9.32 pm
Liz Kendall (Leicester West) (Lab): We have had a wide-ranging debate. I listened carefully to the powerful speech by the right hon. Member for North Somerset (Dr Fox)—I am sorry he is not in his place—on his concerns about Russia, which I share, and to the thoughtful contribution made by my right hon. Friend the Member for Neath (Mr Hain) about the Government’s pension reforms. I for one am sorry that this will be his last contribution in a Queen’s Speech debate and he will be sorely missed by Members on both sides of the House.
The main focus of the debate has been the NHS and social care. My right hon. Friend the Member for Newcastle upon Tyne East (Mr Brown) and my hon. Friends the Members for Mitcham and Morden (Siobhain McDonagh), for Ilford South (Mike Gapes), for Hammersmith (Mr Slaughter), for Wythenshawe and Sale East (Mike Kane) and for Middlesbrough South
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and East Cleveland (Tom Blenkinsop) spoke passionately about their local services and the pressures they face. Those pressures are being experienced by services across the country as our population ages and more people are living with long-term conditions, and the biggest challenge facing us is to reform front-line services to get better results for patients and better value for taxpayers’ money when there is far less money around.
Some services must be provided in specialist centres so that patients get expert treatment 24/7, but there must be a fundamental shift in other services out of hospitals into the community, focused on prevention and joined up with social care so that people can stay healthy and living independently at home. The last Labour Government had plans to deliver these changes in every English region through Lord Darzi’s NHS next stage review, and the single biggest mistake by this Government on the NHS was to scrap those plans and instead waste three years and £3 billion on the biggest backroom reorganisation in the history of the NHS.
Ministers do not want to talk about their reorganisation and their failure to make the real reforms that patients will need in the future. The Queen’s Speech should have included a Bill to modernise the regulation of doctors and nurses, in order to improve the safety and quality of care. That was recommended in the Francis report, it is what the General Medical Council and the Nursing and Midwifery Council want, and it is what patients desperately need, but Ministers have failed to deliver. They are desperate to avoid another NHS Bill after their disastrous Health and Social Care Act 2012, especially in the year before a general election, but let me remind hon. Members of the mess made by that Act.
Ministers said they would cut bureaucracy, but instead they created 440 new organisations: NHS England; Public Health England; Health Education England; four regional NHS England teams; 27 local area teams; 19 specialist commissioning units; 221 clinical commissioning groups; and 152 health and wellbeing boards. It is a system so confusing and dysfunctional that no one knows who is responsible or accountable for leading the changes that patients want and taxpayers need to ensure that the NHS is fit for the future.
Ministers promised that their reorganisation would save money, but £1.4 billion has been spent on redundancy payments alone and more than 4,000 people who were made redundant have now been rehired somewhere else in the system. And as if this chaos and confusion was not bad enough, the new chief executive of NHS England says there has got to be yet more change, with yet another reorganisation of specialist commissioning, because costs have spiralled out of control, and a reorganisation of NHS England’s regional and local area teams. As my right hon. Friend the Member for Leigh (Andy Burnham), the shadow Health Secretary, said, this truly is the reorganisation that never ends.
The real cost of the Government’s failure on the NHS does not stop with their reorganisations. Labour Members warned that handing responsibility for local GPs to a national quango such as NHS England, scrapping the 48-hour waiting target and removing Labour’s incentives for evening and weekend appointments would mean GP services going backwards and, as my hon. Friends the Members for West Ham (Lyn Brown)
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and for Scunthorpe (Nic Dakin) said, that is exactly what has happened. A quarter of all patients now say they cannot get a GP appointment in the same week, let alone on the same day. We warned that cancer care would go backwards when the Government abolished vital cancer networks, and that is exactly what has happened. Two weeks ago, the NHS missed the cancer waiting time target—the first time any cancer target has been missed since 2009. We warned that disproportionate cuts to mental health services would mean worse care for patients and extra costs elsewhere in the system, and that is exactly what has happened. Patients are being sent hundreds of miles away because there are not enough beds locally, causing them and their families terrible distress and costing taxpayers millions of pounds extra.
We warned that slashing council care budgets was a false economy that would mean fewer elderly and disabled people receiving the support they need, forcing them into hospital and piling pressure on families and local A and E units. As my hon. Friends the Members for Worsley and Eccles South (Barbara Keeley), for South Shields (Mrs Lewell-Buck) and for Westminster North (Ms Buck), as well as the hon. Member for Newton Abbot (Anne Marie Morris), rightly said, that is exactly what has happened. Fewer elderly people are getting vital help, such as home care visits or support from district nurses, so more of them are ending up in hospital and getting stuck there for longer.
We have had the worst year in A and E for a decade, with a million people waiting for more than four hours. Delayed discharges are at their highest ever for this time of year. These delays cost £268 million last year, which could have paid for 20 million hours of home care. Where is the sense in that?
Rising emergency admissions mean planned operations are going backwards too. Three million people are now on hospital waiting lists, which is up by half a million people since 2010. Last year, 64,000 operations were cancelled—the highest figure in a decade.
The combined effect of the Government’s disastrous reorganisation and their incompetent decisions means that Ministers have lost a grip of NHS finances too. This year, trusts are in deficit for the first time in seven years, and twice as many foundation trusts will be in deficit compared with last year. The NHS trust deficit will be three times higher than they predicted even at the beginning of this year. The real tragedy is that all that could have been avoided if Conservative Ministers had not been blinded by politics and ideology and if Liberal Democrat MPs had had the guts to oppose them.
The truth is that there was nothing on the NHS in the Queen’s Speech because the coalition Government have no plan and no idea how to solve the problems they have created. In contrast, a Labour Queen’s Speech would repeal the Health and Social Care Act so that services can work together in the best interests of patients and get the best value for taxpayers’ money. A Labour Queen’s Speech would use savings from scrapping the costs of competition to guarantee new rights for patients to see their GP at a time that is convenient for them. A Labour Queen’s Speech would end the scandal of inappropriate 15-minute home care visits and exploitative zero-hours contracts so that elderly and disabled people get the quality of care they deserve.
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A Labour Queen’s Speech would deliver the real reforms that patients and their families need to create one health and care system and ensure truly personalised care: integration, not fragmentation; wise expenditure, not waste; putting people first, not playing politics with their health and the services families rely on. That is what patients want, what taxpayers need and what our constituents deserve, and that is what a Labour Government will deliver.
9.41 pm
The Minister of State, Department of Health (Norman Lamb): I thank all right hon. and hon. Members who have contributed to today’s debate. It has been a wide-ranging debate stretching well beyond the NHS, as the shadow Minister said. I think that we all enjoyed the alternative Queen’s Speech from the hon. Member for Blyth Valley (Mr Campbell). His Front-Bench colleagues looked horrified, but it was the authentic voice of Labour.
Mr Ronnie Campbell: There were some good policies in there.
Norman Lamb: Well, let us just make sure that Opposition Front Benchers listen to the hon. Gentleman.
We can be justifiably proud, it seems to me, of the action we have taken in health and care over the course of this Parliament. The hon. Member for Scunthorpe (Nic Dakin) made a speech that faded away from agreement, but at the very start he made the point that we should all pay tribute to a really remarkable work force in the NHS—1.3 million people doing incredible work. We want to free those people up as much as possible to do the very best they can.
Andy Burnham: Would not the best way to pay tribute to those thousands of staff in the NHS be to honour the 1% pay increase that the Chancellor promised them?
Norman Lamb: That is equivalent to about 6,000 nurses a year. The right hon. Gentleman has to demonstrate how that would be paid for. The fact is that there is an average wage increase of 3% as a result of annual pay increments under Agenda for Change. We have ensured that at least everyone will get a 1% increase. If he is arguing for something different, he has to say where the money would come from to pay for it and how he would cope with 6,000 fewer nurses, which would be the result of his action.
For the first time, it is this Government who have made decisive moves to join up the care and health system and focus more on preventing ill health. Contrary to the shadow Secretary of State’s claims, the better care fund has been widely welcomed, and it has initiated action across the country to join up a very fragmented system. We have sent out the signal that we encourage innovation and change, driven by clinicians from the bottom up, not from the top down. Brilliant pioneers across the country are ending this fragmented system that has interrupted patient care for so long and failed patients. Those pioneers are combating loneliness, which my hon. Friend the Member for Burnley (Gordon Birtwistle) spoke passionately about. It is so far removed from the caricature offered by the shadow Secretary of State and the tired old refrain about privatisation. It
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was, after all, a Labour Government who mortgaged the future of the NHS to the tune of billions of pounds with their private finance initiative programme, giving massive windfall profits to private consortiums—a scandal of historic proportions. Yet Labour Members continue to argue that the Government are privatising—an argument that is based on thin air, not substance.
Tom Blenkinsop: Will the Minister tell the House at what point the provisions of the Competition Act 1998 were introduced into the Bill that became the Health and Social Care Act 2012? I think it was this Government who did that. In the Public Bill Committee, I commented on the fact that they were exposing the NHS and undermining the category B status of the European competition regulations by putting the Competition Act at the very heart of the Bill.
Norman Lamb: I am sorry to disappoint the hon. Gentleman, but it was under the Labour Government that it was made clear that competition law applied to the health care system. Indeed, the Labour Government’s guidelines on the NHS replicated exactly the regulations under section 75 of the Competition Act that this Government have introduced. Time and again, we hear false claims by Labour Members.
This Government have developed a new health and care system that is totally patient-centred, led by health professionals, and focused on delivering world-class health outcomes. The difficult decisions that we have made on public finances have meant that we have been able to protect the NHS budget. The shadow Minister spoke as though the Government have had to face no financial challenge at all. She knows that across Europe, Governments have slashed pay for health workers and introduced co-payments. We have done none of that. We have protected the budget for the NHS, and we are proud of doing so; Labour did not commit to that in its manifesto at the last election. The truth is that the NHS is doing extremely well under a great deal of pressure.
This Government have laid solid foundations to transform our NHS to help it to meet the challenges of an ageing population, drive up standards, and focus absolutely on compassionate care. My hon. Friend the Member for Mid Worcestershire (Sir Peter Luff) spoke movingly about his experience of the importance of compassionate care. We have introduced tough, robust inspections overseen by new chief inspectors of hospitals, of social care, and of general practice. We have introduced ratings of hospitals, care homes and GP practices so that people know how good their local services are. We have introduced, for the first time, fundamental standards and the ability to prosecute—to hold to account organisations and directors who seriously fail patients. We have introduced a fit and proper person test for directors; for the first time, compulsory training for health and care assistants; and—I am particularly proud of this—a statutory duty of candour to ensure that there is openness when things go wrong in the NHS or the care system.
Geraint Davies:
Given the Minister’s focus on accountability and transparency, why will he not support the regulation of psychotherapists and counsellors? My private Member’s Bill would have protected 1 million people.
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He or I could set up shop as psychotherapists tomorrow and see these vulnerable people who are currently at risk. Why will he not protect them?
Norman Lamb: The Government are not convinced by the argument for statutory regulation. The hon. Gentleman and I have had this debate many times, and I am happy to continue to discuss the matter with him.
In the wake of Francis, the Government are clear that poor or unsafe care will not be tolerated. There will be consequences for those who fail patients.
Opposition Members have criticised the lack of health legislation in the Gracious Speech, yet, as several of my hon. Friends, including the Members for Witham (Priti Patel) and for Rochford and Southend East (James Duddridge), have noted, people are not out there on the streets demanding a new NHS Act of Parliament; they want safe, good, compassionate care.
The Government remain committed to legislating on professional regulation when parliamentary time allows.
Mr Jamie Reed (Copeland) (Lab): Will the Minister give way?
Norman Lamb: Let me complete this point.
This is a complex area and we should not rush to legislate. We will keep making progress to respond to the scandal of Mid Staffordshire for the remainder of this Parliament. We are working closely with the regulators to ensure that key provisions, such as a faster fitness to practise test for nurses and midwives and English-language checks for all health care professionals, are in place during this Parliament.
The shadow Secretary of State quoted selected statistics on access to a GP, yet 86% of patients are satisfied with their GP practice. The Government have introduced a £50 million challenge fund, which will support more than 1,000 practices to develop innovative and flexible services. That will include Skype and e-mail consultations, as well as extended hours, and will benefit more than 7 million people.
The right hon. Member for Cynon Valley (Ann Clwyd) again spoke extraordinarily passionately, giving a voice to those who feel they have no voice in our system. We should all express our gratitude to her for her continued campaigning on this critical issue, which demonstrates that we still have a long way to go if we are to ensure that we have a system of which we can all be genuinely proud. Like the right hon. Lady, I hope that one day the flood of letters on poor care will stop. We are doing what we can through the actions we are taking and we are grateful to her for the enormously valuable work she did on the complaints system. I hope the Labour Administration in Wales will do the same, especially after she eloquently highlighted the problems there in a recent BBC documentary.
Barbara Keeley: Will the Minister give way?
Norman Lamb: I have given way quite a lot; I need to make some progress.
The right hon. Member for Newcastle upon Tyne East (Mr Brown) asked about allocations. It is right that
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the allocation of funding is no longer a political football but in the hands of experts. NHS England is seeking to make progress on reducing inequalities.
The hon. Member for Blyth Valley talked about charging in the NHS. Access to NHS services is based on clinical need, not on an individual’s ability to pay. That is fundamental to the NHS, and for as long as this coalition Government are in power the NHS will remain free.
We heard from Members on both sides of the House —my hon. Friend the Member for Bracknell (Dr Lee) and the hon. Member for Westminster North (Ms Buck)—that health care needs to change so that care is provided more locally. The better care fund establishes a £3.8 billion pooled fund, to help people to stay healthy and independent.
Barbara Keeley: It is not new money.
Norman Lamb: Of course it is not new money—this is a different way of working. We have never claimed that it is new money; this is to ensure that we use the money more effectively. Indeed, the hon. Lady’s Front-Bench colleagues have made the argument that by pooling the health and social care budgets, we can achieve more with the money available.
Barbara Keeley: Will the Minister give way?
Norman Lamb: No, I will not; I have given way many times. The fund is the largest financial incentive by any Government to promote integrated care, and it would be better if Opposition Members applauded the initiative rather than constantly criticising it.
At the start of this Parliament, this Government had five priorities for health and social care. We have delivered on all of them. Through the Care Act 2014, we have delivered the most profound change to the care and support system for a generation. After a decade of inaction under the previous Labour Government, we have introduced, for the first time, a cap on care costs and extended means-tested support. No one will have to sell their home during their lifetime to pay for care.
Under the leadership of Public Health England, we have created a new public health service, giving public health the priority it deserves in local government alongside other local services. As my hon. Friend the Member for Newbury (Richard Benyon) outlined, it is vital that we prevent ill health in the first place, as opposed to repairing the damage once it is done.
We are transforming health and care so that services are integrated around the needs of patients and users. We have revolutionised NHS accountability and seen a successful transition to a new health and care system. Finally, by focusing on outcomes rather than top-down diktat, we can identify what works and where we need to give additional support to help the system do more.
Mr Jamie Reed: I always enjoy the hon. Gentleman’s emollient Dr Jekyll, in contrast to the Secretary of State’s Mr Hyde. Will he be following the Crosby diktat and keeping his head down and his mouth shut about the Government’s record on the NHS between now and the general election, or will the Liberal Democrats be doing something rather different?
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Norman Lamb: I am very happy to speak for myself, and I will do so in due course. I am sure that the Secretary of State is enormously grateful to the hon. Gentleman for his description of him.
In the final session of this Parliament, the Government will continue to ensure that the new health and care system works with both integrity and purpose, delivering safe and compassionate care to patients, their families and friends.
Ordered, That the debate be now adjourned.— (Mr Gyimah.)
Debate to be resumed tomorrow.
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Undeclared Work (Reasoned Opinion)
[Relevant document: Forty-ninth Report from the European Scrutiny Committee, Session 2013-14, on Undeclared Work: Reasoned Opinion, HC 83-xliv.]
9.56 pm
The Parliamentary Under-Secretary of State for Business, Innovation and Skills (Jenny Willott): I beg to move,
That this House considers that the draft Decision on establishing a European Platform to enhance cooperation in the prevention and deterrence of undeclared work (European Union Document No. 9008/14 and Addenda 1 and 2) does not comply with the principle of subsidiarity for the reasons set out in the annex to Chapter One of the Forty-ninth Report of the European Scrutiny Committee (HC 83-xliv); and, in accordance with Article 6 of Protocol (No. 2) annexed to the EU Treaties on the application of the principles of subsidiarity and proportionality, instructs the Clerk of the House to forward this reasoned opinion to the Presidents of the European Institutions.
This debate will give the House a welcome opportunity to discuss the proposed platform on undeclared work, and to decide whether to send a reasoned opinion to the European Commission. The Commission proposal seeks to establish an EU-level platform on undeclared work. Undeclared work is defined by the Commission as paid activities that are lawful but are not declared to public authorities. This matter is high on the European Commission’s agenda, against a backdrop of efforts to improve job creation, job quality and fiscal consolidation.
The proposal highlights a number of concerns, based on a perception of high levels of undeclared work in the EU, including tax evasion, mis-declaration of hours worked and benefit fraud. The Commission is proposing a platform, whose members will be drawn from member states’ nominated enforcement bodies, to try to improve co-operation, share best practices and identify common principles for inspections. I should of course stress that addressing undeclared work is a priority for the Government. We have taken action at national level to detect and deter fraud through inspection, as well as to encourage good practice by providing guidance for employers.
The debate has been called because the European Scrutiny Committee requested an opportunity to discuss its concerns about whether the proposal respects the principle of subsidiarity. There are also very short time scales and deadlines to which the European Commission is seeking to secure agreement on a position; hence the debate taking place tonight.
Let me first turn to the issue of subsidiarity. The concerns that I set out in the explanatory memorandum—the Committee shares those concerns—were based on the initial draft of the proposal, which sought to mandate member states to participate both in the platform and in any enforcement activities arising from the platform’s recommendations. Like the Committee, we remain to be persuaded that the Commission has demonstrated a need to mandate member states to take part in the platform or that EU-level intervention action will add value.
However, it emerged in negotiations late last week that although member states’ participation in the high-level platform would be mandatory, participation in any cross-border operational activities recommended by the platform would be voluntary. The Council’s legal service has indicated that that is the case, and we have asked it
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to clarify its official position. Therefore, the principal concern about subsidiarity that we identified in the explanatory memorandum—based on an earlier text—drops away. We could decide, issue by issue, whether the UK should participate in further activity, and we would of course seek the Committee’s views on such matters. However, we have not yet had advice from the Council’s legal service in writing, and the proposals are still being negotiated, so they may change. I therefore understand that the Committee will want to decide for itself whether the proposal respects the principle of subsidiarity.
Our concerns about the detail of the proposal have been shared by other member states and, together, we have secured some changes. The changes, alongside the fact that the activities identified will not be mandatory, mean that the majority of member states will support the proposal. Therefore, the original subsidiarity risk that we identified does not still stand. Moreover, we should be involved in discussions about activities in relation to which we could be asked to take action, even if we probably do not want so to act. Negotiations are ongoing and the European Parliament is yet to begin its consideration of the proposals, so we will be continuing to work throughout the negotiations to ensure that our concerns about subsidiarity are addressed in the final text.
Let me now turn to justice and home affairs. Since publishing the explanatory memorandum, our ongoing analysis has identified that the proposal may include elements relating to justice and home affairs, thus invoking the UK’s JHA opt-in. That is because the proposals suggest, for example, that enforcement bodies such as the police will collaborate in cross-border activity. No decision has yet been made on whether or not to opt in to the proposal. Once a decision has been made, we will write to the European Scrutiny Committee. Having said that, as it is not mandatory to participate in any activities that result from the discussions, no significant burden would be placed on the UK by opting in.
The Commission and presidency are pushing hard on the proposal, and we were informed on Friday that they hope to reach a general approach on 11 June, which is very soon. The deadline for sending the reasoned opinion to the Commission is 11 pm tonight. With the timing of the recess and the Queen’s Speech, this evening was the earliest opportunity to facilitate a discussion in time to meet the deadline, although I appreciate that the timing is not ideal for such an important discussion. If we run out of time tonight, I will be happy to follow up any questions in writing, although given the numbers present, that seems somewhat unlikely—[Interruption.] The shadow Minister may want to raise lots of questions.
Ian Murray (Edinburgh South) (Lab) indicated dissent.
Jenny Willott: Oh, I am looking at the wrong side of the House. I hope that we will have time for a reasonable discussion and come to a decision on issuing a reasoned opinion tonight.
10.1 pm
Ian Murray (Edinburgh South) (Lab):
I thank the European Scrutiny Committee for its consideration of this issue and the Minister for her comments. Given the
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time scale involved and the number who would like to speak, we should try to meet the European Commission’s 11 o’clock deadline, although I doubt that I share the Minister’s enthusiasm or optimism that we will do that, given the Members who wish to speak. Nevertheless, as the Minister said, we have the first opportunity for the House to start banging on about Europe again so soon in the new Session.
It is worth reflecting on what is in the document, because undeclared work is an important issue. We should reflect on how harmful it can be to our economy and to the people who participate in it, and particularly on bogus self-employment in the construction sector. I was going to talk a little about that, but, given the time scale, I would like simply to agree with the Minister on the issues around subsidiarity and what the proposal is trying to achieve.
We have no problem whatever with trying to improve co-operation between member states’ enforcement authorities in order to prevent and detect undeclared work, including bogus self-employment. We should all share that aim, and it is welcome for all member states to work together on that. We should also be improving member states’ enforcement authorities by giving them the technical capacity to tackle cross-border undeclared work. We are very good at that in this country and should be sharing our best practice, as well as getting best practice from other member states on other mechanisms for doing that.
The third aim of the document is to increase public awareness of the urgency of action and to encourage member states to step up their efforts to deal with undeclared work across the European Union. I could spend a few minutes bashing the Lib Dem Minister and ask her what she is doing to persuade the Commission to look seriously at subsidiarity, because if they were to remove the mandatory element of the proposal, everyone would welcome taking it forward on a non-compulsory basis and be able to help other member states to go forward with the rest of the proposal.
The reality on the ground is that people are often looking desperately for work and will sign any contract placed in front of them in order to secure employment. With the freedom of movement across the EU, it is right that member states work with one another to tackle rogue employers who perpetrate undeclared work and attempt to hide behind other member states’ borders—they hide behind undeclared work in order not to pay their fair share of taxation and to undermine workers’ rights. It is that sort of limited and practical proposal that shows how the European collaboration project could work and add value to member states.
I do not know whether the Minister will get an opportunity to respond to the debate, or whether she will have time to do so, but I would like to pose a number of questions; if she does not get an opportunity to respond, perhaps she could write to me to give me some comfort.
What assessment has the Minister’s Department made of the scale of undeclared work across the EU, and in particular the UK? What investigation has she made into the cross-border problems of undeclared work? That information may be incredibly helpful in indicating the problem we are dealing with and what the benefits of such an EU-wide platform would be. What recent discussions have current enforcement agencies such as the Gangmasters Licensing Authority, the Employment
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Agency Standards inspectorate, and Her Majesty’s Revenue and Customs had with the Government and the European Commission on undeclared work and the usefulness of the proposal? Finally, I do not think the Minister mentioned this, but does she agree with the proposals in principle? The Opposition agree with the Government’s position, and hope we can get it to the European Commission as soon as possible.
10.5 pm
Mr William Cash (Stone) (Con): We are extremely conscious of the timetable this evening, and the fact that the whole business must be dealt with by at least 10.45 pm. We will do our best—at least, some of us will—to ensure that we get through the business as quickly as possible, but we must also have regard to what needs to be said.
The explanatory memorandum that the Minister has just discussed states:
“The Government is not yet persuaded that the proposed decision to require Member States to participate on a mandatory basis is consistent with the principle of subsidiarity and believes that participation in any platform should be on a voluntary basis.”
I know that further consideration is being given to that position, and as far as we are concerned the matter is of sufficient importance to be regarded as a breach of subsidiarity. That is our view, and the view of our legal adviser and the European Scrutiny Committee. The Minister added:
“The Government’s view is that the proposal lacks the empirical evidence base or analysis of structural failure at Member State or Union level which would support a case for intervention.”
We wish to underline the inadequacy of the Commission’s impact assessment, which acknowledges the absence of a clear “incidence chain” linking the establishment of the EU platform to a reduction in undeclared work, greater social well-being and better economic outcomes.
We also seek a clear explanation from the Government about their position on the content of the draft reasoned opinion prepared by the European Scrutiny Committee, as well as an indication of how they intend to use it in Council negotiations on the draft decision. Will member states continue to express a preference for voluntary participation in any EU platform on undeclared work? The Commission’s impact assessment indicates that most member states favour a voluntary approach.
We wish to press the Minister for a clearer indication of the scale and significance of the cross-border dimension in tackling undeclared work. In that context we bear in mind that, as she has said, there are justice and home affairs implications in respect of that and of whether there should be an opt-in. Will the Minister confirm that the Government will oppose any attempt in the general approach proposed to interfere in internal governance structures and the co-ordination mechanisms of national enforcement authorities responsible for tackling undeclared work?
I think that that is as much as needs to be said at this stage, but I wanted to put that on the record and make a general comment about reasoned opinions. I have been sceptical about reasoned opinions and the yellow card system for a long time—in fact, from the moment they were first put forward. We know that there are thresholds, but we were extremely disturbed when, in relation to the European Public Prosecutor’s Office, the threshold was
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passed by all member states and—surprise, surprise—the European Commission ignored that fact. The national Parliaments, which the Commission keeps telling us are so important, took the view that there was a breach of subsidiarity. On account of that it was assumed that the Commission would withdraw the proposal, but no such thing occurred.
I say that in general as we start the new parliamentary Session, because it is no good getting these grand statements—we are getting a lot at the moment—from the likes of Mr Juncker and company about the kind of European Union they want. There are very serious questions about the drive towards political union. If they want to trample on national Parliaments, when they put forward and achieve the threshold in terms of reasoned opinions and subsidiarity, and just ignore them, then I am afraid the increase in disaffection with the European Union will grow exponentially.
10.10 pm
Chris Heaton-Harris (Daventry) (Con): I shall be very brief, because I, too, know the time limits. I prepared a great oration to last for 90 minutes, because I know the Minister loves it so much. Really, I have just two questions: first on the detail of the Government’s position and secondly on the legal base.
The first question is a fairly easy one. The Government were uncomfortable with the legal base put forward by the Commission in article 153(2)(a). I am not sure what the Government’s current position is and I would very much like to hear what the Minister has to say.
Equally, I was not quite sure from what the Minister said whether the Government’s position on subsidiarity was shifting following the clarification at Council working group level that, while participation in the proposed EU platform will be mandatory for all member states, participation in the activities of the platform will be voluntary. I am not sure that that will be the case, because in the proposed text issued by the Commission it does not appear that the national authorities’ participation in the activities of the platform could, or would, be voluntary. Article 5(1) requires that
“Each Member State shall appoint one single point of contact as a member of the Platform.”
“Single points of contact shall liaise with all enforcement authorities which are involved in the prevention and/or deterrence of undeclared work regarding the activities of the Platform and guarantee their participation at the meetings and/or contribution to the activities of the Platform or its working groups if issues discussed involve their field of competence.”
It strikes me that there is a bit of an issue here, which is one of the very good reasons why we should issue a reasoned opinion. I would like the Minister’s clarification on that.
Finally, there is quite a budget attached to this platform. Europe is very good at spending money on doing these things. Personally, I do not see the value in half of this stuff, but I would very much appreciate it if the Minister clarified those two points.
10.12 pm
Jenny Willott:
A number of the points that have been raised by hon. Members are very similar. First, it is important to put on the record that undeclared work
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is an extremely important issue across Europe. It is on a larger scale in some countries than others. The hon. Member for Edinburgh South (Ian Murray) asked what research had been undertaken on the levels of undeclared work in the UK. The most recent estimate for the UK was, I think, 1.7%—extremely low. In other member states the figure is significantly higher, so it is clearly a bigger issue in other states.
Cross-border working was mentioned by the hon. Member for Stone (Mr Cash) and the hon. Member for Edinburgh South. One of our concerns is that very little evidence has been put forward on the implications and requirement to take action on cross-border work. On the assessment of the numbers and the amount of detriment that can be attributed to them, we are not convinced that the data are particularly accurate. We have asked the European Commission to identify, in a much better way, the scale of the problem. The UK, alongside other member states, does a lot of work internationally across borders, in a completely voluntary way, to try to tackle these issues. A huge amount of work is done because, as responsible Governments across different countries, we all think it is really important to tackle this issue. We do not feel that the Commission has provided evidence that what is being done at the moment is not a good enough approach and we have not seen evidence to suggest that the problem is significantly larger. That is one of the main reasons why we feel that the Commission has not made the case for why this needs to be done at EU level, rather than at member state level.
The hon. Member for Stone asked about participation and about our position on the subsidiarity principle, given that we are saying that the position has changed. We still have concerns that the mandatory nature of the platform is a breach of the subsidiarity principle. However, as regards the operation, given that the only mandatory element is attendance at the platform, we now believe that the concerns we raised in explanatory memorandums about the requirements for member states to take action when it is for them to decide—it has been agreed in the negotiations that it should not be mandatory—are not such a problem for the UK. Yet we feel it is really important that any activity should remain voluntary rather than mandatory.
Mr Cash: Is the Minister saying that she still believes that, as far as the UK Parliament is concerned, there should be a yellow card for the purpose? The question is as simple as that.
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Jenny Willott: We certainly support today’s motion, and we think that we should be sending a reasoned opinion. Our concerns are, however, less, now that the rest of it appears to be voluntary. We still feel strongly about the mandation, which is why we are working with other member states on the negotiation to ensure that the activity that follows from the platform should be voluntary. That is why we have asked for written confirmation from the Council legal services. We tried to get it for this evening’s debate so that we could be clear on the position. It is still a moveable feast and we are still in negotiations, but we hope to reach that position. A number of other member states have similar concerns about the mandatory element and we are not the only member state working to try to ensure that the rest remains voluntary.
The hon. Member for Edinburgh South referred to the issue of bogus self-employment in the construction sector. We hope that the work of the platform will include looking at such issues and analysing them. We will press for a full analysis of areas that we think it would be useful for the platform to consider.
The points raised by the hon. Member for Stone about the yellow card system generally are above my pay grade, but I think that his points were well made and I will make sure that they are referred back to the most appropriate Minister.
I hope that I have tackled all the issues raised. If I have not—we can go through the Hansard—I will be more than happy to clarify anything I may have overlooked.
Business without Debate
business of the house (private members’ bills)
That:
(1) Private Members’ Bills shall have precedence over Government business on 5 and 12 September, 17 and 24 October, 7, 21 and 28 November, 5 December 2014 and 9, 16 and 23 January, 27 February and 6 March 2015; and
(2) the resolution of the House of 2 December 2013 relating to Adjournment (February, Easter, May Day, Whitsun, Summer, Conference recess, November and Christmas) shall be amended by leaving out ‘Thursday 11 September 2014’ and inserting ‘Friday 12 September 2014.—(Mr Lansley.)
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Children with Epilepsy (Children and Families Act 2014)
Motion made, and Question proposed, That this House do now adjourn.—(Mr Gyimah.)
10.18 pm
Paul Maynard (Blackpool North and Cleveleys) (Con): It is a pleasure to be able to initiate a debate on this issue. It is not the first time that we have discussed epilepsy in the Chamber, and I certainly hope it will not be the last. We had a useful Westminster Hall debate back in February 2013, initiated, I believe, by the hon. Member for Walsall South (Valerie Vaz), and I had a debate back in October 2010, which was my first on the topic.
Rather than look at the wide spectrum of epilepsy today, I want to focus—laser-like if I may—on the issue of epilepsy in education and the implications of the Children and Families Act 2014, which has just been introduced and which I think represents a fork in the road for how we deal with pupils who have serious medical conditions such as epilepsy.
Before I get into the nitty-gritty, it would be worth focusing once again on the numbers and the context. There are 122,000 children with epilepsy at any one time in our schools system—four times more than have diabetes. Diabetes has, quite rightly, had a lot of attention of late in this Chamber, so it is interesting to balance the two.
There are more than 40 types of epilepsy. It covers an amazingly massive spectrum, not just the classic “grand mal” fit with which many associate it. It can be as simple as the occasional “absence”, when people lose their attention for some reason. Epilepsy is often the least noticeable of a range of complex conditions that an individual has. More than 42% of pupils with epilepsy are on the learning disability spectrum. For some people with very severe forms of conditions such as cerebral palsy, epilepsy is almost the least of their concerns, but it is still an ever-present part of their daily lives.
A recent CHESS—Children with Epilepsy in Sussex Schools—study found that 42% of pupils with epilepsy were not fulfilling their potential in the school system, and I think that that important fact represents the crux of the debate. This is about not only the medical implications of epilepsy, but the societal context. So much is based on ignorance of the condition. That does not just mean not knowing what to do when someone is having a seizure; more important, it means ignorance of the causes, the background and the neurological underpinning of epilepsy, and, in an educational context, the implications for an individual’s learning capacity.
Lurking behind all that are the consequences of prejudice and the stigma that is attached to epilepsy. I often cite one example of that. When I was a Conservative candidate in Twickenham, I wrote to my local paper about national epilepsy day in an attempt to raise awareness of the condition. I was shocked when, the following week, a constituent wrote, “Mr Maynard should not have to worry; he has merely been possessed by evil spirits.” At the time I found it hard to believe that such a level of prejudice could exist, and I find it just as hard to believe now. However, it occurs not just in the playground, but in the classroom. Many
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pupils with epilepsy report a lack of understanding on the part of members of staff, which I think needs to be tackled.
The Children and Families Act represents a major opportunity in that regard. It has numerous good aspects, but I must ask the Minister a fundamental question: how can he ensure, as he implements the Act, that the needs of children with epilepsy are not left by the wayside just because they are among the more complex needs in terms of both health and education? I am sure the Minister agrees that the challenge posed by the Act will not simply disappear following Royal Assent. If anything, the challenge of implementation is that much greater. I ask him to bear it in mind that, as I said earlier, 42% of pupils fail to fulfil their educational potential. I should welcome his thoughts about how we can ensure that that percentage is reduced.
As I have said, I think that the Children and Families Act contains much that is good. I welcome the fact that school governors will have a duty to address the medical needs of pupils who are in their care. I welcome the fact that we are moving towards a more practical acceptance of epilepsy in the classroom. A couple of months ago, the Minister and I were lucky enough to launch the Council for Disabled Children’s “Dignity and Inclusion” documents, which provide teachers with a practical way in which to assess how to deal with children with epilepsy in their classrooms. However, there is still more to be done.
I myself have nocturnal epilepsy. I have night-time fits, which are triggered by alcohol. When I come to the next morning, my short-term memory is gone. I struggle to remember what I did the day before. I would probably even struggle, initially, to answer that classic question, “Can you name the Prime Minister?” I would have to think long and hard about it, and might actually fail to answer it, although I assure the House that I could answer it now.
It must be borne in mind that epileptic attacks, seizures and fits all have consequences for pupils’ learning. Young Epilepsy, the major charity that campaigns on behalf of people with epilepsy, which has been a great help in putting together the information for the debate, has produced what it calls “A Manifesto for Change”, which contains some useful guidance on matters on which I should like the Minister to focus. First and foremost, it wants to ensure that all pupils have access to a high-quality personalised assessment of their needs, rather than being subject to a standard tick-box approach. I know that Young Epilepsy has a graph assessment tool called ABLE, which may be helpful in that regard. It is all very well having an assessment and determining needs, but one must go to the next stage. All pupils, parents and teachers need to understand what the entitlements are as a consequence of the assessment. There is no point being assessed and then not knowing what one is entitled to and what the local offer consists of.
The third aspect that Young Epilepsy is campaigning on is perhaps the trickiest: teacher training. I realise that central Government have little control, if any, over the composition of teacher training syllabuses, but the key point is that it is not just about the first aid aspects of dealing with a pupil with epilepsy, important though that is—it often seems to get the main focus in political debate; it is also about understanding the consequences
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for an individual’s learning of those epilepsy seizures. More important again, it is about trying to understand that knowing how to spot the warning signs can incentivise earlier diagnosis and better care for the pupil.
I would welcome the Minister’s view on what he can do to encourage a greater role for epilepsy in initial teacher training. What can we do as part of continuous professional development to incentivise teachers who have already been trained and are in the classroom to look at epilepsy and understand not just the first aid consequences but the learning consequences? The two go hand in hand.
Another aspect that is worth bearing in mind and on which I would welcome the Minister’s view is the assessment that he has made of the pathfinders that have been reviewed recently. I understand that one of the initial conclusions is that within the existing resource allocation, it has been very hard to make a real difference to the lives of individual families. I know that that is an initial finding. Does he share that view? Does he have an alternative opinion?
I understand that £70 million has been allocated across the country to a range of local councils, which have all spent that money differently. Some have spent it on improving data systems, others on improving the local offer. Others have hired extra staff. How will the Minister assess all these different funding streams? What has had the most impact on families and the children? How will he measure the effectiveness of the £70 million? It is good to have £70 million, but we need to know how local authorities can best spend it.
Equally welcome is the £30 million that will go into what will be called independent supporters. That term seems a bit nebulous. I am not sure I can give a precise definition on the Floor of the House. I would welcome a bit more information from the Minister on what that might involve.
I would also like some reassurance. There is a slight concern in the epilepsy community that the £30 million may go to the larger charities, which can spend their money on branding, rather than investing in service delivery, expertise and competency down the years. It would be a great tragedy if the expertise were not utilised to ensure continuity of care for pupils between home, school and any other setting. That is why it is worth paying tribute once again to the Minister for his determination to ensure that we have education, health and care plans. I know that that was a running sore throughout the development and legislative process of the Act. We had to try to meld education and health, which did not always fit together neatly. It is vital that we have education, health and care plans, which will allow pupils to fit in between the two.
The other question I have for the Minister relates to the role of Ofsted. How will it assess the quality of the provision? At the moment I understand that we can rely on parent satisfaction surveys as a key indicator of whether services are working well. Although those are not to be dismissed, I am not sure that they constitute a proper statistical basis on which to make evidence-based policy decisions. I know that the Government are strong believers in an outcome-based system and in assessing the effectiveness of legislative intervention, but in this specific instance what outcomes will be used to make
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that assessment? Who will be doing the assessing—Ofsted or some other body? Will they have sufficient powers to assess the health component of what will occur in the educational setting as well as the educational activities?
My final question relates to what are called key workers, which is a relatively broad term and encompasses people who truly understand epilepsy and who can help families to navigate their way through what remains a complex minefield of different service providers. It is noted in the Children and Families Act that key workers are seen to be a good thing, but they are not mandatory: they are merely an advised addition that local authorities can consider. I would be interested to know how the Minister thinks we can strengthen the appeal of key workers, though not necessarily to make them mandatory, because I understand the importance of localism and ensuring that local authorities make up their own minds. There is a case, however, for ensuring that key workers do not become a luxury optional extra that gets tacked on at the end of a local offer if there is some money left over, but are the building blocks of the local offer provision for families with children with epilepsy.
I realise that, as is the nature of Adjournment debates, I have peppered the Minister with detailed questions, some of which I hope he can answer—civil servants in the Box are passing yet more answers to him as I speak. If he cannot answer all my questions, I hope he will be able to write to me at a later date. I thank him for agreeing to meet Young Epilepsy, which I am sure will be an interesting meeting in the light of this debate. I thank him and all hon. Members who have attended for their time, and I look forward to hearing his reply.
10.31 pm
The Parliamentary Under-Secretary of State for Education (Mr Edward Timpson): May I begin in the traditional and in this case very pertinent way, by congratulating my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard) for once again initiating an important debate about the wide subject of special educational needs and the specific area of those many children and young people who have some form of epilepsy? This is not the first debate of this kind that we have had, and it is good that he reminds us that as we move on from the statute book to the implementation of the Children and Families Act 2014, we should keep our focus very much on what this means to the families and children whom we hope to benefit from the reforms.
Like my hon. Friend, I understand the importance of supporting pupils with medical conditions such as epilepsy, and it is imperative that the right support is put in place quickly and effectively. I will try to cover as many of the points that he made as possible, and I will of course endeavour to make sure he has a full and proper response in writing to those that I do not.
I should like to start by restating our ambition that every child with SEN, or who has a disability or a medical condition that impedes their ability to learn, including those with epilepsy, receives the support they need, so they can achieve well in school and go on to find employment and lead happy and fulfilled lives. The special needs reforms in the 2014 Act are deliberately focused on joining up help across education, health and social care, so that children receive the help that they need when they need it throughout their education.
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Parents and children will be involved in decisions about the support they receive much more closely than hitherto, so that they have a genuine say in what they want to achieve and how they will achieve it.
Epilepsy is just one of the many medical conditions for which pupils require support, to help them progress properly through school, and it is right to acknowledge the excellent work that most of our schools do to provide the support that their pupils need. However, there can be no excuse for the poor practice that evidence suggests exists in some schools.
Under the Equality Act 2010, schools have clear duties not to directly or indirectly discriminate against children and young people with disabilities. Government guidance on the Act clearly identifies long-term health conditions, such as epilepsy, as being among the impairments from which a disability can arise, and they are therefore covered by this duty. As such, this form of discrimination is simply not acceptable.
As my hon. Friend skilfully argued, however, pupils with epilepsy often face significant challenges and difficulties not just in school, but in all aspects of their lives, and I also recognise that these challenges can be exacerbated because of a lack of understanding of the condition by others.
I remember a family holiday from about 30 years ago when we had with us a school friend of my sister who had epilepsy, unbeknown to me. During our holiday, this child, who sadly and tragically died this year, suffered an epileptic fit. As a young boy, I was shocked by what I saw happen in front of my eyes, but, having had had it explained to me, it has left me in good stead for the rest of my life, in terms of understanding the cause, effect and manifestation of epilepsy and the surrounding context for someone who has it. That was pure chance, and many people, whether pupils or even teachers at school, do not have that experience and cannot draw from it.
As my hon. Friend said, that is one reason why we introduced a new duty for school governing bodies to make arrangements to support pupils with medical conditions and to have regard to guidance, so that they get the support they need at their time of need. Our aim in putting that duty in the 2014 Act was to send out a clear message that poor practice will not be tolerated and that conditions such as epilepsy must be properly recognised. Pupils with medical conditions deserve to be supported properly in schools and to have the same chances as everyone else to succeed in whatever they choose to do.
The new statutory guidance on supporting pupils with medical conditions acknowledges the negative social and emotional implications associated with medical conditions such as epilepsy. That is why there is a clear expectation for a child’s social and emotional needs to be taken into account when considering the support that they require. This guidance, which comes into force in September, is deliberately child-focused, recognising that medical conditions will present differently in different children. Epilepsy is a case in point; no two children with epilepsy will have identical needs, and it is therefore right, as my hon. Friend said, that each case is treated individually, based on the needs of each child.
That is why we have also made it clear in the guidance that the school’s policy should cover the role of individual health care plans and clearly state who is responsible for
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their development. The plans will help to ensure that school staff know how to support pupils in lessons, how to help them with administering medication and what to do in an emergency. They will be drawn up in collaboration between the school, the parents and the pupil—that is important—and the most relevant health care professional, such as the epilepsy specialist nurse. I am pleased that we have developed the new statutory guidance in such close collaboration with a wide range of interested parties. Young Epilepsy, as a member of the Health Conditions in Schools Alliance, was actively involved in that work and added substantial value to the guidance, for which we are extremely grateful.
In identifying children and young people who need additional support and adjustments, whether because they have a health condition, a disability or special educational needs, the key is that professionals should look at the particular needs of the individual and seek to co-ordinate support, so all these needs are addressed coherently. Children with epilepsy will not necessarily have SEN. What is set out in a child’s individual health care plan might be enough to ensure that he or she has access to differentiated, high-quality teaching. However, where a child has SEN, the new nought-to-25 SEND—special educational needs and disability—code of practice sets out how schools should work with parents to identify underlying issues, including health needs, and reflect those in the support given and the outcomes we all want to see achieved. Where a child or young person has an education, health and care plan, the code sets out a thorough process—again, with parents centrally involved—for putting in place a comprehensive plan covering the full range of a child’s needs; obviously, that can include support provided by specialist services.
These plans are also supported by the strategic arrangements in the 2014 Act. The joint commissioning duties require education, care and health services to come together to commission services for children and young people with SEN and disabilities. Wider provision is also covered, including through a consideration of how to integrate education, health and care provision to provide that most effectively, in line with wider duties. As my hon. Friend will also be aware, the new local offer will set out details of all the services for children and young people with SEN and disabilities in a local authority area and how to access them. We expect that that will reflect the full range of services, including those for children and young people with epilepsy, and those offered by the voluntary and community sector.
On initial teacher training, I fully understand the case my hon. Friend makes, and it is always tempting to look to ITT as a solution in respect of the desire to see every teacher well versed in the practice of dealing with many of these conditions. Teaching standards include duties on schools to ensure that their staff understand how to deal with children’s special educational needs. We can also look at reviews into initial teacher training to satisfy ourselves that they are going far enough.
My hon. Friend will know that there have been a number of evaluations of pathfinders in 31 local authority areas. We now have pathfinder champions who are helping those non-pathfinder areas to learn from the evaluation of the progress that they have made. We have excellent examples of families who feel that the culture has shifted. For the first time, they have been able to sit in a room with someone from education, someone from
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health and someone from social care, and they have been asked what they think should happen, rather than it being told to them.
The special educational needs reform grant of £70 million has gone to local authorities. We have done a local authority readiness test to see how each local authority is performing in preparation for the changes in September. Ofsted is doing some thematic work to look at how some of the reforms will bed in over the next months and years, and I hope to see progress in time towards a more cohesive inspection regime of special educational need provision across all the different services. Ofsted is starting to consider that that is the best way forward for children’s services, and there is a good case for looking more carefully at how education, health and social care inspection can be brought together, so that it looks at the experience of the child and the family, rather than at the individual services.
The independent supporters are, in many ways, the key workers about whom my hon. Friend was talking. The £30 million will pay for 1,800 independent supporters who will be drawn predominantly from the charitable sector. I encourage organisations such as Young Epilepsy, which want to get involved, to contact the Council for Disabled Children, which is helping us to recruit those independent supporters. It works out at about 12 in each local authority area. We know from speaking to parents right across the country that one of the things
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that they value more than anything else is to have someone who is not from the local authority, the school or one of the health providers to provide them with that genuine independent support to navigate them through what can sometimes be seen as a very convoluted system—a system that we are trying to make clearer and easier to access. It is very much an investment in service delivery, as my hon. Friend says, and the £30 million will be invested over the next two years. To monitor its progress, we will work closely with our strategic partner, the Council for Disabled Children, to make sure that it is having the impact that we all want to see.
Over and above that, I will be saying more tomorrow about how we will ensure that the extra burdens that we are placing on local authorities will be met, so that the authorities have sufficient funds to ensure that the system really does reach the parts that we want it to. Ultimately, this is about ensuring that parents and young people who have special educational needs and disabilities see that cultural change in the system that for too long has been absent. As my hon. Friend says, this is a fork in the road, and we need to take the right path. I believe that we can do that, but we need to pull together to make sure that this really does make the difference that we all want to see.