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Westminster Hall

Wednesday 30 April 2014

[Mr Dai Havard in the Chair]

Type 1 Diabetes (Young People)

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

9.30 am

Mr George Howarth (Knowsley) (Lab): May I take the usual step of thanking you for chairing this sitting, Mr Havard? I know that that is something of a ritual, but on this occasion I am sincere. You may be aware that I was originally on the list to chair this sitting, so you have saved me the embarrassment of having to congratulate myself.

I begin with some acknowledgements. I am particularly grateful to the staff and patients at the diabetes centre at Aintree university hospital and the specialist diabetes services team at St Helens and Knowsley. I also thank the young people with diabetes who took the time to speak to me; the Juvenile Diabetes Research Foundation; Diabetes UK; Diabetics with Eating Disorders, known as DWED; Circle D; and Dr Mike Merriman in my constituency.

I sought this debate on behalf of children with type 1 diabetes in the UK, but I should point out that the condition does not affect children only. There are 400,000 people of all ages with type 1 diabetes in the UK and, currently, 35,000 children and young people have diabetes, 93% of whom have type 1 diabetes. It is important that we understand the difference between type 1 and type 2 diabetes, because, all too often, the two conditions are dealt with in the media as though they were one and the same thing. For example, a prominent businessman, Jim Ratcliffe, was recently quoted in The Sunday Times as saying:

“Childhood diabetes didn’t exist when I was growing up. It was an old man’s disease. But now lots of kids have diabetes. They are eating so much sugar that by the time they are 16, the pancreas is giving up the ghost”.

That is quite simply a misunderstanding of type 1 or childhood diabetes. Type 1 diabetes has absolutely no connection to dietary habits or a lack of exercise; it is an auto-immune condition and, as such, cannot be prevented. All people who suffer from type 1 diabetes have to deal with the consequences, which, for the most part, are inescapable and unremitting. A daily battle must be conducted to maintain blood glucose level within the medically safe range, balancing food and insulin intake, while taking into account physical activity, stress levels and temperature.

Young diabetics can take up to eight daily insulin injections and often have to perform invasive blood testing even more frequently. Yet according to research by JDRF, even those who stick rigidly to the prescribed regime will fall outside the medically safe range on more than three occasions in any 24-hour period.

Not staying within safe blood glucose levels has consequences. In the short term, high levels, which are known as hyperglycaemia, at the very least cause

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fatigue, and continued high levels can lead to diabetic ketoacidosis—known as DKA—which is a potentially fatal condition. Longer-term consequences include heart disease, kidney failure, neuropathy, blindness and amputations. Low blood glucose levels, known as hypoglycaemia, cause dizziness, incoherence and potential loss of consciousness and are often followed by severe headaches.

Blood glucose levels can alter dramatically, and apparently inexplicably, at any time of the day or night and require immediate attention. According to research undertaken by the National Paediatric Diabetes Audit, 85% of children and young people aged over 12 with diabetes have blood glucose levels higher than the recommended targets. That is perhaps unsurprising, because only 6% of those in that sample received the recommended care, services and support to which they were entitled.

Some children are diagnosed with diabetes in infancy, or when they are too young to take responsibility for managing their condition. Inevitably, the responsibility must be taken by family members, most commonly parents. For many families, having a child with type 1 diabetes affects them all and many adjustments have to be made to support that young person. As one young type 1 diabetes sufferer told me recently, until she was 18, she was almost entirely dependent on her mother monitoring her blood glucose and ensuring that she injected the right amount of insulin at the right time.

In advance of this debate, people contacted me about difficulties they have experienced with the Department for Work and Pensions and the disability living allowance system. Some of the problems raised arise from the fact that the DWP does not fully understand the complex needs of young people with type 1 diabetes. I would be grateful if the Minister raised that with the relevant Minister at the DWP to see whether that could be satisfactorily resolved.

Two young type 1 diabetics, Lauren and Nicole, both told me that they had experienced bullying at school as a result of their condition. Nicole, who is 16, states that she

“frequently experienced bullying because of my diabetes and because everyone thought it was because I was fat”.

Several young people have commented on the embarrassment that they feel at having to inject insulin in public. In some cases, they have been referred to as drug addicts, or been asked not to inject or test their blood, as others find it offensive.

I made two visits recently to the diabetes centre at Aintree university hospital and the specialist diabetes services team at St Helens and Knowsley Teaching Hospitals NHS Trust, both of which provide outstanding services for type 1 diabetics. They have a different range of specialisms to call on beyond the use of nurse specialists and diabetologists. For example, they can refer to psychological or, where appropriate, psychiatric services.

Alison McGovern (Wirral South) (Lab): I pay tribute to the work that my right hon. Friend has done in this area. Before he moves off the stigma issue, does he agree that we need to think about how we can raise awareness among young people? Does he also agree that social media organisations need to be responsible but not

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afraid about stigma arising from the use of needles and so on? We need to talk frankly and honestly about type 1 diabetes and its consequences for young people, so that those with the condition do not feel in any sense as though they must hide away.

Mr Howarth: I am grateful to my hon. Friend for that intervention. She is quite right to say that social media has an important role to play. I will say more about that shortly, but one example was drawn to my attention where Facebook removed an image of someone injecting on the grounds that that was offensive. That is offensive, but not in the way that it thought. I will say something more positive about how social media can be used in a few moments, but it is important that more people understand exactly what we are saying.

I was talking about psychiatric services. On a national scale, psychological support is not necessarily integrated into the diabetic service, and the practitioners are therefore unlikely to have sufficient understanding of diabetes. Psychiatric services are even more difficult to access, and I am told that patients can wait up to two years for an appointment. In some cases, that is a matter of life and death. The diabetes attitudes, wishes and needs survey, known as DAWN, published in Diabetic Medicine, interviewed 15,000 people in 17 countries and found that people with diabetes are more likely to suffer from depression. Those services are therefore very important.

I want to say a little about young people with type 1 diabetes who also have an eating disorder. According to the charity Diabetics with Eating Disorders, as many as 40% of young women between the ages of 15 and 30 admit taking insulin as a means of achieving weight reduction. The phenomenon sometimes referred to—although it is not a medical term—as diabulimia is increasing. Rapid weight loss is achieved when diabetes is left untreated, but the consequences can be catastrophic. DKA, a potentially fatal condition where the body turns on itself for energy, rapidly develops. Even if it does not prove fatal, it can result in serious health complications.

Diabulimia is difficult to diagnose and there are no current NHS guidelines on how to deal with the issue. Young people can be treated for their diabetes and for an eating disorder, but there is no integrated thinking to cover the two elements of care. Yet the treatment for a diabetic with an eating disorder is quite different from that for a person without diabetes. DWED has provided an example of a young woman who was admitted to a unit dealing with eating disorders, where no insulin needles were available and where the patient was fed via a tube without any insulin being administered. That exacerbated the problem that the unit was supposed to be treating.

There is a clear need for a more integrated service, with mental health professionals who have a knowledge of diabetes. A further and tragic example from DWED illustrates the point well. Jane, the mother of Rhys, a young man who was suffering from diabulimia, repeatedly requested that he be assessed psychiatrically. She did so every time her son was admitted to A and E suffering acute DKA, which happened on several occasions. She repeatedly raised it with the diabetes clinic and with the community mental health team. Unfortunately, her pleas

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were ignored, despite her saying that she was terrified that she would find her son “dead in bed”, and her son lost his battle with diabulimia on 25 July 2009. The ombudsman concluded that

“had a more coordinated and holistic care plan been put place it might have resulted in a different outcome.”

Jane has been fighting for recognition since 2009, and says that there was never an investigation into why her son died, which she attributed to his mental health problems. That was another complaint upheld by the ombudsman.

There is a serious need for a much more integrated service, so that all aspects of the treatment of type 1 diabetes can be dealt with together. There must be greater investment to ensure that emotional and psychological support becomes an accepted and routine part of management for all children with diabetes and that appropriate services are in place. Incorporating psychological services with routine clinic visits would avoid much of the stigma associated with treatment for mental health problems. In addition to regular clinic attendances, young diabetics require separate appointments for special eye checks and chiropody. Those should be available under one roof in an effort to improve the care achieved.

I am grateful that the urgent need to improve access to and integration of services is now being recognised with the introduction of the best practice tariff for paediatric diabetes. From April this year, the standards included in the best practice tariff are mandatory for all paediatric diabetes units, and the tariff has been extended to cover in-patient care, which will hopefully incentivise lower admission rates. However, I would argue that the best practice tariff should be extended to include all young patients up to the age of 25. Each young person is different, and transition from child to adult services must happen at a stage and time appropriate to them. The current cut-off for the tariff is 19, but the available data suggest that that is too soon, because 25% of all hospital admissions for diabetic ketoacidosis involve young people aged 16 to 25; the annual cost is £5.3 million. Extending the best practice tariff to 25 would provide an opportunity for better alignment of the service with the needs of young people.

Steve Rotheram (Liverpool, Walton) (Lab): My right hon. Friend is making a powerful speech on an issue close to his heart. I hope that hon. Members will know his family circumstances. He is raising an important matter; there is a need to inform a much wider audience, not only so that everyone will be more aware of problems and issues to do with type 1 diabetes, but to inform people with the condition who believe they can manipulate their insulin intake for one reason or another. Does he believe that more should be done to highlight the problems that can arise when people do not stick rigidly to their insulin intake regime?

Mr Howarth: My hon. Friend makes his point well, in support of my argument, and I am grateful.

One in four children are diagnosed with type 1 diabetes when they are already in DKA, and the rate is even higher for children under the age of five. A number of clinicians I have met recently have advocated the removal of barriers between primary care and specialist teams, arguing that primary and secondary care teams should

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be sharing their expertise with one another in an attempt to close the skills and knowledge gap. In Merseyside, for example, specialist nurses have been working as mentors in practices to support primary care development and tackle deficits of knowledge, skills and confidence. Education is a major component of the improvement of care and outcomes. In many European countries, diabetes-specific training is mandatory for health care professionals who provide paediatric diabetes care. That is not the case in the UK. Although there has been a huge amount of work in the past five years to improve education for health care professionals, investment is needed to ensure that all paediatric units can access nationally standardised and accredited training.

David Simpson (Upper Bann) (DUP): I congratulate the right hon. Gentleman on securing the debate. There are young teachers in schools in my constituency who are reluctant to inject children who are insulin-dependent. Surely, something more in the way of education and awareness needs to be done about that. Parents cannot come in to do that, so it needs to be done by someone such as a teacher or a nurse in school.

Mr Howarth: There are a number of problems to do with primary care. Sometimes, the lack of knowledge is appalling. The fact that on many occasions young people can go to a GP with what turn out to be classic diabetes symptoms without being diagnosed is a serious problem and needs to be addressed. The hon. Gentleman is right that education programmes for health professionals are important. It is equally important for people working in GP practices or other primary health care settings to be aware of the phenomenon that they are dealing with; otherwise they will make wrong decisions and give wrong advice, which in some cases can make things even worse.

We must prioritise access to education for self-management for children and young people. I am optimistic about the introduction under the best practice tariff of the requirement that children and young people will have access to education. There is, however, huge concern about the variety and standard of education. Considerable work is needed to ensure that what is offered is nationally standardised and tailored to meet the needs of children and young people, as well as their families. Unfortunately, there is no single best practice model throughout the NHS, although I am aware that the Government’s national clinical director for obesity and diabetes, Dr Jonathan Valabhji, understands that and is working with diabetes groups to find the best way forward. Today, I simply ask the Minister to take an active interest in Dr Valabhji’s work and to provide the support necessary to make progress.

I am told by those involved in diabetes that much research is focused on type 2 diabetes and that the principal source of funding is often pharmaceutical companies. That is of course welcome, but whereas with type 2 diabetes pharmaceutical companies can see long-term benefit in new and existing products, such a link is less clear with research into type 1 diabetes. There are some counter-examples, but it is an issue that needs addressing, so it is crucial for central Government to invest in type 1 diabetes research. Despite the UK having the fifth highest incidence of type 1 in the world, our contribution to type 1 research per capita is currently less than half that spent in the United States or Australia.

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A more positive story can also be told, however. Many young people now use insulin pumps. Last week, I met 23-year-old Alex, who told me how her pump had changed her life: “It’s a little like you don’t have to think about it anymore. I don’t have to get my needles out; I don’t have to offend anyone. I can have a biscuit, go to the gym. I can change it to temporary settings and go out with friends. I can do things now. Before I used to say, ‘I can’t be bothered having to plan around it.’ It only takes two seconds; it’s hidden.”

One of the research projects that holds the most hope for people with type 1 diabetes is the work to develop an artificial pancreas, which is known as an AP. The AP is in essence a combination of an insulin pump and a continuous glucose monitor. The clever part is that the two devices talk to each other via a complex algorithm. The monitor automatically checks blood glucose levels and then, in effect, tells the pump exactly the right amount of insulin needed by the body. Such technology holds great promise to help people to safely achieve the recommended blood glucose control, as well as alleviating an enormous amount of the burden associated with self-management. Recent trials of the device have been encouraging.

A consortium led by the type 1 diabetes charity JDRF is leading the development of the AP. JDRF’s artificial pancreas consortium encompasses 22 institutions worldwide participating in the study. It is a great credit to the UK’s life sciences sector that we can count Cambridge, Leeds and University college London among the contributors, alongside Harvard, Yale and Stanford. Another artificial pancreas, developed by Professor Joan Taylor of De Montfort university, could have its first human trials by 2016. It has a reservoir of insulin kept in place by a special gel barrier, which liquefies when glucose levels rise, releasing insulin to the liver, thus mimicking a normal pancreas. As the insulin lowers the glucose levels, the gel reacts by hardening again and preserving the reservoir. Such research is an important step towards developing a portable, usable and safe AP system.

To return to the point made by my hon. Friend the Member for Wirral South (Alison McGovern), social media are increasingly used to help and support young diabetics. Many young people with diabetes experience a sense of isolation and have no contact with others who share their condition. A good example of young diabetics helping themselves is the 18-to-30 support group Circle-D, which was founded by the inspirational Shelley Bennett and is celebrating its sixth birthday today—congratulations to Circle D. They have regular social activities and a rant room where people can have a rant and share experiences before going to the pub. Their motto is “you are not alone” and they now have a massive network of diabetics of all ages offering support online, via Facebook and in person. Another group, targeted at teenagers and young adults, is Hedgie Pricks. Information about both organisations can be found online, and I would certainly encourage young diabetics to get involved and to share their experiences with others in a similar position.

The debate today is an opportunity to praise the steps that are being taken to improve paediatric diabetes care and to pinpoint where we need to do more. With that in mind, I reiterate my support and optimism for the best practice tariff. Given that the tariff was only introduced

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recently, I hope that the Minister agrees that it would be sensible to return to the subject of type 1 diabetes in young people once we have had a chance to see how well that is working.

In the immediate future, however, the Government can and must do more. I would welcome the Minister commenting on extending the best practice tariff to 25, ensuring that children and young people with type 1 diabetes get the psychological support that they need and ensuring that educational standards for health care professionals and for children and young people with diabetes and their families are nationally standardised and accredited. I will be grateful to learn of any steps that the Minister can take to increase our contribution to type 1 research.

I have one final point to make. I feel strongly that the issue of type 1 diabetes needs a champion within the Government. I hope that the Minister will rise to the challenge and provide the political leadership that is so needed if we are to tackle this important matter.

Mr Dai Havard (in the Chair): Six people wish to speak. I am looking at the time for planning purposes. We have just over an hour left, with 10 minutes each for the Front Benchers. I am trying to gauge the time, but you can do the mathematics for yourself. To be fair to one another, if you could plan for about seven minutes or something of that nature, that would be helpful.

9.57 am

Mark Field (Cities of London and Westminster) (Con): From our joint experience on the Intelligence and Security Committee, I am well aware that the right hon. Member for Knowsley (Mr Howarth) has a robustness at times, and perhaps he would have liked to be judge and jury in today’s debate. I congratulate him, above all, on bringing the subject to the House. I am well aware that, as alluded to earlier, these are issues that are very close to his heart, and he speaks with immense knowledge and passion about this particular affliction.

I wish to contribute a few words to the debate, because the subject has been raised a number of times with me at constituency level in recent months. As we have heard, type 1 diabetes is a chronic and life-threatening auto-immune condition, which is caused when the body mistakenly attacks the insulin-producing beta cells in the pancreas. It is a separate and distinct condition from the more common and perhaps more widely known type 2 diabetes.

Estimates put the number of people in the UK with type 1 diabetes at as high as 400,000, which means that each and every MP in the UK has, on average, some 500 constituents suffering with type 1. As recently as 2010-11, it was thought that the direct and indirect cost of type 1 diabetes alone to the UK was around £1.9 billion; judging by the growing rate of increase, it is feared that by 2036 that figure could rise to some £4.2 billion each and every year.

A few months ago, a mother in my constituency wrote to me explaining exactly what life was like, day by day, hour by hour, caring for her young child with type 1 diabetes. She described how her experience reminds her daily of the urgency and importance of finding a

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cure. My old friend and colleague on Kensington and Chelsea council, Rupert Cecil, has a delightful 10-year-old daughter, whom I have got to know throughout her life; she has similarly suffered from type 1 since infancy and requires constant monitoring. Rupert and his wife, Juliet, have tirelessly raised funds for and awareness of the condition since Polly was diagnosed with this life-threatening and incurable illness at the age of two and a half.

From the outside, Polly is just like any other 10-year-old, but a close look may reveal a wire poking out from under her school uniform and attached to something resembling a money belt. This is the insulin pump that Polly relies on from day to day. It is the artificial pancreas to which the right hon. Gentleman referred. She is attached to it each and every day and will be for the rest of her life. Without it, she could not survive longer than 24 hours. In addition to her insulin pump, her parents must test her blood by pricking her finger at least five times a day. They often have to wake her in the middle of the night to give her glucose if her sugar levels have dropped dangerously, or some insulin if they are running high. That is the daily tightrope that is walked by each and every parent of a young child with type 1 diabetes.

Ian Lavery (Wansbeck) (Lab): I understand what the hon. Gentleman is saying about his friend’s young child, but many young people, particularly in areas of social deprivation, cannot access insulin pumps unless they buy them, and I believe that they cost around £1,500 or £2,000. If people do not have the money, many of them suffer greatly.

Mark Field: That is a fair comment and I hope the Minister will comment on it.

I want to touch on an imaginative and innovative scheme in my constituency at St Mary’s hospital, Paddington, which is part of the Imperial College Healthcare NHS Trust and which I visited recently. I hope that it will not only raise awareness, but reduce the cost to which the hon. Gentleman referred. During my recent visit, I discussed the everyday realities for diabetes sufferers.

The International Centre for Circulatory Health is based on the St Mary’s hospital campus of the Imperial College Healthcare NHS Trust, just behind Paddington station. Imperial college has published some of the lowest amputation rates in the world from its diabetic foot service, led by Dr Jonathan Valabhji. It has a large diabetes technology centre that is closely linked with a research programme developing closed-loop insulin delivery for type 1 diabetics and novel continuous glucose sensor devices. Its clinical technology research is led by Dr Nick Oliver, who talked me through the pioneering work he is doing to develop the artificial pancreas system for everyone with type 1 diabetes. I hope that that will also reduce the costs to which reference was made earlier.

That ground-breaking research aims to offer the next best thing to a cure for type 1 diabetes patients in the future. I saw for myself how a small, discreet device, connected to the blood stream via micro-needles, can monitor glucose levels. When paired with insulin and glucagon pumps, the artificial pancreas should be able to give diabetics an approximate response to blood sugar levels close to what a body would normally produce. With consistent levels of insulin delivered, sufferers are

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liberated from the constant monitoring and worrying that comes with the daily management of the disease. The St Mary’s site is just one research centre forming part of a global effort that could help to change the lives of many of the 400,000 people who are living with type 1 diabetes, and save the NHS a significant proportion of the money that is currently spent on treatment.

The artificial pancreas system has three components. Two, the insulin pump and continuous glucose monitor, are available. However people with type 1 diabetes face difficulties trying to access insulin pumps despite a supportive technology appraisal from the National Institute for Health and Care Excellence. Indeed the national uptake of insulin pump therapy stands at just under half the NICE benchmark, set as long ago as 2008, which is extremely low and means the UK is lagging behind many western countries. There seems to be consensus among those working in diabetes research that greater investment from the Government is vital to drive developments in this area. At present, our Government invest less per capita than the US, Australia and Canada in type 1 diabetes research.

I am aware that there is some joined-up thinking, not least by my right hon. Friend the Minister for Universities and Science, but I would be grateful if the Minister here told us how the Government will work to ensure that the sort of treatment for type 1 diabetes sufferers will be matched up to the level of other western nations, what more can be done to fund pioneering research, and how we can roll out the level of service received by patients at Imperial college to patients throughout the country.

I am pleased that so many hon. Members are here today. We all have our contribution to make and I look forward to hearing what they have to say. The 400,000 sufferers and their many millions of relatives and carers will be cheered that we are treating the issue seriously.

Mr Dai Havard(in the Chair): Thank you, Mr Field, for managing your time well with an intervention.

10.5 am

Mr Alan Campbell (Tynemouth) (Lab): As ever, Mr Havard, it is a pleasure to serve under your chairmanship. I am grateful to my right hon. Friend the Member for Knowsley (Mr Howarth) for securing this important debate and for the way in which he opened it. He knows better than almost anyone else the terrible price that this condition sometimes forces sufferers to pay and its impact not only on individuals, but on their families. If the Government need a champion for the matter, they could not find a better one than my right hon. Friend.

My short contribution will support many of my right hon. Friend’s points, but first I want to thank the health care professionals involved in the management and treatment of this condition, particularly those at my North Tyneside General hospital. As we have heard, diabetes affects around 35,000 people aged under 19, 90% having type 1 with a peak age of diagnosis between 10 and 14. We are making good progress in the treatment and management of type 1 diabetes, including among young people, but we have a long way to go. I am no scientist, but my fervent wish is that we find a cure not just in my lifetime but much sooner. Important work is being done in this country and elsewhere on stem cell research, which is a possible route to finding that cure.

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I welcome the Prime Minister’s interest in promoting the work of the UK-Israeli partnership. It is important when Prime Ministers take an interest in a particular issue, but I echo the points made by my right hon. Friend that we must look at where the funding is coming from, where it is being directed, and the overall amount.

My first brief point is about timing. Type 1 diabetes in young people often occurs at a difficult time in young people’s lives when they are struggling to cope with the physical changes that come with being a teenager. After an acute episode they often find themselves managing a chronic condition. They may be struggling to come to terms with a new health regime and may suddenly find themselves being treated in the NHS as an adult. That difficult transition may lead to a break in service, and add to complications further down the line with damaging consequences.

The statistics for young women with type 1 diabetes are startling. Young women between the ages of 15 and 34 have a mortality rate seven times higher than the general population. I welcome the introduction of the best- practice tariff up to the age of 19, but ask the Government to consider extending it to 25. That would allow greater continuity of care and a more flexible transition, which should be based on clinical need and not age.

Type 1 diabetes is more than simply a physical condition, although it is that, and health care has improved in many ways with advice on diet, the massive impact of accessing eye tests and checking feet regularly, but there is a psychological impact. Anyone with a serious chronic condition that will last the whole of their lifetime will think about that and may become depressed at some point. I do not know enough about anorexia or bulimia to comment, but I do know that type 1 diabetics must at some point in their lives not only think about it but become depressed as a result. Therefore, access to psychological services should be part of the offer that is made. That should, when necessary, involve family members as well, because it is not just about the individual, but about their family.

I very much welcome the professional pathway that has been created for paediatric diabetes as a specialism, but, as my right hon. Friend and the hon. Member for Cities of London and Westminster (Mark Field) mentioned, we need to ensure that health care professionals are also aware of the condition and are supported by clear national standards. I would like that to be extended to teachers and other staff in schools as well. It is as important that the person looking after the dinner queue knows about diabetes in young people as it is that the person at the front of the class teaching them knows. That is why I support very much Diabetes UK’s “Make the Grade” campaign. I want every young person with type 1 diabetes to get the health care that they need, but I want them to get the educational opportunities as well. I want them to do well and go on to further and higher education. I want them to be able to take part in school sport and school visits without being worried and without the member of staff with them being worried.

The Government have produced figures—we have heard them today—about the cost to the NHS of diabetes. We have heard that the figure is £1.9 billion and rising, but, as ever, behind those statistics are thousands of

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young people with type 1 diabetes. Frankly, we could do more, and Government could do more, to make their lives not only better, but longer.

10.11 am

Caroline Nokes (Romsey and Southampton North) (Con): It is always a pleasure to serve under your chairmanship, Mr Havard. I add my congratulations to the right hon. Member for Knowsley (Mr Howarth) on securing an important debate. He will recall that previously—I think that it is now nearly two years ago—I led a debate in this place on eating disorders. He came along and enlightened everyone present about the problems with diabulimia—a condition that until that point I had never heard of—and he has done the same today. As the chairman of the all-party group on body image, I am very conscious of the way in which young diabetics—I have said “young” and I shall probably focus on women; I appreciate that people of all ages have type 1 diabetes and that eating disorders affect men as well as women—and, in particular, young women are manipulating their use of insulin to achieve very rapid weight loss, which poses a very significant risk to their health.

Diabetes is an entirely manageable disorder. It takes some time, experience and a lot of work for the sufferers to come to terms with it, but they can manage it. However, when it is combined with body-image issues, it can have terrible and long-lasting effects and, in some tragic cases, it can be fatal. Today, therefore, I want to focus on the issue of eating disorders among those with type 1 diabetes.

Of course, I appreciate that young people with diabetes face many issues and problems. I had a great Easter card from a six-year-old constituent of mine, Isabelle. She uses an insulin pump, as many people do, but she still has to test her blood sugar levels six times a day. I know from her letter that she is a fantastically brave young lady. She has specifically asked me to raise with my hon. Friend the Minister the issue of research funding and has highlighted the work of JDRF, which we all agree does amazing work in this area.

The all-party group on body image does a great deal of work to emphasise the pressures that young people in particular are under to conform to our so-called beauty norms, and part of that of course is about weight. It is shocking but true that too many people are prepared to sacrifice their health and well-being just to be thin. I have a view on the role that the media play in that. I am talking about the manipulated images—the use of Photoshop and airbrushing to create digitally an image of so-called perfection that of course in the real world is impossible to achieve.

Many young people fall victim to eating disorders, which can wreck lives. Nearly 4,000 people under 18 have been admitted to hospital with eating disorders in the past four years. That includes 270 boys and 163 girls under 10. And the situation is getting worse, not better. As the chairman of the all-party group, I have seen some of the most horrific consequences of eating disorders, but if they can have that effect on otherwise healthy young people—those who have previously been in good health—what effect can they have on someone who is already vulnerable?

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Most children diagnosed with diabetes receive their diagnosis between the ages of 10 and 14, which as we all know is a hard time, as it is for any teenager. They are going through puberty, experiencing physical and emotional changes and, crucially, trying to fit in with their peers. Let us now take ourselves back to those years—that may be hard for some of us—and imagine reeling from a lifelong diagnosis, a diabetes diagnosis, and having to deal with the other pressures on us at that stage in life. Suddenly, the weight-loss benefits that can be had from diabulimia might seem highly attractive.

We have heard about social media and how that can be a force for good. Sadly, it can also be a very detrimental force. A quick scan of Google will show that there are many forums and chatrooms where advice is given on how to control diabulimia and how to use it to drop weight dramatically.

The prevalence of depression is twice as high among people with diabetes as it is among the general population. Particularly when people are at this vulnerable age, a diabetes diagnosis can cause dangerous levels of depression. Other hon. Members have mentioned the stigma. I was very upset to hear of a primary school in my constituency that did not want to manage a young lad’s diabetes through his being allowed to have tests and insulin injections in the classroom. It felt that that would upset other pupils. My ex-husband is a diabetic and routinely injected in front of our at that point very young daughter and, indeed, her friends. They were never upset by that; in fact, they had a morbid fascination with it and were all gripped to watch it go on. I think that it is a positive thing for children to learn from a very young age that other children have conditions that they can manage perfectly safely, that involve injections and that are not a reason for fear or stigma.

Obviously, diabulimia—the practice of reducing insulin injections to reduce calorie absorption and therefore cause rapid weight loss—is hugely unhealthy. It is one reason why the mortality rate for women with diabetes who are aged 15 to 34 is seven times higher than that for their non-diabetic counterparts. Of course, death is the most extreme consequence of diabulimia, but it is not the only one. One hundred amputations are carried out every week as a result of diabetes, and diabetics are 20 times more likely to go blind than non-diabetics. With poor management, those disabilities become far more likely. After those effects are seen, it is often a steeply downhill slope: 70% of amputees die within five years of the operation.

The combination of eating disorders and diabetes is so deadly that groups such as Diabetics with Eating Disorders have been formed to deal directly with the issues. They have found that far from a tiny minority, about 40% of 15 to 35-year-olds regularly omit the use of insulin in order to lose weight. Some people might try to pass that off as young people simply forgetting, but when we factor in that 25% of all hospital admissions for diabetic ketoacidosis are in the 16-to-25 age group, it becomes hard to believe that such a consistent and extreme lack of insulin is entirely a result of forgetfulness.

Clearly, the problem of diabetes in conjunction with body-image issues is a more widespread threat, especially to young people, than is widely known. There are some fairly obvious conclusions. Young people must be convinced to adhere to strict care processes, but efforts must also be made to identify those who might have psychological

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issues and who could do with support by means of a united, combined approach to both their diabetes and their eating disorders. It is unusual to find a diabetes nurse with experience of eating disorders and an eating disorders practitioner who knows about diabetes. We must address that, and I urge the Minister to make a response on it. I hope that this debate has drawn his attention to these issues and that he will share with us his views on what more can be done to identify, assist and properly care for this important group of young people.

10.18 am

Jim Shannon (Strangford) (DUP): I thank the right hon. Member for Knowsley (Mr Howarth) for bringing this issue to our attention in Westminster Hall today. It is good to have a subject that we can all relate to and on which we can speak on behalf of our constituents. The right hon. Gentleman has knowledge of it on a very personal basis.

I was just sitting here and thinking about those deep sleeps that people get into—not that we often have them, Mr Havard. Young children who are diabetic are woken out of their sleep and will wonder what is happening to them. Someone—one of their parents—takes their hand, pricks their finger and checks their blood. That is the reality that many children in the UK face today, and many parents have the same reality because they have to wake them up during the night and have to set the alarm for that purpose. They have regularly to monitor and check their child’s blood sugar levels. It is surprising just how many children have to go through that every day.

The UK has the fifth highest rate in the world of children with type 1 diabetes. In Northern Ireland, there are 1,092 children with type 1 diabetes. The hon. Member for Cities of London and Westminster (Mark Field), who has just left the Chamber, referred to there being 400,000 diabetics in the United Kingdom. In Northern Ireland, we have almost 80,000; one fifth of the diabetics are in Northern Ireland.

Mr Gregory Campbell: When my hon. Friend refers to the high prevalence of diabetes in Northern Ireland, as well as across the UK, does he agree that need for greater emphasis on research, which has been repeatedly raised this morning, is a fundamental way to address the increasing problem? The UK, and the various regions thereof, must place greater emphasis on higher expenditure and greater research to ensure that future generations do not suffer in the same way as the present generation.

Jim Shannon: I thank my hon. Friend for that contribution. He and other hon. Members have reiterated the need for research, including stem cell research, to enable us, I hope, to come up with a cure for diabetes. The prevalence of diabetes in Northern Ireland is now more than 4%. In addition to almost 80,000 people in Northern Ireland who have diabetes, some 10,000 have not yet been diagnosed. As an elected representative, I have had the opportunity to fight cases on behalf of parents who are under intense pressure because they have a type 1 diabetic child. In Northern Ireland, health is devolved. We have been able to speak to the Minister, Edwin Poots, and through his office and through the pressure that we and others have created, we have

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succeeded in getting the health service in Northern Ireland to provide 400 insulin pumps for type 1 diabetics. Getting the pumps is only one part of the story. The second part is to train people to use them, so the second stage of the process has been training parents how to do that. Good things have happened.

Diabetes has increased in Northern Ireland, but it has also increased worldwide. Type 1 and type 2 diabetes have increased by 33% in Northern Ireland, by 25% in England, by 20% in Wales and by 18% in Scotland, and some 24.5 children in every 100,000 aged 14 and under have diabetes. That shows the magnitude of the problem. The Minister is responsive and has a particular passion for health. He has attended, as have others in the Chamber, the type 1 diabetes events that have taken place here with young children. Those events have given us all a chance to see how important the issues are. We have far higher rates of diabetes in children than do Spain or France. In Northern Ireland, there are 1,092 children under the age of 17 with type 1 diabetes, and almost one in four of them experienced diabetic ketoacidosis before a diagnosis was made.

In my constituency, the number of diabetics has gone up by 30%, with 800 people becoming diabetic in the past seven years. I should have registered an interest at the beginning of my speech. I am a type 2 diabetic, and I am one of those 800 people who were diagnosed in the past seven years. In our small part of the United Kingdom, the total number of adults aged 17 and over who have diabetes and are registered with GPs is just shy of 76,000, and there are a further 1,092 under the age of 17. Diabetes UK Northern Ireland has launched a report that highlights the latest findings into diabetes in Northern Ireland, and I think it is important to put those figures on record. The Diabetes UK Northern Ireland national director Iain Foster said:

“The State of the Nation report is a timely and important piece of work which highlights, not only that Northern Ireland has seen the biggest rise in people being diagnosed with diabetes compared to the rest of the UK but that there is a real difficulty in collecting data as Northern Ireland is not included in the National Diabetes Audit. Our State of the Nation report gathers limited local information and we have found that there are now over 80,000 people living with diabetes in Northern Ireland.”

The official figure is just shy of 76,000, but the latest figures from Diabetes UK Northern Ireland indicated that more than 80,000 people are affected. Therefore, within the past five years, there has been a 33% increase in Northern Ireland in the number of people living with type 1 or type 2 diabetes. More than 100 new diagnoses are expected each year if the current trend continues, and 4% of the local population now has a diagnosis of diabetes.

I cannot emphasise enough that diabetes is a ticking time bomb, which has the potential not only to destroy lives, but to bankrupt the NHS. The financial cost of diabetes cannot be discounted. I agree with Iain Foster:

“It is not enough to shout from the side-lines: ‘something must be done’”—

we have been talking today about what must be done, and we want to see what will be done—

“so instead we have outlined ways in which we think the situation could be helped, for example, working to enable access to available treatments including insulin pumps for both adults and children and integrating diabetes clinical databases to create an accurate diabetes register.”

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My hon. Friend the Member for Upper Bann (David Simpson) and the right hon. Member for Knowsley referred to education. It is so important, as hon. Members have said, for teachers, classroom assistants and staff in our schools to be aware of what it means to be a diabetic in school. In Northern Ireland, we have implemented a system of training for teachers and classroom assistants to ensure that they have the knowledge to deal with the condition.

In conclusion, I ask the Minister to outline what co-operation exists between regional assemblies to deliver a better strategy for the whole United Kingdom. He will be aware of the 10-year strategy that ended in 2013. I have asked on a number of occasions for a new strategy to be put in place, because it is important that all the regions of the United Kingdom of Great Britain and Northern Ireland work together to deal with the problem. To address the issue of the many children who suffer from diabetes, and many more who are predicted to be diagnosed, we must take action and take it now. I congratulate the right hon. Member for Knowsley on bringing the matter forward, and I urge the Minister to do more than simply talk about it. He must take action quickly, while there is still time to make safe this ticking time bomb.

10.26 am

Mr Adrian Sanders (Torbay) (LD): I congratulate the right hon. Member for Knowsley (Mr Howarth) on securing this important debate and on his comprehensive introduction to the problem. As has been said, the UK has the fifth highest rate of diabetes in the world and the fifth highest rate of diabetes among children aged up to 14 in Europe. It is important for us to do the best we can to help people with the condition.

I cannot emphasise enough the importance of getting across the difference between type 1 and type 2 diabetes. They are both chronic conditions, but type 1 is known to be genetic while type 2 is a consequence of lifestyle and diet, and is not necessarily related to genetics. Consequently, the treatments for type 1 and type 2 are varied. People with type 2 can be treated mostly with a change in diet and exercise, and some medication. Increasingly, however, insulin injections are being prescribed for people with type 2. People with type 1 are those whose pancreas has basically stopped producing insulin, and they have to take insulin via subcutaneous injections. There is no alternative to that treatment for people with type 1. Additional medication can be added to the insulin regime to reduce the risks of common complications that can affect all people with diabetes, such as stroke, heart disease, sight loss and limb amputations.

Only one in five people with diabetes is type 1, and most are diagnosed before the age of 40. I was fortunate to have been diagnosed after I had finished full-time education, because type 1 diabetes can have a major impact on a young person’s life and health in many ways—educationally, socially and psychologically. One of the major problems for children is how they treat themselves for their condition at school. There are three stages through which a young person has to go. There can be problems at primary school, which have been referred to, where teachers may refuse to help the child medicate. Some schools will not admit a child because

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they have diabetes. Others will admit the child but will insist that the parents come in to do the blood test and help the child deliver the insulin. That is not fair to the parents, and it increases the overall cost of the condition to the taxpayer.

In secondary school, there is the problem of the young people themselves, which has been mentioned. There are psychological difficulties inherent in having to set themselves apart from the rest of the school because they have a condition that requires them, from time to time, to test their blood sugars—that means a simple finger prick to take blood out of their finger and put it on to a test strip—and find somewhere healthy and clean to use their pen, which looks like a normal pen but is in fact an injection device, to make an injection.

The next stage is higher education, where the young person will move from their GP setting to a student health service. Transition is a major issue, and every young person with diabetes should experience a smooth transition to adult diabetes services at a stage and time right for them. Adolescents with diabetes have unique health requirements. They must cope with the biological, psychological and social transitions to becoming an adult while managing a chronic condition. Many people experience deterioration in their control of their diabetes in adolescence, and they are particularly vulnerable as their care is transferred from child to adult services.

Adolescence is also a time when lifelong health behaviours are laid down, so transition must be carefully instigated at a time when the young person has sufficient clinical understanding of managing their condition to get the most out of the adult diabetes service. If that does not happen and young people are simply transferred to adult services, they will often disengage with the service, leading to poor control and an increased risk of long-term complications.

The importance of getting transition right for young people with diabetes is increasingly acknowledged across the international health care arena. That is reflected in the best practice tariff, which includes the criteria that provider units must have a clear policy for the transition to adult services. Will the Minister explain why the best practice tariff cannot be extended—as was asked for earlier—to include all young people up to the age of 25?

The other big issue is the regional disparity of care. The problem is not just about access to medical equipment such as insulin pumps, although really that should not be an issue at all. All children diagnosed with type 1 diabetes should be offered pump treatment on diagnosis, and I would like to ask the Minister a second question: why is that not so? Parents who have engaged with the paediatric diabetes peer review have expressed to me their concern at the plan to discontinue the programme this September.

As we have heard, there is huge regional discrepancy in the provision of care for children with diabetes, in terms of both patient experience and outcomes, with the number of children achieving target HbA1cs falling woefully short in some areas and compared with other countries. Parents have been very impressed by the work of the networks to try to address variation and achieve considerable improvement. However, there is still a long way to go, and the audit can provide only benchmarks and goals, not strategies for achieving higher standards.

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The peer review programme, on the other hand, has been meticulously and carefully designed to address the causes of discrepancies in care standards. The programme managers and lead clinicians in each network have worked hard to design a set of measures that enable teams to understand more fully how to provide the highest standard of care for the children who attend their clinics. It seems that the peer review programme has the power to drive change and raise standards across the country, ensuring that children with diabetes can lead healthy and productive lives.

My third question to the Minister, therefore, is why is the paediatric diabetes peer review programme being discontinued? The lifetime cost to the UK economy of everyone living with type 1 today will be more than £55 billion. With the incidence rising, that figure will only increase, and remember that only one in five people with diabetes is type 1. The three priorities for type 1 or type 2 diabetes, whatever a person’s age, must therefore be prevention, early diagnosis and the best treatment to avoid expensive complications. Where young people are concerned, whether children or young adults, we can and must do better.

10.33 am

Caroline Lucas (Brighton, Pavilion) (Green): It is a pleasure to serve under your chairmanship, Mr Havard. Like other Members, I congratulate the right hon. Member for Knowsley (Mr Howarth) on securing such an important debate. It is interesting how much cross-party agreement there is on this issue—I hope that that clear message is reaching the Minister.

I shall be repeating some points that other Members have made, but first I want to say a little about a young constituent of mine in Brighton with type 1 diabetes, with whom I have been working closely. We have been focusing particularly on good practice support for young people in schools. As a result, the local authority in Brighton and Hove is now convening separate groups of parents, teachers and young people to talk through ideas. My constituent, Izzi, is especially keen to develop a system of mentors, where older pupils with type 1 can support younger pupils in school, particularly at stressful times such as transition or during exams.

Some of the proposals we have been discussing are not rocket science—they are very simple, but would make a huge difference. For example, young people should have a safe and pleasant place to go and inject. That place should not be locked, as sometimes such places have been; it has meant that young people have had to inject in the toilets. That gives the impression that people are trying to push the issue away. As many others have already said, we must address stigma, and one way to do that is to make injection far more normal and provide much greater support for it in schools.

As others have said, it is important to stress that type l diabetes is not just a medical condition. It can have severe psychological and educational implications and affect people in very different ways. Type 1 young people need to have medical and educational support tailored to their individual needs. Just because a person does not look ill, that does not mean that they are not juggling a vast number of factors to try to keep themselves well.

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Izzi has warned that, increasingly, type 1 young people are being refused disability living allowance, despite the massive extra burden on them and their families to maintain their health. She had a DLA application turned down when she was 16, and it was obvious from the assessor’s comments that there was very little understanding of her condition and how it needs to be managed. For example, the assessor judged that Izzi’s age and the fact she has had her condition for many years meant that she was able to deal with taking her medication without help. Izzi very much wishes that that were the case, but when she is severely hypo or hyper, it simply is not.

After a great deal of extra work, she appealed against the decision and was awarded the lower rate of DLA for a further year—she had previously been on the middle rate. Many people would not have challenged that decision and might therefore be missing out on vital support. Izzi will still be only 17 when her DLA stops—not legally classified as an adult, but still supposed to be able to totally self-administer a potentially lethal drug several times a day, without any help or supervision—even when she is not able to concentrate because of high or low blood sugar levels. On behalf of many other type 1 teenagers who are or have been in the same position, she wants Ministers to understand that reality.

Izzi also wants to raise the issue of plans to scrap the national peer review programme, which the previous speaker mentioned. There are real concerns about the risk that that programme will end, as NHS England has committed funds only until September. Across the country, there is a huge difference in the provision of care for children with diabetes, in terms of both patient experience and outcomes. The peer review system provides important information and opportunities to help improvement. I would like to draw my remarks to a close by identifying a couple of areas in which peer review is important and working for children, and the benefits that it brings to families, as set out by the Families with Diabetes National Network.

Peer review measures the extent to which teams can provide 24-hour cover as prescribed under the best practice tariff. That cover is essential for families because it avoids expensive hospitalisations, and serious concerns have been raised where cover is inadequate. Peer review highlights the extent of paediatric ward staff training to ensure that children with diabetes who are admitted to hospital can be looked after safely. That is a huge issue for families, and the peer review programme has helped teams to understand better how to achieve ward staff training. Peer review also highlights the ongoing training of team members, ensuring that they are all trained to an appropriate level, which is key to the provision of good care for children.

Peer review measures the extent to which teams review patient feedback and take action accordingly. Families can help teams to improve by providing that feedback, and peer review ensures that it is both used and acted on. It also measures the extent to which teams provide self-management education to families. Self-management education is essential in keeping children out of hospital and enabling them to achieve good control and avoid complications.

Peer review measures the extent to which teams support children in school, which is an essential pillar of good self-management, and the programme has enabled teams

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to share strategies and documents and therefore to disseminate best practice. Finally, peer review examines arrangements for the transition to adult care—arrangements that, as we know, are key to ensuring that young people do not fall out of the system and develop complications at such a critical age. The peer review programme has encouraged teams to work together to address the issues relating to transition.

For all those reasons, along with the many others raised by Members this morning, I hope that the Minister can assure us that he will look again at peer review. There is real concern about it, as well as about the level of research funding, and I would like to add my voice to those who have said that the UK must do more research, particularly for type 1 diabetes.

In conclusion, I welcome the opportunity to have this debate and very much hope that it will increase awareness of the needs of young people with diabetes. There are more than 25,000 young type 1 sufferers in the UK, and, like Izzi in my constituency, they all deserve the very best chance.

10.39 am

Mr Jamie Reed (Copeland) (Lab): I, too, thank my right hon. Friend the Member for Knowsley (Mr Howarth). I know how much this means to him and his family. I am genuinely grateful for all the work that he does in this regard.

This is a vitally important debate. We have had a tremendous debate today, involving hon. Members from all parties, providing us with a brief opportunity to deal with important issues that have stood neglected for too long. People with type 1 diabetes are not receiving the services they need or the support that they deserve; this is a fact. Often—let us be honest about it—we debate pure opinion, but it is an absolute fact that people with type 1 diabetes are not getting the level of services that they require.

I declare an interest as someone who has lived with type 1 diabetes for four years, after being hospitalized as an undiagnosed type 1 diabetic suffering from advanced diabetic ketoacidosis, two weeks before the last general election. The things people do to get out of it! I have never particularly enjoyed talking about the condition, principally because our medical histories are our own private business, but also because of the risk this poses of allowing others to define me as a person and as a politician. As the hon. Member for Torbay (Mr Sanders) has proven, reservations that people might have about people with the condition are unfounded. The longer I live with the condition—it is important to point out that this is a condition and not a disease—the more angry and frustrated I become with the treatment I receive and, more importantly, about the treatment that other people living with the condition receive.

The National Institute for Health and Care Excellence recommends that type 1 diabetics should receive nine key tests for diabetes care every year, yet thousands are missing out on these tests. In the four years that I have been a type 1 diabetic, only once have I received all nine tests. These tests are essential to ensure that diabetes is controlled. If left unchecked, diabetes can, as we heard, lead to blindness and kidney failure, and can increase

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the risk of developing cardiovascular problems, such as heart attacks and stroke. The National Diabetes Audit found that young people are the least likely of any group to access these nine treatments.

We have also heard that type 1 diabetes is a chronic, life-threatening condition that has a lifelong impact on those diagnosed with it and their families. It affects about 400,000 people in the UK, including 29,000 children, which is equivalent to more than 600 people in each constituency. Type 1 diabetes is not caused by lifestyle factors, such as obesity, poor diet or lack of exercise—I should know; I have just run the London marathon on behalf of the Juvenile Diabetes Research Foundation—and there is currently no way to prevent the condition.

People with type 1 diabetes rely on multiple insulin injections or pump infusions every day, just to stay alive; we know this. In 2014, a person with type 1 diabetes will on average undertake more than 2,000 finger-prick blood tests, have 1,500 insulin injections and count the carbohydrates in more than 1,000 meals.

A child diagnosed with type 1 diabetes aged five faces 19,000 injections by the time they are 18 years old. Since my diagnosis, I have been fortunate enough to meet many young people with the condition and each and every one of them inspires me. I am incredibly grateful for the work that they do through the Juvenile Diabetes Research Foundation and through Diabetes UK. Their advocacy is superb and their voice is becoming louder, but I say to them that it needs to become much louder still.

Good blood glucose control is hard to achieve. Type 1 diabetes reduces life expectancy by approximately 12.5 years in people with the condition aged 20 to 24 years old, compared with similarly aged adults without the condition. High blood glucose can cause very serious long-term damage to the body. On average, complications of type 1 diabetes set in 20 years after diagnosis, meaning that a child diagnosed at age five may begin to show signs of damage that can lead to sight loss, kidney disease, limb amputation, heart attacks and stroke by the age of only 25.

Just 6.7% of children with diabetes in England and Wales, 96% of whom have type 1 diabetes, are receiving their full set of annual recommended checks. That is a national scandal and it should shame these Houses of Parliament. Type 1 diabetes in young children presents more than a health burden. In 2011, members of the parent group, Children with Diabetes, reported that 60% of families had to change their working arrangements and almost half—48%—had seen a significant drop in their family income. Shockingly, as we have heard, more than half felt that their child had been bullied as a result of having type 1 diabetes.

Type 1 also brings with it an increased risk of depression, with 32% of people with type 1 diabetes showing signs of depression, compared with 16% in the general public.

In addition, type 1 diabetes leads to huge costs for the health service and the wider economy. The lifetime cost to the UK economy of everyone living with type 1 diabetes today is more than £55 billion. This figure is only going one way, and that is up. In 2014, conservative estimates suggest that type 1 diabetes will cost the NHS £1 billion directly and a further £1 billion to the wider economy more generally, excluding a number of treatment costs.

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In 2008-09, the Medical Research Council invested £6.6 million in type 1 diabetes research, but unfortunately that fell to £3.9 million in 2010-11 and £4 million in 2011-12. In short, we are spending less than half the per capita figure spent in Australia—the hon. Member for Cities of London and Westminster (Mark Field) made this point earlier—and less than a third of the United States per capita figure, and the Canadians spend almost three times as much per capita as we do. Will the Minister explain why?

Incidence of type 1 diabetes is growing at a rate of about 4% each year. The recent report “Impact Diabetes” estimates that 650,000 people in the UK will live with the condition by 2035, if incidence continues at the same rate. That report also estimates that by 2035-36 the direct cost to the NHS of treating type 1 diabetes will be £1.7 billion and the indirect cost to the UK more generally will be an additional £3 billion.

The UK has the fifth highest incidence of type 1 diabetes in the world and it is increasing at an alarming rate. Research is the key to addressing this growing problem, but UK Government funding for type 1 research has fallen significantly. Let us be honest; this reduction is jeopardising our position as Europe’s number one place for type 1 diabetes research and investigation and I passionately believe that this is letting people with type 1 diabetes down.

The truth is that we are failing people with type 1 diabetes. As a nation we need a war effort—I am not ashamed to say it—in our work to improve treatments and services for people, particularly young people living with type 1 diabetes. We must ensure that every young person with type 1 diabetes receives the nine annual tests. Will the Minister explain how he thinks this can be done and what he will do about it?

Too often I hear from type 1 diabetics and their families that they cannot access insulin pumps, that blood glucose monitoring strips are being rationed and that it is getting harder to access primary care to get the help they need to manage their condition. Will the Minister take a close interest and deal with these issues where they arise around the country? There is huge, clear geographical disparity and it needs some close Government attention.

I will write in detail to the Minister about what needs to happen to improve the lives of people with type 1 diabetes. What is needed is more attention and understanding and more research and resource, to ensure that people with type 1 diabetes receive the care that they deserve. I look forward to the Minister’s reply.

10.47 am

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): It is a pleasure to serve under your chairmanship for the second time this week, the first time being during the Defence Committee sitting yesterday.

I pay tribute to the right hon. Member for Knowsley (Mr Howarth) for securing the debate and for his articulate and reasoned contribution to it, and for his passionate advocacy of the needs of people with type 1 diabetes. He has family experience of these issues that will have strongly informed his understanding of them. The balanced, perceptive way that he approached the debate, raising important issues, particularly about tariff-setting, which is in my view the strongest and best way to drive up the

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quality of care available for patients with type 1 diabetes, is of great credit to him and helped set the tone for a consensual debate. It is also a pleasure to respond to the right hon. Gentleman formally, because he responded to my maiden speech when I was first accepted into the House. He was kind to me then and I hope that my response will do this debate justice and will bring some comfort to hon. Members who have raised concerns.

I also pay tribute to hon. Members’ contributions to the debate. As always, the hon. Member for Strangford (Jim Shannon) makes important points about how, although we have devolved health systems, we need to learn lessons from best practice throughout England and Northern Ireland. It is important, even in a devolved health system, that we work collaboratively together to improve standards of care. I will try to deal with points raised in the contributions from the right hon. Member for Tynemouth (Mr Campbell) and the hon. Member for Brighton, Pavilion (Caroline Lucas).

My hon. Friend the Member for Cities of London and Westminster (Mark Field) eloquently outlined for all of us what this means on a day-to-day basis for a young person with type 1 diabetes. In many respects, that sets out the challenge for our health service: working together with the education sector and with other parts of our health and care system, it needs to help improve the day-to-day quality of life for people with type 1 diabetes. My hon. Friend the Member for Torbay (Mr Sanders) made a similar point. My hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) raised the importance of research funding. I will address those points later in my remarks.

As we have heard, type 1 diabetes has a potentially devastating effect on children’s health. Poor diabetic control for children increases their risk of developing long-term complications over the course of their lives—we have heard about renal complications, diabetic retinopathy and the consequences of diabetes-related peripheral neuropathy. Such consequences are potentially life changing, and so it is important that we do all that we can to address them and to support people with type 1 diabetes. It is a question not just of early diagnosis but of the right care and support in the secondary care setting, in primary care and in the community, to give better support to people with the condition so that they can stay well and be properly looked after. That is a challenge that we face in all aspects of the care that we provide to young people.

The children and young people’s health outcomes forum, which was set up by my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), highlighted a number of challenges faced by children with long-term conditions such as diabetes and by their families. It is worth highlighting two or three. The first was that there are poor arrangements for transition to adulthood—that has been highlighted throughout our debate. Secondly, there is a need for better integration of care, with co-ordination around the patient—the child or young person. We need a comprehensive, multidisciplinary team approach to care, with a much greater emphasis on better support for young people in the community and in their own homes. There also needs to be much speedier diagnosis of long-term conditions in young people, including asthma, diabetes and epilepsy.

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The NHS atlas of variation has identified an unacceptable variation between different areas, a point raised by the shadow Minister. That is clearly unacceptable to us all. There is variation in the quality of management of children’s diabetes, and in the number of children with previously diagnosed diabetes admitted to hospital for diabetic ketoacidosis. We all know, then, that we have some way to go on improving the care of children and young people with diabetes. I hope my remarks will be able to give some reassurance that we are now firmly on the right track, particularly with our best practice tariff.

Jim Shannon: In my contribution I outlined the diabetes strategy that was in place for the 10 years up to 2013. I have asked Ministers about that issue a number of times and am keen to see a continuing initiative for a UK-wide strategy. Will the Minister give us an idea of his intentions in that regard? That strategy could address regional variations.

Dr Poulter: As I mentioned earlier, it is important that we learn from good practice, not just in the UK but elsewhere. A key driver of improving practice is clinical audit of the quality of services delivered. Outcomes for people with diabetes in England will also be assessed by the national diabetes audit, which includes a core audit, the national in-patient diabetes audit, a diabetes pregnancy audit, the national patient experience of diabetes services survey and the national diabetes foot audit, which is due to be launched this summer. Having that high quality comparative data, gathered through clinical audit from different care settings across the UK, will help us to understand where services are and are not delivered well. Audits in particular care settings always make recommendations for improvement, and the following year there is another audit. Exposing where care is good or not so good and putting in place plans for improvement on the ground will be a big step forward. At a national level, we can then look at which improvement plans have worked and which have been less successful. That learning is a good way of driving up standards and can be shared with Northern Ireland and other devolved parts of the United Kingdom, and indeed on an international basis. I believe that in this country we are historically good at collecting data. The purpose of national audits is to drive up standards of care, which is why NHS England is putting many more national audits in place throughout the health service. We will be able to compare what is done in different care settings, learn where care needs to be better and drive up standards throughout our health service.

We all understand the importance of the integration of mental health care and diabetes care for the young people who have serious health issues resulting from that combination of issues, which puts them at high risk of complications and premature death. The Government are investing £54 million over four years to enhance the children and young people’s improving access to psychological therapies—CYP IAPT—programme. That programme is helping to transform services through training in evidence-based therapies to support children and young people with a range of mental health issues. I am sure we all support that programme and want to see it expanded further.

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I am glad to say that investment in type 1 diabetes research by the Medical Research Council and the National Institute for Health Research has risen from more than £5.8 million in 2011-12 to more than £6.5 million in 2012-13. The National Institute for Health Research is funding a £1.5 million trial focusing on children and young people with type 1 diabetes, which is comparing outcomes for patients treated with multiple daily insulin injections to outcomes for those using pumps, one year and five years after diagnosis. The report of the trial is due to be published in a few months. When we are looking at how best to support people with type 1 diabetes in leading as normal a life as possible, whether that be in education or in the workplace, it is important that we understand which interventions and methods of support work best. I am sure that that research will put us in a much better place on that.

Mr Jamie Reed: Is the Minister aware of the JDRF’s “#CountMeIn” campaign? It is calling for an investment of £12 million per annum by the MRC and NIHR to bring the UK in line with recent per capita spending by Governments internationally. Has he given any thought to that and if so will he comment on it?

Dr Poulter: With research funding there is often a bidding process, and it is up to organisations to bid for funding. I am pleased that the amount of money going into diabetes research is improving and that there is a now a project specifically on type 1 diabetes that is looking at the impact of different interventions and support—such as the use of pumps—on young people’s lives to see which methods work better. The emphasis is not just on clinical outcomes but on how young people’s experience and quality of life is affected, so that that is taken into account in how we look at diabetes. Health care research funding is moving in the right direction, and not just for diabetes—research funding has increased considerably over the past few years in a number of areas of health care, something that we should welcome.

As we know, NICE has national standards, but in the few minutes left I want to discuss the best practice tariff. The way that we set up commissioning arrangements and the best practice tariff will help us make a difference in the future. The tariff ensures that payment is linked to the quality of care provided, an important driver of how services are delivered to patients.

I will briefly set out aspects of the diabetes best practice tariff. A young person’s diagnosis is to be discussed with a senior member of paediatric diabetes team within 24 hours of presentation, to get early specialist support in place. All new patients are to be seen by a member of the specialist paediatric diabetes team on the same or the next working day, and each patient is to have a structured education programme, tailored to their needs and the needs of their family, to support them and help them understand how they can better cope with their condition and manage it themselves as best as they can. The tariff places a strong emphasis on multidisciplinary team work, including support from dieticians—we have heard about issues connected to eating disorders, and dieticians will have a key role on that. Many other aspects of the tariff focus on multidisciplinary working to put things on a better basis for young people with diabetes.

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The right hon. Member for Knowsley raised a number of other issues in the debate; I will write to him about those matters. The issue is complex and important, but I hope that I have been able to offer some reassurance. The tariff and the increased spending on research mean that we are moving to a better place with our support for people with type 1 diabetes.

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Bowling Greens

11 am

John Woodcock (Barrow and Furness) (Lab/Co-op): It is a pleasure, Mr Havard, to serve under your chairmanship. I sought this debate on behalf of bowlers—crown and flat green alike—who are facing a growing crisis that is emerging not only in the game’s traditional heartlands, such as my constituency of Barrow and Furness in the north-west of England, but wherever the cry of “jack high” is heard.

Bowling is part of the fabric of these islands. Its precise origins are obscured by the mists of time, but a form of the sport that we know today was certainly flourishing on Plymouth Hoe as far back as 1588. On the Hoe, as elsewhere in the country, the game in under threat. The reassuring click of kissing wood is gradually being replaced by the unsettling clank of mechanical diggers ripping up greens in every corner of Britain.

Local bowlers, led by green keeper Keith Mills, first alerted me to this problem soon after I became MP for Barrow and Furness at the previous election. Seven Furness greens had been redeveloped since the mid-1990s, and there were fears that more could follow. The “Hands off our Bowling Greens” campaign was born on College Green just across the way. With a bit of mowing and rolling, it would make a surprisingly good bowling green.

My ten-minute rule Bill, the Protection of Bowling Greens (Development Control) Bill, was presented to the House in March 2011. The combined pressure resulted in a promise of action from the Government. On August bank holiday three years ago, the Minister’s Department for Communities and Local Government announced that bowling greens would receive greater protection under the national planning policy framework. That move was, of course, welcome, but since then it has all gone very quiet and greens continue to disappear. In written answers, Ministers have not been able to tell me how many greens have been designated as local green spaces under the new powers. The Minister may have the figures at his fingertips now in his reply.

Our greens continue to be trapped in a vicious pincer movement. Council-owned greens are falling victim to spending cuts—as in the case of the one I recently visited at Hove at the invitation of superb local parliamentary candidate, Peter Kyle. The local Green party-run council, no less, is threatening the future of well-used greens. It is hard to believe that it is using one of them as a dumping ground for refuse.

Many privately owned lawns are tempting prospects for development, especially if the pub or social club to which they are attached is struggling financially. As greens shut down in an area, players drift away. It is estimated that around 40% of bowlers where a green closes leave the game altogether, even if there is another green half a mile or so down the road.

These bowling greens are at the heart of their local communities, providing social interaction as well as physical activity. Too often, we see underhand tactics from the owners of greens to make them appear unused and thereby smooth the path to selling them off, right down to some examples, including one in my constituency

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that I will go into in a more detail in a moment, of bowlers finding the locks on the gates to the greens super-glued shut.

Only last month, another story emerged. I am grateful to Mel Evans, a friend, a bowls commentator and keeper of the flame in Staffordshire, who was recently deservedly awarded an MBE for services to the sport. He provided me with fresh information that McKechnie’s club in Aldridge in the west midlands has become one of the latest community clubs to come under threat. That bowling green was attached to a once-booming factory that has closed down. The bowls team played in a number of local leagues and its members were told just a few weeks ago that they must vacate their premises and find another home. Such short notice has caused a crisis for members that they are still grappling with. That is another example of how economic woes in apparently unrelated sectors are threatening the game of bowls.

Some people might ask why that matters. Bowling helps form the sinews that make this country great, obviously, but there is even more to it than that. The health costs alone of seeing greens closed could be enormous. Think of the savings to social care and the NHS from keeping older people active—physically, mentally and socially—longer into retirement.

Bowling is for all ages. I am a retired crown green bowler, having played in the junior leagues in Sheffield in my youth. It is obviously particularly popular among older people. It is a top 10 sport in this country, although it receives nothing like top 10 billing around the country and on the nation’s media. It is a vital antidote to the sedentary lifestyle that some older players might otherwise lead. For the price of keeping open a bowling green—under £10,000 a year—the potential is there to save far more in reduced health care costs.

There are groups valiantly taking action. Bowls England and the British Crown Green Bowling Association do a sterling job on behalf of bowlers across the country. Organisations such as Fields in Trust offer support with recreational land protection to communities. Sport England, according to figures it gave me yesterday, has so far offered support to 54 clubs from the inspired facilities fund, totalling nearly £2 million. However, we need to do so much more.

To mark the start of the new bowling season, last month I was proud to launch, alongside Peter Kyle, the Labour Bowlers’ Charter at the Hove and Kingsway Bowling Club on the south coast. We and local bowlers became the charter’s first signatories at a club that has lost three greens owing to cuts. Although that is a Labour initiative, I think the point of the charter can command cross-party support and would certainly do so much in offering greater protection to the sport and to the conservative estimate of 400,000 people who regularly enjoy it.

The charter calls first for an end to active bowling greens being designated as surplus to requirements by local planning authorities, thereby allowing the redevelopment of the greens—building over them—to go ahead. Secondly, it calls a halt to the practice of locking bowlers out of their greens. I am sorry to tell the Minister, but it was at Dalton’s Conservative club in my constituency where bowlers turned up for practice

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one September morning in 2009 and found that the electricity and the water at the club house had been turned off and the gates to the green had had the locks changed. Those appalling tactics were designed to put the green out of use forcibly and soften it up for redevelopment. That is the fate that has befallen too many bowling organisations that were attached to pubs and clubs.

Thirdly, the charter calls for the creation of a community right to buy for any green where disposal is agreed to by the planning authority. Where a club is prepared to commit to keeping the green in use, bowlers would be given the opportunity to buy it on the basis of its market value as—this is really important—a sporting facility, which is often much more affordable than the amount developers are prepared to pay.

Fourthly, the charter calls for extra support for bowlers who want to form co-operatives to run threatened greens. We should help clubs that are willing to form such co-ops to preserve their prized assets. This is a field in which Supporters Direct has blazed a trail for other sports. The Co-op club in Barrow has flourished since taking that route to protect its green. When its members were offered the green and clubhouse by the Co-op, people living in the vicinity even gave extra money towards the cost to prevent the land from being built on.

So how about it? Does the Minister want to sign up to our charter today? I have a copy right here if he wishes, but if he wants a bit of time to mull it over, will he at least answer the following questions?

Have the Government made any assessment of whether the local green spaces designation powers announced in 2011 are effective in protecting bowling greens? How many greens have been protected through that process? Are communities finding the rules and regulations too bureaucratic, as we fear?

Will the Government consider a community right-to-buy scheme specifically for bowling greens, where they are in active use and threatened by development, with the right of a vote by the bowlers themselves—the people who actively take part in the sport and not the wider club, where sometimes, financial fears can overtake the poor, embattled team members?

Will the Minister agree to raise the protection of bowling greens linked to pubs with major pub chains, which may be able to make a difference? Will he join the Department of Health in commissioning a study to quantify what I hope we both agree are the undoubted health benefits and savings to the NHS and social care budgets from people continuing to bowl?

Finally, will the Minister agree to join the House of Commons team in the first annual House of Lords versus House of Commons bowling match in July, adding his no doubt great skills to the elected side and showing his support for Britain’s bowlers?

Mr Dai Havard (in the Chair): With no bias, Mr Boles.

11.13 am

The Parliamentary Under-Secretary of State for Communities and Local Government (Nick Boles): It is a pleasure to serve under your chairmanship, Mr Havard, and to discuss a matter that is close to my heart, to my name and to lots of other things.

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I congratulate the hon. Member for Barrow and Furness (John Woodcock) on securing a debate on a matter that not only concerns his constituency, but many constituencies, including one he mentioned where I previously stood as the parliamentary candidate—Hove and Portslade. I was very familiar with the bowling greens and bowling clubs there and with the important role that they play in providing recreation, fresh air and social contact for many people, and particularly retired people in that community.

I also welcome the debate because we heard a poetic speech from the hon. Gentleman about the virtues and history of bowling. Conservative Members have a great affection for the great Englishman who was found playing bowls in Plymouth when the Spanish decided to come knocking. It is perhaps a little unfair of me, but I always thought that as a buccaneer in an early version of the global race, Sir Francis was clearly a Conservative supporter.

On protections for bowling greens, I understand entirely the hon. Gentleman’s concerns. In time, when he is serving as a Minister in a Department of State—in 10 or 20 years—he will discover one of the features of Government, which is that people legislate, and create new powers and possibilities, and it is often a very long time before those to whom powers and possibilities have been given take them up with the enthusiasm and gusto that the Government had originally intended. In the Localism Act 2011, as he mentioned, we created powers that had never existed before on the statute book to designate places as local green spaces—in a sense, as a planning matter, to say that a particular piece of ground that is open and green has a value to the community, and people want it to be recognised as that, and then any planning decision needs to take that into account as a material consideration in considering any proposal to build on a local green space.

We also created the concept of an asset of community value and the ability to register various kinds of community assets as assets of community value, with particular protections stemming from that. The asset of community value provision gives a community the ability to say that a particular asset can only be put up for sale—and for sale with a view to convert it into some other use—after the community has been given an opportunity to bid for that asset. They have to register their interest in bidding, and then they have a six-month moratorium in which no transaction or sale can take place in order to be able to put together a bid for an asset that is designated in that way. That provision has great potential power, if only authorities would use it.

John Woodcock: It was really useful to take through that provision. Will the Minister say what the definition of a community is in that regard? The concern to which I alluded was that sometimes the bowling club forms a minority in the community, but nevertheless, its needs and the bowling green’s value should not be ignored and overruled by a larger group.

Nick Boles: That is a very good question. I shall ask for support—for a definition of a community interest group. Meanwhile, I will go on to explain how it works, then come back to that point.

Ultimately, the point of the Localism Act was to do what it said on the tin, which was to further localism.

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Localism takes place, as it were, on many different levels. There is the level of individual community groups, neighbourhood groups and the like, and there are the democratically elected authorities that represent them, such as district councils, county councils and metropolitan councils. Ultimately, the decision making about whether to list an asset as an asset of community value, with the protections, therefore, that flow out of that, has to rest with a democratically accountable body, which is the local authority. Therefore, a community interest group needs to persuade its local authority—the only authority that has a democratic mandate to make such decisions on behalf of the public—to accept the proposal to designate something as an asset of community value.

I am fortunately now informed that a community interest group can be just 21 local people on the electoral register in the area in which the asset is located, so hopefully, even if, as the hon. Gentleman says, they are just a subset of the membership of a broader club, finding 21 people to form such a community interest group is within the reach of most existing bowling greens.

I thought that the hon. Gentleman had possibly applied for this debate, in part, to celebrate a decision that was made very recently—indeed, only a week ago. It was one of the very first appeals that we are aware of against a decision by a district council to register a bowls club as an asset of community value. I will spend a little time explaining that decision.

Rother district council decided on 16 September 2013 to include the site of Gullivers bowls club at Bexhill-on-Sea on its list of community assets, and there was an appeal against that decision. The owner of a bowls club, or some other party, quite properly has the right to appeal against a decision in which they have an interest. I am delighted to report that the first-tier tribunal general regulatory chamber, which for some reason hears such appeals rather than the Planning Inspectorate, found that it was entirely proper for Rother district council to register Gullivers bowls club on its list of community assets.

Such decisions include a test of whether the criteria for an asset of community value have been met by a bowls club. An important criterion is that the bowling green is still sustainable in its current use and, as the hon. Gentleman points out, has not become neglected. I was truly shocked to hear of the case he mentioned in which a bowls club’s locks were superglued shut. I have no doubt that if such evidence were presented to any appeal or tribunal, it would dramatically undermine any claims that a bowling green is no longer in use and therefore no longer sustainable. It is clearly not fair if people who want to play bowls cannot access a bowling green.

I hope the hon. Gentleman and those who are keen on the sport of bowls will take encouragement from this debate that powers and provisions already exist. The local green space power is important but, if anything, the asset of community value power is more important. Within that power—he talked about the right to buy—there is a community right to bid. A community can say, “This is an asset that we want to preserve in its current use, and we want to have a bit of time to raise money through a local appeal, or whatever it is, to acquire that asset and retain it in its existing use.”

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John Woodcock: I thank the Minister for giving way again. This is all helpful. He mentioned at the beginning of his speech the difficulties found between setting out the Government’s intentions, putting in place the needed legislative changes and the time it takes for those changes to reach fruition. I am sure he has a sense of the difficulty of translating those intentions on the ground, even once the changes have been made. How will he monitor how the changes actually work on the ground and address our fear that the powers are either not known or seen as too bureaucratic?

Nick Boles: The hon. Gentleman asks a reasonable question, and to some extent I throw it back at him. I am happy to work with him, and with any associations that exist in the sport, to write to every bowling green and bowling club in the country to make them aware of the powers under the Localism Act to register as an asset of community value and as a local green space, to draw their attention to the two bowling greens of which we are aware—there is not only the Rother case that we have just discussed but a bowling green in Camden, too—that have been registered as assets of community value and to make them aware that the bowling green in Rother was able to sustain that position against a challenge. The designation was upheld on appeal. Hopefully, we will be able to encourage other bowling greens to take up that right, because it may be the case that, first, they are not aware of the right and that, secondly, even local authorities are not necessarily completely up to speed on how the right works and how other people are using it. I am happy to ensure that bowling greens and bowling clubs across the country are aware of those rights, but I might need to work with him and through him to do so.

Finally, the hon. Gentleman invited me to join a match. I hope he understands, as he would if he had ever witnessed me take part in any athletic activity, and certainly any activity involving a moving ball, that I decided long ago at the start of my political career that I would say no to any invitation to partake in a sport. If it satisfies him, however, I would be pleased to attend and cheer on the more able participants.

11.25 am

Sitting suspended.

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Catholic Schools (Admissions)

[Jim Dobbin in the Chair]

2.30 pm

Damian Hinds (East Hampshire) (Con): It is a great pleasure to serve under your chairmanship, Mr Dobbin. As we gather today to discuss matters of education and those who dedicate their lives to it, all our thoughts and prayers are naturally with the family of Ann Maguire and all the children and staff at Corpus Christi Catholic college in Leeds.

This debate was originally in the name of my hon. Friend the Member for Canterbury (Mr Brazier). He secured the debate, but he sends his apologies for being unable to attend owing to a long-standing engagement at the Ministry of Defence in Glasgow for his work on reserves. I am grateful to him for the opportunity to speak in his place and to Mr Speaker for allowing the transfer.

The Catholic Church is this country’s largest provider of secondary education, and it is the second biggest name in primary education. Altogether, the Catholic Church educates more than 800,000 children in more than 2,000 schools. The Catholic Church has always seen education as vital to the formation and development of the whole person, and historically it has prioritised the building of schools in England, even over building churches.

At their heart, Catholic schools always have a mission to provide for underprivileged children and serve a Catholic population that has primarily been made up of many waves of immigrants from France, Ireland, south Asia, the Philippines, Africa, eastern Europe and elsewhere. Under the Education Act 1944 —the Butler Act—Catholic schools became voluntary-aided schools, part of the state system but with a distinct Catholic ethos guaranteed through various legal protections. Unlike the Church of England, which is the established Church in this country, the Catholic Church has always established its schools primarily to educate Catholic children and puts substantial resources into that effort. These days, the figure is some £20 million a year.

Catholic schools today are high performers in the state sector. On average, they get higher Ofsted ratings for overall effectiveness, pastoral care and various other criteria. Their results are above average at the ages of seven, 11 and 16, and they perform strongly on value-added measures. Such schools are also plugged into their local communities. At secondary level, two in five Catholic schools are judged by Ofsted to be making an outstanding contribution to their local community, which compares with one in four schools overall. A key question is whether all that is just a coincidence and, if not, what the driving factors are behind that performance.

Robert Flello (Stoke-on-Trent South) (Lab): I congratulate the hon. Gentleman on standing in for the hon. Member for Canterbury (Mr Brazier), who secured this debate. I often hear from a small number of constituents that they feel Catholic schools must be selecting only the cream of pupils. Would the hon. Member for East Hampshire (Damian Hinds) like to put on record his observations on that point?

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Damian Hinds: I will happily do so: I contend that the ethos and character of Catholic schools, although they are not the only factors, are key contributors to the performance of such schools in all senses. It is categorically not the case that Catholic schools get better results by being some sort of middle-class filtering service.

Mr Barry Sheerman (Huddersfield) (Lab/Co-op): I, too, congratulate the hon. Gentleman on introducing this debate. I associate myself with his remarks on the tragedy in Leeds, which is close to my constituency. It is an awful thing to happen.

I press the hon. Gentleman on the point raised by my hon. Friend the Member for Stoke-on-Trent South (Robert Flello). When I chaired the Select Committee on Education, we found real evidence that many Christian schools, both Catholic and Anglican—I am an active Christian myself—manage to get far fewer people from poorer backgrounds than one would expect from any interpretation of the population both inside and outside the Catholic community. There is evidence, and surely the hon. Member for East Hampshire (Damian Hinds) must worry about that.

Damian Hinds: That would be a worry. I never had the privilege of serving under the hon. Gentleman’s distinguished chairmanship of the Education Committee, although when I subsequently served on the Committee, we had a session on similar matters, and we did not find that to be the case. Depending on our point of view and the point that one is trying to make, we can draw boundaries around schools in different ways. We can draw an immediate boundary or a wider boundary. A little later, I will go through some of the actual statistics on the intake of Catholic schools.

Mr Sheerman: The hon. Gentleman is being kind in giving way again. The Education Committee’s report—I am looking at the hon. Member for Isle of Wight (Mr Turner), who was a member of the Committee at the time—recommended a mandatory code for admissions, which made a difference. Under the mandatory code, schools have to obey a fair admissions policy. That is why, when the Education Committee returned to the matter, many of the problems had been resolved.

Damian Hinds: Catholic schools and all maintained, state-funded schools are, of course, subject to fair admissions procedures, which I will address later.

Mr Andrew Turner (Isle of Wight) (Con): Will my hon. Friend bear in mind that some areas have no boundaries other than the sea? The Isle of Wight has the best secondary school, a Catholic-Anglican school, and it can be chosen by anyone.

Damian Hinds: I am grateful for my hon. Friend’s unique geographical perspective. This comes up time and again, and I will shortly address some of those instances, but on the key point of whether Catholic schools are some sort of filtering device for middle-class, wealthy and bright kids, the answer is no. That would be a fundamental misunderstanding of the demographic profile of this country’s Catholic population, the location of those schools and the communities that they serve.

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There is a school about a mile from here across the river that may be a contender for England’s most diverse school: St Anne’s Catholic primary school in SE11. The school’s pupils come from a wide variety of ethnic backgrounds. Half of key stage 2 pupils are classed as disadvantaged, with most coming from the immediate wards, which are among the poorest in London. The school’s deprivation indicator is in the top 10%, but there are also families from higher income brackets. Altogether, pupils speak 32 different mother tongues, and 99% of pupils have English as an additional language, which is what we used to call English as a foreign language. The one thing that almost all pupils have in common is their faith, with more than 95% being baptised Catholics.

That is a striking example—that is why we politicians use such examples—but overall the profile of Catholic schools is more diverse than schools in the maintained sector in general. At primary level, the proportion of schools at which more than 5% of pupils do not speak English as their mother tongue is 57% for Catholic schools and 38% for schools overall. Some 34.5% of Catholic primary school pupils are from ethnic minority backgrounds, compared with 28.5% in the maintained sector as a whole; at secondary level, the figures are 30% for Catholic schools and 24% for other schools.

The proportion of children on free school meals at Catholic schools is somewhat lower on average than at other schools, and there are various explanations for that, but I do not think we know the answer conclusively. One thing that we do know conclusively is that pupils at Catholic schools tend to come from poorer places than children at schools in general. At secondary level, 17% of children at Catholic schools are from the most deprived wards, compared with 12% for schools overall. At both primary and secondary, Catholic schools over-index in the bottom four deciles and under-index in the top six deciles.

The diversity of Catholic schools, notwithstanding the water boundaries of some places, is partly due to the potential for much larger catchment areas. Typically, a Catholic school may have a catchment area 10 times the size of a typical community school’s catchment area. I saw a bit of that in my own schooling. The school that I went to in south Manchester had kids from leafy north Cheshire, but it also had kids from Stretford, Old Trafford, Stockport and Warrington. It really had a very wide intake.

Schools must comply with the schools admissions code, and over-subscription policies mean that Catholic schools typically give priority to Catholic children over the wider area and welcome others where there is remaining capacity. That system enables more parents who desire a Catholic education for their children to get one, bearing in mind that it is a minority religion in this country, so the population is likely to be more sparsely spread.

As has been mentioned, the admissions criteria of faith schools make regular media space-fillers. Headlines have included, “Faith schools ‘biased towards middle classes’”, “Faith schools ‘skewing admissions rules’” and, “Faith school admissions ‘unfair to immigrants’”. Those came respectively from the Daily Mail, The Daily Telegraph and The Guardian after the publication of the schools adjudicator report in 2010. As was alluded to, we had the chief adjudicator into the Education Committee

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to discuss that report, which was extremely fair and balanced and made hardly any reference to faith schools. Somehow, between the publication of that report, the press conference and journalists filing their copy, the story became about bell ringing, schools insisting that parents clean churches and giving priority to white middle-class families. I do not know about you, Mr Dobbin, but I struggle to think of many Catholic churches that even have a bell tower. Anyone saying that people who clean churches having priority somehow advantages white middle-class families has a poor understanding of the demographics of those who clean churches.

Kevin Brennan (Cardiff West) (Lab): Does the hon. Gentleman acknowledge that the London Oratory school withdrew that requirement from its admissions criteria as a result of the adjudicator’s ruling?

Damian Hinds: I will tell the hon. Gentleman what I acknowledge: there are 2,000 Catholic schools in this country, and one of them is the London Oratory school. When these stories come up, they always centre on literally a handful of schools, virtually all of which are in west or south-west London. They are in no way representative of Catholic education as a whole, whether in location, resident population or type of school and so on.

Mr Sheerman: We all know why London Oratory became so well known: Tony Blair, the former Prime Minister, sent his children there. I always defended that, because he was, as I understand it, the first Prime Minister ever to send his children to a state school. To put the record straight for anyone reading the report of this debate, before the reforms, when I was Chair of the Education Committee, the crucial thing was not just the number of children on free school meals, but the numbers of looked-after children and children with special educational needs. Things have not much improved, but I have to put on record, as a lay canon at Wakefield cathedral, that we often found that Anglican schools were worse than Catholic schools.

Damian Hinds: That is probably a road that we do not want to go down today. Overall, notwithstanding the poster child cases that can be found on occasion—

Kevin Brennan: You mentioned the cleaning.

Damian Hinds: I say gently to the shadow Minister that that was represented as faith schools plural, not as one school where it was the case. The figures speak for themselves. In 2010, 337 Catholic secondary schools made 54,830 offers of a place to year 7 pupils. The number of complaints to the Office of the Schools Adjudicator about the application of the admissions code in Catholic schools was nine. In fact, there were proportionally fewer complaints about Catholic schools than there were for schools of no denomination.

There is a view that no admissions procedure or criteria should include a religious element and that if these are high-quality, sought-after schools, they should be made available equally to all, so that more people, or at least people living closer to the school, would benefit. I contend that that misses the point of what makes

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Catholic schools distinctive and sought after. If they were open to all, they would lose their distinctive character—not immediately, but over time.

Schools can withstand some variety, which is a good thing, in admissions. The proportion of non-Catholic children at Catholic schools today is 30%, which is probably higher than most people realise. A 50% cap on admissions would gradually erode that character in two ways. It would not only erode it directly by diluting the religious nature of the school’s population, but indirectly, because Catholic parents would cease to see a distinction between those schools and entirely non-denominational schools, as my hon. Friend the Member for Fareham (Mr Hoban) effectively argued in a recent debate in this place. Put simply, a half-Catholic school is not the same thing as a Catholic school.

The 50% cap is not in the coalition agreement, but is an interpretation of some of its wording. We would probably all agree that it was well-intentioned, because there is concern about diversity, inclusiveness and mixing in schools, and I understand the sensitivities around those topics. As I hope that I have demonstrated, Catholic schools are more diverse than the average, with mixing beyond that available in the average school. The cap is inhibiting the creation of new quality schools that will be just as sought after. It is clear that the 50% cap directly precludes the creation of Catholic free schools, because the Catholic Church feels unable to support, with all the implications of commitment that that brings, new so-called Catholic schools that would in the end have to turn away some families seeking a Catholic education for their children in favour of others who happen to live a little closer to the school.

There is an alternative, which is to create a new voluntary-aided school that can subsequently convert to an academy, and the same result could be had that way. That is not an impossible route to pursue, but there are two problems with it. First, it is a somewhat convoluted approach to reach that end, inevitably carrying additional inefficiencies and costs. Secondly, it is not as straightforward as a free school application, because voluntary-aided applications do not have the same priority as free school applications. The applicants for the new voluntary-aided school at Richmond experienced a legal challenge from the British Humanist Association, which claimed that the Government had to look first at free school applications that would have the 50% cap. That legal challenge failed, but it is inevitable that parents will feel some uncertainty about what will happen with future openings. That could affect the number of applications and the viability of such a new school.

Kevin Brennan: The hon. Gentleman mentioned that voluntary-aided schools do not have the same priority as new free schools. Why?

Damian Hinds: The hon. Gentleman is a man of letters, and he will understand that I can answer the question only in the sense of why I said that, which is because it is my understanding. It is for the Minister to talk about how these things work in practice, and he might want to contend that point.

I have some questions for the Minister. First, has the Department made projections of demand for Catholic places at schools, the growth or otherwise in the Catholic population and the propensity of parents of those

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children to seek a Catholic school? Secondly, has the effect of the 50% cap on applications for faith-based schools been assessed? Thirdly, would the Department consider a pilot of a Catholic free school without the 50% cap? Fourthly, is it possible to construct a new fast-track, voluntary-aided through to converter academy route that would effectively be a single process?

In conclusion, Catholic schools are a key part of the education landscape in this country, and have been for a long time. They are diverse—more diverse, in fact, than the average—and that diversity includes already having a substantial proportion of non-Catholic children. They also have something special about them, and that specialness comes at least partly as a direct result of their religious nature.

Robert Flello: The hon. Gentleman is being extremely generous with his time. On that point, it is the special nature of Catholic schools that appeals to many people of other religions. For example, in Stoke-on-Trent, a large proportion of the Muslim community want their children to go to the local Catholic school because of its Catholic nature. That might seem a little bizarre at first, but that is the reality.

Damian Hinds: I agree with the hon. Gentleman entirely. Many Catholic schools have large numbers of children of other faiths. As I came to my close, the point I was making was that the specialness of Catholic schools comes at least partly as a direct result of their religious nature. I suggest that that helps to promote cohesion and community spirit, rather than detract from it. That specialness would inevitably be eroded over time by enforcing a lower cap on admissions made on the basis of faith.

As Cardinal Vincent Nichols—as he is now—said in 2006, when faced with a not entirely similar proposal,

“Catholic schools make a positive and clear contribution, and do so in an open and proven manner. They are part of the solution. They should not be undermined.”

2.51 pm

John Pugh (Southport) (LD): I thank the hon. Member for East Hampshire (Damian Hinds) for introducing this significant and important debate. The backdrop to debates on education is often the London scenario. Frankly, I fail to recognise the landscape spoken about in such debates: the fierce competition for places; sharp elbows; tiger mums; socially-segregated intakes; and back-door selection via baptism and church attendance. I come from an area where half the schools are denominational, with the bulk of them being Roman Catholic. Unlike the Minister, I did not go to a Roman Catholic school, but in the ’70s and early ’80s I taught at a Catholic comprehensive in Bootle, where the situation was very different from London: St Kevin’s in Kirkby was not the Oratory.

My school was run by the Salesians, a religious order that originally set out to look after the poor of Milan. When I taught there, that spirit prevailed, although over time as an order they had migrated into selective and boarding schools, as is often the way. However, some of the original fervour was certainly there: the headmaster taught remedial maths and, even after he resigned as headmaster, continued to do so.

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When I joined, the school had just amalgamated with another Catholic denominational school, St Joan of Arc, which was again far from being like the Oratory. That was a school that, throughout its history, had had a proud reputation of never having entered a pupil for a public exam. It was a dockland school and the only qualification that pupils left with was the—slightly discounted now—Bootle school leaving certificate. In fact, to get a job in that area, one needed only to befriend the local shop steward to be assured a job; one did not need to be particularly good at maths or anything like that. The comedian, Tom O’Connor, honed his act in such a school.

I was latterly a governor and a parent. My children went to Christ the King school in Southport, which was a community school with a tradition of caring for pupils; it did not expel them even when they had appreciable problems. When I reflect on that, I must say that the system that we have got is not a planned system, but one that has evolved. The state took responsibility for education only after the churches had spent many decades doing so in the 19th century. It funded what was there, but, at that time, there was political sensitivity that we might now find difficult to understand about Rome on the rates, or, in fact, any church on the rates, particularly in my party. The solution was the funding of religious autonomy but only in return for a capital contribution: the Butler settlement. Congregations did indeed partly fund the schools and, as a result, got certain privileges.

That deal has now been superseded by the Blair Government and the coalition Government with a new deal that I do not claim to understand perfectly: it does not have the same funding snags, but there certainly is a protracted debate about admissions and admission policy. That policy has been developed by the coalition, but I do not claim to understand the rationale perfectly. Perhaps the Minister can help me with that.

However, insofar as the Government make the offer to religious bodies to promote schools, it is almost certainly not because they want to promote a religious ethos or because they believe that, because those schools have a religious ethos, they are good per se. The promoters certainly believe that, but secular Governments in a secular, pluralistic society cannot usually claim that. The argument appears to be that there is a demand and will to provide these schools in many parts of the country, that educational standards are good—I think that that is recognised widely—and that no social objectives are being significantly impaired.

That is a point on which most Members party to this debate are probably on a different side from, say, the British Humanist Association, which regards serious social objectives as being compromised by the sheer existence of faith schools: it talks about the promotion of sectarianism and the like. That claim is contentious, but that is not the issue of this debate. The issue today is whether schools set up for an avowedly religious purpose function in a way that separates pupils by class or ability, because that, surely, is what the Government are against and the real question is whether there is a case for saying that.

There seem to be three bits of evidence to look at. One is the disparity that occasionally exists between a school’s social mix and the neighbourhood. It must be acknowledged that that exists. Secondly, frequently cited is parents affecting religious affiliation or enthusiasm to

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get their children into faith schools and that schools overtly collude in that. Thirdly, which I think is the point made by the former Chair of the Education Committee, the hon. Member for Huddersfield (Mr Sheerman), there is some evidence that, in faith schools, there are relatively lower numbers of pupils on free school meals compared with other schools.

None of that strikes me as conclusive. As the hon. Member for East Hampshire pointed out, a disparity between neighbourhood and social mix should sometimes be expected. In an area where Catholics are very much a minority population, such as Salisbury, where there is only the one Catholic church, there will be a difference between the families immediately adjacent to the Catholic school and those who send their children to that school, but that would equally apply to other faith schools. A good example is in Liverpool, where one of the most popular and successful schools is King David high school, which is a Jewish school that does not necessarily reflect the wider social area in which it sits. I do not think, therefore, that that argument is conclusive.

Equally, I do not think that it is conclusive to point out what we probably all know: sometimes, parents affect a degree of religiosity to get their children into a school that they might not otherwise succeed in doing. That argument is hard to address, because it is not possible for schools—or churches, for that matter—to have proper insight into the fervour or motives of the people who turn up en masse on a Sunday. We surely cannot ask the Government to do that either.

Therefore, we come to the crucial point, which is the most difficult point for faith schools to address: a lower proportion of children receive free school meals in faith schools than in state schools in comparable areas. It cannot be supposed that Catholics, or those of any other faith, are innately prosperous and unlikely to be on benefits. That is a dilemma for Catholic schools, but also for the Government. If there is a remedy to that, that would be for the faith schools to be more rigorous in applying the faith criterion rather than any of their others, and I am not sure that the Government could advocate that.

None of the solutions would satisfy the critics of faith schools. I regard the Government’s policy as a muddle to some extent, though not a pernicious or problematic muddle. I do not see how what we have in the way of faith schools at the moment can concern a Government who are seeking to address the joint objectives of promoting educational achievement and ensuring that all pupils have fair access to it.

3 pm

Mr Mark Hoban (Fareham) (Con): I commend my hon. Friend the Member for East Hampshire (Damian Hinds) for opening the debate in such a thorough way. I will not speak for long, having aired the issues in an earlier debate, to which the Under-Secretary of State for Education, my hon. Friend the Member for South West Norfolk (Elizabeth Truss), responded. I am pleased to see the Minister for Schools, my right hon. Friend the Member for Yeovil (Mr Laws), in the Chamber, because he might be able to shed some light on some of the discussions that his colleague and I had in the previous debate.

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It is important that we recognise the role of the Catholic Church in providing education. I, too, am a product of a Catholic education. The role of Catholic schools has been widely praised, with the most recent example I have coming from the Deputy Prime Minister. He praised faith schools, rightly highlighting:

“In my own view the crucial thing for faith schools, and I think all the best faith schools do this, is to make sure they act as engines of integration and not silos of segregation.”

He made that comment on visiting a Catholic school in east London, which perhaps provides an antidote to the slightly obsessive nature of the discussion about faith schools elsewhere in London.

The Church has a long tradition of providing education, in particular in urban areas, initially to meet the needs of migrants from Ireland, not only during the great famine, but in subsequent waves of migration as well. The view of the Catholic hierarchy, the bishops, when they established schools in England and Wales, was that this was a good way to enable migrants to integrate into the wider community, by providing them with the opportunities for education that would enable them to progress in different careers. Certainly in my own family, coming from the north-east, some found such opportunities to progress in particular through education. That is highly valued, and the role in integration is still played now with subsequent waves of migration, especially with migrants from eastern Europe. Also, in many communities throughout the country, large numbers of people from the Philippines can be seen at mass; they are in this country to work in the health service. Again, we are helping to integrate people into the wider community.

Integration is reflected in the demographics of Catholic schools. They are ethnically and socially diverse, reflecting the Church itself. To use my own experience, the Catholic school that I attended in Durham attracted pupils from a wide area, not only from leafy, middle-class housing estates in the centre of Durham, but from the former pit villages around Durham. It was a socially diverse school, different from the nearest school, which predominantly served leafy, middle-class housing estates. There is something about the catchment area of Catholic schools, and their coverage, which means that they have a much wider range.

Robert Flello: The hon. Gentleman’s comments put me in mind of my constituency and of my city of Stoke-on-Trent. If we compare Stoke-on-Trent with Kensington, Chelsea or Westminster, they are in almost completely different worlds, let alone different cities. Stoke-on-Trent could hardly be described as incredibly affluent, but the Catholic and indeed Church of England schools do a good job of educating people in the area.

Mr Hoban: Indeed. That diversity of social class is important, although I would counsel a note of caution. It is not only about what happens in Stoke-on-Trent; churches and Church schools in central London are socially diverse, and we should not get away with thinking that Westminster and Kensington and Chelsea are predominantly or exclusively upper middle-class areas.

Robert Flello: I am grateful to the hon. Gentleman for allowing me to come back on that point. Absolutely—I am merely illustrating a point, in case colleagues refer to the Oratory, which is not the same as Stoke-on-Trent. However, I take his point entirely.

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Mr Hoban: The Oratory is socially diverse, because it allows in the children of both Prime Ministers and Deputy Prime Ministers these days. We should not forget that diversity.

The catchment areas mean that Catholic schools, rather than serving a narrow cross-section of the population, tend to serve broader communities. They are not aimed exclusively at either the children who live in pit villages or those who live in middle-class housing estates.

Free school meals have been mentioned by a number of hon. Members and the issue is a cause for concern, which is why the Catholic Education Service has looked at it carefully to understand some of the barriers. The service highlighted cultural aversion, immigration status and language as potential barriers to people claiming free school meals. We need to understand that a bit more: is there a factor here that we need to take more action on?

I have a concern about Government policy in the area—I do not have many concerns about Government policy, because I am by nature loyal.

Robert Flello: I paused before intervening, because I thought the hon. Gentleman was going to move on to talk about the figures. It is worth putting on record that in 2012 the difference in the number of those receiving free school meals nationally and of those receiving them in Catholic schools was about 0.7%; in 2013, the figure might have risen to about 2%. It is worth putting the scale of the difference into the context.

Mr Hoban: Indeed. The hon. Gentleman is absolutely right, although that closer difference is between secondary schools; the gap is slightly wider for primary schools. Nevertheless, we need to get to the bottom of the issue and to understand it.

Since Catholic schools are so diverse and so inclusive, I have a problem in understanding the nature of Government policy in the area. Why is the admissions cap in place? Why has faith been singled out for such treatment? No other cap is in place and there is no cap for ethnicity or social class; the focus appears to be entirely on faith, and yet we can see from the track record of Catholic schools that they are more representative of the population and more diverse in ethnicity and social class than schools as a whole. I find it hard to understand why the barrier is in place.

When my hon. Friend the Member for South West Norfolk responded as the Minister in the previous debate, she talked about the need to demonstrate broad support in the community for such schools and the need for access. I could understand that if it applied to all new free schools and academies and if there were similar constraints in place on other aspects of diversity, but there are not. The cap applies only to faith schools. In a situation in which a faith school is oversubscribed, that oversubscription demonstrates that a school is popular and that people want to send their children to it, so it is more likely to have a broader range of applicants. My concern, if we are concerned about exclusivity and segregationism, is with schools of a particular faith that are undersubscribed. What message of ethos or approach is therefore being sent to other people in the community who are not of that faith? We need to be clear about why things are happening and why the cap is in place.

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I hope that my right hon. Friend the Minister will provide the logic, because I cannot see it the moment. If I look at other factors involved in setting up free schools, one such school might be in the middle of a middle-class housing estate where there is a lack of capacity, and yet there is no requirement to ship pupils in from other areas. Such a school could serve exclusively children from that middle-class area. There is no constraint on that or any cap to require pupils coming from elsewhere. I am not sure what mischief the Government are seeking to address by such a narrow approach to one aspect of admissions policy.

My right hon. Friend the Minister might be able to shed some light on one aspect of the issue, because he was there at the birth of the coalition. The cap flows from language in the coalition agreement, but I am not clear whose ask that was. Was it an ask of my party or of his? I suspect that I know the answer, because the Liberal Democrat manifesto for which the Minister stood in 2010 pledged to prevent faith schools selecting on the basis of their religion. I suspect that the policy flows from that manifesto commitment. Since he and others have now had experience of Catholic schools, he might feel that that manifesto commitment is no longer appropriate. The Liberal Democrats might seek to change that. I will be interested to see if that is their policy.

I do not see where that commitment sits logically in an admissions policy. Why have the Government decided on that one demographic characteristic, above all others, in determining admissions policy? I do not think it is logical. It is perceived to be unfair and discriminatory, and is certainly preventing the establishment of new Catholic free schools and academies that could support the demand for places and want to be able to offer a Catholic education but do not want to be in the position, as would be the case under this policy, of having to turn away Catholic parents. That is the barrier—those schools would have to turn Catholics away under the policy.

I would like my right hon. Friend to explain the logic behind the policy—why it is faith that has been singled out, and no other demographic characteristic.

3.10 pm

Dr Thérèse Coffey (Suffolk Coastal) (Con): It is a pleasure to contribute to the debate. I congratulate my hon. Friend the Member for Canterbury (Mr Brazier) on securing it and—more amazingly—my hon. Friend the Member for East Hampshire (Damian Hinds) on starting the debate with such aplomb. I am slightly disappointed that the hon. Member for Huddersfield (Mr Sheerman) has left the Chamber; frankly, I did not understand what he was going on about and would have enjoyed a debate with him.

One concern for people and particularly for Catholics who send their children to Catholic school is that when topics such as this are debated in Parliament, the debate seems to become an assault on the values of those parents and on the fact that they choose to send their children to a school that selects by faith. They are often attacked by various campaigning organisations for trying to be separatist and for not wanting to be part of a wider society. Frankly, such attacks are so ridiculous as to be untrue.

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Although it is not quite an interest, I should declare that I only ever attended Catholic schools, so I have that narrow vision, as it were. My parents taught principally in Catholic schools, although they taught in other types of state school as well.

I am glad to see the Minister in his place today. I hope that he is not overly influenced by Liberal Youth—a Liberal Democrat group of students and young people in education that has joined the British Humanist Association in a coalition against faith schools—particularly on the admissions code. I am pleased that he was part of a Government that resisted amendments trying to remove any selection based on faith during the passage of the Academies Act 2010 in the early days of this Parliament. It was important that we took that step at the time. I share the views already put forward by hon. Members on the impact of the 50% cap on admissions to free schools.

I know that this debate is going out to the world, but let us talk openly: was the issue that small minority faiths would set up particular kinds of schools and the Government were concerned that that would lead to extremism of one kind or another being taught in our schools and being paid for by the taxpayer? If that was the case, it was an overreaction. As we know, the setting up of a free school is subject to stringent tests, which apply to some elements of the curriculum. Although certain things are not banned for academies or free schools, those schools still have to satisfy the Department for Education and Ofsted that they are providing a suitable education that covers a broad spectrum—albeit that the minutiae of the curriculum are not mandated in the same way as for other state-maintained schools.

We need to set the right tone. We must allow new schools to develop where they are needed. My hon. Friend the Member for East Hampshire has already referred to the extended process in Richmond, which led to considerable opposition both politically and from other groups that deliberately tried to stop the school being set up.