22 July 2014 : Column 421WH

Lisa Nandy: I agree with almost everything the hon. Gentleman has said. Is not the tragedy of this process that, as he and my hon. Friend the Member for Blackley and Broughton (Graham Stringer) said, most of us could get behind some principles underlying the proposal, including greater care in the community locally when people need it, greater specialism and supporting people to get care outside hospital? There is consensus on all those things, but the way the process has been handled, as has been compellingly outlined, has left people feeling that there is simply no point getting involved.

Mr Nuttall: The hon. Lady makes a good point. The vast majority of the public would, in an ideal world, like every service to be provided at their local hospital, so that they could have everything just by travelling a couple of miles. In a perfect world, they would have every conceivable treatment available at their nearest hospital. However, they have long since accepted, and we all know, that that is not possible. The clearest example of that in Manchester is, of course, cancer care and Christie’s. People accept that if, sadly, they are diagnosed with cancer, they will have to travel to a specialist cancer care hospital, where they will get better treatment.

It gets a bit more difficult when moving further down the specialism chain. Certainly, we were at the front line in that regard, as were Rochdale and other areas in Greater Manchester, when maternity services were being considered, because people felt that such services ought to be available everywhere. Of course, there are drivers behind this, if truth be known—if truth could be expounded by the health chiefs—in that, whether we like it or not, it comes back to the working time directive, for example, which has had an effect on the configuration of doctors’ working hours.

Medical negligence claims against the health service have also had an impact in this regard. I can understand that, coming from a legal background. People are better protected if they are in an environment where greater numbers of people are working together to watch each other’s backs. That is another driver of these reconfigurations, as some people like to call them.

To get back to the points I was making before that intervention, one of the problems with this consultation, which the hon. Member for Blackley and Broughton mentioned, is that the website and the documents are littered with unintelligible gobbledegook half the time. I am not being patronising, because I do not understand half of it myself, to be perfectly honest. Most people will look at that website and think, “Frankly, it goes over my head.” That will be their general view. I accept that the website and the documents sway wildly the other way as well and have apple pie and motherhood statements that absolutely everyone will agree with, such as “Do I want mum to get that good treatment if she goes into hospital?” No one will say no to that, will they? It is a complete waste of time and effort, and I cannot believe that highly qualified individuals have put together this mishmash of a website and consultation. It is not clearly thought through.

I have no idea of where this will end in terms of the hospitals where there is an option, but I know that my constituents in Bury want access to an accident and emergency department at their local hospital. Going back to what I said about the specialism ladder, by

22 July 2014 : Column 422WH

definition, one expects things such as accident and emergency to be available at the nearest general hospital. That is what my constituents will be looking for. If these services are salami-sliced away from Bury, my constituents will be concerned that they will be left with a hospital in name only—one that does not provide them with the services that they have come to expect.

I echo what has been said about Healthwatch England. Bury Healthwatch has e-mailed me and wants me to put on record its concerns about its involvement in this process. I appreciate that it is a new body, but clearly there are problems with the introduction of the legislative order for clinical commissioning groups, the Legislative Reform (Clinical Commissioning Groups) Order 2014. Healthwatch England has written to the Secretary of State about that. I understand that the order will come into force on 1 October. I can only assume that, to meet that deadline, those problems will be dealt with in our September sitting.

To be perfectly honest, demand for health care services will always outstrip supply, under any Government. It does not matter whether it is a Labour Government or a Conservative Government; people’s desire to be healthy and their need to feel that they and their loved ones are receiving the best possible treatment will always result in demand being greater than the ability of the public purse to meet that demand. That is of course largely driven by the fact that so many people think that our NHS is free. Of course it is not free. We all know that it is not free.

In the current year, the NHS is spending something like £119 billion. It is a huge consumer of public funds, and rightly so. It is right that the Government have protected the health care budget. Notwithstanding that, there are pressures, because the population is getting older and new treatments are being discovered and becoming available all the time. I am grateful for the opportunity to put on record my constituents’ concerns, and I am conscious of the fact that others want to put similar concerns on the record.

3.14 pm

Mike Kane (Wythenshawe and Sale East) (Lab): It is a pleasure to serve under your chairmanship today, Mrs Riordan. It is also a pleasure to follow the hon. Member for Bury North (Mr Nuttall), who speaks with passion about his constituents, and the authoritative contributions from my hon. Friends the Members for Stretford and Urmston (Kate Green) and for Blackley and Broughton (Graham Stringer), whom I congratulate on securing a timely debate.

We have world-class health services in Greater Manchester. My constituency is home to University Hospital of South Manchester, which delivers services amounting to £450 million, employs 6,500 people and has 530 volunteers, who give up their free time to help patients and visitors. The hospital has several fields of specialist expertise, including cardiology and cardiothoracic surgery, heart and lung transplantation, respiratory conditions, burns and plastics, cancer and breast care services. Indeed, the trust is home to Europe’s first purpose-built breast cancer prevention centre, which I visited just a few weeks ago to see the unveiling of the new plaque dedicated to my predecessor, Paul Goggins, who worked so hard for the services at Wythenshawe.

22 July 2014 : Column 423WH

The hospital not only serves the people of south Manchester, but helps patients from across the north-west and beyond.

David Rutley: The hon. Gentleman speaks with passion and great knowledge about his local hospital. I was fortunate enough to be able to witness how good the services are at Wythenshawe, because I was whisked away when I spent a day with the North West ambulance service. I went in to see heart surgery taking place there, and it is first class. We must recognise that the care pathways that link Wythenshawe—or Stepping Hill, for that matter—to outlying hospitals outside the Greater Manchester area, such as Macclesfield, are vital. Does he agree with my hon. Friend the Member for High Peak (Andrew Bingham) that it is critical that the ripple-out effects of the consultation are taken into account?

Mike Kane: I cannot agree more. Wythenshawe hospital lies at the south of the conurbation and at the south of the area of the Healthier Together consultation. Being at the south of the conurbation and south of the River Mersey, it has traditionally looked to provide services to people in Cheshire as a whole, including the hon. Gentleman’s constituency.

David Rutley: I am sorry to take the hon. Gentleman’s time again, but I thank him for giving way. It is odd that there are at least two options—options 4.1 and 4.2—where there would be no hospital in the south, with neither Wythenshawe nor Stepping Hill. Does he agree that that would be a strange outcome that could endanger patient health?

Mike Kane: I agree. It would be odd not only for my constituency, but for constituencies to the south in the Cheshire belt and the Cheshire plain that those hospitals serve.

Wythenshawe hospital is very much looking to the future and its long-term sustainability. It is developing the Manchester MediPark in partnership with Manchester city council and private sector developers. MediPark will exploit the huge strengths of Greater Manchester and the north-west in health and life science services. Research and development forms a key part of the new Manchester airport city enterprise zone, which I had the opportunity of updating Members on only last week during my Adjournment debate on regional airports.

UHSM is recognised as a centre of excellence for research and development, and is a founding member of Manchester Academic Health Science Centre. The partners of the science centre share the common goal of providing patients and clinicians with rapid access to the latest discoveries and improving the quality and effectiveness of patient care. It is clear that the hospital is going from strength to strength, but I fear that the planned Greater Manchester Healthier Together proposals, to which my hon. Friend the Member for Blackley and Broughton referred, could fundamentally destabilise the trust and lead to a loss of its major emergency service, many of its specialised services, its trauma service and even its teaching status.

The additional reorganisation is set against the backdrop of the Government’s £3 billion reorganisation of the NHS, which has siphoned off money from the front line

22 July 2014 : Column 424WH

to pay for back-office restructuring. In the first three years of this Government, attendances at A and E have increased by 633,000, yet Trafford general, to which my hon. Friend the Member for Stretford and Urmston referred and which serves many of my constituents, has seen a downgrading of its A and E department. It has got harder to get a GP appointment since the Government scrapped the previous Government’s guarantee of an appointment within 48 hours, and cut funding for extended opening hours. That is a key cause of Wythenshawe’s A and E problems.

Julie Hilling: Does my hon. Friend agree that the major vision that seems to be emerging is simply one of pitching hospital against hospital—fighting about whether to have a hospital in Wigan or Bolton, or four or five specialist hospitals, when, as has been said, we all want a good local service? Should not the concentration be first and foremost on getting primary care services correctly in place? That should be sorted out, and afterwards we can look at what hospital care we need.

Mike Kane: I agree; the most important thing is to get primary care in place first. Starting a consultation nine months from a general election that will pit MP against MP is not a good idea.

A quarter of walk-in centres, including Wythenshawe, have closed, and NHS Direct has been dismantled. On top of all that, the new Healthier Together proposals mean there is potential for a downgrade at Wythenshawe hospital. That would, as has been pointed out, be a broken promise for people in Wythenshawe and south-west Manchester, who following the downgrading of the A and E at Trafford general were assured that University Hospital of South Manchester would not be affected.

The aim of Healthier Together, to give patients across the region the same excellent standard of service wherever they live, is the right one. The challenge is huge. Manchester has the highest premature death rate of any local authority in the country. There can be no doubt that health care services in Greater Manchester need to change. Almost £2 billion has been taken out of the budget for adult social care. We need to do things differently to meet the challenges of the time and better integrating local authority services with the NHS will be a key part of that change. However, the current process is flawed and is moving too fast. The proposals fail to recognise that Wythenshawe is already a major specialist site that provides many vital services to the people of Greater Manchester.

The public are not being provided with enough detail to enable them fully to understand the implications of the proposed changes. The consultation meetings have been criticised—as they have today—for being jargon-ridden and held at inaccessible times. No financial models have been provided in the information for the public and UHSM believes that the current proposals could destabilise the finances of the trust.

Wythenshawe is a level 1 major trauma centre, and is currently the only site capable of developing a single level 1 trauma site for adults for the whole of Greater Manchester. As my hon. Friend the Member for Blackley and Broughton pointed out, it covers Manchester airport, and if an accident were to happen such a nearby centre would be vital. The current proposals could leave the southern sector of Greater Manchester and north Cheshire with no specialist major emergency hospital. The proposal

22 July 2014 : Column 425WH

does not reflect the view of providers and local commissioners in the southern sector that Wythenshawe should remain and be developed further as the sole specialist site in the southern sector.

The failure of the proposals to acknowledge Wythenshawe as one of the fixed sites threatens the future clinical, operational and financial sustainability of the trust. For changes at such a level to have the desired impact on services across Greater Manchester, all the partners must be firmly on board. I urge Healthier Together to look again and ensure that the baby is not being thrown out with the bath water, because of a rushed consultation and flawed proposals.

3.23 pm

Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op): I thank my hon. Friend the Member for Blackley and Broughton (Graham Stringer) for securing the debate. It is particularly useful that we can express our views before the summer recess. I do not want to speak for too long. I will echo my colleagues’ sentiments about the quality of the consultation process, but I want to give a view from the eastern part of the conurbation, Tameside, and make a couple of additional observations.

A lot is going on with the NHS and health care in Greater Manchester at the moment, so the timing is not very conducive to running such a consultation. The changes to Trafford A and E have already been mentioned. Passenger transport has been privatised from the NHS ambulance service to Arriva. Most of the walk-in centres that I am aware of have gone. I do not know about the situation in other constituencies, but in mine GP access is a huge issue—people regularly wait a fortnight for access to a GP in Stalybridge. Of course, in Tameside there are particular challenges because of the Keogh review in Tameside hospital. All the Tameside MPs warmly welcome that. It has been a positive process enabling a light to be shone on many of the things that we have been discussing for several years. However, when all the factors I have mentioned are added together, it is a difficult time to carry out a consultation on any part of the NHS and particularly on hospitals, because the public are most sensitive about them in many ways.

I understand the need for specialisation. I echo the remarks of my hon. Friend the Member for Stretford and Urmston (Kate Green). Even if we had substantially greater resources, it would be difficult to recruit the people we would need to meet the standards now required for hospitals in the conurbation. With the financial modelling that has been done in Tameside, we are perhaps a little more advanced in our forward projection work than some other boroughs, and I think that we are in a perfect storm. We have had to spend a lot of money at the hospital to try to meet the higher standards that people should expect by correcting some of the processes that the Keogh review highlighted as wrong. On top of that, the council was always one of the leanest in the country, let alone in Greater Manchester, so it suffered the worst from the severe reductions made by the coalition in northern local authorities. Our clinical commissioning group is in a relatively good position, but clearly it is not to anyone’s benefit simply to use that financial picture to prop up other parts of the system that are not working so well.

22 July 2014 : Column 426WH

History will be hard on the coalition for prioritising such a big ideological reorganisation at a time when the figures show that the situation I have described is the challenge that incoming Health Ministers should have concentrated on. The promise that no A and E departments in our hospitals will close is welcome news, but I wonder whether the scale of the rhetoric around Healthier Together justifies or validates that promise. Either we shall not produce the results that have been promised, or that promise on the long-term future of hospitals and A and Es may not be honoured in the way we expect.

Graham Stringer: My hon. Friend is right to say that that commitment was given when we met the Healthier Together people and in some background documents. Does he agree that it is worrying that it is not in the consultation document, whatever credibility we give to the commitment itself?

Jonathan Reynolds: I do agree. That is a matter of extreme concern to me. My understanding is that we have been given a cast-iron pledge that there will be no hospital or A and E closures as part of Healthier Together. The problem with all hospital reconfigurations anywhere—it happened with the maternity services consultation—is that they always appear to people to be about cuts. It is hard to get across the argument that they are about improving services. There is some mixed messaging about the primary outcome of such a process.

My principal problem with specialisation is the one that arises with specialisation in any field. Greater Manchester’s geography makes it hard to get from one borough to another. Public transport and the railway system are not configured to operate in that way. I should love the opposite to be true—if we had the resources and local autonomy to make public transport work differently. That will come one day, I think, but it is not true at the minute. I did not by any measure expect to become an MP in the 2010 general election, and my daughter was booked in to be born at St. Mary’s, because I worked in the centre of the city and it was easier to have appointments there than to get back to Tameside for them. Frankly, we were concerned about the possibility of labour starting in Tameside at the wrong time, because of the journey to get to St Mary’s and what that might mean. I think that that would be the same for many people, whatever the health issue: the journey is not easy in a car, but by public transport it is almost untenable. That would be people’s primary concern when they thought about the outcome of such a consultation

Lisa Nandy: I am grateful to my hon. Friend for raising that matter, because I do not think that the Healthier Together team has given it enough thought. My constituency has not only chronic transport problems, including traffic and the fact that some areas of the borough are densely populated and quite far from the existing hospital, but also large, tightly knit families who often do not have a huge number of resources. When a loved one is suddenly taken ill, the whole family wants to visit, which is particularly problematic and something that the team has not thought about. Does my hon. Friend agree?

22 July 2014 : Column 427WH

Jonathan Reynolds: That is absolutely true. If someone lives near the station in Stockport, it is sometimes quicker to get to London than to another part of Greater Manchester.

I am pleased that the hon. Member for High Peak (Andrew Bingham) was here, because something that is forgotten across the conurbation is that the health economy and structures are not coterminous with the political structures of Greater Manchester. Glossop is part of Tameside’s health economy and getting from Glossop to Ashton-under-Lyne is not an easy journey, but trying to get to a different part of Greater Manchester in an ambulance or with a need to access a particular service would be extremely worrying.

Julie Hilling: It must be recognised that people living within Greater Manchester will also travel to hospitals outside. Some of my constituents might travel to Chorley for treatment, for example, because it is much closer than Bolton or Wigan. My hon. Friend is absolutely right that there is no wall around Greater Manchester in terms of people travelling in or out.

Jonathan Reynolds: That is absolutely true and has been mentioned by several colleagues today. My specific point about Glossop is that it shares an NHS trust hospital and clinical commissioning group with Tameside and that must be considered in a manner that people do not fully appreciate at the moment.

Looking at the financial picture for the NHS in Tameside and Glossop, we see many challenges to meet in future. I cannot see the utility in a big hospital reorganisation such as this unless there is much wider reform of out-of-hospital care, because we will still face the problem of too many medically healthy people being in hospital because they have nowhere else to go. Such reform would require much stronger integration of social services, public health, the CCG and the hospital, but the Government’s entire direction of travel is towards a more fractured and competitive system. I understand the motivation, but I cannot see how it tallies with something such as the Healthier Together programme.

The Minister has several points to address in his speech, but I hope that he can respond to that one in particular, because I am unsure about why we are going through this process if it will not deliver the improvements in health care that should be the ultimate goal of any kind of reorganisation.

3.32 pm

Mr Jamie Reed (Copeland) (Lab): It is a pleasure to conduct a debate under your chairmanship for the first time, Mrs Riordan. I congratulate hon. Members on both sides of the House on the spirit with which they have conducted themselves today and on their genuinely well informed and impassioned contributions. I also congratulate my hon. Friend the Member for Blackley and Broughton (Graham Stringer) on securing the debate.

Members of all parties will appreciate the concerns expressed in the House over many months on behalf of communities that are worried about changes to their local NHS services. Consultations and how they are conducted are vital to ensuring that people have the necessary information to participate effectively in the

22 July 2014 : Column 428WH

consultation process, but that does not always happen. The Healthier Together review of health and care services across Greater Manchester is intended to deliver improvements to primary and community-based care to reduce the need for people to go into hospital, and that principle has received broad endorsement from colleagues today. The intentions of the review for primary care are admirable, including that by

“the end of 2015, everyone living in Greater Manchester who needs medical help, will have same-day access to primary care services…seven days a week; by the end of 2015, people with long-term…conditions…will be cared for in the community…supported by a care plan which they own; community-based care will focus on joining up care with social care and hospitals, including sharing electronic records which residents will also have access to; and by the end of 2016, residents will be able to see how well GP practices perform against local and national measurements.”

The plan also aims to improve joined-up care and hospital care. Although the aims are good, it is essential that the review also provides reassurance and clarity. From what I have heard today, it is clear that that is missing by some measure and has not been achieved—at least not yet.

As is too often the case, the review started with what services will be taken away from hospitals. Instead, it should have begun with what services people will in future be able to receive in their own homes or in a local community setting. Rather than identify the services that will be taken from the general hospital and put into a specialist hospital, the review should have identified the services that will be repatriated from the specialist hospital to the general hospital.

We all recognise that how and where services are delivered does need to change, but it is a quid pro quo process and the specialist hospitals also need to put some services back into a general hospital setting. When the proposals from a review appear to be a power grab by the big players in the local health economy, it is no wonder that people fear for the future of their services. If services are taken away, “How viable will we be?” becomes a worrying question. We need specialist hospitals, as shown by the case of Fabrice Muamba, who was taken not to the nearest hospital but to the specialist hospital that would save his life, but we also need general hospitals serving their local communities.

The Healthier Together review has the chance to shape services across Greater Manchester, moving out into the home and community setting, at the same time as securing the future for the general hospital. However, several colleagues have raised genuine concerns about the process. If a review of health services is to command support and achieve success, it must be open and transparent and provide all the necessary information to the public. Members have expressed grave doubts about whether that truly is the case with the Healthier Together review. The future viability of all hospitals needs to be secured, the continuation of A and E services has to be ensured and the issue of travel times across a conurbation such as Greater Manchester has to be taken into account in precise detail.

Although the aims and objectives of the Healthier Together review are commendable and, if introduced properly, would deliver improved health and care services across Greater Manchester, as we have heard in detail today, many worries have not been addressed and significant concerns remain. It is now for the Healthier Together

22 July 2014 : Column 429WH

review team to provide the answers and reassurance that are needed for the review to be successful. I look forward to hearing from the Minister.

3.36 pm

The Minister of State, Department of Health (Norman Lamb): It is a pleasure to serve under your chairmanship, Mrs Riordan. I congratulate the hon. Member for Blackley and Broughton (Graham Stringer) on securing the debate. The opportunity to debate important issues at the start of a process is welcome. I also thank my hon. Friend the Member for Bury North (Mr Nuttall) and the hon. Members for Wythenshawe and Sale East (Mike Kane), for Stalybridge and Hyde (Jonathan Reynolds), for Stretford and Urmston (Kate Green) and the shadow Minister—[Interruption.] I thank my hon. Friend the Member for Harrogate and Knaresborough (Andrew Jones) for ensuring that I also thank the hon. Member for Wigan (Lisa Nandy) for her important interventions.

The impression that I got from all hon. Members is that there is a recognition that things need to change and of the importance of developing an integrated system of out-of-hospital support and strong primary care. Some hon. Members also recognised the importance of specialisms in specific cases, but concerns centred on the nature of the consultation. The shadow Minister was extremely fair in describing the process’s objective as a good one and the hon. Member for Wythenshawe and Sale East said that the aim is right, so there is something of real value to achieve here if it is possible. I completely understand, however, why hon. Members feel the need to speak up for and express concerns on behalf of their communities.

Lisa Nandy rose—

Norman Lamb: I will give way in a moment, but I was about to comment on the intervention of the hon. Lady, whom I rudely left out of my list earlier, in which she mentioned the lack of democratic legitimacy. The reforms have strengthened legitimacy. Until the reforms, there was no local democratic accountability for the NHS, but every area now has a health and wellbeing board. Interestingly, Lord Peter Smith, who I think is from the hon. Lady’s own community, said:

“We accept the case for change made in this consultation document…Remember it is not buildings that deliver good health care, it is the dedicated NHS staff who make it possible.”

To pick up on the point made by the hon. Member for Stalybridge and Hyde, Lord Smith, a local Labour leader, also talked about the move being towards greater integration:

“We are clear that this improvement in integration and in GP services needs to be up and running before the changes to the hospital services are introduced”—

clear support there for the objective.

Lisa Nandy: The Minister is right. Like the leader of my council, I accept the case for greater integration. I wanted to make one point, because the Minister seems to be suggesting that the concerns centre only on the consultation. I have a real concern, which I am not sure has been expressed clearly so far, about how the consultation sets up hospitals as either specialist or local.

22 July 2014 : Column 430WH

My hospital specialises already, and it is rightly fighting to retain that because good outcomes are delivered. That does not mean that my hospital can, or should, do everything. Indeed, many of my constituents travel, for example, to the Christie for cancer care, as the hon. Member for Bury North (Mr Nuttall) said. There is, however, a real issue about some hospitals being specialist and some being local, but with nothing in between.

Norman Lamb: I take that concern on board, and the hon. Lady should respond to the consultation. It is really important for hon. Members to do that.

Incidentally, I should say something on behalf of my hon. Friend the Member for Cheadle (Mark Hunter), because he is a Whip and so is unable to speak in the debate, although he has attended it all. He has expressed particular concerns about the potential implications for the University Hospital of South Manchester and Stepping Hill, and about options 4.1 and 4.2. It is important that I place that on the record.

Julie Hilling: Will the Minister give way?

Norman Lamb: Will the hon. Lady let me make another point that is on the tip of my tongue? I will then be happy to give way.

The hon. Member for Stalybridge and Hyde expressed the concern that, in his assertion, we are moving away from integrated care. Precisely the opposite is the case. Indeed, the hon. Member for Copeland (Jonathan Reynolds), the shadow Minister, expressed clearly some of the fantastic potential gains that could be achieved in the Greater Manchester area if the objectives were achieved. When I announced the pioneer programme to demonstrate the exemplars of integrated care, Greater Manchester was one of the applicants to get on to the shortlist and was close to securing pioneer status, so my every impression is that exciting work is going on in Manchester to change local health and care services in a way that all of us could probably sign up to.

Julie Hilling rose—

Kate Green rose—

Norman Lamb: I give way first to the hon. Member for Bolton West.

Julie Hilling: I thank the Minister for giving way. The bit that I do not understand is that local authorities, leaders such as Lord Smith and others, have been saying, “Yes, we need to sort out the integrated care”, but the consultation has been putting front and centre the need to change the status of hospitals. What everyone in the conurbation is saying is, “Let’s look at the integrated care and then see what comes out of that”, rather than putting changing hospitals up front, which is what exercises the whole community.

Norman Lamb: I note the hon. Lady’s point, but I come back to Lord Smith’s statement:

“We accept the case for change made in this consultation document”.

It cannot be clearer than that.

Jonathan Reynolds: Will the Minister give way?

22 July 2014 : Column 431WH

Norman Lamb: Let me finish the point. I am acutely aware that it is critical to develop those out-of-hospital services to which the hon. Member for Wigan referred. That is the whole essence of integrated care, of which Manchester is seeking to be an exemplar. I applaud Manchester for doing that, because that is a big shift towards the greater focus on preventing ill health, rather than on repairing the damage once it is done.

Jonathan Reynolds rose—

Norman Lamb: I am conscious that I need to make progress in my response to the debate, but I will give way to the hon. Gentleman.

Jonathan Reynolds: I am extremely grateful to the Minister for addressing my point directly. It is pleasing to see that he is well briefed. He is right about some of the exciting conversations about integration going on in Greater Manchester. I anticipate that he knows something about the proposals. If they develop into specific plans, is it his desire and belief that the Government would not seek to apply the competition law to which the NHS is now subject and allow them to proceed?

Norman Lamb: I have made the case very clearly that the whole purpose of the pioneer programme is to use the pioneers—although we are not simply focused on them—to identify the barriers to integration and to remove them. That is the whole point. There are concerns about all sorts of things that could block integrated care, such as information sharing across different providers and competition.

I should stress, incidentally, that in the section 75 regulations is a specific recognition that integrated care is an ambition that should be achieved, so commissioning can be for the whole integrated care pathway. There should be no problem in securing our ambition. Where barriers are found, they need to be addressed and removed.

I am conscious that the hon. Member for Stretford and Urmston asked to intervene—

Kate Green indicated dissent.

Norman Lamb: The hon. Lady has moved on, so let me make some progress.

It is important to recognise that we are discussing proposals that originated with local clinicians. Dr Chris Brookes, who is not a politician or a bureaucrat, who too often get condemned, but an accident and emergency consultant and a medical director of Healthier Together, says—

Lisa Nandy: Will the Minister give way?

Norman Lamb: May I make this point? I am sure that the hon. Lady will be interested to hear it. Dr Brookes said:

“Currently, there are too many variations in the quality of treatment, whether its emergency surgery or getting to see a GP when you need to. Not one of our hospitals in Greater Manchester meet all the national quality and safety standards.”

I am sure that all hon. Members present are concerned about that. He goes on to say something which, if we think about it, is shocking:

22 July 2014 : Column 432WH

“At present your chance of being operated on by a consultant surgeon in an emergency at the weekend is much less than midweek. Your chance of recovering well from surgery carried out by a consultant is greatly improved.

But it’s not just about hospitals. It’s about access to a GP, and better community-based services—more services provided locally or at home and joining up the care provided by local authorities.”

That is a clinician making the case for integration.

Before I turn to the Healthier Together changes, it is probably best to make a few points about service changes in the NHS generally and Government policy towards them. The Government are clear that the design of health services, including front-line services and A and E, is a matter for the local NHS and, critically, the health and wellbeing boards, which have democratic accountability. Our reforms put doctors in charge of the care that people receive and how it is delivered to best serve their populations.

The NHS has a responsibility to ensure that people have access to the best and safest health care possible, which means that it must plan ahead and look at how best to secure safe and sustainable NHS health care provision—not only to meet today’s needs, but to plan ahead for next 10 or 20 years.

Kate Green: In Trafford, my understanding is that neither the local authority nor the CCG supports the proposals before us. Will the Minister explain the role of the health and wellbeing boards in the final decision on the plans?

Norman Lamb: I understand that the health and wellbeing boards are keeping a watching brief throughout. They will have a decisive voice at the end of the consultation process in declaring whether they support the outcome. They bring together the local authority and the NHS, so they are pretty central to the whole process—and rightly so. The local NHS is constantly seeking to modernise delivery of care and facilities to improve patient outcomes, to develop services closer to home and, most importantly, to save lives.

The hon. Member for Stalybridge and Hyde focused on specialisation, and expressed scepticism about the case for it. Let me give him a case. It is from during the Labour Government and should be applauded—the lessons from it should be learned here. Stroke care in London, centralised into eight hyper-acute stroke units, now provides 24/7 acute stroke care to patients, regardless of where they live across the city.

Transport links are not that great across much of London—[Interruption.] Hon. Members should listen to Members from London complaining about transport links. Stroke mortality is now 20% lower in London than in the rest of the UK and survivors with lower levels of long-term disability are experiencing better quality of life. Hundreds of lives have been saved as a result of the specialisation undertaken predominantly under the previous Government.

Jonathan Reynolds: I was very fair in my speech and said that I absolutely accept the case for specialisation. I actually made the most positive case of any made by an Opposition Member today as to why that might be important for my borough, so the Minister has perhaps misunderstood that. But I have to say that comparing the transport situation in Greater London with that of

22 July 2014 : Column 433WH

Greater Manchester or any other northern city will, I am afraid, have our constituents in uproar: it is simply not the same picture by any means.

Norman Lamb: I acknowledge that, just as in London, there are real bottlenecks in Manchester. I have a son who was at university in Manchester—and found it to be a very fine city—so I understand the transport challenges there completely. The point remains that specialisations can save lives. We all have to recognise that.

All service changes should be led by clinicians and be based on a clear, robust clinical case for change that delivers better outcomes for patients.

Julie Hilling: Will the Minister give way?

Norman Lamb: I really cannot. I have been pretty generous in giving way many times, so I will make a bit more progress.

It is therefore for NHS commissioners and providers to work together with local authorities, patients and the public in bringing forward proposals that will improve the quality and sustainability of local health care services. Government policy has been to emphasise local autonomy and flexibility in how NHS organisations plan and deliver service changes, subject to meeting legal requirements, staying within the spirit of Department of Health guidance and ensuring schemes can demonstrate robust evidence against four tests. Those are that there is support from GP commissioners; there is a focus on improving patient outcomes; that schemes consider patient choice; and that they are based on sound clinical evidence.

I recognise that change is often difficult to achieve because the consequences of not getting it right could be so profound—hon. Members have been absolutely right to raise their concerns. It is therefore right that the NHS does not rush into change without fully understanding all the potential consequences, sometimes including unintended consequences. Change can be difficult to explain to patients who have had quite reasonable anxieties exacerbated by speculation—in many cases, in the media—about whether this or that service might close. Services are sometimes described as closing when in fact they are simply being provided in a neighbouring facility or changing for the better in response to advances in treatment.

For example, my hon. Friend the Member for Macclesfield (David Rutley) referred to the possibility of hospitals closing, but I am not aware of any proposal to close hospitals. When we communicate to patients and the public, it is important that we are clear on what this issue is and is not about, so as not to raise anxieties. From my perspective, we have to be careful to avoid ramping up anxieties inappropriately by playing on fears. We see that too often; unfortunately, it stifles genuine debate and discussion about what health services will need to change in order to do better in future. But I applaud all hon. Members for speaking in this debate very reasonably and about legitimate concerns.

The right hon. Member for Leigh (Andy Burnham) has agreed that the NHS needs to have the freedom to change the way services are provided. He said:

22 July 2014 : Column 434WH

“If local hospitals are to grow into integrated providers of whole-person care, then it will make sense to continue to separate general care from specialist care”—

the point made by the hon. Member for Wigan a moment ago—

“and continue to centralise the latter. So hospitals will need to change and we shouldn’t fear that.”

Perhaps the hon. Lady will take the point better from her party’s health spokesperson than from a Minister, but the right hon. Member for Leigh was making the case for the specialisation of services.

Lisa Nandy: I thank the Minister for being so generous in giving way. He seems to be setting up straw men that he then batters down. As far as I can work out, there is no disagreement from me or any Member on either the Government or Opposition Benches about the need for specialisation, integrated health care and locally delivered services. That is not what we are talking about. We are talking about a process that lacks democracy, that has been top down and centrally driven and that the public have lost confidence in.

Norman Lamb: To be fair, when I indicated earlier that the issue is about process, the hon. Lady came back at me—as is her right—to say that it is not just about process but about the model of separating specialisms from general hospitals. I therefore quoted what the shadow Secretary of State for Health had said in that regard.

I turn to the specific case raised by the hon. Member for Blackley and Broughton in this debate. Healthier Together was launched by the NHS in Manchester in February 2012 and is part of the Greater Manchester programme for health and social care reform, which seeks to improve outcomes for all Greater Manchester residents. The scheme is substantial, involving 12 CCGs and 12 hospital sites across Greater Manchester. As the consultation sets out, the case for change aims to improve access to integrated care and primary care, community-based care and in-hospital care services, including urgent and emergency care, acute medicine, general surgery and children’s and women’s services.

The House should appreciate that although those are the services being looked at, there are interdependencies with the core in-hospital services, including anaesthetics, critical care, neonatal services and clinical support such as diagnostic services. Changes in one area might have consequential effects elsewhere, as hon. Members have pointed out, and those effects have to be fully understood.

I should also repeat that the proposed changes are not a top-down restructuring. They are led by local clinicians who know the needs of their patients better than anyone. They believe that the clinical case for change—

Graham Stringer: Will the Minister give way?

Norman Lamb: I am conscious that I have only three minutes left. I have tried to be generous.

Local clinicians estimate that across Greater Manchester around 1,500 lives could be saved over five years as a result of implementing the proposed changes; that is not my assessment, but that of local clinicians. That would be an impressive improvement in health care, touching and affecting the lives of thousands of ordinary

22 July 2014 : Column 435WH

people—not only the individuals concerned, but their families and friends. It is because of the area’s current performance: if all trusts in Greater Manchester achieved the lowest mortality rates in the country, the CCGs believe that the number of deaths in Manchester could reduce by some 300 per year, equating to saving 1,500 lives over five years. That is an objective that we should all sign up to.

I am sure hon. Members will agree that it is not an unrealistic aim for hospitals in Greater Manchester to want to be the very best in the country. I am also sure all hon. Members want the very best for their constituents. Greater Manchester has some of the best hospitals in the country. However, not all patients experience the best care all of the time. In particular, the consultation sets out evidence that suggests that for the sickest patients who need emergency general surgery, the risk of dying at some Greater Manchester hospitals might be twice that at the best hospitals. That is simply not acceptable.

There is a shortage of the most experienced doctors in services such as A and E and general surgery, leaving some hospitals without enough staff. Only a third of Greater Manchester hospitals can ensure a consultant surgeon operates on the sickest patients every time; similarly, only a third can ensure a consultant is present in A and E 16 hours a day, seven days a week.

Healthier Together aims to ensure that all patients receive reliable and effective care every time. The programme is endorsed by the independent National Clinical Advisory Team, which offered strong support for the programme’s ambition, vision and scope, as well as its impressive public and clinician engagement. The NCAT felt that the programme’s approach was an exemplar of how the NHS should try to improve safety, value and sustainability.

I have not had time to say everything that I wanted to. I am conscious that hon. Members raised specific issues that I should respond to and am happy to write to all Members who have taken part in the debate. I hope my remarks have been of some help.

22 July 2014 : Column 436WH

SMEs (Local Authority Procurement)

[Relevant documents: Sixth Report from the Communities and Local Government Committee, Session 2013-14, on Local government procurement, HC 712, and the Government’s response, Cm 8888.]

4 pm

Mrs Mary Glindon (North Tyneside) (Lab): It is an honour, Mrs Riordan, to speak in this debate. I welcome the Minister to his new role in the Department for Communities and Local Government, and I hope that he will be able to give me some positive responses on small and medium-sized enterprises as a result of this debate.

I was prompted to apply for this debate because of a recent meeting I had with the Federation of Small Businesses in my constituency, at which we discussed late payments as one of the most serious issues facing its members. I was shocked to hear some of the facts and figures associated with the problem.

Late payment volumes have risen from £18 billion in 2008 to £46.1 billion in 2014, and although that is partly due to the economic climate, it is also because of a wider cultural trend in large companies’ approach to their cash flow. The Federation of Small Businesses found that 60% of SMEs are now experiencing late payments, with the average SME waiting for more than £38,000 in overdue payments. Worryingly, one in four SMEs have said that if the amount they are owed reached £50,000 it would be enough to make them bankrupt.

A poll conducted by the Federation of Small Businesses in November last year found that larger businesses are the worst performers when it comes to paying on time and have the worst late payment record, with small businesses reporting that 51% of invoices to those firms are paid late. For small businesses that means reduced profitability with a knock-on effect of those businesses paying their suppliers late and ultimately restricting business growth.

I want to focus on the subject of this debate—late payment to small and medium-sized enterprises under local government procurement—and refer to the sixth report of the Select Committee on Communities and Local Government, of which I am a member. It noted that most councils have policies to ensure that their suppliers are paid promptly, but there is a problem with the terms being passed down to subcontractors. The report showed that 95% of councils had specific prompt payment policies, but that just over one third expected their contractors to apply the same standard.

The recommendation in the report was that councils should, as a matter of course, pay contractors promptly and include a requirement in their contracts to require main contractors to ensure that their subcontractors are paid promptly right down the supply chain. That policy should be monitored, and failure to comply with the conditions should be reported. Furthermore, local authorities should take into account any failure of contractors to comply with the conditions when assessing tenders for future work. I hope that the Minister, in his new role, will comment on that important recommendation in his response.

The Government’s prompt payment code had been recognised across the political spectrum as a move in the right direction, but it must be strengthened if it is to achieve its goal. Since the code was introduced last year,

22 July 2014 : Column 437WH

it seems that some large companies, to avoid being named and shamed, have extended their payment terms from 30 days to 60 days or even 90 days, which has caused more harm than good to many small and medium-sized businesses. For many smaller enterprises, 60 or 90 days is anything but prompt.

Does the Minister agree with the shadow Minister, my hon. Friend the Member for Corby (Andy Sawford), who said at the Local Government Association conference that early rather than prompt payment is what matters? There are schemes to incentivise early payments, and some councils have adopted a scheme run by Oxygen Finance Ltd, which allows councils to pay suppliers immediately in exchange for a cash return or a rebate. Oldham borough council was the first to adopt the scheme, and it is being operated across 20 local authorities. It seems to be a success for councils and is a lifeline for small businesses in the supply chain. With the call to Government from businesses and politicians to strengthen the prompt payment code, such a system could be one answer.

We all recognise that small and medium–sized enterprises are an important part of our economy locally and nationally. The Government must listen to their concerns about late payments and about strengthening the prompt payment code. The Federation of Small Businesses wants more thorough reporting and a more transparent framework whereby all signatories clearly state what their maximum and average payment terms are, with a named contact for small businesses that face difficulties. The federation believes that prompt payment for small businesses must be within 60 days and no more. Will the Minister clarify whether the time limit for payment starts from the date when an invoice is received or when it is authorised? The Communities and Local Government Committee’s report says that the FSB believes that there should be a single contract term that applies to all in the supply chain. I hope that the Minister will comment on all those points in his response.

Councils should be commended for doing all they can to support businesses in their local communities. SMEs play a vital role in all our communities, and if they are to prosper, create jobs and help to build our economy they must be confident of their own financial security. Finding the most positive way to end the problem of late payment is one way in which the Government and local government can help. I look forward to the Minister’s response.

4.7 pm

The Parliamentary Under-Secretary of State for Communities and Local Government (Kris Hopkins): It is a pleasure, Mrs Riordan, to serve under your chairmanship. I congratulate the hon. Member for North Tyneside (Mrs Glindon) on securing this important debate. I say that not just as a Minister, but as a Member of Parliament and a former council leader. I know how important the issue is for small businesses in my constituency, and I hope to answer all the questions that have been asked.

Prompt payment is important to all businesses and is often critical to the survival of small businesses and voluntary organisations. Suppliers must be confident

22 July 2014 : Column 438WH

that they will be paid on time. Many small businesses now cite late payment as more of a problem than access to external finance. As the hon. Lady said, 60% of small businesses suffer from late payment. Small businesses cannot afford to be kept waiting for payment and to have to spend time and resources on chasing late payments.

Councils have an important role, because they are substantial buyers of goods and services. Last year, local government spent £57 billion on procuring goods and services from a wide range of businesses and voluntary organisations, both large and small. Prompt payment is critical to the cash flow of many suppliers and failure to pay on time can lead to serious problems, especially for small businesses, ultimately putting at stake their ability to continue trading.

The problem of prompt payment is about not just how quickly a council pays a supplier but, as the Communities and Local Government Committee identified in its report on local government procurement, how quickly payments are made down the supply chain. That view is supported by a Federation of Small Businesses survey, which found, as the hon. Lady has pointed out, that although 95% of the responding authorities had policies in place for payment of suppliers, only 39% were identified as passing their payment terms on to their main contractors and therefore down the supply chain.

Central Government has an important role in ensuring that suppliers are paid on time and we are leading by example, seeking to pay 80% of central Government invoices within five working days and making other reforms to increase prompt payment further down the Government supply chain.

Significant legislation is in place already. The Late Payment of Commercial Debts (Interest) Act 1998 has been amended twice, most recently in March 2013, when the Government transposed the updated EU directive on combating late payment in commercial transactions into UK law. That late payment legislation allows companies to charge interest on late payments at 8% above base rate; to apply charges to cover administrative costs; to assume a 30-day term for the purpose of calculating late payment charges if a contract term is not explicitly agreed; to be subject to mandatory 30-day payment terms, maximum, for transactions with public authorities, which reflect the current policy in the UK; and to be subject to maximum 60-day payment terms between businesses, unless they expressly agree otherwise and it is not grossly unfair.

In addition, the Government will be introducing a number of other key reforms later this year as part of the transposition of the EU directive on public sector procurement into UK law. Those reforms will include—I think they will reflect some of the hon. Lady’s concerns—a legal requirement for all new public sector contracts to include 30-day payment terms for all the contracts in the supply chain, so that smaller businesses are paid on time; and a requirement from next year for all public bodies to publish details of instances of late payment and interest paid as a result of those late payments.

There is also a range of new procurement reforms in the Small Business, Enterprise and Employment Bill, which has had its Second Reading in the House, including a new enabling power allowing Government to place new duties on bodies relating to procurement. In future,

22 July 2014 : Column 439WH

and subject to consultation, the power may be used to require procurers to run timely and effective procurements and to manage contracts effectively.

The Government have also set up the mystery shopper scheme. Suppliers can refer instances of late payment on public procurement contracts or in public procurement supply chains to the scheme. That will then be investigated and reported on by the scheme.

Tackling late payments is also about creating a responsible payment culture. The prompt payment code, which was developed by the Institute of Credit Management, encourages and promotes best practice between organisations and their suppliers. Signatories to the code commit to paying their suppliers within clearly defined terms and ensuring that there is a proper process for dealing with any issues that may arise. Seventy-five per cent. of the FTSE 100 companies have now signed up to the prompt payment code, following a campaign by the then Minister, my right hon. Friend the Member for Sevenoaks (Michael Fallon), in 2012. Independent analysis by Experian suggests that current signatories to the code represent over 60% of the total UK supply chain value. However, there is a clear desire for signatories to be more open about practices and to be visibly accountable if they fail to live within the spirit of the code. That is why the Institute of Credit Management will be speaking to signatories and consulting on what can be done to strengthen the code and increase its membership.

Mrs Glindon: I thank the Minister for answering my questions so thoroughly. Will he refer to my question relating to early payment, as opposed to prompt payment? If it were 60 days and the payment were made on the 59th day, that could still be a problem for some small businesses.

Kris Hopkins: I do not know the terms under which that phrase came about, but if I were living my previous life as the leader of a council, I would expect us not just to push to the maximum; I would expect us to seek to respond proactively to the other needs of small businesses. In some of the examples I will refer to, I think I can demonstrate how much the Government want to support that.

We recognise that there are numerous examples of local authorities supporting their suppliers and customers. The Government’s “Best councils to do business with” contest last year showed that many councils understood the importance of the prompt payment terms. Bury, the City of London, Halton and Harrow are all committed to paying small and medium-sized enterprises within 10 days of invoices. Other councils, such as North Tyneside, have introduced e-procurement and e-invoicing, all of which are intended to streamline the procurement and

22 July 2014 : Column 440WH

payment process, reducing the instances of late payment. In addition, a number of councils, such as Blackburn with Darwen, have signed up to a prompt payment code and actively encourage their suppliers to do the same to ensure prompt payment throughout the supply chain. Through the points made by the hon. Lady and the good examples we have here, I think I can send a note to other authorities, signposting them to really good practice and, if they are not proactively seeking to pay their bills in the terms that we are talking about, encouraging them to go further.

Before I conclude, I want to get a fact on the table—the hon. Lady asked about this point, but I have not included it in my speech so far—namely the 30 days start from the receipt of a valid invoice. I just want to get that on the table, so she is aware of it.

The Government recognise that being paid on time is vital to suppliers. There is already a legal requirement for public bodies to pay suppliers within 30 days or be liable to interest resulting from paying late, and we are legislating to ensure that small firms get treated fairly by mandating prompt payment terms all the way down a public procurement supply chain. However, the sector also has a role to play, and I am pleased to see that the Local Government Association recently published a national procurement strategy that sets out the need for prompt payments. It makes it clear that councils can no longer accept their small and medium-sized enterprises having to wait longer for invoices to be paid.

Mrs Glindon: The requirements that are being placed on councils seem fairly onerous. It is right that that should happen, but my question relates to the seeping down from the main contractor to the subcontractor. Perhaps the Minister has covered this, but I am not sure how we can ensure that that seeps right through to the smallest person in the supply chain.

Kris Hopkins: I am sure that, in the House in the coming months, there will be a great debate on the “how”. We have expectations of local government—the terms and conditions that we expect public bodies to meet. Providers of services and goods down the chain of supply will also be expected to agree to those terms and conditions.

In conclusion, I agree with the recent Select Committee report recommendation that councils should, as a matter of course, pay contractors promptly and include a clause in contracts requiring contractors to ensure that their subcontractors are paid promptly right down the supply chain, just to reiterate that point.

4.19 pm

Sitting suspended.

22 July 2014 : Column 441WH

Disabled People (Developing Countries)

4.30 pm

James Duddridge (Rochford and Southend East) (Con): It is a pleasure to be here on this warm day and to see the Minister, my right hon. Friend the Member for New Forest West (Mr Swayne), in his place. I congratulate him enormously on his elevation to Minister of State in the Department for International Development, which is well deserved and comes on the back of many years’ work in the sector in Rwanda and beyond.

I thank Mr Speaker for allowing time for the debate. As chair of the all-party group on Africa and as an ex-member of the Select Committee on International Development, I have followed the issues that I will raise carefully. I also did so while working in developing countries across Africa during a business career outside the House. In all countries, the prevalence and awareness of disabilities is growing. As a result of an ageing population and a number of other factors, people with disabilities now make up 15% of the global population, or more than 1 billion people around the world. Of those 1 billion people, 80% live in developing countries, and at least 785 million are of working age.

Across the world, people with disabilities are statistically more likely to be unemployed, more likely to be illiterate, less likely to have access to a formal education and less likely to have access to the support networks that even people in the developing world currently enjoy. They are further isolated by discrimination, ignorance and prejudice. Disability is only one driver among many of social and economic exclusion. When disability combines with other factors—gender, ethnicity, caste, age, geography and location—it makes individuals more disadvantaged in society. People with disabilities are more likely to be excluded from the benefits that society has to offer if they hold a combination of those attributes.

Mark Lazarowicz (Edinburgh North and Leith) (Lab/Co-op): I congratulate the hon. Gentleman on securing this important debate. On the question of exclusion, does he agree that a particular priority should be to ensure that children with disabilities have access to education? If children are excluded from education at an early stage of their life, they are even more likely to suffer some of the challenges and exclusion that disabled people suffer later in life.

James Duddridge: Although we have made much progress on the millennium development goals, my understanding is that people with disabilities make up approximately a third of those who are still uneducated. In the post-2015 model that is the successor to the millennium development goals, it is essential that we pick up on those issues. I will touch on that later in my speech, but I agree with the sentiments expressed by the hon. Gentleman.

Disabled women and girls, in particular, lack support. They face great difficulty accessing education, which the hon. Gentleman mentioned, and training and employment compared with non-disabled females and even disabled men in a similar environment. According to the UN, a survey conducted in Orissa, India, in 2004 found that virtually all women and girls with disabilities were beaten at home. I could not believe that fact when

22 July 2014 : Column 442WH

I read it; it is quite unbelievable. The survey found that 25% of women with intellectual disabilities had been raped and 6% of women with disabilities had been forcibly sterilised. Those are horrific statistics. The National Council of Disabled Women in Bangladesh, which helps to promote the rights and dignity of women with disabilities, has noted that the isolation and stigma faced by such women can lead to violence in the home and discrimination in the workplace, but that violence and discrimination often go unreported and criminals escape punishment.

Jim Shannon (Strangford) (DUP): We are debating an important issue, and it is a good opportunity to come to the Chamber and present the case. In 2006, the UN General Assembly adopted the international convention on the rights of persons with disabilities. Under that convention, countries should ensure that people with disabilities are granted equal rights and freedom from discrimination. Does the hon. Gentleman share my concern that eight years after that convention was adopted, some countries have yet to implement it, so the very things that he describes are happening and most countries are ignoring them?

James Duddridge: Terrible things are happening, and they are happening on our collective watch. I urge the Minister, on his many visits to places where the Department for International Development is spending significant amounts of money, to try to leverage that influence and ensure that countries abide by the relevant UN conventions. I urge him to encourage people to move in the right direction, while allowing them sometimes to move at a different pace. Not everyone can move as fast as we can, but there is a lot more to be done—

Jim Shannon: Eight years should be plenty of time.

James Duddridge: It needs to be done faster, and greater leadership would be fantastic, as the hon. Gentleman has said.

Closer to home, in my constituency, I recently attended a school assembly where the children spoke incredibly eloquently about the “Send all my friends to school” campaign. They informed me that 60 million children around the world are not in education, 19 million of whom have a disability. Investing in those people is absolutely essential.

Dame Anne Begg (Aberdeen South) (Lab): Secondary 1 pupils from Kincorth academy have sent me drawings as part of “Send all my friends to school”—I think every second one is in a wheelchair—which I have now displayed in my office. Campaigns about sending friends to school, which have been run for a number of years, have really engaged young people and made them realise the importance of education not only for people abroad, but for them, because the campaigns force them to realise how important it is for them to go to school.

James Duddridge: I entirely agree with the hon. Lady. I was sent similar cut-outs, and I took some to Downing street when I visited the Prime Minister about another issue. Although the children at the school I visited in my constituency were eloquent and understood some of the problems, when I talked about living on a dollar a day, the lack of electricity and the lack of opportunity to go to school, one of the children piped up and asked,

22 July 2014 : Column 443WH

“But how do they charge their iPods?” The message gets through, but we have to keep repeating it. Campaigns such as “Send all my friends to school” are instrumental in raising awareness of what is happening in developing countries and in emphasising the value of education, whether in Cork, Southend or anywhere around the United Kingdom.

People with disabilities have a huge amount to contribute to society and benefit us all. A little support can go a long way in helping them to integrate in society and play a role.

Mr Tom Clarke (Coatbridge, Chryston and Bellshill) (Lab): The hon. Gentleman has been gracious in giving way, and I congratulate him on an excellent debate. I am reminded of a visit that I paid to Angola, where I saw many people who had suffered as a result of landmines and who had got together as an advocacy group. Does he agree that advocacy in the situations he describes is extremely important?

James Duddridge: I could not agree more. Without advocacy, parts of the community have no voice at all. Anything that we can do to help give them a voice through advocacy sets people on the road of explaining what their problems are, accessing support, moving forward and being a part of society. The Special Olympics, which are for people who have intellectual rather than physical disabilities, fall squarely into that category. The term “intellectual disabilities” is used to distinguish those disabilities from mild learning difficulties such as dyslexia, and it refers to what we in the UK might call severe learning difficulties of an intellectual rather than a physical nature. Worldwide, 200 million adults and children have been identified as having intellectual disabilities, but research has shown that in at least three quarters of cases, intervention and assistance can make a transformational difference. That is not to say that we should leave behind the other quarter, but such investment is well leveraged and will transform people’s lives.

The Special Olympics is one of the world’s largest sporting organisations for children and adults. It provides year-round training and competitions for more than 4.2 million athletes in 170 countries. But the Special Olympics are about much more than just sport. They are about education, early intervention training, health screening, making communities more inclusive and bringing people with intellectual disabilities into the mainstream of the community. They are about identifying and being proud of individuals, rather than the cases I have heard of people being pushed to the back of the village and, in more extreme cases, chained to the tree as a way of monitoring them and keeping them subdued.

The international community is beginning to recognise that we cannot tackle poverty without addressing the issue of people with disabilities. The Select Committee on International Development recently published an incredibly good report, “Disability and Development”, which touched on all these issues. There is a huge opportunity for the UK to work on inclusion issues, on which we have been so good, in places around the world where we offer support. DFID already supports a diverse range of projects designed to benefit disabled people and disability rights programmes through supporting broader civil society organisations. I understand that in 2012-13, DFID spent just shy of £200 million on programmes designed to benefit disabled people. I welcome

22 July 2014 : Column 444WH

that, and I think that Members in all parts of the House would welcome that as a baseline from which to move up. I also welcome the pledge that all new DFID-funded school constructions will be accessible to disabled children, and I welcome the renewed support for the Disability Rights Fund, which helps small disabled people’s organisations in developing countries, and to which Ministers recently committed £2 million.

I welcome a number of new commitments that the Government spelled out in their response to the “Disability and Development” report, including one to publish a disability framework by November 2014—I think I know the Minister’s summer reading, at least in part. That framework will set out a

“clear commitment, approach and actions to strengthening disability in…policy, programmes and international work.”

DFID has set out commitments to scaling up inclusive programmes, to funding new research and to reviewing internal processes through the multilateral and bilateral aid reviews. Such commitments are extremely important.

Going forward, there are key questions about how DFID’s disability framework will be implemented. It is important that it addresses both the infrastructure required for disabled people to participate fully in society and the social barriers that they face, including stigma and underlying discrimination. It is essential that sufficient resources are ascribed to implementing the disability framework so that it enables the stated objectives to be achieved.

We must support the Government to develop their disability framework over the coming months and, crucially, to implement it over the coming years. The millennium development goals, to which I referred earlier and which were established in 2000, have fundamentally shaped international development over the past 14 years. The goals can be credited for the focus that they have brought to international development issues and for their contribution to the progress made over the years. Remarkable gains have been made on a number of different issues, but we are now looking at how to replace the millennium development goals. Unfortunately, they did not give enough prominence to disability issues. Before the UN meeting later this year, we have a window of opportunity to lobby the Government and for them to lobby other parliamentarians and representatives.

The Under-Secretary of State for International Development, the right hon. Member for Hornsey and Wood Green (Lynne Featherstone), has recognised that too few people with disabilities currently benefit from international aid, and has described the future poverty goals as

“a once-in-a-generation chance to finally put disability on the agenda.”

I could not agree more; this year, there really is an opportunity to get something set in stone. That opportunity is not going to come around again for another decade.

The Prime Minister’s appointment as co-chair of the UN high-level panel on the post-2015 development agenda was most welcome. He has shown great leadership over the broader golden thread, within which I would certainly include disability issues.

Dame Anne Begg: I share the hon. Gentleman’s concern that we have a once-in-a-decade opportunity to get this right. I see that the Minister is listening carefully in one

22 July 2014 : Column 445WH

of his first debates in his new job. Hopefully he will realise the importance of raising the issue of disability and mainstreaming it to ensure that disability is taken into account in everything that DFID does.

James Duddridge: I totally agree. I know that the Minister has already been involved in these issues in Rwanda, but I echo the hon. Lady’s call: he should continue his work in the coming years and use this window of opportunity as Minister of State during the period in which the vision for 2030 is set. That seems an unfeasibly long time away, but we are going to be fixing our goals, and it is essential that disability is at the heart of the report.

The UK is a member of the UN’s open working group, which is going to finalise some of the goals. There have been encouraging signs that the document will reflect the needs of disabled people. In particular, proposed goal 10, which is to reduce inequality between and within countries, is relevant to disabled people. Proposed goal 17, which focuses on the means of implementation and the global partnership for sustainable development, includes the need for disaggregated data by disability. Those are big words, but, basically, if we do not know how many people are disabled within the overall data set, we cannot monitor, country by country, progress on aid inputs and outputs.

Like others around the world, the UK Government are currently preparing for the intergovernmental negotiations in January 2015. There are a number of opportunities to support the needs of people with disabilities, and I would welcome the Minister’s comments on the UK’s approach to engaging people with disabilities in the ways that have been mentioned, as part of the post-2015 framework. All the issues must be incorporated into a broader framework across the full range of policy areas, including health, education and employment, to name a few. To ensure that that becomes a reality, it is important that the goals that make up the post-2015 framework clearly reflect all those needs. I would welcome the Minister’s comments on whether the UK will be championing explicit references to disabled people across the range of goals in the framework.

I am conscious that time is getting on, so I want to start to come to a conclusion. To monitor progress, we need a data revolution. We need the data coming out of developing countries so that we can benchmark the number of people with disabilities and monitor progress. Within those data, disaggregated by disability, we would need to see a number of things. First, we would need to see that the data would lead to a more informed policy-making process, allowing policy makers to see which areas it was necessary to target. Secondly, the data would need to enable initiatives supporting disabled people to be monitored. Thirdly, the data would need to provide civil society with the ability to hold Governments to account, locally and internationally, on those goals. I would welcome the Government’s comments on the steps they propose to support the development of those disaggregated data and on how they will be used.

Although the data are necessary to enable civil society to scrutinise decision making, it is also important that civil society can access and make use of those data. In particular, people with disabilities must be involved in

22 July 2014 : Column 446WH

the decision-making process. As a trustee of SHIELDS—Supporting, Helping, Informing Everyone with Learning Disabilities in Southend—I have seen the value of those with a whole range of disabilities. This is not a top-down process; those with disabilities should be included in looking at the data set and prioritising. Can the Minister elaborate on how the Government are working to ensure that people with disabilities have a voice at the table?

The links between disability and poverty are strong, meaning that it is not possible to overcome extreme poverty without dealing with these important issues. People with disabilities have a huge contribution to make to the development of their societies. Our fantastic 2012 Paralympic games and the remarkable performances from Team GB athletes started to help to change attitudes, showing Britain and the world that people with disabilities can achieve amazing things when the opportunity is available. If we are to improve the lives of those with disabilities in developing countries, they need our support. We have a window of opportunity.

I sought this debate to secure the opportunity for colleagues to lobby the Government and to make it clear that all eyes are on them. They must secure the necessary changes, seize the opportunity and make life better all around the world for those with disabilities and those born today with disabilities, so that their future and their place in society will be brighter and better. That will build a much stronger society for us all; one of which we can be proud.

4.49 pm

The Minister of State, Department for International Development (Mr Desmond Swayne): I begin by congratulating my hon. Friend the Member for Rochford and Southend East (James Duddridge) on his success in securing this debate and on the passion and commitment that he has shown in the speech he has just delivered. I also pay tribute to his record of championing this issue over a long period. In his opening remarks, he set out the number of years he served on the International Development Committee, and he has continued to campaign and draw attention to this issue. He has done us a service, and I owe him my thanks for having selected for this debate a topic so central to the priorities of the Department to which I have just been appointed.

My hon. Friend is right about the opportunity to which he drew attention; that opportunity was also referred to by the hon. Member for Aberdeen South (Dame Anne Begg), who chairs the Work and Pensions Committee. This is a period of opportunity and I feel deeply privileged to have been appointed to the Department at this particular time, when such an opportunity presents itself.

It is, of course, true, as my hon. Friend said, that the statistics show that one in seven people in the developing world is disabled, but I suspect that the proportion of disabled people among those who are chronically poor is much higher than that. He is also right to draw attention to the fact that, as we all know from our own experience as constituency MPs, where there is the opportunity, the support and the access that they need, disabled people are not only able to maintain themselves but can contribute effectively to the community, just like anyone else. Our objective in policy terms must be to enable disabled people to be contributors to their communities and not burdens on them, and I believe it to be absolutely achievable.

22 July 2014 : Column 447WH

The hon. Member for Strangford (Jim Shannon) drew attention to the fact that we have signed up to the UN convention on the rights of persons with disabilities and pointed out that significant progress has not been made in pursuit of the convention’s goals. We ratified the convention in 2008 and are encouraging other countries to do so. At the moment, 153 countries have signed the convention and 71 countries, including the UK—about 46% of those who have signed—have ratified it. However, we have to do better and pursue that agenda more vigorously.

Having said that, I should also say that we are paying considerable sums to support countries in the developing world as part of our pursuit of that agenda. I will give three examples of particularly good practice. In Mozambique, we are funding resource centres to support some 24,000 children with special needs in schools; in Ethiopia, we are supporting the production of materials in Braille, which are used to help some 10,000 children between the ages of five and 18; and in Zimbabwe, we are supporting some 27,000 disabled children through the child protection fund.

My hon. Friend the Member for Rochford and Southend East drew attention to the lack of reliable data in this area, and of course that is a significant problem. It is very difficult to assess the needs of disabled people if we do not know how many disabled people there are. I suggest that there is a greater danger: “if we can’t count ’em, they don’t count”, an attitude that we must be very careful about.

It is vital that we should be able to come to a clear analysis of the size of the problem and of the needs of disabled people. Until recently, there was not even an agreed definition of what amounted to disability. That is an issue on which the Department has been driving forward the agenda on; we want to get an agreement on the definition of disability, so that we can get reliable statistics.

It is also important that we concentrate on the prevention of disability. For example, for every female who dies in childbirth, some 20 to 30 females will suffer complications in childbirth that will give rise to disability. Therefore, an important part of the agenda must be to support women in childbirth, and an equally important part must be tackling those preventable diseases that give rise to disability, such as polio and trachoma.

I have no doubt that we need to do more. My hon. Friend was right to say that we must attend to the post-2015 agenda. My right hon. Friend the Under-Secretary of State for International Development has been championing the agenda of the disabled during the past 18 months and last year announcements were made with respect to infrastructure in schools, to make access much easier for disabled pupils in the areas where we are providing financial support.

My hon. Friend referred to the International Development Committee’s first report of the last Session, published in June this year. He was right to draw attention to its challenging conclusions, and we agree with virtually all of them. We share the report’s objectives

22 July 2014 : Column 448WH

and the most important point is the one he made—namely, that in our response to the report we will publish a framework for disability in November.

My hon. Friend was right to say that the framework must involve the input of disabled groups and other interested parties. Currently the Department works with some 400 disabled groups; it is right that we do so and we should seek to expand our dialogue with disabled groups. As we go forward and develop that framework, which will determine how we work in the future, it is important that we also take into account the opinions and input of hon. Members. I hope that that dialogue will proceed.

The framework will set out our commitment and our approach to policy, and how that policy will actually work on the ground. We will also increase the size of our team who work on disability; we will appoint a disability champion who will be able to give guidance to all our employees; and we will increase the role of disabled groups and disabled people in policy making, to strengthen our response to events—particularly our response to some of the emergencies, such as natural disasters, that arise, so that we take greater cognisance of disabled people in those situations.

The international development community may have been late on to this field, and late in appreciating the size of the problem of disability. I hope that we can ginger that process up. It is very important, as my hon. Friend said, to ensure that the post-2015 development goals address the issue of disability. The Prime Minister, when he chaired the UN high-level panel on the post-2015 development agenda, came up with a principle that I thought was exactly on the money, the key message being that we can eradicate poverty in this generation if we “leave no one behind”, which includes leaving no one behind because of their race, gender, geographical location or disability. That is the principle that we must abide by, and that is the commitment that we give.

My hon. Friend asked a number of specific questions. I think that I have addressed the one about how many groups the Department works with. As for the issue of the disaggregation of data and targets for disabled people, the principle I would support is that we have a target for a development project in a nation that we are helping; let us say, for example, that there should be zero poverty by such and such a date. I would not like to see a separate target for disabled people. Within the overall target, I would want to include every gender, every racial minority and every disability. Of course, it is absolutely right that we should be able to disaggregate the total, so that we can identify disabled people and know that none of them are being left behind—that is an important principle—but I would not want to see separate targets being set.

Mrs Linda Riordan (in the Chair): Order.

5 pm

Sitting adjourned without Question put (Standing Order No. 10(11)).