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Westminster Hall

Wednesday 11 July 2012

[Mr James Gray in the Chair]

Hospital Services (West London)

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

9.30 am

Mr Andy Slaughter (Hammersmith) (Lab): It is a pleasure to be here under your chairmanship, Mr Gray, and a pleasure to see so many colleagues from west London, of various parties, here for an important debate that concerns us all. It is a particular pleasure to see the hon. Member for Ealing Central and Acton (Angie Bray), relieved of the cares and constraints of office and therefore able to speak. I am slightly surprised that she chose to be pushed over House of Lords reform rather than this issue, the third and fourth runways at Heathrow airport or the cuts to Sure Start, pensions and other things that are going into the next manifesto, but we all find our path to salvation. I also welcome the hon. Member for Cities of London and Westminster (Mark Field), who already adorns the Back Benches. I hope that we can see others, including the hon. Member for Chelsea and Fulham (Greg Hands), joining the hon. Member for Ealing Central and Acton soon in order to fight the appalling changes to our health service.

Members of Parliament for the north-west London NHS area represent 2 million Londoners, and I know that all of them, whether they can be here or not, are very concerned by the proposals in the consultation document, “Shaping a healthier future”, published on 2 July. I will primarily deal with that document today. I intend to confine my comments, as the debate’s title suggests, to the effect on the major hospitals in north-west London of the proposed changes. Given the time constraints and the fact that hon. Members with more knowledge of hospitals in their own constituencies are here to speak, I will deal principally with the risks to Charing Cross and Hammersmith hospitals, but I will try to put those in the wider context of what can only be called a crisis in the NHS in north-west London. That is in the light of the further decision last week to put the future of Royal Brompton hospital at risk by the closure of children’s cardiac services there and the failure by Imperial College Healthcare NHS Trust to manage waiting lists and GP referrals.

The Minister will have seen the letter that I sent last week to the Secretary of State, asking for independent intervention to rescue the health service in west London before matters get more out of hand. I will expand on that and hope that the Minister can respond positively.

The other point that I will make in opening the debate is that the consultation should not be a Dutch auction. I do not think that any hon. Member will have come here to say, “Don’t close my hospital; close his or hers.” Every hon. Member and, indeed, every member of the public I have spoken to in the past few weeks wants to challenge not the detail or options that we are offered, such as they are, but the premise that such a

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major downgrading of the health service is sustainable, safe or sensible. If any hon. Member here felt a moment’s relief when they saw the schedule of closures—in particular, of accident and emergency departments—and realised that their local hospital was not on it, that relief was short-lived. The question immediately arose: how will the five remaining A and Es cope with the consequence of closing four busy departments and the consequent downgrading of other hospital services?

I am pleased to see here hon. Members representing, I think, all the north-west London hospitals, not only those under threat. Neither I nor my constituents are resistant to change in the NHS or unaware of the cost pressures that it faces. Indeed, it is the Government, not us, who need to be candid about both their failure to fund the NHS and the underlying financial motivation for these proposals.

The medical director for north-west London has been admirably frank. In approving the consultation two weeks ago, he stated that the local NHS would

“literally run out of money”

if the closures did not go ahead.

Mary Macleod (Brentford and Isleworth) (Con): I congratulate the hon. Gentleman on securing the debate. Does he agree that whatever the shortfall in funding in London that he talks about, more funding has gone into the NHS from the current Government than ever before?

Mr Slaughter: Apart from the bit of fun that I had at the beginning of the debate, I am going to stay off party politics. I think the hon. Lady knows that the NHS was rescued under a Labour Government, and knows about the increase in funding then. She will also know from articles in the press this week and last that in fact, the promise made by the Prime Minister before the election to increase funding for the health service is not being kept. [Interruption.] I therefore think that that was a bad point to make. [Interruption.]

Mr James Gray (in the Chair): Order.

Mr Slaughter: There has already been significant change in hospital services in north-west London. That has been for clinical and financial reasons. It has involved within Imperial the centralising of services, including renal, paediatric, oncology and vascular specialisms. More of that was anticipated. Other proposals for savings have been leaking out of Imperial for the past six months. Further moves away from hospital to community or GP services were expected—but nothing on the current scale.

This review is driven by the need to cut costs and is unrestrained because the chaotic reorganisation in the NHS, for which the Minister must answer, means that there is no accountability on the part of those who are making decisions. The Joint Committee of Primary Care Trusts, itself a body artificially created to make these cuts, is neither their author, nor will it survive to see their execution.

I would like to say a little about the history of hospital services in my part of west London, the scale of the changes proposed and the flawed process under which they are being made. I would then like to summarise

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the emerging public and professional views on the proposals, before finally asking the Minister for his response. Given that many in the NHS see the north-west London proposals as a prototype for what will happen elsewhere, it is not satisfactory for him to disown interest. He must either justify or be prepared to criticise the loss of front-line hospital services.

Each of the hospitals now under threat has a long and distinguished history. I am afraid I am old enough to remember when Charing Cross was Fulham hospital and when Chelsea and Westminster was St Stephen’s. Hospitals have stood on the Hammersmith campus since 1905 and at Charing Cross since 1884. Originally, these were workhouse infirmaries, fever hospitals or military hospitals. They have evolved into the world-class treatment centres that they are today. I do not want to take up a great deal of time with the history, but while preparing for the debate, I did come across this interesting paragraph on the opening of Hammersmith hospital:

“Immediately on opening, there was an outcry about the cost of the…building…£261,000…and its lavishness. The vestibule was paved with mosaic and was surrounded with a dado of the most expensive encaustic tiles. The dining hall was ‘of baronial splendour’. The press dubbed it the ‘Paupers’ Paradise’ and the ‘Palace on the Scrubs’.”

I did not know the Daily Express was going in 1905, but clearly it was. I am not sure that that was a completely accurate representation of the hospital, because its annual report for 1957 illustrated a granite block—part of the last consignment to the workhouse for breaking up by the inmates of the casual ward. I do not want to give the Minister any ideas about reintroducing rock breaking for out-patients, but that does show that we have come a long way over that time.

The Minister may say that I am being nostalgic in looking at the history of Hammersmith’s hospitals or that it is evidence that change in the health service is nothing new, but that misses the point. These hospitals have grown up on their current sites and changed in response to local need. These are some of the most densely populated parts of the UK. There is intensive residential development in the area: tens of thousands of new homes are planned for the next decade. This is a population with complex health needs and high turnover. This is an area with major transport infrastructure—air, road and rail—and with risks ranging from major trauma accidents to tropical and infectious diseases.

The accident and emergency departments under threat are always busy. They are trusted by my constituents. They have evolved to work side by side with GP practices, walk-in clinics and urgent care centres. However, they work, because the level of clinical expertise available can be adapted to cases ranging from the relatively minor to the very serious. I understand the debate about having fewer major trauma centres—the trade-off between travelling further and losing critical treatment time against the quality of care on arrival. I do not think that that argument is settled, not least because of the unpredictable and congested road system in west London, but also because of the conflicting opinions as to how crucial minutes can be in reaching specialist care in different trauma cases. What is unarguable is that the vast majority of patients currently attending A and E will potentially receive a worse service. They will not be

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sure whether their condition merits a longer trip to a hospital that still has A and E services, or whether seeing a GP at an urgent care centre will suffice. There will certainly be confusion and delay, and overall standards in quality of care will fall.

Mr Gareth Thomas (Harrow West) (Lab/Co-op): I apologise for missing the first couple of minutes of my hon. Friend’s remarks. Does he accept that, notwithstanding the proposed closure programme, there is already growing concern about the length of waiting times in A and E? Many of my constituents will be worried that their wait at Northwick Park hospital A and E unit will increase as a result of this closure programme.

Mr Slaughter: My hon. Friend missed the point that I made at the beginning: this affects all MPs and all communities in north-west London, not only those expecting the closure of services. The closures go against the thrust of the changes in the health service over the past five to 10 years, which have seen the huge pressure on A and Es relieved by the addition of urgent care centres, not the replacement of A and Es by them.

The Minister of State, Department of Health (Mr Simon Burns) rose

Ms Karen Buck (Westminster North) (Lab) rose

Mr Slaughter: I give way to my hon. Friend and will give way to the Minister in a moment.

Ms Buck: I am grateful to my hon. Friend. He was with me when we met representatives of north-west London recently and were advised that the number of A and E attendances is rising by about 10% a year. Does he agree that, even for those of us who agree that in an ideal world, we would reduce unnecessary A and E admissions through the provision of quality care in the community, it is wrong to propose the closure of A and E units before we have a demonstrable improvement in the community facilities that would allow for that reduction in unnecessary A and E admissions?

Mr Slaughter: Indeed, and I will come on to that when I talk about the process and history of the closure of services.

Mr Burns: I rise in response to the comments of the hon. Member for Harrow West (Mr Thomas) on A and E waiting times. Would he like to tell us what the percentage standard is for A and Es and what was achieved in his trust?

Mr Slaughter: I am here to question the Minister, and I hope that in response he will not adopt the complacent tone that he has just shown.

Mr Burns: rose

Mr Thomas rose—

Mr Slaughter: I will not give way to the Minister again yet. I want to make some progress. We shall see what happens in a few moments, but after I give way to my hon. Friend, I really must move on.

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Mr Thomas: I am grateful to my hon. Friend for giving way. I do not know whether the Minister’s intervention was prompted by the recent answers he gave to my parliamentary questions. He will be aware of the approximately 180,000 people who waited more than four hours from arrival in A and E to departure. Will my hon. Friend ask the Minister for an assurance in his final remarks that the figure is not likely to rise for the 2011-12 period?

Mr Slaughter: I am happy to trade statistics with the Minister, but the debate is not about incremental performance, but the fundamental change to services.

Mr Burns: I just want to inform the hon. Member for Harrow West (Mr Thomas), because he clearly does not know, that the percentage standard for A and E waits is 95% and in his trust in the past quarter it is 97.5%, which is 2.5 percentage points above the standard.

Mr Slaughter: I am glad that the Minister is praising the standards of health care in Hammersmith. Saving the recent problems over referrals, we are all very proud of the standard of clinical care that people receive in our world-class hospitals under a world-class trust. The subject of the debate, which I hope that the Minister will address, is the fundamental changes being wrought on that and other trusts in north-west London, which will damage the standard of medical care and the health of my constituents. He has entirely missed the point.

The headline news from the consultation launched last week is the proposed closure of both A and E departments in my constituency, along with two of those closest by: Central Middlesex and Ealing. Clearly, that is a disaster for everyone living in the area, perhaps particularly for those in Shepherds Bush, White City and Old Oak, which include some of the poorest areas in London, with low car ownership, poor health outcomes and low life expectancy. The consequences for the two hospitals however are very different. Although neither will provide emergency care for my constituents, Hammersmith will remain a specialist hospital, but Charing Cross will be reduced to little more than an urgent care centre on an otherwise vacated site. Of the 500 beds, all but 30 will be closed or moved elsewhere. One of the largest and busiest hospitals in London will effectively become a clinic.

I want to move on to talk a little about the process of the review. I want to spend time on that, because it is the reason why there is so much disquiet and so much need for external intervention. Proposals for the closure of hospitals in Hammersmith have a chequered history. In my constituency office, I have a photograph of the former Health Minister, Ann Keen, standing on a chair with a megaphone outside Charing Cross hospital, when she was head of nursing there in the early 1990s and there was a massive community campaign against the then Conservative Government’s attempt to close the hospital. That campaign was successful, as I am sure this one will be. Over and between the past two elections there were, what I can only call scurrilous rumours that Charing Cross hospital would close either wholly or in part. That substantially muddied the waters, and was done, I think, purely for electoral advantage, in that there was no substance to those rumours at the time.

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The rumours resurfaced last autumn in an article on the front page of The Independent, which speculated that either St Mary’s or Charing Cross or both would close. Following that, I, my hon. Friend the Member for Westminster North (Ms Buck) and, I am sure, others, sought assurances from Imperial College trust that that was not the case, and we were given those assurances. We are now told in the documentation, which I have brought with me today and was approved by the Joint Committee of Primary Care Trusts two weeks ago, that, over the past two years, when we were being assured that there would not be closures of the type now mooted, a very close consultation was going on and we all knew about it.

To take one page from the documents, it tells me that I received five pieces of correspondence from the trust in relation to the closures, and that at a meeting in March, which I did not attend, I was represented by my hon. Friend the Member for Westminster North. She is in the room and may contradict me: I did not know about that meeting and I certainly did not authorise her to represent me at that meeting.

Although I do not rule out some of the documents having been sent to me, they are junk e-mails—I do not use the term offensively; it is accurate. They are electronic newsletters that go straight into the very efficient House of Commons spam system. If we retrieve the e-mails and look at them, we can read things like, “There will be major improvements at Hammersmith and Charing Cross hospitals in the near future.” Even the document sent on the Thursday before the decision was taken, which was hidden in another newsletter from the chief executive of the trust, did not spell out the proposals.

When we walked into the decision-making meeting at Central hall Westminster two weeks ago, we were handed a bundle of 18 volumes of documentation to look at, which I believe had been available online for two days before that—very generous. We were expected to understand and respond then. That is not consultation. We are now told that a thorough process has been gone through, in which opinion formers have been consulted, and therefore we can proceed to the public consultation. We are presented with a fait accompli. The medical director of NHS North West London, Dr Spencer, when asked whether it was worth people lobbying and petitioning as part of the consultation process, said:

“No. People are currently wedded to mediocre services. If we don’t do this then people need to realise that our hospitals will go bankrupt. We have already seen this in south London.”

That does not sound to me like open and reasonable consultation. What is taking place is a pretence of consultation.

The options are no options at all. There is a preferred option, which I am sure will be adopted, and two others. All of them involve closing the A and E department at Hammersmith hospital, and two involve closing the A and E department at Charing Cross hospital. We will get the usual farrago of road shows, boards and helpful-looking people standing around with clipboards asking for our views. I am told that there is a five-page document that will be delivered, doubtless summarising the much larger consultation document, to all households in the area. However, if someone actually wants to take part in the consultation, they either have to go online—a lot of my constituents do not have access to the internet—or request a questionnaire.

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NHS North West London could not provide me with a copy of the questionnaire or indeed a copy of the consultation document for the meeting that I had last Friday. I managed to print one off the internet and Sir Humphrey would have a field day with it. Buried at question 15, it says:

“How far do you support or oppose our recommendation that we should use our high quality hospital buildings with spare space as elective hospitals?”

At question 17, it says, and this is the closest that the questionnaire comes to asking a clear question in all its 50 pages:

“How far do you support or oppose the recommendation that there should be five major hospitals in North West London?”

At the meeting where it was decided that there would be consultation, I specifically asked, “Will there be questions that people will understand? Will there be questions such as, ‘Do you agree that Hammersmith hospital’s A and E should close?’, or, ‘Do you agree that the hyper-acute centre should move?’, or ‘Do you agree that the A and E at Charing Cross should close?’” There are no questions of that kind. As far as I can see, there is no question that relates to Charing Cross hospital’s A and E department at all. The only question that relates to Hammersmith hospital says:

“All the options above include the recommendation that Hammersmith Hospital should be a specialist hospital. There would continue to be a maternity unit at Hammersmith. How far do you support or oppose the recommendation that Hammersmith Hospital should be a specialist hospital with a maternity unit?”

My constituents are supposed to take from that the fact that they are losing their A and E service. As I have said already, they are living in some of the most deprived communities in the country and many of them have English as a second language. So I do not accept that this consultation is a valid process.

I want to finish before 10 am, because I know that a number of Members wish to speak. However, I will just make two or three other points. First, there is professional opinion to consider. It is increasingly clear that this proposal does not have the support of the local GPs. At a meeting of Ealing GPs a week or so ago to which my colleagues—my hon. Friends the Members for Ealing, Southall (Mr Sharma) and for Ealing North (Stephen Pound)—may wish to refer if they speak, there was universal opposition to the proposal from the 50 or so local GPs who were present. The only local GPs who did not oppose the process were those who are involved in it, and they abstained. I have written to Hammersmith GPs and they have expressed only questions, queries and doubts about the process in response to my inquiries.

Stephen Pound (Ealing North) (Lab): Will my hon. Friend give way briefly on a point of information?

Mr Slaughter: Yes.

Stephen Pound: At that particular meeting of GPs, the voting figures, which I am sure hon. Members will want to know about, were 47 against and three for.

Mr Slaughter: I am grateful to my hon. Friend for that information. I had thought that the vote was 47 against, with three abstentions, but I always stand to be corrected by him.

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The bodies that have supposedly devised these proposals are indeed the commissioning groups. As far as I can see, the only people supporting these proposals on a clinical level among the GP community are those who are heavily involved and who perhaps have a vested interest in relation to those commissioning groups, which of course will not take control until April next year.

It is absolutely true that, unlike some other hospital trusts, Imperial College Healthcare NHS Trust is at best acceding to this process and at worst actively supporting it. It is very clear why it is adopting that approach and why it would see the closure of two of its own A and E departments. The Imperial trust is in deep and dire financial trouble. It has a deficit of more than £100 million and the ability to close down significant services and, perhaps more importantly, to free up one of the most lucrative pieces of real estate in London—in other words, most of the Charing Cross hospital site—presumably for commercial disposal will, it believes, allow it to see its way out of its financial difficulties. Therefore, I am afraid that its opinion is coloured by that judgment.

Let me move on to discuss public opinion briefly. At 48 hours’ notice, I called a public meeting by e-mail and 250 people turned up. I also put a petition online and within a day 750 people had signed it. We have set up a consultative committee under the banner, “Save Hammersmith and Fulham hospitals”, which involves 40 concerned local residents. They have no particular political affiliation; they simply care about their local health services.

All that is but the germ of what I am sure will be the largest campaign of public opposition across west London that we have seen. There will be no safe parliamentary seats in west London if the Government pursue this course of action; there will be no limit on the opposition to the proposals, and there will be marches, petitions and protests until they are withdrawn.

I am hopeful that there will be a debate—at least a partial one—next Tuesday on the Floor of the House about children’s cardiac services, and therefore I will not spend as much time today discussing that issue as I had planned to. All I will say now is that the same body that has been involved in the proposals about my area—the Joint Committee of Primary Care Trusts—has taken the extraordinary step of recommending the closure of the children’s cardiac unit at the Royal Brompton hospital, despite knowing that there were no risks attendant on keeping it open. On the contrary, it is a world-class unit with world-class doctors and surgeons. Moreover, the JCPCT also took that step in the knowledge that a range of other world-class services at the Royal Brompton hospital—the respiratory service, the cystic fibrosis service and the neuromuscular services—are also at risk. The Royal Brompton hospital is not in my constituency, but it is used by my constituents and indeed I substantially used it myself when I was severely asthmatic in younger life. It is unthinkable that it should be put at risk by this decision to recommend the closure of services and I am glad to see that there is opposition to the review by the JCPCT from around the country.

Let me also mention the concerns that we in Hammersmith have about the Imperial trust and its use of data. I will quote from an article in last week’s Fulham and Hammersmith Chronicle, a local newspaper:

“An investigation has been launched to determine whether data recording blunders by Imperial College NHS Healthcare Trust could have cost lives. The panicked trust…realised there

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had been major errors in the way it handled recording files for patients referred for cancer tests earlier this year. People suspected of having cancer are required to be tested within two weeks of being referred by their GP. But Imperial found its records of this treatment path was flawed, with many incomplete, giving no indication of whether the patient was tested or not, and others duplicated.”

Furthermore, as was widely reported in the press last week, there were 25 deaths in that period in the local area that are still under investigation.

The issue of the Imperial trust’s record keeping and referrals was first raised by me in February. I know that there has been some limited improvement in clearing the backlog of cases, but it is simply not acceptable that a trust serving such a large proportion of west London’s population can continue to keep data in this condition.

That brings me to my final point, which is what I am seeking from the Minister. The Secretary of State for Health wrote to me last week and said that the consultation process

“is a matter for the local NHS.”

However, he acknowledged that

“there is an independent scrutiny and review process…which is overseen by local Health Overview and Scrutiny Committees (OSCs). OSCs have the power to refer proposals…which I am then able to pass…to the Independent Reconfiguration Panel for advice.”

I have no doubt that will happen at some stage, because there is such overwhelming opposition to these proposals from local authorities as well as from MPs and their constituents across west London. However, given the farce of this purported consultation and the way that this matter has been handled so far by NHS North West London, it would be better for the Government to act now and call off this consultation, review the proposals and engage genuinely with MPs, clinicians and local authorities in reaching a sensible set of conclusions and proposals. We are not luddites; we do not oppose change in the health service for the sake of it. But our NHS and our local hospitals are very special places. People who have used those hospitals—sometimes over generations—have a unique relationship with them. I am sure that is true. I know that the Minister is familiar with the area and has past associations with it, so he will know what I am talking about. I know that he will also be aware of my constituents’ special and particular problems in terms of complex health needs.

I ask the Government in what I hope is an open-handed spirit to look now at what is happening, not only in the Imperial trust but in NHS North West London, because this situation cannot be allowed to continue.

9.59 am

Mark Field (Cities of London and Westminster) (Con): I congratulate the hon. Member for Hammersmith (Mr Slaughter) on getting this important debate, which affects all of us who are central and west London MPs. I am sure that he regrets the necessity of the debate. Our constituencies have a number of hospitals in common and, over some time, he and I have discussed health matters that affect them. New commissioning boards, run by local GPs, will come into play from next April. The Westminster board will share its management with Hammersmith and Fulham, Kensington and Chelsea, and Hounslow, and it is currently considering how the hospital configuration in west London should work. It is the soon-to-be-defunct primary care trusts, however, that will formally make the final decision.

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As recently as 25 June, the North West London Joint Committee of Primary Care Trusts considered the business case for closing four A and E departments in the north-west London region. The plans are out for consultation until 6 October, and the results will, I think, be presented to the PCTs in advance of final consideration next January. As the hon. Member for Hammersmith pointed out, it is recommended that four departments in west London be closed, including those at the Hammersmith and Charing Cross hospitals in his constituency. The plan is that people can easily be steered away from A and E and towards their local health centres and GP services. There are of course a couple of fall-back options, both of which involve closing Hammersmith, though. One also involves closing Charing Cross, and the other affects the Chelsea and Westminster hospital, which, although outside my constituency—in that of my hon. Friend the Member for Chelsea and Fulham (Greg Hands)—serves a considerable number of my constituents. The joint committee seems to favour the closure of both Hammersmith and Charing Cross A and Es.

I agree with the hon. Member for Hammersmith that there is little doubt that if Charing Cross’s A and E is closed, we will see the end of a hospital there, because it would, I suspect, be only a matter of time before the majority of the Fulham Palace road site was disposed of commercially. I have two major hospitals in my constituency, one of which, Barts, serving the eastern part of my patch from over in the City of London, is not affected by any of the considerations. The other is St Mary’s, Paddington which, ironically, is probably more important to the constituents of my neighbour, the hon. Member for Westminster North (Ms Buck), than to mine, although a significant number of my constituents in the Hyde park area and Marylebone use it as their local hospital.

The Department of Health has been mindful of the fact that hospitals in the centre of London, which serve large working populations as well as residential ones, give the NHS more bang for the buck. I have often observed that my constituency has been well served over the past decade and a half by new walk-in centres and the like. The joint committee might have been tempted to realise one of its most valuable assets on the St Mary’s site, which is, like Charing Cross, a prime piece of central London real estate. From the recommendations, it seems that that temptation has been resisted, and I am glad about that, but, like the hon. Member for Hammersmith, I am not going to take anything for granted until the whole process is over. There is, inevitably, a sense that there is an element of a zero-sum game here but, like the hon. Gentleman, I do not recognise that we should necessarily be in this place, for reasons I will set out.

My constituency next-door-neighbour, the hon. Member for Westminster North, and I would have vigorously fought any plans to close St Mary’s, because the hospital has a proud historical importance and is incredibly well served by public transport, which makes it a key local service for countless central London residents. Let us not forget, in this week of all weeks, the seventh anniversary of the terrible 7/7 bombings in London. One of the bombings was on the Edgware road, and St Mary’s, Paddington had pride of place as one of the sites that played an important part in ensuring that lives were

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saved. I have a great deal of sympathy, therefore, with the hon. Member for Hammersmith, as he faces two closures on his doorstep. If the closures went through, they would not, perhaps, cause me the same amount of political grief, but they would affect my constituents, many of whom receive hospital treatment from some of the institutions earmarked for closure. There would also be the ongoing effect of the substantial burden of increased pressure on the area’s existing hospitals.

I accept the clinical wisdom of trying to steer traffic away from A and Es as far as possible, but before we press ahead with closures, particularly in this part of west London, we must ensure that the alternative services are truly in place and that we are not operating on some naive hope that the pressure on A and Es will miraculously dissipate once four west London departments are removed. Until there has been a proper assessment of out-of-hours care, I question the wisdom of closing as many as four busy A and Es in this area of the capital. The plan is misguided because the population is transient, with huge numbers of non-residents spending time in central London as workers, visitors and tourists. The pressures on central London are very different from those in other parts of the UK. I can understand that the Minister does not want to hear all sorts of special pleading from different parts of the country, but I think that he will recognise that in my unusual constituency I have 70,000 UK nationals, but 920,000 people working there every day of the working week. That is an extreme example, but it is fair to say that around Ealing Broadway and Heathrow airport there are also huge clusters of people who work but do not live in the area, and that should play some part in the thought process about the closures.

I want to say a little about two slightly more parochial issues, because this is not the only health proposal that has caused my constituents alarm. One is the Royal Brompton hospital, which the hon. Member for Hammersmith mentioned. The hospital is just outside my constituency, in that of my hon. Friend the Member for Chelsea and Fulham, but it serves a lot of my constituents. I have received many e-mails and other correspondence imploring me to fight the decision to close the specialist children’s heart surgery unit at the hospital, as I am sure have other central London MPs. I buy into much of the thinking on the issue of specialist care, not just by this Government but also from before 2010. In my view, it is better to concentrate specialist services in fewer and larger centres, rather than to hold on to a widespread but perhaps more mediocre service. I know that it is easy to make that case in a constituency such as mine, where services are in parts of London that are only 10 miles apart, and I appreciate that in more rural parts of the UK we are talking about distances of many dozens of miles, but I have great sympathy with the concerns that some of my constituents have highlighted. They are particularly worried that the review of the Royal Brompton has failed to consider what a difference having child and adult cardiac services in the same centre makes to the quality of care.

My constituents will point out that the Royal Brompton is one of only two hospitals in the country where four surgeons already handle well over 500 congenital cardiac cases a year, meeting, therefore, the standards expected

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by professionals and the review panel’s criteria. It is the only centre in the country to have undertaken more than 1,000 interventions in a year for such diseases, and the service has consistently been rated as excellent by the Care Quality Commission, the review team and, of course, Ministers. The campaigners fear that the decision to close children’s heart services will threaten the viability of the entire trust in the Royal Brompton area. The hospital hosts the country’s largest service for children with cystic fibrosis, which requires intensive paediatric care, and also anaesthesia teams to support the respiratory team with some of the most complex cases. I hope that the Minister will continue to listen to some of the concerns.

Finally, the other parochial issue, which the hon. Member for Hammersmith also raised, relates to Imperial College Healthcare, which has an important part to play on the St Mary’s, Paddington site. If the changes go ahead, the hospital looks set, rightly, to become ever more important in that part of London. I wish to touch on the recent negative press coverage, and give Imperial the right to reply, as it were. Following the deaths of some 25 patients, my local authority, Westminster city council, has expressed concern about Imperial’s poor record keeping, and the loss of a large amount of referrals data.

I received this week a missive from Mark Davies, Imperial’s chief executive, explaining that in January the trust took the rare step of taking a temporary break from reporting its performance in meeting the 18-week waiting time target for referral to treatment, and waiting times for both cancer and diagnostics. He contends that the break was necessary to establish new and robust systems for recording and reporting patient data. Reviews of that period have found that there is no evidence of the trust missing any cancer diagnoses, and the measure was a short-term one, allowing for new configuration. The trust’s view is that the negative press coverage rather overstates the case.

The matter we are debating affects us all as Members of Parliament. We understand that it will inevitably be a partisan, party political issue to an extent, but we all hold close to our hearts the area of London that we represent, and I hope that as far as possible we will work together to get the best deal for west and north-west London as a whole.

Several hon. Members rose

Mr James Gray (in the Chair): Order. There are no formal time limits, but I intend to call the Opposition Front-Bench spokesman at 10.39, unusually, which gives us exactly half an hour to accommodate the five remaining hon. Members who want to catch my eye. If my arithmetic serves me right, that works out at about six or seven minutes a head. As a courtesy to each other it might be nice to attempt to achieve that.

10.11 am

John McDonnell (Hayes and Harlington) (Lab): I associate myself with the sentiments expressed by the hon. Member for Cities of London and Westminster (Mark Field), particularly about the Royal Brompton and its specialist services. I will focus briefly on the impact of what is happening on my constituency, but I follow what my hon. Friend the Member for Hammersmith

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(Mr Slaughter) said: there has been an attempt to divide and rule Members over whether to save some A and E units and close others. Yet it is healthy that all Members across west London are working on a common cause to try to get a long-term view of the health care needs of our areas.

I was reminiscing a few weeks ago with one of our chief executives, who has been dealing with this issue in our area for about as long as I have—almost 40 years. I think that this is our ninth reorganisation. On average, a reorganisation takes place over roughly a two-year period and operates for about 18 months, and then we start all over again. I started off in my area with a network of GPs, a community hospital, a district hospital and specialist services. In the first reorganisation, we lost the community hospital. After that, I was promised five GP centres; I got two. Then we had the wonderful idea from Lord Darzi about polyclinics, which looked awfully like community hospitals, but I did not get one of those. By the time that they had been discarded, it was decided there should be a walk-in centre. After that, we lost a lot of the capital investment in relation to GP improvements, so I am left with some GP centres, but many GPs still working out of converted houses and many single practitioners. Many of them are about to retire. The walk-in centre is about to be closed and relocated to Hillingdon hospital, where I am told that all the basic triage will be performed. We seem to have come full circle but have cut out some of the basic elements.

I am now told that, under the present consultation, the coming plan is to devolve services into the community, with more community care and improved GP services, which will then reduce the need and desire to go to accident and emergency and make it possible for specialist services to be concentrated into fewer units. The problem with that form of devolution is that the walk-in centre in central Hayes is being lost; no further capital investment in GP centres is planned; many GPs, although they have given good service over the years, are ageing, will soon retire and, as I have said, are working in poor quality settings; and there are, to be frank, cuts in community care support as well, particularly those that are happening in personal budgets. Some bizarre judgments are being made at local authority and other levels about qualification for community care. People are winding up in my office to attend my constituency surgery because the care that they have had for years has been withdrawn.

The next stage of the proposal is the closure of Ealing accident and emergency. Ealing dealt with 84,000 people in 2010-11, with 12,000 urgent care cases and 30,000 serious in-patient cases. If even half that number transfer to Hillingdon, it will be swamped. My fear is that in the next round of cuts A and E performance at Hillingdon hospital will be examined and criticised, because it has been swamped, and that it will eventually become a target for further closure. I worry also because it appears possible to extrapolate from the numbers in the consultation reports the cutting in the next 12 months of up to 1,700 NHS jobs, with the prospect of 5,000 being cut by 2015. That could be yet another reorganisation that exhausts staff, confuses patients and the community, and wastes large amounts of resources. In the end, it will reduce the quality of services and might result in further cuts. I predict that, within four years, we will be back here again if we continue on this path.

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All that my community is pleading for is an element of stability. I agree with my hon. Friend the Member for Hammersmith that the consultation process has been tainted from the start, because information for the community and opportunities for engagement have been lacking and there has been a failure to disseminate information in a form that people can understand properly. I think that that has been done by what is now emerging in our sub-region as a group of elite GPs, who seem to control the process rather than engaging even with many of the other GPs. When, in our meetings with GPs, we ask whether they support the proposals, those at the grass roots say clearly they do not. They do not feel involved.

It is time to draw breath in the consultation, start a proper process of discussion and try to get some form of longer-term stability into the process. My hon. Friend the Member for Feltham and Heston (Seema Malhotra) is here, and there is a 17-year difference between life expectancy in some wards of our constituencies and in some wealthier constituencies represented by hon. Members present for the debate. It is clear to me that the eight or nine, or perhaps more, reorganisations of the past 40 years have not dealt with the real health care issues and needs in our area. What is happening will be another exercise involving abortive costs, which will frustrate the provision of real health care to whose who need it.

10.17 am

Angie Bray (Ealing Central and Acton) (Con): I congratulate the hon. Member for Hammersmith (Mr Slaughter) on securing this important debate. He is right to extend its scope to hospital services across west London because the proposed imminent reorganisation of services—the “Shaping a healthier future” programme, led by NHS North West London—will affect all hospital users in the area. It is a hugely ambitious and, I am sure, well-intentioned programme, but none the less it presents perhaps more questions than it answers. It raises serious concerns, especially for my constituents in Ealing and Acton.

Mary Macleod: I thank my hon. Friend and neighbour for giving way. My constituents use the West Middlesex university hospital and Charing Cross hospital, and I was glad to see that the aim is to retain the West Middlesex as a major acute hospital with A and E and its award-winning maternity provision. Does my hon. Friend agree that the ultimate aim of what is happening, whatever decision is made—any constituent would find the closure of any part of a hospital a difficult thing—is better clinical outcomes, and the key issue is whether they are achieved?

Angie Bray: Of course, we all want better clinical outcomes for all our constituents. The question is how to get to that result, and how to provide services for residents. An unfortunate aspect of the way things have been done is the pitching of one hospital against another, with everyone being asked to decide on one or another. That has been a divisive process.

My constituents face the real possibility of Ealing, Central Middlesex, Hammersmith and Charing Cross hospitals all having their A and E departments downgraded —a result that would surely be disproportionately negative for them and that threatens to destabilise health care

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provision across my constituency. In making its three key recommendations for the current consultation, NHS North West London seems to have completely overlooked their needs. While the consultation document does at least mention the full list of eight possible options, the pressure on people to support one of its three main recommendations leaves the impression that minds have already been made up. Minds should not be made up when my constituents in Acton—a place with a rapidly expanding population—look set to be left without any local emergency cover.

The consultation and pre-consultation business case documents make bold predictions when calculating travel times to justify recommendations. One document even states that the

“geographic distribution is proposed to apply to the remaining sites to minimise the impact of changes on local residents”.

Tell that to the people of Acton, as they battle their way through traffic to Chelsea and Westminster hospital, or the people on the western edge of my patch doing the same to get to Hillingdon hospital, in the event of downgraded services at Ealing hospital. With London’s transport infrastructure as it is, I remain unconvinced that those bold predictions stack up.

The current recommendations take all my constituents further away from access to emergency health. That is why I am encouraging all constituents who get in touch with me on this issue to contribute to the ongoing consultation, regardless of my concerns. That seems to be the best way forward. After all, we all know that, for many people, their local hospital is more than just a physical structure. Attachments to hospitals are often incredibly emotional. Quite naturally, people want to know, when or if they or their loved ones fall ill, that they can access the care that they need in good time. It is all very well presenting a case for change based on facts, figures and statistics in a hefty document, but it is clearly important that local people—the people who use these hospitals—are given a proper chance to have a proper say on their future.

Seema Malhotra (Feltham and Heston) (Lab/Co-op): Does the hon. Lady agree that it is very important that the many people in our constituencies who do not have a car are able to get to a hospital quickly? Relatives also need to travel to hospital in a way that has a minimal impact on their families, particularly those with caring responsibilities.

Angie Bray: I agree. It is always important to bear in mind the impact on families who want to visit, because that is all part of the healing process. That is an important consideration.

The consultation is not made easy when the options to choose from are buried in such a heavy document. I have concerns about how that will affect the consultation process. The consultation document is itself a barrier to participation, as it is so huge and bulky as to be virtually impenetrable.

It would be helpful if NHS North West London were to encourage the GPs that it says support its proposals to actually speak out in support of them. The public are much more inclined to listen to their doctors than their politicians—we all know that, unfortunately—and I

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have urged those behind “Shaping a healthier future” on numerous occasions to do exactly that. So far, however, there has been a deafening silence. If the case for change is so strong, why are we not hearing more local GPs coming out publicly in support of the recommended options?

It is, of course, important to acknowledge that the NHS is set to undergo a series of improvements. The health reforms will fully kick in in April next year, crucially putting GPs in charge of decision making. It therefore seems extraordinary that, after the lengthy process of getting legislation through Parliament, we are now seeing a last-minute, top-down reorganisation of local health care pushed through by NHS North West London, instead of waiting for the GPs to take charge.

The “Shaping a healthier future” programme is a bureaucratically-led initiative by NHS North West London. As such, I urge my neighbouring MPs to accept that this is not about Government cuts. In fact, the Government are putting extra funding into the NHS in real terms year on year, and the Conservatives were the only party to pledge to do so in their 2010 election manifesto.

Mr Slaughter: I entirely respect the position that the hon. Lady is speaking from today, and I accept that the NHS locally is behaving very badly. However, does she not agree that the Government must take some responsibility and that, as local MPs, we all ought to be talking to the Government as well?

Angie Bray: I spend quite a lot of time talking to Ministers, who have been very generous with their time on this and other issues. Finance is at the root of the problem, but I suspect that the Government have decided to make the NHS a major spending priority; rather more so than some other Departments. We have to accept that there was a problem with funding relating to NHS London for a long time before the Government took power—a point that I was going to come on to in a moment.

As I said, we were the only party to make a pledge on extra funding in its 2010 election manifesto. Furthermore, any efficiency savings do not go back to the Treasury, but are instead ring-fenced for reinvestment in the health service. The latest figures from the Department of Health show that by 2014-15, there will have been funding growth of £12.5 billion across London. The problem is that NHS North West London has been struggling in the face of a huge £5 billion or £6 billion deficit in the past five years or so.

Clearly, we cannot stand against every proposal for change. All institutions occasionally need refreshing and reforming. The key to “Shaping a healthier future” is to work with local communities to establish clinical need that works for those who use the hospitals. This clunky consultation does not do the trick. Nevertheless, I urge people to persevere and wade through the massive document. My message to the Minister is that for my constituents to have all four of their nearest A and Es downgraded is absolutely disproportionate. I hope that, should the consultation go the way that I suspect is intended, the decision will be then called in and a fairer way forward will be found.

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10.26 am

Mr Virendra Sharma (Ealing, Southall) (Lab): Thank you for allowing me to speak in this important debate, Mr Gray. It is important to my local constituents and to me personally. I congratulate my hon. Friend the Member for Hammersmith (Mr Slaughter) on securing the debate and thank him for allowing me to join him and speak in it. I agree with everything that my hon. Friends have said. As hon. Members have repeatedly said, this is not a scaremongering debate and we are not taking a party political line—these are the genuine concerns expressed by constituents and health professionals.

I will not repeat my colleagues’ arguments on whether the consultation is fair and transparent, but I hope that the Minister will take this one point on board about the way that people are being asked to access the document—by making a request, downloading and then responding online. I do not know about other areas, but in my constituency the people who are going to respond are those who are very keenly concerned because they have used the services before and they have lived in the area for many years. Many of my constituents will not have access to the documents and will not be able to respond.

I hope the Minister will take that point on board and understand the reasons for it. There are old people who do not have access to computers. Ethnic minority communities, whose first language may not be English, will not have the access to do that, either. It is not easy. There is always the response that they could ask friends, relatives and others, but it is not that simple to respond to the fear that the hospital services are going to close. Those people should be taken into account as well.

The future of all the hospitals in north-west London lies in the balance. I am particularly concerned about Ealing hospital, which is very close to my heart. My two grandchildren were born in Ealing hospital, my daughter worked there and I live just a short walk away. Many of my constituents depend on Ealing hospital for life-saving treatments.

It is therefore with shock and anger that I speak about the current proposals to close Ealing’s accident and emergency unit, maternity unit, paediatric services, intensive care unit and other acute services. If the proposals go through, they will mean the effective closure of Ealing hospital. It will cease to be a district general hospital and be little more than a glorified polyclinic, with the surplus land sold off for luxury flats. I am deeply concerned about the proposals, and fear that they will have a significant detrimental impact on the health care that my constituents receive. It is being said that the proposals are clinically led, but the House should be aware that Ealing hospital consultants and local GPs almost universally oppose them. It is clear to me that the proposals are financially driven and that clinical care for my constituents will suffer.

I have been warning for some time about the significant threat to Ealing hospital. I have had numerous exchanges on the subject with the Prime Minister at Question Time. In October 2010, in answer to my specific question about whether there were any plans to close Ealing hospital, the Prime Minister gave a broad answer. He stated that the purpose of the health reforms was to put decisions about A and Es in the hands of patients and doctors, and that decisions to close A and Es that did not do so were often wrong. I agree.

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Seema Malhotra: My hon. Friend rightly raises the particular circumstances of Southall and the surrounding areas, where there is a distinct community that operates in a particular way. Decisions about health care must take into account not just clinical issues but how a community behaves and how its members access health care.

Mr Sharma: I am sure that the Minister will take note of that and will respond.

Ealing is a case in point, as the decision is being made by the unaccountable north-west London primary care trusts in their dying days before they are abolished, and not by patients and doctors. Patients and doctors are firmly against the proposals. I ask the Minister to listen to them and abandon the proposals.

After the Prime Minister visited Ealing hospital in May 2011 to deliver his keynote speech on the Government’s health reforms, I again asked him specifically at Prime Minister’s Question Time whether there were any plans to close Ealing hospital. In his answer to me on 8 June 2011, he said that he was impressed by what he saw, stated twice that there were no plans to close Ealing hospital and said that the maternity service was undergoing phased redevelopment. Those assurances and answers now seem hollow and almost worthless unless the Prime Minister intervenes to stop the closure of Ealing hospital.

The Secretary of State for Health has also said on the record that there were no plans to close Ealing hospital’s A and E, and asked where all the people would go who use it. My hon. Friend the Member for Hayes and Harlington (John McDonnell) has given the figures on how many people use the services, and I am sure that the Minister will have taken note.

My constituents, local GPs and hospital consultants, local Members of Parliament and councillors of all political parties are totally opposed to the proposals, and there is a massive campaign against them. I ask the Prime Minister and the Secretary of State to listen to local people and intervene to safeguard our health services at Ealing hospital and other hospitals in west London. Lives are at risk and the future of the health service is at stake. With the support of Ealing Hospital SOS, Ealing trades council, Ealing council and West London Citizens, I will not stop campaigning, and neither will my hon. Friends and constituents, until the proposals are stopped dead in their tracks.

10.34 am

Stephen Pound (Ealing North) (Lab): It is an honour and a pleasure to serve under you, Mr Gray. Like all other right hon. and hon. Members, I congratulate my hon. Friend the Member for Hammersmith (Mr Slaughter) on securing this debate. I assure him that although I was not present at the inauguration of the “Paupers’ Paradise” in Hammersmith, I was present at Queen Charlotte’s hospital on the same day that the national health service was born, having also been born on that day.

We have heard a great deal of extraordinary information that underlines the seriousness of the situation facing us. The hon. Member for Ealing Central and Acton (Angie Bray) put her finger on it: the root of the problem is finance. This is about money. It is not about clinical need, clinical determination or a reconfiguration of the health service. As many have said, there is no

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luddite tendency facing the health service. It has changed massively. I spent 10 years working at Middlesex hospital, which may or may not have been in the constituency of the hon. Member for Cities of London and Westminster (Mark Field), although he certainly knew that hospital. It closed because people realised that there was alternative provision at University college hospital.

The situation in north-west London has been dramatically illustrated by the range of geographical interests represented here. Although Ealing hospital is in the constituency of my hon. Friend the Member for Ealing, Southall (Mr Sharma), it is the hospital used by my constituents. Those who do not use Ealing tend to use Northwick Park hospital, which is in Brent, although it is used predominantly by people from Harrow. We have extraordinary crossover. If the toothpaste tube is squeezed in one place, the shape changes in another.

This is the message that I want to give the Minister, who is a decent man. I have known him for a long time, and in many ways I respect his instincts on this matter. We must recognise that London is different. The days of “predict and provide” may have changed and we may not consider it a fashionable option any more, but the reality is that we in west and north-west London face health problems. We face the resurgence of rickets, tuberculosis and illnesses that we thought did not exist any more. We have a massively mobile population, but above all a growing population. Every single school in my constituency is having to expand. Looking around, I see colleagues on both sides of the Chamber whose schools are having to expand. The population is increasing.

What possible clinical case can there be for reducing accident and emergency services, which at Ealing provide succour for nearly 100,000 people every year, as we heard from my hon. Friend the Member for Hayes and Harlington (John McDonnell)? Those people will wash up at West Middlesex university hospital and Hillingdon hospital, with appalling, dire consequences.

Can it be that we have changed so much in terms of clinical delivery that an ambulance service is a mobile operating theatre and that it does not matter how far an incident or accident is from the hospital, because the ambulance service is now so brilliant? That is very different from when a former Conservative Health Minister referred to ambulance staff as lorry drivers with first aid certificates. I cannot believe that moving people at speed, however efficient the vehicle, will help the problem. In many cases, it will make it worse. How many times have we seen people on the blues and twos hammering through our streets, which at the moment are crowded, congested and dangerous? It can only make matters worse.

I have less than a minute left to speak. I say to the Minister through you, Mr Gray, that the public are not persuaded that there is a clinical case. The Secretary of State has said that there are four criteria. There should be

“support from local clinical commissioners; strong public and patient engagement; clear evidence of the clinical benefit; and reflecting current and prospective patient choice.”

Ealing Hospital Save Our Services has been mentioned, and Colin Standfield, the organiser, is here in Westminster Hall today. I say to the Minister that there is no evidence at any level that anyone is committed to the proposals

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to cut the A and E department. We heard earlier from the hon. Member for Cities of London and Westminster that there might be political grief. The Minister and I have both sat in the House for a while, and we both remember an Independent Member who represented one hospital anti-closure campaign. Hospital closures are a massively toxic issue. That is not a threat; it is a reality.

People are not with the Government on this issue, they are not with a shadowy PCT and they are not at all confident that the process is anything other than the biggest, crudest, roughest and most brutal rubber stamp. That is the impression that we in west London have. I implore the Minister to put our minds at rest and tell us that the consultation is genuine, and that there is a prospect of something other than an evisceration, an amputation without anaesthetic and a destruction of what we in north-west London hold so dear.

10.39 am

Andrew Gwynne (Denton and Reddish) (Lab): As ever, it is a pleasure to serve under your chairmanship, Mr Gray. I congratulate my hon. Friend the Member for Hammersmith (Mr Slaughter) on securing this important debate. As we have heard, there is widespread concern in his constituency and throughout the capital about the future of hospital services in west London. He has been doing a great job in raising the issues, and has done so again today.

NHS North West London claims that its proposals, as outlined in the “Shaping a healthier future” programme, will improve NHS services for the 2 million residents of the area and save lives. As we have heard, the proposals will lead to the loss of accident and emergency departments at Charing Cross, Ealing, Hammersmith and Central Middlesex hospitals. That means that people will have to travel further for treatment. I ask the Minister: how will that help save lives, and does he agree with NHS North West London’s analysis?

It is not only my hon. Friends who are concerned about the future of A and E departments in west London; the local authorities in Ealing and Hammersmith and in Fulham are also formally opposed to the proposals and committed to fighting the downgrading of their hospitals.

We all know what happens to hospitals after they lose their A and E departments. We have seen in other cases hospitals lose their A and E departments and, sadly, subsequently become glorified health centres without proper resources to provide immediate health care to the local community.

Charing Cross hospital has a 200-year history of providing a wide range of services and is one of the capital’s largest teaching hospitals. It has one of London’s busiest A and E departments, which had 69,300 cases last year. Under the proposals, it will be downgraded to a local hospital. Ironically, while in opposition, the Conservative party often produced and perpetuated unfounded scaremongering about the future of Charing Cross hospital—my hon. Friend mentioned it in his opening remarks—yet now seems content for it to be downgraded under its watch.

It is understandable that there is such widespread concern about the proposed closures in my hon. Friend’s constituency. The whole of the borough of Hammersmith

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and Fulham will be left without an accident and emergency department; facilities that both the Prime Minister and the Secretary of State had promised to save as recently as last year will close. Travel times to the nearest alternatives could be far too long. As we have heard from both Government and Opposition Members, journeys to the hospitals run by the Chelsea and Westminster Hospital NHS Foundation Trust can be subject to delays of up to an hour in heavy traffic. That could put the lives of many west London residents at risk. What action does the Minister’s Government propose to take to ensure the safety of my hon. Friend’s constituents and the residents of west London as a whole?

The Secretary of Sate has not, to date, taken a clear position on the proposals, and I understand that he wrote to my hon. Friend on 3 July to say that they are a matter for the local NHS. I appreciate that the consultation closes on 8 October and that, according to the Secretary of State, no final decision will be made until early next year. The plans, however, are not only unpopular with local people; other Conservative politicians, such as Councillor Joe Carlebach of Hammersmith and Fulham council, have not refrained from taking a position and have openly voiced their opposition to the plans.

Mr Virendra Sharma: My hon. Friend may recall that, during his visit to my constituency, many constituents voiced their opposition to any threat to Ealing hospital.

Andrew Gwynne: Absolutely. I enjoyed my visit to Ealing hospital with Ken Livingstone in the run-up to the London elections, although I am not sure whether my support did Ken’s campaign much good.

Stephen Pound: We did win the Greater London assembly seat.

Andrew Gwynne: Yes, as my hon. Friend confirms, we did win the GLA seat.

Councillor Carlebach told the BBC in April:

“We have some serious concerns at closing that many A and Es in such a large region.”

The hon. Member for Cities of London and Westminster (Mark Field) has expressed similar concerns.

The scale of the problem is easily grasped when one considers that NHS North West London serves a population of 1.9 million people in eight boroughs: Brent, Ealing, Hammersmith and Fulham, Harrow, Hillingdon, Hounslow, Kensington and Chelsea and Westminster. Does the Minister agree with the remarks made by his colleague on Hammersmith and Fulham council?

The chief executive of NHS North West London, Anne Rainsberry, has been clear on what is driving the decisions. She told the BBC in February:

“The financial challenges in London are pretty much unprecedented.”

The local Joint Committee of Primary Care Trusts has said that there will be a £332 million gap to plug by 2014-15 if no changes are made.

My hon. Friend the Member for Hammersmith, and the Labour party, are not opposed to change. He said a few weeks ago that there was

“nothing wrong with economies of scale if you can join forces and do something cheaper that provides more resources,”

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and I associate myself with those remarks. The chief executive of the King’s Fund agrees that

“London’s NHS is in urgent need of change,”

but, he goes on to say,

“the risk is no-one will be in the driving seat”.

My hon. Friend the Member for Westminster North (Ms Buck) also warned about the lack of leadership and the timing of the changes when she said:

“The question is how do we get there from here at a time of chaotic reorganisation in the health service, when planning is falling apart, when north-west London hospitals alone have to save over £120m between now and 2014.”

I am afraid that what we are seeing goes much further than, and is in direct contradiction to, the Prime Minister and Health Secretary’s general election promise to halt the closures of hospitals, A and E units and maternity departments. What happened between the general election and now that caused both those right hon. Gentlemen to change their position? Why does the Minister think that there is such widespread concern about the lack of leadership in the health service in London, at a time when the NHS is being put through an unnecessary upheaval?

It is obvious from what the Government have had to say to date that Ministers are hiding behind their new localism and are happy to blame the soon-to-be-abolished PCTs for the forthcoming closures. We all know what happened between the general election and now: the unpopular and, frankly, unnecessary Health and Social Care Bill—the biggest threat to the NHS in its long history—was introduced. It was a disastrous decision on the part of the Government to spend £3 billion on an unnecessary top-down reorganisation that has led to the loss of financial grip on the NHS.

In the case of west London, we are seeing another broken promise on the part of the Prime Minister, who spent millions during the general election putting up posters throughout the country reassuring the British electorate that, under the Conservatives, there would be a moratorium on hospital and A and E closures.

Does the Minister think that the proposals in the “Shaping a healthier future” document will save money in the long term? If all the closures go ahead, would that not leave Imperial College Healthcare NHS Trust with just St Mary’s hospital as a single site, and pose huge financial and practical problems for the expansion of its services to cope with the extended case load?

The Opposition warned Ministers repeatedly during the Bill’s passage that it would lead to the break-up of the NHS, and the “Shaping a healthier future” proposals seem to be a missed opportunity to improve care by reducing duplication where it occurs and ensuring that hospitals work together for the benefit of patient care.

10.49 am

The Minister of State, Department of Health (Mr Simon Burns): It is a pleasure to serve under your chairmanship, Mr Gray. I congratulate the hon. Member for Hammersmith (Mr Slaughter) on securing this debate, the importance of which is indicated by the significant number of Government and Opposition Members who have either taken part or listened. I also congratulate my hon. Friends the Members for Ealing Central and Acton (Angie Bray) and for Cities of London and Westminster (Mark Field) and the hon. Members for

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Ealing, Southall (Mr Sharma), for Hayes and Harlington (John McDonnell) and for Ealing North (Stephen Pound) on their contributions.

Before I get to the nub of the debate, it is important to pay tribute to all those who work in the NHS in north-west London, including in the constituency of the hon. Member for Hammersmith, for the selfless dedication and determination that they put in day in, day out—whether doctors, nurses, consultants, porters or ancillary workers—to ensure that the people of north-west London get the quality of care that they deserve.

I am aware of the controversy and high emotions that surround any service reconfiguration, or proposed reconfiguration, and I respect the way that hon. Members, including my hon. Friends, rightly draw the attention of the House to their concerns about aspects of the proposed reconfiguration. I should like to give a general message to all hon. Members: I urge them to engage fully in the consultations, to the best of their abilities, and make their case and argument, which can be part of the information gathering and ideas that will be considered when the consultation process ends in early October.

The reconfiguration of services is a matter for the local NHS. I hope that the hon. Member for Hammersmith agrees that that should not be dictated or micro-managed by Ministers in Whitehall. Reconfigurations are affecting local services and should be determined by the local NHS in full consultation with stakeholders within the local NHS in north-west London and the local community.

Mr Slaughter: Given that the medical director of the NHS, who the Minister says has to make the decision, has said that the NHS is doing this because it would be out of money otherwise and given that he has said that it would not take any notice of the consultation, does not the Minister see a role for the Government?

Mr Burns: First, the hon. Gentleman has unintentionally only given the Chamber half the quote. Secondly, the medical director will engage in the consultation responsibly and fully. It is—hon. Members asked about this—a full, proper and valid consultation, which is why I urge all hon. Members to take part.

My right hon. Friend the Secretary of State for Health wrote to the hon. Member for Hammersmith on 3 July—he mentioned this in his speech—on the process and the localism of the decision making, following the conclusion of the consultation, and to set out the process for service change that my right hon. Friend strengthened in 2010. For the record and for other hon. Members, I remind the hon. Gentleman of the position. The NHS in London, as elsewhere, has constantly to evaluate how services can best be tailored to meet the needs of local people and to improve the standards of patient care. The proposals in north-west London seek to do that, and the local NHS has now embarked on a full consultation with patients, the public and the local NHS. It is important to remember that no decisions have been taken.

On Monday 2 July, NHS North West London launched the full public consultation. It will last more than 14 weeks —two weeks longer than the normal period—to take into account that it spans the traditional holiday month

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of August. Patients, staff and the public will have the opportunity to review the clinicians’ suggestions, look at the evidence provided and have their say.

The hon. Gentleman knows that the NHS has always had to respond to patients’ changing expectations and advances in medical technology. As lifestyles, society and medicine continue to evolve, the NHS also needs to evolve. Reconfiguration is about modernising the delivery of care and facilities to improve patient outcomes, develop services closer to home and, most importantly, save lives.

As I said, the Government are clear that the reconfiguration of front-line health services is a matter for the local NHS, which knows the needs of local people and how to deliver services far better than Ministers in Whitehall. That is why we are putting patients, carers and local communities at the heart of the NHS, shifting decision making as close as possible to patients, devolving power to clinicians and removing top-down influence.

In 2010, my right hon. Friend the Secretary of State set out four tests that all proposed reconfigurations had to pass. I trust that that will help to answer the point made by the hon. Member for Ealing, Southall about the decision-making process. Reconfiguration and the consultation process that accompanies it must have support from general practitioner commissioners, strengthened public and patient engagement, clear clinical evidence and support for patient choice. Without all those elements, reconfigurations cannot proceed.

The health needs of north-west London are changing as its health services are increasing. The local NHS does not believe that the way that it has organised its hospitals and primary care in the past will meet the future needs of north-west London. I understand that north-west London has 8% more internal hospital space per head of population than the English average, even after excluding the specialist hospitals. Indeed, when combined with the number of beds available, hospitals in north-west London have approximately 50% more space per bed than the rest of the country. However, much of that extra space is not suitable for clinical care and costs those hospitals more money to run and maintain every day.

Under the preferred option proposed for changes to hospital services, the NHS in north-west London will invest £112 million in capital that will add capacity for expanded services, develop local hospital sites in the community and address maintenance issues. For example, I am sure that hon. Members, particularly in the Westminster and Fulham side of the area, will be acutely aware that only two weeks ago the Earl’s Court health and wellbeing centre re-opened after having £2.7 million capital invested in it to serve the local community.

Emergency services have been mentioned a lot. The quality of care and the time taken for hospitals to see and treat patients varies. A recent study showed that patients admitted at weekends and evenings in London hospitals, when fewer senior doctors are available, stand a higher chance of dying than if they were admitted during the week. Clinicians in north-west London have agreed clinical standards for emergency surgery and A and E that include providing expert consultant cover 24 hours a day, seven days a week. Therefore, patients admitted in an emergency at the weekend will have the same standard of care as those admitted on weekdays.

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We would like that approach to spread throughout the country. Rationalising emergency care in five north-west London acute sites will enable the NHS in north-west London to meet these standards, address service variability and save an additional 130 lives per annum, on the basis of the number of lives expected to be saved across London.

Clinicians argue that, to provide safe and effective care, they need experience of the most acute cases regularly, which means centralising services on fewer sites. A good example of that is stroke care provided in London, in respect of which significant improvements in outcomes and the quality and safety of patient care have been made. I hope that hon. Members agree that that is the right way forward.

Mark Field: Will the Minister give way?

Mr Burns: I only have one minute left; I hope that my hon. Friend will forgive me.

Trauma services have also been centralised, with a major trauma centre sited at St Mary’s and the two heart attack centres at Harefield and Hammersmith, which will continue to provide service.

Let me remind hon. Members of the process after the consultation is completed. As the hon. Member for Hammersmith rightly said, after the consultation has concluded, the responses have been considered and a decision taken, if the local authority overview and scrutiny committees do not agree and do not think the proposition is in the best interests of the local community, they have the right to communicate with my right hon. Friend the Secretary of State to request that he refer it to the independent reconfiguration panel. If my right hon. Friend does so, the panel will independently consider the proposals and advise him whether it believes that they are right for north-west London, and he can then take a decision accordingly. There is full consultation, full involvement and a mechanism to allow the matter to be pursued further after the consultation has concluded.

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Oceans and Marine Ecosystems

11 am

Kerry McCarthy (Bristol East) (Lab): It is a pleasure to serve under your chairmanship, Mr Gray.

This debate is important for the opportunity not only to highlight in Parliament the plight of our oceans but to focus more on the international dimension of protecting them, including the high seas beyond national jurisdictions. Thankfully, the issue is now coming to the attention of international policy makers—it was not even raised at Rio in 1992, but became one of the most high-visibility issues at Rio+20 this year. Although Rio fell a long way short of the actions identified by scientists as crucial, its decisions were, in the words of Professor Alex Rogers of the International Programme on the State of the Ocean,

“urgent, important and game changing measures which should be immediately implemented by governments as a direct response to the oceans text.”

I hope today’s debate is timely in focusing on the role that the Government should play in making progress. Britain can make a real difference. The United Kingdom, through its overseas territories, is responsible for the world’s fifth largest marine area after the US, France, Australia and Russia, amounting to nearly 2% of the world’s oceans. We are, therefore, a major player, with a duty to act.

I will outline the scale of the crisis facing the world’s oceans. Oceans and seas are of course critical to sustaining the earth’s life support systems and to our survival. Covering 72% of the earth’s surface, oceans and seas moderate our climate by absorbing heat and around 30% of global CO2 emissions. They are the habitat of nearly 50% of all species and, as a result, are vital for global food security—providing 2.6 billion people with their primary source of protein—and for the well-being of many national economies, especially in developing countries.

The health of the oceans, however, is under threat. Organisations such as Greenpeace, with its “Defending our Oceans” campaign, the World Wildlife Fund—WWF—and many others have been campaigning to raise awareness of the findings of marine scientists, which I hope to give expression to in this Chamber. The findings in the IPSO report published last June are particularly shocking. It said that the seas are degenerating faster than anyone had predicted because of the cumulative effect of a number of severe individual stresses—from climate change and sea water acidification to widespread chemical pollution and gross overfishing. In particular, it said that the world’s oceans are facing an unprecedented loss of species, from large fish to tiny coral, comparable to the great mass extinctions of prehistory. Approximately 90% of the big predatory fish in our oceans, such as sharks and tuna, have been fished out since the 1950s. The UN’s Food and Agriculture Organisation estimates that 85% of global marine fish stocks are fully exploited, overexploited or depleted, a subject to which I shall return.

Scientists are also discovering growing areas of the ocean that suffer from hypoxia—regions that are starved of oxygen—caused by warmer sea temperatures, which is also increasing sea levels and changing ocean currents. Whole species of fish are at risk due to the temperature rise. They simply cannot survive in the changed conditions.

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Pollution is also damaging our seas. Although oil spills from tanker accidents are among the more visible and more talked-about pollutants, their impact is less than that from other sources, which include domestic sewage, industrial discharges, urban and industrial run-off, accidents, spillage, explosions, sea dumping, plastic debris, mining, agricultural nutrients and pesticides.

Not only are there severe declines in many fish species, and an unparalleled rate of regional extinction of some habitat types, such as mangrove and seagrass meadows, but some whole marine ecosystems, such as coral reefs, could disappear this century in what has been described as

“a first for mankind—the extinction of an entire ecosystem”.

Mr Andrew Smith (Oxford East) (Lab): I congratulate my hon. Friend on securing this vital debate. I do not want to anticipate the rest of her speech, but does she agree that the evidence shows that rigorously enforced marine conservation zones can make a real difference in starting to turn things around? The lesson is that we, internationally, and the world need to be more ambitious about the scale of such zones and more rigorous in restricting the activity that can take place in them.

Kerry McCarthy: I shall come on to marine conservation zones mooted in the UK and what we can do internationally to persuade and join up with other countries to have larger zones.

One of the reasons why I am interested in the issue is that I am a keen scuba diver. At an anecdotal level, I have heard stories about the decline in coral reefs. I was speaking to someone the other day who has been running trips from Bristol for about 30 years. He said that the Great Barrier reef is now almost unrecognisable as the place where he used to dive 20 years ago, because of bleaching and reef damage and disappearance.

Around one fifth of global coral reefs have already been damaged beyond repair, including catastrophic mass bleaching in 1998 when scientists watched between 80% and 90% of all the corals die on the reefs of the Seychelles in a few weeks. Professor Callum Roberts said that

“outside the world of marine science, this global catastrophe has passed largely unseen and unremarked.”

It is predicted that 90% of all coral reefs will be threatened by 2030 and all coral reefs by 2050, if no protective measures are taken.

That goes some way to outlining the scale of the problem, so I now want to discuss the solution. Although Rio was disappointing—I think most people agree—and it mostly reaffirmed existing commitments and promises, it marks a point from which countries should now focus on action and implementation. The High Seas Alliance and the Deep Sea Conservation Coalition have set out the key commitments that Governments now need to act upon. I hope that the Minister can make a firm commitment today to implement those decisions and to set out how the Government will do so.

The top commitment was

“to address, on an urgent basis, the issue of the conservation and sustainable use of marine biological diversity of areas beyond national jurisdiction”—

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in particular through networks of marine protected areas—

“including by taking a decision on the development of an international instrument under the United Nations Convention on the Law of the Sea”

before the end of the 69th session of the UN General Assembly.

More than 64% of our oceans are beyond the jurisdiction of any one country—the so-called high seas. UNCLOS, the UN convention on the law of the sea, provides the legal framework for governing such areas, but the current structure is highly fragmented and has huge governance gaps. It is widely acknowledged that an agreement under UNCLOS is needed to assist the creation and management of marine reserves; to set a framework for environmental impact assessments to be undertaken before damaging activities are allowed to take place; and to co-ordinate a highly fragmented structure of regional organisations that currently regulate human activities.

The Arctic ocean provides a strong case for reform of UNCLOS as it becomes accessible to deep-sea oil drilling and large industrial-scale fishing fleets with the melting of the permanent sea ice. Regulation of such activities is entirely inadequate. The Environmental Audit Committee has been hearing evidence as part of its inquiry into protecting the Arctic, highlighting grave problems with responses to an accident or major oil spill, which would have even more serious environmental consequences than a similar incident in warmer water.

The biggest disappointment at Rio was that an unholy alliance of the US, Venezuela, Russia and Japan blocked a decision on an agreement under UNCLOS for a maximum of two years, until the 69th session of the UN General Assembly in 2014. Although action is desperately needed now, that at least sets a deadline towards which Governments in favour of an ocean rescue plan can work. The 2014 deadline should not, therefore, be seen as a target date to start looking at how we protect and rescue our oceans, but rather as a deadline by which to have completely decided on the way forward for formal negotiations.

What steps will the UK now take, with the others that spoke in favour of an agreement—such as Brazil, Australia, the European Union, South Africa, India and the Pacific Islands—to move the agenda forward and to urge the UN General Assembly to convene, as a matter of urgency, a diplomatic conference to deliver a new implementing agreement under UNCLOS? What steps will the Minister take towards establishing marine protected areas and marine reserves, creating offshore oil and gas no-go zones in the Arctic, and agreeing a mandatory polar shipping code?

Marine protected areas, which have been mentioned, are underwater national parks that help areas to recover and rebuild, and help fish stocks to be replenished and marine ecosystems and coastal communities to have breathing space and better protection from the effects of climate change. Just before Rio, Australia announced its plan to create the world’s largest network of marine reserves, an area encompassing one third of its territorial waters, where fishing will be restricted and oil and gas exploration banned in the most sensitive areas.

In addition, all 1,192 of the Maldive Islands will become a marine reserve by 2017. The UK’s overseas territories provide an opportunity to designate large

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marine reserves, such as that created in Chagos under the previous Government. I would be grateful if the Minister reported on the progress the Government are making in supporting overseas territories in designating more large-scale marine reserves in the near future.

What discussions has the Minister and his ministerial colleagues in the Foreign and Commonwealth Office had with other nations that have overseas territories, such as France, about the creation of marine protected areas or about joint working with them to join up areas where our territories coincide?

Mr Ben Bradshaw (Exeter) (Lab): I commend my hon. Friend on an excellent speech. Does she agree that it is important that the UK show leadership in this regard, and that it is very disappointing that our network of 127 marine protected areas is two years late? There are even suggestions that the Government might drastically reduce the number of such areas, thereby rendering them completely useless in environmental terms.

Kerry McCarthy: I thank my right hon. Friend for his intervention. He has done a great deal of work in this area and, indeed, has been trying to get a debate on the topic since Rio.

I was just about to come on to the subject of the UK’s marine conservation zones. If we are to try to encourage other countries to sign up to marine protected areas, we need to get our own house in order. The Government have delayed designating any new marine conservation zones until 2013, failing to fulfil the promise they made at the 2002 Earth summit to do so by 2012. They are now shifting the goalposts by raising the evidence bar for designation. There is real concern that the Government may be preparing the ground for designating between just 27 to 40 sites out of the 127 sites that were originally recommended. However, we are already committed to 127 sites, which have had buy-in from all marine industry stakeholders following the regional project consultation, and were recommended where they had the least socio-economic impact.

The Science Advisory Panel, appointed by the Department for Environment, Food and Rural Affairs, stated that all 127 marine conservation zones need to be designated if the UK is to follow its own guidance on delivering an ecological network. Without those 127 zones, the seas will not have the necessary chance of recovery. How will the Minister achieve such a network if he does not designate all 127 sites?

In the few minutes left to me before I ask the Minister to respond, I shall talk about overfishing, the one area of the debate that has been discussed in Parliament in some detail. There have been debates about overfishing and fish discards, so I will keep my comments fairly brief. Rio agreed to maintain fish stocks at levels that would at least produce the maximum sustainable yield and eliminate destructive fishing practices. I was pleased to see that progress was made on that at the recent EU fisheries council, with agreement to a ban on discards and to legally binding limits on fishing levels. The timetable for phased implementation of that agreement is too lengthy and the decisions were more politically than science-led, but some good progress was made. I hope that we can take that forward.

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I would like to raise with the Minister his Government’s failure to protect marine protected areas by sanctioning destructive fishing practices, such as scallop dredging, in areas recommended for designation as marine conservation zones and special areas of conservation.

Katy Clark (North Ayrshire and Arran) (Lab): I congratulate my hon. Friend on a most powerful speech. In the part of the world I represent, scallop dredging is a significant problem. At one time in North Ayrshire there were huge numbers of fishing fleets, but we now have none. Does she agree that we need to consider that, but that we also need to look at other species such as dolphins and whales? Does she also agree that it is concerning that the Scottish Government are not including such species in their network of marine conservation areas?

Kerry McCarthy: I thank my hon. Friend for that intervention. I was not aware of what was going on with the Scottish Government in that regard. It sounds like very disappointing news. Any of us who have seen films such as “The End of the Line,” which talks about the huge impact overfishing is having on species—particularly dolphins, tuna and some of the bigger fish that she mentioned—would regard that as very disappointing. Has the Minister’s Department assessed whether scallop dredging and trawling is in breach of the EU habitats directive, which states that site integrity, not features, must be conserved?

My final point is that commitments were made at Rio to eliminate illegal, unreported and unregulated fishing. Some 15% of all sea catch is from illegal fisheries. I know that the EU is starting to play its part by demanding strict traceability on all fish sold in Europe, but, globally, more effort is needed to address suspicious consignments landing at ports. The Environmental Justice Foundation estimates that Sierra Leone, where coastal communities are dependent on fishing for their food and livelihoods and where fishing represents around 10% of GDP, is losing almost $29 million a year to pirate fishing operators.

There is also concern that illegal fishing off the coast of west African countries such as Senegal and Mauritania is contributing to growing levels of piracy in those countries, and that they could end up like Somalia, with armed pirates attacking ships. As the President of Puntland said at last year’s conference in London on piracy:

“the violation of Somali waters by foreign trawlers triggered a reaction of armed resistance by Somali fisherman, whose livelihoods were disrupted by the illegal fishing fleets. Over time, payment of ransom by the foreign trawlers to the poor fishermen of Somalia encouraged the escalation of pirate attacks to current levels”.

That obviously does not excuse piracy, but it goes some way towards explaining why it has increased to such dramatic levels.

Turning to my final questions to the Minister, what assessment have the Government made of the impact of illegal fishing on increased levels of piracy around the shores of Africa? What steps are the Government taking to help build the capacity of local communities in affected countries to end illegal unreported and unregulated fishing? What steps are they taking to collaborate internationally to develop national, regional and global monitoring, control surveillance, compliance and enforcement systems?

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11.16 am

The Minister of State, Department for Environment, Food and Rural Affairs (Mr James Paice): Good morning, Mr Gray. I start by congratulating, as others have, the hon. Member for Bristol East (Kerry McCarthy) on obtaining the debate. I apologise for my presence and, more importantly, the absence of the Under-Secretary of State for Environment, Food and Rural Affairs, my hon. Friend the Member for Newbury (Richard Benyon), who the hon. Lady had presumably expected to reply to the debate. Unfortunately, he cannot be here this morning. I assure her that most of what I have to say addresses the points she quite properly raised. If I miss or am unable to respond to any points, I will ask my hon. Friend to write to her with more information.

The Government recognise, as the hon. Lady does, that marine ecosystems are central to human well-being as a source of several important marine ecosystem services. The sustainable management of oceans and seas is essential to achieve the goals of a blue economy in terms of sustainable economic growth, poverty eradication and job creation. As she has rightly pointed out, oceans are globally, regionally and nationally important.

That is why, as she has described, the Government are acting on all fronts, pressing for action on a global scale in Europe and nationally. The Government have been quick to realise that there is an urgent need for a governance structure for areas beyond national jurisdiction to ensure the conservation and sustainable use of those vast areas. In June 2011, in the White Paper on the natural environment, the Government committed themselves to working towards delivering a new global mechanism to regulate the conservation of marine biodiversity in the high seas. As she says, even though marine issues were not the main focus of Rio+20, there was tangible progress on them, which is good news.

Against a background of delay and intransigence that has dogged previous negotiations on the issue—and as the hon. Lady said, still persists in some quarters—agreement was secured that a decision on the matter should be taken by the UN General Assembly in 2014. I can assure her that we will continue to work to ensure that such an agreement provides a coherent structure for the conservation and sustainable use of those areas beyond national jurisdiction, including a globally accepted mechanism for the designation of high seas marine protected areas and the effective use of environmental impact assessments in so doing.

In the absence of such a global agreement, the UK continues to work through regional sea conventions such as OSPAR, which is the convention for the protection of the marine environment of the north-east Atlantic, and the Commission for the Conservation of Antarctic Marine Living Resources, which is known as CCAMLR, to protect those high seas. Following the establishment in 2009 of the world’s first high seas MPA under CCAMLR at the ministerial conference to OSPAR in 2010, the Under-Secretary of State for Environment, Food and Rural Affairs, my hon. Friend the Member for Newbury, together with fellow Ministers from OSPAR contracting parties, agreed to establish six marine protected areas in the high seas of the north-east Atlantic. A further site was added at the OSPAR Commission meeting in June this year. I assure the hon. Lady that the UK will

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continue to work within OSPAR and other regional conventions to consider other designations on the high seas.

There was also consensus at Rio on understanding and dealing with the effects of climate change and, consistent with the Government’s position and that of the hon. Lady, a more sustainable future for fisheries. We agreed on the need for better implementation of the UN fish stocks agreement and the Food and Agriculture Organisation’s code of conduct from countries to ensure that they ratify and implement the provisions quickly to demonstrate their international commitment to the protection of fisheries resources.

We welcomed recognition of the efforts made by regional fisheries management organisations to improve the management of resources for which they are responsible. As the hon. Lady said, illegal, unregulated and unreported fishing—IUU—is a blight on our seas. The regional management organisations have a key role to play in combating IUU fishing and in ensuring the sustainability of fishing stocks, and we will continue to work within those of which we are members to step up those efforts.

At this year’s International Whaling Commission meeting in Panama last week, we were successful in demonstrating the UK’s commitment to the IWC’s conservation work and our fundamental support for the moratorium on commercial whaling. The meeting delivered positive results for the conservation and welfare of whales. However, we must match our efforts on the global and regional stage with our own implementation.

It is surprising to some that the UK has established the world’s largest marine protected areas, including the world’s largest no-take zone—I speak of the vast biologically rich marine resources of our overseas territories—and in February an area of more than 1 million sq km around South Georgia and South Sandwich Islands in the Southern ocean was designated a sustainable-use marine protected area, establishing one of the largest areas of sustainable managed ocean in the world. That built on the equally impressive no-take marine protected area around the British Indian Ocean Territory of 640,000 sq km, designated in 2010. As the hon. Lady knows, it includes the protection of some pristine coral reefs, to which she referred. Further work is under way elsewhere.

The recently published White Paper on overseas territories illustrates the Government’s commitment to enhance our work in partnership with overseas territories so that we understand, value and preserve their rich natural heritage appropriately, and ensure that their resources are managed sustainably, building on measures already in place. However, as the hon. Lady and the right hon. Member for Exeter (Mr Bradshaw) said, the UK itself has a rich, diverse and economically important marine area.

“Charting Progress 2” was published by the Department in 2011, and shows the progress that the UK has made in achieving the Government’s vision of clean, healthy, safe, productive and biologically diverse oceans and seas, but our seas will remain sustainable, productive and healthy in the long term only if the right balance can be struck between conservation and economic activity. That will work only if marine conservation sits alongside other policies, such as marine planning and fisheries. That is at the heart of our recent consultation on targets for achieving good environmental status in our seas

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under the marine strategy framework directive. That consultation has now closed. We aim to publish our response in the autumn, finalising proposals for targets that are ambitious, but recognise the need to achieve sustainable use of our seas.

We remain committed to establishing a network of marine protected areas, but it is important that the right areas are designated and managed, as opposed to simply designating a large number of sites.

Mr Bradshaw: Will the Minister give way?

Mr Paice: Let me say what I was about to say because it relates directly to the right hon. Gentleman. My right hon. Friend the Secretary of State said in response to the right hon. Gentleman that we already have a network of 84 marine protected areas in English seas out to 12 nautical miles from the coast. We plan to complete the set designated under the EU habitats directive this year. In addition, we are working to designate more sites under the EU birds directive, and marine conservation zones provided for in the Marine and Coastal Access Act 2009, for which he was responsible.

Mr Bradshaw: The Minister is quite right to say that such areas need to be properly designated, but two years of painstaking work went into identifying the potential 127 sites, involving all stakeholders: commercial fisheries, recreation fisheries, environmental groups and others. The fear among most of those groups now is that the Department is selling out to small but very powerful commercial fishing industries by dragging its feet in setting up those areas. We would be grateful for his reassurance that that is not the case.

Mr Paice: I am very happy to give the right hon. Gentleman that assurance. The information I have is that the problem is not, as he implies, special interest groups, but simply that there is insufficient evidence for some of those zones. That is not to say that they will be ruled out, and the delay is because of trying to find sufficient evidence to justify their inclusion. I hope to reassure the right hon. Gentleman and the hon. Member for Bristol East a little more.

More than 22% of English waters are protected by European marine sites, and we have set a target that at least 25% of these waters will be covered by well-managed marine protection areas by the end of 2016. By then, we expect the coverage of all UK waters to be consistent with the 10% target for marine areas agreed at the convention on biological diversity in 2010. The first tranche should be designated in summer 2013, after we have held our public consultation on recommended sites and examined all the evidence before us. We fully expect further tranches of sites to follow in future.

That MPA network is central to achieving good environmental status by 2020 under the marine strategy framework directive, and as implementation of management measures will take time, and biological recovery from pressures can be slow, early action, when possible, is a pragmatic approach. However, marine protection areas

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are only one tool we are using to deliver clean, healthy, safe, productive and biologically diverse oceans and seas.

Katy Clark: Will the Minister give way?

Mr Paice: If the hon. Lady will forgive me, I want to deal with the fishing issue, which the hon. Member for Bristol East addressed. I believe, as did the right hon. Member for Exeter when he had responsibility for the matter, that only a very urgent change in European fisheries policy can ensure that our seas deliver a sustainable future, for both conservation of biodiversity and a viable fishing fleet.

The UK has been leading the way in trialling schemes to improve the selectivity of how we fish, and to tackle the waste of discards by managing fisheries by what is caught, and not what is landed. We have taken that experience into the current reform of the common fisheries policy. Hon. Members will know that the recent meeting of the Agriculture and Fisheries Council successfully made the case for measures progressively to eliminate discards. Not all member states shared our ambition, but a commitment to implement a landing obligation with a provisional timetable is a major step in the right direction.

At that same meeting, we also secured a responsible approach to setting fishing levels. Overfishing has been a central failing of the current CFP, and the UK was adamant that the text should include a clear legal commitment and deadlines to achieve a maximum sustainable yield in line with our international commitments.

Zac Goldsmith (Richmond Park) (Con): Will the Minister give way?

Mr Paice: No, I am sorry. I want quickly to finish by answering the point that the hon. Member for Bristol East made about scallops. The use of bottom trawls or other types of gear and activity must be managed appropriately in European marine sites to ensure site compliance with, as the hon. Lady rightly said, the habitats directive. Appropriate measures must be considered by regulators and relevant authorities for their specific areas for activities that may have a significant impact. Banning an activity or type of gear, such as bottoms trawls, as the hon. Lady suggested, can be one example of management action for some scenarios. Orders prohibiting bottom trawling are already in place in areas such as Lyme bay, and we are committed to ensuring that appropriate regulation is put into practice where it is important.

The hon. Lady referred to illegal fishing off Africa and the link with potential piracy, and I confess that that has never been raised with me or my officials. If she will allow me to do so, I will write to her.

I have tried to answer most of the hon. Lady’s questions. I know that she is extremely diligent on such issues, and I respect that.

11.30 am

Sitting suspended.

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Child Support Agency

[Mr Mike Weir in the Chair]

2.30 pm

Nicky Morgan (Loughborough) (Con): It is a pleasure, Mr Weir, to speak in the Chamber this afternoon with you in the Chair. I am not sure whether we are setting a record here, but women outnumber men by about five to one at the moment. That is an extremely good sign on an afternoon when Parliament is debating sitting hours.

This afternoon’s debate is about reform of the Child Support Agency. When I was elected, I expected to deal with a number of cases relating to welfare benefits, the United Kingdom Border Agency and organisations such as Her Majesty’s Revenue and Customs. What I did not expect was that one of my largest and most enduring case loads would relate to the Child Support Agency. In just over two years, my constituency office has dealt with 70 individual cases in which something has gone wrong, and I am just one Member of Parliament. In the borough of Charnwood alone, in December 2011 the CSA had a live case load of almost 2,600 cases.

Before I go into the details of some of those cases, it might be helpful if we consider why the CSA was set up in the first place. Back in 1993, when John Major’s Government introduced the agency, the aim was for it to pursue parents who failed to support their children financially. Savings were expected because parents claiming benefits from the state would instead find their income supplemented by a maintenance arrangement paid by the non-resident parent. I support that intention, but as I aim to show in this debate, it is clear to me and doubtless to other hon. Members that the system is not working and must be reformed, as children, through no fault of their own, are not receiving the financial support they need or deserve.

Despite an often heavy-handed approach, and costs of £440 million every year, half of children living in separated families in this country have no financial maintenance support in place. The CSA is expensive to run, with 40p being spent to collect each £1. Those costs often result from the Child Maintenance and Enforcement Commission running two separate, failing IT systems, and an additional 100,000 clerical cases—that is, paper cases—that the system cannot cope with.

Recent CMEC statistics show that 48% of complaints were from non-resident parents, and 50% were from parents with care, so it is clear that no one is happy with the current system. CSA data also show that more than 5,000 past and current CSA cases remain, with more than £50,000 in arrears. I congratulate CMEC on producing an excellent set of statistics. It should be congratulated on the transparency with which it produces its figures. It is a model for many other non-departmental public bodies and other arms of Government to follow.

Despite the statistics, there has been some progress, with deduction orders, under which money is removed directly from debtors’ accounts, having trebled since 2009. We need a simple and flexible system that supports families in making and sticking to their own arrangements, if that is possible, and that steers families through a tough time, keeping negotiations constructive and preventing a difficult family break-up from becoming worse or potentially destructive.

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The problem with the current system from my perspective is, first, that it seems to invite conflict, and is often accused of being heavy-handed and far too arbitrary. The evidence shows that the most effective and enduring arrangements are ones that parents come to themselves. Secondly, the CSA does not offer value for money; and thirdly, enforcement may be ineffective, with huge arrears totalling nearly £4 billion in March 2012. A specific issue that I suspect other hon. Members will also speak about relates to self-employed partners paying child maintenance.

Mr Mark Spencer (Sherwood) (Con): I congratulate my hon. Friend on securing this debate. Does she recognise that at the moment the system seems to penalise those dads and absent parents who want to do the right thing and want to contribute to their children’s welfare, but the CSA seems to have no power to grab hold of those who want to avoid the system, and to make them contribute to their children’s lives?

Nicky Morgan: I thank my hon. Friend for making that point. He is absolutely right, and I will refer to a couple of constituency cases in which the non-resident parent, usually the father, is trying to do the right thing, perhaps by looking after the children on one or two days a week, but that is not recognised, when other people seem to be able to play the system. That is certainly something we in my constituency office have found.

I want to bring a human element to this debate. Numbers and statistics are all very well, but what I and other hon. Members—including the Minister—see in our constituency casework is the negative effect that the CSA is having on people’s lives, particularly children. I do not expect the Minister to comment on the individual cases I am about to raise—she has been good enough to see me twice with her officials to discuss two very difficult cases—but I feel that I owe it to my constituents, who often come to see me and my caseworkers in a state of some distress, to talk about their cases.

I shall start with poor enforcement. Karon Hollis is the mother of four children. All have the same father, who is self-employed and was using the accounting system to tell the CSA that he does not earn enough to pay her anything but the bare minimum of £5 per week—£5 for four children. Ms Hollis gathered evidence to show that his lifestyle could not possibly match what he was saying about his finances, but the CSA did not take her evidence, or lost it on the several occasions when she sent it in. Ms Hollis asked for our help with putting her evidence to the CSA, which has resulted in an assessment of £50 per week—10 times the amount she was originally getting. Why must ex-partners so often have to become detectives to get a fairer assessment?

My second case relates to Tracey Warren. It is currently with the adjudicator, who is carrying out a formal investigation. Ms Warren told the CSA 18 months before her ex-husband left the country that he was planning to go, and kept doing so, but nothing was done to get him to pay before he went. He has now moved to the middle east, and because Britain does not have a reciprocal arrangement with the country in question, the CSA cannot chase him for payment. The same issue has arisen in another case, in which the mother has moved to China.

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Moving on to cases where paternity is an issue, I have had two cases in which the father queried the paternity of the child and, as a result, the whole CSA claims process ground to a halt. I cannot say whether that is a delaying tactic, but in one case, after a father had asked for a DNA test, he heard nothing further from the CSA for three years, when they contacted him to say he was £16,000 in arrears. Surely an efficient and effective system should not allow such a long period of silence to occur. Paternity should be swiftly established to allow the CSA system to proceed, or the CSA to cease involvement if paternity is not proven.

On arrears being allowed to accrue without the CSA seeming to notice, Mr B in my constituency had a deduction of earnings order so that maintenance was deducted from his salary every month. Unfortunately, the employer failed to pass that amount on to the CSA, and the CSA failed to notice. When the employer went into administration, my constituent, Mr B, was told by the CSA that he would have to pay the outstanding amounts all over again. He did eventually recover a percentage of the debt as part of the administration process. What I cannot understand is why the CSA failed to spot that it was not receiving the money from the employer in the first place.

An element of flexibility is needed in the system. My constituent, Christine Barrell, is claiming maintenance from her husband, who is self-employed. He has been “nil assessed”, which Mrs Barrell is challenging. Her husband’s business accounts, which will support her appeal, are not due until the end of the year, but the CSA needs her appeal within the next 28 days. Can that period be extended to reflect the particulars of this case?

Finally, I want to highlight those cases that I have already mentioned, thanks to the intervention by my hon. Friend the Member for Sherwood (Mr Spencer), in which the non-resident parent is trying to do the right thing and to maintain contact with their children by seeing them regularly. They often feed and clothe their children, as well as incurring transport costs to see them and to return them to the parent with care. But those costs are not reflected in the maintenance calculation, and the parent with care may not agree to the calculation being adjusted to help to meet those costs. In one case, the CSA recommended that the parent with care should share the child benefit they are receiving, but that was met with a flat refusal.

I hope I have shown that we have a system that no one seems satisfied with; so where do we go from here? In a recent survey carried out for CMEC, two thirds of parents with a family-based arrangement said they were happy with their situation. Only one third of CSA clients said they felt the same. Almost 90% of non-resident parents complied with their own arrangements, compared with just under two thirds of those who had payments assessed and enforced by the CSA. Most parents with family-based arrangements considered them to be fair, whereas only 42% of those whose payments were calculated and enforced by the state system did so. More than 50% of parents who use the CSA say that they could make their own arrangements if only they had the right help and support.

I welcome the Government’s proposed collaborative approach. Hopefully, it will mean that separated parents are able to avoid the conflict that often comes with

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CSA involvement by making their own, family-based maintenance arrangements whenever possible, and the Government have already committed £20 million to developing better co-ordinated local support services to help that happen. The money will be used to work with voluntary and community groups to make it easier for parents to navigate existing support, and to consider what additional help is needed.

There has been criticism of the charges that will be introduced to allow people to access the statutory system. The previous Government introduced a wide-ranging power to charge all parents as part of the Child Maintenance and Other Payments Act 2008, and the coalition is building on that legislation and on Sir David Henshaw’s report to the previous Government on the CSA, and implementing those charging proposals. I understand that there will be heavy discounts for those on the lowest incomes, and total exemption when domestic violence has occurred.

In her response to the debate, will the Minister say more about those charging proposals? Who will be affected, how will they work, and when will they be introduced? Will she also address an issue that has been raised with me by Gingerbread: what will happen to new and existing cases when the new system comes into force? We hope that parents who separate after the new system is introduced will be signposted to a range of support services and encouraged to make a private arrangement, but what about parents who are already caught up in the system? If, for example, a deduction of earnings order is in place, what will happen to that when the new system comes into force?

In conclusion, I hope I have shown that the current statutory child support system needs speedy reform. I appreciate, however, that it is difficult for any Government system to cope with the complexities of family life. Parenting is hard enough for both mothers and fathers, without having to make allowances for the access arrangements, work pressures and new relationships that make every situation unique, and that is why any child support system will, perhaps by necessity, be a fairly blunt instrument.

Jessica Morden (Newport East) (Lab): The hon. Lady is making a powerful case and we all agree that changes to the CSA are needed. Does she feel that it is important that the new system works smoothly immediately—something that has foxed all previous Governments? At a time of cuts and rising living costs, child maintenance really matters to families. We must not risk making things worse by getting things wrong and making the situation even more difficult for those families who are on the breadline.

Nicky Morgan: I think the hon. Lady might have read the last sentence of my speech, and she is absolutely right. It will be interesting to hear speeches from all parts of the House, but we probably all want to get to the same place and ensure that families who cannot make arrangements receive help to do so, that children get the money they need in order to have the essentials required in life, and that families get the support they need. The hon. Lady is right to say that any transition must be as smooth as possible, and I am sure the Minister will address that point. We are talking about IT systems and family arrangements, and although

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things will never be entirely smooth, we do not want to see families put in a worse position than they are already in, or the unhappiness that I have already mentioned.

It is right to encourage families to make their own maintenance arrangements. However, the Government should consider how we can become better at getting assessments right in the first place and at enforcing arrangements when things go wrong, and how we can best help families to resolve such issues themselves. I hope to hear from my hon. Friend the Minister on those points.

As I have already hinted, it would be a terrible legacy if, in addressing all the problems I have highlighted, we were to introduce new instabilities into the new system. I look forward to hearing from the Minister about how lessons have been learned and how the system will avoid the situation—this is where I started my speech—in which half the children in this country who live in families that have separated have no financial maintenance support in place.

Several hon. Members rose

Mr Mike Weir (in the Chair): Order. It is my intention to start the winding-up speeches no later than 3.40 pm, which gives us just under an hour. Six Members wish to speak, so I would ask you all to do the maths and tailor your speeches accordingly.

2.43 pm

Sheila Gilmore (Edinburgh East) (Lab): It is a pleasure to serve under your chairmanship, Mr Weir, and I congratulate the hon. Member for Loughborough (Nicky Morgan) on securing this important debate. It is an issue that, even during our discussions on reform, often comes at the end of a lot of other matters and has sometimes not received the full amount of time that it deserves.

I do not for an instant pretend that the CSA has not had problems, but I am concerned that we are making a wrong analysis of them, and it is possible that we could again make a gigantic mistake. Many mistakes were made when the CSA was set up in 1993, and one reason for that was because at the time, the views of those who worked in the field were almost totally disregarded.

I had better declare an interest because I am a family lawyer by profession although I am not currently practising. The CSA was introduced to meet a need because the previous systems were not working well. Then as now, many children and families were not receiving the money that they should have been getting, and the Government did not invent the CSA simply to be difficult. When it was introduced, however, it was an all-or-nothing system that was not terribly helpful and produced a huge work load right from the start. That was probably the wrong end to go from. I am still convinced that the CSA should have been started, at least in the early stages, on a slower basis, perhaps dealing only with some types of situation, and that we should have listened to some of those who were used to working in the field.

Many of the problems that the hon. Lady mentioned are endemic to the situations in which people find themselves, rather than caused by the Child Support

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Agency. The hon. Lady mentioned self-employed people, and they are always extremely difficult to tackle. They were extremely difficult under previous legal powers when we went to court, or used the system in Scotland that did not involve going to court—I will mention that in a minute. Trying to get from the self-employed what we felt they ought to be paying was extremely difficult, and their ability to produce accounts that made it look as if they did not earn much was notorious. That was always a problem, as were people who disappeared and went overseas. I had a client whose husband worked on oil rigs. Every time we got an earnings assessment for him, he would simply give up that job and take another. He was a scaffolder and very well paid, and his ability to thwart the system, as it was then, was great. I do not, however, believe that that situation would have been any easier for the CSA. We must address the real problems, and not necessarily blame the CSA.

Mr Spencer: Surely the hon. Lady will acknowledge that within her constituency there will be people who experience enormous frustration when trying to communicate with the Child Support Agency. People get moved between different offices around the country; the CSA loses information and does not acknowledge the simple facts that are happening in people’s lives. That is the fault of the CSA rather than the lifestyle of those individuals.

Sheila Gilmore: I must say that my case load on this matter is not as large as some people’s appear to be. Some of the cases are almost a legacy because they come from the previous system. I have some long-standing cases, and in my experience, although I do not seek to defend the CSA, it is not necessarily much worse than dealing with other large Government agencies.

I am worried that we are in danger of making another big leap based on a wrong premise. The Minister’s assumption—this also came through in the opening speech by the hon. Member for Loughborough—is that the statutory child support system is the cause of discord and bad feeling between parents. However, if we start off with a wrong premise, we will come to a wrong conclusion.

The hon. Lady cited research that indicated that two thirds of people with family-based arrangements were happy with them, whereas only one third of CSA clients were happy. Some 74% of those with family-based arrangements considered them to be fair, compared with 42% of those with CSA arrangements. However, the crucial point missing from that analysis is that the people who end up using the CSA are those who cannot reach family-based arrangements. Those who can reach such arrangements do so, and we are not comparing like with like if we come to that conclusion and decide that we should basically shrink the existing statutory system. If I understand the situation correctly, those currently within the system will be asked to close their cases and restart the process by trying to get a family-based arrangement. If they cannot, presumably they will come back through the process. The idea is to shrink the system due to the analysis that the CSA is what causes discord between parents.

My experience as a family lawyer is that separation is a very difficult situation. People do not separate because they are getting on well. They do not usually separate

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because they can communicate well. Often they are angry and often they have good cause to be angry. That anger is not something that is just stirred up either by the courts, which is one of the assertions that we hear, or by the Child Support Agency. People are angry. They do have difficulty getting money, and there are reasons why that will always be quite difficult.

Generally, when people separate, both partners lose financially. It is a financially difficult situation for them, and often it does not get better after a few weeks, months or even years of separation, because new liabilities come into play. People form new relationships and they find it even more difficult to cope. These things influence people’s attitudes to one another, and some people clearly are not willing to come forward to make an agreement. My concern is that we are making the wrong assumption—that having a statutory system is causing discord—and if we start from the wrong point, we will reach the wrong conclusion, and the solution will not be the one that cures the problem.

I would like to make a practical proposition to the Minister. It is drawn from Scots law and could fill a gap. The Government should think seriously about it, especially if they are determined to shrink the child support arrangements. In Scotland, it is possible to have not just the vague, family-based arrangement that everyone talks about, but a legal minute of agreement, which is enforceable in the same way as a court order would have been under the previous system. These minutes of agreement are usually negotiated with the assistance of solicitors. Many people have them drawn up, and they have worked extremely well. As I said, they are directly enforceable. All the same steps can be taken to enforce them as could have been taken with a court order. That model would enhance the system here tremendously. I offer it up, from Scotland, as something that perhaps the Minister will want to discuss with the Ministry of Justice. They may want to discuss how something such as that might be introduced into the English legal system to enable people to have something that, yes, is agreed—it is negotiated and agreed—but also has legal enforceability.

There is one minor point about minutes of agreement that the Minister might also want to consider. Under the previous CSA arrangements, after one year of having a minute of agreement, it was possible to go to the CSA and renege on it—that was possible for either partner, in effect. The Law Society of Scotland suggests that it would be better if that were a four-year period, and I concur. I think that if people have been properly advised and a minute of agreement has been drawn up—people can ask for a minute of agreement to be reduced in certain circumstances, such as if they have been coerced—a four-year period would be sensible.