That is shown by the food banks that we discussed earlier.

Some things must be done. I was privileged to chair the Committee that considered the Small Charitable Donations Bill, which aimed to make gift aid simpler. However, in the face of such a crisis, that is simply not enough. Charities employ the most successful fundraisers and they are very good at what they do, but a few steps from Government could make a huge difference to the amount they receive. Over £750 million of gift aid goes unclaimed each year. It is clear that more needs to be done to get that to those who need it most.

Jim Sheridan (Paisley and Renfrewshire North) (Lab): That is a significant amount of money—£750 million unclaimed. Do my hon. Friend or the Minister have any idea where that money is and how it can be accessed by charities, including a number of charities on my own patch? Erskine, which looks after disabled service personnel, would very much welcome access to that kind of money.

John Robertson: My hon. Friend is absolutely right. The Erskine hospital fund is greatly supported by many companies, as well as many people in the Glasgow area, but it may find that it does not get the funding that it has had in the past. Perhaps the Minister could answer what happens to that £750 million. Please do not tell me, Minister, that it goes back to the Treasury, when people really need it and we can direct it to some of those charities, rather than giving it to the Chancellor of the Exchequer.

We desperately need to modernise an outdated system. The fact that people fill in a gift aid form each and every time they donate is ridiculous. We could have a central database of gift aid donors, which would allow charities to claim it much more easily. They could check their

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donor quickly and easily against the system, so that they would not need to rely on people making extra effort each and every time they donate.

We also need an awareness campaign on the gift aid scheme. Many people do not use gift aid, because they simply do not know it exists. An awareness campaign could encourage thousands of people to take that extra step and allow gift aid, which is a great benefit to charities, at no additional cost to the donor. If charities were able to claim gift aid on doorstep donations, we could also mitigate the crisis with our charity shops. Charities may see donations decreasing, but that step from Government could see smaller amounts of donations go further. Following the reduction in donations, Age UK has seen a real-terms reduction in potential income of £750,000. Payroll giving—whereby money is taken out of employees’ pay packets—is also massively underused. Only 2% of employees use it, and yet giving £10 could cost them as little as £5. We need to push that further, and education is needed.

We also need to help charity donations to move into the new millennium. Many small charities cannot benefit from text donations due to high—actual or perceived— set-up costs. However, a key issue is that Apple, for example, does not allow direct donations from applications on smart phones. That is ridiculous. It would be simple to donate. The Government have been looking publicly into the issue since around 2011, so why has nothing been done?

We also need the Government to act on data about donating habits. We know that older people donate more. Why, and how can we harness that? We know that younger people donate less. How can we target them specifically? Are the Government scrutinising that data? We welcome the Innovation in Giving Fund, which will give rise to the use of new technologies targeting that group, but we need to ensure that any innovations are available to smaller charities as well.

As our move towards new technologies may reduce the role of our charity shop culture, we need to look at how we can move it online. It seems that the rise of e-books, for example, is a huge blow to the second-hand book trade. With Amazon taking a huge profit from that technology—while paying no corporation tax, it must be stressed—here is a chance for it to play a role in facilitating a charity book culture online. Could Kindle users donate their old books to a charity marketplace, and could they be resold with donations shared between Amazon and chosen charities? Could the same work be done with music? We owe it to Britain’s charities to look into how such a scheme might work, and how else online shopping could be used to benefit our voluntary organisations. We also need a way for people to identify how their donations are distributed and what percentage actually gets to the people who are being targeted.

There is some concern that a small minority of charities are not reputable. We believe that it is necessary to encourage people to trust the majority of charities that truly help people. Therefore, I would like to see a central portal where we can see how reputable they are and how donations are spent.

Finally, we need to protect our smaller charities. They are often disadvantaged through a lack of expertise in fundraising techniques. We need a system of sharing

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that knowledge. The Government should work together with charities of all sizes to provide training on fundraising techniques and on the ways in which they can reach the full potential of each donation given. There is also a role for business to play in training, and employees should be encouraged to donate their time to smaller charities to help them to modernise fundraising systems.

We are facing a crisis in the economy and a knock-on crisis in the charity sector. People want to donate, but I do not believe that they know the full potential of what they can do. Charities provide a vital service that we cannot do without, and we need to tackle the problems now before it is too late. I call on the Government to set to work on a comprehensive strategy to save our charities.

4.47 pm

The Parliamentary Secretary, Cabinet Office (Miss Chloe Smith): I thank the hon. Member for Glasgow North West (John Robertson) for a thoughtful, wide-ranging speech, and I welcome the additional comments provided by the hon. Member for Paisley and Renfrewshire North (Jim Sheridan). I venture to guess that my hon. Friend the Member for Warwick and Leamington (Chris White) was going to mention his valuable work on introducing the Public Services (Social Value) Act 2012, which I congratulate him on as well.

I turn to the comments made and the issues raised by the hon. Member for Glasgow North West in the debate today. I agree that charities play an important role in our society, and I take this opportunity to extend my thanks to the charitable organisations in this country that work so hard, and to those who work in them. They will be glad to see us taking these issues seriously in the House, and I know that there is much more that we must do.

I start with a general point that the hon. Gentleman will be well aware of. Matters pertaining to donations to charities in Scotland are, of course, devolved matters. He is nodding, and he will know as well as I do that it is for the Scottish Government to comment on those matters. Perhaps they have a clear idea of what they wish to do in the long term in Scotland about such things, but he and I can take that into a different debate any time that he wishes.

I turn to the broad issue of current donations and the health of the sector, which was raised in the hon. Gentleman’s speech and in reports a short while ago. Much has been said about the health of the sector generally, and I add that the picture is very mixed. Clear trends are not easy to discern at this stage. The evidence of recent reports from the Charities Aid Foundation suggests that charitable donations are down, while other evidence, such as the Taking Part survey commissioned by the Department for Culture, Media and Sport, finds that there is a slight increase in the proportion of people giving to charity. Similarly, the overall effect on the health of the charitable sector is unclear.

There are, however, grounds for optimism. Some reports suggest that the total income of registered charities has grown from £52 billion in 2009 to almost £59 billion now and that there are 2,000 more registered charities now than in 2009. Those figures are to be welcomed and cast an interesting light on the debate that we are having here today. What appears clear is that no one can say for certain whether donations are decreasing and certainly

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not at what rate. There is some debate in the sector about whether a decrease is what charities are experiencing on the ground.

We will need to wait and see if there is a clear trend in donations, but regardless of what trends emerge, it is also true that life goes on. We need to acknowledge that it is a challenging environment for charities and, clearly, for the people they serve. We should all make every effort to help the sector to raise money efficiently and effectively to meet the challenges, and that is exactly what we are doing. If the hon. Gentleman will allow me, I will go on to deal with a couple of ways in which the Government are seeking to play their part.

The hon. Gentleman referred to face-to-face fundraising, often referred to as chugging. That is certainly seen regularly in Norwich. Indeed, only recently I was corresponding with a constituent on exactly that matter. It is an important and successful method of fundraising, which can bring millions of pounds into the charitable sector every year, but I welcome the announcement in November by the Public Fundraising Regulatory Association and the Local Government Association of an agreed template for voluntary site management agreements as a way for local authorities to control chugging in their areas. I think that more than 50 site agreements are in place, with more being negotiated.

Much more is being done by this Government to support the sector, including by supporting a culture of giving both money and time—an important area of debate—by opening up new sources of income and finance through social investment or delivering public services where organisations decide that that is right for them and by providing wider support for the sector, thereby making it easier to set up and run a charity or social enterprise. All those actions support the health of the sector, either through increasing access to income of various kinds or through reducing costs and burdens, so that that income goes further.

The debate has focused on charitable donations, and perhaps the biggest help that the Government give to the sector is gift aid, which the hon. Gentleman went through in some detail. He will know that it is a matter for the Treasury. Although I used to be that Minister, I would not dream of going on to such territory here today, but he did mention his pride in chairing the debates in Committee on the gift aid small donations scheme, and I was the Minister responsible for much of the work on that and was deeply proud to be so, because it is a very good avenue of further help—up to £100 million a year, we hope—for the sector. I shall say more on that in a second.

I want first to deal with the administration of gift aid and ways in which traditional gift aid can be made better for the sector. My right hon. Friend the Chancellor of the Exchequer announced in the autumn statement that an examination would be carried out to identify ways to improve the administration of gift aid to reflect new ways of giving money to charity and, in particular, digital giving, to which the hon. Gentleman referred.

Richard Fuller (Bedford) (Con) rose—

John Robertson: I accept what the Minister is saying. I have no doubt that she is right and I think that gift aid is a good idea. The problem is that the small and

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medium-sized charities seem to be suffering the most, and they do not seem to have the access to gift aid that the larger charities have.

Miss Smith: I shall be very happy to answer that, but first I shall take the other intervention.

Richard Fuller: On a similar note to what has been said by the hon. Member for Glasgow North West (John Robertson), rather than looking to reform gift aid, would my hon. Friend the Minister consider scrapping gift aid entirely and putting in place a system whereby people can make direct deductions from their taxation? If we want to create a culture of giving, nothing is better than letting people write a cheque to a charity. That is one way in which smaller charities would benefit, rather than having to go through the more cumbersome process of gift aid.

Miss Smith: My hon. Friend makes a fascinating point, and I am always very interested to hear his ideas, some of which I have time to debate at length with him in this Chamber. I shall ensure that that idea goes where it can be well considered.

In answer to the point made by the hon. Member for Glasgow North West, the instigator of the debate, I think that the most important way to help smaller charities is to reduce the costs and burdens associated with what the state can provide to charities. That includes what we did in Budget 2011, which made it clear that we intend to make it easier for charities to claim gift aid by introducing a new IT system that will allow charities to claim gift aid online and through, as I mentioned, the gift aid small donations scheme, which will allow charities of all shapes and sizes—we hope that it will be of particular benefit to small local charities—to claim top-up payments equivalent to gift aid on small cash donations of up to £5,000 a year, without the need to have gift aid declarations from donors. That scheme should commence in April of this year, and as I mentioned, it is expected that it will increase the amounts received by charities by about £100 million a year. It is my sincere hope that it will be put to very good use by smaller charities as well as others.

Jim Sheridan: Can the Minister confirm whether the figure of £750 million is correct and, if it is correct, how small charities in particular access it?

Miss Smith: If the hon. Gentleman will forgive me, I shall have to write to him on the figures because I did not catch the one that he was referring to. I will ensure that he gets the correct Minister’s response to the figure given. He does give me the opportunity to answer a question that was posed earlier: what happens to unclaimed gift aid? I think that both he and the hon. Member for Glasgow North West mentioned a £750 million figure in that regard. If they will forgive me for making a particularly political point at this stage, it is important to note that there is no such thing as a Treasury coffer that just sits there. There is no such thing as the Chancellor wishing to stockpile. There is every such thing as public spending, and if money that is within the public finances is not spent on one thing, it is spent on another. That is a very important point to note. I could also note plenty of other things that past Governments failed to do with public spending, such as control it properly, but I think

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that what is most helpful in this debate is to come back to the reasons why gift aid may be unclaimed. I want to return to that because I think that it is the constructive area for us to debate. We need to ensure that everyone who has a reasonable business claiming gift aid can do so easily, without costs and burdens.

I want to go on to payroll giving. The Cabinet Office, the Treasury and Her Majesty’s Revenue and Customs will come together to produce a joint consultation document on payroll giving in due course. I hope that that reassures the hon. Member for Glasgow North West on some of his points. We are further supporting giving at the top end by ensuring that people who donate at least 10% of their estate to charity will be eligible for a reduction in their inheritance tax bill from 40% to 36%. That is an incentive to help giving as well.

The hon. Gentleman suggested a number of other ideas to increase giving, and I am grateful for them. We will look at many of them; we will constantly look at this issue. We are making £10 million available to the Innovation in Giving fund. Many of the schemes use technology to further their aims. That fund will be delivered by NESTA—the National Endowment for Science, Technology and the Arts. In England only, I should note, the fund will find and support the growth of the most promising ideas with potential to create a step change in giving. That is something that we can all welcome.

In addition, the Institute of Fundraising, which is one of Government’s strategic partners, provides training and guidance to small organisations on fundraising issues. We are also doing much to support the giving of time and wider community action, such as through the National Citizen Service, which gives young people the chance to do voluntary activities, meet new people and put something back into their communities. We are supporting Join In, to encourage people to volunteer and get involved in local sports clubs.

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We are also supporting the sector to find other forms of income. We launched Big Society Capital with up to £600 million. That is the world’s first social investment institution. We have provided support with a wider package of social investment measures. In addition, the Cabinet Office recently published guidance entitled “Making it easier for civil society to work with the state”, which brings together the range of reforms across the Government and the wider public sector. That is aimed at making it easier to set up and run a charity. Part of that is that charities and social enterprises should be able to shape and deliver public services.

We are doing much to support charities to work better, including finding sources of income, through the £30 million Transforming Local Infrastructure fund, to help 74 local support organisations to improve their performance in supporting front-line organisations locally. We have looked at the bureaucracy that frustrates charities and adds to their costs and expenses. We are making good progress in implementing the recommendations on red tape that Lord Hodgson made in 2011 and are undertaking a red tape challenge for the civil society sector.

I should like to make one brief point on the international aspect, which the hon. Gentleman’s comments very interestingly turned to. I am sure that he would welcome, in both the coalition agreement early on and yesterday’s mid-term review, the reinforcement of this country’s aim to give 0.7% of our GDP to development aid. That is an important way to fulfil the aspiration that his speech articulated, and we should not forget it.

The Government recognise that charities face a challenging time in the current economic conditions. We will continue to work with the sector to help them.

Question put and agreed to.

4.59 pm

Sitting adjourned.