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Westminster Hall

Tuesday 25 March 2014

[Sir Edward Leigh in the Chair]

NHS Funding (Ageing)

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

9.30 am

Dr Thérèse Coffey (Suffolk Coastal) (Con): It is a great pleasure to serve under your chairmanship, Sir Edward. I thank Mr Speaker for granting this important debate. It is a pleasure to see that my constituency neighbour, the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), will reply for the Government. As a practising doctor, it is natural that he is active on local health matters. Before arriving in Parliament, he, together with my hon. Friend the Member for Ipswich (Ben Gummer), campaigned hard to secure better cardiac facilities at Ipswich hospital, which were formally opened by Her Royal Highness the Countess of Wessex last week. I was pleased to join that campaign, although rather late on, because I was selected only three months before the general election. Nevertheless, those facilities are in place. Together, we have continued to highlight issues that affect our constituents, particularly the performance of the ambulance trust and our local hospitals.

I am proud that the NHS budget has risen under this Government and will continue to do so. I am proud, too, that my right hon. Friend the Secretary of State for Health has continued the focus on patients and has been prepared to lift the lid on when a normally high-performing NHS has let patients down. I join him on that crusade to ensure that patients are not sacrificed at the altar of targets, which is a sad, though unintended, legacy of the previous Labour Government.

From my experience as an MP with a rather elderly constituency—more than a quarter of its population are pensioners—I have come to realise that how the NHS has allocated its funding is simply not fair to older patients. That unfairness has become embedded in NHS finances over several years and significantly increased under the previous Government. We have an increasingly elderly population, and we have to tackle that funding issue. Let us remind ourselves that although the Labour party substantially increased health funding during its time in government, it did not sufficiently reform the NHS, and that includes the particular factor in the funding formula that could have helped older patients by focusing more on their needs.

The right hon. Member for Leigh (Andy Burnham) signed off on the £20 billion savings challenge, commonly known as the Nicholson challenge, which was supposed to redirect funding towards coping with demand for NHS services from the UK’s ageing population and the higher costs of drugs and treatment. As the challenge is being followed through, Labour MPs often complain loudly about cuts to the NHS, but they effectively endorsed those cuts by starting those savings when they

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were in government. The savings are gradually being made, but the only evidence I can see of their helping the ageing population is the Government’s transfer of some NHS money to help with social care for that ageing population, which I welcome. Labour MPs seem to forget that the right hon. Member for Leigh set that in action. Just before the emergency Budget in 2010, he said that it was irresponsible to increase NHS spending in real terms. I do not think it was irresponsible to increase NHS spending, but it is irresponsible not to have addressed a funding formula that does not help the elderly.

The date of 17 December 2013 will go down as the landmark day when NHS England turned its back on the needs of elderly patients, stuck its head in the sand on the dawning impact of an ageing population and crumbled to political pressure from the Labour party. Here was an opportunity for the board of NHS England to put right the funding formula so that the NHS was no longer a postcode lottery and would provide equally for people in need and on access to services. Frankly, I think the NHS bottled it. I do not know why. It ignored the advice of its expert committee. Was it the letter sent to them by the right hon. Gentleman? Blatant political pressure was put on the board of NHS England, and it fell at the first hurdle.

Meanwhile, the Labour party has actively campaigned against the proposed change in the funding formula, which would have started to recognise the increased demands of an ageing population. One of the points made by the right hon. Gentleman in that letter was that he felt that money was being reallocated from certain areas in the north to certain areas in the south. He wanted

“to retain and strengthen the health inequalities and weightings in the allocations formula…and a health service based on need.”

Elsewhere, he has said that the NHS seems to be ignoring the needs of elderly patients. I am concerned that we end up—is this too strong to say?—speaking with forked tongues on this issue. He said:

“A country is defined by how it cares for its older people”.—[Official Report, 14 July 2009; Vol. 496, c. 157.]

He also suggested that the problem of ageing

“will become more pressing as the population gets older…If the system is left unreformed, there are real questions about its sustainability in the long term.”—[Official Report, 8 December 2009; Vol. 542, c. 165-166.]

Since being in opposition, the right hon. Gentleman has said:

“Should we not all set much higher ambitions for the care of older people and, in so doing, learn the most fundamental lesson of all from what happened at Mid Staffs?”—[Official Report, 19 November 2013; Vol. 570, c. 1099.]

He also said:

“The ageing society is not a distant prospect on the horizon. Demographic change is happening now and it is applying increasing pressure on the front line of the NHS.”—[Official Report, 5 February 2014; Vol. 575, c. 282.]

There are a number of times when the right hon. Gentleman has rightly highlighted the challenges facing the NHS.

The Keogh review states that much of the pressure on operational effectiveness

“is due to the large increase in the numbers of elderly patients with complex sets of health problems.”

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There we have it. In responding to the Age UK report, the hon. Member for Copeland (Mr Reed)—I am sure he will participate in the debate—said:

“Older patients in the NHS are paying the price of the financial crisis this Government is inflicting on the health service.”

I am not sure what financial crisis he is referring to, given that the Government have increased health spending and are simply putting in place the Nicholson challenge set by the previous Government. He also said:

“Warnings do not come more authoritative than this report. Yet as long as Ministers remain in denial, patients will continue to face the agonising choice of going without treatment or paying to go private. Labour has repeatedly warned of the postcode lottery now running riot in the NHS.”

That is absolutely ridiculous. The hon. Gentleman will have his chance to respond later, but I put it to the House that it is consistently not addressing the funding formula that leads to the postcode lottery for elderly people. It is disgraceful that we allow it to continue in the 21st century. Patients need a board that stands up for them and does not bow to political pressures, from one side or the other.

I thought it might be useful to give a little history on the funding formulas, and I thank the Library for producing the briefing on that. Going back some time, there used to be a weighted capitation formula. That always presented a challenge, because the pace of change showed that it would take more than 20 years to reach an equitable formula. People will know that the urban authorities tend to get higher funding per head than rural authorities. We are still a significant distance from the target under the new formula released in December 2013.

The clinical commissioning group allocations are not the same as those of the primary care trusts, because they have different commissioning roles. Public health has gone to local authorities and specialist commissioning is done centrally. The PCTs started to do a person-based resource allocation, trying to allocate at practice level, recognising that they knew what problems patients had and could fund according to their needs. In 2011, the Department of Health commissioned a Nuffield Trust report to look at approaches to that particular direction, and in 2012 the former Secretary of State for Health, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), was specific in saying:

“Wherever you are in the country you should broadly have resources equivalent with access to NHS services.”

He also strongly recognised that the age of a patient was the most significant factor in determining their health needs. People mainly use the NHS in the first six months and the last years of their lives. There is no doubt that an increasingly elderly population, as has already been recognised, continues to bring the NHS challenges, with more and more complex needs.

David Simpson (Upper Bann) (DUP): I congratulate the hon. Lady on securing this debate. Does she agree that GPs have a lot to answer for in putting pressure on the NHS? Under the new contracts, they no longer have to look after their patients out of hours, which puts a lot of pressure on the NHS and its finances. Surely we need to look at some way of getting round that.

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Dr Coffey: I respect what the hon. Gentleman is saying. There is no doubt that allowing doctors to lose the responsibility for effectively caring for their patients 24 hours a day has caused significant change. An ageing population means that that is increasing and will continue to be a pressure on alternative sources of health treatment. A lot of work is going on and I am pleased that the landmark Health and Social Care Act 2012 will start to tackle some of the issues, but I want to give credit to GPs, who are doing so much more for patients in our local surgeries now than 20 or 30 years ago, mainly because of technology changes, but also through a recognition that we can prevent people from going to hospital by doing more in primary care. That is an admirable change, so I want to praise GPs, while agreeing with the hon. Member for Upper Bann (David Simpson) that rescinding that 24-hour care responsibility was a backwards step for patients. The lack of out-of-hours care was one of the big doorstep issues before the 2010 general election.

Turning to the different formulas, one big change in the 2012 Act was splitting funding for the NHS, with public health going to authorities, recognising the deprivation inherent in different parts of the population. That was the right thing to do. Surrey ended up with £20 a head for public health and places such as Hackney had £115. Westminster, for example, has an even higher allocation, recognising that parts of the borough have significant deprivation, but it was the right thing to do. Local authorities not only got the staff from NHS trusts who focused on public health campaigns, but were also given responsibility for tackling the long-term factors that contribute to health inequalities, be they quality of housing or local employment. Frankly, the NHS was not in a position dramatically to change the levers affecting such inequalities in local communities, so it is right that councils took on that leadership. I hope and pray that they continue to take the initiative, rather than just focusing on public health programmes. It is a real step change in the responsibility of and the opportunity for our local councillors to make a difference.

Meanwhile, the opportunity was there to examine the formula for the rest of the NHS budget. I refer to section 23(1) of the 2012 Act, which inserted a new chapter into the National Health Service Act 2006. Section 13G, “Duty as to reducing inequalities”, of that new chapter states:

“The Board must, in the exercise of its functions, have regard to the need to—

(a) reduce inequalities between patients with respect to their ability to access health services, and

(b) reduce inequalities between patients with respect to the outcomes achieved for them by the provision of health services.”

The effect is twofold, but the latest funding formula has not taken account of the

“ability to access health services”,

and inequalities have been strengthened.

David Mowat (Warrington South) (Con): I thank my hon. Friend for giving way and congratulate her on securing the debate. The problem is not with the formula that was developed by the Advisory Committee on Resource Allocation, but that the board of NHS England inexplicably decided not to implement it. That is what we are now living with.

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Dr Coffey: I agree with my hon. Friend. Funnily enough, I do not think that the formula was strong enough in reflecting the demands of age. It could have gone a lot further. The sparsity challenges are also a constant issue for those of us who represent rural seats. There is no doubt that a patient’s health care experience is somewhat diminished when a cardiac check-up means a 200-mile round trip. I realise that we cannot have a cardiac hospital within five or 10 miles of everybody—that might be the case in London, but I will not get into the London health funding debate. There is no doubt, however, that such trips are not helpful with regard to the patient experience. The funding formula has had negative consequences. We have seen a more rapid reconfiguration and regionalisation of services. The quality of care for patients has been affected and there are funding challenges. The problem is particularly acute where there is a high proportion of elderly patients. That is not good enough.

Sarah Newton (Truro and Falmouth) (Con): My hon. Friend is making a powerful case for patient care in rural communities and I wholeheartedly agree with her. Does she agree that the market forces factor is having a negative impact on rural communities in poorer parts of the country where average incomes are much lower? People within the NHS and the care system are often paid national wages, but the funding formula discounts for local wages.

Dr Coffey: My hon. Friend makes an interesting point. I have not gone into that level of detail and do not have that level of understanding, but she makes an important contribution to the debate. Local clinical commissioning group and NHS trusts must contend with that challenge and should make that point to the board of NHS England.

I come back to the formula. I said in response to my hon. Friend the Member for Warrington South (David Mowat) that the focus on age may have slightly increased, but that it did not go far enough. The correlation between age and per capita funding increased only marginally between the old formula and the partially adopted current formula. South Sefton receives 40% more per capita than Ipswich and east Suffolk, but it has 50,000 fewer pensioners and a lower proportion of pensioners. Life expectancy in my part of Suffolk is considerably higher than in others, which is good, but that does not necessarily mean that people, in particular the elderly, do not have complex health needs that need addressing. At the moment, the formula continues to discriminate against the elderly and even further against people in rural areas.

David Mowat: This is a really important point on which we need clarity. The issue here is not the formula. Indeed, it does not really matter what the formula comes up with, because NHS England will not implement a formula that does not give everybody an inflation-based pay rise. That is what happened. With all due respect, the formula could be anything we liked, but if it will not be implemented, it just does not matter.

Dr Coffey: I can understand why the board of NHS England made a decision not to cut per patient funding in different parts of the country. We could get into the politics of the different aspects of what happened under

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previous Governments when overall funding went up, but parts of the country, such as the one that I represent, did not receive the same increases and seemed to suffer as a consequence, despite overall funding going up.

I am not into playing party politics with NHS or public funding, so I recognise exactly what my hon. Friend says. I guess that is what led to the outcry in the autumn about the “Tory-run NHS cutting funds to northern Labour seats,” which was disgraceful, because it was down to the ACRA’s independent assessment. I recognise, however, that that must be managed. Nevertheless, the board of NHS England bottled it by not being prepared to be a little braver in deciding on the allocations. It also ignored the formula and, as a consequence, effectively decreased the recommendation on the proportion that should go to elderly patients, which was wrong in principle, but I recognise what my hon. Friend says.

Various proposals were suggested—I say this as a constituency MP and not as a Conservative party representative—that could have seen an improvement in the pace of change towards getting a fairer funding formula while still not cutting funds to patients in different parts of the country. I regret the final decision of the board of NHS England. Of the two options proposed, I would have hoped that it would have gone for the first, recognising that it was a unique opportunity to tackle the unfairness, but the board bottled it.

I want to discuss why the issue matters. There are four community hospitals in my constituency: Felixstowe, Aldeburgh, Southwold and the Patrick Stead, in Halesworth. The first three have been highly commended by the Care Quality Commission and they are well recognised and loved in the community. The Patrick Stead also does an excellent job. The CQC made some slight criticism, but, true to form, the hospital addressed that straight away and is back to doing good things. After I was elected to the House, it was understandable that my constituency neighbour, who is now the Minister, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), should be the local expert on health, as he is a distinguished doctor. However, in my own case work, the experiences of older patients in particular, who had not got the care or treatment they needed, kept coming up. That is what got me going on the entire issue.

We have in the past debated the East Of England Ambulance Service NHS Trust. That was a classic example. At the top line things were running fine. The trust was hitting its targets and financially it was very good. It was trying to get foundation trust status, and the chief executive was awarded the Queen’s ambulance service medal. However, at the heart of things, the NHS relied on the meeting of targets, and forgot about patients. As a consequence, elderly people with broken hips waited for hours for an ambulance to arrive, because their condition was not life-threatening. I am pleased about the big shift that has happened only in the past few months: finally we have got rid of the entire board of the ambulance trust. I am sure that they were all good people who wanted to do the best to help guide the trust. Nevertheless, they seemed to be satisfied with hitting targets, and patients were forgotten. The arrival of Anthony Marsh will be particularly useful.

I supported most of the service reconfigurations, as the Minister knows, but there was one I did not support. A proposal to reconfigure stroke services would effectively

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have removed them from Suffolk. One need not know a lot about medicine to know of the excellent FAST campaign, which I recommend all MPs share with their constituents. That recognises the need to act quickly and get good treatment after someone has a stroke. Ambulances in the east of England were not reaching people quickly enough to help them with the first steps in care. If stroke services had been removed from the county, it would have taken well over an hour to get access to the sort of care that is necessary to enable a stroke sufferer to have a good life. In the case of cardiac services, when people were treated en route and taken to the regional specialist centre in Cambridge, they got higher-quality care, and I support that, but I was concerned about the stroke proposals. That is why I was pleased when the local clinical commissioning groups came together and said, “No. We are going to keep stroke services in the county.”

However, I must admit that our significantly lower funding per head means that that decision has potential consequences in the local NHS. The fact that our funding level is so different is one of my concerns. Despite a small above-inflation increase, which I am pleased about, I contend that we should be doing considerably more to help NHS CCGs to meet the needs of a significantly higher proportion of the relevant population. The constituencies with the highest proportion of people over 85 include places such as Worthing West, Christchurch, North Norfolk and Newton Abbot—largely rural and often coastal areas. By definition, those are often the places away from regional centres of excellence. I am concerned that the funding formula did not address the needs of patients living on the coast.

I have discussed at length my concerns about what the NHS board has not done, but opportunities are coming through, to do with local innovation. The King’s Fund report, “Making our health and care systems fit for an ageing population”, was an important contribution. One of the examples of local innovation to which it referred was at Gnosall GP surgery in Staffordshire, which provides patients over 75 with an annual health review and uses experienced “elder care facilitators” to support patients, helping them to navigate the system and draw up care plans. That is a good example of local innovation. I tabled a parliamentary question on 20 January at column 76W asking about bringing health visitors in for people over 75. I recognise that health visitors’ primary focus is, rightly, young children. However, there may be something that we can do, and perhaps the board of NHS England could think about rolling out the practice I suggest, particularly in parts of the country with a high proportion of elderly patients.

I could speak for the entire hour and a half on this subject, but I will not, the House will be pleased do know. It is regularly talked about. The board of NHS England had a golden opportunity, with the Health and Social Care Act 2012, to step away from the political pressures and do what was right for patients. As I said, I think it bottled it, and I am sad about that. I hope that it will reconsider its decision and think again about the needs of the elderly. Those people have served the country with distinction. We say that we do not want to discriminate by age, but the postcode lottery seems to determine whether elderly patients get the treatment

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they deserve. The debate will not be settled today. Unusually, perhaps, the Government cannot wave a magic wand and change the formula. It is for the board of NHS England to do that. I hope it will reconsider and truly look after the patients in question. In a few years we will be the ones in their position, and we need to do our bit to address the challenge.

9.56 am

Mr Gareth Thomas (Harrow West) (Lab/Co-op): It is a pleasure to serve under your chairmanship, Sir Edward, and to follow the hon. Member for Suffolk Coastal (Dr Coffey). I apologise to the House and in particular to the Front-Bench spokesmen for the fact that, because of a long-standing commitment, I shall have to read their responses to the debate in Hansard.

I want to raise a concern similar to the one raised by the hon. Member for Suffolk Coastal, about the funding formula, although there are constituency differences. Many health professionals in my constituency are concerned that Harrow does not receive an appropriate share of NHS funding and that that is already affecting elderly people there, and may affect many others. The context is that both the key hospital serving my constituency, Northwick Park hospital, and its parent trust, the North West London hospitals NHS trust, have been in a challenging financial position for many years.

In 2010-11, the trust made a tiny operating surplus; in 2011-12, it had an operating deficit of some £7.5 million; and in 2012-13, the operating deficit had increased to £20.5 million, approximately. Figures in papers submitted to the NHS Trust Development Authority’s recent board meeting suggest that the trust is again heading for a sizeable deficit this financial year, of about £20 million. Although final 2013-14 accounts are clearly not yet available for Harrow’s clinical commissioning group, the prediction, from NHS England information, is for an end-of-year deficit of £10.4 million. Indeed, Harrow clinical commissioning group is one of only four in London where there is significant concern about financial performance.

By setting out that information, I do not mean to criticise the trust management, the clinical commissioning group or their staffs. I have been treated at Northwick Park hospital several times, and I think the staff and management do a first-class job. I know the chair and many of those who serve on the board of the Harrow clinical commissioning group, and they, too, do a first-class job in extremely difficult circumstances. Those circumstances are made difficult by the amount of funding that Harrow receives from the NHS.

To humanise the consequences of those statistics on the financial situation that Northwick Park hospital and Harrow clinical commissioning group face, I should make it clear that there are increasing concerns about cancelled operations and longer waiting times in the A and E department at Northwick Park. Given the cuts to local government funding, there are fears that Harrow council’s social care budgets, which are already hard hit, will be cut further by an estimated £70 million over the next three years. The concern is that the NHS in Harrow will come under even greater pressure to meet the needs of elderly people in our area because of an inevitable lack of access to social care.

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Additionally, the popular Alexandra Avenue polyclinic, which was open from 8 am to 8 pm for 365 days a year and provided an excellent walk-in service, has for some time been closed to patients without an appointment for all but a short period on Saturdays and Sundays. Again, the service was heavily used by elderly people, as well as by many others in my constituency. The closure of large parts of the Alexandra Avenue polyclinic’s service is particularly galling because health professionals in Harrow accept that the polyclinic was making a difference by helping to improve health care opportunities and access to health care for elderly people and many others in my constituency. That is the context of my participation in this debate, and I am concerned about whether the funding formula properly reflects the needs of the NHS and my constituents.

The hon. Member for Suffolk Coastal set out some of the funding formula issues, and I will present them in a slightly different way; that is perhaps a reflection not only of our different political parties but of the different nature of the seats we represent. The Minister and the shadow Minister, my hon. Friend the Member for Copeland (Mr Reed), will be far more aware of the debate on changes to the funding formula than I am. Like the hon. Member for Suffolk Coastal, I understand that a weighted capitation formula based on population, the local cost of providing health services, the level of health care need and health inequality is used to determine allocations to each clinical commissioning group. I also understand, as she set out, that the Advisory Committee on Resource Allocation was charged with developing a revised funding formula based on the standardised mortality ratio for those aged under 75—the so-called fair shares formula.

After substantial consultation—the hon. Lady made this point—the board of NHS England decided not to adopt the fair shares formula, and clinical commissioning group allocations were initially uprated based on their estimated share of previous primary care trust allocations. In December 2013, the board of NHS England decided on CCG funding allocations for 2014-15 and 2015-16. I understand that, again, the board decided to reject proposals for a faster move towards CCG allocation targets. I do not intend to make a party political speech, but I gently insert the point that perhaps the board might have felt differently if it had had access to the £3 billion that has been spent on reorganising the NHS, about which Opposition Members are somewhat sceptical.

The hon. Lady alluded to distances from target figures for 2014-15 and 2015-16. The figures indicate that Harrow’s allocation was almost 10% away from the target for 2014-15 and almost 9% away from the target for 2015-16. The total estimated funding shortfall for Harrow is some £23.4 million over the next two financial years. That information was provided to me by statisticians from the House of Commons Library based on estimates using the closing target allocations per head and our estimated CCG population.

I recognise that, as the Minister will presumably point out, the figure is not completely settled and that there may be movement given how far Harrow clinical commissioning group is from receiving its target allocation, but I hope that I can persuade the Minister today to scrutinise the Harrow figures. I hope he will ask his officials to talk to Harrow clinical commissioning group

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to see whether there is more information that might justify a further funding increase for the NHS in Harrow, to close the funding gap that has been identified.

A little like the hon. Member for Suffolk Coastal, I have tried not to be party political in this debate, although she will understand that I think I have managed it better than she did. In that spirit, I hope the Minister will take seriously my concerns about the NHS in Harrow and will ensure that his officials talk to those who do an excellent job working for Harrow clinical commissioning group.

Sir Edward Leigh (in the Chair): When the Minister replies, I have no doubt that he will refer to Harrow’s ageing population.

10.6 am

Sir Tony Baldry (Banbury) (Con): It is always good to submit to the chairmanship of a brother knight, Sir Edward. I congratulate my hon. Friend the Member for Suffolk Coastal (Dr Coffey) on her excellent speech, analysis and introduction, and on providing the House with an opportunity to consider this important subject.

However large the budget is for the national health service, money has to be allocated to local clinical commissioning groups through a formula. The easiest formula, of course, would be to allocate a certain amount of money per person so that for each clinical commissioning group we simply took the size of the population of both adults and children—a straightforward and transparent calculation. I suspect that since the start of the NHS, however, there has been a belief that the health needs of some people and groups within the community are greater than those of others, and that the NHS allocation formula should be adjusted to recognise those needs. I think it is clear to everyone that one of the most significant factors affecting demand and spending in the NHS is an ageing population.

Last Saturday’s Daily Mirror summarised the situation thus:

“More than half a million Britons are now aged over 90—an increase of a third in just 10 years.

Average life expectancy is now up to 78 for men and 82 for women, according to the Office for National Statistics.

Its figures showed there were 513,000 people over 90 in 2012. Of those, there were 372,290 women… And 141,160 men... The number of centenarians has also increased by 73% to a record high in the past decade. In 2012 there were 13,350 people over 100 in the UK.”

That is a lot of telegrams from the Queen. The Daily Mirrorcontinued:

“It comes amid concerns over how the NHS will cope with an ageing population… A newborn boy can expect to live 78.7 years and a newborn girl 82.6.”

In Oxfordshire, according to the Office for National Statistics, on average, men aged 65 can expect to live a further 10-and-a-half to 13 years and women an extra 11 to 14 years. The Oxfordshire clinical commissioning group has calculated that the impact of demographic change in Oxfordshire will lead to an increase in costs of £54 million over five years. In Oxfordshire, the population of over-65s is expected to grow by 2.5% a year, so the proportion of the population aged 65 will grow from 15.8% to 18.2% by 2017 and to 25.2% by 2035. By 2035, more than a quarter of everyone living in Oxfordshire will be over 65. The proportion aged over 85 will grow from 2.3% to 3.4% by 2017 and to 5.6% by 2035.

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I am not suggesting that the increase in Oxfordshire’s elderly population is necessarily significantly greater than in other parts of the country. What I am saying, however, is that an ageing population is a significant cost to the NHS and therefore the amount of funding for Oxfordshire should be much nearer to the average for NHS spending. The size of the difference between the clinical commissioning groups that are receiving the most money per head and Oxfordshire is too great and is unsustainable.

For a long time, I have been arguing that the NHS allocation formula does not give sufficient weight to the fact that we have a significant and growing ageing population. It is of course good news that people are living longer, but there is no doubt that older people on average have greater need for NHS support. We have been arguing that the formula for NHS allocations needs to be reformed to reflect more reasonably and fairly the number of elderly people in an area.

The facts and the needs speak for themselves. One would have thought that on an issue as self-evident as this, there would be a degree of cross-party consensus. Whether the significant number of elderly people is in Oxfordshire, Blackpool or any part of the country, they have similar needs. An average 80-year-old in Oxfordshire does not have significantly fewer needs than an 80-year-old in Bradford, Birmingham or Bermondsey.

Understandably, in making any change to the funding formula, NHS England might wish for some cross-party consensus; sadly, it has clearly not been possible to find it. The shadow Secretary of State for Health has campaigned vigorously against any changes to the allocation formula that would better recognise the needs of those aged over 65. My hon. Friend the Member for Suffolk Coastal has done the House a service in securing from the chair of NHS England, Professor Sir Malcolm Grant, a copy of the letter sent to Sir Malcolm last December by the Labour shadow Secretary of State, who started his letter by saying:

“I wish to register the strongest possible concerns about proposed changes to NHS resource allocations being considered by your board on Tuesday, 17 December”.

The shadow Secretary of State sought to defend his resistance to allowing NHS funding to reflect more fairly the needs of the elderly in the community with a rather convoluted argument: that

“health care utilisation is not the same as healthcare need and resources should not be allocated based on demand levels rather than the level of need”.

Lewis Carroll and Alice in “Through the Looking Glass” would find it difficult to dissect what that sentence is meant to mean. I suspect that it is meant to mean all things to all people.

The Labour party has made it clear that it does not want any change to the existing allocation formula—a formula that in no way adequately reflects the local needs of an ageing population. I think it is fair to draw the conclusion that at the NHS England board meeting last December, faced with such hostility by the Labour party to any changes in the formula—I agree entirely with my hon. Friend who introduced the debate—NHS England simply bottled it. It made some changes, but it bottled introducing the original new formula proposed by—let us remember this—an independent committee,

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which had recommended much greater weighting for age. NHS England simply added an adjustment for what it described as “unmet need”, which it said was a particular issue in deprived areas, in effect negating any improvement in the formula to take account of the number of elderly people in a local area.

The consequence of not making reasonable provision for the number of elderly in a clinical commissioning area is that, under this year’s funding allocations, the CCG allocation for the NHS in Oxfordshire for 2014-16 will be the lowest amount of money of any clinical commissioning group in the country—£856 per head, at present. That compares with a national average—I stress, average—of £1,115 per head. By definition, many parts of the country will be above average. Oxfordshire is the third most underfunded CCG in the country, at nearly 11% below target. If, however, NHS allocations took proper account of the number of elderly, Oxfordshire’s NHS funding allocation would increase by an extra £57 per person.

Any NHS funding formula, of course, has to have appropriate regard to indices of deprivation, and I understand Labour’s wanting to stick with a formula that largely directs funds to parliamentary constituencies held by Labour MPs. It is absolutely no good, however, everyone’s acknowledging that one of the greatest pressures, if not the greatest, on the NHS into the future is the fact of an ageing population if that fact is not then fairly reflected in the funding formula. It is little wonder that the Oxfordshire CCG and the Oxford University Hospitals NHS Trust are both running at a deficit; Oxfordshire receives the lowest amount of money per head for the NHS of anywhere in the country, but, that notwithstanding, it has a significant and growing elderly population.

10.15 am

Jim Shannon (Strangford) (DUP): It is a pleasure to make a contribution to the debate. I congratulate the hon. Member for Suffolk Coastal (Dr Coffey) on bringing the matter before the House for consideration and giving us all the opportunity to contribute.

We are long past the days when people who die at the age of 68 would be considered to have had a good innings. Now, we would shake our head and describe them as in their prime. The rising age of our population has meant an increase in the pension age, with further increases to come. That is something my parliamentary aide has questioned, saying that she will have to work until she is 72. She wonders who will hire her to write speeches and come to the House then. At the age of 35 or thereabouts, she is already thinking of the future.

One of the figures in the press last week, which hon. Members have referred to, was that we in the United Kingdom now have the greatest number of people living to the age of 100 since records began. Approximately 600 people have lived to 105, which is another indication of the statistical trends. Although that is perhaps great for families who use the free grandparent babysitting service offered nationwide—that is what grandparents do—and which has ensured that families get to enjoy time together, with stories and wisdom passing easily down the generations, it has also put a lot more pressure on our NHS. The NHS is not equipped to handle that pressure without major investment or a redirection and reprioritising of funding.

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The sheer beauty of my constituency and the area’s strong links to Belfast and other cities make it one of the most desirable places for older people to retire to—indeed, Strangford and the neighbouring constituency of North Down are the top two retirement locations in Northern Ireland. The hon. Member for Suffolk Coastal said that people want to retire to her constituency because it too is beautiful, and quieter and more serene than many places. As they do in my constituency, people might look forward to seeing the sea in the morning and taking walks, because these are the attractions of such locations. More people retiring to such places, however, certainly puts pressure on our local NHS.

If the Government took account of this debate and increased the funding given to the NHS, offering additional ring-fenced funding to the devolved Assemblies, the level of care would be much greater. I look forward to the Minister’s response, as I always do, because he understands the issues and I respect his comments. It is fantastic to read about the available drugs, treatments and therapies, but the fact is that the NHS cannot afford to provide them fully. Any additional funding would benefit not simply the ageing population, but the entire community. There are pressures on the NHS, given the prioritising of funding to the sections where it is needed most, but I am sure I am not the only person in the Chamber to have read the media speculation about the NHS and the ageing population. Statistics from the Institute for Fiscal Studies indicate that spending per patient will have fallen by 9% within four years even if health service funding is ring-fenced and protected.

I have already alluded to the reasons: 2 million more over-65s on the UK mainland, which is a 20% rise, will place far greater demands on the NHS. To give the Northern Ireland perspective, new figures released by the Northern Ireland Statistics and Research Agency show that the number of people aged 65 and over is projected to increase by a quarter, to 344,000, by 2022. That indicates the pressures on the NHS in Northern Ireland, where health is a devolved matter.

Dr Coffey: Has the hon. Gentleman seen the figures circulated by the Royal College of Physicians, which show that two thirds of people attending A and E and admitted to hospital are aged over 65? We all recognise that we need to do more to prevent people going into hospital when they might not need to, and certainly to expedite their leaving. Does he recognise that, right here, right now, we still need to allow CCGs to have appropriate funding to address that need?

Jim Shannon: I agree with that. If more preventive action is taken at an early stage in surgeries, that will have dividends further down the line. The hon. Lady is quite right and I wholeheartedly agree with her.

David Simpson: Does my hon. Friend agree that more emphasis is needed on care for the elderly at home, and that adequate funding needs to be put in place so that the older generation can be comfortable and be looked after at home?

Jim Shannon: I thank my hon. Friend for that contribution. That is probably a subject for a different debate, but at the end of the day it is also clearly a matter for us all. Most elderly people in my constituency

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would like to spend their days at home. They do not want to go into homes, which may not be as homely, if I can use that terminology, but there are additional pressures on carers who support the elderly at home. That is a debate for another day, but it is an important factor. It is about balancing the budget and making the butter go even further, as it were. Many elderly people want to spend their time at home and enjoy being with their families.

That puts us under even greater pressure in providing a high-quality NHS. The number of the oldest people—those aged 85 and over—is expected to rise by 50%, from 33,000 to 48,000. When we take into account the fact that the average 80-year-old costs the NHS seven times more than a typical person aged 30, even those without a degree in mathematics can see that there is a major accountancy problem in the NHS, and difficulties with funding streams.

Thus far only efficiency savings have been requested, but they have not been enough to keep things ticking over. The Institute for Fiscal Studies has said that to keep pace with the ageing population, spending needs to grow by 1.2% a year above inflation, which has been running at about 2.4%. Again, that gives a clear indication of what the financial issues are. Such an increase has not happened so far, and the pressure cannot be sustained without something giving. I look forward to the Minister’s response on the difficult but urgent question of how that situation will be addressed.

I recently held a public meeting on the provision of cancer care in my trust area, at which were the top breast cancer consultant and the director of policy for the trust. Both cited the pressure their hospital faces due to care of the elderly. Indeed, almost 10% of the people at that meeting said they had been operated on by the consultant and owed their lives to that man, but probably only one of them was under the age of 50. Again, that shows the pressures that are on the elderly generation and the greater level of care that they need.

Those pressures, ranging from broken bones to cancer, diabetes and strokes, are increasing. Levels of diabetes are higher among the elderly population. The lifestyles we have lived over the years have contributed to that, I suppose, but it is a growing problem affecting those over 50 much more seriously than any other group. Given those increased pressures, we need to increase the funding. We cannot ignore the situation. Unless we, God forbid, begin to put an age limit on what services and treatments are available, we will have increased pressure every year. It therefore follows that funding must keep pace with that pressure. I see little point in funding research and development into cutting-edge technologies if the Government are unable to fund their use within the NHS.

I am a great believer in the notion that money does not grow on trees. I have used the analogy on many occasions. My parents said it to me, I said it to my children and they in turn now say it to their children. I understand that we need to cut borrowing and to restore a workable bank balance, but I also understand that life is precious and that if there is one thing we cannot afford to scrimp on, it is health care and quality of care for our elderly. There are a large number of elderly people in my constituency—I meet them, probably,

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more than any other group. They tell me what the issues are and I want to see care delivered for them in every way possible.

It is said that a society is judged on how it treats the most vulnerable, including the elderly and children. I ask the Minister to consider the compelling facts that all hon. Members have put on the record today, and which will be added to by those yet to speak, and to realise that there must be a ring-fenced increase in NHS spending if we are to do our duty by the most vulnerable in our society.

10.24 am

David Mowat (Warrington South) (Con): I congratulate my hon. Friend the Member for Suffolk Coastal (Dr Coffey) on securing this important debate. Although NHS funding has increased in real terms, what matters is the allocation that we get in our communities. We have learned a lot already from hon. Members’ remarks. Personally, one of the most important things I have learned is that my right hon. Friend the Member for Banbury (Sir Tony Baldry) reads the Daily Mirror. I will reflect on that fact.

The issue of ageing has been a known problem in the NHS for some while. It was a problem for the previous Government and there was an attempt to reflect it better in what was then the ACRA formula. Like the current Government, the previous Government did not implement that formula. The direction for travel adjustments that should have been made in the years before the general election were not made and the formula was essentially static.

As an MP for an underfunded area—Warrington is underfunded—I was optimistic that a new Government bristling with talent and enthusiasm for sorting out such issues would fix the problem. As has been mentioned, the Secretary of State asked the independent ACRA committee to make a clinically based decision on how money should best be allocated—of course, allocation can mean that there are winners and losers—based on ageing, deprivation, population and any other salient factors. The consequence was that a new formula was developed and submitted.

To be clear, nobody who wants the problem fixed is expecting a new formula to be implemented immediately. As hon. Members have pointed out, some areas are significantly under-allocated while others are over-allocated. There therefore has to be a process by which we move towards the correct number over a period of years—that is, the direction of travel adjustment—so that big, unmanageable changes do not happen. That would be perfectly acceptable.

Is that what happened, however, when we went to the board of NHS England with the new, clinically developed formula designed by an independent group? The answer is no. The board of NHS England said, “If we implement the formula, there will be winners and losers. Our view”—perhaps this was because of political pressure—“is that the losers complain more than the winners celebrate. We are going to give everybody an inflation increase. With the bit left over, we will give a little more to those furthest away from target.”

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One of those areas was Warrington. We are grateful that we got extra money, but it was not enough. I suspect that the situation was similar in Suffolk and Oxfordshire: some extra money was allocated, but not as much as would have been allocated had the formula been implemented.

What does that mean for public health? We are stuck with a static formula, developed around 2002 or 2003. The previous Government made no direction of travel adjustments to it other than for inflation and we are apparently reluctant to make those adjustments as well. That is a pity. A static formula may be politically expedient but it is not right. That is why we have ACRA—to go into the issues and come up with the right answer. The situation, for me, raises the question of why someone would be on the board of ACRA, given what happens to its recommendations.

There are consequences. I have seen the numbers: 34 CCGs are more than 5% underfunded—that 5% is a lot of money in health allocation—and 38 CCGs are more than 5% overfunded. What to me is even more significant is that 84% of CCGs that will have a deficit are underfunded. That is an issue because if we are trying to make people accountable for managing an efficient operation, but start that process by saying that we are not going to implement a formula that would give a fairer allocation, it is reasonable for them to come back and say, “Yes, and therefore we have a deficit.” It hits the whole process.

What is the impact in our constituencies? We have heard about Harrow, Oxfordshire and Suffolk. Warrington is also underfunded. The issue is not necessarily that older folk get worse services, but that marginal or discretionary activities are not carried out in underfunded CCGs. For example, in Warrington we are unable to provide IVF in the way that the National Institution for Health and Clinical Excellence would like because funding is not available. GPs decide how to allocate what funding they have and consequently the people who lose are not always the ones who would be imagined to have lost in the formula. Overfunded CCGs can undertake more discretionary activity than others, and someone should look at which parts of our NHS are spending large amounts of money on alternative therapies such as homeopathy. That is likely to be the result of overfunding, and that is not acceptable.

There was an element of politics. Everyone agrees that ageing is a good proxy of health need, but there is an issue about the weighting that we should give to deprivation. That was in the letter from the shadow Secretary of State for Health that was read out, and it may have been part of his concern. That does not allow for the fact that ACRA was an independent committee and either we accept what it said or we do not. I have some questions for the Minister on that because it goes to the heart of whether the NHS is manageable. If such important decisions are, in the end, made for reasons of political expediency, why do we have an NHS board and senior NHS managers who are supposed to provide the right answers? We would not need any of that; we could just link the issue to inflation or inflation plus a little bit.

Dr Thérèse Coffey: My hon. Friend is making a key point. One point about the Health and Social Care Act 2012 was to remove that party political element of

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manipulating or managing the formula or putting in extra factors. That is where a key opportunity has been missed.

David Mowat: I agree with my hon. Friend, but as I said, the issue is not the formula, although it may also be the formula—my hon. Friend and I may not agree on that. I accept the formula, and I would have liked it to have been implemented. I have difficulty in accepting that, for political reasons, it was not implemented.

People in my constituency and elsewhere who are not affluent and do not understand this stuff lose out because the previous Government did not do the distance from target adjustments under the old formula and NHS England has refused to implement the right thing under the new formula. It is hard to justify that. Why have ACRA if we are not going to do what it says, and why have an NHS board if it cannot manage change and do the right thing? That is why big organisations have senior managers who are paid lots of money.

Are there symptoms of waste in the 38 CCGs that are overfunded by 5% or more? Is the incidence of alternative therapies and all that goes with that higher there because they have the money, so why not spend it? Does the Minister really believe that he can hold CCGs accountable for budgets given that how those budgets are allocated is apparently so political and not based on clinical judgements by independent people such as those on ACRA?

10.33 am

Mr Jamie Reed (Copeland) (Lab): It is a pleasure, Sir Edward, to speak under your chairmanship again, although I am afraid I am not a brother knight.

Sir Edward Leigh(in the Chair): Give it time.

Mr Reed: I am even more afraid that it is a fraternity I will never be invited to join.

I thank the hon. Member for Suffolk Coastal (Dr Coffey) for securing this timely debate and for her opening remarks. Particular thanks should go to Government Whips for drafting so much of it. As she knows, the last Labour Government took a malnourished, failing NHS with an annual budget of approximately £30 billion and left it with a budget of more than £110 billion. The Conservative party voted against every increase in that budget. The same Labour Government oversaw the biggest ever hospital building programme in this country. It recruited tens of thousands more doctors and nurses. It inherited an NHS in which Bruce Keogh said people were dying waiting for treatment, and left a service with the lowest waiting times and the highest patient satisfaction rates in its history. Of course, there was much more to do.

I warn the hon. Lady against complacency. If she wants to see a health economy that has been plunged into crisis as a result of the Government’s policies, she should come to Cumbria where a crisis is unfolding, patients are paying the price and the Secretary of State is entirely disinterested in what is happening.

It is incredible to hear that NHS England does whatever it is told by the Labour party. That is extraordinary—this must be the most powerful Opposition of all time. Government Members should consider whether they

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are in office but not in power. A canard seems to be being established whereby the NHS England board have become the new reds under the bed. That fascinating argument will be rolled out between now and the next election.

Dr Coffey: I am not suggesting that anyone on the NHS board made a decision because they supported the Labour party—the reds under the bed. I am suggesting that the Labour party had the opportunity in the legislation to try to break away from party political interference in the formula and it failed to take advantage of that.

Mr Reed: I thank the hon. Lady for her intervention. I am not sure that I agree with her. Not for the first time today—I am not laying this singularly at her feet; she knows that I have great respect for her—we have heard the argument that I hear frequently from Government Members about there somehow being an enemy within. That does not deserve significant air time in this Chamber or on any other platform in this House.

It is a mark of how important these issues are that so many hon. Members attend these debates—not just today, but every time I have responded to a debate such as this in Westminster Hall. As we have heard again today, hon. Members passionately represent their constituents, often with moving testimony of constituents’ experiences. Today, we are discussing an issue that will affect many more people in the future.

The NHS is now more than 65 years old and to ensure that it is still here in 65 years’ time, it needs to adapt to the challenges of this new century. In 1948, the health challenges facing the UK were clearly very different from those we now face. As consistent improvements in medical knowledge have enabled more people to live better for longer, we are now tasked with providing a system to cope with an ageing society. Surely we all agree on that. One of the core principles of Labour’s plans for the NHS is that there should be a system fit for the 21st century. My right hon. Friend the Member for Leigh (Andy Burnham) will speak about that and the impact of an ageing society later today.

The hon. Member for Suffolk Coastal has raised on the Floor of the House and in recent Health questions the issue of the NHS funding formula and its impact on the elderly, and in my view the Government’s response has been poor. Late last year, NHS England consulted on a new funding formula based on recommendations from ACRA and we have covered such issues widely this morning. ACRA said:

“The objective of the formula is to provide equal opportunity of access for equal need. The basic building block of the formula is the size of the population of each CCG, and then adjustments or weights per head for differential need for health care across the country. The weights per head are based on need due to age (the more elderly the population, the higher the need per head, all else being equal) and additional need over and above that due to age (this includes measures of health status and a number of proxies for health status). There is also an adjustment or weight for the higher costs of delivering health care due to location alone, known as the Market Forces Factor…This reflects that staff, land and building costs are higher in”

for example,

“London than the rest of the country.”

I can point to life expectancy gaps in Cumbria exceeding 20 years. Healthy life expectancy ages in some areas of the country are well below 60 years and the local

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population, by default, will be younger than in areas where healthy life expectancy is much higher. Health funding in areas with low life expectancy will be disproportionately affected.

It is right that NHS England listened to the concerns not just of the Opposition, but of medical professionals and others about the funding formula, and it is right that deprivation will be taken into account as part of the formula, but that has not changed the overall direction of travel. Over time, money will still be taken from areas with the poorest health and given to those where healthy life expectancy is longer. I would be grateful if the Minister explained how that is justifiable. It is the very antithesis of the founding principles of the NHS that funding should be allocated disproportionately to more wealthy areas.

The pattern is also demonstrated across the public health spending formula. Areas such as Westminster and Kensington and Chelsea receive in excess of £100 per head more than my own county, Cumbria, despite Cumbria’s having some of the greatest health inequalities in the country.

David Mowat: Just to get clarity, is the hon. Gentleman’s position that ACRA’s formula was wrong and therefore should not have been implemented, or would he have liked to have seen it implemented over time?

Mr Reed: I will come on to that question. The funding formula on its own is a blunt tool that will struggle to address intricacies within a health economy as varied as the one in England and, therefore, more needs to be done at the interface between medic and patient to improve care for older people.

Funding is crucial, but financial pressures mean that we have to use existing funding more efficiently. Day after day, we are getting repeated warnings about the sustainability of the NHS and the £3.5 billion reorganisation that nobody wanted and nobody voted for has left NHS finances on a knife-edge. As such, more has to be done with less and that requires more than small changes at the system’s periphery. Last year, more than half a million pensioners had an emergency admission to hospital that could have been avoided if they had received better care outside hospital.

A study undertaken by researchers at Imperial college London found that nearly a third of hospital beds are used for patients who might not have needed them if their care had been better managed, which shows that we should focus on improving community care services to allow older people to remain in their own homes. The CQC has also found a general acceleration in the rate of avoidable hospital admissions.

Pensioners tend to have at least one long-term condition and those over 75 tend to have two or more. As society ages and the number of comorbidities increases, we need a system set up to care for the whole person, rather than the individual ailments that have no regard for the person behind them. The system needs greater integration and better co-operation between services to improve care for older people and ensure that they can be cared for in their own homes, rather than being forced into hospital just because the services in the community are not good enough or, in some cases, are not there at all.

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The Government, however, have legislated for competition and fragmentation—and, as a result, for service isolation. Cuts to council budgets have meant that community services have suffered and patients are paying the price. I see that every day in my constituency. To improve health and well-being for the elderly in our society does not require penalising deprived areas with an obtuse funding formula; it requires improvement in collaboration between primary and secondary care and improvements in community care services to ensure that people can get the treatment they need, but also live independently in their own homes.

Thus far, the Government have provided no real solution to the challenges posed by changing health needs. We need to introduce a system of whole-person care and to respond to the changing health needs of our society: for young and old, and for the poor and those not in poverty. To do that—I end on a partisan note that reflects the tone of the debate so far—we need a Labour Government.

10.42 am

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): It is a pleasure to serve under your chairmanship, Sir Edward, for what I believe is the second time. I congratulate my hon. Friend the Member for Suffolk Coastal (Dr Coffey) on securing today’s debate. As I am also an MP who represents Suffolk, which is a predominantly rural county, I recognise and support her interest in the allocation of NHS funding in areas with a high proportion of older people. I understand that she is meeting with colleagues at NHS England, who lead on clinical commissioning group funding allocations, to discuss the matter later in the month.

It is worth outlining at the outset that the funding formula allocations for this year mean that Suffolk and every other CCG is a winner. They have all seen an increase in their NHS funding. It is important to make that clear.

Before I go any further, I will pick up on some of the points made. I will not detain the Chamber by talking further on the issues raised by the hon. Member for Harrow West (Mr Thomas). His was a wide-ranging contribution, and I understand that he had to leave early, so I will write to him separately.

My right hon. Friend the Member for Banbury (Sir Tony Baldry) made an eloquent case, as he always does, for Oxfordshire and the issues faced in that county. He outlined in particular the challenges presented in rural areas by an ageing population.

My hon. Friend the Member for Warrington South (David Mowat), as ever, made a compelling case for his constituents and for the importance of changes in the funding formula being gradual. I think he was saying that it is important not to destabilise local health care economies. The funding formula was a political formula set by the previous Government, while the current formula is not political but set independently with no political interference. It is important, however, as has been outlined in the debate, that we move towards a new set of arrangements in a staged and managed manner. Otherwise, local economies will be destabilised and that could lead to unintended consequences and potential effects on local hospital services, something none of us wants to see.

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The hon. Member for Strangford (Jim Shannon), as always, made a useful contribution on behalf of his constituents. I understand that Northern Ireland has the fastest ageing population in the UK, with the number of over-65s due to increase by 10.7% in the next few years. The only sustainable long-term strategy is one that engages actively with the population through not just the health sector, but the community and elsewhere, to ensure that the focus is on whole-person care in Northern Ireland, with communities working together with the NHS to deliver better care and dignity in care for older people. That was, I believe, outlined in the Budget and it is to the Northern Ireland Assembly’s credit that they highlighted the significance of an ageing population. That issue is a funding priority for them, and rightly so.

It is also important to highlight the context in which this discussion is taking place. My hon. Friend the Member for Suffolk Coastal was right to highlight the Nicholson challenge and to say that, to meet it, we need to transform radically the way we deliver care, in particular in rural areas and communities. She was also right to highlight that the £3.8 billion integration fund that the Government are setting up to join together and better integrate the primary care, secondary care, care in the community and adult social care delivered by local authorities—in her constituency, by Suffolk county council—is the way to do that. The focus is no longer on seeing a patient or a person within the silo of where they are cared for, but on joined-up, holistic care and ensuring that people with long-term conditions such as asthma, diabetes, chronic obstructive pulmonary disease and dementia are cared for in the right way throughout their care. The primary focus for that must be to deliver more care in the community and in people’s own homes. That is something we can all sign up to.

I turn briefly to the points raised by the hon. Member for Copeland (Mr Reed). I cannot let him get away with some of the things he threw into the debate today. He talked about fragmentation of services. Service fragmentation is shown no better than through the decisions on the use of private sector providers made by the previous Government. Let us not forget that they paid those providers 11% more than the NHS to provide the same service and care—something a Labour Government should have been ashamed of. This Government were certainly ashamed of that, which is why we put that right and ensured that the tariff is now set so that the private sector cannot be advantaged over NHS providers. We have also ensured that the tariff is much more focused on integrated care, rather than fragmented care.

The previous Government—understandably, to some degree—focused on reducing waiting lists, but unfortunately that did lead to fragmented services. For example, when an older person went in to have a hip replaced, the focus was purely on the operation and not necessarily on the rehabilitation and recovery that is so important after such operations. That led to fragmentation. That is why this Government and NHS England are looking at tariffs across primary and secondary care and the community to ensure that there is a genuine focus on holistic care for those who have operations, rather than just seeing people as a widget in the context of an operation, as the previous Government’s tariff setting

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did. We need to see such people, whether young or old, in the round and ensure that, importantly, there is a more holistic focus on rehabilitation and care.

I notice that although the hon. Gentleman said that he would get on to whether he supports an independently-set formula, he failed to do so. I am sure that all hon. Members find that disappointing. Not committing himself either way on that question suggests that he prefers the political, set formula encouraged and supported by the previous Government, which disadvantaged areas with ageing populations. I hope that at some point in the next few months when we have these debates, the Labour party will clarify its position and we will understand whether it does support an independently set formula or whether it would like to return to the political, fixed formula of which the previous Government were so fond. It would be useful for us to understand that.

David Mowat: I think the Minister is not doing do justice to the Opposition spokesman, who did semi-answer the question. He made it clear that he did not accept the independent, clinically driven formula. I think he called it obtuse. It is extremely interesting for, among others, my constituents and health care professionals in towns such as Warrington, who would have gained from a fairer formula, that the Labour party will not accept an independent, clinically driven formula as a basis for allocation. That very important point was made today.

Dr Poulter: If that was the case—I may have missed it—my hon. Friend has made an important clarification. It is important that we have a formula that is as far as possible beyond reproach and set according to clinical need—the needs of patients. It is important that a number of factors be taken into account when that formula is put in place, as has been articulated clearly by NHS England in the discussions about how the formula is set. Deprivation is a factor. It is important to note that one of the primary drivers for setting the funding formula is now age and the needs of an ageing population. That is an important factor to highlight in this debate.

I shall now deal with some of the points made by my hon. Friend the Member for Suffolk Coastal. She may be aware NHS England has undertaken a fundamental review of its approach to allocations, drawing on the expert advice of ACRA and other external groups. The review’s findings have resulted in a new formula that provides a more accurate model of health care need. Last December, NHS England published the allocations for 2014-15 and 2015-16, based on the new formula. That gives CCGs two years of certainty about what their funding allocation is, which we can all welcome.

I know that my hon. Friend is very busy and may not have had the time or opportunity to review in detail during the past three months the information relating to the new formula, but I hope I can reassure her on the direction of travel. The formula is putting us much more on the trajectory she wants to see. It is independently set and therefore has a lot of clinical merit.

Dr Coffey: Will the Minister also recognise that the concept of unmet need was reintroduced in a more significant way than previously, and that that does not necessarily help where we know there are elderly populations with specific conditions that need treating?

Dr Poulter: It may be helpful if I outline the way the new formula works and how some of the weighting has

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changed, which will help to address the point my hon. Friend has just made and shed more light on the direction of travel that is under way.

The new formula uses a new indicator to recognise how health inequality should be reflected, which is based on the standardised mortality rate for those aged under 75. Previously, adjustment has been made on the basis of a measure of disability-free life expectancy. The new indicator is technically better, in that it can pick up pockets of deprivation within more affluent areas. The formula focuses much more on real population need, rather than taking a blanket approach across the population.

The new formula moves to the more powerful method of using individual rather than small area utilisation data—this is fundamental to the formula—to derive estimates of need. The main factors in the model are age, gender and 150 morbidity measures from the diagnoses of admissions to hospitals. That picks up on the point that my hon. Friend just raised. The formula looks at the pressure of long-term illness. Those 150 morbidity measures will pick that up. The increased need for health care in deprived areas is captured in the base formula by directly taking account of much of the increased need in deprived groups. In addition, further adjustments are made for factors such as the claimant rate for key benefits. That ensures that the model captures increased need that is linked to deprivation but is not linked to earlier utilisation of hospital services.

The new formula reflects more up-to-date data on population growth and measures population based on registered GP lists, rather than population projections based on the census. I am sure we can all recognise that where there has been growth in a population or changes are happening at local level, basing the formula on up-to-date GP lists is a much more accurate way of reflecting the health care needs of the local population than basing it on a 10-yearly census.

The new formula also reflects the responsibilities of CCGs rather than PCTs, as my hon. Friend outlined in her contribution. CCGs are not responsible for specialist services or primary care, although of course NHS England is now also taking over responsibility for the GP contract, as she will be aware. As a consequence, it is important to stress that the new formula for allocating funds to CCGs follows the advice provided by ACRA. A strong element of the allocation is focused on age. The primacy of age, an ageing population and the needs of older patients are very much built in, as are the needs of patients with long-term conditions. There is still a strong weighting for deprivation.

Sarah Newton: How does my hon. Friend the Minister feel that the market forces factor is reflected in the new formula?

Dr Poulter: These are obviously factors that NHS England will keep under review and take advice on from ACRA, but importantly, the new funding formula is not based on census data every 10 years but on real-time information coming in from GP practices. It looks at

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the health care needs of local populations, at deprivation, at areas where there are groups of patients with multiple medical co-morbidities. We know that as people live longer and our NHS is more successful, that will of course throw up new challenges. People are living longer not just with one long-term condition, but sometimes with two, three or four. Someone with dementia may also have heart disease, diabetes and a whole host of other conditions. A much more accurate reflection of real-time patient information is used to help set and adjust the formula for future years, and I think we would all welcome that. It is all part of having an independently set formula, rather than one based on the whims of a particular Government.

Almost two thirds of total NHS funding, as we are aware, now goes to clinical commissioning groups, which have the clinical expertise and local knowledge to best commission health services according to local needs and priorities. We are very proud that, as part of our reforms in 2012, we ensured a clinically led NHS at local level. Doctors and nurses are now making decisions for patients, which is already leading to improved services not just in Suffolk but throughout the country, because it is ensuring that the money from the increased budget that we are giving the NHS is being spent in a way that focuses on the needs of patients.

The Government have been able to ensure real-terms growth in funding until 2015-16, despite the stark financial challenges that we face as a country, and we should be very proud of the fact that we are continuing to put more money into the NHS. That means that NHS funding in England will be almost £15 billion higher in cash terms in 2015-16 than it was in 2010-11, and spending will rise from £100.4 billion in 2010-11 to £115.1 billion in 2015-16. Importantly, transforming care and delivering more personalised care under the integrated health fund—the £3.8 billion fund that my right hon. Friend the Chancellor of the Exchequer set up last year—is an important part of ensuring that that money is spent not just more efficiently, but in a more patient-centred way, particularly for patients with long-term conditions, both in Suffolk and in other parts of the country where there are many older patients.

In concluding, I want to highlight the fact that although, as we have already discussed, every CCG is receiving an increase in funding, the three CCGs in Suffolk in particular have seen funding growth. Ipswich and East Suffolk CCG’s funding allocation will increase by 2.85% in 2014-15 and by 2.19% in 2015-16 to reach £412.4 million in that year. As a result of the new funding formula that has been put in place, Suffolk is doing well, as are many other parts of the country.

Having a formula that is independently set according to clinical need and population information, and that is up to date and accurate, puts us in a much better place properly to look after the needs of patients, be they young or old, in the years ahead. That formula and the Government’s bold decision to ensure that it is independently set puts us in a strong position to deliver high-quality care for older people. That, together with the £3.8 billion integration fund, means that we will radically transform and improve the way in which we deliver care.

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Warm Home Discount

11 am

Sarah Newton (Truro and Falmouth) (Con): It is a great pleasure to serve under your chairmanship, Sir Edward. I am pleased to have secured this debate about the warm home discount. Along with the energy company obligation, the warm home discount is a key tool for tackling fuel poverty.

The Government have a good track record in bearing down on heating bills. According to the House of Commons Library—I am grateful for the note that it has prepared for the debate—the Government are doing much more than the previous Labour Government to help people in fuel poverty. Although considerable effort has been made to keep heating bills down this winter, with particular help for pensioners and other groups of vulnerable people and with an estimated 2 million homes receiving the warm home discount, we must do more to stop people of all ages living in cold homes.

There is a particular group of people whom we must do more to help. Across Great Britain, off-mains-gas customers make up at least 11% of the total population, but that proportion varies wildly by region. Just under half of all homes in Cornwall are off the mains gas system, and a much greater proportion than the national average lives in detached homes, which, as we all know, are difficult to insulate. Dual fuel deals offer the best value, but they are just not available to off-mains-gas homes. The alternatives—bottled gas, oil, biomass or electricity—all cost much more than mains gas. The Government are to be applauded for setting up a ministerial working group to find new ways of supporting off-mains-gas households. It is already making some really positive differences. I apologise for my croaky delivery; I am trying to fend off a cold.

There is a wide range of measures that we can all take to save money heating our homes. It is important to ensure that people know about the help that is available, such as energy-efficiency measures, oil-buying clubs and cash benefits, but that is sometimes much more difficult to do than we might think. The winter wellness partnership in Cornwall is working well to tackle that problem, joining up voluntary sector organisations, the NHS, Cornwall council and rented housing providers to deliver warmth to cold homes, and at the same time improving people’s health and well-being. With more financial support allocated from growing public health budgets to the winter wellness partnership, much more could be achieved and more people enabled to live in warm homes next winter.

Greater use of data matching by Government to enable energy companies to target help where it is most needed will also help to heat more homes. Recent analysis by the Department of Energy and Climate Change and the Department of Health suggests that warming up cold homes will prevent ill health that costs the NHS an estimated £15 million a year. In addition, there is research to show that warming up cold homes where children live could enable them to do better at school and help to close the academic attainment gap.

In the medium term, money is being spent in Cornwall on improving the insulation of homes and extending the mains gas grid, as well as exploring the feasibility of local renewable geothermal heat networks. For next

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winter, targeting cash benefits to people who need them most can also help. The £135 warm home discount, which will rise to £140 this winter, is available for low-income and vulnerable households. At the moment, low-income pensioners are eligible to be part of the core group for the warm home discount. The Department for Work and Pensions and DECC will match their details against those held by different energy companies to determine which energy company they are with, after which the relevant energy company will be notified of its eligible customer and instructed to apply the warm home discount to their electricity bill. The discount is, therefore, applied automatically for core group customers, including those off the mains gas grid.

The approach for low-income families with children is very different, however. Instead of having their details automatically matched and the discount applied, families have to check their circumstances against their energy company’s eligibility criteria, which vary considerably between suppliers, and apply to have the discount applied to their bills. The decision over whether to apply the discount is at the energy company’s discretion. About half of eligible families do not receive the discount, probably because they do not know about it, or, as Community Energy Plus, a leading fuel poverty charity based in Cornwall, has said, because energy companies do not always inform potentially eligible customers about the discount and because people are often put off by the forms that they have to complete to get it. The energy companies say that it can be difficult and expensive to find non-core group customers to help.

I have decided to support the Children’s Society campaign, which asks the Government to treat low-income families with children in the same way as low-income pensioners by having fixed eligibility criteria that apply across suppliers; by automatically identifying eligible families with children through data matching, rather than relying on families to apply; and by requiring energy companies to apply the discount to families who meet the eligibility criteria, rather than allowing that to be discretionary. An estimated 120,000 homes in the south-west would be helped by those changes. That is a lot of children who could be helped.

The Government are planning to consult in the coming months on how the warm home discount will be applied from 2015. I hope that the proposals I have outlined for using data matching and automatic payments can be considered to target financial help better to those who most need it, and to improve the health and well-being of many children. I also hope that as part of the consultation the Minister will consider representations that I and others have made about enabling park home residents and tenants of private sector landlords whose heating costs are paid by their landlords to benefit from the warm home discount as well. Those groups of people are often living in fuel poverty and would otherwise meet the criteria, and they would benefit enormously from the discount. I appreciate that the Government have given us helpful feedback on the points that we have made regarding those groups.

The Government have done a great deal to help people keep warm and well during the past winter. I hope that, through the consultation, we can build on that and ensure that even more people are helped in 2015 and beyond by the warm home discount.

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11.8 am

The Minister of State, Department of Energy and Climate Change (Gregory Barker): I welcome this debate secured by my hon. Friend the Member for Truro and Falmouth (Sarah Newton), who is a formidable champion for the people of Truro and Falmouth. Yet again, she is raising in Parliament an issue that is important not only for her constituents but nationally. Although I appreciate the importance that she places on its impact in Cornwall, we are aware that it has a wider impact, and I assure her that the Government are working further to improve our policy on the warm home discount. We are working hard to reach even more of the people who need the help most, many of whom will be in her native part of Cornwall.

I also commend the important work of the winter wellness partnership in Cornwall to make cold homes warmer and improve the health and well-being of those in the south-west. The Government will be adopting a new fuel poverty definition this year, as well as introducing a new strategy and an ambitious target. That will not be just another document; it will be the first new fuel poverty strategy since 2001. We are doing more than just refreshing an old strategy; we are coming at it with a new level of determination and ambition, tempered by realism and what is practical.

That is why we will be using the low-income, high-cost definition that has been put forward by independent experts. It places greater emphasis on the energy efficiency of the home in identifying the households most likely to be suffering fuel poverty. The new definition will be particularly helpful in my hon. Friend’s part of Cornwall. Under the new definition, households living off the gas grid, particularly families in larger old homes, are likely to be judged the most at risk of fuel poverty. We are keen to strengthen the warm home discount scheme by aligning it to the new definition. We also share my hon. Friend’s desire to make it more accessible to those who are eligible.

Since its introduction, the scheme has been a success in helping a large number of households across the country with their energy costs. Between its launch in April 2011 and now, more than £700 million has been disbursed to help vulnerable households. That is £300 million more than under the previous three-year voluntary agreement. More than 2 million households have received help each year. Most of the poorest pensioners have received automatic rebates, providing much greater customer service for them.

The scheme has also helped low-income families and those with disabilities. There has been an increase in the value of the rebate, year on year, and more people receive it each year. Because the scheme provides rebates off electricity, it also readily reaches people who are off the gas grid. It is innovative and efficient, and, by and large, it has low delivery costs compared to other welfare payments. We believe that it is increasingly helping those who need it most, when they need it most. Next year, the scheme will provide 2.1 million rebates of £140—more than ever before. That will bring spending for the four years of the scheme to more than £1.1 billion. That is no small measure. Nine suppliers will be part of the scheme, providing even greater choice for consumers.

As a result of the success of the warm home discount, the coalition Government have committed to extending support through to 2016, spending £320 million in

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addition to the £l.1 billion that will be spent over the first four years of the scheme. That will mean continuing support for the people who need it most. However, like my hon. Friend, we recognise that people who are not part of the core group can have difficulties accessing the scheme, including low-income families with young children. Although eligible, those groups are required to apply to their energy supplier.

Under current legislation, the Government cannot provide the same data-matching service for working-age people as they do for the poorest pensioners. However, my Department is considering how policies could be better targeted, including whether and how legislation could be expanded to allow automatic payments for non-pensioners. I am happy to assure my hon. Friend that my officials have met the Children’s Society and will be working closely with it during the consultation.

Our ambition does not end there. We also want to be able to do more to identify those households, particularly in rural areas, that are off the gas grid. Despite more data being available on off-gas homes, there is still much to be done. My hon. Friend rightly made the point that there is a far greater preponderance of off-gas-grid homes in Cornwall than almost any other part of England. The coalition is absolutely committed to doing more to help off-gas-grid customers who, historically, have had a very poor deal indeed.

As well as looking at whether we can remove legislative barriers to the sharing of off-grid data, we are working closely with the Fuel Poverty Advisory Group to improve the use of the data we already have. I am also pleased to announce that, as part of our efforts to double-up our focus on helping off-gas-grid customers, my hon. Friend the Member for Suffolk Coastal (Dr Coffey) has accepted the new role of DECC off-grid champion. She will bring her insight from the all-party group on fuel poverty, as well as her own experience, to help us to drive action across a number of the Department’s policies. I met her and the big six energy companies last month in order to drive forward the deployment of energy company obligation funding in off-grid areas. We have been troubled about that, because it is clear that the larger energy companies are failing to live up to their responsibilities to deliver the ECO in rural areas in the required proportions.

Stemming from that positive meeting, a number of actions were agreed on. They included potential changes to the brokerage system in order for ECO to split off rural communities as a separate visible group to enable better targeting of ECO measures that are put to brokerage to be accessed by the large energy companies, and publishing the rural postcode list within a month of the consultation. We are also considering how parish councils and other local community groups can help to drive the deployment of ECO in rural off-grid areas by being advocates for action, by helping to collate the number of households that are keen for improvements—particularly improvements to the fabric of buildings—and by bringing them together in larger numbers so they can make efficient propositions to the energy companies for dealing with them.

The problem at the moment for many of the energy companies is that it is difficult to deal with isolated individual households scattered across an area. If we can use local communities and parish councils to collate data, find households that want measures installed and present them as a coherent group to the energy companies,

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it might enable us to get around some of the barriers involving data and present an attractive proposition to the major energy companies for delivering ECO to rural communities.

We also want to link ECO and the domestic renewable heat incentive, which will be launched in the next few weeks and will be an exciting development in the provision of innovative low-cost low-carbon technologies for those who are off the gas grid. It will present them with a genuine, viable alternative to very expensive heating oil. The launch of the renewable heat incentive next month will provide us with opportunities to broaden the offer to off-grid homes. My officials are working with the industry to identify opportunities to combine RHI and ECO and provide a better offer for those without access to up-front funding to install the new technologies. All that work sits alongside the regular round tables on off-grid chaired by the Minister of State, Department of Energy and Climate Change, my right hon. Friend the Member for Sevenoaks (Michael Fallon). I would also like to mention that Community Energy Plus now plays a role in the inter-ministerial round table. Following a suggestion by hon. Members, Public Health England has also been included in those discussions.

To return specifically to the warm home discount, this spring, we will consult on changes to the scheme for 2015-16, ensuring that the £320 million is spent effectively in helping low-income and vulnerable households. The consultation will include questions on further improving customer service and simplifying the scheme wherever

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possible, providing more help to those off the gas grid and even better targeting of those in fuel poverty based on our new low-income, high-cost definition.

I appreciate the points that my hon. Friend raised about park homes. The difficulty is that park home residents are not bill payers, so it is harder, as she mentioned, to identify them. Nevertheless, we welcome pragmatic suggestions on how we can reach them as part of the consultation. I encourage park home owners and those who speak on their behalf to participate in the consultation.

We want to make a transition to a scheme beyond 2016 in which as many of the people eligible as possible get help automatically and our data allow us to give more help to those suffering the deepest fuel poverty. Our warm home discount proposals will coincide with our consultation on a new fuel poverty strategy and an ambitious new target. We will ensure that the warm home discount is consistent with that strategy and continues to be our first line of defence on a mass scale against the impact of winter bills on the most vulnerable.

The coalition shares my hon. Friend’s determination to do far more for the off-gas-grid customer. We are in no way complacent about the need for much more action to help the fuel poor. There is a great deal of action in the pipeline and more coming forward this year. I am grateful to her for securing this debate and allowing us to put that on record.

11.21 am

Sitting suspended.

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Under-Occupancy Penalty (North-West)

[Nadine Dorries in the Chair]

2.30 pm

Yvonne Fovargue (Makerfield) (Lab): Thank you, Ms Dorries, for calling me to speak. It is a pleasure to serve under your chairmanship.

We are fast approaching the first anniversary of the bedroom tax, as I prefer to call it. Anniversaries are usually pleasant occasions, a time to celebrate and congratulate, but not this one. The legacy of the new tax is not benign; it is cruel and unfair. The tax has heaped hardship and misery on families already struggling with the rising cost of living and the increased personal indebtedness that have characterised the past few years. This is not the building-up of debt to pay for luxury items, as some would have it. Instead, increasing numbers of people are getting into arrears on basic household essentials such as food, rent and fuel.

Clearly, many of those people are turning to payday loans to get themselves through the week—borrowing to pay borrowing. The situation is all the more worrying because people are not only struggling to pay their everyday bills, which are increased by this cruel and unfair tax, but using high-cost credit to make ends meet. That results only in a downward spiral into further and further debt, with potentially catastrophic results. As Stepchange said in its response to the Work and Pensions Committee inquiry:

“Households struggling to meet rental payments are far more likely to have high-cost credit—33 percent of tenants with rent arrears have payday loans, a two-thirds increase on those without rent arrears…Because of the urgent and regular nature of rental payments, we are particularly concerned about people facing payment difficulties turning to payday loans. Analysis of our clients shows that those with rent arrears are far more likely to have at least one payday loan.”

The bedroom tax simply adds another layer to the problems that people face.

Many social housing landlords work to help their tenants to improve their income, but they are faced with an impossible situation. Many housing associations have invested millions of pounds to mitigate the effects of the bedroom tax, or spare room subsidy. Housing associations with tenants who have been affected spent on average £73,250, including on welfare and financial advice services, before April 2013 to help their residents to prepare and cope. Wigan and Leigh Housing, in my constituency, manages 22,500 properties on behalf of Wigan council. Recently, it had to deal with a tenant in arrears who also had more than 15 concurrent payday loans and no visible income other than benefits.

The fact is that the extra charge has tipped many households who were struggling but just coping into an unmanageable situation. Now many of those people are at risk of being evicted because they simply cannot find the extra money to pay their rent. Why has that happened? It has happened because people in social housing have been given a false choice, or rather no choice at all. They are told to move to a smaller property, or else pay the difference. Well, they cannot do so. There simply are not enough smaller homes to go around.

In Wigan in my constituency, we have a shortage of one and two-bedroom properties, so people who have had their housing benefit slashed have nowhere to go to.

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That is true of much of the north-west and indeed the north-east. It is not often that I agree with Lord Tebbit, but he said that spare rooms are “vital”. He said on the tax:

“I think we introduced that rather without thinking it through very well”.

Many social landlords in the north-west would agree with that .

In my constituency, 3,300 tenants are affected, with the reductions in housing benefit ranging from £517 a year to £1,273 a year. If those sums are to be found from somewhere, it is most likely they will be found by cutting down on essentials such as heating and food, because after all people must have a roof over their head. Often, the sums cannot be found, so arrears are rising.

Last month, a survey of the English housing associations carried out for the National Housing Federation by Ipsos MORI found that more than two thirds of their residents who have been hit by the bedroom tax are in rent arrears. That is the national average; the figure is higher in the north-west. In fact, the north-west has been the hardest hit part of the country, with 83,000 people seeing a cut in their housing benefit last year, according to the Department for Work and Pensions’ own figures. In fact, that could be a serious underestimate; the figure could be as high as 110,000 people.

The DWP’s figures also show that Manchester is the hardest hit city, with more than 11,300 households affected and an average shortfall of a whopping £724 per year. Other cities such as Liverpool are not far behind. More than 10,700 families in Liverpool are coping with a housing benefit reduction. Data collected from 15 social landlords operating in Merseyside, including the Halton Housing Trust, Liverpool Mutual Homes and Riverside, found that arrears rose from £21.2 million at the end of December 2012 to £22.9 million at the end of December 2013, a rise of £1.7 million.

I will now cite some findings from the excellent Real Life Reform report. Statistics are often used to prove and disprove policies, but it is worth remembering that this change and all the other welfare policy changes impact on people’s homes and their lives. These reports give social housing tenants the chance to be heard and I am grateful for this opportunity to share tenants’ views and experiences.

Perhaps it is worth noting a comment from the facilitator of the report. She is a communications officer, not a front-line housing officer, and she was profoundly moved by the stories. She says that the people who contribute to such reports do not match the stereotypes of social housing tenants on benefits. They do not drink or smoke. They all work. They run voluntary groups. They have children doing well at school or university, or children bringing up their own families. They are dignified and private people who want to make meaningful contributions to their families and communities. However, they are desperately worried about how they will pay their basic bills. They are concerned about how their families are being affected. They are choosing between eating or heating and, most tellingly of all, they have given up hope of being happy. In total, 76% of the people surveyed in the report said that they were rarely optimistic and 55% said that they were never optimistic.

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What of discretionary housing payments, a limited emergency fund provided for the most vulnerable households? Yes, they have helped some households to manage their situation better. However, there is simply not enough money going round and the stress of continually applying for a fund that is discretionary cannot be underestimated. It is no wonder that 83% of participants in the Real Life Reform report felt that their health, particularly their mental health, was being negatively affected.

Wigan and Leigh Housing has used discretionary housing payments to help to reduce the number of people facing debt from the bedroom tax, but it has only managed a reduction from 73% to 63%. During the past year, applications for such payments have risen by 302% on average in the north-west, but the overall arrears keep rising and with them the threat of eviction.

Housing associations and councils are doing all they can to avoid evicting residents, but they cannot simply write off unpaid rent. Many of them have to spend huge sums in legal fees to recover unpaid rents. There are other costs, too. What is not fully appreciated is the increase in tenancies ending through a notice or people simply abandoning their properties and walking away. Each vacant property costs an average of £3,000 to repair prior to re-letting. In my area, many are being left empty because we simply cannot let the four-bedroom properties. People do not want to take four-bedroom properties, particularly those in the one block of maisonettes that we have.

Sheila Gilmore (Edinburgh East) (Lab): In talking about her own region, my hon. Friend is surely illustrating exactly why this tax was poorly planned and poorly thought out. There was talk about 1 million spare bedrooms, but the mix of housing and the size of housing are distributed so differently across the country. In my area, we have a shortage of large houses as well as a shortage of small houses. We cannot have a one-size-fits-all policy in this way.

Yvonne Fovargue: I agree. People are not chess pieces. They have lives, families and communities and simply will not move from Wigan to London or London to Wigan; it is not as easy as that. For example, some people, including a constituent of mine, have family support networks, but she is being asked to move, although her mother lives down the road and looks after her daughter daily, sometimes overnight while she works. If she has to move away because she cannot afford the spare room subsidy, she will be penalised and may have to give up her job.

There are lots of other costs as well. Many people live in adapted properties with a spare room. My constituent, Clare, is paraplegic and blind. She has two carers, 24 hours a day, but under the rules was only allowed a bedroom for one of them. Her property had significant adaptations and, should she move to a smaller property, the cost to adapt it would run into tens of thousands. She is depending on discretionary payments to stay in her current property and has to reapply every 13 weeks, with the stress that that brings. This penalty affects the sick and disabled and it makes no moral or financial sense.

I just want to make a quick aside about fairness. It is often said that the policy brings parity with the private rented sector. However, the penalty was introduced

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retrospectively, when local housing allowance was introduced for new tenancies. People could then make a choice when choosing a home. This tax affects people who have lived among friends and family for years, have built their lives in a community and are forced to pay to stay there or look elsewhere—in my constituency, that is often in the more expensive private sector, due to the shortage of one and two-bedroom properties.

We in the Opposition have been clear that we will scrap the bedroom tax because it is cruel and unfair. The chief executive of the National Housing Federation described the policy as

“an unfair, ill-planned disaster that is hurting our poorest families.”

I agree, but we will not scrap it just because of that. It does not work on any level. There is now a risk that the bedroom tax will cost more money than it saves. The National Housing Federation has said that the savings claimed by the Government are “highly questionable”, partly because those forced to move to the private rented sector will end up costing more in housing benefit. Nor does the policy deal with the problem of under-occupation. In fact, the Government’s costings on the yield raised from the under-occupation subsidy explicitly assume that people do not move into smaller properties. The DWP’s own impact assessment states:

“In many areas”—

as my hon. Friend the hon. Member for Edinburgh East (Sheila Gilmore) said—

“this mismatch could mean that there are insufficient properties to enable tenants to move to accommodation of an appropriate size even if tenants wished to move and landlords were able to facilitate this movement.”

In Wigan, it would take more than seven years, at current vacancy levels, to re-house even the 30% of people affected who might wish to downsize.

It is clear that this policy, and any savings predicated on it, depend on people choosing to pay to stay in their communities, near friends and families. It affects those with disabilities, those struggling to get by and it is having a negative impact on their mental health. It is putting additional costs and pressures on social housing providers and, perversely, it is likely to increase the housing benefit bill by forcing people into the more expensive private sector. One year on, it is time to think again and repeal this unfair and unworkable policy.

2.43 pm

Sheila Gilmore (Edinburgh East) (Lab): It is a pleasure to serve under your chairmanship, Ms Dorries, and to have the opportunity to say a few words. Self-evidently, my constituency is not in the north-west of England. It is not in the north-west of Scotland, either, but in the east of Scotland, but it is important to see how the experience in one area of the country compares with another.

As I said in my intervention, part of the problem with making this policy work, even if it is thought to be a good idea, is that the housing situation in each local area is different. It is impossible simply to assume, as it has been assumed, that there are more than 1 million spare bedrooms, as has frequently been repeated, as if those were somehow easily accessible by people wherever they are.

We have to think about realities. It is galling and frustrating for me, as someone who was the chair of housing in a local authority and retains a strong interest

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in housing, to hear that there are empty large houses in some areas. If it were possible, I would dearly like to do that American thing of putting them on wheels and wheeling them up to Scotland.

It is not feasible for people simply to up sticks and go somewhere else. A few may be able to, and a few may welcome the opportunity to do so, but for many their attachment to their home area is not just an emotional one, although it can be that; there are practical issues for them to consider. Often, the areas where there is a surplus of certain kinds of housing are also likely to be those where there are poor job opportunities. My city, where unemployment is well below the Scottish average, is a net importer of people. People come to the city from other parts of Scotland, and from England, because the jobs are there. For a low-paid worker in Edinburgh in receipt of housing benefit, for example, to move to the north-west of England just because there are houses there, even if it would mean their being less overcrowded, is counterproductive for them and for our spending on social security, because if they could not get a job they would be drawing more in benefits than previously and their opportunity to move on from that situation would have decreased.

Even people who do not have a job issue in relation to moving have other ties. Despite commentators and sociologists sometimes suggesting that we have become a society without ties and that we live completely separate lives from one another, far away from our families, I am always struck by the degree to which that is not necessarily so. And help is often reciprocal; it is not just one way and not just about older people getting help from younger people. Obviously, grandparents will often give important help to members of their family. I met a constituent recently who said that, having retired, he and his wife have virtually full-time jobs, because each day of the week they look after a different group of grandchildren, although they do not look after any of them full time. That is not uncommon. People cannot always move huge distances, and even moving across a city can be difficult for those who pick children up after school, for example, to help their family. We have to be realistic about what people can do. I do not think that people are being awkward in any sense.

The other mismatch, throughout the country, is that houses of different sizes are often of different types. I know a number of older people—although pensioners are exempt from this measure—and even people approaching retirement who might want to move to a smaller house, but they are not going to move to a flat that is up four flights of stairs at that time in their life, because even if they are fit at the moment, they would say, “Why am I going to move to a tenement building where I would be climbing up and down stairs, when in a few years’ time I might not be able to do that?” Having looked in depth at the housing supply in my area—I am sure my hon. Friend the Member for Makerfield (Yvonne Fovargue) has done so, too—there is such a mismatch. Not a lot of housing becomes available, but what does will not necessarily suit the needs of the people we might be trying to move.

Realistically, this measure was invented as a savings measure, and a lot of the justifications are trying to make it sound better than it is. There is a case for

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helping people to move, for example, and I know people who would want to move. Older people particularly might want to move from a family house and might be pleased to see it going to a family, but they have certain needs that also have to be met. I have been pressing my local authority and housing associations to look in depth at an area and say, “Actually, maybe we should build houses for older people who could move into them and thereby release family houses, rather than building family houses.” People will not move out into just anything, and for good reason. They are looking to their future.

If this measure is about people moving, which I do not believe it is, it does not work, and it certainly does not work on an all-country level. It is about saving money, which is why it was in the Budget. The cost is not trivial for people. I have described other housing benefit changes as slow burn because they have had an effect over several years and it will take time for them to play through.

A constituent of mine is on jobseeker’s allowance of £71 a week. She was approaching retirement age, but unfortunately retirement age is receding from her, so she feels as if she is running to catch up. Of her £71 a week income, she now has to pay £12 a week towards her rent, which is on top of all her other bills. Scotland has not yet had the council tax changes, but she has to pay water rates, energy bills and bus fares to get to the jobcentre or training centre. She is trying to get another job after being made redundant in her late 50s, which is never easy, and £12 a week is a substantial sum of money; it is not something that people can easily make up. She does not fall into any of the priority groups that we are told discretionary housing payments will cover because she is not disabled and does not have a particularly adapted house, or anything else. All she happens to have is a rather small second bedroom in a house that she and her husband lived in for 18 years until he sadly died. They put a lot of effort into the house.

If we want to address the housing benefit bill in any area of the country, we need to build more homes and consider the cost of housing benefit in the private rented sector, which is far greater per person than in the social rented sector. We are attacking the wrong part of the problem, and it is therefore no surprise that housing benefit spending is predicted to continue rising in real terms throughout the entire five-year period, despite such changes. Not only do the costs outweigh the savings for individual housing associations and authorities; the policy does not make sense on a macro level because it will not achieve what it is supposed to achieve. We will still end up having a large spend on housing benefit, which the Government have much criticised, but if we want to change that, we have to look at where the real problem lies, and it does not lie in the social rented sector. I contend that the policy is ill conceived.

As my hon. Friend the Member for Makerfield said, there is a constant reiteration of “Well, Labour did it in the private rented sector.” I was a member of the Welfare Reform Bill Committee, and I do not remember Labour’s changes being mentioned at any point in Committee as a primary driver. Someone obviously thought, “We are not doing very well with our publicity on this one, and we are losing a bit of public support. Let’s find another argument.” The argument that was chosen is, “Labour did it in the private rented sector, which is why it is fair.”

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People in the private rented sector did not suddenly find themselves presented with a Bill one April: “Here’s the Bill, which means that you now have to pay extra money, whether you can move or not.” Any changes introduced in 2008—there were rules prior to 2008 on the size of homes and the amount of housing benefit that people could claim, so it is not entirely true to say that the Welfare Reform Act 2012 was entirely a response to the changes in 2008—applied only when people moved into a new tenancy, which is very different from saying, “Regardless of whether you can move, you have to pay.” That is why we have called it a tax, and although many people get agitated and say that it is not, it certainly feels like a tax rather than a benefit.

Wherever we live, there are problems with the policy. Many of our constituents have problems with it, and if the Government are really serious about addressing housing benefit—I hope they are, because we certainly are—they should be seriously looking at the private rented sector. If they do that, the graph, instead of going up over the next four years, might start to go down.

2.54 pm

Chris Bryant (Rhondda) (Lab): It is a delight to serve under your chairmanship, Ms Dorries. I note that I am the only man taking part in this debate, which must be a first for the House of Commons. I hope there are many more debates in which men are in the minority. It is a shame that, all too often, debates involve men talking to men—probably with nobody listening.

I warmly congratulate my hon. Friend the Member for Makerfield (Yvonne Fovargue) on securing this debate, not least because all too often in Westminster politics we think that, once we have pulled a lever, everything will suddenly change out in the rest of the country. Actually, the vast majority of policies advanced by any Government, of left or right, end up having to be implemented by local authorities, and this policy is a classic instance. In many cases, not just local authorities but a series of social landlords are involved.

The direct relationship between Government and those implementing the policy is not as clear as people might assume, which is one of the reasons why the Government have got some areas of the policy profoundly wrong. They did not do the groundwork to establish what the real situation is out in the wider country before enacting the policy.

This is the kind of policy that someone might dream up just before they go to bed or when they are in the shower. They suddenly think it is a brilliant idea because there is no official there to say, “Ah, but Minister.” By the time they have got into the office, they think it is the best idea ever. Unfortunately, they then meet other Ministers who are also desperate for a good idea, and they think, “That sounds like a good old wheeze. Let’s do that.”

The policy, as a whole, was advanced too rapidly. However shiny and new it might have seemed to the Government, I know a large number of Conservative Back Benchers who wish it had not been implemented and look forward to the day when the whole thing can go. All that glisters is not gold, and this has been a meretricious policy.

My first problem is that, as my hon. Friends the Members for Makerfield and for Edinburgh East (Sheila

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Gilmore) have said, the policy’s implementation has been fundamentally unfair. Both my hon. Friends have said that the significant difference between the Government’s policy and our policy, which addressed commercial landlords, is that the Government’s policy has been implemented retrospectively. In other words, it affects people who are already living in a property.

In recent months, we have discovered that people who live in social housing, particularly council housing or housing association properties, are more likely to live for long periods in the same property than anyone else in the housing market. Some may see that as a problem, but it also presents a significant challenge because the policy is radically changing people’s understanding of their home.

What I have just said does not apply to me because I moved so frequently as a child that I have always thought of wherever I lay my hat as my home. However, the vast majority of people live in the same house for 10, 15 or 20 years, and sometimes for much longer. In some constituencies in the north-west, there will be people who not only live in the house they moved into when they were first married, but live in the same street or estate in which the rest of their family have lived since the estate was first built. In some cases, they will have taken over the tenancy from their parents and have effectively lived in the same house all their lives.

The policy, of course, drives a coach and horses through that understanding of a home. Ultimately, it is profoundly—I want to say un-English, but I am Welsh and my hon. Friend the Member for Edinburgh East is Scottish—un-British not to think of the home of an Englishman or Englishwoman as their castle.

Yvonne Fovargue: Does my hon. Friend agree that it is not only family lives that are being destroyed? The aim was to build stable communities in which people support and help each other and run voluntary groups. The policy destroys communities, as well as lives.

Chris Bryant: Absolutely, not least because one of the key things that all parts of the House agree about is that we need to get more people into work. Particular families and communities have historically found it much more difficult to get into work. The issue is not only about whether work pays—although that is key and is why we originally supported the national minimum wage, facing down the howls of those who said it would lead to mass unemployment—but the support mechanisms that someone has when they first go into work. Otherwise, benefits are seen as more reliable, and if someone thinks that, they will stick with them.

If someone has child care responsibilities or care responsibilities for an adult relative, they need other family members close by. All too often since the bedroom tax was introduced, we have seen people forced to move to areas where they have no support, which makes it more difficult for them to get into work. Perhaps we Opposition Members too often rant and rave at Conservatives for being cruel, out of touch and not having any interest in the working poor—that has not always been true of them, historically—but some of the policies advanced, particularly those of the Department for Work and Pensions, have effectively cut off a nose to spite a face. They have seemed like savings and cuts, but in practice they have just added costs to the social

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welfare budget, which is why the Chancellor had to announce last week that he was increasing the estimate for welfare spending for this year by £1 billion and for next year by another £1 billion.

People are living myriad different lives, with different congregations of families and different community set-ups, social understandings and cultural mores, and it is incumbent on Ministers, particularly DWP Ministers, to work with the grain of human nature, rather than against it. The policy fundamentally works against the grain of human nature and the housing market.

All too often the Government have presumed that, because they said in theory that the policy is all about dealing with the mismatch of some properties being under-occupied and many properties being over-occupied, they have to get the families that are overcrowded to move into undercrowded properties. If everyone could step on to the pavement on one day, immediately swap and move into the next property, that might be true, and if there was an exact match of overcrowded and underused in each area—whether geographical, local authority or housing association—that presumption might work.

The facts on the ground, however, as we know from all the different surveys that have been done over the past year, are that there is a total mismatch. People have no choice about moving, downsizing or going to smaller properties, particularly in the short term. It might take them two, three, four, five, six, or, as my hon. Friend the Member for Makerfield said, seven years to move, and that is why the measure is a tax. In the end, people have no choice and have to surrender that extra bit of money.

The £16 might seem like nothing to Ministers in a Department that thinks that pensioners might spend their pot on a Lamborghini, but that is a significant amount of money to my and my hon. Friends’ constituents, particularly when real wages have been depressed and the number of hours and amount of overtime that people are allowed to work have fallen. Many more people have been put on zero-hours contracts. In that environment, £16—or £25, if it is two rooms—extra cost a week is a significant amount of money, and that is why the policy is unfair. It might seem fair to put all the overcrowded people into the underused accommodation, but if no one has checked whether there is enough accommodation to do that, it ends up being unfair.

The evidence of the unfairness is that the Government have had to provide discretionary housing payment schemes for local authorities. With discretionary housing payments, the word I dislike most is “discretionary”, because it means that someone living in one local authority on one side of the road in the north-west might be granted a DHP, while someone on the other side of the road will not get that payment, for the single reason that they live in a different local authority.

There is an added problem with discretionary payments, which is that the local authority knows—let us say it is getting £1 million over a year—not to spend any in April, May or June. That happens every time the Government introduce such a system. The authority will start spending a little only in July, August and September, because it knows that the big numbers will come knocking on the door in December, January and February. That means that there is no consistency across the year.

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The Minister revealed that fact—I do not think she intended to—when she was attacking one of my hon. Friends from Manchester about the discretionary housing payment system there. She said that it was outrageous that we were complaining about the amount available to Manchester last July and September, because the city had not spent that part of the year’s money. Of course the city had not spent it, because no local authority does. Local authorities are prudent and save money for when they will have to spend more, which is in winter, at Christmas and towards the end of the year. They have to save against what might be a particular rainy day. The Minister, by her own admission, has laid out that the policy is unfair.

As my hon. Friends said, the Government never expected everyone to move. They said:

“In many areas this mismatch could mean that there are insufficient properties to enable tenants to move to accommodation of an appropriate size even if tenants wished to move and landlords were able to facilitate this movement.”

If there was ever an ownership of the fact that the measure is a tax, that was it. It made clear that the Government know that many people will simply have to pay more money.

I disagree with the policy’s fundamental principles and also with how it was introduced. The Prime Minister more than once boldly stated at Prime Minister’s Question Time that no disabled people would be affected by the bedroom tax. He said that on countless occasions, but we know that two thirds of those affected, according to every survey that has been done in local authorities up and down the land, are disabled. The Prime Minister is closing his eyes to the truth, he does not know the truth or someone is not putting the truth in front of him. I do not know what it is, but the point is that the Prime Minister is completely and utterly misled. I am not saying that he has misled people; I am simply saying that he must be misled.

The other incompetence in how the Government have advanced the policy—we know the legislative incompetence: they brought forward the legislation quickly and then discovered a loophole some nine months into the process, or perhaps a little earlier—is that they are still going through this ludicrously bizarre process of denial about how many people are affected by the loophole. On one day earlier this year, the Minister for Welfare Reform, Lord Freud, said in the House of Lords that an insignificant number of people were affected, the Minister here replied to a written question saying that she did not have any idea how many people were affected, and the Secretary of State said that between 3,000 and 5,000 people were affected.

Yesterday, after the urgent question in the Chamber, the Minister let it be known that the Department will provide £2.1 million for local authorities to do the trawling. That is just for the process of trawling, and not for the payments that will have to be made to those who were illegally charged. She says, and said again yesterday, that the £2.1 million applies to 5,000 people. Sometimes she says it quite angrily and sometimes she says it more emolliently; we will see which version we get today, although it looks like it will be the angry one, given the furrowed brow I am getting. I presume that the Minister can calculate for me how much that is per person. Is a trawl really going to cost £420 per person? By her own admission, the Minister has yet again

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suggested that the 5,000 figure is not right. I do not know whether it will be 40,000 in total, but it certainly will not be just 5,000.

The Minister has regularly pooh-poohed the statistics that the Opposition provide, but we are only going by the freedom of information requests that we have made to local authorities. Let us look at how some authorities in the north-west replied when we asked them how many households had been affected. Burnley borough council said 60, Bury metropolitan borough council said 83 and Chorley borough council said 32. Eden district council said 30, while Fylde borough council said 80. For Lancaster city council, the figure was 35. Preston city council said 124. South Ribble borough council said 22, and Stockport metropolitan borough council said 126.

It is true that I do not have figures for all local authorities, because, despite our being long past the date by which they should have replied to the FOI request, only 15 out of 39 local authorities in the north-west have replied. Even so, there are 2,609 cases in the north-west alone thus far.

The Minister has criticised me several times, saying that the figure of 480 that I provided for St Helens is incorrect, but we have never provided that figure. We said that there were 178 confirmed cases in St Helens—178 cases where people have already been paid back. Not included in the figure for the north-west, however, is what Liverpool city council states it has already paid back, which is 1,300 households. It is absolutely clear that the 5,000 figure that the Minister cites for the whole country will probably be exceeded in the north-west alone.

It could be said that this is all neither here nor there and that it is dancing on the head of a pin and just about statistics, but what it suggests to me is that the Department for Work and Pensions simply has not done its homework and does not know. I would be quite happy were the Minister to stand up and say, “You know what? I really don’t know what the numbers are. They may be 40,000 or 5,000. Let us see what they are.” However, I object to the Minister’s simply going into denial and saying that nothing is happening because it implies a degree of callous disregard for what is going on in people’s lives. Incidentally, the total number of cases that we have received from local authorities is, with no spin from us, 23,309. That figure is based on the responses of fewer than half the local authorities asked, so it is likely that the final figure will be much higher than the Minister has suggested.

The danger is that if the Department has got this wrong, what else has it got wrong? I am absolutely certain that the Government’s predicted savings will nowhere near be met. Indeed, I suspect that the total effect, including people claiming other benefits, such as out-of-work benefits, will end up costing the taxpayer more. I hope that the Government will one day provide the full details.

So many areas of the policy have been incompetently laid out, not least what counts as a bedroom. Last year, the Minister tried to say that people should take a sledgehammer to walls and knock them down and that that would change the rules. According to the Department for Work and Pensions guidance, however, it does not. Liverpool city council was sent an e-mail by the Department that flatly contradicted what the Minister said in the

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House yesterday afternoon about who qualifies to inherit a tenancy. According to the e-mail, those qualified include any child or relative of a “polygamous marriage”. I thought that polygamous marriages were illegal in this country, but that is the advice that the DWP has provided to the council. Perhaps the Minister can respond to that specific issue.

Some people who have been illegally forced to pay the bedroom tax will now, because of the loophole, have been given discretionary housing payments. What is the Minister’s advice to local authorities? To how many people does she think that it will apply? How much is it costing? Is the Department paying it or do local councils have to pay it? Will individuals have to pay that money back or are the Government writing it off? If so, how much will that be?

We have already heard about some of the problems caused by the faulty policy. Thousands more people are in arrears, which is a real problem for local authorities and for social landlords around the country. Thousands more have been evicted—not only a tragedy for the families and individuals concerned, but also a problem for social landlords.

The policy fails to address some big, long-term issues and has made them worse. When I come up to Westminster from south Wales, it often feels that there is something of an economic recovery going on and I can see house prices rising magnificently, but my experience elsewhere in the country is completely and utterly different. My anxiety is that an economy that is already heavily overloaded towards London and the south-east will become more so. It is a problem for the people of London and the south-east as house prices get further and further out of reach for ordinary people in ordinary jobs. I worry that the Government’s policies will make that worse.

In the 1980s, contrary to my party’s policy at the time, I completely supported the idea of people being able to buy their own council house or social housing. It was actually first piloted by a Labour authority in Newport. [Interruption.] That is not in the north-west, as I think you are about to warn me, Ms Dorries.

Nadine Dorries (in the Chair): I was about to remind you.

Chris Bryant: I can read your mind.

What was a mistake at that time in the north-west and everywhere else in the country, however, was that local authorities were not allowed to build more social housing, and we are paying the cost of that now. The previous Labour Government did not get it right either, but unless we build more houses and provide more supply at a time when demand is increasing every year, partly because more households are breaking down into smaller units and partly because there are simply more people, we will fail in the future.

I end with two remarks. First, the Government should repeal the bedroom tax for the people of the north-west and the whole of the country. If they do not, we will, and we have costed that commitment. Secondly, we need to do something to tackle the root problem in housing benefit, which is that antisocial landlords, who often provide substandard housing, are effectively being subsidised by the taxpayer. That must be wrong and that we will change.