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If there are 2 million or 3 million more people here, we have to build a corresponding number of additional homes, because those people by and large are of child-bearing age, they will want to form households and we have to accommodate that. We also have to avoid the excuses that are often given for not building homes, not least in my constituency. I have a Hertfordshire constituency, and Hertfordshire is the most densely populated county outside central London. None the less, we have to build more homes there and avoid the excuses for not doing so.

The first excuse for opposing any proposal that gets planning permission is, “They’re the wrong type of houses.” In Hitchin people say, “They’re too small. There are too many flats, and we don’t want to build any more flats. Any new proposal must be stopped because it is for small homes or flats.” Elsewhere they say, “They’re too big. We don’t want those. If we have got a housing shortage, we should be building the small homes for first-time buyers and flats.” We must avoid seeking refuge in excuses. We probably need more of all kinds of property, including flats, small starter homes and larger family homes.

The second excuse that people use in Hertfordshire is that immigrants do not come to our area. By and large, that is true: the vast majority go to central London or to areas with an existing large immigrant population, including Luton. I see my distinguished neighbour, the hon. Member for Luton North (Kelvin Hopkins), nodding in agreement. Immigrants tend not to come to Hertfordshire, but the people who would have lived in the homes in central London that are now occupied by people from abroad—or kept empty by people from abroad, as the hon. Member for Hammersmith (Mr Slaughter) says—do move out to the home counties. We cannot pretend that that does not happen. We cannot just shut the gates and pull up the drawbridge and pretend that we are not going to accommodate them. We have to accommodate more people.

The third excuse that people use is that we cannot build new homes because there is no infrastructure to support them, and if we build, it will just create a demand for such infrastructure. However, it is not houses that create that demand for more schools, hospitals, roads and water; it is people, and the people are already here. It is people, not houses, who consume water and who need hospitals and schools. The people are here, and we need to provide the infrastructure and the homes for them. We cannot pretend that the lack of one is an excuse for not providing the other.

The housing shortage creates problems for people like me who represent densely populated constituencies whose distinctive feature is the green belt. When I was first elected, I made the defence of the green belt a feature of my maiden speech. I pointed out that the one thing that united the diverse settlements in my constituency was the desire to remain separated from each other by strips of green belt. They should indeed remain separated in that way: the green belt is a vital and valuable part of our planning law, and we should attach enormous importance to keeping it. However, that means that we must build elsewhere, on brownfield sites or using infill development, unpopular though that often is.

New towns will also have to be built, not too far from London. We cannot pretend that this can all be done in the north of England. We cannot tell people to go

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and live in the north, or give them incentives to do so. There are already enormous incentives to move out of London and the home counties to the north. Anyone who sells their house in Harpenden can buy an equivalent property in the north of England for a fraction of the price and live off the investment income from the rest of the money. There are therefore already enormous incentives, but if people still have a desire to live in London and the home counties, that reflects the reality of economic and other forces that have to be taken into account.

We must do everything we can to stimulate and promote growth in other regions, but let us not pretend that we can avoid the need to build homes in and around London. We must do that, and we must avoid the excuses that have been used to prevent us from doing it. We must defend the green belt, but we must not be so hypocritical and bigoted as to pretend that we can have no housing at all elsewhere. I hope that enough of us will have the courage to say that, so that we can at least double the rate of house building in this country, as we must do if we are to tackle the underlying economic and social problems. If we do not do that, we will continue to suffer indefinitely.

2.33 pm

Jim Shannon (Strangford) (DUP): I should like to start by thanking you, Madam Deputy Speaker, and the hon. Member for Hammersmith (Mr Slaughter), for agreeing to allow me to speak now, ahead of the hon. Gentleman.

I should like to use this opportunity to draw attention to social isolation in rural constituencies, which is an issue that is close to my heart. As I often have said in this House, I represent the most beautiful constituency in the United Kingdom. Strangford is made up of many rural and some isolated areas. I am well aware of the beauties of living in the country, but I am also aware of the drawbacks, one of which is isolation. For most people, it is no problem to run to the local corner shop or the nearest garage when the milk runs out sooner than expected, but this is not the case for an elderly person who lives in the countryside, where there is no such thing as the corner shop.

My rural constituents are reliant on cars to run even the smallest errand. I can hear those with green hearts crying, “Use public transport” or “Get on your bike”, but that is not as easy as it might be for those living in London. It is much more difficult for those of us who live in rural communities. The only public transport available in my constituency is the bus, as there are no rail lines, but with the way things are in our economy, the bus routes are designed to maximise the number of people on board. That is a fact of life—it is simple economics—but it does not always work for those who have to wait half a day to get to their local village or to the bigger towns.

More and more people are cycling, but the roads that are not main thoroughfares are not fit for bikes, even for those who are fit to cycle. Steps have been taken in my constituency and elsewhere to provide more opportunities for those who wish to cycle, including cycle lanes and portions of the road being set aside for cyclists. I welcome the fact that there are some good things happening in my constituency, but they are not happening everywhere.

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That leaves people reliant on their cars, and the increases in fuel prices have hit these isolated areas hard. We are rightly urging people to get into work, and trying to encourage mothers to work even part time, but for anyone who lives in one of my rural areas and works in Belfast, the two-hour round trip costs £10 a day. That is £50 week or £250 a month, which is a huge chunk out of any wage packet. If the two earners in a household are on completely different work schedules, that might necessitate two cars, which will double the cost.

I will in no way minimise the fact that the fuel companies are taking advantage of the situation and making jaw-dropping profits, but we in this House also have a case to answer. I have been outspoken, as have others—including, notably, the hon. Member for Harlow (Robert Halfon)—about the rate of UK fuel excise duty, which results in 58p a litre being added in tax. I give credit to the Government, however, because they have taken significant steps to address the cost of fuel through the abolition of the fuel duty escalator; we welcome what they have done in that regard over the past four years.

The high cost of fuel further isolates those in rural communities, as rural residents travel more often, and cover greater distances, by car than those in urban areas. Taking children to the boys brigade or the girls brigade, to sports or to after-school clubs is now a costly venture. If a local church is putting on a play, there will perhaps be a practice on Wednesday, Saturday and Sunday. That is three days and six journeys, in addition to taking the children to the Campaigners on a Tuesday night. This is another example of the costs multiplying for people who live in rural communities. For many families, the cost of those journeys is too much, so their children do not get to dress up as a shepherd or an angel. The isolation is clear.

The RAC has identified transport as the single biggest area of household expenditure bar none, even housing, food and power. If people were having to deal only with rising pump prices, that would be one thing, but they are also experiencing soaring insurance costs. Northern Ireland has the highest insurance costs in the whole of the United Kingdom. Many TV adverts offer insurance at premium rates, but the small print at the bottom of the screen often says. “Not available in Northern Ireland”. People are also experiencing hikes in parking charges, and train fares are increasing well above the rate of inflation, so every extra penny spent on the forecourts makes a real difference.

Unsurprisingly, it is those on the lowest incomes who are hit the hardest. They spend more on running a car as a proportion of their income than any other section of society. There is a high degree of car dependence in the rural communities that I represent. About 80% of the population live in a car-owning household, and over the past 50 years, car ownership among the poorest fifth of households has increased from 5% to 51%. The dependence on cars is critical. Those figures show how the economy has had an impact throughout the United Kingdom, and that is magnified in rural areas. And with less funding for community groups, services such as community transport are having difficulty putting on the special taxis and buses for those who are disabled and live in the countryside. That is yet another blow for those who cannot get out of the house and who exist in a contactless world. For elderly people, this is a critical issue.

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How can we make a difference to the lives of those who live in our rural communities—the children who cannot get to after-school activities and clubs, the stay-at-home mums who have no car and no opportunity to meet other mums and have some adult company, the people who are ill or disabled and cannot drive and who no longer have an affordable taxi service, and the elderly who oft-times end up all but imprisoned in their own homes? What difference can we make? Again, a reduction in fuel duty would be a start, and although I accept and understand that the Government have taken significant steps, I believe that those who live in the countryside need a special reduction—or a pilot scheme of some sort—to enable the rural community that I represent, with the highest prices in the whole United Kingdom, to address that issue. A reduction in fuel duty would be a start, but more needs to be done. I am anxious to hear what steps or action the Government plan for the isolated in our rural communities.

Madam Deputy Speaker, may I wish you, your family, right hon. and hon. Members who are here and who have participated, and their staff, all the very best for a happy Easter? I hope the weather is good and you have a very relaxed time.

2.40 pm

Bob Blackman (Harrow East) (Con): It is a pleasure and an honour to follow the hon. Member for Strangford (Jim Shannon), who took us on a tour of his constituency.

The key point behind these debates is the opportunity to raise a range of issues that might apply not only to Members’ constituencies, but to things of international and national importance. I shall raise some issues related to my constituency that are creating great turmoil. As we approach the most holy week of the Christian calendar, it is appropriate that we consider some of the things that are happening in my local area.

First, there is the good news. My constituency already plays host to the first state-sponsored Hindu primary school in the country, which has operated very successfully for a number of years. I was pleased to be present at the laying of its foundation stone and have supported the school since its inception. This week we had the really good news that the country’s first state-sponsored Hindu secondary school will be sited in my constituency, on the Whitchurch playing fields. I trust that that decision will be endorsed tonight at Harrow council’s cabinet meeting and we can look forward to the redevelopment of the site in keeping with what is required. It will be the biggest free school in the country and one where parents of Hindu faith will be able to make a choice about their children’s secondary education. That is something we should endorse across the House.

I also note, I have to say, that the people who formed the rather oily, shady Whitchurch consortium, which was going to take over those playing fields, turn them over to private use and exclude the public from using them, will be shown the door. No one locally will mourn their passing. That is the good and positive news that we can look forward to.

Secondly, there is the bad news. We have a site in my constituency called Anmer Lodge, which was closed many years ago. It belongs to Harrow council; it is a landlocked site in Stanmore and it borders a car park

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that is associated with a shopping centre in Stanmore and is a district centre. The site has been sold to Notting Hill Housing Trust and last night a planning application was approved not only for a Marks & Spencer superstore, which will be welcomed locally, operating as a supermarket and providing competition to other supermarkets in the area, but for the development of 120 flats—tightly arranged, densely configured and not particularly, in my judgment, well designed—that will lead to a dramatic increase in traffic and degrade the quality of life for residents around the area.

Residents were almost united in the view that the Marks & Spencer supermarket was welcome, and that some housing was welcome as well. We need housing, as my right hon. Friend the Member for Hitchin and Harpenden (Mr Lilley) said. The problem is that the consultants estimate that the whole development, including 120 flats—likely to involve two cars per household—and a Marks & Spencer supermarket, which will have footfall seven days a week, will generate only about 69 extra car parking visits a day.

From 8.30 to 10.30 in the morning, and from 3 o’clock in the afternoon to about 7 o’clock in the evening, the site is gridlocked, so it is incredible to believe that it will not impinge on the quality of life for all concerned. Regrettably, Harrow council’s planning committee did not see the good sense of all the various local groups objecting to the overdevelopment of this site, and allowed it to pass.

I move on to the issue of Barnet football club and the Hive. Madam Deputy Speaker, you might say, “What is Barnet football club doing in Harrow?” I am a great football fan, as many will know, and a fan of great football as well. Barnet football club was kicked out of Barnet and its Underhill stadium, because of disagreements with the local council and a large number of residents. The club sought a contract with Harrow council many years ago to develop the Hive as a centre for the development of youth football, women’s football and other associated activities, but not for first team matches.

Of course, this did not stop the club. First, it applied for planning permission to complete the stadium on the Hive, and this meant it got planning permission for a new stand, for floodlights and to complete the stadium that had been half-built in the interim. But it then decided to ignore the planning permission that had been given, build a stand that is twice as high as the original permission allowed and put floodlights in that are three times the height of those that were permitted.

I wonder sometimes whether Barnet football club has a solution to the so-called energy crisis in this country, because those floodlights are on all winter, until all hours of the day and night—often until 11.30 pm or midnight—and they light up everyone’s homes throughout the area so that people do not need to turn on their lights. In fact, if they did, they would not see the difference, because the floodlights illuminate their bedrooms, front rooms, dining rooms and kitchens. All local residents complain—quite rightly—that the lights have been operated in an outrageous way.

Barnet football club did not stop there, though. It then decided to use the stadium for its first team matches, despite the fact its contract with the council does not permit the playing of first team matches there until 2015, thinking “Well, what’s a couple of years between people? Let’s just ignore it, because after all we can just carry on and the council will roll over.”

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Not content with that, the club then introduced London Broncos to the site, so at the Hive we now have the impact of unrestricted car parking all over residential streets for Barnet football club first team matches; and London Broncos, the rugby league club, who are not doing particularly well in the Super League, who are also impinging on residents every week. Basically, throughout the whole year, the area around the Hive is a nightmare for local residents. The council has failed to implement any controls on parking, so people can park on residential streets wherever they like, whenever they like, and nothing is done about it. It is a real and serious problem.

At the same time Barnet football club has ignored all the rules. The planning application it submitted was rejected, yet it just carried on regardless. To me, Tony Kleanthous and his ilk at Barnet football club deserve to return to Barnet as fast as possible—I wish them well in that—and to get out of Harrow.

The other two issues I want to raise briefly relate to the Royal National Orthopaedic hospital and to Stanmore station. The Royal National Orthopaedic hospital in my constituency has been around for about 100 years. Over the past 30 years it has developed as a national and international centre of excellence in the treatment of and recovery from orthopaedic elective surgery. It is a brilliant hospital. The surgeons and medical staff do brilliant work, and recent clients have included Princess Eugenie, who required an operation at a very young age to correct a spinal problem, and the noble Lord Tebbit’s wife, who spent almost a year in the hospital, recovering after the Brighton bombing.

It is a wonderful hospital, but it exists in Nissen huts that were built during the second world war. It has one of the best records of any hospital in the country, and certainly of any in London, on methicillin-resistant Staphylococcus aureus—it has not had a case of MRSA for five years. One reason for that is that the hospital is exposed to the elements; it has no such thing as the closeted central heating that exists in modern hospitals—far from it.

We have had a plan for the redevelopment of the hospital for many years. The previous Government, on three separate occasions, promised the redevelopment of the hospital but failed to deliver. Prior to the election, I took the then shadow Health Secretary, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), to the site and he stated categorically, “If we are elected to government, we will see the rebuilding of this hospital on the existing site during the duration of the Government.” There is one year to go and, as yet, not a spade has been laid in the ground. However, we do have a comprehensive plan: for 300 homes to be put on the site—once again, this is much needed housing—having freed up some of the land; for a private hospital to go alongside the national health hospital as a centre of expertise and excellence; for not only the Aspire centre, which helps people recovering from orthopaedics and is already there in a modern facility, but a nursing home, which will look after many people who need to be resident at the site; and, crucially, for the rebuilding of the national health service hospital.

Trying to grapple with the intricacies of NHS funding and decision making has been a real eye-opener for me. The number of business cases that hospital trusts and boards have to go through to get proper funding is incredible. We have now reached the stage where NHS London has the business plan from the board, all the

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figures stack up, as I understand it, and there is a dispute involving the NHS TDA—the appropriately named Trust Development Authority—on agreeing the numbers and confirming the funding and financing. That is despite the fact that one of the first acts of this Government, when we reviewed the capital allocations made by the previous Government, was to confirm the funding available for the rebuilding of this hospital on the existing site. The NHS people who are looking at this—I am talking about officials, not Ministers—are doing a really bad job, holding up the redevelopment of this site. Planning permission was granted for the master plan a year ago, yet we have not made progress with the site. I trust however that with the plan the board has laid out, we will see the start of development this summer of part of the work. I believe there is one last figure to be agreed, of some £20 million, which is in dispute between NHS London and the board, but I trust that over the next few days, having entered a new financial year, that will be signed off and approved. I regularly apply for Adjournment debates on this subject and will continue to do so until we get either the money or an Adjournment debate. I hope we get the money first and then we can have an Adjournment debate celebrating the fact.

Finally, I wish to raise the issue of Stanmore station. The Royal National Orthopaedic hospital is a centre of international excellence, and the nearest station to it is Stanmore. The good news is that life expectancy increases by a year with every stop travelled along the Jubilee line from east to west. Stanmore is at the extreme end of the Jubilee line, which means that life expectancy there is the greatest of anywhere in London. The bad news is that Stanmore has an increasingly elderly population. Our hospital treats disabled people, but our station has no disabled access, so disabled people, be they wheelchair users or people with other disabilities, are unable to come to the hospital by public transport. That is nonsense in this day and age. I have been involved in a campaign for more than 10 years to get a lift installed at Stanmore station. The villain of the piece is the former Mayor of London, who took the lift out of the budget when the station was being redeveloped. That redevelopment has been completed, so getting a lift into the station is difficult now. However, I trust that when the enlightened decisions are taken on rebuilding the hospital on the current site, we will get some enlightened decisions on getting a lift into the station, so that wheelchair users and other elderly people will be able to get from the platforms to the street without having to climb the equivalent of Mount Eiger in steps on the way up.

I will end my speech there, Madam Deputy Speaker, but first may I wish you, and all staff and all Members of the House, a very happy Easter break? We look forward to the opportunity to be out on the streets talking to residents about the issues that matter to our constituents. Given that the Indian elections have started today, we should send out a strong message from this House wishing the biggest democracy in the world every success in having peaceful elections, and I hope that Shri Narendra Modi will be elected as the next Prime Minister of India.

2.56 pm

Mr Andy Slaughter (Hammersmith) (Lab): I want to talk about housing and planning policy in my constituency, which is having a detrimental effect on the quality of

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life of tens of thousands of my constituents in the short term and on the physical and social integrity of the area in the longer term. Given the nature of this debate, I will take a Pearl & Dean moment and give three tasters of other issues that will occupy my time and that of my constituents between now and the general election, and probably long beyond that.

The first is truly a life and death matter: the inaptly named “Shaping a healthier future” programme of NHS North West London, which is overseeing, in effect, the closure of two major hospitals and four accident and emergency departments in north-west London. An article in last night’s London Evening Standard by its health editor, Ross Lydall, summed up the futility, incompetence and callousness of the way in which this largest ever hospital closure programme is being carried out. It was based on research by the London assembly Labour group, which revealed that 200,000 people in London last year went beyond the four-hour limit in A and E. The article stated:

“Imperial NHS trust, which runs St Mary’s in Paddington, Charing Cross and Hammersmith, missed the target on 50 weeks. North West London hospitals trust…missed the target on 51 weeks.”

Those two miscreants run three of the four closing A and E departments.

This process has been a stitch-up from the beginning: it has had fixed consultations; it has been subject to the most appalling propaganda by Hammersmith and Fulham council which simply tells lies, saying that hospital departments are going to stay open when in fact they are closing; and the trust has now put back the final decisions on the closures, which should have been taken as long ago as last October, to the week after the local elections. That does not fill me with anything other than dread.

I am glad that the arguments over the central issue are being made in the local elections on 22 May. It is not because people are Luddites that they oppose new developments and specialisms within the NHS; that has being going on for years in the area. It is because these are crass and life-threatening proposals. What really sealed the issue for me was a garbled letter that I received from the NHS this week. It said that it was going to find, from the various clinical commissioning groups, about £100 million in this financial year to provide the community services that it said it would have provided before the closures went ahead. It then added for good measure that it also wants to share out £35 million between the CCGs, which means that my CCG will have to give money to those CCGs that are in deficit. That is a shambolic way in which to run the health service.

The subject of dodgy consultations links me to my second subject, which is Heathrow’s expansion. People in west London have received a consultation document called “Black Heathrow” from a front organisation for Heathrow. It is completely unintelligible, talking at one stage about the closure of Heathrow, which no one wants, and then trying to advocate a third or additional runways on the site. I am pleased to say that there is a genuine cross-party organisation on this subject, which includes the right hon. Member for Uxbridge and South Ruislip (Sir John Randall), the hon. Member for Richmond Park (Zac Goldsmith), my hon. Friend the Member for Hayes and Harlington (John McDonnell), me and many

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others of all parties and of none who genuinely represent the views of the 2 million people in west London, the overwhelming majority of whom do not want Heathrow expanded.

I share the frustration of Howard Davies over the political fix that both coalition parties go along with. I am talking about the fact that the decision on airport capacity in the south-east has been kicked into touch until after the election. I think Mr Davies is a constituent, and his report so far is good as it explodes the myth of the need for a hub airport and raises the prospect of a second runway at Gatwick, which is, on every criteria, a better option. I hope we can have a little more honesty and transparency in this debate, and that we can force a decision before the next election.

The third issue is police crime statistics, which we have already touched on in our discussion on the report from the Public Administration Select Committee. The end of neighbourhood policing, which is what we are seeing in London and around the country, is a huge step back, and does nothing to ensure public confidence in the police force. On the misuse of statistics, I gave the example earlier of a propaganda exercise, which in fairness to the police was carried out by the local authority on their behalf, that pretended that extra resources were going into policing. In fact, the official statistics, if we can believe them, say that there has been a cut of 158 officers—police community support officers and police officers—in Hammersmith since the last election. I raised that matter with the police and crime commissioner.

I raised another matter with the commissioner which will affect Members across London. He was perfectly clear that it was not in his gift to do anything about this, as it was a political decision by the current deputy Mayor to sell off police houses across London. Most police accommodation is effectively social housing. Many tenants are current or former police staff. Many are families who have lived in that accommodation for 15, 20 or 25 years. They do not have security of tenure, so families are being evicted on a daily basis. I have 40 homes in my constituency at Broadmead. Families who thought that they had a home for life are being thrown out on to the streets or the tender mercies of the local authority.

That brings me neatly on to the issue of housing proper. I am only able to talk about that thanks to two sources. One is what I call, pace Sherlock Holmes, the Uxbridge road irregulars. I am talking about the hundreds of my constituents who write to me every month about housing issues and tell me about things such as the 300% rise in complaints about council housing repairs or identify the hundreds of empty council flats that are being sold off on the open market by the local authority. I also want to thank Martin Peach, one of my constituents who happens to be a housing expert. He has written a report on the issue, which reveals the depth and cynicism of the housing policy in Hammersmith. I have had to rely on those sources because, unlawfully, the local authority refuses not only to give me the information voluntarily but to answer freedom of information requests. Over a two-month period, before and after Christmas, I submitted nine such requests. I do not think that is particularly excessive, and I usually put in a lot more, to be honest.

As the local elections are approaching and the authority is so ashamed of what it is doing, it aggregated those freedom of information requests because most of them

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had the word “housing” in them. Some were about how many properties were sold, some were about rent arrears and one was about the Christmas card sent at great expense to all tenants that said, “Please don’t get drunk this Christmas, pay your rent instead,” which I thought was an excellent use of public money, but because they all contain the word “housing” they were aggregated and I was told that under the Freedom of Information Act it was too expensive to answer those questions. Clearly, I will go to the Information Commissioner and clearly I will get a decision in my favour, as I am sure that that is an unlawful step, but that will probably take me six months and the aim will have been achieved. That is another example of how the Freedom of Information Act is misused by local authorities. However, as I say, we have other sources to help us find out what is going on.

Let me briefly summarise what is going on. The policy in Hammersmith is to build no new social rented accommodation, in a borough where the average house price is, at a conservative estimate, £675,000, although some estimates say that it is £750,000, and where rent for a two-bedroom flat is £400 to £500 a week. At least 10,000 families are in housing need. The local authority’s response is not simply to say that it will not build a single additional social rented home, but to decide that it will reduce the existing stock. In 2011 it decided that any property that required repairs costing more than £15,000 could be sold on the open market. At the end of 2013, 262 properties had been sold, generating £112 million in revenue.

At the time, the local authority was warned—again, this takes us into the realms of illegality—by the director of legal services that it should not sell off scarce properties, when in fact it had sold off 72 ground-floor flats and 31 whole houses, that it should not sell off properties if there was a pressing housing need, which of course there is, and that it should have regard to the effect on persons protected by the Equality Act 2010. The people who are disadvantaged—those who are most in need—tend to be from minority ethnic groups, people with disabilities and other groups who are protected by that Act. The director of legal services also said that sales should not be tainted by considerations of electoral advantage. I will let that one hang in the air.

Selling off perfectly good, sound council flats that could be rented to homeless families is step one, and step two is a joint venture with a private developer that will ensure that initially 150, and over time perhaps several thousand, blocks or estates of council property will be emptied out, not replaced, and then developed into what one of my constituents poetically called “zombie homes for absentee oligarchs”. That is obviously a waste of public funds. Most of those properties have been newly refurbished under the decent homes programme, but they will either be sold off by auction or demolished. Housing the families who would have gone into those properties and who will now be in the private rented sector will cost a great deal in housing benefit, and that does not deal at all with the social cost.

In the period from 1 January 2010 to 20 November 2013, 2,505 homeless households approached the council for help. As of 20 February 2013, 138 people were sleeping rough on the streets of the borough. The council’s emergency housing costs rose from £387,000 in 2009 to £1.7 million in 2012. It placed 463 households

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with one child or more outside the borough, and a further 121 households with no children but to whom the council owed a homelessness duty were placed in accommodation outside the borough. Of all the households that were housed temporarily, 329 were placed in bed-and-breakfast accommodation, often for longer than the law permits. A further 22 households were housed outside London altogether, at a further cost of £79,000. All told, 600 households were housed outside the local area and 12 hostels were sold off.

How many people are in housing need in the borough? I said more than 10,000, which was the number on the housing waiting list this time last year, but then the housing waiting list was effectively abolished and now the council will tell you that the figure is only 700. However, the waiting time for properties was between two and seven years depending on the size of the property. How selling off or demolishing hundreds of homes helps, I do not know.

What reasons are given for this? First, that there is too much social housing, but there is 31% social housing in Hammersmith and Fulham, which is below the inner London average. Secondly, that there is no need for social housing; we need a property-owning democracy. The net effect between this census and the one before is that owner-occupation in the borough fell from 43% to 35.6%, the second highest fall in the country. That is a very successful policy.

On planning, the target is 40% affordable housing in any scheme. What is achieved, on average, is 16%, and none of that is social rented housing. Most of it will be for a discount market sale or some form of shared ownership, with a likely income needed of £50,000, about £37,000 net. That is not affordable housing by my definition, yet the definition of affordable housing has been extended so that it now applies to households earning £80,000 a year.

Who are the 50,000 homes in Hammersmith being built for? As I said in an intervention on the right hon. Member for Hitchin and Harpenden (Mr Lilley), that is the target number. The answer is in a letter that comes through my letterbox in an ordinary street in Shepherd’s Bush every day, from estate agents who say that they have demand from overseas investors. They say they have 3,000 purchasers looking to buy in our area, many of whom have 100% cash funds.

I shall give one example of a riverside development next to an ordinary terraced street in Hammersmith. It is a modern, contemporary development of one, two and three-bed luxurious apartments in a tranquil riverside location, priced between £600,000 and £1.7 million. The agents details say this:

“Also exclusive to the services residents will sport complex, which includes a swimming pool, sauna, spa room, gym, massage room, virtual golf, movie theatre for residents, a wine room and a room for meetings…The complex is in walking dostants…and the Royal Borough of Kensington Park…is another Stronie away through the area Fulham—is one of the larges parks in London—Richmond Park.”

I apologise for the English, but, of course, that was translated from the Russian by Google translator, because almost all the developments in my constituency are marketed either through The Straits Times or through websites in the middle east or Russia. That is who a local authority in London thinks it is appropriate to build for when we have tens of thousands of local people of—I say this to the right hon. Gentleman—

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whatever ethnic origin, whether they are indigenous, first, second or third generation in the UK, who need homes. We have a successful and vibrant mixed community in Hammersmith, which suffers only because of the direct policies pursued by this Government, this Mayor and the local authority in my area.

3.12 pm

Richard Graham (Gloucester) (Con): It is a pleasure to speak in this debate. My right hon. Friend the Member for Uxbridge and South Ruislip (Sir John Randall) introduced his speech by saying that the recess debate was one of the highlights of the year. He proceeded to make it so with a bucolic description of blinking at an orange butterfly on the edge of the A40, which itself was gently sipping on flowers. Not everyone here will know that my right hon. Friend’s Twitter address is “@uxbridgewalrus”, which irresistibly drew me to one of the great parliamentary speeches of all times, by his spiritual ancestor in Lewis Carroll’s “Through the Looking-Glass”:

“‘The time has come,’ the Walrus said,

‘To talk of many things:

Of shoes—and ships—and sealing wax—

Of cabbages—and kings—

And why the sea is boiling hot—

And whether pigs have wings.’”

But, alas, my right hon. Friend then moved from the sunny uplands of orange butterflies to the darker territory of vultures and the EU.

Let me take you, Madam Deputy Speaker, and all remaining Members, on a journey from the edge of the A40 to the M4, and so to the A417 and down the Cotswold hills into a glorious sunset with views all the way to May hill, the Malvern hills, Wales beyond and the ancient cathedral city of Gloucester, nestling beside the River Severn below. There is only one problem—people might find, especially on a Friday evening, that they will be blocked on the A417, especially around the Air Balloon roundabout. They might also be blocked on a Saturday afternoon. This Saturday, when heading to Kingsholm to watch Gloucester defeat Bath in an epic game of rugby, they might even miss the first half waiting for the queues of traffic at the Air Balloon roundabout to dissolve.

I want to talk about the so-called missing link of the A417—the road that links the M4 near Swindon and goes on to the M5 on the edge of Gloucester. Some 5 km of this road is single-carriageway, and that causes a major blockage at the roundabout I described. This route linking the M4 and the M5 is a major strategic route not just for Gloucestershire but beyond. It provides the connectivity for businesses to local, national and international markets. It is the major strategic route from the midlands to London, the Thames valley, the airports, and even the south coast ports. As a result of the 5 km of single carriageway and some 34,000 traffic movements a day, many of which are held up, this heavily congested road is, alas, recognised nationally as a notorious accident black spot.

It is time that this situation was resolved. The so-called brown route scheme has therefore been proposed as a solution with which we very much hope the Government are going to help. The first stage involves including the

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missing link in phase 2 of the Department for Transport’s route-based strategy for further development. I hope that my right hon. Friend the Deputy Leader of the House is taking careful note of the importance of the case that has been made to the Department. We need his support not just for the proposal itself but to encourage his colleague, my hon. Friend the Member for Cheltenham (Martin Horwood), to get behind this plan wholeheartedly and join his five coalition colleagues in Gloucestershire—and many other MPs, from Stafford at the top of the M5 to the outskirts of London at the beginning of the M4—to ensure that visitors can get to the Cheltenham literature festival in his constituency, and Cheltenham races on the edge of it, in time to listen to great talks and see great races. We all need to back a plan that will turn the missing link into a rediscovered link and enable millions of people every year to experience a stress-free discovery of the joys of Gloucestershire.

After resolving how to get to Gloucester, either by road or by train—my favoured route, which is about to be made quicker and easier by the redoubling of the Kemble to Swindon line, also long overdue and being undertaken by this Government—the next issue is to improve the regeneration of the city centre and make Gloucester again, as it once was, one of the leading cities of the realm. I pay tribute to Gloucester city council for its continued leadership on many aspects of the regeneration of our city, particularly city council leader Paul James, who told me earlier this afternoon that we had been successful in our bid for funding for a new bus station, which will benefit not just my constituents but many others around the county as a transport hub in the shire capital. Councillor James and the city council in general have been working extremely hard on the part of the city centre regeneration around the King’s Quarter shopping area, and I believe that the bus station will be the catalyst for further announcements on that in due course.

I now want to focus on the regeneration of the area that we know as Greater Blackfriars. You will know, Madam Deputy Speaker, from your own visits to Gloucester cathedral and, in particular, the spectacular Crucible exhibition of two years ago—surely one of the best sculpture exhibitions in the country for a generation—how important it is when in Gloucester not only to be able to visit the cathedral but to see the other great buildings and places of heritage interest. Later this year, we have Crucible 2, which I hope will bring you, Madam Deputy Speaker, and bring all Members present from their constituencies, including Harrogate and Knaresborough, to come and see it.

We need to improve and regenerate the area that I call Greater Blackfriars, which stretches from the former prison to Shire hall at Westgate street and includes many buildings in between, which are ripe for regeneration, and a cleared site known as the Barbican outside the former prison, now in the ownership of the city council. This offers us a unique opportunity for a master plan of regeneration that will incorporate the prison, which is shortly to be sold, the buildings known as Quayside, which is surplus county council estate, the building in which the police currently have their city headquarters, which they will be leaving soon, and the city council site of the Barbican.

Regeneration enables us to offer a vision that includes new accommodation—new housing for perhaps 2,000 residents—new offices for perhaps 1,500 people, and a

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new justice centre which can incorporate all the current courts and tribunals, many of whose current premises have passed their sell-by date and need replacement. Perhaps in due course, if the proposal is right and properly costed, that vision could include a new civic centre which could house both the county and city councils, alongside a five-star hotel, perhaps close to Westgate, in which visitors can stay when they come to see our great rugby team—unfortunately the new hotel will not be there in time for the world cup in 2015, but there will be some great games played next year—and to visit the cathedral, which I hope will shortly be successful in its bid to the Heritage Lottery Fund to improve the experience for visitors.

This vision, which covers the whole of the Greater Blackfriars area, will radically transform the impression and perception of what Gloucester is all about. It will be the link between the already successful Gloucester Quays shopping area, which attracts over 3 million visitors a year, and a walk alongside the docks, which is one of Gloucester’s and the country’s great masterpieces, the deepest and furthest inland port in the country, towards the cathedral, through the new Greater Blackfriars area.

Both the proposals that I have mentioned, the resolution of the A417 missing link and the housing-led regeneration of the Greater Blackfriars area, are included in the strategic economic plan put forward by our local economic partnership, the LEP for Gloucestershire. This is a relatively dense 100-page document which not all my constituents will read in the half-hour or so before this Saturday’s game against Bath at Kingsholm. That is why I wanted to draw attention today to two major elements which will help to transform access to and the regeneration of our city centre.

That is a good note on which to bring my speech to an end and to wish Madam Deputy Speaker and all colleagues a very happy Easter.

3.22 pm

Bob Stewart (Beckenham) (Con): I want to talk about something serious: the lack of a maritime patrol aircraft for our country. The Nimrod MRA4 was scrapped in 2010. We had squandered £4 billion on it and it was a total write-off. In fact, it was cut up. Four years on, we still have no maritime patrol aircraft for our country. The United Kingdom is a maritime nation. We are surrounded on all sides by seas. Others, arguably less maritime than our nation—France, Spain and Portugal—all have a maritime patrol aircraft capability.

The UK has clear international obligations to have oversight of adjacent oceans and seas, as laid out in four conventions: the international convention for safety of life at sea, the international convention on maritime search and rescue, the United Nations convention on the law of the sea and the convention on international civil aviation.

What are our responsibilities under those conventions? In essence, we are required—and we have agreed—to have oversight of 1.25 million square nautical miles of the Atlantic and North sea. We are required to maintain an operational search and rescue capability over that area. In rough terms, we have to look after up to 1,200 nautical miles of the Atlantic up to Iceland, but we are not able to do it. We use our search and rescue helicopters and surface vessels, sometimes with dunking

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helicopters, but helicopters can reach only up to 240 nautical miles. They have no linger time at that distance and have to come back and, frankly, surface vessels using helicopters cannot do the job because even then there is a gap of 1,000 nautical miles that we just cannot supervise. Therefore, we have to get allies such as the French, with their Breguet Atlantic maritime patrol aircraft, or the Spanish or the Portuguese to help us. That is fine, in a way, but not great, given that we should have responsibility for our own seas.

The fact is that maritime patrol aircraft look not just over but under the seas. The invulnerability of our SSBNs—our nuclear submarines, which have a deterrent on board—is threatened by the inability to see exactly what is following them. We can hardly ask our allies to do that for us. I will not go further into that.

We definitely need a squadron of maritime patrol aircraft. I declare an interest, because my brother, ex-Wing Commander Andy Stewart, was commanding officer of 201 Squadron—the Nimrod squadron—and flew Nimrods throughout his career. He is on my back about this all the time, so I hope the House will forgive me for continuing to ask questions about maritime patrol aircraft and for taking up its time on the subject this afternoon. However, this is terribly important to our country. We cannot guarantee the security of the waters around us, but we should be able to do that, especially given the increasing incursions of Russian aircraft and naval vessels around our northern waters.

According to the Defence Committee, the Ministry of Defence gave back about £2 billion in underspend to the Treasury last year, and there is likely to be another underspend this year. That is great—we all want that—but I wonder whether it could be used to start ordering something crucial. This is the biggest military capability gap in our armed forces.

Perhaps we could afford to start the process of getting a maritime patrol aircraft before the next strategic defence and security review. There are two obvious options for off-the-shelf buy. The first is the Boeing P-8 Poseidon, which is probably the leading contender and which operates in the United States. The second is the Orion maritime patrol aircraft from Lockheed Martin, which operates in Canada, New Zealand and Australia.

At the moment in the southern Indian ocean, Poseidons operated by the United States and Orions from New Zealand or Australia are combing the waters to try to find the remains of an aircraft that, frankly, has just disappeared. Australia, New Zealand and the United States can do that, but what would happen if one of our aircraft or an aircraft flying over British territory disappeared 900 miles out into the Atlantic? We do not have anything that could get there quickly or could search like a maritime patrol aircraft, which is something we desperately need. We should seriously consider restoring a maritime patrol aircraft capability to our country as soon as possible. We should start moving towards that even before the next SDSR, which will presumably be after the election, perhaps in 2015 or 2016.

I seem to be the last Back-Bench speaker this afternoon. I thank all hon. Members who have stayed here to listen to me. I thank the staff of the House of Commons for being such decent people—kind, hard working and always up to help. I end by thanking you, Madam Deputy Speaker, for calling me to speak. God bless everyone, and happy Easter.

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3.31 pm

The Deputy Leader of the House of Commons (Tom Brake): It is a pleasure to respond to the pre-recess Adjournment debate. As is customary, I will do so at some length to my hon. Friend the Member for Southend West (Mr Amess), who opened the debate. Hon. Members who can see the Dispatch Box will notice that I have a significant number of notes relating to the points he raised—I will take them in no particular order—but I hope to leave time to respond to the points made by other hon. Members as well.

My hon. Friend mentioned the Maldives and the double taxation and bilateral investment treaties. I will ensure that his comments are passed on to the Treasury, which is the lead Department on this issue. It is clearly important that action is taken to strengthen the Maldives economy. We hope that President Yameen will now work towards economic reform in the Maldives, in addition to considering the treaties.

My hon. Friend also mentioned the Assisted Dying Bill. The Government believe that any change in the law in this emotive area is an issue of individual conscience and a matter for Parliament to decide, rather than one for Government policy. The Government will take a collective view on the Bill in order to respond to the debate on Second Reading, a date for which has yet to be confirmed.

My hon. Friend raised the issue of dog breeding—puppy farming—about which there is a significant petition. Legislation is already in place to control the breeding and selling of dogs. Local authorities have powers to grant licences for dog-breeding establishments, and have powers of refusal based on the grounds of welfare. Powers are also available to local authorities to investigate and enter premises in relation to allegations of poor welfare or cruelty.

My hon. Friend referred to the all-party group on hepatology. The Department of Health is concerned by the increasing burden of liver disease—he said it was the fifth biggest killer—and the resulting premature mortality, much of which is preventable. Together with NHS England and Public Health England, the Department of Health will support local authorities and clinical commissioning groups in their responsibility to deliver improved outcomes in relation to liver disease.

My hon. Friend mentioned the controversial issue of gender selection abortion. As I am sure he and other hon. Members are aware, abortion on the grounds of gender alone is illegal. The Abortion Act 1967 states that two practitioners must be of the opinion, formed in good faith, that the woman has grounds for an abortion according to the criteria set out in the Act. The chief medical officer has written twice to all doctors involved with abortion provision to remind them of the need to ensure that they work within the law at all times.

My hon. Friend also referred to melanoma. The National Institute for Health and Clinical Excellence has recommended Yervoy as an option for treating advanced melanoma in people who have previously received therapy. NHS commissioners are required to fund Yervoy if there is an indication that clinicians want to use it. NICE is currently developing guidance on the drug’s use in previously untreated, unresectable stage 3 or 4 malignant melanoma.

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I hope I have addressed all the medical issues to which my hon. Friend referred, and I will now talk about Quilliam. In a previous guise, when I was my party’s home affairs spokesman, I had knowledge of that organisation. He talked about the need to ensure that we address the promotion of extremism on the internet. Members will be aware that terrorist groups make extensive use of the internet to spread their propaganda, and we have seen how that can contribute to individuals becoming radicalised. A number of those convicted under the terrorism Acts were exposed to radicalising content that they found online, including Inspire magazine, sermons and bomb-making instructions. A number of people who have been involved in terrorist activity have admitted to accessing radicalising content online. Keeping up with the scale and pace of terrorist and extremist content online remains a challenge, so it is important that we have a balanced approach, including working with industry, law enforcement and the public. The police counter-terrorism internet referral unit is removing more illegal terrorist content than previously. Since 2010 we have taken down more than 29,000 pieces of illegal terrorist material.

My hon. Friend referred to the work of Seetec recruitment in Southend, and he talked about South Essex Partnership University NHS Foundation Trust. He previously talked about the trust’s services in the pre-recess Adjournment debate in December 2013. He had an opportunity to discuss his concerns in Westminster Hall on 5 March this year, and I hope he secured suitable responses. It is crucial that all NHS care providers deliver care to the highest standard possible. As a local MP, he is well placed to help ensure that the trust is held to that high standard. I hope he will continue to engage with the trust, local GP commissioners and national regulators to that end, and I am sure he will.

My hon. Friend raised the further health issue of thalidomide victims. He will know that on 20 December 2012 the Department of Health announced a new 10-year grant for the Thalidomide Trust. The grant will be paid on an annual basis, uprated in line with inflation, which means that over the 10-year period it will be worth some £80 million. The Department of Health currently has no plans to make representations to the German Government on compensation from Grünenthal to the UK victims of thalidomide, but the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), who is responsible for care services, hopes to meet representatives from the Thalidomide Trust to discuss the matter further.

My hon. Friend praised Westcliff high school for girls in his constituency, which has the second-best GCSE results in the country. I congratulate the school. In 2013, 100% of pupils achieved five or more A to C grades. The school cannot do any better, but it now has the challenge of maintaining that performance hereafter.

My hon. Friend mentioned tongue-tied breastfeeding—it is very difficult to say “tongue-tied.” I was not aware of the issue, and I do not know how many other Members were aware of it, but he is right to raise its profile, particularly as he has found that even medical practitioners are not necessarily aware of the condition. I hope there will now be greater recognition. He will be pleased to know that NICE has issued full guidance to the NHS on division of tongue-tie for breastfeeding. He asked for a meeting with Health Ministers, and although I

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cannot commit the diaries of other Ministers, I am sure he will pursue the matter vigorously. I am sure that the Department of Health will look carefully at the different health-related points that he has raised during this debate in case there are things that it wants to respond to him on directly.

That might include the issue of FH. I will leave it at that, rather than spelling out precisely what it stands for. My hon. Friend may know that the NICE clinical guidelines recommend that health care professionals should use cascade testing to identify people with FH. Those guidelines represent best practice as they are based on the available evidence and developed through wide consultation. In view of their complexity and the different states of readiness for implementation in the NHS, clinical guidelines are not subject to the same statutory funding requirement as NICE’s technology appraisals.

My hon. Friend clearly has some strong views about the effectiveness of the Essex probation trust. I understand that he has corresponded with Ministers at the Ministry of Justice about rehabilitation services in Essex. I am sure he welcomes the changes that the Government are making to ensure that people who were not receiving support and assistance will do so. He has put his concerns on the record. I am sure that in any process of assessing individual bids, the competence of the organisations that submit the bids will be taken into account.

My hon. Friend spoke about Bahrain. The Government remain supportive of the reforms that are under way in Bahrain. We commend the steps that have been taken by the Bahraini Government to implement the recommendations of the Bahrain independent commission of inquiry. Progress has been made in a number of areas, but there is more to be done. We encourage the Bahraini Government to ensure that the remaining recommendations are implemented soon.

My hon. Friend talked about the importance of ensuring that drug treatment is tailored to the individual. I certainly support that. It must be the most effective way to help someone overcome their addiction and to reduce the health harms that are associated with their illicit opiate use. It is for NICE to decide when there is sufficient evidence to update its guidance and appraisals. It might be considering that issue at the moment.

My hon. Friend spoke about the wine and spirits industry and wine duty. I am sure that he supports the steps taken in the Budget, such as the reduction in beer duty and, in relation to the spirits industry, the freezing of the duty on Scotch whisky. We all know that pubs are an important community asset where people socialise and consume alcohol responsibly. Supporting pubs through the reduction in beer duty was therefore a welcome measure. Ending the wine duty escalator will support pubs that have diversified away from beer. It also ensures that beer and wine duties remain broadly similar, as is required under EU law.

The last thing that my hon. Friend raised was the issue of CCTV spy cars, which councils use in some circumstances to raise money by issuing parking fines. The feeling among drivers is that they suddenly receive a fine some weeks later, when they are not aware that they have committed an offence. Clearly, we do not propose to do anything to prevent a parking warden or police officer from issuing a penalty in cases of genuinely

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dangerous parking. We want to ensure that, particularly around schools, parking restrictions are enforced. Parents often request the presence of a CCTV car to monitor other parents who do not observe the rules and, as a result, might endanger the safety of children. I hope that I have dealt with all my hon. Friend’s points.

I now move on to my neighbour, the hon. Member for Mitcham and Morden (Siobhain McDonagh).

Sir Edward Leigh: May I congratulate the Deputy Leader of the House? In all my time here, that is the fullest reply I have ever heard to any Member’s speech. It was fantastic, and we now want him to give as full a reply to all the other speeches.

Tom Brake: I rather worried that the final sentence of my hon. Friend’s intervention would be a requirement to respond in suitable detail to all the other speeches. I do not want to give away any secrets, but there are advantages to Members letting me know in advance what will be in their speech, because it perhaps ensures a slightly greater degree of detail in the response. Fortunately for me, however, my neighbour the hon. Member for Mitcham and Morden raised an issue with which I am extremely familiar—the future of St Helier hospital, which is in my constituency—so I required no briefing notes from officials on it. I have been living, eating and breathing it for the past 25 years or so, and my wife had my children there.

As the hon. Lady will be aware, £219 million was allocated to St Helier under the previous Government, which I welcomed, and that was confirmed under the current Government, which I also fully supported. As she said, a review called Better Services Better Value was put forward. Had the Surrey GPs not said that they did not support it, it would potentially have led to the closure of the A and E and maternity services at St Helier and Epsom, which I opposed. She referred to the 13,000 signatures on her petition, and I think mine currently has 19,000, so we are both raising awareness of the issue. She commended the supporters of the campaign in Merton, as I do, and a wide range of organisations in Sutton, such as the league of friends, that are campaigning on the issue.

I must say, however, that I do not think it is entirely helpful to the campaign to try to make it partisan in the way that I am afraid some of the hon. Lady’s fellow party members have. They have claimed that clause 119 of the Care Bill will allow the Secretary of State for Health to close any hospital anywhere in the country at any time if he decides on a whim to do so. That is clearly not what the clause is about. It is about scenarios such as Mid Staffordshire, where the way in which the hospital was run meant that more patients were dying than should have been the case. In a very limited number of circumstances—it has been used only twice—there is a need to take urgent action, and that is what the clause is about. It is not about a well run hospital such as St Helier, which is in category 6, the category for the safest hospitals in the country. I wish that that argument were not being deployed, because it does not add to the campaign, which is strong enough as it is. The hon. Lady and I, along with my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), who is also campaigning hard on the issue, will continue to run the campaign.

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The hon. Lady also referred to surgery schemes that have stalled. I am sure that her local clinical commissioning group will have noted her concerns, and I hope that it will respond promptly, and preferably positively. I will also draw the matter to the attention of the relevant Health Minister, to ensure that the Department of Health takes whatever action it can.

The hon. Lady referred to GPs charging for letters. I am not aware of any other organisations that I contact that charge for providing a letter to assist a Member of Parliament in pursuing casework—I do not know whether any other Members know of any. It is regrettable that some GPs choose to do that. I should point out, however, that although GPs have a statutory duty to provide certain things for free, they may charge fees in some circumstances. I will ensure that her concerns are raised with the Department of Health and that it responds to her directly.

My right hon. Friend the Member for Uxbridge and South Ruislip (Sir John Randall) said that the pre-recess Adjournment debates are one of the highlights of the year, and I agree with him. He referred to the butterfly supping on the nectar of a flower alongside the A40. I hate to spoil the picture that he built up for us, but I suspect that by now the butterfly has been demolished by a juggernaut driving along the A40. I heard on Radio 4 that this has been a slightly better year so far for butterflies, and I also felt rather guilty about removing a substantial amount of ivy from a tree when I learnt from the same programme that ivy is exactly what butterflies need in the winter and to provide nectar in the autumn when few flowers are available.

My hon. Friend also talked about vultures and I think we all wondered for a moment what he was about to say. He then mentioned the European Union and I thought it would be one of those stories in which the EU is to blame for everything. In this case, it would seem that the EU is to be blamed for the deaths of European vultures. I will ensure that, if appropriate, the Department for Environment, Food and Rural Affairs responds on the issue of bearded vultures as I know that my right hon. Friend identifies with those birds and wants to see their numbers grow—

Sir John Randall: I just wish to point out that the bearded vulture is also known as the lammergeier and the bone breaker.

Tom Brake: We have learnt two more stunning twitcher facts this afternoon. They will go down on the record, and in years to come people will read my right hon. Friend’s contribution and benefit from his expertise in bird watching.

My right hon. Friend also explained that Malta was not on his holiday list until it addressed the issue of turtledoves and the wall of lead that birds fly into as they approach that island. He then went on to the subject of the Wildlife Trusts and the campaign it is running to save grasslands as part of our natural environment—something that I am sure we would all support. He referred to the Allerton project which is a farm that operates on a commercial basis, but takes its conservation responsibilities very seriously. That best practice should perhaps be more widely promoted, and I am pleased that DEFRA is aware of it.

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My right hon. Friend then talked about the modern slavery Bill, and I am sure that the Home Office will look seriously at the recommendations from the Joint Committee. I agree that modern-day slavery is an abomination. Members of Parliament all read their local papers avidly, and we can all spot the cases of modern slavery they contain, such as the brothels that have been closed down or the cannabis farms that can be found in all sorts of places, including neat, tidy and relatively affluent suburbs such as Sutton, Carshalton and Wallington. Cannabis farms are regularly found in houses, empty warehouses and empty blocks of flats. My right hon. Friend referred to early-day motion 1257. He does not normally support early-day motions, but this one was to celebrate the 175th anniversary of Anti- Slavery International, and we join him in congratulating that organisation on its anniversary.

My right hon. Friend also mentioned his central library and the investment that has gone into it. He said that he was not being partisan in saying that the London borough of Hillingdon was brilliant in terms of its library provision, and I am not being partisan when I say the same about the London borough of Sutton, where we have also succeeded in investing in libraries, especially those that work jointly with sports centres and so on to maximise footfall and other benefits.

My right hon. Friend plugged Northern Ireland as a holiday destination, and I agree with him that it is a place that everyone should visit. Great steps forward have been taken since the Good Friday agreement, but some significant issues still need to be addressed. We are all very pleased that he got a bat detector for Christmas. I hope he makes good use of it.

The hon. Member for Harrow West (Mr Thomas) also mentioned the Wildlife Trusts and praised its work. He touched on residents’ associations. We all have effective residents’ associations working hard in our constituencies. In my case, they are fighting against a proposal for a very large McDonald’s on Stafford road. He referred to RAF Northolt, wanting to ensure that any consultation, for example on plans to increase the number of flights, goes beyond just Hillingdon council. I will pass on his concerns to the Ministry of Defence to ensure that perhaps a wider consultation is embarked upon.

The hon. Gentleman referred to underrepresentation of black and minority ethnic people in the media. The Government are committed to black and minority ethnic diversity in TV, film and the arts, both on and off screen. The Under-Secretary of State for Culture, Media and Sport, my hon. Friend the Member for Wantage (Mr Vaizey) recently met leading figures from these sectors to consider options to improve representation. I think we all support the idea that people who appear on our screens or on our airwaves should be fully representative of the population as a whole, and be in roles that do not stereotype.

Mr Thomas: Will the Deputy Leader of the House ask the Department for Culture, Media and Sport whether Ofcom might be tasked with more specific monitoring of what is really going on? That is the nub of the point I was trying to get across.

Tom Brake: Indeed. The hon. Gentleman raised a point about monitoring data no longer being published. I cannot provide any further information, but I will, as he requests, ask the Minister to respond.

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The hon. Gentleman mentioned a decline in police numbers in Harrow. The independent crime survey has identified that since 2010 the level of crime has gone down by 10%. That is something we can all welcome. I note the drop in the number of officers in his borough as a result of changes that have happened in London. I have seen a similar decline in the number of officers in Sutton. My concern is that people need the reassurance of police visibility. As a result of these changes, there is concern that the deterrent effect is not what it used to be. His concerns are on the record. The Mayor of London may wish, if he is following this debate, to respond directly to him on that point.

My hon. Friend the Member for Colchester (Sir Bob Russell) had the novel proposal, which I think we all wish we had thought of ourselves, of redirecting the Tour de France through every single road in his constituency, or at least the ones that are the responsibility of Essex county council, to ensure that all the potholes are filled in. I commend him for his initiative. He clearly has strong views on his county council and has used this debate to put them on the record. On the subject of potholes, he will be pleased to hear that in this financial year the Department for Transport is providing more than £1 billion to local authorities for local highways maintenance, which includes tackling potholes. There was, of course, £200 million announced by the Chancellor in the Budget for pothole repairs. I hope he welcomes the activity on this front. He also referred to an exchange on quarterly meetings of Essex MPs. I would hope that any local authority seeking to work with its Members of Parliament would not choose to do so in a way that gives favour to one party over another. I hope it takes note of this debate.

The hon. Member for Hackney South and Shoreditch (Meg Hillier) referred to the Co-op Group, which, as she knows, is going through a difficult time. The resignation of Lord Myners from the board after some directors criticised his review of the group’s structure has created further instability, and the group is now facing losses of up to £2 billion. There is clearly a need for action, and she did a very good job of specifying the action that she considered appropriate. I am sure that the members of the Co-op Group will read carefully what she had to say. They clearly need to put their house in order—something that only they can do—and I agree with her that a period of calm reflection, building trust and confidence is required. I also agree with her that if we were to lose the Co-op, we would lose some of the richness and variety from which we currently benefit.

The hon. Member for Cleethorpes (Martin Vickers) said that he felt that there was unintended bias on the part of the BBC. I suspect that, whatever coverage it had or had not given to Nelson Mandela, there would have been an issue: the coverage would have been too little for some, or too much for others. I am not sure that the BBC could ever have got everyone on board. What the hon. Gentleman certainly did, however, was reinforce the point that his constituency is key and should not be neglected at the expense of any other constituency in the country, especially given that it was so badly affected by a tidal surge. He drew attention—perhaps with some justification—to the difference between the coverage of the floods that hit the south and the coverage of those that hit the north.

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The hon. Member for Falkirk (Eric Joyce) concentrated on the extractive industries transparency initiative, which the Government fully support. He praised the work that the Department for International Development is doing. I agree with him that the fact that the United Kingdom is the only large industrialised nation that is contributing 0.7% of its GDP to overseas aid gives us significant clout in discussions on these matters, and that much of our investment in developing countries benefits the UK as well. That cannot be stressed too often. The Government certainly would not want any actions involving the extractive industries to reduce investment in developing countries, because that investment, and growth in those countries, can make a far bigger contribution to their development than even the significant level of financial aid that comes from countries such as the UK. If the transparency initiative comes to fruition in three years’ time—as the hon. Gentleman and I hope it will—we shall be able to learn a great deal from it about best practice which could be applied to other industries.

I think we would all agree with the hon. Member for Gainsborough (Sir Edward Leigh) that Parliament should be made more relevant to people’s needs. I do not necessarily agree with some of the solutions he suggested, but I would certainly welcome a debate on the subject. One of the issues that we must address is the under-representation of different communities and women in the House. If we want Parliament to be more relevant to people’s needs, we must ensure that there is a better representation of people from different backgrounds and genders. He may be right in saying that open primaries could be a way of achieving that, but there are a number of other things that we can do. Many of the actions taken by the Government since 2010, such as the introduction of the Backbench Business Committee —as well as the actions taken by Select Committee Chairs to raise the profile of Select Committees and election to them—have led people to believe that Parliament represents their views slightly more effectively than it used to, and some of the polls have confirmed that. Clearly, more can be done. For instance, there is a move to ensure that we enhance the handling of petitions within the online petition system, which I think members of the public will appreciate, too. I welcome the hon. Gentleman’s contributions to ways in which we can ensure that Parliament reflects people’s needs or is more relevant to them. I am not going to comment on whether there are too many Ministers in the Government, although I point out that in my case I am a Minister but at least I am not paid, so there is no impact on the payroll.

The hon. Member for Luton North (Kelvin Hopkins) raised the issue of rail freight, which he campaigns on vigorously. He set out a scheme that is being put forward by the GB freight group at a minimal cost, he said, of £6 billion, which would enable freight to go from Glasgow to the channel tunnel and beyond to Beijing, which would be quite a journey. We would need to take lots of sandwiches and many flasks of tea to get from Glasgow to Beijing on that freight train, but that would certainly open up new markets to freight. I will pass on his interest in that scheme to the Department for Transport. He said Ministers in past Governments and, indeed, the current Government were supportive but he felt the blockage may be elsewhere.

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The right hon. Member for Hitchin and Harpenden (Mr Lilley) raised the issue of housing. It was also mentioned by a number of other Members. I would like to put on record some of the progress we have made. Almost 420,000 homes have been built since April 2010. The new housing construction output is now at its highest level since the crash in 2008 and housing starts are at the highest level since 2007 as well. We are therefore making progress. We believe that by the end of this Government we will have more affordable homes than there were at the start of the Government, something previous Governments have not achieved. We expect to deliver 165,000 new homes in three years. That will be the fastest rate of delivery in the past 20 years. I agree with him that increasing house building can address many issues beyond those of homelessness, overcrowding and employment. He also raised the issue of the impact of immigration on the housing shortage. Clearly, the UK has seen substantial inward migration. That is something the Government are now starting to tackle, and clearly immigration does have an impact on housing.

I had an interesting meeting a couple of weeks ago with an organisation called Pocket which is trying to develop, on a relatively small scale, on areas of land in London that are perhaps difficult for larger developers to use, and which would provide housing for those caught in the middle—people who will never be able to access affordable housing because of their income, but who in London at least are very unlikely to be able to afford to buy housing because of the level of house prices. That sort of initiative can make a contribution.

The hon. Member for Strangford (Jim Shannon) pointed out that cycling is not easy in rural areas. I agree: the distances might be greater and it may be hillier and windier. Those who advocate cycling, including me, do not all argue that everyone has to cycle wherever they live and whatever distances are involved. He rightly highlighted the issue of fuel costs and the impact they can have, particularly on people in rural areas. I know colleagues from all parties—particularly those from rural areas and places like Scotland—are very concerned about that. He welcomed the measures the Government are taking to address fuel costs and I know he would like us to go further, but the Government are aware of the issue and we are doing as much as we can.

The hon. Member for Harrow East (Bob Blackman) referred to having the country’s first state-sponsored Hindu primary school in his constituency, and said that it is now going to have the first state-sponsored Hindu secondary school. I wish the schools well. He also mentioned Anmer Lodge, and expressed concerns about the scale of that development. His contribution highlighted the difficulties that any area faces when trying to address the housing issue. As the right hon. Member for Hitchin and Harpenden said, we need to increase provision but local residents need to feel that that is being done in a way that does not present a challenge to them.

The hon. Member for Harrow East is clearly not going to be buying a season ticket for Barnet football club. Indeed, he probably would not be given one if he asked. Many Members will have football clubs in residential areas of their constituencies, and they can have a significant impact. I do not know whether that is the case in his

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constituency, but the problems can be exacerbated in that kind of environment. I am sure that his concerns will be listened to in the appropriate places.

The hon. Gentleman also referred to the Royal National Orthopaedic hospital, saying that he wanted the development of that centre of excellence to happen as soon as possible. He will have noticed that the Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison) is in her place and that she heard his speech. That subject is on her agenda, and she is aware of his concerns. He also mentioned the difficulty of getting in and out of Stanmore station because there was no lift, and I understand his reasons for wanting action to be taken on that as soon as possible.

The hon. Member for Hammersmith (Mr Slaughter) talked about a variety of issues. He mentioned the “Shaping a healthier future” programme. He and other Members will have received proposals with names that, on the face of it, sound positive but which might not be to everyone’s satisfaction, given the impact they could have on the local health service. The Department of Health, NHS England and the trusts need to take into account the medical benefits of specialisation—as happened in London, for example, in relation to stroke services—as well as the possible disbenefit that can derive from a lack of access to local services. The right balance needs to be struck.

The hon. Gentleman also referred to his campaign to oppose a third runway at Heathrow. As the Liberal Democrats’ party spokesman on aviation back in 1997, I confirmed at the time that our policy was to oppose a third runway, and we have not deviated from that position since then. On housing, he referred to the refusal to respond to freedom of information requests relating to a wide range of issues. It is incumbent on all local authorities, and the Government, to be as open and helpful as possible in relation to FOI requests.

The hon. Member for Gloucester (Richard Graham) has apologised for leaving the debate early. I understand that he had to catch a train. He referred to the need to take action in relation to the missing link between the M4 and the M5. He also rightly concentrated on the importance of regenerating the city of Gloucester and the Greater Blackfriars area. From his description, the area certainly sounds ripe for investment and will provide an opportunity to deliver a vision for the city.

Members will be pleased to hear that I have nearly finished. The hon. Member for Beckenham (Bob Stewart) referred to the need for a maritime patrol aircraft. He explained some of the technical advantages of being able to see not only what was on the surface but also what was below it. That is an invaluable asset when dealing with submarines. He also said that we needed to work in partnership with our allies. That is something that I welcome, although there could be times when it is difficult to achieve. He will know that defence procurement is an area in which the Government have had to take action to address significant overruns. However, he could not have put his request for the maritime patrol aircraft more clearly, and I will ensure that those in the Ministry of Defence see his speech and respond to him on that point.

Madam Deputy Speaker, I am on to my last note, which says “Thank you” at the top, so thank you for chairing this debate so ably. I thank also all Members who have taken part in what has been a fairly comprehensive

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tour, from butterflies on the A4 to the Maldives. I conclude by thanking my officials who have worked in supporting me today, and the House authorities for keeping us safe. I hope everyone has an absolutely fantastic Easter.

Madam Deputy Speaker (Mrs Eleanor Laing): Unusually, I think the House should thank the Minister for his extremely thorough response to the debate.

Question put and agreed to.


That this House has considered matters to be raised before the forthcoming Adjournment.

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Cystic Fibrosis

Motion made, and Question proposed, That this House do now adjourn.—(Mark Lancaster.)

4.15 pm

Kerry McCarthy (Bristol East) (Lab): Thank you, Madam Deputy Speaker, for this opportunity to discuss an issue that is important not just to me personally and to my family, but to those constituents who have families or friends with cystic fibrosis and have written to me recently in support of the Cystic Fibrosis campaign. I thank also the Cystic Fibrosis Trust and the Bristol Adult Cystic Fibrosis Centre for their assistance in preparing for today’s debate, and those with whom I trekked across the desert in Jordan back in February to raise funds for the Cystic Fibrosis Trust. I am so grateful to the many people who sponsored me on that trek and, in particular, to those constituents, many of whom were not known to me personally, who were very generous with their contributions.

I chose to join the trek because I have a nine-year-old niece, Maisie, who has cystic fibrosis. Almost everyone who went on that trek to Petra had a relative, spouse, partner or friend with CF. so as well as being a fantastic if physically challenging experience, it was also useful for me, as we went through the mountains and the desert, to speak to people about their experience of dealing with family and friends with CF.

CF is an inherited disease that affects more than 10,000 people in the UK. One in 25 people carries the CF gene, and if both parents are carriers there is a 25% chance that their child will have CF—so one in 2,500 babies born in the UK has cystic fibrosis. My niece was diagnosed on Christmas eve when she was only a few weeks old. She had been losing weight and her parents were worried so they took her into hospital. But, thankfully, since 2007 newborn babies have been routinely screened, and that is very welcome.

CF is a genetic deficit that causes the production of thick mucus which predominantly affects the lungs and digestive system. The symptoms include a persistent cough, breathing difficulties and repeated chest infections. It also affects the pancreas, meaning that fatty foods in particular and fat-soluble vitamins are not digested or absorbed properly, causing malnutrition, poor growth and diarrhoea. This means that people with CF generally need between 20% to 50% more calories than average, and one third of them go on to develop CF-related diabetes.

Treatment varies because the condition can vary from person to person. Some people are not diagnosed and do not realise they have the symptoms of CF until they are an adult, as was the case with one lad on the trek with me. He was in his mid-20s and had been diagnosed at 18, so he had a milder form of the disease without the pancreatic symptoms. Treatment can vary according to how severe a person’s condition is, but it usually involves daily time-consuming physiotherapy, an oral nebuliser and, occasionally, intravenous antibiotics and having to take enzyme tablets when food is swallowed.

Patients are susceptible to cross-infection, which sadly means it is not a good idea for people with CF to come into contact with each other. That is where online forums have become valuable, because people with cystic fibrosis can now talk to each other about their condition.

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I want to flag up the Twitter account @CFAware, which I have only just come across. It retweets people who have contacted it with anecdotes about how cystic fibrosis affects their lives and about their treatment. It has been really valuable to me in informing me about the illness.

Cystic fibrosis used to be known as a childhood disease because life expectancy was so short. When the Cystic Fibrosis Trust was founded in 1964, a child born with CF was not expected to live beyond the age of five. Advances now mean that half the people with CF are expected to live beyond 41 years, and the life expectancy continues to rise—indeed, I was told the other day that a child born today with CF could expect to live into his or her 50s. That progress is, of course, very welcome, but it has implications for people with CF and their families, and for treatment and public policy, which I want to focus on this afternoon.

One recent breakthrough was the development of ivacaftor—the brand name is Kalydeco—a tablet treatment that addresses the genetic causes of CF, but that is valuable only for those with the G551D mutation, who comprise just 4% of CF patients. For them, the fact that this drug is now available reduces CF to a manageable lifelong condition—it is something they can live with, rather than a deteriorating condition—so the confirmation that this drug would be funded in England from January last year was an unimaginable relief. The drug demonstrates why investment in research and drug development, and in gene therapy, is so crucial. If a drug were found that could help the remaining 96%, the cost of providing it could be prohibitive, but of course that should not prevent our carrying out the research and continually trying to find better treatment, better genetic experiments and, ultimately, a cure for CF.

In the more immediate term, patients need a focus on the care and support available to them. Bristol is fortunate to have both a specialist paediatric centre at Bristol children’s hospital and, next door, an adult CF centre at the Bristol Royal infirmary, where I met staff and patients when I visited last week. It has a multi-disciplinary team comprising consultants, nurses, dieticians, physiotherapists, pharmacists, psychologists and a social worker. It was clear from my visit that each and every member makes a vital contribution to the treatment and well-being of CF patients there. The dieticians’ input is crucial in trying to help them maintain a healthy weight and deal with the added complication of diabetes. Psychologists are there to help with the psychological impact of having a life-limiting disease or the trauma of waiting for a lung transplant—that is an issue I will return to later. The medics I met also emphasised the importance of the social worker’s role.

The team also helps patients and families cope with the transition from paediatric to adult services at the age of 18. That comes at a time when not only are teenagers struggling with all the usual things that teenagers struggle with and they are perhaps making that transition into managing the condition themselves—by carrying out their own physiotherapy and administering drugs themselves, rather than having their parents do it for them—but their condition is likely to start deteriorating. Young adulthood is often the time when there is a dramatic decline in the health of CF sufferers, so having expert specialists, as well as exercise facilities and in-patient

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beds, at the specialist unit in Bristol, in a dedicated space for CF, which stops the risk of cross-infection, too—patients have their own rooms—is really important.

It is important to remember that many patients are trying to balance employment with their treatment: 70% of adults with CF who completed an employment questionnaire for the CF Trust were in work or education. Many of these patients are trying to administer treatment, such as IVs, at home and have to struggle with the equipment; they are trying to manage the costs of travelling to the specialist centre; and they may well be trying to apply for the assistance to which they are entitled from the Department for Work and Pensions. Indeed, the financial pressures are considerable, and one consequence of CF having been a “childhood disease” is that it was not included in the prescription charge exemptions, so patients now reaching adulthood face significant bills for their cocktail of medication. As we know, the prescription charge increased last week to £8.05.

Sir Bob Russell (Colchester) (LD): I hope that when the Minister responds she will explain why successive Governments refused to acknowledge the very strong arguments that the hon. Lady has made about how the disease was once a childhood condition whereby people never made it beyond being teenagers but now people make it to adulthood and they are having to pay prescription charges—if they are in employment—to stay alive. People who abuse their body and become drug addicts receive state funding, but people who have been served by mother nature in this way do not get the help. The Government should give that help.

Kerry McCarthy: I thank the hon. Gentleman for his intervention. I know that he has campaigned on this issue for many years. To people who think that early-day motions are a magic bullet that will solve things overnight, I point to the hon. Gentleman, who managed to get an early-day motion calling for the removal of prescription charges for cystic fibrosis patients. I think that his early-day motion has been No. 1 on the list for many, many years, but it has not yet managed to progress. He also had a debate on the issue last year. I sometimes use him as an example of how early-day motions do not automatically mean that the Government will sit up and listen, but I hope that the Minister will listen today and hear our plea.

The previous Prime Minister, my right hon. Friend the Member for Kirkcaldy and Cowdenbeath (Mr Brown), recognised this issue, and his Government committed to phasing out prescription charges for people with long-term health conditions, but we did not manage to do it before the 2010 general election.

Some people with cystic fibrosis will be forced to make the difficult decision to give up work, but research conducted last year by the Cystic Fibrosis Trust with Parkinson’s UK, the Multiple Sclerosis Society and the National Rheumatoid Arthritis Society reported that Atos found 45% of people with these progressive conditions fit to work. Obviously, it has now been belatedly acknowledged that the assessments carried out by Atos were far too unreliable. Most worryingly, some people with cystic fibrosis were given “prognosis reports” of when they would recover from the illness—an illness from which it is impossible to recover.

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Critically, welfare reforms may increase the barriers to getting to work and hospital appointments—not least the new personal independence payment and the 20 metre mobility limit. A survey of people with CF found that more than a third would no longer be able to work if they were not awarded the higher rate of mobility under the new PIP, while 90% said they would find it difficult to access hospital appointments. In a survey for the Cystic Fibrosis Trust, a third said that they would not be able to attend hospital appointments. The trust also warns that patients fear isolation and loss of independence, which would affect their mental health.

When I visited the Bristol adult cystic fibrosis centre last week, it was explained to me how the trust and the centre fundraise to help the service and the patients. For instance, they buy more nebulisers to lend to patients. The ordinary nebulisers are huge and cumbersome, but the nice neat little ones are far more expensive. The trust and centre want to help patients manage their condition with the least amount of inconvenience. They fundraise to buy the smaller nebulisers. They also buy physio equipment, because it is really important for CF patients to undertake exercise to loosen up the mucus on their lungs. They buy fridges for patients’ medication and desks for their rooms—as I said earlier, patients need their own rooms to avoid cross-contamination.

The Bristol centre is clearly making an invaluable difference to its patients’ lives, but it has a growing patients list, which is due in part to the very welcome increases in life expectancy. I understand that Bristol’s patient numbers are increasing in line with the national average—by around 10% each year—and the patient case load has doubled over the past six years to around 200. I think the Manchester centre has about 600 patients and is the largest in the country.

With the Bristol centre, the transfer of patients from further afield, such as from Taunton and Swindon, has contributed to the growth in numbers. This year, it is also taking on patients from Cheltenham and Bath.

Patients are often admitted for a course of intravenous antibiotics, which they will generally need about three times a year, with the antibiotics being administered about three times a day for a couple of weeks. Some patients can self-administer at home, but that is not always appropriate or safe, depending on their living conditions and how ill they are. Sometimes it may just be that they have not been monitored by the team for a while, so they will be admitted to the centre. I met a young woman who had just started work. She had an understanding employer. She had been in her new job for two weeks and then decided that she needed to go into hospital to have the intravenous antibiotics. She felt much safer there than administering a course of treatment at home, which was her normal way of doing things. The condition clearly requires considerate employers.

It seems that hospital admissions at specialist CF centres are becoming increasingly difficult to plan for and more prone to cancellation because the units cannot guarantee a bed will be available. It seems that, particularly in winter months, the specialist beds also come under pressure from other departments, which have a shortage of beds. Ordinary patients may be put in a CF unit, and the CF patients cannot get the treatment that they need. In Bristol, the annual number of in-patient “bed days” required by patients for their IV antibiotics has increased

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from just over 500 in 2005 to nearly 2,500. That is due to the number of patients, and not because the length of stay is increasing.

Over the past few years in particular, there has been a steeper rise in the number of bed days at home, which is now at more than 3,500 annually. The unit is trying to facilitate more self-care at home and has developed an outreach service so that patients do not always have to travel to Bristol. It also tries to offer community liaison and health care at home, for example to help with IVs, and is developing innovative ways to help patients, including through an agreement with BUPA to deliver supplies to the homes. There can be a huge amount of equipment and pills and so on, and patients who have to use public transport to get to the hospital, perhaps not feeling very well as they are travelling, do not want to have to carry huge amounts of drugs and equipment around with them. That delivery service is proving very useful. Staffing and resources, however, mean that the centre has limited capacity for outreach and community services.

Importantly, the University Hospitals Bristol NHS Trust is working with the centre and has increased funding for specialist staff but, more generally, the Cystic Fibrosis Trust told me that specialist CF centres around the UK are reporting that resources, personnel and space provision are inadequate and warns that in light of the increasing patient numbers nationally, the lack of capacity for in-patient beds, combined with a lack of funding for out-patient staff, threatens to curtail the clear progress made over the past few decades. I would therefore be grateful if the Minister could update us on the Department of Health’s plans to ensure that CF services are equipped to keep up with increasing patient numbers and the complexity of the condition and assure me that she will work with the Cystic Fibrosis Trust, the specialist centres and their expert staff. Will she also consider the issue of co-ordination between trusts? For example, CF patients who phone an ambulance will often not be taken to the specialist centres even though their consultants recommend it.

Some patients will be assessed and referred for a lung transplant and, as the Minister will be aware, last month the Cystic Fibrosis Trust launched its “Hope for more” campaign. Although a lung transplant is not appropriate for everyone with CF and does not cure it, it can mean the priceless gift of a few more years for the patient and their family. Tragically, though, one in three people with CF on the lung transplant waiting list will die before they can receive one, so the Cystic Fibrosis Trust is campaigning to maximise the use of organs and increase the number of organs available for transplant.

One tragic case was that of Kerry Thorpe, a very brave young woman who became the face of the organ donor campaign. She died only a few weeks ago at the end of March at the age of 23, because new lungs could not be found for her. She spent seven years on the waiting list. Today, I was sent an account from the Daily Record of another 23-year-old, Lynette Armitage, who had a lung transplant in December in an eight-and-a-half-hour operation. She asked surgeons whether she could have a photo of her old lungs when they removed them, but they told her that the lungs had completely disintegrated when they had taken them out. They were only held together by her rib cage and the surgeons said that if she had not had a transplant within the

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next two weeks, she would have died. The lungs got to her just in time. It might be that she lives for another seven years or so, which is the average, but some people who have had transplants can live into their 50s or 60s. She is talking about having a normal life, having children and looking forward to going to T in the Park this year. That just shows what a difference can be made if lungs can be found: two 23-year-olds with very different outcomes.

There are a number of ways to reduce the length of time people are waiting and, critically, to reduce the number of deaths. That includes increasing organ donation rates and promoting more public discussion of organ donation. Less than a third of donors are registered, so it is not necessarily an obstacle if someone is not on the register. The Cystic Fibrosis Trust reports that the UK has one of the highest rates of family refusal in the western world. I am not suggesting that this is an easy decision for bereaved families to make during such a difficult and emotionally charged period, particularly if the family member has died suddenly, but it is nevertheless an indication of the need to focus on consent as well as registration and to ensure that more people understand what an incredible and generous gift they can give to other people if they sign up to be donors.

The organ donation taskforce led to a 50% increase in the number of deceased donors and a 30.5% increase in transplants in the five years to 2013. That was important progress, but I am sure the Minister will agree there is still more to be done. I would be grateful if she could update us on the “Taking Organ Transplantation to 2020” strategy and the latest assessment of the case for an opt-out system. I know that Wales is moving to a system of presumed consent next year.

As the Cystic Fibrosis Trust has highlighted, it is not only a case of increasing donor rates, as significant numbers of donor lungs are not used, despite the next of kin giving their consent. Lungs from fewer than 25% of donors after brain death are utilised in transplantation. Medical innovation means that more lungs could be used, and the trust has called for more transplant surgeons to be trained in downsizing donor lungs. It has also funded a study at the university of Newcastle on ex-vivo lung perfusion, a technique for the assessment and potential repair of sub-optimal lungs. That was explained to me as a service where damaged lungs are reconditioned so that they are fit for use in transplants. I urge the Minister to consider the results of that study, and whether such techniques could increase the number of suitable donor organs.

In recommending the development of a national lung allocation system, the report focuses on a concern amongst the cystic fibrosis community about the equity of lung allocation, and whether they go to those most in need, irrespective of where the person lives. I am aware that NHSBT has developed a new super-urgent group, separate from the main waiting list, but the Cystic Fibrosis Trust emphasises that that is unlikely to have a significant impact on people with cystic fibrosis waiting for a transplant. It also highlights the evidence from the USA, where the introduction of the lung allocation system led to an increase in the number of transplants and a significant reduction in the number of people with cystic fibrosis dying while on the waiting list.

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Kate Green (Stretford and Urmston) (Lab): I am grateful to my hon. Friend for raising the issue of allocation of lungs for transplant. In the north-west of England we have poor levels of transplant. People wait longer and are more likely to die on the waiting list. Does she agree that it is important that the Minister presses for the modelling, which I understand is being carried out, on the impact of a national allocation scheme to be given great attention and accelerated if possible, so that we can have the evidence on the benefits of such a scheme in this country as quickly as possible?

Kerry McCarthy: I agree entirely with my hon. Friend. As I have said, it makes such a difference if more people come forward as donors, not just for lung transplants but for many other types of donation as well, from blood through to other organs. I urge the Minister to give this the utmost priority, because, as we have said, it can make such a difference to people’s lives.

The Department of Health has advised that the most recent analysis showed no significant difference in allocation across UK lung transplant centres. But the Cystic Fibrosis Trust clearly believes that an improved allocation system could address the shocking fact that one in three cystic fibrosis patients die before they get to the top of the waiting list. So I ask the Minister to review this with NHSBT, and consider the evidence from the Cystic Fibrosis Trust. It would also be helpful if she could provide more information on the current review by the cardiothoracic organs advisory group, and say whether it is considering a national allocation system, as referred to by my hon. Friend, or consulting stakeholders such as the Cystic Fibrosis Trust and specialist centres, and when it is likely to report.

The “Hope for more” report also highlights that 62% of survey respondents reported that psychosocial support during the whole transplant process is insufficient, and concludes:

“The demand for services that assist the family and individuals in coping with cystic fibrosis is drastically underestimated”.

In response to a parliamentary question that I tabled, the Minister explained that decisions on psychosocial support are a matter for clinicians and commissioners, but I would urge further consideration of the report’s findings and how the Department of Health can help to improve provision and ensure that clinicians have the resources that they need, working with commissioners to address gaps in information, support and psychosocial services for patients waiting for a transplant and post-operative.

It is clear that the specialist centres, working with the Cystic Fibrosis Trust, are making an incalculable difference to their patients’ lives. The trust is putting real money into the provision of services for cystic fibrosis patients. In 2012-13, the trust contributed more than £1.6 million to research projects, and more than £1.1 million to clinical care. It also provides a helpline that takes more than 3,000 calls every year, and it is able to provide limited welfare grants to people with cystic fibrosis and their families who are, understandably, struggling with the impact the condition can have on their lives.

I congratulate the Cystic Fibrosis Trust on its work and all those people that I met at the cystic fibrosis centre in Bristol, who were so dedicated and keen to get across to me the fact that with more resources they

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would be able to do an even better job in coping with the increased number of patients. I hope that the Minister takes that on board.

4.39 pm

The Parliamentary Under-Secretary of State for Health (Jane Ellison): I congratulate the hon. Member for Bristol East (Kerry McCarthy) on securing this debate. She made a wide-ranging speech demonstrating a very deep knowledge of this subject. She alluded to her own family connection to this condition. Obviously, I convey my best wishes to her constituents, particularly to her family and especially to her niece, who is, as she described, suffering from the condition.

I commend the hon. Lady’s recent achievement in raising funds for the Cystic Fibrosis Trust. That is an excellent achievement for an excellent charity; she is right to be generous in paying tribute to it. I am sure she will be interested to know that in recent weeks many Members of Parliament have contacted me in support of the trust’s current campaign on behalf of the 10,000 or so people in the UK who battle with the everyday challenge, which she so eloquently described, of living with cystic fibrosis.

Let me take this opportunity, as I like to do, to pay tribute to those who work in our NHS and their dedication, determination and commitment to provide a first-class care service to all patients, not least CF patients. I pay tribute to them for their efforts, all the time, on behalf of all of us and all our constituents.

Let me first speak more generally about organ transplants and the challenges of organ transplantation. In the UK, the need for an organ is greater than the number of donor organs available. About 8,000 people are on the national transplant list waiting for a transplant that will save their lives or significantly improve their quality of life. Unfortunately, too many people wait too long for a suitable organ to be donated. About 1,000 people a year die waiting—about three adults or children every day. That applies to organs in general. Many others lose their lives before they even get on the transplant list. As of 3 April this year, 75 people with cystic fibrosis were waiting for a lung transplant. About 50 cystic fibrosis patients receive a transplant each year, but unfortunately about 20 patients die each year on the transplant list. We can see the clear challenge to meet that need and assist those people.

This means that there has to be a system to ensure that patients are treated equitably and that donated organs are allocated in a fair and unbiased way based on the patient’s clinical need and the importance of achieving the closest possible match between donor and recipient. A number of factors are involved. The rules for allocating organs are drawn up by the medical profession in consultation with other health professionals, specialist solid organ advisory groups, and health administrations. Factors such as the blood group, tissue type, and age and size of the donor and the recipient are taken into account to direct the allocation of the organ and identify the best-matched patient or, alternatively, the transplant unit to which the organ is to be offered.

The Cystic Fibrosis Trust report “Hope for all”, published on 10 March this year, makes a number of recommendations focusing on three key aspects: increasing the number of organs donated for transplantation; making sure that we make best use of the donated organs; and

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making sure that patients are fully involved in decisions about their care. We continue to invest in the donation programme to optimise transplantation in the UK. In the five years between April 2008 and April 2013, donation rates rose by 50.3% and transplant rates rose by 30%. That is a record of good and significant progress in recent years. I pay tribute to NHSBT for the work it has done in this regard, alongside other health professionals and the charities. Encouragingly, donor and transplant rates continue to rise, and we see that pattern this year as well. However, we know we can do more to match the successful donation programmes in some other countries —as the hon. Lady said, there are other countries with better records—and to give more people the opportunity of a transplant.

As the hon. Lady and other hon. Members may know, a new seven-year UK-wide organ donation and transplantation strategy, “Taking Organ Transplantation to 2020”, was published in July last year. The strategy expressed the desire to make the UK system comparable with the best in the world. Within that, it aims for a rate of consent—the hon. Lady specifically talked about consent rates—of above 80%; it is currently 55%. Increasingly, consent is the most important strategic aim—interestingly, more so than donation. Spain achieved a consent rate of 84% in 2011—a remarkable achievement. We know that we have particular challenges in relation to consent rates in black, Asian and minority ethnic communities, which I have discussed at length with NHSBT and which hon. Members are aware of. I know of hon. Members not present here today who have done specific work in some of their local black and minority ethnic communities to raise awareness on this point. I would like to see us do more of that and use parliamentarians to do so.

Kerry McCarthy: It is perhaps remiss of me not to have mentioned in my speech the fact that in the past year Bristol has had its first Muslim lord mayor who, during his year as lord mayor, chose to focus on encouraging blood and organ donation from the BME communities. As his term of office is almost up, I ought to take this opportunity to congratulate Councillor Faruk Choudhury on that effort.

Jane Ellison: I join the hon. Lady in congratulating the lord mayor. That is exactly the sort of local leadership that can help. One of the big pluses of the devolution of public health to local government is that we see such leadership from people who know their community best and understand the diversity in their locality. I am keen to encourage that. Only recently we celebrated examples in other areas, where we saw that specific leadership in some communities where health outcomes were not as good as they could be. We are always looking for such opportunities, and I am delighted that the hon. Lady has taken the opportunity to highlight local leadership in that regard.

Our focus in the strategy is initially on increasing consent rates. We want people to support transplantation. We can all imagine that families are being asked to agree donation at probably one of the worst times in their life, but many families find that they get comfort from knowing they have helped others to live. We will keep a close eye on what happens in Wales following the changes there, to which the hon. Lady alluded. NHSBT also keeps international experience under careful review. I mentioned the good success rates in Spain, for example.

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We need to make sure that we make the best use of the donated organs. Currently donor lungs are procured by a retrieval team and allocated to the transplant centre on a zonal basis, based on the location of the donor. The transplant team at the centre will decide whether or not to accept the lungs and will select the most appropriate recipient.

The trust’s report recommends the implementation of a national lung allocation system whereby donor lungs are given to the most urgent patients, regardless of where they live.

This is something that NHSBT’s cardiothoracic organs advisory group, which includes both lung clinicians and lay membership, will be considering very shortly, and in particular whether we should introduce a national lung allocation scheme for people who need a lung transplant urgently, with all remaining donor lungs continuing to be allocated on a zonal basis. The advisory group’s recommendations will then be considered by NHSBT’s transplant policy review committee, and if a change of allocation procedures is agreed, it will be implemented as soon as the governance arrangements can be put in place.

Kate Green: Will the Minister clarify whether the work that is going on now to review the allocation system is looking at the possibility of a national allocation system only for urgent cases, or whether it will also consider the advantages and disadvantages of a national allocation system in all cases?

Jane Ellison: I imagine that the advisory group is considering that, but I would rather check and get back to the hon. Lady after the debate. I should have thought that it was looking at the broader issue, but I will come back to her, if that is acceptable, and confirm that after the debate. It goes without saying that I will follow up this debate with NHSBT, which I am sure will be extremely interested to know that Parliament has an interest in the subject. We will revert to any hon. Member to whom I am not able to respond in detail.

The issues are complicated. I have only begun to get a sense of some of that complexity, partly in preparing for this evening’s debate. NHSBT will wish to be certain that any change of policy can be introduced in a fair and safe manner. We need also to ensure that people with cystic fibrosis receive the best quality of care for them and are involved in decisions about that. NHS England has published two CF service specifications, one for adults and one for children, recognising that, although similar, adults and children with CF have differing needs and it is important that the services provided should reflect that.

NICE has issued technology appraisal guidance recommending appropriate drug therapies—one of which has been mentioned by the hon. Member for Bristol East—in certain clinical circumstances, which NHS commissioners are required to fund where clinicians want to use them. The Government also fund a range of

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research on cystic fibrosis, in particular through the Medical Research Council and the National Institute for Health Research.

The hon. Member for Bristol East alluded to the need for research, so she may be interested to know that the MRC is funding a £3.3 million trial of repeated application of gene therapy for patients with cystic fibrosis. That is being undertaken by the UK Cystic Fibrosis Gene Therapy Consortium, which comprises world-leading teams at Imperial college London and the universities of Oxford and Edinburgh. The trial is testing whether gene therapy can improve the lung function of cystic fibrosis patients and its report is due to be published in May 2015. I am sure we will all await the review with interest. It has the potential for interesting and exciting breakthroughs.

I hope the hon. Lady will forgive me for responding to her points about benefits by saying that I will draw them to the attention of my colleagues at the Department for Work and Pensions. The issue is not in my remit, but her points have been noted and are on the record.

On prescription charges, I pay tribute to my hon. Friend the Member for Colchester (Sir Bob Russell), who has campaigned long and hard—but not successfully today—on the issue. I am afraid I do not have a response for him today, but I will get back to him after the debate.

I think I have covered most of the points that have been made. The hon. Lady raised specific points about local arrangements. Some interesting work is going on between the Royal United hospital in Bath and the Bristol adult cystic fibrosis centre at Bristol University hospital. They are looking at specialist commissioning and I think NHS England is looking to commission a model of adult CF care. I will look at the record after the debate and will draw that particular section of the hon. Lady’s speech to the attention of NHS England representatives, because some of the decisions about clinical care and commissioning sit with them. I will make sure they have a copy of the debate and I will ask them to respond directly to the hon. Lady on the issues within their remit.

In conclusion, I hope I have reassured the hon. Lady and other interested Members that we want to provide the best possible care for cystic fibrosis patients. Service specifications are in place to define that care and what great care looks like. We continue to do all we can to increase organ donation rates, with some notable recent success. We will look in particular at the issue of increasing consent rates so that we can give many more people the opportunity of a transplant. I have referred to the review, which is particularly germane to the current campaign, and I will ensure that interested Members are alerted to its outcome.

I will end by wishing colleagues, hon. Members, Madam Deputy Speaker and the staff of the House a pleasant Easter recess.

Question put and agreed to.

4.53 pm

House adjourned.