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3.11 pm

Mr Peter Hain (Neath) (Lab): Thank you, Mr Streeter—it is a delight to see you in the Chair. Like others, I congratulate the hon. Member for St Ives (Andrew George) on securing the debate and on the work that he, along with others in the room, has done with the all-party group on global tuberculosis, of which I am a member.

As I declared in the Register of Members’ Financial Interests, I visited South Africa in February 2012 with the charity Results UK, which does such important work on one of the most important questions in global health today: how do we move from struggling to control the world’s deadliest diseases to eliminating them? We can control diseases such as TB and HIV, but they continue to represent a terrible burden on individuals, families and communities across the world. In the 90 minutes of this debate, nearly 500 people will lose their lives from just those two diseases.

I am the chair of trustees of a remarkable charitable organisation called the Donald Woods Foundation, in Nelson Mandela’s impoverished homeland of the Transkei, in the Eastern Cape, in South Africa, where it is battling to control the twin epidemics of TB and HIV and to strengthen health services in remote, rural communities. It works closely with the South African Department of Health, and it has screened 150,000 people for TB. It also has nearly 10,000 people on HIV treatment, and it supports outreach to those who would otherwise not be reached. In addition, it has pioneered clinic design for infection control and TB testing.

Despite the huge and highly commendable efforts of the South African Government and of civil society organisations such as the DWF, South Africa continues to battle enormous health challenges, one of the most significant of which is drug-resistant TB. In one small sub-district last year, the DWF reported 49 cases of extensively drug-resistant tuberculosis. XDR-TB has evolved to be resistant to our best drugs, and the few treatments that remain are old, toxic and associated with terrible side effects. Treatment success with XDR-TB and multidrug-resistant TB—MDR-TB—is rare. The drugs involved, taken over years with daily injections, steadily destroy quality of life, often leaving patients with permanent disabilities. The burden of treatment is so heavy that many patients choose to default—to give up—and they discharge themselves from hospital rather than continue with what are, essentially, useless drugs that are causing them pain.

I have met people with XDR and MDR in South Africa, and their examples are tragic. I remember the story of a girl who had been confined in a hospital ward for more than two years. The drugs made her physically sick practically every day, she was losing her hearing because of them and her liver was being destroyed by the disease—TB ruined her life. Before the disease, she was doing well in school, and she had a bright career ahead of her, as well as close friends and a good family, but then the disease struck. Eventually, I am sorry to say, she discharged herself from hospital, knowing that, in doing so, she was most likely surrendering her chances of surviving. She returned to her family home, but it was empty—both her parents had died from the same disease. Soon, she also passed away—pale, sick, deaf and alone.

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Sadly, that is not an isolated story. South Africa has the highest rate of TB in the world, and behind the statistics are thousands of tragic, grim stories. The worst cases are in gold mining. The deep gold mines are a source of a tremendously lethal form of TB, with all the consequences that brings.

Progress is being made against TB and HIV, but it is far too slow. The diseases continue to ravage health systems across southern Africa. Only 2% of South Africa’s TB burden is drug resistant, although that number is increasing, but that 2% accounts for fully 32% of the national budget for tackling TB.

Our weapons against these diseases are becoming less effective with every passing day, and I am struck by the similarities between drug-resistant TB and antimicrobial resistance, which was such a topic for conversation last week, with the Prime Minister launching his own special commission. We need new drugs that the TB bacteria have not already encountered, and we need a vaccine that kills or prevents infection so that resistance never gets the chance to develop. We need to remember that we have TB here in the UK and that a small but growing percentage of cases in the UK are drug resistant.

When drugs are developed, they must be affordable. Of course, commercial sector organisations must generate a profit, and developing a new drug can cost hundreds of millions of pounds and take years of sustained effort and research. None the less, while we want to find a way to unlock a new generation of drugs for diseases such as TB, we must not find ourselves in a situation where the poorest people cannot afford treatment or where the cost of buying drugs cripples local health services in poor countries.

What is required, then, is an alternative model—one that separates the requirement to generate a profit from the direction of research and that separates the cost of research from the price of the final product. Such a model, which is often described as de-linked, is the only way we will be able to encourage research and development for diseases for which there are no significant financial markets and to ensure that the products that are developed are accessibly priced. Will the Minister therefore commission a report examining the costs and implications of commercially driven development, as against de-linked development models, and use the findings to make the case to other Governments? Perhaps he could respond to that request in his reply.

We know that the system is not working; we know that the imperative to act and to find solutions to these problems is as strong as ever, and we know that the challenge of correcting market failure will dictate the future of efforts to control humankind’s deadliest infectious killers, yet we are no closer to breaking the deadlock. For the sake of the world’s poorest, our own national health service and, ultimately, our health in this country—these diseases are very infectious—I ask that DFID champion alternative, non-commercial models of development and thus help to develop the new drugs, vaccines and diagnostics that will help us to see the end of TB, HIV and malaria in our lifetimes.

3.19 am

Jeremy Lefroy (Stafford) (Con): It is a privilege to serve under your chairmanship, Mr Streeter. I thank my hon. Friend the Member for St Ives (Andrew George) for securing this important debate.

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It is extremely important for the UK, and indeed the whole world, to take seriously the question of research and development for global health. I want to outline why it is also important for it to play, as it does, a major role in the work of the Department for International Development. I believe that to be so for five reasons, the first of which is that the aims in question are global public goods. The right hon. Member for Holborn and St Pancras (Frank Dobson) talked about institutions that grew out of a desire to give treatment, including the London School of Hygiene and Tropical Medicine, which I believe was for seamen. The Seamen’s hospital was at the royal docks, and seamen from all over the world who had contracted diseases went there. The hospital that eventually became the London School of Hygiene and Tropical Medicine was set up to help them. The Liverpool School of Tropical Medicine was founded by a ship owner who saw that if he and his colleagues in Liverpool were to engage in trade around the world, there was a need for treatment for diseases that might prevent their trade from continuing. If half of a crew who had been sent overseas succumbed to deadly diseases, it would not be possible to continue to trade. Thus the school came from a compassionate interest in people’s lives, and a commercial interest linked to compassion.

Secondly, the work in question is a matter of global public goods; the diseases are not diseases of far away people in far away lands. My right hon. Friends the Member for Arundel and South Downs (Nick Herbert) and for Eddisbury (Mr O'Brien) have already said that they are the diseases of the poorest people on earth. I declare an interest as chairman of the all-party group on malaria and neglected tropical diseases. Those diseases—some 17 of them—affect well over 1 billion people a year who are among the poorest on earth. Malaria is similar, although like TB it can affect anyone. Those of us who travel to countries where it is endemic catch it, as I have on several occasions. When we invest in global research and development for global health we invest in tackling poverty and helping economic growth and prosperity. When people are sick they cannot engage in economic activity.

Thirdly, there is a need for long-term funding. That is why the role of DFID, development organisations and private foundations is so important. We are not talking about a budget for one, two, three or four years, but about long-term commitment. That is why I applaud schemes set up with the influence of, or sometimes by, the previous Government, such as the International Finance Facility for Immunisation, which I believe committed UK funds for up to 20 years, to develop vaccines. It is not possible to develop them over the short term. The Government have committed up to £500 million a year to tackling malaria. That is not just for research. As my hon. Friend the Member for South Derbyshire (Heather Wheeler) mentioned, diagnostics are key. The money will go on diagnostics research and delivery, as well as bed nets and drugs, but a substantial part of that £500 million a year will go towards research. So will part of the £40 million a year that the Government have rightly committed to tackling neglected tropical diseases.

Fourthly, there is a question of partnership and leverage. We must work with others. As so many right hon. and hon. Members have said, the task is not one that can be

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carried out by the commercial sector alone, although it has an important role to play; by Government alone, because Governments do not really do research; or by the foundations and NGOs alone. I have found from my work on malaria and neglected tropical diseases, as I am sure colleagues have, that it produces some of the finest examples of people working together—the commercial and private sectors, NGOs and Government —to tackle a common global problem.

The final reason I want to outline is one that was eloquently pointed out by the right hon. Member for Neath (Mr Hain), and my right hon. Friend the Member for Arundel and South Downs: resistance. We sometimes think that the problems are solved. They are not. I know far less about TB than the right hon. Gentleman and my right hon. Friend, but they pointed out the problems of increasing resistance to TB drugs. The same is being experienced with malaria, although the problem is perhaps not so advanced. Already the artemisinin combination therapies that have been a life saver for malaria around the world are facing resistance in places such as Myanmar. That is of course where resistance to chloroquine started, before it spread across Africa, resulting in the drug’s becoming almost useless. We must take the situation seriously, and I welcome DFID’s work in Myanmar to help to counter the spread of artemisinin resistance there.

Resistance develops not only against drugs, but against the insecticides with which bed nets are treated. Increasingly the mosquito is becoming resistant to some of them. That is why we must begin to use combinations of insecticides, or develop new ones. There is no doubt that insecticide-treated bed nets in the past 10 to 15 years have dramatically reduced malaria incidence and the death rate.

The debate is incredibly important because investment in research and development for global health is not an option but a necessity. I am proud that the UK takes a lead in research and in development. As the right hon. Member for Holborn and St Pancras has said, there is much of that concentrated in the UK. Also, NGOs and foundations in this country take a lead, and a huge amount of work is done by DFID. I welcome what has been done, but the problem is a long-term one and we need long-term commitment. So far we have had that from DFID, and I urge the Minister to say that the issue remains at the heart of DFID’s work and will do for years to come.

3.26 pm

Gavin Shuker (Luton South) (Lab/Co-op): I am grateful, Mr Streeter, for your chairmanship and for your maths, which has allowed a good period of time in which to express the Opposition’s support for the work of the all-party group, and for the Minister’s response.

The debate has been well informed and well attended, and there were welcome speeches by people who are hugely knowledgeable about the field. I want to refer to the disease that is predominant among those we have been discussing, and some of the recommendations in the report. I also want to consider structural and systemic issues about the delivery of effective care.

It is crucial in such debates to avoid becoming too fixated on high-level statistics and market processes, or too absorbed in the clinical mechanics of disease prevention

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and control. As my right hon. Friend the Member for Neath (Mr Hain) pointed out, in his hugely passionate speech, that absorption can cause us to forget the lived reality for the many people who have those terrible diseases. Death from tuberculosis, and life with it, is horrible. Cavities form in the lungs, causing bleeding, or resulting in pus-filled infection, blocking vital airways and causing difficulty in breathing. Each breath becomes a battle, because tuberculosis weakens the body and causes weight loss so extreme that, to the outsider, it can appear as if the body is literally consuming itself. When it affects children, it can mean that a child of six weighs 8 kg, which is barely the weight of a newborn baby. Long-term pulmonary damage, collapsed vertebrae, brain damage, lesions so severe that they change the structure of the body: that is the reality. Those are just some of the complications that survivors of the disease face, in addition to the stigma that besieges this disease of poverty and proximity.

As many right hon. and hon. Members have said, tuberculosis continues to ravage the lives of millions of people worldwide. There were 8.6 million new infections in 2012 alone. There are regions of the world

“teetering on the brink of a tuberculosis epidemic”.

If it is left unchecked over the next 20 years almost 1 billion people will be newly infected with TB; 200 million will develop the disease; and 35 million people will die of it. Given that it is curable, that is an unforgivable tragedy. That situation—alongside malaria, HIV, dengue, yellow fever, rabies, sleeping sickness, river blindness, leprosy and many others on the World Health Organisation’s list of neglected diseases—is a spur for our timely, if not overdue, debate.

As Members have pointed out, fundamental market failures have meant that the development of affordable and accessible treatments has simply not been prioritised in the way it should have been. In the past 40 years, just one Food and Drug Administration-approved TB drug has been introduced to market, compared with 15 FDA-approved products introduced for hay fever. Yes, hay fever is debilitating and it is certainly an uncomfortable irritation for many people, but it is not a global killer.

The inquiry and report that sparked today’s debate offer a number of pragmatic solutions that could underpin the currently failing commercial model or support the development of alternative structures and models for product development. It is crucial that these recommendations receive the attention they deserve.

The Department for International Development is already a world leader in research and development for global health, which this Government have prioritised in their parliamentary term, just as the previous Labour Government did in their last parliamentary term. It is vital that DFID’s reputation is maintained and further enhanced if the threats of pandemic proportions posed by these neglected diseases are to be abated.

The Prime Minister’s welcome recent announcement on antibiotic resistance and the £1 billion UK commitment to the Global Health Fund must also be celebrated, but such leadership must be shown across the board. A focus on research and development must not crowd out other important health care considerations. For example, the World Health Organisation’s recommended approach to tuberculosis—commonly known as directly observed

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treatment, short-course, or DOTS—requires daily supervision by a qualified health professional. That is an impossibility for the 2 million Somalians who have no access to health care services, or even for the 8 million Somalians who have access to such services but for whom it takes an average of four hours’ travel to reach them.

Moreover, research and development alone will not address the issue of those people who might never be diagnosed. They are prevented from accessing basic medical assistance because of poverty, stigma or discrimination. They are also isolated from the respite that decent health care can offer and, in the case of communicable diseases, they are unknowingly or helplessly infecting those around them. For these people, the urgent need for universal health care coverage is clear.

The UK death rate for TB is admittedly high in some areas. As many Members have highlighted in today’s debate, TB is a disease that shows no respect for national boundaries. Nevertheless, the reason the UK death rate for TB is low in comparison to other nations is down to the progress made by our NHS, which is undoubtedly my party’s greatest legacy. The NHS is a world-leading health care system built on the principles of fairness, providing high-quality and accessible health care that is free at the point of use.

In addition to responding to the specific recommendations of the report, I invite the Minister to set out how the UK will ensure that the laudable goal of universal health care coverage, which this Government have signed up to, will remain on the post-2015 development agenda, because it is only when we achieve universal health care coverage that the links between disease, poverty and inequality can begin to be broken.

If the main earner in a family becomes ill, the family can be driven even deeper into poverty; disease destroys their ability to earn money, or even their ability to subsist through work. That problem is compounded by the direct medical costs that patients face—such as consultation fees, drugs, diagnosis or hospitalisation—or by the indirect costs associated with ill health, such as travel to the nearest health centre, or increased nutritional or heating needs. Children miss out on school because of illness, or have to earn money to compensate family incomes that have fallen when parents or siblings become sick. So, in considering what support to give, it is essential that we not only look at the specific diseases that have been mentioned but at the mechanisms for delivering treatment.

The gendered impacts of ill health must not be ignored either. Women and girls are not only less likely to seek help, but are often saddled with caring responsibilities on top of their existing work loads. Frequently, they are even expected to give up their own work or education, undermining their chance to reach their potential, which traps the most vulnerable in cycles of poverty, disease and poverty again.

The ability to enjoy free access to health care services as envisaged by universal health care coverage would not only ensure access to treatment but would increase medical visits, which would raise the rates of diagnosis that the report makes clear are crucial in the fight against communicable diseases.

A holistic approach to health requires going beyond even universal health care coverage to include consideration of water and sanitation, inequality, housing and education,

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so it is clear that the challenges faced by the world in responding to the needs identified in the report are massive. However, it is only in adopting such an approach that we can be clear about the true impact of the neglected diseases that we have been discussing today, and about how we can address them.

We face some of the gravest global health care challenges of our time. Addressing them will require a co-ordinated international effort, and I am sure that the efforts of the hon. Member for St Ives (Andrew George), who I congratulate on securing this debate, will go a long way towards holding our feet to the fire and ensuring that we do address them.

3.35 pm

The Minister of State, Department for International Development (Mr Alan Duncan): I thank the hon. Member for St Ives (Andrew George) for securing this important debate—indeed, I thank all those who have contributed this afternoon. Thanks to the right hon. Member for Holborn and St Pancras (Frank Dobson), it looks as if the Chilcot inquiry will have to make a study of infected chickens.

I also thank and commend the hon. Member for St Ives, and the rest of the all-party group on global tuberculosis, for the publication of a thorough report. We all appreciate the group’s tireless work in keeping our collective focus on global health—particularly research and development, which we are discussing today. As I am sure the group will appreciate, as the report was made available to us only last night, I have not had a chance to read it in detail. However, an initial scan shows that there is much in it that we welcome.

The report seeks to answer two fundamental questions: why are diseases of the global poor so badly neglected in research efforts, and what potential solutions are available to unlock the puzzle? Following a cursory reading, I am delighted to say that the Department for International Development is widely praised for our commitment to research and development in global health, and I am also pleased to learn that our willingness to provide flexible and untied support is particularly valued. The Department will consider the report and its recommendations during the next few weeks. However, let me now say just a few words about how DFID’s approach to research and development will proceed more broadly.

In the last two decades, tremendous progress has been made in improving the health, and preventing the deaths, of those living in poverty around the world, particularly women and children. For instance, between 1990 and 2011 the mortality rate among children under five fell from 84 deaths to 53 deaths per 1,000 live births, which is a very positive and encouraging statistic. In fact, as was recently reported in The Economist, it is an astonishing result.

Africa is currently seeing some of the fastest falls in child mortality ever seen anywhere, and one of the ways in which the UK has contributed is through its outstanding research. UK Government funding and UK scientists have contributed to the development of long-lasting, insecticide-treated bed nets, which were mentioned a moment ago, and new diagnostic tests and drugs for malaria. However, the progress has not been evenly spread; more than 7 million women and children still

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die every year, many of them during pregnancy and birth, and the great majority from easily treatable or preventable conditions.

We need to do three things in our research for health: to develop new technologies, such as drugs, vaccines and diagnostic tests; to test them through trials; and to keep abreast of growing medical challenges such as drug resistance, which has been mentioned this afternoon. I assure the House, including all Members here today, that DFID is funding research in all those areas.

Let me highlight a few examples of what we have been doing recently. The first area of our work is about developing new technology. We know what the problem is, but we lack the technology sometimes required to fix it, so research is required to create innovative solutions. For instance, DFID support has helped the Foundation for Innovative New Diagnostics to develop GeneXpert, which my hon. Friend the Member for South Derbyshire (Heather Wheeler) mentioned earlier. GeneXpert is a new diagnostic test for tuberculosis that gives fast and accurate results. She said the results come within two hours; I might say within four hours—if we split the difference, the test is quick and that is what matters. Importantly, it also identifies drug resistance. The test is revolutionising the care and treatment of those suffering from this appalling disease.

Another example is that DFID supported the drugs for neglected diseases initiative to develop a new safer drug for sleeping sickness—one of the world’s worst diseases. The old drug, implicitly referred to by the right hon. Member for Neath (Mr Hain), was highly toxic, killing around 5% of those treated. The new drug, which is now available in 90% of the places where sleeping sickness exists, is a better drug that reaches more people.

Both those examples also demonstrate the importance of securing private sector support through product development partnerships, which hon. Members mentioned. These partnerships act like virtual pharmaceutical companies, where a small, central group of staff co- ordinates the development of new drugs and technologies, drawing on the strengths of academia and industry. The UK is a leading investor in PDPs—with the Gates Foundation, for instance—and we continue to champion their role in global health research and development.

Let me turn to some questions that I spotted being put to me in a co-ordinated way. I have to say, in all honesty, that lifting our research expenditure up to 5% of our budget is unlikely within the competing claims of a tight resource allocation round for the next three years. If one added up the many requests made to us to meet certain percentages for various causes, one would soon find that they are close to, or perhaps even beyond, 100% of our total budget. We have to be honest and should not pretend that we can meet the 10% here and the 5% there, or the nought point this or that everywhere else. We will, within the 0.7% to which we do adhere, try to apportion our budgets rationally and openly.

I hear what was said about tax credits, but hon. Members will appreciate that those are primarily a matter for the Department for Business, Innovation and Skills and the Treasury. On collective action, we agree that better co-ordination should almost invariably be welcomed and pursued.

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The second area of our work concerns using research to test new ways of doing things, including through the use of clinical trials. Much of what is done in international development has not yet been properly tested by rigorous methods. The fact that many experts agree that an intervention should work does not necessarily mean that it will. Proper trials allow us to do new things, but they also allow us to call a halt to old, costly and sometimes dangerous things.

DFID helped fund research in Kenya recently on the treatment of children with severe infections, including malaria. While accepted medical wisdom suggested that one should rapidly increase fluids in children affected by these diseases, research showed that that course of treatment was actually detrimental to the health of the children and, in some cases, resulted in death.

Similarly, in Uganda, research has shown that the accepted practice of using expensive tests to monitor the progression of HIV in patients simply did not work. By stopping the tests, a third of the normal cost of treating someone with HIV can be saved, with no impact on mortality. That means that for the same amount of money, the Ugandan Government can effectively treat a third more people with HIV. That is all down to effective research. DFID is currently supporting more than 40 clinical trials under the joint global health trials initiative, in partnership with the Medical Research Council and the Wellcome Trust. We are funding new trials in TB, HIV and malaria, as well as other poverty-related neglected diseases.

There is a slight misconception that we do not fund UK research directly. We will fund the best research wherever it is located, through global, fair and open competition. However, as it happens, the largest proportion of DFID research contracts are won by UK institutions.

The Department is also breaking new ground in testing public health interventions in humanitarian crises—for example, through its partnership with the Wellcome Trust and Save the Children in the research for health in humanitarian crises project. This innovative partnership enables high quality health research to be carried out rapidly as acute emergencies unfold.

Andrew George: The Minister originally discounted the possibility of looking at the notional cap on research and development within DFID’s budget, but at the same time he has announced the doubling of economic development assistance to £1.8 billion. Given that we are talking about market failure, will he consider that budget as a route by which his Department can engage with the private sector, to enable further research and development that will achieve both the research and development gains and the economic development goals that his Department is seeking?

Mr Duncan: There is a lot that is constructive in what the hon. Gentleman has suggested. Whereas the money might not go into long-term research, there can certainly be work with private companies along the partnership lines that we already have, perhaps to extend activity in areas such as these. We are open-minded about the nature of the economic development activity that will emerge from this new approach—this refreshed

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emphasis—in private sector development, and I am pretty confident it does not rule out proposals such as the hon. Gentleman’s.

Mr Hain: Unless the Minister is to respond later to my specific request for a report, might I press him on DFID’s specifically considering the de-linking question and resourcing for it, conceivably within its budget? That is essential for delivering what we all want.

Mr Duncan: I do not lead on this topic, but my understanding of the Department’s approach at the moment is that we are not wholly convinced about the solution that simple de-linking would offer for the problems that the right hon. Gentleman has identified. Pharmaceutical markets are much too complicated for us to be able simply to segregate a research budget and the price at which a product is sold. The competitive structure has to be considered. Is a new drug competing with something, directly replacing something or marketing itself into a completely new field? There are many more aspects to the pricing and distribution of drugs than the simple de-linkage proposed by the right hon. Gentleman.

We do not have a closed mind on anything of this sort. The least we can say to the right hon. Gentleman is that we will get our very clever people working on it, although I do not think we will commission a great report at this stage. However, we are happy to engage with him in further detail, if he thinks that we are missing something.

Mr Hain rose

Mr Duncan: I sense that the right hon. Gentleman wants to chip in again. Of course I shall give way, because we have time—thanks to Mr Streeter’s mathematics.

Mr Hain: Will the Minister or his colleague make an assessment of and write to me with a view on how this issue, particularly the resourcing, can be approached?

Mr Duncan: We will, of course, write to the right hon. Gentleman, as requested, with our thoughts and views on his proposal. I have no doubt that officials will be happy to discuss with him, in person, what he thinks should be done, should he so wish it.

DFID is also utilising research and development techniques to understand better the environment in which we operate and it is working out how we can anticipate future trends. One example is in antimicrobial resistance, which has been mentioned today—a future threat on which the UK Government are taking a leadership role globally. DFID is supporting an initiative to track drug resistance to malaria in south-east Asia as it potentially spreads through the region and, critically, towards Africa. That will help target new antimalarial drugs, the development of which is also being supported by DFID.

Research alone will not alleviate poverty, which is why DFID also invests heavily into putting research into practice. Our programme, Research into Results, which is designed to convert theory into practice, is a perfect example of that. In my recent visit to Edinburgh university, I saw the good work being done in setting up small-scale businesses able to take the best research ideas coming out of universities and get them into

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widespread use. So many of the development challenges we face today rely on solutions from research, and solving many of the challenges we will face tomorrow will rely on the research and development investments that we make today.

Nick Herbert: Will my right hon. Friend give way?

Mr Duncan: I have only three lines of my speech left, but since it is my right hon. Friend, I will.

Nick Herbert: I am grateful. I welcome everything that my right hon. Friend has said, the commitment that DFID has shown to this area and his undertaking that the Department will look carefully at the report. Does he think, in the overall scheme of things, that the global response to these diseases, many of which are pandemics, is equal to the task? It has taken an enormous global effort in other respects to tackle these diseases, such as with the establishment of the global fund. Only one TB drug has been approved by the Food and Drug Administration in the past 50 years. It was developed by Janssen Pharmaceuticals, by doctors who were not authorised to take it forward because they knew it would not be commercial. Finally, the company allowed the drug. Unless there is a step change in the response in the developing world to this problem, I wonder whether we will deal with it.

Mr Duncan: I agree with my right hon. Friend. We had a passionate debate on TB just a few months ago, in which he spoke on a subject on which he commands the House. The scale of the activity is not yet equal to the task, and it needs to be. That is why I urge all developed countries to match the 0.7% commitment that we have made. We, having taken the lead, should be followed by others. We can be proud that we are in the lead, and if others did what we did, we might well be up to the scale of the task that he illustrated. On that purposeful note, I say that we are committed to maintaining our record of funding high quality, high impact research and to putting that knowledge into use, so that we all, in the work we do, can save many thousands, if not millions, of lives.

3.52 pm

Sitting suspended.

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UK Media (Welsh Rugby)

4 pm

Glyn Davies (Montgomeryshire) (Con): I am looking forward to a debate on an intensely personal topic that I hope will inspire a great response from the Minister. On reflection, I could have asked for a short debate on the status of Wales in the world or defending the Union of the United Kingdom or “Wales, a proud nation, like England” or some similar title. Instead, I chose the UK media and Welsh rugby. I chose to take one specific example of how Wales is sometimes sidelined because she lies alongside the much larger and dominating presence of England. That is not a negative comment about England, which, like Wales, is also a great nation. In fact, my speech is more observation than criticism, even if it was born of deep frustration.

My favourite newspaper has for many years been the Telegraph, especially at the weekend. I derive great pleasure from reading Charles Moore, Boris Johnson, Geoffrey Lean and Fraser Nelson’s occasional columns.

The Parliamentary Under-Secretary of State for Culture, Media and Sport (Mr Edward Vaizey): My hon. Friend describes the Telegraph as his favourite newspaper, but surely he means that it is favourite after his local newspaper, which he may want to take the opportunity to name.

Glyn Davies: I am always so grateful to the Minister. My local Montgomeryshire County Times & Express, the Cambrian News and various other local newspapers would probably qualify as my favourite papers, but the Telegraph is my favourite national newspaper.

Over the past month, I must also say that I have enjoyed the new columns from Isabel Hardman and others. On Sundays, I particularly enjoy the outstanding writing of Matthew d’Ancona, Janet Daley, Christopher Booker and others. Two weeks ago, however, my Sunday reading was completely ruined when I turned to the sports section to read about the two big rugby games that had been played on the previous Saturday. New Zealand had totally smashed England while Wales had come within a whisker of beating South Africa—many people’s favourite for next year’s rugby world cup—and winning in South Africa for the first time ever. In a truly magnificent performance, Wales dominated most of the match. I was able to read extensively in my newspaper about the England game with two full pages plus a good chunk of the front page. The Wales game got a few lines on page 14. I felt so let down, so disappointed, so frustrated. I know many other Welsh rugby supporters who felt just the same.

Over the last two weeks I have cooled off, and my reaction has been downgraded from seething anger to realistic observation. I accept that newspapers should be free to publish what they want—within the law of course.

Mr Mark Williams (Ceredigion) (LD): I congratulate my hon. Friend on securing this important debate. What assessment has he made of how the national Welsh media dealt with our near achievements in the rugby? Mindful that the Minister is here, what about S4C, the Cambrian News, which serves my constituency as well, Wales on Sunday and the Western Mail?

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Glyn Davies: I entirely accept that the Welsh national newspapers gave full coverage to the Welsh rugby, but I want to make a point about the promotion of Wales across the world, and I do not think that the reach of Welsh papers is anything like those that are London based.

No MP is more committed to freedom of the press than I am, and I know well that newspapers have to respond to their market. They are in the business of selling newspapers after all. At the same time, however, I also believe in the freedom of MPs to express their unhappiness about things, which is what I have just done, and I must say that I feel much better for it.

I want to approach the subject of Wales’s status in the world from three distinct angles. The biggest issue facing us is the retention of the unity of the United Kingdom. While I believe and fervently hope the Scottish people will vote to remain part of the United Kingdom when they vote in the independence referendum in September, it is worth asking what has driven so many Scottish people not to value the Union. My sense is that at the root of Scottish disenchantment with the Union is resentment towards a larger, richer, altogether more powerful neighbour in England. That is the basis of my antipathy to a federal Britain as a response to the West Lothian question. No federation can work when one member is as dominant as England would be in a federal UK. I repeat that this is not in any way a criticism of England. It is not her fault that she is big. It is not England’s fault that the majority of UK media coverage relates to England.

Over recent months, it has been great to watch our Prime Minister, other Ministers and Opposition politicians going to great lengths to tell the Scottish people that we love them and that we do not want them to leave. If the Scottish people vote not to leave, we should continue to tell them afterwards that we love them. The same resentment exists in Wales, nothing like to the same extent, but it exists. It matters that England—great nation that it is—loves Wales and makes that clear. I would hope that every part of English society, including our London-based media, would want to play a part in that.

Another crucial angle to the issue of Wales’s status in the world is how we promote Wales overseas as a place to visit and to do business. I remember when 20% of foreign inward investment into the UK came into Wales; when Wales had a close, symbiotic relationship with the great motor regions of Europe, and when the Welsh Development Agency was the best business promotion vehicle in the world. It was a time when the Welsh can-do spirit made anything seem possible. At present, the Welsh Affairs Committee is taking evidence from various bodies in order to produce a report on promoting Wales abroad, and it is already clear to me that there is a problem. The Wales division of the Institute of Directors says that UK Trade & Investment has “failed dismally” to promote Wales abroad. It is also clear that the relationship between VisitBritain and Visit Wales is poor. I was astonished to learn that VisitBritain has never met the Welsh Minister responsible for tourism. Those organisations are funded by the UK and Welsh Governments to persuade overseas visitors to come to Wales and perhaps establish businesses in Wales.

The third angle concerns the Welsh language and what I consider to be inadequate recognition of its importance here at Westminster.

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Mr Gary Streeter (in the Chair): Order. It may help if the hon. Gentleman refers back to the topic of UK media and Welsh rugby from time to time in his now quite wide-ranging speech.

Glyn Davies: Thank you, Mr Streeter, for bringing me back to Welsh rugby. There is an important link between Welsh rugby and the Welsh language. The great things about Wales that make it distinctive are, probably above all else, the language and the national game. More people play football, but rugby is linked to the Welsh language and to our culture. I hope that that satisfies your requirements, Mr Streeter.

About 20% of the population of Wales speak Welsh, but the language underpins Welsh identity and cultural distinctiveness. It seems wrong that the Welsh Affairs Committee does not encourage witnesses to speak in Welsh, and I can see no reason why the Welsh Grand Committee should not allow speeches in Welsh. Most people in the world are bilingual or even trilingual, and most Parliaments can accommodate bilingualism. Huge efforts have been made to maintain and restore yr iaith Cymraeg in Wales. Nowhere do we hear the language spoken more than at the great rugby matches that take place in Wales. Major investment in preserving and promoting Welsh continues to be made in Wales, and many Welsh people have a great love for the language and for singing the national anthem at the Millennium stadium. We should, however, create opportunities for Welsh to be used at Westminster, strengthening the link between Wales and the United Kingdom, of which Wales is a key member.

I continue to enjoy reading The Sunday Telegraph; its great writers still make it an absolute must for me to read at the weekend, despite its failure to cover Welsh rugby as I would like it to.

Guto Bebb (Aberconwy) (Con): I congratulate my hon. Friend on securing the debate. I share his concern about the lack of coverage of some of the rugby matches this summer, but is that a symptom of the London media in general ignoring Wales? Is that not reflected, for example, in the fact that 52% of the people of Wales still believe that the health service is run from Westminster?

Glyn Davies: I moved away from the central point of the debate for a small part of my speech, but the issue is a wide-ranging one. My hon. Friend makes that point, and I chose to refer to one specific aspect of the whole issue today—how Welsh rugby was covered two weeks ago—because it makes that point as well. We can reach out across the world only if the national media—the media read outside Britain—cover Wales. That is how the name of Wales will go out into the world, and there is no better vehicle than Welsh rugby.

I look forward to reading reports of the great games that will take place at the Millennium stadium in the rugby world cup in 2015. It will be a great occasion, but I look forward in particular to the great victory of Wales over South Africa in the final.

4.11 pm

The Parliamentary Under-Secretary of State for Culture, Media and Sport (Mr Edward Vaizey): It is a great honour to appear under your chairmanship, Mr Streeter. This important debate has focused almost exclusively

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on the UK media’s coverage of Welsh rugby and an important subset of that—

The Sunday Telegraph

’s coverage of a particular match between Wales and South Africa that took place in South Africa a couple of weeks ago. I now have some 20 minutes to speak on the subject, at length.

It is important to focus on the issue. Had my hon. Friend the Member for Montgomeryshire (Glyn Davies), who gave an excellent speech, used a title such as “Wales’s place in the world”, a different Minister would be responding on Welsh issues, whether they included the record of the Labour Welsh Government—other Members present in the Chamber may wish to comment—or Westminster’s record of support for Wales in exports and inward investment. Quite rightly, however, my hon. Friend has chosen me to respond to the debate, because he knows that I have a passionate interest in specific Welsh issues, none more so than the The Sunday Telegraph match report.

May I make a brief observation before returning to the main subject of the debate? It is good to see my hon. Friends the Members for Ceredigion (Mr Williams), for Aberconwy (Guto Bebb) and for Carmarthen West and South Pembrokeshire (Simon Hart) in the Chamber. It will not have escaped their notice that not a single Labour MP is present. We have Prime Minister’s questions tomorrow and Tuesday is a busy day in the House; their absence cannot be explained. They may say that I am talking about them behind their backs, but I would be talking to them had a single one of them bothered to turn up to show their interest in Welsh issues. Far be it from me to say that some Labour MPs might take their support in Wales for granted, but in my experience over the past four years, in particular dealing with S4C, colleagues in the Conservative party have been active campaigners on aspects of Welsh media.

Guto Bebb: The Minister rightly alludes to the battles fought over the S4C budget. That is directly related to the fact that, for 30 years, S4C has been very innovative in its coverage of Welsh rugby, including in how it has extended the hand of friendship over the border into England by allowing people to choose their preferred language via the red button.

Mr Vaizey: That is true. One of the aspects that emerged during our many debates about S4C was indeed its coverage of Welsh rugby. S4C is very much part of the UK media, as I will go on to explain. It may be, should time allow, that other Members might want to comment further on S4C’s excellent coverage of Welsh rugby.

Some might ask what the problem is. Do we need better coverage of Welsh rugby? Welsh rugby stands as a legend for all people who follow international rugby. Here am I, an Englishman from the south-east, but the names of Edwards, John, Bennett, Quinnell and a man who can be recognised by just three letters, JPR, are part of my childhood and growing up, and they still define our understanding of the modern game.

In more recent years, the Millennium stadium—on the site of another legend, the Arms Park—has been one of the most iconic rugby stadiums in the world, it is so well known. It is absolutely right and proper that it will host eight world cup fixtures next year, including

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two of Wales’s home games. That is a great illustration of the sport and its Welsh tradition throughout the globe.

The influence of Wales in rugby extends to the women’s rugby world cup in France. My hon. Friend is no doubt aware that the Prime Minister himself last week sent a message of good luck—interestingly, my own Secretary of State said last week that politicians wishing good luck could have the opposite effect, but he has also wished the Welsh women’s rugby world cup team good luck. Jokes aside, that shows the esteem in which the powerful Welsh women’s team is held. They have a chance to grab the headlines and do their great rugby- loving nation proud. I hope that the Telegraph gives their games the coverage that they deserve.

Frankly, it is not only in rugby that Wales has great achievements to its credit, and I hope that those other sporting achievements will also be recorded by the UK media. Who can forget that a Welsh football player commanded the highest transfer price on record? Gareth Bale is worth more than a Neymar or a Robben.

The importance of sport in our national identity and in keeping our nations together should not be underestimated. I happen to think that it is a great thing that Cardiff and Swansea have played in the premier league—Swansea is still in—because, were I to be indiscreet, it occurs to me that perhaps the majority of the population is more interested in and passionate about sport than politics. One of the things that will keep our country united is a shared passion for sport and the opportunity for all our nations to participate together in great sporting occasions.

I have mentioned rugby and football, but the great Commonwealth games are starting imminently in Glasgow. Again, I hesitate to place a jinx on them, but I wish good luck to Dai Greene in the 400-metre hurdles, Jazz Carlin in the swimming, Geraint Thomas in the cycling and the rugby sevens team. We look to the Telegraph to give suitable coverage to what will no doubt be great achievements in the games.

Simon Hart (Carmarthen West and South Pembrokeshire) (Con): Will my hon. Friend give way?

Mr Vaizey: I would be more than delighted to give way to my hon. Friend.

Simon Hart: I rather thought you might be.

The Minister has been mentioning a lot of the major sports, but will he spare a thought for those taking part in the Ironman competition in Tenby in the coming months—1,800 of them, I think? It is a global event, which is staged in only two places in the UK, one of which is Bolton and the other Tenby. It is a fantastic sporting event, which gets minimal TV coverage, but if anyone wants an indication of athleticism at its best, Ironman Tenby in September is the place to be.

Mr Vaizey: My hon. Friend makes a good point. Ironman Tenby is a legendary sporting event. History does not relate whether my hon. Friend is intending to take part—in terms of engagement with his voters, it would be a sensible thing for him to do. Perhaps in this Chamber today we could start the campaign for him to take part in that event, because he has three months left

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for training. I take his point and call on the


to give Ironman Tenby suitable coverage. It is an important event for the nation as well as for Wales.

We are discussing the UK media’s coverage of Welsh rugby; it is important to talk about the UK media as a whole, not just about the Telegraph. Our television and radio broadcasting are underpinned by frameworks designed to ensure that both regional and national content reach a wide audience, be that in coverage of sporting events, news coverage or in the production of drama and entertainment programmes.

We should note that the BBC should also provide suitable coverage for Welsh international matches. I have not done any research on that, and my hon. Friend the Member for Montgomeryshire did not mention it in his speech, so I am not aware of whether it is a particular problem, but I hope that those listening to the debate take note that there should be suitable coverage.

The licensing regime for the public sector broadcasters supports investment in the UK regions and nations, something from which everybody benefits. The levers that both we and Ofcom have are kept under constant review. For example, in terms of UK media coverage of Welsh rugby, Channel 4 has a quota for production of content outside England. That is going to increase from 2020 from 3% to 9%, which should be good news for Welsh content. The BBC has made an ongoing commitment since 2008 to grow its regional production, with 17% of network spend coming from the nations by 2016, which again should be good news for Wales and Welsh rugby.

The separation of the new ITV Wales from the current ITV Wales and West regional franchise will also give artistic freedom for that Welsh broadcaster to invest in high quality Welsh public service programming—I hope that includes suitable coverage of Welsh rugby matters. I know that Members from both sides of the House have strongly welcomed that important development.

Welsh broadcasting has had a lot to celebrate in recent years. Only last year we saw the 30th anniversary of S4C, an organisation that the current Government continue to fund, with the BBC, to the total tune of more than £80 million a year. We have already referred to S4C’s excellent coverage of Welsh rugby.

Guto Bebb: I would not like to be accused of correcting the Minister, but it is important to state that the cash funding for S4C is to the tune of £80 million, although the BBC also provides £19.6 million in funding in kind. The total funding for S4C is in the region of £100 million.

Mr Vaizey: I would like to say that I stand corrected, but I rather feel that I stand elaborated. Clearly, I was referring to the £82.6 million cash funding. My hon. Friend has elaborated on the funding in kind through provision in content from the BBC.

Although our subject is Welsh rugby, I hope you will indulge me, Mr Streeter, if I mention S4C’s fantastic coverage of the Eisteddfod and Royal Welsh Show, as well as its famous soap opera, “Pobol y Cwm”. I have taken part in many debates on S4C and have been challenged by hon. Members about my interaction with content from the channel, so I am genuinely delighted

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that the superb drama “Hinterland” has made a real impact on English audiences as well as Welsh ones. It has shown that the Welsh can play the Scandi game and produce great drama that can be sold around the world, regardless of its language of broadcast.

Mr Mark Williams: I am sure my hon. Friend would like to acknowledge that “Hinterland” was filmed in my constituency of Ceredigion, and so serves a double purpose as it promotes Ceredigion as a tourist centre for our friends across the world.

Mr Vaizey: Anyone who has seen “Hinterland” will have been incredibly impressed by the quality not just of the drama but of the filming of those incredible landscapes, which must now serve as a wonderful calling card for Welsh tourism and tourism in Ceredigion in particular.

As is the case for many cultural institutions, S4C’s successes have been delivered alongside significant challenges. I was therefore delighted that we protected S4C’s funding in the last autumn statement. Our commitments on regional and national programming are also enhanced by the new local TV services, which so far have been licensed in Cardiff and Swansea, with services for Mold and Cardiff due to come on air shortly.

In talking about the UK media’s coverage of Welsh rugby, it is also important to point out that the Government’s broadband programme will provide another potential avenue of access to content. We have provided about £100 million, I think—that figure is off the top of my head—to the Welsh Government to carry out a broadband programme. Something like half a million homes will be connected under that rural broadband programme, getting figures for Wales up to 90% and beyond. It is going extremely well and we have covered more than 160,000 premises so far. People can get television content on broadband and now that new competitors are in play—not just Sky, but BT Sport—one may well see enhanced coverage not just of Welsh international rugby but Welsh domestic rugby. Much of that will be down to the fact that infrastructure coverage is going so well in Wales.

We are going through a golden age of investment in sports coverage. In 2012, more than £2 billion was invested by all broadcasters in sports programming and sport became the most watched genre on TV. That is why my hon. Friend the Member for Montgomeryshire was so right to bring up the UK media’s coverage of Welsh rugby as a way of bringing to the attention of the House the broadcasting opportunities that now exist for Welsh sport and Welsh rugby in particular. [Interruption.] Given the leaning position that my hon. Friend has taken, I cannot tell whether he is fascinated by my remarks or about to make an intervention, but I will keep a weather eye on him in case he wishes to intervene at any point.

Glyn Davies: Will the Minister give way?

Mr Vaizey: Of course.

Glyn Davies: I had not intended to intervene, but I feel tempted to do so. Does the Minister agree that sport is probably the most effective way to take the name of Wales to the wider world, through the stars

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whom he has mentioned? One issue we have is promoting Wales across the world as an identifiable country that is not a part of England. Does he agree that sport is the best and most effective way to do that?

Mr Vaizey: I absolutely do. Let me elaborate. I was lucky enough to watch the end of the Tour de France yesterday—it was only up the road—and somebody turned to me and said, “That is soft power at work. That is the French making a bigger impact on the UK psyche. What is our equivalent?” I said that to a certain extent it was probably the premier league. We should think about the reach of the premier league and the opportunities that Swansea and Cardiff have to promote Wales when they are in the premier league.

The Welsh rugby team, of course, has an impact in South Africa, Australia and all around the world. We should also think of the stars of Welsh rugby and football, as I mentioned earlier. Gareth Bale will do a huge amount to promote Wales, as a passionate Welshman himself. Ryan Giggs was part of a squad that was probably one of the most successful football teams in the world. Their utter loyalty to Wales is impressive—they could perhaps have played around with their genealogy to get to play for other teams but they were loyal to Wales, a great international football team.

Sport is incredibly significant, which is why it is so important that my hon. Friend has brought to the Chamber’s attention the coverage that our own domestic media give to Welsh rugby and other great Welsh sporting achievements. Another point to raise—although it might perhaps be a bit late in the day to mention it—is that almost more important than the players themselves are the fans. The passion of the Welsh rugby fan is known all across the world, and it is Welsh rugby fans who are devouring more and more sports media content through the internet, including sites such as “The Bleacher Report”. I have mentioned BT Sport and Sky. Wales’s recent rugby tour to South Africa was covered on Sky Sports and the BBC’s online rugby service “Scrum V” enables viewers living outside Wales to watch live games on satellite and cable and via the internet.

I have more to say on this subject, but I see that time is running out so I must bring my remarks to a conclusion. I am grateful to my hon. Friend for bringing this matter to our attention. I note that Conservative and Liberal Democrat MPs have turned up in force to debate an issue that is important to Wales, to emphasise the importance of Wales’s place in our United Kingdom and to remind us all that, whether in rugby, at the Commonwealth games, in football or in cycling, Welsh sporting achievements deserve the full attention of the whole of this United Kingdom.

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Learning Disabilities (Care in the Community)

4.30 pm

Mr Tom Clarke (Coatbridge, Chryston and Bellshill) (Lab): It is a pleasure, Mr Streeter, to serve under your chairmanship, and I am grateful to have been granted this debate. There are 1.4 million people with a learning disability in the UK and many require care and support to live full lives in their communities. Many do so, supported by families, friends, charities and funded social care. However, a small but significant number—just over 3,000—are far from their homes and communities, stuck in assessment and treatment units. They are some of the most vulnerable people in our society. Many display challenging behaviour and require skilled support from a range of professionals, but that is no reason why they should not be cared for and supported in their community.

In 2011, the BBC’s “Panorama” programme exposed truly horrific abuse and neglect of patients with learning disabilities at the Winterbourne View assessment and treatment unit. Many hon. Members will remember the deeply distressing images of people being hit, verbally abused, viciously restrained and thrown into seclusion. Some of the perpetrators were rightly sent to prison, but Winterbourne shone a light on the wider scandal of how the NHS and local authorities throughout the country have failed to give people the right support to enable them to live in the community. They had hidden that failure by sending people with learning disabilities to in-patient settings, in many cases for years and often hundreds of miles from their families and communities, isolated and alone. That was against Government policy and was a scandalous misuse of what assessment and treatment beds should be used for. It was estimated that the cost was around £500 million.

Kate Green (Stretford and Urmston) (Lab): I am glad that my right hon. Friend is raising this important matter this afternoon. Does he agree that the situation, far from improving, may be worsened as a result of the closure of the independent living fund if it means that more learning-disabled people who are currently able to live independently are forced into residential care?

Mr Clarke: My hon. Friend makes a valid point and was right to do so.

Some £500 million of public money was spent to pay for people to be over-medicated with anti-psychotic drugs and kept in seclusion at risk of assault and self-harm. In December 2012, the Government put in place an action plan with the objective of giving people with learning disabilities support to enable them to move out of places like Winterbourne View and to return to their communities. A joint improvement programme was also put in place, and the NHS and local authorities were given a deadline of 1 June this year to make that happen.

The result is nothing short of a scandal. Not only has the deadline been missed, figures from the NHS show that more people are going into those units than coming out. Not only that, there seems little appetite to move people. Recent NHS data showed 90% had no discharge date. Meanwhile the human suffering continues. The

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learning disability census showed that 57% had experienced self-harm, an accident, physical assault, hands-on restraint or had been kept in seclusion.

Mr Andrew Smith (Oxford East) (Lab): I, too, congratulate my right hon. Friend on this enormously important debate. Last Friday saw the first anniversary of the preventable death of Connor Sparrowhawk in the Slade unit in my constituency. One year later, we have not had the inquest or the serious case review, and his family are scrambling around to raise money so that they will be legally represented at the inquest where the public authorities will be represented at taxpayer’s expense. Does my right hon. Friend agree that more needs to be done to prevent such tragedies and, when they occur, to help the families and victims to see justice?

Mr Clarke: I agree entirely with my right hon. Friend. It was important that he put that case on the record.

The picture we are seeing is clearly unacceptable. Mencap, the Challenging Behaviour Foundation and Enable in Scotland have campaigned vigorously with the families of those affected, and I thank them for their advice for this debate. Many of the families have experienced the sheer pain of knowing their son, daughter, brother or sister has suffered horrific abuse and in some cases died. They have battled in many cases for years to get their loved ones out of these dreadful places, but have been blocked by an uncaring system that is often more focused on money than high-quality care and the rights and dignity of people with learning disabilities.

To mark the passing of the 1 June deadline, the families came together to write an open letter to the Prime Minister asking him to take urgent action and to meet them. I understand from them that to date there has been no reply. That is unacceptable and I hope the Prime Minister will look again at their letter and take the opportunity to meet them.

I had the privilege of meeting many of the families some time ago prior to my Adjournment debate back in autumn 2012, and more recently at last week’s all-party group on learning disability which I chair with Lord Rix, who has of course campaigned vigorously in this area. In common with all my colleagues, I cannot praise Brian more highly. I pay tribute to the families’ determination in fighting to change things for the better, not only for their loved ones, but on behalf of the thousands of others trapped far away in these places.

I turn to the case of Josh. The Wills family have campaigned for their son, and #BringJoshHome has caught the public interest, which we welcome. Phil Wills, his dad, spoke at the all-party group meeting last week and I know how moved everyone in the room was. Phil and Sarah’s son, Josh, lived in his family home in Cornwall with his siblings until July 2012 when his self-injurious behaviour increased. As a result, he was sent to a unit 260 miles away. Phil and Sarah reluctantly agreed to that because they were told there were no local services and it would be for a six-month assessment period to give everyone an understanding of the support and services Josh needed.

Almost two years later, Josh is still in Birmingham, a five-hour trip for his family. The Kernow clinical commissioning group continues to procrastinate and

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refuses to commission the services needed locally. Meanwhile, away from his family, Josh grows more anxious and his parents fear for his life because of the severity of his behaviour. He spent both his 12th and 13th birthdays there and has never met his newly born little sister.

I am very grateful to the Minister for his address to the all-party group meeting last week. I understand that he has met Phil and Sarah on more than one occasion and, to his great credit, many of the other families. I know he shares my deep concern over what has happened, and indeed, what has not happened. At the meeting, he shared his feelings about the lack of progress and the work he has been doing with NHS England, which has powers to intervene and address local failings. I say to him today that his views were very much appreciated.

I also welcome to the debate the shadow Minister, my hon. Friend the Member for Leicester West (Liz Kendall), and I welcome the contributions of my hon. Friend the Member for Stretford and Urmston (Kate Green) and my right hon. Friend the Member for Oxford East (Mr Smith). I look forward to what the Minister has to say, and in particular, I would like him to answer the fundamental questions that every family affected wants an answer to. Given that the June deadline has passed, what are he and other Ministers now doing, and what will the new deadline be? Where will the leadership come from across health and local government to ensure that we make progress?

It would be beneficial if the Minister could clarify the status of the joint improvement programme originally tasked with getting people back within their communities. Patently, that has failed and it has been dealt a further blow with the resignation of its director only yesterday. Are we to see a second joint improvement programme? Who will it consist of? How will it be successful? Critical to the solution, in my view, is also how we refocus money away from these high-risk units and into good-quality, locally based provision. If he could comment on that as well, I would be extremely grateful.

With regard to Scotland, it should be said that despite the Barnett formula, which means that 10% of the money spent in England is allocated to the Scottish Government, the widespread concern that is here in England also applies in Scotland. It is not helpful that Scottish data on these matters are poor, and that the £34 million allocated on the basis of the Barnett formula—arising from the committee that I chaired on disabled children and their families—was not spent on that purpose, but was used to keep council tax static. Scottish decisions on such placements can mean that placements out of area can also lead to placements out of Scotland. In one case, a man was sent to Carstairs, an NHS hospital for the criminally insane. He was later dispatched to Newcastle, where his elderly father finds the greatest difficulty in visiting him.

According to John White, the positive behaviour support adviser of Enable Scotland:

“The issue with assessment and treatment units can be that such environments can become the ‘setting conditions’ for people developing the challenging behaviours they are meant to be assessing and treating in the first place. We know from experience that people who had to live in NHS institutions for many years developed challenging behavioural repertoires in response to the experience of living in such environments and so it is logical that

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similar environments with similar institutional features are likely to encourage the development and maintenance of similar challenging repertoires.”

I would add that, important as it is, positive behaviour support is not a panacea and should be available as a part of a multi-agency health and social care collaborative approach. We need services to be designed around people, who along with their families, should have as much choice and control as possible. We need strong local crisis supports, staffed collaboratively by the NHS and local providers working in partnership, preventing hospital admission in the first place for all but those few people with a significant mental health problem that requires treatment.

For many years, we have been talking about care in the community, and there have been great strides. But the 3,250 people we are talking about today have been failed, let down by poor-quality or non-existent local services and then placed in high risk in-patient settings, where we have seen abuse, and tragically, loss of life. This is a national disgrace, and one that I hope right hon. and hon. Members from both sides will agree must be addressed decisively now.

I look forward to the Minister’s reply. I thank him for his presence, and I know he will share my view that these issues are crucial to the services that we provide, particularly in social services, remembering the rights of every individual citizen of this country.

4.45 pm

The Minister of State, Department of Health (Norman Lamb): I congratulate the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke) on securing the debate and thank him for doing so. I do not think I disagree with a single word he said in his speech today. The right hon. Member for Oxford East (Mr Smith) also talked about the scandalous case of Connor Sparrowhawk. I have met his mother and what happened there should shock us all. There was acknowledged negligence in the care and these things simply cannot go by without a proper and effective response to stop repeats of this sort of thing ever happening again.

One thing that the right hon. Member for Coatbridge, Chryston and Bellshill focused on was the families, to whom I pay enormous tribute for their campaigning. What is most shocking when one talks to them is the sense that they are not listened to—that they raise their concerns with public bodies and get no effective response. They are ignored and that should shock us all.

The right hon. Gentleman also said that it is an ongoing scandal and a scandalous misuse of public money, and I completely agree with him. This has now gone on for very many years. It is an unacceptable remnant of the previous system of institutional care that has to come to an end. The thing that has depressed me in this job, more than any other aspect of it, is the extent to which it is so difficult to change the culture that allows this sort of thing to carry on. There is the sense that those commissioning care seem, it appears, to be willing to carry on with business as usual, when we know that the outcomes for those individuals are not acceptable, and that very many of these individuals are able to live a better life in supported living in their communities. The imperative to achieve change is as strong as ever, and for as long as I am in this job, I will do everything I can to try to change things.

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Because of my total frustration about the way in which commissioning has happened, I chose to go out to visit one 17-year-old girl a couple of weeks ago in an assessment and treatment centre to see it for myself, and to see the barriers that that family are up against and the problems that they have had engaging with the commissioners of care, which, in that case, is NHS England. Indeed, with regard to the case of Josh that the right hon. Gentleman mentioned, I have invited the clinical commissioning group to come into my office on, I think, 22 July, together with NHS England and with the family, so that we can get to the bottom of what has gone wrong and try to achieve a solution. I am prepared to intervene in this way if necessary, to force change to a situation that I regard as completely unacceptable.

I am very pleased to have the opportunity to focus on the needs of people who, as the right hon. Gentleman said, are among the most vulnerable in our society. Many of us share the concern that people with learning disabilities and their families are still getting an unacceptable raw deal from the health and care system, from other public services, and from society in general. People with learning disabilities have exactly the same rights as anyone else, yet they continue to experience discrimination, abuse and a basic lack of respect for their fundamental rights. That should shock us all.

Margot James (Stourbridge) (Con): I am most encouraged by my hon. Friend’s remarks, and I congratulate the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke) on securing this important debate. Has my hon. Friend come across the organisation based just outside my constituency, Changing Our Lives? It was founded by Jayne Leeson, who was awarded the MBE for her services in this area. It is doing such innovative work that demonstrates clearly the potential of people currently in residential care with learning disabilities, who can live a most fulfilling life outside, in the community, through supported living.

Norman Lamb: I am very grateful to my hon. Friend for that intervention. I would be interested to hear further information about the organisation to which she refers. It is clear that sometimes a leap of faith is required to give a person the chance of a better life outside, and the system is horribly risk averse. We know that the main cause of decisions to keep people in assessment and treatment centres is the clinical judgment that the person needs to stay there, so that needs to be challenged. I want to give people the right to a second opinion and I am in discussions with Simon Stevens, the chief executive of NHS England, to give people that right, because we have to find ways of giving a voice to people who hitherto have felt that they are ignored and not listened to and that nothing ever changes.

I pay tribute to the two organisations mentioned by the right hon. Member for Coatbridge, Chryston and Bellshill: Mencap and the Challenging Behaviour Foundation, which have continued to make the case on behalf of people with learning disabilities.

Winterbourne View and the appalling abuse of people there reminded us that there is still a massively long way to go to ensure that people are safe and get the right support—the support that they need. The Government’s review following the Winterbourne View case looked at

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the systemic issues facing people with learning disabilities and their families. At the end of the review, we published the concordat—the right hon. Gentleman referred to that—bringing together all the national organisations to commit to change. In a way, the most distressing thing is that I felt that organisations committing to the concordat and the change set out in it were doing that with a seriousness of intent that they would deliver on. The lack of change that there has been since then is really shocking, given that they committed to achieving that change. Eighteen months on, we all need to remind ourselves that progress so far has not been nearly good enough and that we all need to continue to work in partnership to deliver on the commitments solemnly made at the start of all this.

I have said recently, and the information that we have shows, that far too many people with learning disabilities are still stuck in hospitals, often hundreds of miles from home and in many cases for years, with serious questions about whether they are getting the right care and support.

I have also met Mike Richards, the chief inspector of hospitals, and Paul Lelliott, the deputy chief inspector for mental health, to ensure that the Care Quality Commission challenges organisations. If someone is living in an assessment and treatment centre, which is there for assessment and treatment, not for long-term living, surely it is not delivering the right model of care. That needs to be challenged by the Care Quality Commission and not simply accepted and tolerated.

Collectively, we need to be honest and say that the system has so far completely failed to deliver on the commitment made in the concordat significantly to reduce the number of people with learning disabilities who are in effect living in hospitals—for whom hospital is their home.

Jim Shannon (Strangford) (DUP): Will the Minister give way?

Norman Lamb: I will very quickly; I am conscious of the time.

Jim Shannon: I want to say just one thing. Is the Minister saying that this Government are committed to partnership relationships with housing groups and those who are committed to facilitating supported living for people outside these homes? I think that, if he is, he will find that many outside bodies are prepared to take him up on that.

Norman Lamb: I very much agree and I am grateful to the hon. Gentleman for that intervention. Providers of supported living care need to be much more central to the task of changing this culture. Indeed, I have asked for a meeting to be arranged that will bring in some of those providers, with Simon Stevens and the chief nursing officer, Jane Cummings, who I am pleased is now in charge of this programme, to demonstrate how they can play a part in effecting change.

I also want to acknowledge the work that has been done from the concordat and what has been achieved by NHS England and other delivery partners.

It is appropriate for us to start by looking at the people who were in Winterbourne View before it closed. I am pleased to report that NHS England’s Improving

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Lives team, who include senior clinicians, social care staff, third sector partners and family members of people with learning disabilities, have now reviewed the care of all but one of the 47 people who were in Winterbourne View, and the care of the one remaining individual will be reviewed by the end of this week. Those reviews have resulted in some people moving out of hospital into circumstances that are more appropriate for them as individuals.

The Government have provided funding so that the people who were in Winterbourne View can have additional trauma assessments where the need has been identified and they have consented to those assessments. We are providing additional funding to support families through a telephone helpline, regular telephone counselling and family support days. The funding will also support other people with learning disabilities—including the 17-year-old girl whom I visited a fortnight ago—who have experienced institutional abuse, and help their families.

Involving people with learning disabilities and their families is key to ensuring that the work that we are doing means that they have a better experience and better outcomes. We have provided funding to organisations to allow people with learning disabilities and their families to share their views with us, so that we can listen to them and respond to the concerns that they raise.

We have also made progress on other Winterbourne View concordat commitments. For example, guidance has been developed on commissioning advocacy for people with learning disabilities so that, again, they get a voice and they get access to information, advice and support when necessary. It is vital that local commissioners ensure that people have proper access to high-quality advocacy where they need it.

Mr Tom Clarke: I am very grateful for the Minister’s tone and I know that he feels deeply bound to respond to the problems that we are discussing. I welcome the fact that he mentions advocacy. Will he assure us that his Department will do everything possible to insist that advocacy remains at the heart of all our discussions?

Norman Lamb: I very much will do that. I have specifically talked to Simon Stevens about that. I am conscious that time is tight, so let me just mention one or two specific things. First, there is now movement on people getting plans for leaving institutional care. NHS England expects that clinical commissioning groups and its area teams will discharge or transfer 35% or 892 of the 2,615 people currently in in-patient settings within the next 12 months. That is 385 within three months, 266 within six months and 241 within 12 months. That is what they have come up with in terms of going through individual plans. We now have to ensure that it happens, and there is no guarantee in my mind that it will happen, so we have to hold the system to account.

I have mentioned that we have to unlock barriers wherever they exist. For me, one of the barriers is this. When someone transfers from the responsibility of NHS England to the local authority, the responsibility for the funding transfers to the local authority. That creates a disincentive for the local authority to take responsibility for that person, so the money has to flow with the

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individual. We have to ease the transition and not make money a barrier to an appropriate transfer to supported living in the community.

I have also mentioned that we have to address the question of the clinical judgments. That is not to say that in individual cases a clinician will not be making their best judgment about an individual’s need to stay in a particular setting, but surely the family need access to a second opinion to be able to challenge that judgment. I am conscious—I say no more than this—that the clinicians who are making the judgment are often employed by the organisation that is receiving payment for providing

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the bed to the individual. Whether it is in the state sector, the independent sector or the voluntary sector does not matter. The right to a second opinion is essential.

In the moments left to me, let me say that I remain totally committed to getting the culture change that we are all after. What has happened so far is not acceptable.

5 pm

Sitting adjourned without Question put (Standing Order No. 10(13)).