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Westminster Hall

Wednesday 16 October 2013

[Sir Edward Leigh in the Chair]

Psychological Therapies

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

9.30 am

James Morris (Halesowen and Rowley Regis) (Con): It is a pleasure to open this very important debate under your chairmanship, Sir Edward. First, I want to talk about why this debate is important. Mental illness is one of the biggest health challenges that we face over the next 20 or 30 years. The NHS spends approximately £14 billion on support for people with mental health conditions, which amounts to about 13% of total health spending. However, mental ill health accounts for about 28% of morbidity and 23% of all GP appointments, and recent estimates show that the overall economic cost of mental illness in Britain is about £105 billion a year.

Those are the raw statistics, but behind them is a story of broken lives, isolation and mental suffering. Every week in my constituency, I see people suffering from a range of difficult mental health conditions as a result of personal circumstances, family breakdown and all kinds of different issues. I am sure that other hon. Members here today have had similar experiences in their constituencies. As a compassionate society, we have a duty to address the growing crisis of mental health in Britain, not only by seeking to control its symptoms, but by tackling its underlying causes.

Our approach to mental health has been dominated for too long by what I characterise as a medicalised model. A psychiatric approach has been dominant. I am not arguing that psychiatry does not have a role to play in mental health, but it has been a dominant model for the way in which we approach mental health care in Britain, and the national health service is very focused on drug-based solutions to mental health problems. The number of prescriptions for drugs to try to solve mental health problems has gone up exponentially over the past decade, and as a result, I believe that our approach to mental health in the national health service is very much focused on control, rather than on tackling the profound underlying causes of the growth of mental health problems in Britain.

That is why I want to discuss talking therapies today. It seems to me that talking therapies are a human and compassionate response to mental suffering, as our constituents, our fellow citizens, and we all come to terms with the pressures of modern life, the increase in family breakdown, and the sheer stresses of dealing with information overload and the complexity of living in the modern world. This issue is not confined to any one part of the population; it crosses the whole age range, from children and young people through to older people.

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David Simpson (Upper Bann) (DUP): I congratulate the hon. Gentleman on securing this very important debate. An alarming thing that I have discovered recently is that 80,000 young people across the United Kingdom suffer from severe depression, and 8,000 of those are under the age of 10. It is alarming, and it is running out of control. As the hon. Gentleman has said, personal counselling is an avenue that we can go down. An organisation in my area called Yellow Ribbon does exactly that, and it has had some fantastic results.

James Morris: The hon. Gentleman makes a good point; there are major issues with children and young people’s mental health, and I will come on to that later in my speech.

I want to talk today about improving access to psychological therapies. That is a big area on which I have been focused on in my role as chairman of the all-party parliamentary group on mental health. The improving access to psychological therapies programme was established under the previous Government in 2006, following work by Lord Layard, who looked at the economic benefits of a widespread programme of access to psychological therapies across the country. IAPT was initially launched with small pilot areas and then was formally launched in 2008. I do not think anyone here would deny that the IAPT service has made progress. We have seen 1 million people entering treatment and 680,000 people completing treatment, and we have seen recovery rates of about 45%, with 65% significantly improved. The IAPT programme has led to 45,000 coming off sick pay and benefits, and we have seen 4,000 new practitioners trained in the national health service.

The programme was started by the previous Government, and in February 2011, the current Government published their “No health without mental health” strategy, which committed them to investing more than £400 million over four years into the IAPT programme. At the same time as the publication of that strategy, the Department of Health also published its “Talking therapies: A four-year plan of action”, which had the objective that by March 2015, 15% of the adult population would have access to evidence-based psychological therapies that are capable of delivering rates of recovery of 50% or more. Therefore, some progress has been made, but I want to raise serious questions today about how we should take the IAPT programme forward, about the scale of our ambition, and about the extent to which real choice is embedded in the system. I believe that those questions need to be addressed urgently.

The Department of Health, in its assessment of IAPT—its very comprehensive report was published in November 2012—was clear about challenges that the IAPT programme faced in the future. In particular, its report talked about the challenge of waiting times, stating that one of the challenges is

“building adequate service provision (including number of services, and size and efficiency of workforce) to ensure access for all who need treatment within 28 days of first contact.”

The report discusses the challenge of:

“Unmet need—addressing issues concerning equitable access to services where access is lower than expected among some population groups.”

It also refers to the challenge of “Patient choice”, which goes to the heart of the questions that I am raising today, and

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“increasing information on treatment options and ensuring that treatment plans are agreed by both patient and therapist.”

Another challenge is the:

“Funding distribution process—ensuring that appropriate investments continue to be made in local IAPT services, to continue to expand capacity and assure quality in line with the overall financial expectations set out in the Spending Review.”

The Department of Health is clear, therefore, about the challenges faced by the further roll-out of the IAPT programme. In order to meet the challenges that come out of the Department’s assessment, we need radical thinking. We need to build on the strength of the existing IAPT programme, but we also need to address some of its fundamental weaknesses, which I believe are holding the programme back.

A central issue that we need to have an honest debate about is the fact that the IAPT programme is still dominated by the use of one therapy—cognitive behavioural therapy, or CBT. The National Institute for Health and Care Excellence guidelines that were drawn up in 2005 made the recommendation that CBT should be the default treatment option for the NHS, because it had the most random-controlled-trial supporting evidence for its effectiveness. In 2010, the guidelines were modified slightly to allow five other therapies into the NICE recommended mix. The reality, however, is that IAPT is still dominated by CBT. Again, I am not arguing that, in many circumstances, for patients with particular forms of anxiety and depression, CBT is not an appropriate form of treatment. However, it is a short-term, highly manualised approach to mental health treatment.

There is an interesting quote from NICE’s recommendations on psychological therapies:

“In using guidelines, it is important to remember that the absence of empirical evidence for the effectiveness of a particular intervention is not the same as evidence for ineffectiveness.”

That is a wonderful little quote from NICE.

One of the consequences of our approach to research into the efficacy of particular forms of mental health treatment, and of NICE’s approach to the formulation of its guidelines, is that long-term therapies such as psychotherapy and psychoanalysis, to name just two, which require long-term commitment from the patient and from the analyst, have effectively been locked out of IAPT. In Britain, we have a mature and highly professionalised cohort of therapists in psychotherapy and psychoanalysis. They have, over the past five years, found themselves unable to provide the sort of capacity that we need in IAPT. One of the consequences of that, and of the dominance of CBT, with a focus on training up therapists to concentrate on CBT, is that we have a monolithic model.

Within IAPT, we have access, but no effective choice for the patient—choice that is focused on the individual needs of the patients and on an assessment of the patient’s particular requirements. We have a professional cohort of highly trained therapists in long-term therapies who are unable to assist the NHS in extending capacity for the provision of psychological therapies and who are unable to become part of the conversation to address the programme challenges identified by the Department of Health’s assessment of the three-year IAPT programme in 2012.

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We need to recognise those weaknesses in the existing IAPT programme, because there are still 50% of people who have been through the programme who have not responded well to CBT. Some 85% of people who are currently suffering from severe mental anguish cannot gain access to any appropriate psychological therapy on the NHS. We urgently need a review of the existing NICE guidelines, and I know that Professor David Haslam, the chair of NICE, has recognised the issue and has agreed to initiate a review.

We also need to look again at how we formulate evidence on the efficacy of mental health treatment. For certain long-term therapies, it might not be appropriate for research to be totally focused on randomised control trials, which are also costly to undertake. We therefore need to look at new types of evidence base. We also need to think about developing a new commissioning model for psychological services to create real choice. I will come on to talk about how that might work.

We also need to consider other groups who may benefit from greater choice and access to psychological therapies. The hon. Member for Upper Bann (David Simpson) talked about children and young people. He is right to be concerned about them; it is a major issue that we face in Britain today. Some 850,000 children between the ages of five and 16 are known to have mental health problems. There is a children and young people’s IAPT, which provides a broad range of interventions —parenting therapy, interpersonal psychotherapy and family therapy.

I think we all know and agree that early intervention for children and young people is crucial to prevent problems from becoming more serious. Lots of evidence shows that early intervention at the onset of psychosis in children and young people and suitable psychological therapy treatment can prevent that from blowing up into something much more serious later on. Perhaps we can learn some lessons from the children and young people’s IAPT for adult services, while recognising that the children and young people’s IAPT needs to be developed further.

Also, we must not exclude or not think about the needs of people aged over 65. As we all know, we have an ageing population, meaning that mental health in older people is an increasing problem. The Department’s “Talking Therapies” action plan committed the Department to address the underrepresentation of older people using IAPT. A quarter of people over the age of 65 have symptoms of depression that require intervention, but only one in six will consult their general practitioner. Therefore, IAPT needs to be tailored to meet the needs of older people. Those needs are not just one, single need; the needs of a 65-year-old may be different from those of a 90-year-old.

Mr Gregory Campbell (East Londonderry) (DUP): I congratulate the hon. Gentleman on securing the debate. Earlier, he alluded, as my hon. Friend the Member for Upper Bann (David Simpson), did, to the problems in the younger age group, and now he is talking about the older age group. Given the significant increase of referrals in the past couple of years, does he agree that one of the overarching principles is that we will need significant additional resources to deal with the problem right across the age groups, from the young to the old?

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James Morris: The hon. Gentleman makes an important point. The fundamental nature of my argument is that the current system, while it has made some progress, is not utilising the capacity that we should be able to develop in order to cope with the increasing problems that we face. IAPT needs to be tailored to older people and to be more flexible to meet their needs.

As I said, IAPT has made some progress, but we need to go further. Improving access is one thing; guaranteeing it is another. The NHS constitution provides a right to treatments recommended by NICE. The handbook to the constitution explains that that relates to any treatment that is

“recommended by a NICE technology appraisal.”

I am sorry to get a bit technical here, but I think the point is an important one. Technologies appraised by NICE include devices, medicines, diagnostic methodology, surgical procedures, health promotion activities and other therapeutic technologies. Regarding technologies, computerised CBT for depression and anxiety is the only NICE-approved psychological therapy, which, on the basis of the constitution, patients should have a right to. Psychological therapies have been excluded from the rights embedded in the NHS constitution, and we need to address that gap.

Also, there is no 28-week or any other waiting time target for psychological therapies. If I have a serious physical illness, for example cancer, I will be seen and treated within a particular time frame, and I will know my pathway of care, if that is the right way of describing it. However, if I have a mental illness, there is neither a guarantee nor a waiting time target.

Dame Angela Watkinson (Hornchurch and Upminster) (Con): Does my hon. Friend agree that that is similar to what happens during the perinatal period? If a woman has a premature baby, thousands of pounds—if not hundreds of thousands—will be spent on neonatal intensive care; whereas if she has a full-term baby, but has a psychotic episode and requires in-patient mental health care, it is a complete postcode lottery as to whether she receives any help at all?

James Morris: I thank my hon. Friend for that intervention. She has done a tremendous amount of work in that area. I totally agree with her point; we need to shift our emphasis towards much more early intervention and ensure that the issue she identifies is addressed.

Dr William McCrea (South Antrim) (DUP): The burden of the hon. Gentleman’s address today concerns the therapies necessary to deal with mental health difficulties, but surely, as my hon. Friend the Member for Upper Bann (David Simpson) identified a few moments ago, the problem for the under-10s age group is that more research is needed into how a person under 10 is taken down the dark path of mental illness. We must find out what the problem is, as well as identify some of the treatment.

James Morris: The hon. Gentleman makes a good point. The chief medical officer is producing recommendations about children and young people’s mental health care, which will specifically look at evidence on why the prevalence of such difficulties is increasing. She is becoming concerned about the growing problem.

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A consequence of no guaranteed or set waiting time is that thousands of people are awaiting referral while suffering severe anguish. A constituent of mine who is suffering from a relatively severe mental health problem has received a referral, but is still waiting for treatment. That wait has been going on for a long time and he is in a state of severe anxiety and anguish. That is the direct human consequence of the situation. We need to move towards a waiting time target. I know people are wary of talking about targets, but such targets speak to a parity issue in the health service. If we have waiting time targets for severe physical illness, it is surely right that we move towards waiting time targets for access to appropriate psychological therapies. Appropriate access builds in choice, meets the needs of individual patients and moves us away from the monolithic approach I described earlier.

When responding to the debate, I ask the Minister to consider the following points. We urgently need further research into the efficacy of long-term psychological treatments. We need more holistic research combined with a more flexible NICE regime; as I said, Professor Haslam recently acknowledged that work is needed on the way that NICE approaches recommendations in that area. We need to give serious thought to a new commissioning model assisted by some of the reforms that have been brought into the NHS, such as commissioning groups, and building on the any qualified provider model, which brings choice and capacity into the NHS by allowing the highly professional cohort operating in the private sector to provide therapy on the NHS through IAPT.

Would the Minister seriously consider making or at least working towards a commitment to a 28-week waiting time target for access to psychological therapies? Too many people are in a state of anxiety about when they will get treatment and what that treatment will be. We need urgent action, as other hon. Members have said, to ensure that the IAPT programme is further developed for younger people and children and we need to commit to further research into what is causing the disturbing trend in mental illness among our young people. We also need urgent action to ensure that older people are not locked out of the IAPT programme. The debate is about more than the right policies; it is important because we must address the anguish and suffering of our fellow citizens whose voices desperately need to be heard and whose stories are often the key to their cure.

Several hon. Members rose

Sir Edward Leigh (in the Chair): Order. In addition to the Opposition spokesperson and the Minister, three hon. Members have intimated that they wish to catch my eye. I am sure that they will keep an eye on the clock.

9.54 am

Jim Shannon (Strangford) (DUP): It is a pleasure to come here and support the hon. Member for Halesowen and Rowley Regis (James Morris), who has brought this matter to Westminster Hall for consideration. As my hon. Friend the Member for East Londonderry (Mr Campbell) said here yesterday, whenever we come to Westminster Hall, we congratulate the Member whose debate it is on bringing an important matter to the attention of the House. This is an important matter.

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The hon. Gentleman clearly outlined the issues and their importance. My interest and that of my hon. Friends is in how such issues affect our young people. That will be the thrust of my speech. I also want to give a Northern Ireland perspective, which I believe is mirrored across the whole United Kingdom.

Dr McCrea: Does my hon. Friend agree that, for many years, mental ill health has been a taboo subject? Many of those suffering from mental health difficulties were pushed away or hidden from society. The value of such a debate is that it ensures openness in society, to deal with the important issue of mental ill health.

Jim Shannon: I thank my hon. Friend for raising that matter. That is exactly the problem; if I wanted to sum it up in one phrase, that is the phrase I would use. There was a taboo around mental ill health in the past, but hopefully we can discuss it now. I hate the word “mental”, because it almost puts the thought in one’s mind of someone to be kept at bay. We must be able to find another word in the English language that is more sympathetic. I am not sure what it would be, but we should give the matter consideration.

Psychological therapies are defined as an interpersonal process designed to bring about modification of feelings, cognitions, attitudes and behaviour—all issues the hon. Member for Halesowen and Rowley Regis mentioned—that have proved troublesome to the person seeking help from a trained professional. That is what we want to achieve.

The psychological therapies in the NHS 2013 event marked the halfway point of the coalition Government’s mental health strategy. Psychological therapies generally fall into three categories: behavioural therapies, which focus on cognitions and behaviours; psychoanalytical and psychodynamic therapies, which focus on the unconscious relationship patterns that evolved from childhood, which are important; and humanistic therapies, which focus on self-development in the here and now. We need to focus on those three categories.

I presume that most Members catch up on the news on BBC or Sky before they come here. A story today covered the role of carers and what they do for elderly people, but it also mentioned their role for those with mental health issues and focused in particular on the time that carers have to deliver care to people in those two categories. It underlined where we are in the debate about those who suffer from psychological imbalance and emotional issues.

The improving access to psychological therapies programme was built on evidence, produced in 2004 by the then National Institute for Health and Clinical Excellence, on treating people with depression and anxiety disorders. It was created to offer patients a realistic and routine first-line treatment, combined, where appropriate, with medication, which traditionally had been the only treatment available.

Things have changed. The Minister, whom I respect greatly, will outline the issues when he responds. The IAPT programme was dedicated to spending more than £700 million on psychological therapies between 2008 and 2014. It was first targeted at people of working age,

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but in 2010 was opened to adults of all ages. There has been success—it would be wrong to say that there has not.

In the first three years, 900,000 people were treated for depression and anxiety; 450,000 patients are in recovery, with another 200,000 moving towards recovery; 25,000 fewer people with mental health problems are on benefits; and the average waiting time has reduced from 18 months to a few weeks. In terms of what has been done so far, that is good news, but it is fair to say that there is a lot more to do. There has been a significant increase in the number of people with such issues, and all statistics indicate that that number will continue to grow.

People require psychological therapy for many reasons. Members have spoken about the things that lead to the position we are in today and why society and Government must respond. Reasons for therapy can be to do with home life and bereavement. On many occasions in my constituency office, we deal with bereavement and how it affects not only the partner, but the young people in the house. The hon. Member for Halesowen and Rowley Regis referred to that in his introduction. I regularly see it in my office—the frailty of life, the suddenness of death and how that affects people.

Unemployment, when young people who cannot get the jobs they need or the discipline that a job brings, and trouble in the workplace are other reasons for therapy. Another reason is childhood trauma, as we can see from the sexual abuse cases of the past few years. Many people were not aware of such trauma, but it existed. Social deprivation is another one, and all those issues contribute to where we are.

David Simpson: My hon. Friend mentioned young people again. Surely our schools, whether primary or secondary, need to focus on our teachers being trained to identify when a child has difficulties—the hon. Member for Halesowen and Rowley Regis (James Morris) mentioned early intervention—so that treatment can be introduced at an early stage, which could solve the problem for a lifetime.

Jim Shannon: As my hon. Friend and colleague mentioned, education is one of the areas in which Government can play a role, as can, I would say, Departments responsible for health, social services and welfare. They all need to come together.

Among many other factors, one comes to mind to do with young carers who look after their mum, dad, brothers or sisters. In my constituency, there are about 230 young carers, which is a massive number. They are making a contribution to society, but they are also the main carers for their adults or siblings. Again, that is a real issue.

In Northern Ireland, unemployment, too, causes problems because, among the regions of the United Kingdom, it has the highest percentage of working-age population not in paid employment—the figure is 30% higher than the UK average, which is 19% of individuals receiving a form of out-of-work benefit. The highest rates are recorded in Londonderry with 29%, Strabane with 29% and Belfast with 26%. Some 9% of the working-age population receive disability living allowance, including

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the 3% who receive DLA for mental health reasons. That proportion has risen by 25% since 1998, and is more than the UK average, while 70% of those registered with a disability are not in paid work.

Incidentally, am I the only elected representative to have had an increase in referrals for those who have served in the forces suffering from post-traumatic stress disorder? I know the answer: no, I am not. In all my years as an elected representative, I cannot recall having so many referrals of soldiers, male and female, for emotional, mental-health trauma suffered as a result of their service.

The Prince’s Trust, which many of us have knowledge of and great faith in, has found that one in four young people at work are down or depressed “always” or “often”—for people of that age to be downhearted or depressed is incredible. Unfortunately, that leads to an increase in the suicide rate among young people. In parts of our Province, suicide is at frightening levels. A few years ago in my constituency, there was a spate of suicides by young people, which was saddening for the people of our area, because we knew most of them—young people who did not feel that there was much for them in the future. We must address that issue.

The figure for young people who are down or depressed always or often, but are unemployed, is 50%. That is a massive figure. Clearly, a large section of people are at risk and, in my opinion, early intervention can and will make a difference. However, to establish it, there must be funding. My hon. Friend the Member for Upper Bann (David Simpson) referred to those in education diagnosing cases early, and that is one thing we can do. Our own Health Minister in the Northern Ireland Assembly, Edwin Poots, has taken steps to address the issue, but a UK-wide strategy would be useful and must be considered. I am keen to hear what the Minister will say.

Improving access to psychological therapies in all areas such as health and employment for individuals, families and carers in Northern Ireland could relieve anxiety, depression and distress. The long-term benefits would be more than worth any initial cost. The funding has to be in order, but it has to be there to discharge effectively what has to be done.

In addition, improving mental and social well-being can help to prevent antisocial behaviour and family breakdown for children and young people—again, in my constituency, we regularly witness the effect on people of family breakdowns. It also might make a positive input into the rehabilitation of offenders and assist in the maintenance of independence, reducing reliance on residential and hospital care. The benefits are numerous and clear.

Due to the years of suffering through the troubles, many people in Northern Ireland have poor physical, emotional, behavioural and/or mental health conditions. Dr Nichola Rooney, chair of the division of clinical psychology in Northern Ireland, said that there is

“historical underinvestment in psychological therapy services for people suffering from mental health difficulties in Northern Ireland”.

I am sure that is replicated UK-wide.

Clearly, we must continue to invest and see the rewards of such therapy, not simply as a method of cutting the costs of help in the future, but because it changes the quality of people’s lives and—a knock-on effect— the lives of the people around them. Everyone benefits.

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10.6 am

Mike Thornton (Eastleigh) (LD): I am glad to follow my hon. Friend the Member for Halesowen and Rowley Regis (James Morris) and the hon. Member for Strangford (Jim Shannon), whose points were particularly relevant. I shall try not to repeat them too often in my speech—that might mean reducing its length slightly, people will be pleased to hear.

When I was first elected, a new aspect of my life was the size and complexity of the casework that came my way. Much of it I expected and was familiar with, having been a councillor, but the one facet that surprised—no, shocked—me was the obvious failure in our duty to those with mental health issues. The next surprise was to discover that, in fact, the situation has improved over the past few years, and for that I pay tribute to the Minister, my hon. Friend the Member for North Norfolk (Norman Lamb), and his predecessor, my right hon. Friend the Member for Sutton and Cheam (Paul Burstow).

Today, we have the news that Dr Martin Baggaley, commenting on the results of a BBC freedom of information request, said that we are in “a real crisis” regarding the provision of mental health beds in England. My hon. Friend the Member for North Norfolk, the Minister, is reported by the BBC to agree that that is unacceptable.

At least, however, the BBC was able to obtain figures for the number of beds that have been lost. What would the response have been had the local trusts said, “Sorry, we don’t keep such figures. We have no idea of the number of beds available”? In another possible scenario, one of us asks the Secretary of State for Health, “What is the waiting time for the treatment of breast cancer or leukaemia?”, but the answer is, “I don’t know and I can’t find out.” Would not the whole House erupt in outraged uproar? Would not the press ask how proper provision for those patients can be provided in such circumstances?

Without adequate data and reporting, the needs of millions of ill people cannot be addressed—people with mental health issues. Without decent information, resources cannot be allocated correctly, results properly analysed or effective treatment provided. Yet for much of mental health provision, there is insufficient knowledge of whom we are treating, how we are treating them and how long they are waiting for treatment. As my hon. Friend the Member for Halesowen and Rowley Regis mentioned, we do not have minimum waiting times for much psychological therapy.

Few data are collated for the national policy framework. The data that we have focus on IAPT services and the rates for early mortality. My hon. Friend mentioned how early treatment of mental health problems can stop far worse developments, but without proper data we cannot understand that.

Seema Malhotra (Feltham and Heston) (Lab/Co-op): The hon. Gentleman is making an important point about early intervention in mental health conditions. Does he agree that early intervention does not just stop an individual from cascading to the point at which their life becomes dysfunctional, but has a tremendous economic impact in preventing time off work and the difficulties that that causes for employers?

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Mike Thornton: I agree. There is no doubt that early intervention for all forms of illness usually produces good results, and saves large amounts of money both in relation to rates of people off work and the costs of treating them in the NHS. That can be seen for cancer and heart failure, as well as mental health issues, so I entirely agree with the hon. Lady.

In my constituency, I have been particularly impressed by Solent Mind’s talking therapy programme. That IAPT programme has been effective and easy to access, and figures show that it has provided access to a huge majority within 28 days of a referral. I am not sure whether that is replicated across the country; I have been told that probably it is not.

Such IAPT services are invaluable, but there are disturbing reports that funds are provided for them with money taken away from other mental health provision. My hon. Friend the Member for Halesowen and Rowley Regis mentioned some examples, so I will not repeat them, but it is a bit like increasing funds for bowel cancer care by taking cash from ovarian cancer treatment. I wonder if this morning’s BBC report reflects what is happening in beds being lost to provide money for other therapies and services.

Public Health England and NHS England have announced the development of a mental health intelligence network, which has the potential to link all existing data and map data gaps. However, given the consistent failure to give mental health provision the same status as that for so-called physical health, there is a real risk that the network will not have the resources needed to provide the data and analysis that are so urgently required.

If we are to provide adequately for the one in four of us who suffers from some form of mental illness and for their families who suffer with them, I urge the Minister to ensure that all local commissioning groups and trusts treat information regarding all forms of mental illness with the same parity of esteem as that relating to physical illnesses. I again urge Members to remember that if someone is ill, they are ill. There would be no such lack of data if the absurd, anachronistic and artificial distinction between physical and mental illness did not exist.

10.12 am

Andrew Selous (South West Bedfordshire) (Con): Like my colleagues, I congratulate my hon. Friend the Member for Halesowen and Rowley Regis (James Morris) on bringing this important debate before the House. We know from this morning’s radio bulletins that the discussion is topical and timely, and I am pleased to have the opportunity to contribute to it.

My focus will be on the need to broaden the scope of what is offered under IAPT, particularly in relation to couple relationships. I strongly believe that it is hugely in the interests of the NHS and the Department of Health to realise the significance of strong couple relationships to good health, which is essential to protecting the NHS budget. That point is really important—[Interruption].

Sir Edward Leigh (in the Chair): Order. Officials should not talk to a Member of Parliament while the debate is continuing.

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Andrew Selous: As colleagues have already stated, data on the type of therapies available under IAPT show that couple therapy is available in less than a quarter of cases. The data came from the “National Audit of Psychological Therapies for Anxiety and Depression, National Report 2011”, so they are official. The figure for couple therapy is only 24.6%, while interpersonal therapy is available in under half, or 48.3%, of the settings in which provision is made. For psychodynamic and psychoanalytic therapy, the figure is under 40%, at 39.8%, whereas cognitive behavioural therapy is available in 94.9%—just under 95%—of cases.

Those figures demonstrate the significance of CBT, which for some people with mental health issues is absolutely the right treatment, but it is important to realise that CBT is clearly not the appropriate treatment for all those with mental health conditions. We should also remember that all those therapies are approved and recommended by NICE, and the evidence shows that all such treatments are effective for the right patients.

I am particularly concerned that the benefits of a relational approach to the treatment of depression are not being realised and that, in many cases, individual CBT counselling is given where it is not appropriate. I want to tell a true story of one young couple’s experience of interacting with the IAPT programme. Figures and sums of money give the broad picture—they are our stock in trade as Members of Parliament—but they are a bit high-level and do not capture the essence of mental health provision on the front line.

Let me tell the story of Polly and Mark—to protect their anonymity, those are not their real names—who experienced considerable challenges in having two children, with several miscarriages and a stillbirth. Polly became very low and left her successful career. The hon. Member for Feltham and Heston (Seema Malhotra) has already pointed out the cost to the economy when people have mental health issues. Polly’s husband, Mark, had a very difficult childhood, and he was badly affected by his parents’ violent and stormy relationship.

When Polly and Mark’s youngest child was two, Polly confessed that she had had an affair seven years earlier, which left her feeling guilt and shame long after it ended. On learning that, Mark was utterly devastated by the revelation and fell into a deep depression, with unmanageable rages during which he threatened to kill the other man. Polly developed severe headaches, so she went to her GP and was sent for tests. On finding nothing wrong, the GP recommended that Polly have individual counselling focusing on the stillbirth four years previously. After being unable to work and having three weeks of sleepless nights, Mark also visited his GP. Mark was referred to a psychiatrist, who diagnosed him as suffering from acute depression and prescribed him antidepressants.

The couple were acutely conscious that their relationship was about to break down. Not having been offered any form of couple therapy by IAPT, they approached a voluntary sector service, and for six months, they went to weekly couple therapy. At the same time, they were offered cognitive behavioural therapy through IAPT. They believed that the problem was their relationship, but health professionals clearly thought that the depression needed treatment. In couple therapy, Polly was able to share her anxieties about her parents’ divorce and about how she did not want her children to suffer as she had.

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As the couple therapy progressed, Mark and Polly became more open with each other and began to understand how their relationship problems were a product of both recent and past difficulties.

An important point is that that couple therapy—it was not provided through IAPT; Mark and Polly had to go to the voluntary sector for it, because IAPT had offered them CBT that they did not need—was voluntary help that lasted for six months. My concern is that IAPT provision, whether of CBT or other measures, is often given for only a short period, which is not always appropriate or likely to be successful in such cases.

That true story illustrates powerfully why we need to look again at the IAPT programme, excellent though much of it is, and to take a relational approach to many of the issues where appropriate. I hope that it has been helpful to Members to put that real-life case study on the record.

Academic studies show why what I have said is important and matters. Evidence reveals links between relationship quality, depression and re-employability. For example, a meta-analysis conducted by McKee in 2005 concluded that lack of social support by partners in a relationship has negative impacts on the physical and psychological health of the unemployed person and is especially associated with more frequent development of psychosomatic symptoms, stress and depression.

The all-party parliamentary group on strengthening couple relationships, which I chair, and the newly formed Relationships Alliance published only last week a report that said that relationships were the missing link in public health. That report showed that relationship quality is often a key determinant of health and well-being, and that it has strong links with the ability to deal well with cardiovascular disease, obesity, alcohol misuse and mental health issues. All those issues link up, and strengthening the health of couple relationships is often right at the heart of them.

If we look at what has happened since the IAPT programme began—I understand that it receives funding of about £400 million a year—we can see that the investment has been very much towards cognitive behavioural therapy, with interpersonal psychotherapy, counselling for depression, brief dynamic therapy and couple therapy the poor relations in the area.

In a written parliamentary question, answered on 8 January 2013 and printed in volume 556, column 258, of the Official Report, we learn that of 1,225 sessions in 2012-13 only 99 were for couple therapy, whereas 459 were for CBT low-intensity therapy and 322 for CBT high-intensity therapy. If we look at the period from 2008-09 all the way through to the projections for 2013-14, we will see that of nearly 8,000 different sessions—7,958 to be precise—only 297 were for couple therapy. The story that I have just given of Polly and Mark shows that such sessions are needed up and down are country and can indeed make a significant difference.

Seema Malhotra: The hon. Gentleman is making a powerful speech on the importance of having a relational base to services. In my own constituency of Feltham and Heston, I visited a service that was started a year ago by the National Society for the Prevention of Cruelty to Children. It works with children who have parents with drug and alcohol problems. I am struck by what

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the hon. Gentleman is saying. Is he able to talk a bit more about, or perhaps give a comment on, how having such a focus in a service can help children who are the victim of the illness of their parents?

Andrew Selous: I am grateful to the hon. Lady for her comments. May I extend to her a very warm invitation to come to the next meeting of the all-party parliamentary group on 6 November when we will consider such issues further? She is absolutely right that these issues are intergenerational. If she was following the example of Mark and Polly, she would have learned that it was their own parents’ stormy relationships that had affected them. Of course their children were suffering deeply from the problems that they were having in their own relationship or marriage. Such issues are deeply related, and she is completely right to say that the children suffer hugely when there are relationship problems between the parents. It is vital that we get this matter right for the children, and I would welcome her support on a cross-party basis on these important issues; they are just too important to be bipartisan about. I would love to have cross-party agreement on the importance of relational issues in public health, because I feel so passionately about the matter.

Another concern is the geographic differences in the ability to get couple therapy through IAPT at the moment. Ruth Sutherland, the chief executive officer of Relate, told me only yesterday that the programme is very geographically bound. Provision is better in the north of England—I note that there are not many colleagues from the north of England in the Chamber today—than in the south, so there is an inequality of access geographically, as well as there being fewer of these sessions available across the UK as a whole.

Let me make one further point to the Minister about why one part of IAPT provision is an incredibly serious matter for the whole NHS. As a clinician, he will know about the huge importance of long-term conditions, which are faced by so many of our constituents. He will be well aware of the significant demands that they will make on the NHS in years to come. I am talking about strokes and dementia and all sorts of other long-term ailments that many of our constituents will live with for a very long time.

I heard a moving story a couple of weeks ago from a gentleman who was visiting his elderly parents in Manchester. He said that between them as a couple they could function. Between the two of them, they had one pair of eyes, ears and legs that worked. They were both sick in different ways. They could cope and look after each other, but what would have happened if they had split in younger years? They might have been like Polly and Mark and had difficulties and not been able to receive the type of help that I have outlined. Let us say that they did sadly split up, like so many couples do today. They would be in two different flats in different parts of Manchester needing far more help from their GP and far more adult care, and that would fall on the clinicians for whom the Minister is responsible and on adult social services. Yes, it would have an impact on their families, and we would all be paying more through our taxes and there would greater burdens on business as well from having to look after that couple in two different settings. The importance of strong couple relationships in older age, in later life, is critical not least

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to deal with the increase in long-term conditions, which are becoming more and more prevalent and which many of our constituents will be coping with for many years to come. That is my final pitch to the Minister.

We are talking specifically about mental health and IAPT. I understand that a lot of good work is being done under IAPT and that it is an excellent programme, but I ask the Minister, when he goes back to his Department and talks to his colleagues and the Secretary of State, to take back with him the absolute centrality of strong relational health up and down are country as far as public health, the burdens on the NHS and his Department are concerned.

10.29 am

Luciana Berger (Liverpool, Wavertree) (Lab/Co-op): Sir Edward, it is a pleasure to serve under your chairmanship this morning.

This has been a thoughtful and important debate on a subject that is not talked about nearly enough. Every day in Britain, people of all ages and backgrounds, and from all communities, have their lives blighted by the spectre of mental illness. Theirs are some of the great untold stories of our society. As many hon. Members have already said, the issue of mental health has been swept under the carpet for too long. One in six people are afflicted by mental illness, but all too often they are scared into silence. That is why this discussion is so important.

I also congratulate the hon. Member for Halesowen and Rowley Regis (James Morris) on securing this debate and on the campaigning that he has done on this issue. In addition, I thank him for giving me the opportunity to talk about mental health in my first debate as Labour’s newly appointed shadow Minister with responsibility for public health.

This debate is even more timely because of the news that we have heard on the BBC this morning, to which a number of hon. Members have already referred. Dr Baggaley, the director of medicine at South London and Maudsley NHS Foundation Trust, has said that our mental health services are in “crisis”, following the news—after the BBC made freedom of information requests—that in a little more than two years we have seen the loss of 1,700 mental health beds. I note that the Minister of State, Department of Health, who is the Minister with responsibility for care, said this morning that the situation is “unacceptable” and that the provision must improve. I hope that the Minister who is here in Westminster Hall today will refer to that when he responds to the debate.

We have heard a number of valuable contributions this morning. In responding to the excellent points that have been made, I will cover three broad themes: first, I will reiterate the importance of early intervention; secondly, I will talk about the improving access to psychological therapies programme, including some specific issues about how IAPT needs to work better; and thirdly, I will talk about what we need to do beyond IAPT.

Let me begin with early intervention. As hon. Members have already said, the long-term consequences are clear if we do not tackle mental illness early; indeed, we can already see those consequences right across our society

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today. We can see them in the workplace, where mental illness is the largest single cause of long-term sick leave; we can see them in our criminal justice system, where 70% of those in our prisons have a mental illness; and we can see them in our economy, where mental ill health costs Britain’s businesses £26 billion every year, or £71 million every day. Also, in our health service, according to the London School of Economics the physical health care necessitated by mental illness costs the NHS an extra £10 billion each year. All those points show why the case for action could not be any clearer.

I am sure that, like myself, many hon. Members will have had experience of constituents coming to them for assistance; indeed, several hon. Members have referred to those experiences in their contributions to the debate. Constituents come to us in deep distress and dire circumstances. However, many of those situations could have been avoided if those people had received specialist treatment for mental illnesses at a much earlier stage. I echo the hon. Member for Halesowen and Rowley Regis, who said that it is absolutely crucial that we look at this issue of early intervention.

That was why in 2007 the last Labour Government launched the IAPT programme, which helped to make respected and evidence-based therapies available to more people than ever before. As we heard in the hon. Gentleman’s opening speech, thousands of people have been helped on that programme so far. Since then, the current Government have continued the programme and extended it to cover more people, which is a welcome step. However, as this debate has made clear, IAPT is still a developing scheme, with areas that are in need of much improvement. So, my second theme is to focus on those areas that require attention, and I would be grateful if the Minister could address them in his closing remarks.

There are three areas in particular that require attention. The first is funding. Spending on IAPT has increased from zero in 2008-09, when the programme was first launched, to £214 million in 2011-12. The Department of Health has also allocated £54 million to improve access to therapies for children and young people, which is a good step. However, it must be noted that Ministers always pledged that IAPT funding would be additional funding and would not replace existing psychotherapy services. Despite those assurances, non-IAPT therapy services have been cut by more than 5%. Funding has fallen from £185 million in 2009-09 to £172 million in 2011-12. What makes that even more worrying is that overall mental health spending has been cut in real terms for the second year in a row.

That real-terms cut has particular resonance when it comes to the second area that requires attention, which is waiting times; again, waiting times have already been mentioned by hon. Members during this debate. NICE’s aim is that patients receive access to evidence-based therapies within 28 days of referral. It is regrettable that this debate falls the day before the latest programme statistics are published. According to the latest figures, however, which are for 2012-13, more people are having to wait longer to start receiving treatment for anxiety or depression.

Seema Malhotra: My hon. Friend makes very important points about waiting times and how they have continued, and also about the cuts to services. Given that the

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number of university students seeking counselling has risen by a third in the last four years, does she agree that it is important to recognise the impact that the drop in funding could be having on vulnerable students, sometimes forcing them to leave university, which can affect the rest of their life? With the number of students in that situation increasing and without data for average waiting times, we must recognise the importance of early intervention and very fast response.

Luciana Berger: I thank my hon. Friend for that intervention, and she raises an important issue. There are lots of different groups of people who do not have access to these sorts of services or who have to wait a disproportionate amount of time to access them. We have already heard hon. Members talking about older people who might not be able to access the IAPT programme, and my hon. Friend refers to university students, who do not necessarily fall into the category of children and young people, but who, as young adults, are struggling with leaving home and with financial pressures.

I have not seen any direct research about what effect the current cost of living crisis is having on our population—I hope that there will be some research into that issue—but my experience from my case load as a constituency MP indicates that we have a problem in our society regarding the pressures of life. More people are having to access these services and therefore the services should be available, which makes the issues of waiting times even more relevant.

More than 115,000 people had to wait more than 28 days from referral until their first treatment or therapy session, which was a 19% increase from the previous year. The hon. Member for South West Bedfordshire (Andrew Selous) made the point that this issue is not only about the statistics but the people behind the statistics, who have to go through the trauma of waiting for treatment and suffering the uncertainty of not knowing when it will come.

On Monday, someone contacted me to say that they had been waiting for a year and a half for cognitive behavioural therapy in the Wirral, on Merseyside, and just this morning on BBC “Breakfast”: there was a woman who was interviewed who had had to wait 17 months for talking therapies treatment. Eventually, she had to be sectioned as her condition deteriorated while she waited for treatment. These cases are not unusual— there are too many cases like them—and it pains me to learn of them. According to a report produced by the We Need to Talk coalition of mental health charities and royal colleges, one in five people have been waiting for more than a year to receive treatment. However, the same report found that people who receive treatment within three months are almost five times more likely to be helped back into work by therapy than others who have to wait for one or two years. As another person wrote to me this week, even a six-week wait can seem a whole lot longer if someone is clinically depressed. Just as we focus on waiting times for cancer treatment and other examples of physical care, we must do the same for mental health therapies.

I will repeat the commitment, which my right hon. Friend the Leader of the Opposition made a year ago, that the next Labour Government will rewrite the NHS constitution; that we will strengthen the rights that it

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grants to patients; that we will create a genuine parity between mental and physical health care; and that we will set down a new right of access to the therapies that we have been talking about this morning. That will mean that mental health patients will be entitled not only to drugs and other medical treatments but to psychological therapies, and they will have the same guarantees on waiting times, professional advice and patient experience.

However, in addition to how long it takes to receive treatment, we need to examine the range of therapies that are available in the first place, which brings me to my third broad theme; again, it is a theme that has been already been referred to by other hon. Members, but it is important to reinforce it and to ask the Minister to respond to it. Different people are affected by different mental health conditions for all sorts of different reasons. That is why we need diverse mental health provision, with a range of therapies, to cater for people with different needs, preferences and personalities. As the hon. Member for Halesowen and Rowley Regis said, only five types of therapy are currently available via IAPT. Moreover, 90% of IAPT funding has gone towards cognitive behaviour therapies, with limited support for other modes of therapy. The United Kingdom Council for Psychotherapy has described this as an

“overwhelmingly manualised and brief approach to therapy that sits at odds with the professional practice of the majority of leading psychotherapists and counsellors.”

We need to look at going beyond basic therapies that help people go about their day-to-day lives more adequately. There needs to be appropriate room for more intense and longer term psychological treatments, so that the underlying causes do not go unaddressed.

The hon. Member for South West Bedfordshire mentioned the need for couples therapies. The hon. Member for Halesowen and Rowley Regis also talked about older peoples’ problems with accessing treatment.

There is a patient choice issue, too. According to a survey of 500 service users by Mind, only 8% of people had a full choice about which therapy they received and just 13% had a choice about where they received therapy. The 8% who had full choice of therapies—a very small number—were, on average, three times happier with their treatment and five times more likely to say that therapy had helped them back into work. As the programme develops, we need to do all we can to ensure that it caters to people’s individual needs.

What needs to be done beyond IAPT? As welcome as IAPT is, we have to remember that the programme currently only aspires to be available to 15% of the population. The programme’s three-year report, published last November, shows that it is currently delivering 45% recovery rates and aims to reach 50% by March 2015. The big question this raises is, what about the other 50% to 55%—the 50% who continue to suffer from conditions, having gone through the IAPT process, but are not eligible for more intensive psychotherapy services under the stepped care model? That question, and this debate, requires an answer that goes far beyond the IAPT programme. It requires ending the artificial dividing lines in our NHS and pursuing a whole person, fully integrated approach to mental, physical, social and care issues, as Labour has indicated, and it demands a complete revaluation of how we, as a country, think about and approach mental health. That is what Labour’s

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mental health taskforce is looking at, under the expert leadership of Stephen O’Brien, the chair of Barts Health NHS Trust.

General mental health support should not start in hospital or the treatment room. It needs to start in our workplaces, our schools and our communities, even across our kitchen tables and in the conversations we have with one another. There is no reason why we should not be able to talk about mental health and psychological therapies in the same way we do about access to sexual health services, vaccinations or cancer treatment, but we have a long way to go.

I look forward to the Minister’s response. I hope that he will respond to my questions and issues raised by other hon. Members. Returning to my opening comments on today’s news about the crisis in mental health provision and the reduction in the number of beds, the point of our debate is access to services that would prevent people from going into those beds in the first place. However, we hear today that bed capacity is at 100%. I hope that the Minister will mention those issues as well, because they are interlinked.

10.44 am

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): It is a pleasure to serve under your chairmanship, Sir Edward. I pay tribute to my hon. Friend the Member for Halesowen and Rowley Regis (James Morris) for securing this debate, for his tremendous work on the all-party group in highlighting the importance of mental health and the need to continue to raise mental health issues, and for his supporting the Government in seeking parity between physical and mental health, to which we have been committed since the coalition came to power in 2010. I congratulate the hon. Member for Liverpool, Wavertree (Luciana Berger) on her promotion to her new role and commend her largely bipartisan approach to the debate and on recognising that some of these issues are bigger than party politics.

Before I deal with some important issues raised by my hon. Friend the Member for Halesowen and Rowley Regis, I want to touch on the contributions of other hon. Members and talk about the context in which we are operating. We recognise, as a Government—I think that all hon. Members in this debate have recognised—that for far too long we focused on crisis management in health care generally, particularly in mental health, rather than on upstream interventions, which is where IAPT plays such an important role to keep people well in their own homes and communities, instead of picking up the pieces when they become so unwell at the other end. There is a good economic argument for that, but it also provides much better care for the patients and the people we all care about as Members of Parliament, and whom I care about as a doctor.

The hon. Member for Strangford (Jim Shannon) raised some important issues about veterans’ health. He knows that I have personally committed to improving the provision of physical and mental health care for our armed forces veterans. There are now 10 dedicated teams in England, focusing on supporting our veterans who have post-traumatic stress disorder and other mental health problems, post-discharge. A lot of work is going

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on—much more collaborative work—between the NHS and the armed forces, to ensure that general practitioners and health care professionals in England are much more aware of armed forces personnel coming back into their care, after serving in the armed forces, that a more holistic approach is taken, that people do not present too late in crisis and that GPs can be much more proactive in offering reassurance and support to veterans who may be running into the early signs of difficulties. My counterpart in Northern Ireland has been working hard on that and he should be commended for it.

My hon. Friends the Members for South West Bedfordshire (Andrew Selous) and for Eastleigh (Mike Thornton) made important contributions about the holistic approach to health care in general, about how mental health needs to be considered holistically and about the benefits to wider society of upstream interventions. Getting health care right can also provide additional benefits for the economy; for example, by supporting families to stay together and bring up their children. All these things are beneficial and at the heart of my work on early interventions projects. My hon. Friend the Member for Hornchurch and Upminster (Dame Angela Watkinson), who is no longer in this Chamber, and I are working closely on that.

Huw Irranca-Davies (Ogmore) (Lab): I apologise for being late. I was at another meeting. I, too, congratulate the hon. Member for Halesowen and Rowley Regis (James Morris) on securing the debate. Has the Minister already secured a meeting with Welsh Government Ministers, or will he do so in future, to discuss the approach towards veterans that he outlined? That issue is close to my heart, because I am aware of emergency rescue situations in which things have gone too far, when services, including mental health services, have been stretched way beyond their means in dealing with them. There would be benefits from sharing best practice across all the regions and nations.

Dr Poulter: The hon. Gentleman is right. We UK Health Ministers work collaboratively on many issues. However, on veterans, we have to recognise that, although we have UK-wide armed forces, health is a devolved responsibility. We need to share different initiatives better between the devolved Administrations. Some remote areas of Wales, in particular, could learn from best practice in the NHS about how we are using, to good effect, specialist mental health teams for veterans. I should be happy to share that and meet my counterpart in Wales to talk that through in greater detail.

I will focus in particular on the important contribution of my hon. Friend the Member for Halesowen and Rowley Regis. He addressed a number of issues that are central to the provision of good mental health care, and he threw down some challenges on how we could make things better. In particular, he praised the scale of the Government’s ambition to have genuine parity between physical and mental health, which has to be right; it is at the centre of everything that we are looking towards in the good commissioning of services locally.

I reassure the hon. Member for Liverpool, Wavertree that, with the addition of IAPT, there has been a substantial increase in the NHS’s total investment in psychological therapies. As she will be aware, however, it is down to local commissioners to prioritise their

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resources to meet local need, based on the local population that they serve. In the past, the challenge has been that good commissioning has too often been seen purely through the framework of physical health. Through the NHS Commissioning Board’s mandate, we are now ensuring that there is parity between mental and physical health. That journey is already well under way to ensure that good commissioning is no longer just about commissioning for acute services, such as stroke and heart attack, but about looking at the whole patient and considering the importance of upstream interventions, which are central to IAPT’s role in looking after patients.

My hon. Friend the Member for Halesowen and Rowley Regis also talked about the need to consider CBT and its evidence base. As he knows, it is not the role of Ministers to question the integrity of NICE, but NICE keeps its criteria under review, and there is a very strong evidence base to support CBT. The evidence base for IAPT is continually being developed and adapted, and a number of pilots are already in place to consider the potential to extend the scope of therapies, including to older people. I hope that that is reassuring. NICE will be listening to this debate, and it continues to evaluate the evidence. With mental health, there has always been controversy on how evidence is collated, because mental health is different from physical health, and NICE will keep that under review when it adapts and introduces future guidelines.

The debate has been called because all hon. Members in the room believe that, for too long, there has been too much focus on crisis management and acute response when patients with mental health conditions become very unwell. We would all like to see much more focus on upstream intervention, which is what IAPT is all about. We need to move the focus away from SSRIs—selective serotonin reuptake inhibitors—and drug-based therapy towards upstream, proactive intervention for what is sometimes a very vulnerable patient group.

The benefits of early intervention have been outlined by many hon. Members. There are clear health benefits, but there are also economic benefits, benefits to the family and benefits from getting people back to work, education and training, and from supporting people to have more productive and happier lives. That is why we will continue to ensure parity of esteem in commissioning for physical and mental health, and it is why we will continue to support upstream interventions in the early years—I will address early-years IAPT later. We will also ensure that we continually drive good commissioning to encompass mental health as well as physical health. That holistic approach to health care, by prioritising mental health, is good for people’s health care, good for families and good for the economy. That is why we will ensure that it remains a priority.

As hon. Members will be aware, the mandate set by the Government for NHS England last year establishes a holistic approach as a priority for the whole NHS for the first time. Improving access to psychological therapies is fundamental to the success of improving mental health. The mandate makes it clear that everyone who needs them should have timely access to evidence-based services. That is particularly important for mental health. By the end of March 2015, IAPT services will be available to at least 15% of those who could benefit—an estimated 900,000 people a year. We are also increasing the availability of services to cover children and young

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people with long-term physical health problems and those with severe mental illness to ensure that everyone can access therapies. There is an emphasis on those who are out of work, the black and minority ethnic populations and older people and their carers.

IAPT is being made available throughout the country. The programme was started by the previous Government in 2008, and we now have an IAPT service in every clinical commissioning group. There are more than 4,000 trained practitioners, and more than 1 million people are entering and completing treatment. Recovery rates have consistently been in excess of 45%, and they are much greater in many areas. The programme already has a clear track record of evidence-based success, and it is helping to reach some of the most disadvantaged and marginalised people in our society, which we would all say is a good thing.

Andrew Selous: My hon. Friend is absolutely right about the evidence. Although this is a little premature, he might be aware that the Department for Education has just commissioned evidence on the efficacy and cost-benefits of couple counselling. I have sometimes heard it said that there is no evidence for anything other than CBT, so will he say a little about the range of provision available under IAPT, specifically in relation to couple counselling?

Dr Poulter: My hon. Friend is absolutely right. I will address children’s IAPT in a moment, because the hon. Member for Upper Bann (David Simpson) made an important point on that.

My hon. Friend is right that, through not only IAPT but other programmes that consider health care more holistically—particularly the family nurse programme, which is aimed at vulnerable teenage mums—upstream intervention supporting those vulnerable groups helps to keep couples together and helps reduce rates of domestic violence. The programmes also support a stronger bond between mum and baby, so the child does better at school and mum and dad are supported to get back into education, training and work. So it is a win-win situation for the economy, and it helps vulnerable younger parents to have a better start in their own lives and provides a better start in life for their children. That is not exclusive to family nurses; we are also considering how the approach may be developed with IAPT, so that we can have a more joined-up approach both to children’s health generally and to families.

Earlier this year, I launched a system-wide pledge across education, local authorities, the voluntary sector and the NHS to do everything we can to give each and every child the best start in life. Part of the pledge is to do exactly what my hon. Friend outlines, which is to focus on getting early and upstream interventions right to support children in having the best start in life. We are also seeing the benefits of supporting families and reducing rates of domestic violence. I hope that is reassuring, and we will continue to develop and press those policies.

Briefly, our children’s IAPT programme is no less ambitious in its aim to transform services. In 2011, we announced funding for children and young people’s IAPT of £8 million a year for four years, and in 2012, we agreed significant additional investment of up to £22 million over the next three years, which is a total of

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£54 million up to 2015. That additional funding will be used to extend the range of evidence-based therapies to include systematic family therapies and interpersonal psychotherapy, to extend the range, reach and number of collaborators within the project and to develop interactive e-learning programmes to extend the skills and knowledge of professionals such as teachers, social workers and counsellors. Again, there is a multi-agency approach to improving the support and care available to children, because this is not just about the NHS, but about local authorities and education working together to get it right for young people. Behind those facts and figures are the people whose lives and services have been transformed by IAPT.

To conclude, it might be worth outlining a recent conversation that I had with a GP. When talking about IAPTs in West Sussex, he said, “I hear from GP colleagues that this is the single most positive change to their medical practice in the last 20 years, and I echo this. Our local service reaches out to the community, and it is always looking at ways to improve. It is continually developing new evidence-based interventions for people with anxiety and depression, delivered one-on-one and in groups in a flexible way that means patients have real choice. They have filled a huge gap in need and are a force for good.” That is absolutely right, and it is why we will continue to develop parity between mental and physical health and continue to expand the IAPT programme.

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A14 (Tolling Proposals)

11 am

Dr Thérèse Coffey (Suffolk Coastal) (Con): It is a great pleasure to have secured this debate. I welcome the Minister to his new role. If he is as adept in this role as he was when performing his former duties, we will have a terrific roads Minister. He has had a baptism of fire, having already done two 90-minute debates yesterday, but I am sure he is coping admirably.

The A14 is a strategic route for UK plc. It is heavily congested in certain areas, and upgrading it is a national priority. The Government and councils are planning to invest £1.5 billion in upgrading the A14 and also the A1. However, the Government have singled out through-users of the A14 for tolling even though no other major road improvement scheme planned for the next 10 years is to be tolled. There is a risk that that will effectively amount to a tax on businesses in East Anglia—bad news for one of UK plc’s leading growth areas.

The A14 is a key route for traffic between the UK’s largest container port, Felixstowe, and the midlands. Its importance is recognised in its status as a trans-European transport network, or TEN-T. It also serves commuters to the city of Cambridge, home to the world-famous science park, which is a fast-growing economic hub. In the infrastructure statement in June, the Government recognised the importance of the A14 and announced that the start date for the work would be brought forward two years, to 2016—a decision that I and many others greatly welcome.

The infrastructure statement included 24 other road upgrades, which the Government will fund in their entirety. I am proud that the coalition Government are investing so heavily in infrastructure, especially since the previous Government, frankly, did not do enough of that. However, none of those 24 other routes will be co-financed by tolling. Roads supporting other economic hubs and routes with significant increases in capacity will enjoy fully funded upgrades, including the M25 improvements at Tilbury, the A1 in Yorkshire and, indeed, the proposed A1 from Newcastle to Scotland. It was suggested that the £1 billion M4 relief road in Wales would be subject to tolls, but that was ruled out very quickly—almost within 24 hours. Singling out the A14 for tolling appears arbitrary and somewhat unfair.

I represent the constituency of Suffolk Coastal, which includes the port of Felixstowe. However, this is not simply an issue of the potential threat to that port, which competes against many others along the south and east coasts. Tolling the A14 will have a wider impact on many businesses in Suffolk, Norfolk, north Essex and Cambridgeshire. It is therefore no wonder that business organisations and local enterprise partnerships in those areas have come out against the toll.

Two toll-free alternative routes are being offered for all traffic, although each will add considerable distance and time to journeys. The existing trunked A14 is to be de-trunked and key infrastructure is to be removed, so capacity is being removed. That is in stark contrast to the only other tolled trunk road in the country, the M6 toll, which offered a genuine new road.

The proposals also do not reflect the fact that at the point of proposed enhancement, between Cambridge and Huntingdon, HGVs from the port of Felixstowe

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currently make up just 3% of traffic and are dwarfed in number by local commuters. I am afraid that the perception in Suffolk is that East Anglian businesses will end up paying for easing congestion for Cambridge commuters.

Considerable effort has been made to shift more freight on to rail. The Government are helping with that, and I welcome their investment in the Ipswich chord and the work to be done at Ely junction, which will really help efforts to increase the amount of freight moving from road to rail. European funding available to TEN-T projects has also been secured for those projects. However, I am not aware that any EU funding has yet been secured for the proposed A14 enhancement. I would like to hear from the Minister what plans there are to secure such funding.

I shall go through some of the key stages of the proposal. When we looked at the consultation, we were disappointed that the Highways Agency refused to hold a consultation meeting in Suffolk. All the meetings were held in Cambridgeshire, even though there is reference after reference in the consultation document about, in effect, forcing HGVs on to the trunked road by making sure that that was the easiest route to use and making other routes quite difficult to use so that businesses would end up using the tolled roads. The Highways Agency made a bad mistake there, which I hope it does not repeat.

The solution in the consultation removes the existing A14, including demolishing the A14 bridge, therefore reducing road capacity. I would like the Minister to explain why the parliamentary answer given to me by his predecessor, the Under-Secretary of State for Transport, my hon. Friend the Member for Wimbledon (Stephen Hammond), talks about increasing capacity when it feels as if capacity is being reduced.

I mentioned the issues for Suffolk Coastal and the port of Felixstowe. One issue for local haulage businesses relates to DP World, just up the road at Tilbury. Improvements are being planned to junction 30 of the M25, which is close to that port. It is planned that those improvements will be paid for entirely by the taxpayer. Although I am convinced that the magnificent port of Felixstowe will continue to invest and to compete with DP World, imposing tolling charges on one of its key routes adds additional costs for customers and hauliers. There is a real risk, which does not seem to have been taken into account, that container lorries will simply divert to the Al and the M25 at the expense of Felixstowe. That is certainly bad news for the port of Felixstowe and supporting businesses, but it is also bad news for UK plc.

It has been suggested that a tolling element is required to help to pay for all these infrastructure changes, but there has been no indication of how long the tolls will be imposed for. Will it simply be for the financing of the project? I received a written answer suggesting that the anticipated revenue is £30 million per year, but there has been no indication of how long tolling will last.

Tolling has been suggested for only one part of the road, the new A14 carriageway, which is the bypass around Huntingdon. The project has been designed specifically to force through traffic on to the tolled road. However, no charges are planned for the brand-new local roads that will be built or for the enhanced A1.

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It seems contradictory to single out that one stretch of the A14, as the existing A14 is rerouted and de-trunked, when the A1, which will also be significantly improved, will not be tolled. The Highways Agency suggests that de-trunking the A14 addresses the Department for Transport’s ambition to place the right vehicles on the right roads, which suggests that the DFT is, in effect, forcing traffic on to the toll road.

The two non-tolled alternatives for HGVs in the consultation will push a lot of traffic on to the A428 and the A1M. Quite a number of hauliers are already starting to use the alternatives, as we know. There is a risk that the toll will have the unintended consequence that we see considerably more traffic using that route. We will end up in a situation in which people in St Neots are going nuts about how much traffic is going through their town. The situation could be even worse for St Ives, a pleasant little market town, as the other proposed alternative is to go through St Ives and then around the edge of Huntingdon. I hope the Department and the Minister are aware of those possible unintended consequences.

Peter Aldous (Waveney) (Con): I congratulate my hon. Friend on securing the debate. She is making a compelling case.

I was born in Suffolk. I have lived there my whole life and I have worked there for much of it. In that time, I have witnessed a dramatic growth in the logistics industry, based on the port of Felixstowe and mostly located along the A14 corridor. Does my hon. Friend agree that proposals such as this could have a significant negative impact on the logistics industry in Suffolk and on the Suffolk economy as a whole? Does she also agree that the Department for Transport needs to look again at this proposal and to consult properly with Suffolk businesses and Suffolk people, and that, if there is to be a toll road, there should also be a realistic alternative, although, ideally, the A14 should not be tolled at all?

Dr Coffey: I support my hon. Friend’s sentiments. The wider impact does not seem to have been assessed. In fact, there appears to be an assumption in the Government, which I think is wrong, that demand for using the A14 is completely inelastic to the toll. In fact, as the Department will know, there are basically two types of hauliers: first, those that definitely need to arrive on time; and secondly, those for whom cash flow is key. Adding to the cost of coming in and out of Suffolk and other parts of East Anglia creates a risk to our economy. This is an issue not just for Felixstowe, but for other parts of Ipswich, for Bury St Edmunds and for Haverhill, as well as for Lowestoft, which is in the constituency of my hon. Friend.

Mr David Ruffley (Bury St Edmunds) (Con): I congratulate my hon. Friend on a superb speech. She is saying everything that I would say.

Sir Edward Leigh (in the Chair): Order. Will the hon. Gentleman address the Chair and not turn his back?

Mr Ruffley: My hon. Friend asks why there was not greater consultation with Suffolk. Does she agree that now, because, as she mentioned, other A roads in our

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region and other regions are not being tolled, there is a risk that there will be an A road apartheid in Suffolk—discrimination against business users, and other travellers into the county? Could that be deleterious to logistics companies in Bury St Edmunds, Stowmarket and Needham Market, in my constituency, and, equally importantly, in the golden triangle of Norwich, Ipswich and Cambridge? That is one of the engine rooms of growth for the whole nation.

Dr Coffey: My hon. Friend is right. I hope that the Minister realises that we are united across the county in our concern about the economic impact on the county and region, particularly in the light of our growth industries. My hon. Friend put that well.

To go into a little more detail, there were various options with the original consultation and it seems that we have taken up option 3, which includes the Huntingdon southern bypass scheme and removal of the A14 bridge, and whose estimated cost is £687 million, with a benefit-cost ratio of 2.15 and 2.26 million vehicle hours saved; and option 5, which also includes the bypass and would retain the trunked A14 through Huntingdon, with the addition of local roads.

The estimated cost of option 5 is £1.2 billion, nearly double that of option 3, with a BCR of 3.49 and 2.98 million vehicle hours saved. In both cases the eastbound saving is 19 minutes and the westbound saving is 14. The document gave, as a reason for introducing local access roads, allowing tolling to be put in more easily; so it seems that the scheme has been designed to make tolling easier, although introducing those local roads would increase complexity and cost at the Girton junction. The combination of the two options is coming out at £1.5 billion, but that sum is also due to enhancements to the A1, which were never part of the original proposals.

There are several issues to consider. My hon. Friend the Member for Ipswich (Ben Gummer) wants to speak, so I shall draw my remarks to a close. The A14 needs to be improved. I thank the Government for investing so heavily in that key route for our region and for UK plc. However, users feel that they already pay their share; they do not want to be singled out to pay a toll while other parts of the road network continue to be fully financed.

I am proud to support the “No Toll Tax on Suffolk” campaign of the Suffolk chamber of commerce; it has gathered much momentum. I also welcome the backing of Suffolk county council, Suffolk Coastal district council, New Anglia local enterprise partnership and other business organisations. I am sure that the Minister will write to me if he cannot answer all the questions, but I ask him to listen to the concerns being put to him, because the issue is rousing Suffolk as we speak.

Sir Edward Leigh (in the Chair): The convention of the House is that if a Member wants to contribute after the initial speech, they must have the agreement of the person who secured the debate and the Minister. I remind the hon. Member for Ipswich (Ben Gummer) that we must leave adequate time for the Minister to sum up.

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11.13 am

Ben Gummer (Ipswich) (Con): Of course, Mr Leigh. Thank you; I intend to speak for only a minute or two. I thank my hon. Friend the Member for Suffolk Coastal (Dr Coffey) for giving me a little time, and the Minister for allowing me to speak. I congratulate my hon. Friend on securing this important debate.

Today there was another fall in the joblessness figures in Ipswich, which is a sign of a vibrant and important economy. Suffolk, Norfolk and Cambridgeshire have a larger economy than Scotland’s. They are a vibrant part of the country, which has not fallen into recession and which is powering private sector-led innovative economic growth. That is a good thing, and the Government, for once, are investing in that success.

We are always bereft of infrastructure in the east of England. The A11 work that was promised many times by the previous Government is now delivered. The previous Government spoke at length about the A14. We are grateful for the Government’s consideration, and understand the financial pressure on the Treasury. We are also grateful for the fact that much has already been done to make the tolling proposals more reasonable than we feared.

Let us, however, be straight about the reason for what is happening: it is because Cambridge is such a remarkable success. We do not begrudge Cambridge that; it is part of the economic success story of the region. However, we in Ipswich, where many hauliers are based, are effectively being asked to pay a congestion charge for Cambridge, and that is wrong. It is wrong for economic success, which is more fragile in east Suffolk, to be impeded by Cambridge’s wild and ever growing success. We ask the Minister to reconsider alternative schemes that would put the cost on to the main users and the main reasons for the congestion, which do not include the hauliers of Ipswich, Felixstowe and east Suffolk.

Southampton will receive an electric spine under the Government’s bold infrastructure plans. The new Thamesport will receive road upgrades and an electrified link. However, Felixstowe, the largest container port in the country, does not, unlike Immingham, have an electric link by rail. In addition to our not having such a link, our principal route into the country will be tolled. That will be a double disadvantage for the country’s largest container port—the fourth largest in the world. It will have a significant impact on my constituents, many of whom are employed in the shipping industry. It may turn our joblessness figures in the other direction.

11.16 am

The Parliamentary Under-Secretary of State for Transport (Mr Robert Goodwill): It is a joy to serve under your chairmanship, Sir Edward. I thank my hon. Friend the Member for Suffolk Coastal (Dr Coffey) for giving me an early opportunity to examine the issue and make some comments.

The effectiveness of the United Kingdom’s strategic road network is vital to long-term economic growth, providing the means to move people and freight between our centres of industry and population. In June, the Government announced plans to increase the capital provision for critical transport infrastructure through an unprecedented programme of road investments worth

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more than £30 billion. Last year we announced proposals to upgrade one of the most congested sections of trunk road in England: the A14 between Huntingdon and Cambridge—a section that I know well. That 25-mile length of road carries up to 85,000 vehicles a day, which is significantly more than it was ever designed to accommodate, and is the reason why it has become such a frequent source of delay and frustration for motorists. Heavy goods vehicles make up an unusually high proportion of the traffic on the road, contributing to difficult and stressful driving conditions for other motorists and reducing average speeds still further. However, for commercial road users, congestion presents a cost to business efficiency, making journey times slow and unpredictable and increasing fuel consumption as vehicles are often forced to queue. I used to drive a road tanker and understand that problem all too well.

The A14 between Huntingdon and Cambridge is part of a strategic road corridor, which links the midlands to the east coast ports. In addition, it accommodates long-distance movements between the north of England and the south-east via the M11 motorway, as well as a growing volume of local and commuter traffic in what has become one of Britain’s most successful economic hot spots. That mix of local and long-distance traffic is expected to get significantly worse as the economy continues to recover, and one of the aims of the A14 scheme is therefore to separate those making local trips from those passing through the region.

I shall comment now on a couple of questions, so that I do not run out of time. My hon. Friend asked whether EU funding had been secured, and the answer is that it is too early in the development of the project to be able to say yes or no. As to traffic being forced on to other roads, it is interesting to note that the alternative route via the A428 and the A1 is 30 miles, as against 18 miles on the A14. That would be an additional 14 miles, and anyone driving a truck doing eight or nine miles to the gallon would—never mind the lost time—easily be able to work out that with the level of tolls we propose it would be a no-brainer to stay on the toll road and not increase pressure on other local infrastructure. Added to that, a shortage of residential property in Cambridge is fuelling house price inflation in the region, but new housing developments cannot proceed without better infrastructure. The A14 scheme provides the key to unlock a number of major housing developments along the trunk road corridor and is critical to the plans of the local authorities in the area.

The case for improving the A14 in the area is overwhelming. Other rail freight and public transport-based solutions have already been considered, and improvements, including the Cambridge guided busway, have already been made to help to take some of the load off the A14. Significant growth in traffic volumes on this section of the A14 is forecast, however, and without improvement the problem will only worsen. The Government therefore announced a funding commitment of £1.5 billion in June this year to support improvements to the A14 between Cambridge and Huntingdon, together with a challenging development programme that will see the proposed improvement scheme complete and open to traffic by the end of the decade.

The construction and maintenance of the United Kingdom’s trunk roads and motorway network is mostly funded by central Government. The introduction of tolls to fund or part-fund major capital investments in

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the road network is, however, a well established principle. Many of our estuarial bridge and tunnel crossings, including the Mersey tunnels, the River Severn crossings and the Dartford crossing, are tolled, but the M6 toll, which opened in December 2003 to bypass a heavily trafficked section of the M6 through Birmingham, is currently the only principal road in Britain to be tolled. Proposals to toll part of the A14 Cambridge-to-Huntingdon improvement were announced as part of the Government’s commitment in June.

The Government have previously stated that, although they have no intention to toll existing capacity on Britain’s trunk road and motorway network, where investment in new infrastructure constitutes a significant transformation of the existing route the option to introduce tolls on new sections of road is seen as a means of making the capital investment more affordable. Such a situation exists on the A14 between Cambridge and Huntingdon. The proposed scheme, at £1.5 billion, constitutes more than a 10th of the Highways Agency’s entire capital budget to the end of the decade and the transport and economic benefits of the improvement to the east of England, in particular the Cambridge sub-region, are significant.

The Government will still bear the brunt of the capital costs associated with the scheme, but it is fair that the road users who will benefit most should make a contribution to the construction costs. Although my hon. Friend the Member for Suffolk Coastal discussed the impact of the charge on the people and businesses in East Anglia, the current levels of congestion and delay on this section of road already result in a significant cost to those living and working in the region. The local authorities and the local enterprise partnership in the Cambridgeshire area are highly supportive of the scheme and have also been asked to make a contribution to its development. As a result, some £100 million has been pledged by those bodies to offset some of the costs to Government of the scheme.

Tolling therefore makes the A14 scheme more affordable. An important principle underpinning the tolling strategy for the A14 is that tolls, while making a meaningful contribution towards the cost of the scheme, should not deter motorists from using the new road, particularly when making long-distance trips through the region. Tariffs will therefore be kept as low as possible, with light vehicles being expected to pay around £1 or £1.50 at current-day prices and heavy vehicles paying around double that cost. It is anticipated that tolls will be charged seven days a week, but that overnight trips will be free. That may encourage some commercial operators to use the road at night when it is expected to be less busy.

A second principle that remains fundamental to the development of this scheme has been to channel the right traffic on to the right roads, separating long-distance through-traffic from local traffic. The proposed scheme makes provision for local and commuter traffic to use a new side-road network between Cambridge and Huntingdon, which is toll-free and which eliminates much of the conflict between local and strategic users.

Most toll roads in Britain and throughout Europe require road users to stop at toll plazas to pay, but if we are to eliminate congestion on this section of road, the

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introduction of physical barriers is not the solution. The Highways Agency is therefore proposing a free-flow tolling system, in which vehicles are identified using cameras or tag devices and payments are made electronically or by smartphone without delaying road users. I should point out that we do not expect drivers to use their smartphones while driving. The system works in a similar way to the London congestion charge, using technology that is now well proven and collection systems that have proved to be effective in practice.

The tolling proposals for the A14 Cambridge-to-Huntingdon scheme were set out in a public consultation exercise that ended last weekend, together with the Highways Agency’s proposed scheme alignment. More than 5,000 people attended a series of exhibitions staged in towns and villages along the route and nearly 1,000 people provided their views by completing the Highways Agency’s online questionnaire. Discussions took place between the Highways Agency and the various local authorities in the surrounding area and the consultation received a high level of publicity in the press and broadcast media in Cambridge, Huntingdon and throughout the east of England. That was the first in a series of consultation exercises that will take place before a development consent order application is submitted by the Highways Agency in the autumn of 2014. Although it is a little early to comment on the results of the recently closed first consultation, it is clear that aspects of the tolling proposals have been high on the agenda—not least because of the activities of my hon. Friend the Member for Suffolk Coastal.

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Dr Coffey: I just want to impress upon the Minister that businesses were genuinely angry that the Highways Agency refused point blank to hold a consultation meeting in Suffolk. It refused the request of MPs, which was not at all welcome.

Mr Goodwill: I asked my officials about that. The consultation was focused on the area where the road is to be built because of the effect on local communities. If anyone has had involvement in the High Speed 2 project, they will know that it is the communities near such projects that are likely to have the strongest views. Those further afield who will benefit from the scheme may well feed in their views but were not given the opportunity to contribute through road shows. I intend, however, to have regular meetings with representatives of the freight and logistics industry, as I am sure they will have views to voice.

Finding the right highway solution, which is both affordable and fair, remains a priority for the Government. The results of the consultation exercise, when they are published later in the year, should provide an important indication of public opinion and will help the Highways Agency as it develops the scheme proposals. It remains clear, however, that to do nothing to improve this overcrowded section of our trunk road network is really not an option and that traffic congestion in the Cambridge and Huntingdon area will worsen without improvement and will constrain economic growth in the wider east of England in decades to come.

11.26 am

Sitting suspended.

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[Sir Alan Meale in the Chair]

2.30 pm

Sir Alan Meale (in the Chair): The next speaker is Glenda Jackson. Before you begin, Glenda, I need to advise Members that there is a court case in progress at the moment—the GMB trade union is claiming that 70 of its members have been denied work as a result of being named on a list of construction workers drawn up by an organisation.

The matter is sub judice, and Members should be aware of the rules of the House on such issues: I will not permit any direct reference to that particular case. The Member in charge of the debate has written separately, with the advice of the Principal Clerk of the Table Office. I hesitate to cause difficulty for the debate, but I will not allow direct reference to that particular case.

2.31 pm

Glenda Jackson (Hampstead and Kilburn) (Lab): Thank you, Sir Alan; it is a pleasure to work under your chairmanship. I am one of the few Members to have absolutely no legal training whatever, so the possibility of my uttering anything that could be deemed to be sub judice is fairly remote. I do wish, however, that I had selected a rather less bland title for this afternoon’s debate, because we are looking not so much at the practice of blacklisting, but at the illegality and abhorrence of blacklisting.

In common with many of my colleagues over the years, I have had constituents at advice surgeries alleging that they have lost their jobs, or had their career prospects blighted, because of blacklisting. At one time, it was extremely difficult to prove such allegations. In light of your introductory remarks, Sir Alan, I hasten to add that my constituents were not laying the allegations at the door of the construction industry. In my memory, blacklisting could go throughout the employment world, but it was extremely difficult to prove any allegations. Silly me, I thought that when the regulations under the Employment Relations Act 1999 making blacklisting illegal came into effect in 2010, such visits from constituents would end.

One must, nevertheless, pay tribute to all those who, inside and outside the House, worked to bring about what we thought would be safeguards under the 1999 Act. I also pay tribute to those who—again, inside and outside the House—have consistently, and certainly for more than a year, raised the issue of allegations of blacklisting through debates, early-day motions and questions to Ministers. Most recently, some of those against whom the allegations have been most cogently presented have indicated some kind of acceptance—I would not go so far as to say “apology”—that something untoward had been going on.

In my previous work, many of my colleagues—most markedly in the United States of America, and rather less in the United Kingdom—suffered egregiously from someone we could call the godfather of blacklisting, the nefarious Senator McCarthy. His reasons for condemning people as scaremongers and a danger to the body politic and the life of all democratic societies were overtly political.

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Blacklisting, however, can be compared to an infectious disease—it spreads much further than the initial target. Only this morning, I heard from someone who had blown the whistle. She was a care worker, and she blew the whistle on her place of employment, because she found the treatment of those in her care totally unacceptable. Her whistleblowing brought some results, and I believe that that particular care home closed down—this was a few years ago and is not a contemporary case; it is a scandal that we all know about. She said, categorically, that she became unemployable. That is the running theme of all blacklisting allegations—that those who have been blacklisted are deemed by someone in authority to be, in essence, troublemakers; it is a little like David and Goliath. They would be dangerous to employ, because they might cause any commercial project some kind of egregious, usually financial, damage. Nine times out of 10, however, such people are actually attempting to ensure greater safety in their work areas.

Looking back at my previous work experience, I see that the creative people named by Senator McCarthy were not the only ones affected; their creative lives were cut off at the knees, but, in addition, the benefits of their creative work were no longer available to the wider community. That is why blacklisting is like a particularly infectious disease, which can spread far wider than only among those who know themselves to have been blacklisted in those industries or professions in which we know that blacklisting has existed, or possibly still exists. That is why I pay tribute to everyone inside and outside the House who has brought the issue forward.

Steve Rotheram (Liverpool, Walton) (Lab): My hon. Friend is making a powerful point. Last year, with the help of the Union of Construction, Allied Trades and Technicians, I tabled an early-day motion on this important issue. Does she agree not only that the practice is a disgrace and a stain on the country, but that the people who were blacklisted are the very ones who should have been praised for what they were doing to assist fellow workers? The companies that indulged in such dark practices should be held accountable and made to pay for ruining the lives of many thousands of construction workers.

Glenda Jackson: I strongly concur. The stain of being blacklisted and accused of being in some way not committed, whether to the job, the company or the venture, can even spread to members of an individual’s family. I have heard stories of small children being called names by their contemporaries, because their mother or father had been deemed to be working against the industry or profession.

I endorse what my hon. Friend said, but we should now be pushing, most markedly, for the Government to institute a full inquiry into such practices, as previously requested. We thought that we were safe and that blacklisting was illegal—it is there in an Act of Parliament—but now, given reports in this country’s major newspapers and hon. Members’ questions and early-day motions, the problem clearly needs to be re-examined.

Natascha Engel (North East Derbyshire) (Lab): On that important point of having an inquiry, one of the most terrible and serious things about blacklisting is

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that people do not know whether they are on a blacklist. Without an inquiry, which has been called for by unions such as UCATT and the GMB, some people will never know that they are on a blacklist. That is why I support my hon. Friend’s call. I would love it if she could develop that point a little more.

Glenda Jackson: My hon. Friend has developed the point very well indeed—she needs no help from me. As she so rightly says, and going back to my analogy with an infectious disease, people might not even know that they are suffering from such a disease. Only when we have a thoroughgoing inquiry, with all the evidence, and when the symptoms are brought into what we are told is the only effective disinfectant, sunlight—the light of day—can we begin to establish whether the work that has taken place in the past, on ensuring health and safety at work, for example, has gone astray.

Huw Irranca-Davies (Ogmore) (Lab): I commend my hon. Friend on how she is opening the debate. I want to put on the record the fact that I am a member of both the GMB and UCATT. I do so not because I am required to declare that as an interest, but because I am damn proud of it.

On looking forward, will my hon. Friend join me in commending the vocal way in which the Welsh Government Minister, Jane Hutt, has made it clear that there will be no place in public procurement for companies who use blacklisting? She is devising policy and guidance for such companies to ensure that that is crystal clear and explicit.

Glenda Jackson: Being partly Welsh, I always find it easy to commend the Welsh on practically anything. That example should be taken on board by other authorities to ensure that the best of all possible disinfectants—sunlight—is brought to bear on this egregious illegality. Let us not forget what we are talking about. Blacklisting is illegal.

Kelvin Hopkins (Luton North) (Lab): My hon. Friend is making an excellent and powerful speech. On an earlier point about McCarthyism, Sam Wanamaker was a victim. He came to Britain, and founded the Globe theatre and so on. It is to this country’s credit that we would not tolerate McCarthyism and we gave employment to people who were blacklisted in their own country. He could have made an enormous contribution to America, but fortunately he came to us.

Glenda Jackson: I entirely agree with what my hon. Friend said. Sam Wanamaker worked extremely hard and was absolutely fundamental in ensuring that we now have one of the most critically and dramatically acclaimed theatres in the world—the Globe. He was essential in creating for a whole generation that had not thought it would find anything interesting in Shakespeare the extraordinary illumination of what it is to be a human being that only Shakespeare and his plays bring to bear.

I agree entirely with my hon. Friend and pay tribute to what Sam Wanamaker did, but in no way was there equal treatment. America was denied what Sam could have done. He was not alone in being blacklisted. Wider society suffered desperately because of fear during the

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McCarthy era, when entirely innocent people, as has been the case in this country, were victimised because others were afraid to speak out against what was happening. As we all know, it was only when Senator McCarthy took the fatal final step of trying to bring down the army that the President of the day stepped in and said in no small way, “This has to stop.”

The damage was fundamental and we do not want that infectious disease to take root again in this country. We would delude ourselves if we thought it had not existed here. We would not have had to fight so hard to change the employment Bill if that had not been the case. Blacklisting must never, ever be allowed to flourish again in this country. I pay tribute to those in the Chamber today, those on the broader parliamentary estate, the trade unions and those employees—or, rather, those unemployed people—who were not prepared to stand idly by, but were prepared to take the brickbats, insults and allegations that it was all fantasy, and who fought their corner.

I am on the record as saying that if an hon. Member cannot say what they want to say in 10 minutes, they should not stand up, so I will now throw the floor open to eager colleagues.

2.43 pm

Stephen McPartland (Stevenage) (Con): I am grateful to you, Sir Alan, for the opportunity to speak in this debate, and I congratulate the hon. Member for Hampstead and Kilburn (Glenda Jackson) on securing it and on her wonderfully impassioned speech. I will speak for only 10 minutes because, as she said, if hon. Members cannot say what they want to say in 10 minutes, they should not stand up. I shall try to learn from her vast experience.

Blacklisting is completely wrong. Not only does it destroy individuals, their confidence and their personality and who they are, but it destroys their family and prevents them from earning, working, contributing to society and being part of a wider whole. It is wrong for a variety of reasons, and I could wax lyrical on that. I know from my upbringing in Liverpool that blacklisting is a terrible disease, as the hon. Lady said, and must not be allowed to take root. It is illegal and should not be allowed in this country. I am proud that, as the hon. Member for Luton North (Kelvin Hopkins) said, this country has always been good at welcoming people who have been blacklisted in other countries. I want to put it clearly on the record that blacklisting is completely wrong.

I shall focus my comments on the construction industry, but I will not refer to the case going through the courts at the moment, Sir Alan, as you asked us not to. There are 3,213 victims of blacklisting, and we are well aware that around 2,500 people on that database do not know that they are on it. Will the Minister impress on the Information Commissioner the need to contact them directly to make them aware of that?

John Mann (Bassetlaw) (Lab): I found out that I was on the Economic League blacklist during the 1980s only when Ciba-Geigy Chemicals gave me a job but then withdrew it for no good reason. The list was published at an event at the university of London, and I found my name on it. How can there be any decency in society if people are on a blacklist, particularly if they

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have not found work? I was lucky because I was in work and kept work, but some people lose work or do not get it without knowing why because someone, for whatever reason, decided to put them on a list?

Stephen McPartland: The hon. Gentleman always makes powerful and impassioned points, and I agree with him. There can be no justice in society if people are on a blacklist without knowing. I urge the Minister to ask the Information Commissioner to contact those 2,500 people who do not know that they are on a blacklist and make them aware that they are.

I am not a member of any union, but with, I hope, the support of the GMB union and the hon. Member for Luton North, we will launch a cross-party campaign to contact the 44 construction companies that were involved in that blacklisting database, the idea being to ask them to apologise and to provide compensation. What we would ultimately like is for no one in the Government or local government to provide them with any public sector contracts or money until they have taken those actions.

Steve Rotheram: The hon. Gentleman is making really important points. There seems to be cross-party consensus on trying to contact everyone on the list, many of whom do not know they are on it. Would he support a call by UCATT and other unions for a public inquiry into the scandal?

Stephen McPartland: I often agree with the hon. Gentleman, but I reserve judgment on a public inquiry. We have had the result of the Leveson inquiry and no one is sure what the outcome is, and I am keen to get justice for the 3,213 individuals on the blacklist.

Kelvin Hopkins: I congratulate the hon. Gentleman on his speech. I am pleased to be working with him on the GMB campaign. He mentioned the possibility of compensation and apologies. Does he agree that what we really want is those people to be back working in the industry?

Stephen McPartland: I completely agree, and that is why it is important that the Information Commissioner contacts the 2,500 people who do not know that they are blacklisted to make them aware of that, so that they can get on with their lives. At the moment, those 2,500 people cannot get a job and do not know why. I do not want to stray too far into that area, so I will talk about the campaign.

We know that 44 companies are involved, but they are not all involved in the court case. The hon. Member for Luton North and I, supported by the GMB, will publish a website and write to the chief executives of construction companies asking them to come clean. We will publish the letters and the replies, and will then contact the larger shareholders to identify whether they believe that it is ethical to invest in those companies. The campaign will be long-running and is designed to provide justice for people who are currently blacklisted.

I genuinely believe that blacklisting is not about politics, or about one party or another. It is completely wrong; it is a disease; and it should be excluded. I know some Labour Members question it, but at the moment, there is cross-party consensus.

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Jim Sheridan (Paisley and Renfrewshire North) (Lab): The hon. Gentleman will recall that the old Economic League was funded by the Conservative party.

Stephen McPartland: I do not recall that, but the hon. Gentleman might not be aware that I was the first Conservative Member of Parliament in history to write for the Morning Star newspaper. I am often asked whether I am on the left or right of the Conservative party. For me, the reality is about focusing on what is in front of me, and in this case, it is a database that was completely wrong. Those individuals require justice, and I am happy to be working with the hon. Member for Luton North on that.

Natascha Engel: I am sorry to press this point, but it is very important: the database can only be exposed if there is a public inquiry. The public inquiry on Leveson exposed the extent of phone hacking, so I think this is a good example of why we should have a public inquiry, to make sure that every name on the database is exposed and that the individuals are told.

Stephen McPartland: As I said, I want the Information Commissioner’s Office to contact all the individuals on the database who do not know that they have been blacklisted. It is up to the Minister to respond on whether there will be a public inquiry. I have made my position clear: I am reserving judgment, simply because I want to focus on getting justice for the individuals who have been blacklisted. I believe, like the hon. Member for Hampstead and Kilburn, that although we are focusing on the construction industry, the reality is that blacklisting has no doubt gone across lots of other sectors, and there is probably a range of other databases that none of us is aware of. I shall focus on this specific issue, and if there is a public inquiry into the wider aspects of blacklisting, so be it, but at the end of the day, we need evidence to be able to create that inquiry. As I only have a minute left, I will not take any more interventions, as I want to finish within the 10 minutes.

I sum up by saying that I believe blacklisting is wrong. It destroys families and has a pervasive effect on British society and the values that we all hold dear. It should not be a political issue; the focus should on providing justice, so I am happy to work with the GMB union and the hon. Member for Luton North to do so.

Several hon. Members rose

Sir Alan Meale (in the Chair): Order. Before we proceed, I remind Members not to link into the case that is taking place for the GMB and its 70 members. That is sub judice, and we should not debate it.

Twelve Members have indicated that they want to speak, and there is about an hour to go; I would be grateful if Members worked it out together, so that everyone gets the opportunity.

2.52 pm

Mr Michael Meacher (Oldham West and Royton) (Lab): I will be brief, as you have requested, Sir Alan. I shall concentrate on one exceedingly serious aspect that has recently come to light: the allegation of police involvement in the provision of this information. It comes from the Independent Police Complaints Commission’s

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revelation that a Scotland Yard inquiry into police collusion has found that it is—I quote the words that were used this weekend—

“likely that all special branches were involved in providing information”

that led to hundreds of workers being excluded from employment. If that is true, it is dynamite.

Let us put that into perspective. It has been known for four years that more than 3,200 workers, in the period from 1993 to 2009, were blacklisted by up to 44 construction companies. Many of the companies were household names, such as Balfour Beatty, McAlpine, Carillion and Costain, and people were consequently kept out of work, not only for years, but in some cases for decades. Across the nation, we have come to a view that phone hacking is a very serious intrusion into privacy and a massive breach of human rights. However, I put it to the Chamber—I am sure that there would be widespread agreement across the country—that it does not compare with being deprived of a job for years, or even decades on end.

It is known from statements made by the Information Commissioner’s Office to the Select Committee on Scottish Affairs, which my hon. Friend the Member for Glasgow South West (Mr Davidson) chairs, that some information revealed on files on blacklisted workers, again, could only have come from the police or security service sources—those were the words used by the officer from the ICO. The firm belief of the IPCC, based on discussions with the Metropolitan Police—an irrefutable source, I think—is that all special branches were engaged in these illegal and highly damaging activities. If that is proven—I come back to the need for a public inquiry—it will expose a monumental scandal. To be fair, it is disputed at present.

John Cryer (Leyton and Wanstead) (Lab): I am grateful to my right hon. Friend. He mentioned phone hacking; would he acknowledge that phone hacking is a criminal offence? It would make an enormous difference if blacklisting was a criminal offence. That was called for by UCATT and the other trade unions. Unfortunately, it was not in the regulations that were issued in 2010. I am not disputing the Labour Government’s intentions then, as I think they were perfectly good, but the problem was that the regulations did not go far enough and were therefore not effective.

Mr Meacher: I entirely accept that important distinction—what is or is not the law at the time—but I think that the judgment that the nation would make about the enormity of the offence and the consequences rather override that. It is not that those people were breaking the law, but that they were acting in a way that they knew would be intensely destructive to the livelihood of thousands of people, and that, in itself, is a matter for which they should be held to account.

What has been said is disputed by a senior investigating officer recently appointed to Operation Herne, which is the inquiry being undertaken into the activities of undercover police officers. He says that he has seen “no conclusive evidence” that Scotland Yard exchanged information with the blacklisting companies. That needs to be investigated further. However, it is difficult to deny, and in my view, not only is that a rather unconvincing

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denial, but it contradicts the fact that the Blacklist Support Group has now had it confirmed that a secret meeting took place in November 2008 between the Consulting Association, which ran the blacklist, and officers from the police national extremism tactical co-ordination unit, which runs undercover policing.

I have one more point to make. Significantly, this new and damning information comes from a freedom of information request to the Information Commissioner’s Office, which replied that it was holding notes about that meeting. That rather invites the question why it has been sitting on this information for four years and only had it revealed when it was extracted from the ICO by the freedom of information procedure. It also raises the further question, which has already come up in this debate why the ICO has so far declined to inform all 3,213 workers that they were subject to the blacklist. Who took the decision that they would only respond to requests to the ICO? That is a very important question. This is not a matter for the ICO; it is a political question. Who is told about this massive breach of their rights is a question for Ministers.

Jim Sheridan: Like my right hon. Friend, I have been in many marches and protests, promoting and trying to defend the rights of workers. He will recall police officers on roofs with cameras taking pictures of people on marches. I often wonder where those photographs ended up.

Mr Meacher: That is another very good question. I cannot give my hon. Friend the answer, but I see the force of his question, and I think it should be pursued.

John McDonnell (Hayes and Harlington) (Lab): This is a valid point. The Blacklist Support Group discovered that the information passed on to the files goes beyond just workplace activities to demonstrations and all the rest, and that could only have come from the police or security services.

Mr Meacher: That is absolutely correct. As my hon. Friends suggest, this is not necessarily about the passage of information; it could involve photographs, often taken covertly.

I think that I am right in saying that only some 800 of the 3,200 people have been informed, as a result of making an application themselves. Three quarters of all those people still have no idea what ruined their livelihood for so many years. I would like the Minister to respond to this question: why should the Government not instruct the ICO to inform all the other three quarters that they were blacklisted?

My final point relates to where the issue is leading. The 44 construction companies now face a High Court battle about their alleged involvement in blacklisting. I will not pursue that point. However, significantly, eight of them have now decided to compensate some of the 3,200 workers, which might suggest that they believe that the evidence being revealed is now sufficient to prove their involvement—

Sir Alan Meale (in the Chair): Order. I am in a dilemma here. The sub judice rule applies because the case is still ongoing, so the right hon. Gentleman cannot refer to it. As I understand it, the companies have not yet accepted

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liability, even though they have agreed to pay some compensation; they are figuring out the amounts. They have not accepted liability, so the issue remains sub judice. Do not refer to the case, if possible.

Mr Meacher: I take your point entirely, Sir Alan. I was not intending to pursue the issue in that way. I am prepared to come to an end. I have made the point, which I think is a strong one, and I hope that the Minister will respond to it. The ICO has a role to play. I can think of at least 10 grounds for a public inquiry, which I do not have time to go into. An inquiry is crucial. Will the Government commit to a full public inquiry?

3.1 pm

Mr Graham Allen (Nottingham North) (Lab): It is a pleasure to have helped, with 20 colleagues across the House, to secure today’s debate, and to have been involved with trade unions, including my own, Unite, with Tony Tinley helping out; the Union of Construction, Allied Trades and Technicians, with Cheryl Pidgeon researching this debate; and the union that I used to work for before coming to this place, the GMB. If the hon. Member for Stevenage (Stephen McPartland) is not yet in a trade union, I could put a number of offers to him to put that right. He should be careful; being anti-badger culling and pro-exposing blacklisting, he could be highly sought after, in these days of coalition, after the next general election.

It is also a pleasure to follow my hon. Friend the Member for Hampstead and Kilburn (Glenda Jackson). I hope to be a supporting actor in what we have to do today. Blacklisting is, as my hon. Friend said, a disease. It is pernicious, and it spreads without people even knowing that it is there. It is vital, from the point of view of any civil or human rights stance that any party wishes to have, that we ensure that its days are definitely numbered.

What is blacklisting? It is the termination of workers’ employment for issues not related to performance. Such issues can, and have, included raising legitimate health and safety concerns; being a member of a trade union; and belonging to a political party whose ideals employers do not share. For those subject to the practice, as we have heard, the consequences can be incredibly devastating —discrimination, unemployment, poverty, family breakdown, mental breakdown and, in some extreme cases, even suicide.

The phenomenon is not new; it is not something of the past 20 or 30 years, or something, as my hon. Friend said, that concerns only the construction industry. It goes back a long way—way back to the beginning of the old Economic League in 1919. The league created a list of people whom it—not the courts of law or Parliament — regarded as subversive. Many individuals were listed and blighted.

My hon. Friend the Member for Bassetlaw (John Mann), who has had to leave the Chamber, said in his speech to the House on 23 January 2013 that the Economic League’s blacklist was used to create difficulties—he gave his own example—in getting work once someone was on that list. Another colleague of ours in this House who has had first-hand experience of blacklisting is my hon. Friend the Member for Midlothian (Mr Hamilton). He has already gone on record about his experiences of

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being blacklisted. I am sure that he will not mind me saying that, in a conversation this morning, he told me that the only way his wife ever got a job—not him, but his wife—was to use her maiden name; the blacklisting spread past the individual to influence the family.

Steve Rotheram: My hon. Friend is making a powerful point. The current blacklist from the 1990s is a slightly separate issue from blacklisting in general. Blacklisting has gone on for many decades, certainly in the construction industry. He will be aware of another person who was put on the blacklist—a member of the Shrewsbury 24—Ricky Tomlinson, who is now fighting a campaign to clear his name. He was denied the opportunity to make a livelihood for many years.

I do not think that many people fully understand the individual impact of being blacklisted. Those 3,200 people —not just the ones who know—have struggled for many years not only to clear their names but to earn a living. Does he agree that is the main reason why we are pushing the issue with the Government?

Mr Allen: I know that not everyone wants to make a speech: some colleagues may wish to make interventions instead. I will gladly take those interventions so that people can get their views on the record. My hon. Friend’s view is one that I strongly agree with.

Another colleague of ours, my hon. Friend the Member for Dundee West (Jim McGovern), mentioned the story of a disabled war veteran who had one leg and one eye. He found himself on the blacklist. Why?

“Because he sent a letter to the local press commending them for awarding Nelson Mandela the freedom of the city.”—[Official Report, 23 January 2013; Vol. 557, c. 337.]

The problem with this intelligence-based stuff is that it is not verifiable or in the public domain. Things can be said about someone, often trivially, that get them on the list, resulting in all sorts of consequences that they cannot challenge.

The Economic League gave way to the Consulting Association, which purchased the list from the league. It sounds a little bit like one of those building companies that go bust and then suddenly rise again the next day with a different name. That is the blacklist that we have mainly been talking about today—the 3,200 individuals—which has been used by 40 contractors. It is not the street-corner jobbing company that uses the list, but some of the biggest companies, whose names my right hon. Friend the Member for Oldham West and Royton (Mr Meacher) put on the record, and many others too. Looking out of the window at the construction going on around us, we will see their names.

The revelations also highlighted the inadequacy of legal protections. Since 1999, legislation has given UK Governments the power to pass regulations against blacklisting, but all of us have singularly failed to push the Government to do what they should have. Only a year before the blacklisting was uncovered, UCATT, as we heard earlier, began lobbying the Government to pass acceptable regulations, only to be told, “There is no need for them. It is all under control. There isn’t really a serious problem.”

In 1992, the TUC complained to the United Nations International Labour Organisation. What a shaming thing that is for our country: that we were reported alongside sweatshops in the far east to the ILO for

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having no effective protection for workers in our country against being put on a blacklist, which blights the lives of workers and their families. The ILO’s Committee on Freedom of Association upheld the complaint, saying that UK law fell short of article 98 of the ILO convention. Again, Governments failed to act.

To bring the issue right up to date, in March 2012, The Observer published an article claiming that the police and/or security services had supplied information to the blacklist to be used by the nation’s major construction firms, as my right hon. Friend the Member for Oldham West and Royton said. That was reinforced when the Information Commissioner’s Office revealed that the records could have come only from the police or MI5— not from a Member of the House or from someone making a political point. A vast database on more than 3,000 victims, whom somebody else deemed troublesome, was being fed by the security services. David Clancy, investigations officer at the Information Commissioner’s Office, stated in The Observer: