4.30 pm
Mr Tom Harris (Glasgow South) (Lab): I begin by echoing other Members’ tributes to my hon. Friend the Member for Stoke-on-Trent North (Joan Walley) for initiating the debate. Her Committee has published an important and powerful report on the subject and I commend all members of the Environmental Audit Committee for producing it. I am sure the Minister has pored over the document in detail and will give us his thoughts on it later this afternoon.
Outstanding contributions have been made by my hon. Friend the Member for Gower (Martin Caton), the hon. Member for Stroud (Neil Carmichael) and my hon. Friends the Members for Southampton, Test (Dr Whitehead), for Bristol East (Kerry McCarthy) and for Llanelli (Nia Griffith). As usually happens when Front Benchers wind up these debates, we tend to be left with only the task of repeating many of the points that have already been made. It reminds me of the old saying that at any meeting everything that has to be said has already been said, but not everyone has said it yet. So I shall plough on regardless.
The debate around neonicotinoids has brought the decline of bee and pollinator populations into sharp focus. The profound effects this will have on the future of horticulture, agriculture and the wider environment cannot be overstated. Bees and other pollinating insects play a vital role in our food supply, providing essential pollination services estimated to be worth £440 million to UK agriculture each year, as well as enriching our natural environment and biodiversity.
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Two months ago, in April, I convened what I ambitiously entitled a bee health summit, which was attended by leading academics, environmental groups, biotechnology companies, farming unions and representatives from leading apiary organisations. I apologise to the Minister for forgetting to invite him. I am sure his contributions would have been worth while. Predictably, there was a lack of agreement on the topical issue of a ban or moratorium on neonicotinoids, and the evidential base was hotly contested. It is clear that pesticides currently play an essential part in achieving high levels of crop production in the UK and elsewhere, providing affordable food for consumers and contributing to our food security. Getting the right balance between the benefits of natural pollination services and the benefits of pesticides to crop production is crucial.
At the summit, there were passionate calls to support the use of the precautionary principle, which have been echoed in the debate today, to protect against further decline while additional evidence is gathered and analysed. These calls were countered by some bee health experts, bee organisations and, yes, the companies that produce neonicotinoids, which took a more cautious line based on the lack of any assessment of the impact of a ban on farmers’ use of alternative pesticide products and the impact on UK food production and food security.
Such divides are not reserved to the UK, and a split in opinion was also observed at an EU level. However, now that the Commission has approved an EU-wide moratorium on the three types of neonicotinoids beginning in December 2013, it is vital that the Government work with all parties concerned to ensure that any negative, unintended consequences on bee health—for example, the hon. Member for Stroud referred to the wider use of spray insecticides—do not materialise.
What plans do the Government have in place to support farmers in the build-up to and during the moratorium? Does the Minister agree that the moratorium provides an excellent opportunity to help farmers and growers to adopt integrated pest management and reduce the use of pesticides in line with the Government’s own pesticides action plan? Does the Minister agree with the Society of Biology, which has pushed for adequate and stable investment in agricultural research and environmental monitoring, in order to avoid periodic crises where sufficient evidence has not been available for necessary policy decisions? Will he outline how the Government will take advantage of the breathing space afforded by the moratorium to bridge the current gaps in scientific knowledge on the effects that neonicotinoids have on bees and other pollinators?
It is crucial that a monitoring programme is put in place to assess the full impact of a moratorium and the effect that it will have on wild and managed bees and on farmers and their crops. Will the Minister assure the House that an effective monitoring programme will be put in place? I am sure that he, like me, is aware of significant concerns raised in the scientific community that two years will not be sufficient to monitor the effect on bee health of a moratorium on neonicotinoids, not least because of the multiple variables in the natural and farmed environments.
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Mr Harris: I see the Minister nodding. Does he agree that those concerns should not deter the Government from co-ordinating the most effective scientific monitoring programme possible so that we can learn from the moratorium period?
Although divides will undoubtedly pertain over a ban on neonicotinoids, during my bee health summit there was unanimous demand for a coherent strategy to reverse the decline in bee numbers and a recognition of the complex factors that need to be addressed, which go well beyond pesticides. Indeed, many warned that a ban on neonicotinoids could be seen as a panacea for the wider range of measures necessary to tackle bee decline. A moratorium does not represent a silver bullet.
The first event that I attended after being appointed to the Front Bench just over a year ago was the Friends of the Earth bee breakfast. I soon got over my initial shock and disappointment—nay, anger—at the lack of breakfast actually being served, because the point was to show what would be available to eat in the event of a world that no longer had bees. That was a very clever, though frightening, way of getting the point across. I can assure Members that people did finally come forward with the toast, butter, honey and jam. They made the crucial point that neonicotinoids and pesticides were important, but only as part of the wider environmental impact that is resulting in bee decline and hive collapse.
There are many causes behind pollinator decline, including changes in agricultural practice in the UK and across Europe; the growth in monocultural crops; the removal of hedges and other wildlife corridors; the increased use of fertilisers, pesticides, insecticides and herbicides; bee pests, including the Varroa mite and deadly pathogens such as Nosema; and the effect of climate change on patterns of flowering, hibernation and food availability. Those are all contributing to falling populations of bees and other pollinator insects. I have frequently voiced the opinion that if we allow ourselves to see the moratorium on neonicotinoids as a silver bullet for bee decline, we become complacent, think “Job done,” and fail to address the many other important issues that we face. It is clear that there is no single solution to the multiple threats that pollinators face, and that is why it is vital that we do not see the moratorium as a panacea.
Labour believes that the Government have a crucial part to play in reversing falling populations. We commend Friends of the Earth for their work in promoting their national bee action plan, which would put a comprehensive set of UK-wide measures in place to tackle the many drivers of pollinator decline. Though Ministers have cited a number of Government-led initiatives to improve bee health, these ultimately fail to meet the scale and urgency of the task in hand. Current failure to tackle habitat loss, which needs to be approached from both a conservation and a planning perspective, is a prime example of where the Government are failing to make headway. On the conservation side, in their biodiversity strategy for England, “Biodiversity 2020”, they have not set out specific measures to help threatened bee species or to protect or restore habitats most important to bees, such as lowland meadows and upland hay meadows. Worryingly, DEFRA’s latest habitat trend data show that those habitats are in decline. Will the Minister ensure that they are urgently restored and that specific measures are put in place to help threatened bee species?
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The Government are set to publish planning practice guidance on biodiversity. That is an important opportunity to give councils guidance and impetus to protect and restore bee-friendly habitat through the planning system. However, so far there has been no evidence that the Government are planning to take that opportunity or even to issue the guidance for public consultation. Has the Minister spoken yet with his colleagues at the Department for Communities and Local Government regarding this matter, and if so, has he impressed upon them the importance of the issue?
Labour will continue to work with farmers and horticulturists and with bee and environmental organisations to create a future of secure and affordable food produce from a natural and farm environment that minimises the risk to our pollinators and enhances our countryside, wildlife, habitats and biodiversity. In order to do that, I urge the Government once again to use the moratorium period to fill the gaps in scientific knowledge of the effects of pesticides and to bring forward urgently a comprehensive national bee action plan to reverse the awful decline in bee health.
4.40 pm
The Minister of State, Department for Environment, Food and Rural Affairs (Mr David Heath): This has been an extremely good debate and I thank the hon. Member for Stoke-on-Trent North (Joan Walley) and her Committee for their report. She knows that we have had a short delay in responding to her, for the precise reasons that she had a short delay in producing the report. The circumstances have been changing quickly and we want to get it right, so I apologise to her and her Committee for that. My noble friend Lord de Mauley is responsible for this area, but the hon. Lady will appreciate that it falls to me to respond to the debate in this House.
I also thank the hon. Member for Glasgow South (Mr Harris) for his balanced remarks, which showed that this is a complex issue. I am interested in it, not least because as Minister for agriculture I know that bees and pollinators are crucial. I cannot underline sufficiently how important pollinators are to agriculture and horticulture, so of course I have that interest.
I also have an enormous personal interest in the issue. I spoke from the Opposition Benches about bees for a very long time. I spoke on the subject right back in June 1998, when I said:
“We need a step change in investment in the investigation of bee disease if we are to stem a worldwide phenomenon that is lapping at our doorstep and has the potential to become a crisis, both for the insect population and in economic terms”.—[Official Report, 17 June 2008; Vol. 477, c. 204WH.]
That is what I said in 1998, so people are now free to quote that back at me, but I meant it. We were arguing then in the context of very little work at Government level on bees. It took the best part of a decade before we pressed the previous Government to start taking the issue of bees and pollinators seriously, which they did: we now have the national bee unit and I think we now need to go one step further in our approach.
I welcome the opportunity to highlight what the Government have been doing in relation both to pollinators and pesticides and to our future plans. We take this issue extremely seriously. It is crucial. Contrary to what some have said, specifically in relation to neonicotinoid insecticides, we have kept the evidence under close and
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open-minded scrutiny and we continue to do so. We will restrict the use of insecticides. Obviously, neonicotinoids are now dealt with under the moratorium, but we will deal with others as well, if the evidence shows that there is a need to do so. I will come back to that point later.
The hon. Members for Stroud (Neil Carmichael) and for Glasgow South pointed out that pollinators face many other challenges. It is critical that one issue, such as the use of particular pesticides, does not dominate the debate, because so many other individual factors, when taken together, have a complex effect on our pollinator population.
Joan Walley: The Minister has said that the Government will take action if the evidence shows that they need to. Will he explain how that relates to the moratorium delivered by the European Commission?
Mr Heath: I will come back to the specific issue of neonicotinoids in a moment. The moratorium is in place, so we will, of course, fully comply with it. We do not not comply with decisions of that kind. I will return to the evidence, because it is a critical issue.
I repeat that bees are essential to the health of our natural environment and the prosperity of our farming industry. The “Biodiversity 2020” document has been mentioned. We have set ourselves the challenge of achieving an overall improvement in the status of our wildlife and preventing further human induced extinctions of known threatened species. We have put a landscape scale approach to biodiversity conservation at the heart of “Biodiversity 2020”. It is vital that that approach is effective in helping to conserve our most threatened species.
Nature improvement areas are beginning to make a difference for species on the ground. The 12 Government-funded NIAs are by no means the sum total of our ambitions. We want to see that approach rolled out more widely by enthusiasts across the country. The hon. Member for Bristol East (Kerry McCarthy) is seeing exactly that in her city. We want that to be extended and it is clearly already happening.
We want to make environmental stewardship more effective. As the House knows, we are in the process of negotiating CAP reform. It is not clear what the outcomes will be. We do not know the extent to which greening measures will be in pillar 1 or pillar 2, or the exact recipe that will emerge from our decisions on agri-environmental schemes that derive from pillar 2 or voluntary modulation. This matter is a key consideration in that context and I will certainly be pressing for it in the outcome.
Nia Griffith: The European Scrutiny Committee has requested a debate on CAP reform. Will the Minister say when that is likely to be scheduled?
Mr Heath: I am responsible for a large number of things in my Department, but the scheduling of House business is not one of them. In my previous post, I might have been able to give the hon. Lady an answer, but in my current post I cannot. To be honest, now would not be the best time to have that debate because we are just reaching what we hope will be a conclusive meeting of the Council of Ministers. After that, we will have a much clearer idea of the outcomes and how they will be effected in the UK.
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We recognise that there is still a need for targeted conservation action for our most threatened species. Natural England’s species recovery programme is designed to help with projects to support priority species, such as the short-haired bumblebee. Many Members have made the point that we are talking not just about the honey bee, but about many other native bee species and other non-bee pollinators. My noble Friend Lord de Mauley has announced that he is considering the development of a more holistic health strategy to cover all pollinators. He has been meeting interested parties, such as Friends of the Earth, to explore what added value that approach could bring.
We will continue with our wider work to understand and counter the various factors that harm bees and other pollinators. DEFRA’s chief scientific adviser and Ministers have met a number of interested parties to discuss that work, including non-governmental organisations. We will seek to host discussions with other stakeholders over the summer.
As I have said, there are many things that we do not yet understand about the reductions in pollinator populations. There are many major factors, including the varroa mite, which was mentioned by the hon. Member for Stroud (Neil Carmichael), foulbrood and the undoubted effects of climate change and environmental and ecological changes in this country. That is why some experts are very unclear as to the quantifiable effect of pesticides. The British Beekeepers Association keeps an open mind on that, as do we. We want to know what the connections are and to see the evidence.
Let us return to the issue of pesticides. As we heard in the debate, the European Commission recently adopted a ban on the use of three neonicotinoids on crops that are “attractive to bees” and on some cereal crops. The ban also covers amateur use, so the Government do not need to bring in an extension.
It is documented that we did not support action, the reason being that we had urged the Commission to complete a full assessment of the available scientific evidence, taking into account new field research that we had carried out. Let us talk about that because it is a serious issue. The hon. Member for Stoke-on-Trent North asked whether we reject laboratory evidence, but of course we do not; it is extraordinarily important. However, we would like some coherence between what we see in the laboratory and what we see in field trials. That does not make field trials the only thing that matter, but such a correlation is not presently there.
From laboratory tests we are clear that neonicotinoids have a toxicity for bees. We do not know, however, what the exposure is in a natural environment, and the two things go together. Many things are toxic but do not create a deleterious effect in the field simply because the exposure is too low. That is where we must do a lot more work, and that is exactly where we are commissioning it. We were clear that the work done by FERA was by no means a satisfactory field trial. We never pretended that it was; it had to be done quickly to meet a timetable—set not by us, but by others—to give at least some indication of whether that correlation was there. Incidentally, I will not accept criticism of FERA scientists on that basis. They are extremely good and do their work in a totally dispassionate and independent way on the best scientific principles. They were asked to do a quick piece
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of work—which they did—and that is why it was not peer reviewed, as would be normal practice. We felt it was important to put the matter in the hands of the Commission, which was about to make a decision on a highly contentious subject.
I make no apologies for recognising that there is, of course, a strong imperative to look at evidence that suggests a toxic consequence and, where possible, to take a precautionary approach to these matters. However, a precautionary approach is not as two-dimensional as sometimes suggested and must take into account the consequences of the action in question. The hon. Member for Glasgow South mentioned the economic consequences, and of course that is a factor, although not an overriding one.
Of far more concern is a point also raised by hon. Members about alternative pesticides that are fully legal under EU law and that it would be perfectly proper for people to use, such as pyrethroids, organophosphates or carbamates, because the potential is that they would be even more damaging to the pollinator population. That concern does not mean that we should not take action against neonicotinoids if the evidence is clear that they are causing problems in field conditions, but it was not unreasonable to say that the paucity of field-trial evidence was astonishing.
I do not have portfolio responsibility for this matter, but when I looked at it with a view sympathetic to what the hon. Member for Stoke-on-Trent North was saying, I was amazed at how little evidence there was in field conditions, which I think exposes a failure of the scientific world to address the problem. I hope that we can play our part in persuading others across the European Union to take a more rational view of where we concentrate our research so that we get the evidence we need, and that is what we are trying to do. Although our assessment is that the risk to the bee population from neonicotinoids, as currently used, is low, we may be wrong and evidence may come forward from trials that shows otherwise. If such evidence is there, we shall, of course, accept it, but we need more complete evidence than we currently have.
The European Commission has committed itself to a review of evidence by 2015, which we want to be founded firmly on a strengthened scientific evidence base. We will play our part in that and are currently talking about the design of field trials that might be in place during the moratorium period, so that we can gather evidence, not just on the honey bee, but on other bee species as well. The FERA research was on the bumblebee rather than the honey bee. It is important that we understand how other species are affected.
Andrew Stunell (Hazel Grove) (LD): I take a great deal of pleasure in knowing how much my hon. Friend knows about the subject and how sincerely he takes it to heart, but does he understand that some of my constituents see the careful words he has just spoken as indicating that the Government are ducking and weaving? May I ask him, in the nicest possible way, whether the Government will be in a position to take a decision when the further research is done or whether they will want still more research to be that little bit more certain?
Mr Heath:
Let me be very clear—I am not the world’s greatest scientist, although I have a scientific degree—that we cannot have scientific certainty; we can have only a balance of probabilities based on evidence. We think
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that the evidential basis for the decision is weak because we do not have evidence from field trials. If the evidence suggests that laboratory results are replicated in field conditions, we will want to take a decision, because we want to protect our pollinator populations. That is important.
I have very little time left because the hon. Member for Stoke-on-Trent North needs to respond to the debate. She asked three questions, including one on the precautionary principle. I hope I have explained our approach on that. She asked about the research and the difference between laboratory and field studies, and about the EU directive on the sustainable use of pesticides, which I believe the Government will implement in full. More work needs to be done on pesticides across the board. It is a misrepresentation to say that the wicked seed companies are pulling the wool over the eyes of the rest of the world. We need transparency of evidence so we know exactly what is happening during the regulatory process and beyond. We are speaking to those companies to ensure that they provide the greatest possible transparency.
The hon. Lady asked what changed between the abstention and the decision to vote no. The answer is that we pressed and pressed again on the need to commission the evidence that we believe would have given a sound basis for the decision, but we did not secure agreement. That is why we are in the position we are in.
The Government are determined to do everything we can to protect our bees and pollinators. They are essential not only to our economy, but to our environment and our ecology. We will take all necessary steps to do so.
4.58 pm
Joan Walley:
This has been a useful debate. I thank all hon. Members who have spoken, including the
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hon. Member for Stroud (Neil Carmichael), and my hon. Friends the Members for Gower (Martin Caton), for Southampton, Test (Dr Whitehead), for Llanelli (Nia Griffith), for Glasgow South (Mr Harris) and for Bristol East (Kerry McCarthy). The Environmental Audit Committee will consider what we can do to support my hon. Friend the Member for Bristol East in her efforts to make Bristol the capital of green cities. We have had the Friends of the Earth breakfast. In view of our debate, the question is whether, at quarter to 3 or two minutes to 5, there is honey still for tea.
The Committee has sought to produce a timely and considered report. We intend our recommendations to be part of an ongoing process of parliamentary scrutiny. It might be in our interests that the Government response will be delayed, just as the integrated pest management report was delayed—it might be in our interests if the delay means we will get a more informed response, and if the Committee will have greater engagement on how such multifaceted issues can be developed. The breathing space of the moratorium we have as a result of the European Commission might help to take the debate forward, and we would welcome a fully informed response from the Government. However, we do not want the Government simply to dismiss the Committee’s work, and we do not want the lack of targets and everything else in the integrated pest control plan to continue. The Committee is a team and this has been a team effort. We want to engage with the Government on how we can ensure, working with farmers and business, and all those people in the British countryside—
5 pm
Motion lapsed (Standing Order No. 9(3)).
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Augmentative and Alternative Communication Services
Motion made, and Question proposed, That this House do now adjourn.—(Mr Syms.)
5 pm
Paul Maynard (Blackpool North and Cleveleys) (Con): It is a pleasure to speak in this debate on this very important issue. I mean no disrespect to you, Mr Deputy Speaker, but it is a shame that Mr Speaker is not in the Chair, because he has been a great champion of speech, language and communication needs down the years. It is worth quoting his key comment from the Bercow report:
“'Communication is crucial. Recognising that is right in terms of equity for those in need and right in the national interest as we all wish to cut the costs of failure”.
Nowhere is that clearer than with augmentative and assistive communication. As that is rather a mouthful, I shall refer to it as AAC.
AAC is a series of aids, some complex and some not so complex, that assist those with neurological conditions that make it hard for them to express themselves. I was delighted when I received a commitment from the Prime Minister during Prime Minister’s questions in March that, as a result of the new commissioning landscape in the NHS, it would be available to more children and adults. I welcome that, and my aim is to ensure that it can actually happen.
I have a personal interest in this subject; it is not something I acquired when I was elected. I attended Hebden Green special school at the age of just three or four, and many of my fellow pupils would have benefited from these complex aids. It gives me real pleasure that one of my pupils, Alexis Egerton, recently gained a PhD thanks to utilising a complex powered aid—an example of how AAC can change people’s lives.
I am grateful to the Minister for the time he was able to spend yesterday meeting me and representatives from Communication Matters and the ACE Centre. I apologise for detaining him further today with a variation on the same theme. It is worth focusing on how the users of the aids feel about how the system currently works. Toby Hewson is an AAC user. He said:
“I cannot express adequately how frustrating it is for people with disabilities to have to battle with the system in the way we are forced to do...like a game of pass-the-parcel, people like me are sidelined and marginalised until we are exhausted.”
That is just an indication of the frustration so many people, and their families, feel about a system that has not yet worked properly for them.
I would be misleading the House and unfair to the Government if I did not make it clear that a great deal of progress has been made, not least through the Bercow report, the work of communication champion Jean Gross and the decision to ensure that most of the commissioning will occur at a national level. I hope that the Minister can act like a statin in the arteries of NHS England to allow what is good to occur, and for policy to be implemented in the way that I am sure everybody in the Department of Health wants it to be implemented.
However, I would also be misleading the House if I did not express some of the concerns about how policy is being implemented. The issue can be as fundamental as the funding mechanism deployed. I am sure that we
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would all agree that NHS England has to start from somewhere in deciding how much money it will allocate to this type of provision. I am reminded of the farmer leaning over a fence who is asked by a walker, “How do I get to Blackpool?” He replies, “Well, I wouldn’t start from here.” I would not start from where NHS England is starting, because it intends to use historical budgets, which might sound perfectly sensible—perfectly obvious perhaps—but if all that involves is ringing up a local hospital manager and asking how much he spends on AAC, when he might not even know what AAC is, I do not think it a particularly satisfactory starting point.
It is more frustrating still given the work done on levels of need by the communication champion—available to NHS England—and further reports since from the University of Manchester. We know the level of provision and unmet need: 0.014% of the population currently use a powered aid, but total need is 0.05%. I am sure that the Minister can do the maths. It is about 3.5 times what is currently being funded. I am not making the predictable everyday point that more must be spent—far from it—but I want NHS England to begin from a sensible starting point when making its decisions.
Mr Gordon Marsden (Blackpool South) (Lab): I am grateful to the hon. Gentleman, my constituency neighbour, for giving way. I warmly commend his work to bring this matter to public attention. He and I have constituents at Highfurlong school and other special schools in Blackpool where these issues are very important. I have had correspondence from two constituents involved with the school. I know that Governments are not always keen on ring-fenced budgets. Does he agree, however, that NHS England should take account of the technology to come, rather than relying on past practice?
Paul Maynard: Indeed. We disagree on many things, but on that issue the hon. Gentleman and I can agree. In Highfurlong, we have an excellent provider of specialist communication provision, so I hope he shares my concern at the proposals, which look to be coming from the local council, that could result in Highfurlong being shut. It causes me great concern, as it does many parents in his constituency and mine, so I hope he will join me in ensuring that Highfurlong is not threatened in the way it might be.
The funding decisions being made have consequences for the proposed hub-and-spoke model. I would welcome a commitment from the Minister that clinical commissioning groups should not interpret the existence of specialist hubs as a justification for winding down their investment in local spokes. That, to me, is crucial, if only because of the issue of complexity. The hon. Member for Blackpool South (Mr Marsden) alluded to that.
Dr Sarah Wollaston (Totnes) (Con): Does my hon. Friend agree with me and my constituents with children using these important assisted technologies that what matters is not just providing the equipment, but the cost of providing training and support, without which children and adults cannot benefit fully from these important technologies?
Paul Maynard:
I thank my hon. Friend for that perceptive contribution. The concern is that NHS England’s budget for AAC will not be sufficient for training. The
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only way that the hub-and-spoke model can work effectively is if the hub can train up more people in the spokes to deliver the more complex tools. Complexity is at the heart of the problem in the structure. AAC is one of five areas for which complex disability equipment is to be commissioned nationally—incidentally, another is artificial eyes, the national centre for which is based in my constituency. It would be remiss of me not to congratulate that centre during an Adjournment debate on a parallel issue. As I was saying, though, complexity is the key: it determines whether a patient is treated at the hub or at the spoke.
A stroke patient will receive a relatively straightforward medical diagnosis—it might be a devastating incident in their personal life, but its medical nature is relatively simple. None the less, what will restore the power of communication to someone who has lost it will be a complex piece of kit, yet under the current rules, as I understand them, it would be commissioned in the spoke. If the skills are not there to utilise that piece of equipment, that stroke patient will not benefit, so complexity of need has to be balanced by the complexity of the product being supplied. That is crucial.
The other issue on which I want to draw out the Minister is the concerns of worried providers in the voluntary sector about their ability to bid for commissions from NHS England. There has been a long-running battle over whether AAC should be based in the education or the health sector. It is now clear that it will be based in the health sector, but one of the key elements of what NHS England seeks to commission is an educational component in a multi-disciplinary team. That component is most often found in organisations such as the ACE Centre, the Dame Hannah Rogers Trust, near the constituency of my hon. Friend the Member for Totnes (Dr Wollaston), or the Percy Hedley school, up in the constituency of the hon. Member for Blaydon (Mr Anderson). They all have immense expertise, yet they greatly fear that the mood music emanating from NHS England suggests that they will be unable to bid for such provision, because of an understanding that it must be supplied by an NHS provider. That seems strange, given all that the Government have said down the years about trying to ensure a broader spectrum of provision—that more civil society organisations can provide such services. I hope the Minister can provide some reassurance on that.
I would also like a commitment from the Minister—this is another fundamental aspect—that this really is a health issue and no longer just an education issue. I hear far too many heartbreaking stories of children who are equipped with complex equipment when in school but, because it is funded by the Department for Education, lose it when they leave. It is not just a piece of kit they are losing; it is their ability to express themselves as fully formed adults. That is why it is so important that this becomes a health issue, not just an education issue.
My final query is rather technical—I beg the Minister’s forgiveness, but this goes back to acting like a statin in NHS England. A clinical reference group has been set up, but it has yet to meet—it is in a form of limbo, as it were. There is yet greater uncertainty, not merely because it has not met, but because the gentleman who chairs it, one Dr Thursfield, is shortly to retire from his academic post at the University of Birmingham. There is grave concern that his uncertain status in the clinical reference
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group is imperilling its ability to meet, take decisions and do its job. Alexis Egerton—the gentleman I mentioned earlier—was disappointed not to be appointed as a patient representative on the clinical reference group. I have known Alexis since my youngest days. He did his PhD on the funding of AAC provision, and it would be immensely valuable to the Government and the nation as a whole if we could find a way to allow him to play a role in that.
Finally—I want to ensure that the Minister has time to respond fully—will he bear in mind that the right to have a voice is a fundamental human right? We have an opportunity in this place to represent our constituents. If, in doing so, we give a voice to some who hitherto did not have one, we will have spent a useful half-hour in this debate. I look forward to hearing the Minister’s response.
Cathy Jamieson (Kilmarnock and Loudoun) (Lab/Co-op): On a point of order, Mr Deputy Speaker. I apologise to hon. Members for having to raise this point of order at the end of a passionate speech in an important debate. I seek your guidance, Mr Deputy Speaker. Today I had a telephone call from someone in the press asking me to comment on a parliamentary question I had asked and for which they had the answer. Unfortunately I was not party to that answer, as it had not been delivered to me. When I contacted the Table Office, it could not elucidate either. I was, however, able to obtain a scanned copy from the press. Would you agree, Mr Deputy Speaker, that this is not the way to conduct business and ensure that Members are appropriately briefed?
Mr Deputy Speaker (Mr Lindsay Hoyle): It certainly is not good form; in fact, it is very bad form. The Member should always know at least at the same time, but preferably before. The matter is now on record and I hope that those on the Front Bench will pass it on, so that we can get to the bottom of it.
5.14 pm
The Minister of State, Department of Health (Norman Lamb): I am really grateful to my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard) for raising this issue, and for his work, together with that of colleagues, as a member of the all-party parliamentary group on speech and language difficulties. An occasion such as this is particularly valuable, as was the meeting that we had yesterday, in ensuring that Ministers focus on issues that might otherwise not get attention. I learned a lot from the meeting yesterday, and from my hon. Friend’s impassioned speech today. He clearly speaks with real authority on this subject. I was struck by his point about the lad who ended up with a PhD as a result of the support that these facilities can provide. He made the point very powerfully that they can change lives.
Augmentative and alternative or assistive communication is one of the more specialised areas of health and education provision. The number of children who will require support in this way is relatively small, perhaps less than 0.5% of the population, so it is important that we do not lose sight of them. My hon. Friend rightly made the point that the ability to speak and communicate is a pretty basic human right, and that it should be recognised as such.
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Augmented communication has the potential to have a tremendous beneficial impact on the health and well-being of those whose condition places barriers between themselves and others, which until recently were insurmountable, and indeed, on their families and friends. Technological and therapeutic advances have in recent years revolutionised the support that can be given to those who have lost, or never had, the tools of speech and language that allow us all to interact and that are critical to development, to education, to work and to living one’s life. Augmentative and assistive communication—AAC—aids range from tools for paper-based communication to pretty sophisticated electronic equipment.
Support in the past has not always been of sufficient consistency and quality, and the Bercow review in 2007 and the subsequent work of the Communication Champion, Jean Gross, have helped to identify systemic improvements, culminating in a new approach to the commissioning of AAC that began just a few months ago. It is worth pointing out that the new system is in its very early days. I was pleased that my hon. Friend acknowledged that it had the potential to work effectively. It is perhaps understandable that we have not got it quite as we would want it to be, given the early stage that we are at, but I agree that it has enormous potential. There is significant clinical consensus behind the new approach, and I am proud to say that it has been developed from the new structures of commissioning that this Government have introduced into the NHS.
In April this year, NHS England took on responsibility for the direct commissioning of specialised assessment and the provision of augmentative and assistive communication aids for adults, children and young people. NHS England’s role as an independent national commissioner is particularly suited to the effective commissioning of extremely complex, yet relatively low volume, services of this kind. Let us bear in mind that the patients who require AAC aids have extremely complex needs and in many cases require bespoke equipment that has been designed for them. My hon. Friend the Member for Totnes (Dr Wollaston) mentioned the training involved in the use of such equipment. It could not feasibly be provided by small-scale local services. Assessment and provision is needed by specialised tertiary providers with their concentration of expertise.
Previously, we had no national commissioning of AAC services and improvement across the board was essential. There was no standard or nationally consistent definition of those services, which were the commissioning and funding responsibility of the NHS. The effect of that was variation in the organisations commissioning and funding specialised AAC services and, crucially, inequitable access to them. There was a mix of non-NHS commissioning agencies, including social care and the education sector, to which my hon. Friend referred, and charity and third sector funding agencies that were commissioning the assessment and provision of specialised AAC aids. It was haphazard, depending very much on where people lived. That was unfair to those in need, and far from ideal for commissioners or providers.
That has now changed. NHS England—committed to ensuring national consistent commissioning of high quality, equitable and effective specialised services—has
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worked with the expert partners on its clinical reference group for complex disability to develop for the first time a nationally consistent specification for specialised AAC aids, which was subject to public consultation. The specification has allowed a clear demarcation of the responsibilities of clinical commissioning groups in relation to less specialised AACs—around 90% of the total provision. The highly specialised services will be commissioned by NHS England. It will be an important role for NHS England to work to support CCGs in their commissioning of the less specialised end of the spectrum and to ensure that we build capacity rather than lose it, as my hon. Friend feared could happen. If we get this right, the potential of having this specialist team working nationally with local commissioners could be significant.
In implementing the specification, NHS England will draw on the recommendations of the Bercow review and the Government communication champion to consider, in particular, how best to ensure more consistent and responsive commissioning of AAC aids across England and the implications of meeting unmet need. We know from recent research from Communication Matters that there is variation in service provision across England—the postcode lottery to which I referred—and inconsistency in identifying, assessing and providing AAC services.
A key priority is therefore to ensure that commissioning arrangements for this specialised service are placed on a much more robust and equitable footing across England. NHS England is working with its clinical reference groups and area teams to identify areas where there may be inequalities and where additional resources may be required to bring about better access. The clinical expertise both embedded in the organisation and accessed through its close association and close partnership working with organisations such as ACE—Aiding Communication in Education—will be decisive in this. I met Anna Reeves of ACE yesterday, and I would like to pay tribute to the amazing work she has done in leading the case for much better access to these services. She has worked tirelessly in that regard and should be credited for doing so.
I would also like to acknowledge the potential benefits of clinically-led commissioning of services for children with special educational needs as part of new joint arrangements, which will also provide far more tailored support, focused on the health and lifestyle outcomes for the child, for the developmental needs of children who require AAC aids. The Children and Families Bill sets out a framework for a new integrated approach to meeting the needs of children and young people with special educational needs. This will include many children, potentially the majority, of children in need of AAC aids.
In brief, the Bill’s provisions will get clinical commissioning groups and local authorities—and, in some cases, the NHS Commissioning Board, where it is acting as a commissioner of services for a child or young person—to enter into joint arrangements to assess, plan and commission the services needed by children and young people with special educational needs. Each child’s improvement outcomes, and the services they need to deliver them, will be captured in the education, health and care plan, to which the relevant commissioners will contribute. That is a much more joined-up approach than we have ever had in the past.
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The new arrangements will be introduced in 2014, Parliament allowing. Twenty pathfinder local authorities are piloting new approaches to integrated assessments and the plans currently. The amended Bill now includes a duty on CCGs to secure the services that they agree the individual needs and which comprise the education, health and care plan. We have specifically required in the mandate for the NHS—the Government’s priorities—the need for improvement, through partnership working, to support children and young people with special educational needs and disabilities, and for ensuring that children have access to the services identified in the agreed care plan. AAC support will be a significant part of these plans for many children.
NHS England and CCGs will need to work closely with local authorities and, of course, health and wellbeing boards, which will include the local authority director of children’s services and the local healthwatch. That is the vehicle for a consensual local identification of needs and a local strategy for meeting them. The health and wellbeing board must, as our guidance makes clear, have particular regard for hard-to-reach groups and those with complex conditions, which will require more specialised health services, as well as ensuring it has an in-depth understanding of more widespread health needs among the population.
Mr Andrew Smith (Oxford East) (Lab): I congratulate the hon. Member for Blackpool North and Cleveleys (Paul Maynard) on initiating this important debate. In the allocation of resources and the approval of plans, what mechanisms for appeal will there be for individuals who feel that they have not been fairly treated, or indeed for areas that feel that?
Norman Lamb: There will be the potential to challenge and question to ensure that the individual is satisfied that their case has been properly heard, but I will also write to the right hon. Gentleman to fill in the details further to ensure that he understands the position fully.
Let me make a quick point about the historical budgets to which my hon. Friend the Member for
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Blackpool North and Cleveleys referred. To start with, NHS England has worked on the basis of the amount spent hitherto. It is important to say that work is very much ongoing on this matter, and it is absolutely recognised that it is important to get it right and to assess the level of need so that we can identify how much needs to be spend on it. This is not a done deal and he should not assume that this is the end of the story. He also made a point about organisations with great expertise which could be excluded from being able to play a part in this. I can reassure him that they will be able to bid to do work. He also made the point about loss of equipment on leaving school, and it is really important that that is avoided; that sort of thing is utterly crazy and we must ensure continuity. As he rightly said, this is a health issue and it must be recognised as such. He talked about the hub-and-spoke issue. The relationship between the expert team nationally and the CCGs has the potential to work well to build capacity within the system to improve the level of expertise available and to ensure a more consistent approach.
I hope that what I have said today provides significant reassurance to hon. Members about the robustness of the new approach to deliver AAC aids, not least in the role of NHS England in leading the development of expert service specifications and implementing them in a national programme of commissioning to deliver improved and responsive communication support. We are not complacent and, together with NHS England, we understand that more needs to be done to ensure absolute consistency across England, so that everyone who needs it has access to high-quality, equitable and effective AAC support. We have in place the right system to deliver that; my profound belief is that we will shortly be able to recognise NHS England, in this regard, as an exemplar of the effective design and commissioning of specialised services.