9 Jan 2013 : Column 77WH

9 Jan 2013 : Column 77WH

Westminster Hall

Wednesday 9 January 2013

[Mr David Crausby in the Chair]


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

9.30 am

Mr Adrian Sanders (Torbay) (LD): It is a pleasure to speak under your chairmanship, Mr Crausby.

I want to put on the record the difference between type 1 and type 2 diabetes, although the debate is about diabetes more generally. Type 1 diabetes develops when the body’s immune system attacks and destroys the cells that produce insulin. As a result, the body is unable to produce insulin, which leads to increased blood glucose levels and in turn can cause serious organ damage to all organ systems in the body. About 15% of people with diabetes in the UK are type 1s. I wish to declare my interest as someone who was diagnosed as type 1 nearly a quarter of a century ago, and I am still here. Type 2 diabetes develops when the body does not produce enough insulin to maintain a normal blood glucose level or is unable effectively to use the insulin produced. The long-term complications that challenge both type 1 and type 2 sufferers are much the same.

Diabetes remains one of the largest challenges to our health care system, with about 3.7 million sufferers in the UK; almost 1 million more are estimated to have the condition, although they do not know it. The numbers are expected to rise, which all makes for a significant challenge to the NHS, with an estimated spend of £10 billion a year on diabetes-related treatments. Much of that spend is unnecessary: people with the condition far too often suffer from late diagnosis, preventable complications and variations in care; they are often overlooked for specialist care when being treated for other conditions, particularly as in-patients; and they can be prevented from accessing treatment by the short-term financial ethos embedded in some primary care trusts.

None the less, we have made progress in recent years. I pay particular tribute to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) and the former ministerial team for the open and constructive way in which they pursued the issue and ensured that diabetes remained a high priority during the stormy times of NHS reform. The all-party group on diabetes, which I chair, has already met the new Minister, and I am confident that the good progress will be sustained, if not surpassed. I am already heartened by the new Secretary of State’s pledge to focus more on patient outcomes and the patient experience. Let us hope that that intention manifests itself in clear instructions for managers and commissioners.

One of the priorities on which Ministers can have a direct impact is the promotion of leadership by the Department of Health. In recent years, a problem has arisen from the apparent inability to disseminate best practice around the UK and the unwillingness of some NHS organisations to implement it.

9 Jan 2013 : Column 78WH

Keith Vaz (Leicester East) (Lab): I pay tribute to the hon. Gentleman for all his amazing work on diabetes over his parliamentary career. As he has done, I have tabled questions to ask simply how high the spend on diabetes was in individual PCTs last year, only to be told that the information was not available and so could not be given to me. Is not that kind of information vital for an effective strategy on diabetes?

Mr Sanders: That would certainly be extremely helpful and would complement the atlas of care by, in a sense, putting the actuality into the story behind the figures. It is extremely unhelpful not to be able to drill down to what is really happening on the ground; we could do that if such statistics were available.

Some of the problems of disseminating information have been offset by the work of NHS Diabetes. It has been instrumental, first, in monitoring variations in care and driving the collection of more robust data, which has culminated in an extremely important publication, the national atlas of variation; and, secondly, in working tirelessly to rectify the problems it uncovers, linking national policy intention with policy implementation on the ground, including support targeted on where the greatest improvements are necessary. It is important that that work continues, as much more could be done. I hope that the Minister will reassure me that, despite the upheavals in the commissioning architecture, NHS Diabetes will retain its central role.

Rehman Chishti (Gillingham and Rainham) (Con): I, too, pay tribute to the hon. Gentleman for his fantastic work as chairman of the all-party group on diabetes. Does he agree that there need to be performance targets, like those for cancer, stroke and heart disease? At the moment, there are not the mandatory performance targets for diabetes that there are for those other diseases.

Mr Sanders: I am grateful to the hon. Gentleman for making that point. When one puts together speeches, they sometimes go on too long, and I had cut out that bit, so I am glad that he has raised it. The big issue is that the cause of death is sometimes recorded as stroke or heart disease when the underlying problem is diabetes. We have targets for cancer, heart disease and stroke. We really ought to look at diabetes as the root cause of other conditions for which there are targets.

The variation in care across the country is probably the largest worry for patients now, and the new implementation plan should focus on that. Failings in diabetes care cause an estimated 24,000 premature deaths each year. In 2001, the Department of Health published the national service framework for diabetes, which set out clear minimum standards for good diabetes care. Those standards include nine basic care processes that aim to end preventable complications by looking for early warning signs. Despite those targets, much of the country has seen little progress towards improving detection of type 2 diabetes and reducing the number of preventable diabetes complications. In 2009-10, results from the national diabetes audit showed wild variations in inputs and outcomes for both type 1 and type 2, including the astounding figure that the proportion of type 1s receiving the recommended nine care processes ranged from as low as 5% to 50%, with an average of 32% in England. The figures were only marginally better for type 2s. It really is not good enough.

9 Jan 2013 : Column 79WH

The point about the condition is that people treat themselves 364 days a year and see a practice nurse or sometimes a general practitioner—more rarely, these days, a consultant—only once a year, although they should receive the nine care processes. The chance of developing diabetic complications can be reduced by keeping blood pressure, blood glucose levels and cholesterol levels low. Regular monitoring, backed up by periodic checks, is the key. The results from the national diabetes audit demonstrate that more needs to be done to end the postcode lottery of care for people with the condition. When as few as 5% of people with type 1 diabetes are receiving all nine care processes in some areas, there is a definite failure of care. If all health care trusts followed the national service framework, such complications as blindness and kidney disease—as well as stroke, heart and other diseases—could be prevented.

I hope that we will explore a range of best practices, but I want to highlight a couple that have scope to bring immediate improvement at very little cost. An acute issue is the provision of insulin pumps for type 1s. That is an example of where the UK should look abroad for best practice. Type 1s in other developed countries, such as France, Germany or the US, can expect to benefit from a pump if that is required for their diabetes management. Somewhere between 15% and 35% of type 1s in those countries have pumps, which enables them to lead normal lives, but in the UK the figure is less than 4%. That is clearly a failure of the commissioning structure as it is now. Will the Minister address how that is likely to improve? The Work Foundation has estimated that, if pump usage reached 12%, the NHS would save about £60 million a year.

Another example of where best practice is needed is surprisingly simple: good local leadership. Good leadership, as I have been fortunate enough to experience in my own area of Torbay, is essential to promoting effective and integrated services. Integration is key to reducing costs in the long term and, more importantly, to improving patient outcomes, which all too often get lost in the debate over health care services.

The move to clinical commissioning groups, with the potential for better scrutiny and criticism from patient groups, local authorities and health care staff could, in theory, lead something of a revolution in spurring innovation and creativity and in the striving to find best practice.

Just as educating the commissioners is crucial, so, for diabetes, is patient education, which has the happy side effect of making patients far more aware of whether they are receiving a good service and enabling them to become better advocates for their condition. I have no doubt that the great knowledge possessed by volunteers for Diabetes UK, the Juvenile Diabetes Research Foundation, INPUT and the many other groups involved in diabetes will be a considerable asset in shaping good services at a local level now that we have better scope for patient scrutiny and involvement.

In the wider sense, patient education is the core to preventing complications, which diminish the quality of life for patients and which, all too often, reduce life expectancy and increase the costs to the NHS in the

9 Jan 2013 : Column 80WH

long term. Good patient education programmes may require some investment, but they would pay for themselves many times over.

On a broader level, work needs to be done on detection and prevention. The number of people suffering from type 2 diabetes is set to reach a staggering 5 million by 2025. However, what many people do not know is that type 2 diabetes is a largely preventable disease. At the very least, its onset can be delayed and complications reduced.

NHS checks are vital to the detection and prevention of diabetes. In theory, such checks are available to all 40 to 74-year-olds who are seen to be at risk of developing diabetes. Shockingly, a number of primary care trusts in the UK failed to offer a single person an NHS health check last year, which demonstrates the dangerous variations in provision in the NHS. The Government can look to rectify that if they create a new national implementation plan for diabetes. Indeed they may even take up the suggestion by the hon. Member for Gillingham and Rainham (Rehman Chishti) to set targets for diabetes.

This year, the current national framework for diabetes comes to an end. It is important that we build on the successes of the framework, that we focus on reducing discrepancies in diabetes care and that the new framework emphasises the importance of health checks and prevention of the disease through simple means such as diet management. Indeed, it is essential for the Government to spell out to commissioners and to patients what services can be expected and to provide a road map to show where we want to be in a few years’ time and how to get there.

John Pugh (Southport) (LD): My hon. Friend analyses the fair degree of regional variation that exists and talks about a postcode lottery. Does he think that that is primarily down to a lack of leadership at PCT level, or to the qualitative variations that we get anyway in primary care practice among GPs across the country?

Mr Sanders: It is a combination of both. We cannot prescribe from the centre precisely what must happen in every area. Of course local areas must reflect their own demographics and their own health picture and be able to apply priorities accordingly. However, there is something to be said for ensuring that local areas have the tools that they need, which is where NHS Diabetes did such a good job on the back of the NHS framework for diabetes.

It is equally important that health checks are used to detect diabetes in its earliest stages, as early detection and appropriate treatment can prevent the severity of the condition and the risks associated with complications such as amputations.

Rehman Chishti: On health checks, the hon. Gentleman must have seen the report that says that, according to Diabetes UK, nine out of 10 people do not know the four main symptoms of type 1 diabetes. Surely, therefore, the education should look at ways in which people can identify for themselves the symptoms that can lead to type 1 diabetes.

Mr Sanders: That is a very good point. There is the 4 Ts campaign on diabetes. If I remember correctly, the four Ts are thirst, tiredness, toilet and one other—

9 Jan 2013 : Column 81WH

I always remember three, but not four. Anybody who feels thirstier or more tired than usual or is visiting the toilet more often should see their GP. A simple test—it is not an invasive test—can be conducted and after an appropriate early diagnosis a patient can start to feel better very quickly. An ancient fear of great big hypodermic needles being stuck in their skin deters many people from going to a GP, but only 15% of diabetics are put on to an insulin regime on diagnosis and that is because they suffer from type 1. Most type 2 sufferers never have to take insulin via an injection device, and, in any case, those devices are subcutaneous and really nothing to fear. I speak as someone who has to inject four or more times a day, and it really is not as bad as people fear. People should see their GP. If they do not, matters will get worse, complications will set in and they will rue the day that they did not sort out the problem early on.

The Parliamentary Under-Secretary of State for Health (Anna Soubry): I know that it is unusual for a Minister to intervene at this stage, but will the hon. Gentleman help me in this matter? Is it not right that there have been huge advances in the administration of insulin? A constituent of mine showed me the pump on his stomach that gives him the right amount of insulin. He even had a device on his mobile phone that could calculate from a photograph of a particular meal the amount of insulin that should be administered to his body. He clicks on the app and the insulin is given to him at the appropriate time, before or after he has his meal. Does the hon. Gentleman agree that those are wonderful devices that should be prescribed to people as much as possible?

Mr Sanders: I cannot fail but to agree with every word that the Minister has said, and I am absolutely delighted that she has said that. Children in particular benefit from pumps, because they can go to school and lead normal lives alongside their school friends. It is difficult for them to find the space and time to inject, and these little devices are doing the job for them all the time. The technological advances are such that we may well reach a point in the not too distant future where there is a device that both tests a person’s blood sugar level and then injects an appropriate level of insulin, without them having to check what they are eating. The little device is like having a pancreas attached to the side of the body. That is where we are going. At the moment, however, pump usage is very low in the UK. It is about having not just the pump but the services behind the pump—the trained nurses who can train and educate the person to use the pump properly, the technological support that needs to be there to back it up and the medical expertise to understand the difference between a pump regime and any other regime. That is the detail, and I am really glad that the Minister is on the ball here.

The provision of education about diabetes seems to be somewhat of a lottery in terms of who is actually receiving information and advice. There needs to be a standardised programme of education on the condition that is accessible and effective for all.

We must not miss the opportunity to encourage healthier lifestyles as a consequence of the Olympic legacy. It is essential that funding and provision for sports facilities and physical education continue to be given priority in the coming years to capitalise on increased interest in active sport. The Olympics have

9 Jan 2013 : Column 82WH

given people who have perhaps never before enjoyed individual or team exercise a new drive and desire for sport, which needs to be harnessed and nurtured. Gym membership and even one-off sessions for swimming still seem to be extremely pricey, which makes those forms of exercise inaccessible for many who could perhaps benefit from them. However, I am aware that some inner-city areas have set up programmes that allow residents to use facilities at a reduced rate or even at no charge. I wonder whether that idea should be taken hold of by more UK communities, and whether the Government could assist all local authorities to find ways to subsidise it, perhaps by working in partnership with private sector organisations.

Having facilities and making them affordable is an issue, which is why I find it unbelievable that some local authorities, including my own, give permission for building on sports facilities; in Torbay, the only public grass tennis courts in the local area are about to be built on. Andy Murray won his Olympic gold medal on grass and generated more interest in the sport last year, and my area has produced some of the great British tennis players down the decades, including British men and women No. 1s in Mike Sangster and Sue Barker. That makes that act by my local authority one of unforgivable short-sightedness.

I have outlined many of the issues surrounding diabetes care, but I will concentrate now on some of the things that I hope the Minister will focus on delivering in the coming years. There needs to be a comprehensive national implementation plan, containing measures to ensure that local leadership is robust and long term in its thinking. Such a plan also requires measures to focus on detection and prevention, and it needs to ensure that best practice can be effectively disseminated. Three priorities face our NHS and other health care systems around the world: prevention; diagnosis; and care. We have a long way to go to meet the challenges of each one.

Several hon. Members rose

Mr David Crausby (in the Chair): I will not impose a time limit on speeches, but four Members wish to speak and I would appreciate it if they could keep their contributions to around 10 minutes, or less, so that I can call all four of them.

9.51 am

Nick Smith (Blaenau Gwent) (Lab): Thank you, Mr Crausby, for calling me to speak. I congratulate the hon. Member for Torbay (Mr Sanders) on securing this important debate.

Sadly, we had 23 amputations from diabetes last year in my constituency of Blaenau Gwent, despite having a valued specialist foot ulcer clinic run by an advanced podiatry practitioner. So last November I asked the Leader of the House for a debate on how to prevent amputations resulting from diabetes.

The Public Accounts Committee, of which I am a member, was given evidence that the NHS spends at least £3.9 billion a year on diabetes services. It is shocking that the lion’s share of that money is swallowed up in the treatment of avoidable complications. As we know, these complications are not minor; they include

9 Jan 2013 : Column 83WH

amputations, blindness and kidney disease. Such complications are extremely debilitating for the sufferer and extremely expensive to treat. In the worst cases, diabetes can lead to premature death. That is a waste of both precious lives and resources.

Health professionals say that there are 125 amputations weekly because of diabetes, yet 80% of those amputations are preventable. The National Audit Office says that we could save £34 million annually if late referrals to specialist teams were halved. So, it is in the interests of patients and NHS budgets to deliver effective services, with the emphasis—as ever—on prevention and early diagnosis.

The PAC’s report on diabetes services, which was published last November, found that fewer than half the people with diabetes receive the nine basic checks identified in minimum standards of care that were established more than 10 years ago. Unlike cancer, stroke and heart disease, there are no mandatory performance targets for diabetes.

The PAC report highlighted the postcode lottery in provision for people with diabetes, and it also said—to a chorus of consensus—what needs to be done. However, it is just not happening nationwide. Put bluntly, we found that money is being wasted. There is no strong national leadership; no effective accountability arrangements for health service commissioners; no appropriate performance incentives for providers, and no evidence to assure us that the new NHS structure would address the failings that have been identified.

The Leader of the House has told me that diabetes care is a Government priority. So I hope the Government will support a specific pledge that would be widely welcomed. The Putting Feet First campaign, the supporters of which include Diabetes UK and the College of Podiatry, wants there to be a realistic target of a 50% reduction in amputations because of diabetes by 2018. That is a crucial point, because the Health Minister, Earl Howe, told the House of Lords recently that

“Diabetic foot disease accounts for more hospital bed days than all other diabetes complications”.—[Official Report, House of Lords, 29 November 2012; Vol. 741, c. 331.]

Policies to deliver that target include having a multidisciplinary foot care team in every hospital. Shockingly, in 2011 31% of hospitals had no podiatry provision at all. We also need foot protection teams in every community, which will mean more, not fewer, podiatrists in post.

We need a strong message from Government that preventable amputations must be reduced, that local variations will not be tolerated and that precious NHS resources will not be wasted. In addition, as others have already said, the importance of patient engagement cannot be stated too often. In their current consultation on diabetes, the Welsh Government highlight the benefits of having more informed and more confident diabetes patients. Education is an integral part of personalised patient care.

I will now make some concluding comments about how we can turn the tide, given that current projections show that the number of people with diabetes will rise from 3.1 million to 3.8 million by 2020.

9 Jan 2013 : Column 84WH

How can we improve diet, reduce alcohol consumption and encourage physical activity? Good ideas include: a reduction in the sugar content of soft drinks; a realistic minimum price for alcohol of 50p per unit; restrictions on advertising and sports sponsorship; action to maintain nutritious school meals; teaching our children to cook, and encouraging regular sport and exercise in schools. Together, these ideas are a promising mix of radical measures, unlike the Government’s “responsibility deal”, which is just another case of the triumph of hope over experience.

Last week, a report from the Royal College of Physicians called for a senior figure in Government to take charge of obesity issues across all Departments, covering every area from agriculture to work and pensions. In the US, we have seen the mayor of New York, Michael Bloomberg, ban the sale of “super-size” drinks at entertainment venues. Similar bold and symbolic action is now urgently needed from the coalition Government here.

As I said at the beginning of my speech, there were 23 amputations in Blaenau Gwent last year because of diabetes, and across the UK there will have been many thousands of such amputations, many of which were preventable. The Government need to up their game.

9.57 am

Rosie Cooper (West Lancashire) (Lab): It is a pleasure to serve under your chairmanship, Mr Crausby, for this debate.

I congratulate the hon. Member for Torbay (Mr Sanders) on securing the debate on such an important issue, which affects a growing proportion of our population. Indeed, having listened to the contributions that have already been made, it is very clear that there are many facets of diabetes that could be covered during this debate, but I think that we will all probably concentrate on amputation. I will spend a few minutes focusing on the importance of podiatry services, which can reduce preventable amputations for those with diabetes.

Currently, 4% of the population live with diabetes, and a fifth of those people will develop a foot ulcer at some point. At any one time, there are 61,000 diabetics in England who have foot ulcers. A foot ulcer may not sound like a very serious condition, but for a diabetic the consequences of foot ulcers can be severe, and even fatal if the appropriate treatment is not given. Statistics for England alone show that, of those diabetics with foot ulcers, 6,000 people—that is 10% of the total number—had leg, toe or foot amputations in 2009-10. Based on current trends, that figure is projected to rise to 7,000 people by 2014-15. An amputation is devastating. If any individual loses a limb, it will have a far-reaching impact on their life. For many diabetics, an amputation can increase the likelihood of premature death.

Let me put those figures for diabetes in context. The five-year survival rate for those with breast cancer is just over 80%, but for those with a diabetic foot ulcer the five-year survival rate falls to just under 60%. For those people who have a lower limb amputation, their survival rate worsens after five years. The consequences are even more horrific when we consider that 80% of those amputations are preventable. In 2012, that is simply incredible. We are not doing everything we can to rectify that and to ensure that people have the information and services that will help them protect their limbs.

9 Jan 2013 : Column 85WH

It is scandalous that with our 21st-century health care we are allowing people to go through the completely unnecessary, torturous and miserable experience of amputation. Prevention is supposed to be the watchword of the modern national health service; through prevention, people can enjoy a better quality of life and the NHS can save itself millions.

It is therefore hard to understand why better prevention is not deployed with diabetes and amputations. Why is more effective use of podiatry services not a priority for the health service? At a time when the number of diabetics is growing, and with it the costs of treatment, podiatry could be a means of improving a diabetic’s quality of life and saving the NHS money. Amputations cost the NHS considerable sums, which are estimated to be in the region of £600 million to £700 million each year.

Results from pilot projects can demonstrate the positive impact of investing in good podiatry services. A multidisciplinary foot care team for in-patients with diabetes in Southampton led to a reduction in the length of in-patient stays from 50 days to 18 days. Not only were patient outcomes improved but annual savings to the NHS of £900,000 were generated from an investment of £180,000. That savings ratio of £5 saved for every £1 invested was bettered in another example. In James Cook hospital in Middlesbrough, a multidisciplinary foot care team generated annual savings of some £250,000 at a cost of £30,000, which is a ratio of £8 saved for every £1 invested. Those figures show how it would be not only the Government and the NHS that reaped great rewards from a small investment, but diabetics and those who need podiatry care. Based on the pilot evidence, logic would suggest that even in these straitened times we should be investing in podiatry services, because that could save even more money and improve health.

There is evidence, however, that the opposite is happening and that services are not improving. The danger of the new arrangements is that important issues fall between the cracks, are left to local decision making and do not get the prioritisation they deserve. More than half of hospitals do not have a multidisciplinary foot care team. In fact, 31% of hospitals do not even have an in-patient podiatry service, according to data from the national diabetes in-patient audit in 2011. That reflects a worsening service, because in 2010 only 27% of sites had no provision. The amount of provision has dropped, and nearly a third of hospitals no longer have that service.

There is also evidence that there is a problem with GPs having no incentive to refer their patients on to a foot protection team for education or follow-up. Why is that? Why is this woeful situation tolerated? If more referrals were made, we would see a beneficial reduction in ulcer and amputation rates.

John Pugh: Will the hon. Lady explain why a GP would need an incentive to do what is clinically desirable in the first place?

Rosie Cooper: I absolutely share that concern, which is why I cannot understand the current view that doctors do only what they get paid for and if there is no money attached to something, it may not be the first thing they do. As I pointed out in Westminster Hall yesterday, when we had a debate on the Liverpool care pathway,

9 Jan 2013 : Column 86WH

financial rewards to clinicians should not be the driver of what happens or the pathways that are followed. That is good clinical practice. Surely to goodness, if a referral to podiatry is required, that is what should happen. It could also be said that if the services are not there or are being reduced, the GP has less incentive to refer, knowing that it will take so long to get an appointment.

The College of Podiatry is

“fearful that public expenditure constraints mean that rather than being prioritised through the QIPP”—

quality, innovation, productivity and prevention—

“agenda, current podiatric services are at best, being frozen and in some cases being reduced, with patient services including the diabetic foot service deteriorating as a consequence”.

That has massive implications for the NHS budget and for the patients themselves. During a debate in the other place on 29 November 2012, the Under-Secretary of State, Earl Howe, accepted that

“rapid access to multidisciplinary foot care teams can lead to faster healing, fewer amputations and improved survival. Savings to the NHS can substantially exceed the cost of the team.”—[Official Report, House of Lords, 29 November 2012; Vol. 741, c. 336.]

My question for the Minister is whether the NHS, which is in the throes of a reorganisation and being more localised through clinical commissioning groups, as well as being put under increasing financial pressure, will move towards or away from having more multi- disciplinary foot care teams, given that fewer than half of hospitals currently have such a team. Investment in more podiatry services would result in improved foot screening, appropriate follow-up services, enhanced care when required, better outcomes—including fewer amputations—reduced length of stay in hospitals, increased quality adjusted life years and reduced morbidity. We would all win; we would have a healthier nation and significant financial savings.

10.7 am

Jim Shannon (Strangford) (DUP): First, I thank the hon. Member for Torbay (Mr Sanders) for bringing this issue to the House. Secondly, I declare an interest, as I am a type 2 diabetic and have been for four years. It has given me a knowledge of, and an interest in, the issue, although not a total knowledge—far from it. It has also made me more aware when constituents come to me with issues relating to diabetes and has given me an interest in those issues.

The disease has completely changed my life, as it would, because it is type 2. Diabetes is a major issue in every constituency. As someone who enjoyed the sweet trolley more than anyone else—to use Northern Ireland terminology, when there was a bun-worry going on, I was at the front of the queue—the sweet stuff was something that I indulged in regularly. Along with my stress levels, that has meant that I am a diabetic today.

The statistics have been mentioned, but they bear repeating, due to the seriousness of the UK’s problem, which is etched in everyone’s minds. The UK has the fifth highest rate in the world of children with type 1 diabetes. In Northern Ireland, we have 1,040 children with type 1 diabetes, some of whom are born with the condition. I want to give a Northern Ireland perspective, but I will bring in the UK strategy, because diabetes affects the whole UK, and that is why it is important. Some 24.5 children in every 100,000 aged 14 and under

9 Jan 2013 : Column 87WH

are diagnosed with the condition every year in the UK. We had a reception where we met some of those young people, and if we needed a focus, the focus was there that day for those of us who attended. I think that most of the people in the Chamber were there.

The UK’s rate is about twice as high as that in Spain, where it is 13 children in every 100,000, and in France, where it is 12.2 children in every 100,000. The league table covers only the 88 countries where the incidence of type 1 diabetes is recorded. There are 1,040 children under the age of 17 with type 1 diabetes in Northern Ireland, and almost one in four of them experienced diabetic ketoacidosis before a diagnosis was made.

Diabetic ketoacidosis can develop quickly. It occurs when a severe lack of insulin upsets the body’s normal chemical balance and causes it to produce poisonous chemicals known as ketones. If undetected, the ketones can result in serious illness, coma and even death. The diabetes itself is not the killer; it is the offshoots from it, the effects on the heart, circulation, blood pressure and sight, and the possibility of strokes and amputations.

The number of people living with type 1 and type 2 diabetes has increased by 33% in Northern Ireland. In my Strangford constituency, the number has gone up by 30%, with 800 people—I am one of them, by the way—becoming diabetic in the past seven years. That compares to 25% in England, 20% in Wales and 18% in Scotland. In our small part of the United Kingdom, the total number of adults—aged 17 and over and registered with GPs—with diabetes is 75,837, and a further 1,040 young people under the age of 17 have type 1. There has been a significant rise in that number also, with the prevalence in Northern Ireland now at more than 4%. An estimated 10,000 people in Northern Ireland have diabetes and do not know that they do. They have a ticking time bomb in their bodies; they wonder why they are not well, and the cause is diabetes.

Mr Gregory Campbell (East Londonderry) (DUP): My hon. Friend is talking about the different prevalence of diabetes throughout the UK. Does he agree that best practice regarding early detection and the promotion of an active lifestyle could be a target for all the devolved regions across the UK and here in England? The Minister would do well to respond in relation to Ministers in the devolved regions taking on such best practice to combat diabetes.

Jim Shannon: Yes, I agree. When people make interventions, I always wonder whether they have read my script—preventive medication is the very next issue on it.

In my doctors surgery in Kircubbin and, indeed, across Northern Ireland preventive measures are in place. There are diabetic surgeries, and the matter is taken seriously. The UK strategy that we have had for the whole of the United Kingdom of Great Britain and Northern Ireland and that will come to a conclusion this calendar year has made significant progress towards reducing the potential numbers, but diabetes has increased over the same period. There are some 100 diabetics in my doctors surgery in Kircubbin.

Rehman Chishti: The hon. Gentleman talks about the United Kingdom strategy. Does he accept that certain people from different ethnic backgrounds are more

9 Jan 2013 : Column 88WH

likely to get diabetes? For example, according to the Wellcome Trust, 50% of people from south Asian and Afro-Caribbean backgrounds would have diabetes by the age of 80. Any UK strategy would therefore have to take ethnic composition into account, because such people are affected differently.

Jim Shannon: That is an excellent point, and I am sure that the Minister will address it in her response. There are groups in the whole of the United Kingdom in which diabetes is more prevalent, and we need to look at those target areas.

There are 3.7 million people in the UK diagnosed with type 2 diabetes. I was diagnosed four years ago. With me, it was down to bad eating habits, stress and the fact that there were no set hours to my job. I ate whatever was quickest, and that was Chinese, usually with two bottles of coke, five nights a week. That was why I was 17 stone. I am now down to 14 and a half stone because I no longer do that. The issue is eating and living styles—eating what is quickest rather than what is best.

Edwin Poots, the Minister at the Department of Health, Social Services and Public Safety in Northern Ireland, is very aware of the ticking time bomb that is diabetes. I am aware of the key initiatives in operation in Northern Ireland, and I know that the Minister here today has had discussions with the Minister in Northern Ireland. They are doing a great job, including setting aside funding to employ additional diabetic staff—specialists, nurses, dieticians and podiatrists. That is providing all the help that a diabetic needs, but it is still not enough.

We need a concerted effort across the United Kingdom, through the media, and even perhaps through the TV soaps. I am not a soap watcher. I could not tell anyone what happens in “Emmerdale” or “Coronation Street”, but my wife could. She knows everyone in them—what they are doing this week and what will happen to them next week. Could we not perhaps use the soaps to make people more aware of the issue? I understand that plenty of issues are brought up in them regularly, so perhaps we should try this one.

It is great that our children are taught about diabetes in school. It is surprising what a five or 10-year-old knows about food that their mum and dad do not. Who is educating the mums and dads at home who are making the dinner and buying the shopping? The hon. Member for Blaenau Gwent (Nick Smith) made a point about how the food coming into the house is controlled by the parents. Diabetes UK Northern Ireland is taking part in an organisation-wide campaign entitled “Putting Feet First” to raise awareness of amputations among people living with diabetes and to work to prevent unnecessary amputations.

The Minister might want to comment on the new medications that are available. In the press this week, there was talk about a new diabetic medication in tablet form that could replace—not totally but partially—type 1 injections. The figure used was a cost of £35 per month. It would be good if we could get some feedback about whether the new medications will be available across the United Kingdom and whether everyone will be able to take advantage of them.

9 Jan 2013 : Column 89WH

In Northern Ireland last year, 199 diabetes-related amputations took place, and the “Putting Feet First” campaign highlights that an estimated 80% of lower- limb amputations are preventable. There must be a UK strategy to reduce diabetes-related amputations by 50% over the next five years. What can we put in place in this Chamber to highlight and support the campaign? How can we use our influence to see the number of cases of type 2 diabetes dropping, instead of this steady rise?

The links between type 2 diabetes and obesity are firmly established, and it is clear that, without appropriate intervention, obesity can develop into diabetes over a relatively short time. For instance, the risk of developing type 2 diabetes is about 20 times more likely in obese, compared to lean, people. A newspaper recently stated that academic sources have estimated that the predicted rise in obesity rates over the next 20 years will result in more than 1 million extra cases of type 2 diabetes, and that is really worrying. Can that go unchallenged, when it is within our power, as parliamentarians, to do something about it, at least by putting a strategy in place or by beefing up the ones that we already have? When the current UK-wide strategy ends, it will perhaps be time to do something more.

I live the life, as do many others, of testing my blood every day, of feeling unwell when my blood sugar is out of control and of worrying that the next visit to the doctor will bring worse news, which can be the case if we do not discipline ourselves and ensure that we do things right. That is not the life that I want to have, or the life that I want my family, friends or constituents to have. The way to take on the issue is to continue with the UK-wide strategy, with dedicated funding and with all the regions working together, which will save money in the long run and, more importantly, improve the quality of lives across the United Kingdom.

I urge the Minister to take the initiative. I believe that she will and that her response will be very positive, because she understands the issues. I urge her to work with the devolved bodies, in coming together to disarm the ticking time bomb of diabetes—the cost of which some people indicate will be £10 billion—before it explodes. Type 2 diabetes is preventable, and we must do all that we can to prevent it. Education, with attention paid by everyone in this Parliament and the regional assemblies, is the way to do that.

John Pugh rose—

Keith Vaz rose—

Mr David Crausby (in the Chair): John Pugh.

10.18 am

John Pugh (Southport) (LD): I am happy to give way to the right hon. Member for Leicester East (Keith Vaz)—in any case, I will make just a few remarks. I pay tribute to his efforts in the House of Commons in this area, as well as those of my hon. Friend the Member for Torbay (Mr Sanders).

I am provoked to make a few remarks by things that other hon. Members have said. I think that we all recognise that diabetes is a major problem. Rates are increasing—it is almost a worldwide epidemic—and it is a killer, linked to a series of other sorts of organ

9 Jan 2013 : Column 90WH

failure. We all recognise and it has been clearly stated that type 2 diabetes is rampant in our society and is lifestyle-related. Diagnosis is important, but I got the sense that that is fundamentally not the problem. We can get diagnosis right. There are clearly failures in general practice, in not picking up the condition early enough, but we do tend to find out who has it and who does not.

The issue appears to be treatment, as has been phrased by most Members. From events that I have attended from time to time in the House, I am aware that the treatment of diabetes is becoming increasingly sophisticated. A series of technology is attached to that nowadays, and we also have the advent of telehealth. All the major practitioners of telehealth are keen to provide better services for diabetics.

Additionally, there is the expert patient initiative, about which I was slightly sceptical when it was launched. The initiative is becoming very effective in connection to diabetes. The charities are playing along with that, too. A lot of good things are going on, but we are recording a variation in practice. There is something of a postcode lottery. I wonder what will prevent that. In which direction will we go?

My hon. Friend the Member for Torbay voiced concerns about the future of NHS Diabetes, but, like the hon. Member for West Lancashire (Rosie Cooper), I wonder how that will play into the new system. There seem to be two ways in which things could go. Without the local primary care trust, there may be, temporarily at any rate, an absence of leadership, because one of the PCTs’ jobs was to manage GPs, to keep them up to the mark and to assess how well they were performing. Clearly, part of the problem that we are addressing today is the failure of GPs, first, to diagnose diabetes early enough and, secondly, to treat it as effectively as they might. It is a fact that, although they are slow to admit it, GP practices in this country can be something of a lottery; they are extraordinarily variable in quality and character. Such features may be more manifest in the new structure.

My hon. Friend the Member for Torbay sketched a more optimistic scenario, however, in which the health and wellbeing boards will become ever more vigilant and keep GPs up to the mark. GPs themselves have suggested to me that one of the best ways to produce good and more standardised practice is peer review, with every GP knowing what other GPs are doing.

I am not sure which of those two outcomes is more likely, but there is great concern that the Department of Health ensures that the right one results.

I am uncomfortable with the thought, as raised by several Members today, that we could simply impose targets and that that would somehow get things right. The hon. Member for West Lancashire and I attended a debate not 24 hours ago on the Liverpool care pathway, in which we considered the corrosive and dysfunctional effects of targets. Once targets are set, we do not always get the results that we want. What, for example, would a target to reduce amputations do? Would it mean people do not do amputations in circumstances where an amputation might be desirable for the patient?

We come back to the perennial dilemma of many of our debates, particularly on specialist conditions, in that we can identify good practice—we can see it, and we miss it when it does not occur—but the national

9 Jan 2013 : Column 91WH

health service has never successfully found the secret of spreading good practice fast enough, which is happening again with diabetes.

10.22 am

Keith Vaz (Leicester East) (Lab): It is a pleasure to follow the hon. Member for Southport (John Pugh). I am tempted just to say that I agree with everything that everyone has said and then to sit down, but this would not be Parliament if we were able to do that, so I will briefly contribute to the debate.

I pay tribute to the hon. Member for Torbay (Mr Sanders), who has dedicated his life in Parliament to addressing diabetes. Obviously, because he has type 1 diabetes, he has become the Commons expert on such matters, and I pay tribute to him for what he has done as chair of the all-party group on diabetes and for all his other work on diabetes.

I come to debates on diabetes as a type 2 sufferer full of optimism, because I want to hear about what other people are doing, but I hear about blindness, amputations, stroke and death, and I feel extremely depressed as I go out. In this debate, hon. Members have talked about amazing ideas and good practice in their own areas. I did not know about the specialist unit in Blaenau Gwent, and I did not know what a bun worry is—I now discover that it is a feast of sweets held in Northern Ireland, from which I am sure that the hon. Member for Strangford (Jim Shannon) is kept away. The key to such debates is that we hear about good practice that we do not hear about in other areas.

I pay tribute to both Front-Bench teams, because they both understand the importance of the subject. I am sorry that I did not get diabetes earlier, because I would have done better at harassing the previous Labour Government on the issue. I was told that I had diabetes only in 2007, and, therefore, I did not dedicate myself to it in Parliament in the way that I should. I will make up for that in the next few years.

We have high hopes for the Minister, and not only because The Times has said that she is one of the rising stars of the new intake, which gives hope to those of us who have reached middle age—I am on the way down, but she is clearly on the way up. We have confidence in her and the way in which she has addressed diabetes in the Department of Health: she has ensured that diabetes is a priority; she has asked questions of the experts, and she has brought together charities such as Diabetes UK, Silver Star and others. She is doing what all good Ministers do, which is never to accept the status quo and to ensure that the Department’s bright civil servants are using their abilities and skills to deliver what Parliament wants.

I welcome what the Government have done to support the Change4Life initiative by backing the advertisements announced only on Monday to encourage people to address obesity by ensuring that they change their diet and understand that, by taking responsibility, there can be a difference. I know it is in the nature of parliamentarians always to blame the Government or to expect the Government to do more, and, yes, we do, but it is also in the hands of individuals.

9 Jan 2013 : Column 92WH

The hon. Member for Strangford carefully considers what he eats in the Tea Room—I have watched him carefully as we line up to get our lunches. When we go to the Tea Room to get a cup of tea before Prime Minister’s questions, we are faced with Club biscuits, Kit Kats and every sweet thing that can possibly be found. I do not know what the English equivalent of a bun worry is, but it is there for us in the Tea Room. Let us start in this House by ensuring that the food available is acceptable.

I also praise my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) for the work that she and the Labour Front-Bench team have done on the proposals not for a tax, which was the subject of my ten-minute rule Bill, but for a reduction in the sugar and salt content of foods, as announced by the shadow Secretary of State. That is a good thing and goes some way towards what Mayor Bloomberg is doing in New York. Actually, the proposal goes further—a tax was not proposed because, of course, Denmark introduced a fat tax but had to withdraw it because of lobbying from the food industry—by showing the need to do something now. The Secretary of State was on television on Sunday, and he agrees with the principles behind the proposal, although he does not support the idea of doing it through legislation. He was looking very cool, not in a suit and tie but in his cardigan, and he said, “Let’s leave it for the industry to do on a voluntary basis.” The industry has had its chance to do something, and we need to move forward.

The Opposition are right. I know that it is in the Opposition’s nature to say radical things, but they are right to press the Government on the proposal because it means that the clever civil servants and, indeed, the clever Ministers in the Department of Health, including the Minister with responsibility for diabetes, will take note and press the industry to react. Ultimately, being able to express such views is important, and I support what the Opposition are trying to do.

I have not mentioned this so far—Members of Parliament usually criticise GPs for not doing enough, and they do not do enough—but in the five or 10 minutes available when people go to their GP, there is not enough time to have a diabetes test and a long chat about diabetes issues. The hon. Member for Gillingham and Rainham (Rehman Chishti) specifically mentioned the south Asian community—the Silver Star diabetes charity, with which I am associated, and Diabetes UK take this seriously—because certain communities are more susceptible to diabetes. He is right to raise that point. However, I think we should be getting pharmacists to do much more. Before she died of diabetes complications, my mum had great faith in her local pharmacist. Pharmacists have more time to talk to people than GPs, who are very busy. We should include them in our forward plans. We have not mentioned them today, but we need to consider them for the future.

I know that the Minister is off to India to speak at a major conference on the issue in Chennai. We have the best diabetes doctors in the world. I happen to have a few in Leicester—Professor Azhar Farooqi, Professor Kamlesh Khunti, Professor Melanie Davies—and there is also Professor Naveed Sattar in Glasgow, as well as many others. They are world-class experts, and we do not use them enough. As the Minister starts on her journey—not quite without maps, because some have

9 Jan 2013 : Column 93WH

been provided in this debate, and the hon. Member for Torbay has one in his back pocket that he has offered to successive Governments over the past 25 years—will she please use the expertise that we have? The world looks to our medical profession as the best in the world. Let us engage them in the work that we do.

10.31 am

Ms Diane Abbott (Hackney North and Stoke Newington) (Lab): I congratulate the hon. Member for Torbay (Mr Sanders) on securing this debate. I am struggling with the aftermath of a new year flu, so I hope that my voice will hold out.

I should declare an interest: I have been diagnosed as a type 2 diabetic. As always, I follow humbly in the footsteps of my right hon. Friend the Member for Leicester East (Keith Vaz); I have spent 25 years doing that. I am grateful for the opportunity to speak on behalf of Her Majesty’s Opposition about diabetes, one of the leading health threats in the UK. As we have heard, there are 3.7 million people in this country living with the disease. As we have also heard, it is a particular issue for people of south Asian and African and Caribbean descent in our big cities. I am hopeful that one thing that will emerge from the changes to the NHS is more local targeting, both by clinical commissioning groups and in public health, of local issues and local demographics. We cannot engage with diabetes unless we also engage with local specifics in our cities and regions.

As we have heard, diabetes costs the NHS one tenth of its budget—more than £10 billion a year. We have heard in detail about foot care and amputations, but the general problem is that diabetes is a gateway condition to hypertension, stroke, kidney problems and amputations, leading to early death. I was struck by the figure given by my hon. Friend the Member for Blaenau Gwent (Nick Smith) of 23 amputations in Blaenau Gwent. It makes one stop to think about the human reality of diabetes in communities.

The fact that diabetes is a gateway condition makes early diagnosis and engagement so important. It is important to be mindful of the new NHS architecture. It is not just a question of asking Ministers to do more; we must also take the debate to a local level, with CCGs and directors of public health, because healthy living issues will fall to directors of public health and local authorities, rather than Government, to deliver. We can also look to local authorities that have been innovative about healthy living issues by offering free swimming lessons and so on.

We have heard about the basic health service treatments and checks that people should have. The Minister will be aware that the Public Accounts Committee’s report was critical of the management of adult diabetic services in the NHS. The report said that every year, 24,000 people with diabetes die simply because their disease has not been effectively managed. That is not a satisfactory figure in the 21st century for one of the world’s leading economies. Although people now know what needs to be done for people with diabetes, the Public Accounts Committee found that progress in delivering the recommended standards of care and achieving treatment targets has been depressingly poor.

What is the Department’s response to the Public Accounts Committee’s report? What can the Minister tell us about improvements in policy and service in line

9 Jan 2013 : Column 94WH

with the Committee’s recommendations? Does the Department of Health have a plan for ensuring the effective implementation of the NHS health check programme after the NHS reorganisation in April?

I would also like to say a word about children and young people with diabetes. As many as one in four young people are diagnosed with type 1 diabetes. The UK has the highest number of children diagnosed with diabetes in Europe and, sadly, the lowest number of children attaining good diabetes control. Christine Cottrell, a diabetes nurse specialist from Warwick, told The Daily Telegraph last July:

“We are even getting children as young as seven with Type 2 diabetes”.

It is an important public health issue, and the prognosis is not good:

“These children end up having heart attacks, or losing a limb, or their sight, in their 30s and 40s.”

I know that it is difficult in a Westminster Hall debate to bring up issues that cut across Departments, but has the Minister had discussions with her colleagues in the Department for Education about what support could be offered to schoolchildren and young people to manage their diabetes effectively and prevent the development of early complications? What efforts are being made to ensure that both staff and pupils are aware of the nature of diabetic epileptic attacks, which can take place in schools, and the best way to assist sufferers in an emergency?

What steps are the Government taking to increase the number of people not previously diagnosed with diabetes who receive diabetes testing? What was said earlier about the role of pharmacists was an interesting suggestion. Do the Government have a plan in place to make the public aware of the symptoms of diabetes sufferers? Are there any plans for a nationwide public awareness campaign? On prevention, we know that the new NHS commissioning board will be mandated to prevent diabetes. I know that it is perhaps not reasonable to say that GPs do not perform things that are not targeted exactly as well as things that are, but is the Department considering introducing diabetes testing targets for GPs?

The Public Accounts Committee inquiry to which I referred earlier heard that out of 20 trusts that needed to improve their diabetes care, only three accepted the offered help. That is not reassuring. How can the Minister ensure that care through health providers meets the targets set by the Secretary of State? As clinical commissioning groups and directors of public health take over some of those responsibilities, what can the Department do to ensure that diabetes is on their agenda?

On some of the more general issues around diet and healthy eating, although diabetes management, foot care and preventing diabetes from becoming a gateway to even more serious conditions are important, the most important thing that we can do in medical and public health terms is consider diet and healthy eating and other prevention matters, particularly for young people. Most experts agree that the excessive consumption of sugar is a factor in both obesity and diabetes. Increasingly, people are saying that sugar is addictive.

Colleagues have mentioned some important things to engage with in terms of policy, such as minimum pricing for alcohol, about which the Government are consulting

9 Jan 2013 : Column 95WH

and which is supported by Opposition Members. We suggest looking at the sugar composition of some foods, particularly those targeted at children. Most parents want to do their best, and I hope that the advertising campaign launched by the Minister will shed some light on such issues for parents. However, how many parents know that Coco Pops are one third sugar? People joke about it, but although most parents would not sit their child down to breakfast and put a bar of chocolate in front of them, they will give them a bowl of Frosties or some children’s cereal, which can have a higher proportion of sugar than a bar of chocolate. Opposition Members are saying that we need to consider legislating to ensure that the proportion of sugar in some foods that are directly targeted at children can be brought down.

I am glad to advance Her Majesty’s Opposition’s position on diabetes. I congratulate the Government on what they have done up until now, but there is more to be done, both in locking in a concern for diabetes locally when clinical commissioning groups and directors of public health take up their new responsibilities and dealing with the broader issues of healthy eating and a healthy lifestyle and the preponderance of sugar in modern processed food.

10.41 am

The Parliamentary Under-Secretary of State for Health (Anna Soubry): It is a pleasure, as ever, to serve under your chairmanship, Mr Crausby. I pay tribute to my hon. Friend the Member for Torbay (Mr Sanders) for securing this debate and to every hon. Member who has spoken. As you may have gathered, Mr Crausby—and as those hon. Members who have heard or will hear or read about the debate will gather—this is a huge topic. We could have had a 90-minute debate simply on diabetes 1 and diabetes 2. We could have other debates about the causes of diabetes 2. I am the first to put my hands up and admit that, until I was lucky and fortunate enough to be appointed last September to the position that I hold, I did not know a great deal about diabetes, but, goodness me, I have learned a great deal in the months since my appointment. I thank the all-party group on diabetes, chaired by my hon. Friend, for all the great work that it does. I paid the APPG a flying visit and learned a lot; a number of matters were raised with me that caused me great concern.

I hope that you will forgive me, Mr Crausby, if this sounds like a mutual admiration society, because in many ways it is. The right hon. Member for Leicester East (Keith Vaz) and I go back many years. I pay tribute to him for all the work that he has done. I know about his Silver Star charity and I look forward to its coming to Beeston in my constituency and to the van doing some work there. That highlights one thing that has come out of this debate and goes to the heart of the Government’s reforms of the NHS: the remarkable work that can be done and now has to be done locally to ensure that we improve the diagnoses and treatments—in addition to other matters raised by hon. Members—because it is fair to say that, although many localities share common themes, this disease will be more prevalent in certain communities, even down to ward level. My hon. Friend the Member for Southport (John Pugh) raises

9 Jan 2013 : Column 96WH

concerns and, as ever, ideas. My hon. Friend the Member for Torbay makes a good point about how we can ensure that these improvements are delivered locally.

I pay tribute not only to the work of Silver Star, but to Diabetes UK, which must be an outstanding charity, because such was its ability to campaign on this issue that it persuaded Mr Paul Dawson, a constituent of mine who has suffered from diabetes 1 for many years, to visit me on Friday. I thought that that was just a remarkable coincidence, but he told me that Diabetes UK suggested that he visit me. The serious point is that he raised concerns, as a sufferer of diabetes 1, that I had heard at the APPG, so I had already taken up many of those, notably what seems to be a rationing of strips. Frankly, this is bonkers; people with diabetes who use strips need to use them and often need to use many in a day. I am not happy if there is any form of rationing of those strips. I have already met officers in the Department and inquiries are being made of primary care trusts, and beyond. Mr Dawson also told me about the great advances, which I have already alluded to, that have been made in medicine, which my hon. Friend the Member for Southport and others have mentioned.

I have been asked a number of questions and I cannot answer them all in the short time available, but I undertake to answer every question in letters.

Ms Abbott: The issue of rationing strips has been brought to my attention. What would the Minister suggest that people do if their general practitioner is attempting to ration strips?

Anna Soubry: I am concerned about it. It is unacceptable. I have already held a meeting with my officials and they are making further inquiries. I discussed with Mr Dawson what was happening locally in CCGs, which is where this will make a difference, when we see the power of our doctors and other health professionals to commission services, and the power and influence that patients and sufferers of diabetes will have. I am told that NHS Diabetes has now identified a diabetic lead in every CCG. There is an opportunity, through the reforms, to ensure that we now deliver locally as we should. All hon. Members who have contributed to this debate have identified a failure in respect of good outcomes and good practice throughout the NHS, right through to local level. That needs to be, and is being, addressed as a matter of urgency.

I have been alerted to problems with glucose meters and pumps—various new advances in technology. Some of this excites me. However, I am still concerned if there is not the availability that there should be, right across the NHS, notably for all sufferers of diabetes 1.

Jim Shannon: It is not just about the provision of the insulin pumps; it is also about training. There are two facets to that.

Anna Soubry: Indeed. I was going to end this part of my speech by saying that my constituent, Mr Dawson, paid tribute to what he described as his brilliant diabetic nurse at the Queen’s medical centre in Nottingham. He highlighted, as the hon. Gentleman has done, that it is all well and good having wonderful, great technology, but if people have access to it they need, critically, the support to be able to use it themselves. We must ensure

9 Jan 2013 : Column 97WH

that they have the highest-quality support, not just from their GPs, but from diabetic nurses and others who are trained and specialise in this condition.

Diabetes is common and is increasing, as hon. Members have mentioned. It is estimated that, by 2025, 4 million people will have diabetes.

Nick Smith: What are the Minister’s views of Mayor Bloomberg’s plan in New York to ban super-sized soft drinks in cinemas? Does she agree that that could be a good symbolic action that would help bring down diabetes?

Anna Soubry: It could be, but I make it clear, as I said on Monday in various media interviews, that at the moment the responsibility deal is working, which is why we have some of the lowest salt levels in the world. Other countries are coming to us to find out how we have achieved that by working with industry, retailers and manufacturers to reduce salt levels. On the reduction of trans fats, under 1% of our food now has trans fats in it. Again, we have done that by working with the manufacturers and retailers.

My natural inclination is against legislation, and I say that as an old lawyer. At the moment, I am confident that the responsibility deal is delivering in the way that I want it to. I make it clear that, if there is a need to introduce legislation, we will not hesitate to do that. I am almost firing a warning shot across the bows of the retailers and food manufacturers and saying, “Unless you get your house in order and accept responsibility, we will not hesitate to introduce legislation or regulation, because we know that we in this country have an unacceptable rise in obesity, to levels that are second only to those in America.” I will therefore consider everything. I always have an open mind. I am currently content, however, that the responsibility deal is delivering, but it has a great deal more to do. I hope that those who are signed up to the calorie reduction scheme later this month will encourage more manufacturers and retailers to sign up to the responsibility deal on calories. I want to ensure that we make some real, serious and tangible progress.

Ultimately, however, as the right hon. Member for Leicester East and the hon. Member for Strangford (Jim Shannon) identified, the responsibility is ours. Nobody forces us to eat the sugar buns or whatever it may be. When we go into the Tea Room and we are faced with the choice between fruit or a piece of cake, my natural inclination might be for a piece of cake, especially since I have developed a sweeter tooth as I have got older and since I have stopped smoking. We all make the choice whether to eat a piece of cake. The ultimate responsibility lies with us as individuals and as parents, but I always have an open mind.

Diabetes is a growing problem and a major factor in premature mortality with an estimated 24,000 avoidable deaths a year—10% of deaths annually are in people with diabetes. A variation exists in the delivery of the nine care processes, with a range of 15.9% to 71.2% achievement across PCTs, which is not acceptable. However, 75% of diabetes sufferers receive eight out of the nine care processes, which is a huge improvement. In 2003-04, only 7% of sufferers received all nine care processes. In 2010-11, that figure was at 54.3%, but there is much more to be done. In the coming months, several documents will be published to guide the NHS in delivering improved

9 Jan 2013 : Column 98WH

diabetes care, including the response to the Public Accounts Committee report, the work undertaken on diabetes as a long-term condition and the cardiovascular disease outcome strategy.

We must ensure that people get an early diagnosis. I must commend again the work of Diabetes UK. Other hon. Members have mentioned how it is raising awareness of the early signs and symptoms of diabetes with its latest campaign on the 4 Ts, which has my full support. One in every two people diagnosed with diabetes already has complications. I thank the hon. Members for West Lancashire (Rosie Cooper) and for Blaenau Gwent (Nick Smith) for their contributions. I will not be able to answer their points specifically in my speech, but I hear what they say and will write to them if necessary to answer their questions. I am acutely aware of the complications and the devastating effects that those can have on people’s lives.

Mr Sanders: Can the Minister respond to the important point made by the right hon. Member for Leicester East (Keith Vaz) about pharmacists? Some private pharmacy groups offer diabetes tests, which other pharmacies should be encouraged to do. I hope that we can see the roll-out of more collaborative working between the private sector and the health service in order to identify people with diabetes, so that they start to get treated.

Anna Soubry: I am grateful for that intervention not only because I was coughing but, most importantly, because I was going to mention that subject only in passing. I will now expand on that a little. I absolutely agree with the points of my hon. Friend and the right hon. Member for Leicester East about the importance of pharmacies. They are important for so much of the NHS’s work, but here is a good example of where we can link them in far more with delivering the successes, outcomes and diagnoses that we need so desperately. There is absolutely a role for pharmacies, and I look forward to clinical commissioning groups, which are already thinking in new ways about how to deliver better health care at a local level and working in exciting and imaginative ways, collaborating with pharmacies far more than has been done before. It is a good point, and I hope to see more action on it.

When people get a diagnosis, we need to ensure they are managed according to the latest clinical guidelines. The quality and outcomes framework, introduced in 2003-04, has incentivised primary care to perform the nine care processes for people with diabetes, but we know that there are difficulties—I have given the figures—and not enough people are receiving all nine. The National Institute for Health and Clinical Excellence has been asked to review the quality and outcomes framework and diabetes indicators, and we await its response and findings.

Last year, the National Audit Office reviewed the management of adult diabetes services in the NHS. While that highlighted the progress made over the past 10 years, it also highlighted the unwarranted variation that exists across the NHS and the significant challenges that we face over the next 10 years. There is no excuse for poor diabetes care. No one with diabetes should lose a leg or their vision if it can be prevented. We know what needs to be done and we need to ensure that we meet the challenge head on.

9 Jan 2013 : Column 99WH

The prime objective of the NHS Commissioning Board will be to drive improvement in the quality of NHS services, and we will hold it to account for that through the NHS mandate, which makes it clear that we expect to see significant improvement in the outcomes, diagnosis and treatment of diabetes. In addition, through the NHS outcomes framework, we will be able to track the overall progress of the NHS on delivering improved health and outcomes. Diabetes is relevant to all five domains in the outcomes framework, so when work programmes are developed it is important to consider diabetes and how optimising care can deliver improvements.

My hon. Friend the Member for Torbay asked specifically about NHS Diabetes and whether it will continue to play a central role. NHS Diabetes is one of six current improvement organisations that are being replaced by the new NHS improvement body in the NHS Commissioning Board. In the overall context of what I have said, I hope that he will take comfort, will believe and be sure that diabetes is something that the NHS Commissioning Board has put much higher up its list of priorities. It is aware that much more needs to be done and is the ultimate driver of all of that.

Many hon. Members have mentioned diabetes 2, which is largely, but not always, a preventable disease. I have already paid tribute to those hon. Members who have raised the issue both in their local communities and nationally.

I want to end my comments by discussing an undoubtedly serious problem in our society, which is that almost all of us eat too much. We are overweight. Some 60% of adults are either overweight or obese. As a society, we find ourselves in a situation where one third of our 11-year-olds—our year 6 pupils—are either overweight or obese when they leave primary school. Those figures should truly shock each and every one of us, and something can be done about the problem. We can all take responsibility for how we feed our children and for our own lives and diets and what we eat and drink. The Government, however, can also do things, especially at a local level. When health and wellbeing boards identify the needs of their communities, if it is not a unitary authority, they can work with borough councils.

My hon. Friend the Member for Torbay made a good point about leisure services. We are already seeing evidence in shadow form. In my constituency, GPs are issuing prescriptions for activity, and the borough council is offering real assistance. It is almost as if there are no excuses not to go along to the various leisure centres and take up a class or gentle exercise. We even have walking football in Broxtowe. The point of all this is that local authorities are beginning to knit together all the various services to ensure that we all live longer, healthier and happier lives. The ultimate responsibility is ours, but local and national Government can do so much. It is all coming down to a local level. When we see the roll-out in the spring, I am confident that we will see great progress.

9 Jan 2013 : Column 100WH

Local Government (Leadership)

11 am

John Stevenson (Carlisle) (Con): It is a pleasure, Mr Crausby, to serve under your chairmanship today. I am delighted to have the opportunity to bring to the attention of the Chamber leadership in local government and to debate it. My hon. Friend the Member for Cleethorpes (Martin Vickers) will want to contribute. A debate on leadership in councils could last for days. Many people will have many different views on leadership, good and bad, and on what is happening in councils today. However, the purpose of the debate is to consider one narrow point: leadership in councils.

When I became an MP in 2010, I visited organisations in my constituency, as did many of my colleagues in their constituencies. Some of those organisations are in the private sector, and many are large and small businesses. The key issue that struck me, having visited both private and public sector organisations and institutions, was leadership and management. My general observation was that if an organisation has one or the other—leadership or management—it can function reasonably well. If it has neither, clearly it is likely to run into difficulties. If an organisation, whether in the public or private sector, has both, it tends to be a great success, and I am aware of those in my constituency that have good leadership and good management, and are doing a terrific job.

Some local businesses are successful, and some public organisations are able and perform well. However, there is a subtle difference between the private and public sectors. If private sector organisations do not have good management and leadership, they run into difficulty and will either go bust or be taken over by another organisation. The difficulty is that, if they cannot be suddenly taken over or cannot go bust, there is a danger that they may become weak and ineffective. The importance of leadership and management should not be underestimated, and the difficulty for Governments of all political persuasions is how to deal with underperforming public bodies. Obvious examples are schools and hospitals. How can they be dealt with when they begin to fail because they have not been provided with correct leadership or good management? That is an issue for all Governments.

A key organisation that has an important bearing in all our constituencies is local government. Local authorities are subtly different from other public sector organisations because they are elected, and the beauty of elections is that they provide new leadership and new emphasis and direction. A mechanism exists for change.

Karen Lumley (Redditch) (Con): I thank my hon. Friend for securing this important debate. Does he agree that, in these difficult economic times, strong leadership is vital in local government, and will he join me in congratulating Adrian Hardman, leader of Worcestershire county council, which was ranked the third highest performing council in the country, despite being the third lowest funded?

John Stevenson: I am grateful for my hon. Friend’s intervention. I agree that that is a prime example of good leadership in local government, and I will touch on that.

9 Jan 2013 : Column 101WH

Rehman Chishti (Gillingham and Rainham) (Con): I congratulate my hon. Friend on securing this important debate. He has raised the matter of strong leadership in many debates, and I also congratulate him on that. Does he agree that unitary authorities, which have a cabinet-style model of leadership, provide the best form of local government in terms of value for money? Medway council, on which I still serve—I was a cabinet member—is led by Councillor Chambers and has been rated as providing good value for services.

John Stevenson: My hon. Friend raises an interesting point, and we could have a separate debate on unitary councils alone. For the record, I wholeheartedly agree that unitary councils are the correct direction for local government, and I will certainly advocate that when I can.

Leadership and management in councils are central to the economic success not only of individual communities and local authorities, but of the wider economy and the whole country. They are also important for the provision of efficient and well-delivered services, which may range from collecting waste to social care. We have a tendency in this country to underestimate the importance of local government. It is extremely important and should play a much bigger role in our national affairs. It is commonly accepted, probably across the political spectrum, that the country is far too centralised. Direction and instructions come from the centre and tell local government what it should do.

I accept that the Government have tried to redress the balance. I fully support what they are doing, and I would encourage them to go further. I give them credit for the work that they have done, and I fully support them in their direction of travel. However, there are cultural barriers. At the centre, Whitehall thinks it knows best, and likes to tell local authorities so. In turn, there is a failing at town hall level. Town halls are not used to taking the initiative or providing distinct local leadership. That should change, which is why I am concentrating on local leadership.

The present regime includes many able and effective leaders—my hon. Friend the Member for Redditch (Karen Lumley) indicated that she has an able and effective county council leader—but we must accept that there are many ineffective councils with poor leadership and management, although some have difficulties because they must often deal with the machinations of local politics. Some parts of the country are effectively a one-party state. That may not be healthy for democracy, and it creates problems because of internal squabbles within political parties. In hung councils, parties compete for political leadership, and the most able people often do not lead the council because of inter-party debates and tensions. We cannot get away from the fact that some places have poor-quality councillors, and that the job does not attract the most able people. That is an issue for us all across the political spectrum.

What are the solutions? I believe that we should have more elected mayors. Do people know who their council leader is? I went along to a sixth-form school in my constituency and talked to 50 or 60 able students who were all interested in local affairs. My first question was whether any of them could name their local council leader. My second question was whether any of them could name their county council leader. Not one of

9 Jan 2013 : Column 102WH

them could name either, but if the same questions were asked in London and some other parts of the country with elected mayors, I suspect that at least a good proportion could name that person.

Elected mayors provide visible and clear leadership, which is transparent and accountable. People know who is in charge and responsible for local affairs. They have a four-year mandate, and they have the opportunity to carry out their manifesto commitments and to implement policy. They also provide democratic accountability, which is important. There are one-party councils throughout the country, and the introduction of an elected mayor would add a different dynamism to such areas. Independents could be elected, and a party that will never be in control of a council would have a chance to have their political views expressed through the elected mayor.

The Government have taken a top-down approach to date. After the election, they were committed to the introduction of elected mayors in 12 of our largest cities. From my perspective, I was very disappointed that they were rejected in nine of the areas where there was a referendum. Nevertheless, out of those 12 large cities, three have gone down the road of having an elected mayor. That is a 25% success rate. My view, therefore, is that we should try a bottom-up approach, by encouraging local communities to take the initiative, rather than imposing it on them.

Referendums have been held up and down the country for elected mayors, promoted by local initiatives. The success rate has again been around 25%. Some people would say that that is a poor result and that the policy is a failure, but we have to look at the nature of referendums. As a general rule in referendums, people tend to stay with the status quo. We see that time and again in this country, and certainly in other parts of the world. There is an inherent conservatism within the electorate to remain with what they know, rather than taking on something different.

Local referendums have been hindered to a large extent—dare I say?—by the self-interest of local councillors and local organisations, such as councils themselves, which have been reluctant to see elected mayors being introduced. I believe, however, that support for them is widespread and much deeper than we think. Yesterday, I was at a meeting with Lord Heseltine, interestingly enough, who is not only a big enthusiast of unitary authorities, but a strong supporter of elected mayors. He in turn has been greatly supported by Lord Adonis, who is also a great fan and supporter of them. Both believe that elected mayors are the future drivers of success in local government.

How will we achieve that bottom-up approach? We could look at the legislation. At present, legislation lays out certain criteria before the role of a mayor can come into effect. As everyone will know, there is a petition, then a referendum, and only on the success of a referendum is the structure changed. The key for any area is getting a valid petition to initiate such a referendum. At present, the requirement is 5% of the electorate, which is a barrier that, in my view, is far too high. To take my area as an example, for Carlisle district council, a petition requires 4,500 signatures, while 20,000 signatures are required for Cumbria county council. I suspect that the figures would be much higher in other areas, as ours is sparsely populated. I genuinely believe that the number is prohibitively high—5% is far too high.

9 Jan 2013 : Column 103WH

What is the goal? I would like the leadership of local authorities to become more open, more accountable and far more dynamic. They should be able to provide innovation, with new ideas, and bring in a real period of local government, by taking the lead and producing political leaders who are known, respected and make a contribution to their local areas.

Rosie Cooper (West Lancashire) (Lab): The hon. Gentleman has concentrated so far on local political leadership, making comments that apply to all political parties, and I very much endorse some of what has been said. However, the flipside is that, over the past few years, we have seen a contraction in the size of local government, especially smaller district and borough councils, and with that, we have experienced highly skilled chief executives leaving the sector. Does the hon. Gentleman agree that that leadership gap has seen officers over-promoted, which has been to the detriment of council tax payers and the standard of service that they receive? I agree that we should move towards unitary authorities, but it is not a one-horse race. We need both components, with really good, on-the-ball chief executives. I would probably say that I agree that unitary authorities are the way to go, but with ever smaller services and good people moving, just filling the gap will not do.

John Stevenson: The hon. Lady makes a very good point. I go back to my initial comments when I mentioned leadership and management, because the two go hand in hand to a certain extent. With local authorities or any organisation, whether private or public, if the two go together, the organisation ends up being fantastic. When there is only one, it can work, but it is more problematic. When there is neither, it is a problem.

Rosie Cooper: I wonder whether the chief executive mentioned by the hon. Member for Redditch (Karen Lumley) would like a free transfer.

John Stevenson: What the hon. Lady said is absolutely right, and I am concentrating principally today on leadership and political leadership. However, we could have a debate just on the management—let alone the leadership and the management—at a future date.

My view is that elected mayors are the way to help achieve real leadership in local government. We should let communities up and down the country decide whether an elected mayor is right for them, and we should make it easier to allow petitions to succeed. Does the Minister agree that leadership is vital to the success of councils? Does he support, as the Prime Minister does, the idea and concept of elected mayors, and would he like to see them spread across the country? Would he assist in making it easier to initiate such referendums?

My real question for the Minister is how we achieve that. I would like—I am interested to hear his comments—a reduction in the required percentage of local people who need to sign the petition from 5% to 1%. The previous Government contemplated lowering the threshold. Going back to my example of Carlisle, if the threshold were reduced to 1%, only 800 signatures would be required for the district council, and if I get my maths

9 Jan 2013 : Column 104WH

correct, 4,000 would be needed for the county council. It would then become entirely feasible and people would go out and actively seek signatures. That is my first question for the Minister.

Secondly, does the Minister agree with extending the period that a petitioner who is campaigning for this can use the signatures on the petition from one year to two years? At present, such a person has to use signatures from people who support the petition within a 12-month period. That may seem an awfully long time, but if someone is working full time and doing this on an ad hoc basis, time passes. To get the requisite number of signatures can take time, and in the example of Carlisle, even if the figure drops to 800, it is still a time-consuming business. Will the Minister consider increasing the period to two years?

Finally, in this age of modern technology, it would seem eminently sensible—indeed, people would expect it—for petitions to be online. At present, there has to be a physical signature on a piece of paper. We have lots of ways of dealing with modern communications and how we produce petitions. Doing them online would be an eminently sensible solution, and it would make it easier for people who want to push forward a petition to achieve the requisite numbers.

I might be wrong, but I believe that much of that could be dealt with by delegated legislation, and I hope that the Minister will confirm whether that is the case. I genuinely think that this is an opportunity to transform local leadership in local councils. In turn, I believe that it would transform the performance of local councils, benefiting local communities and the country at large. It would help growth in our communities, and I believe that it would help to vindicate the Government’s localism agenda. I look forward to the Minister’s response.

Mr David Crausby (in the Chair): I will allow one short contribution before the Minister responds.

11.17 am

Martin Vickers (Cleethorpes) (Con): Thank you, Mr Crausby. I congratulate my hon. Friend the Member for Carlisle (John Stevenson) on securing the debate.

I served as a councillor for 26 years, with 14 of those on a district authority, which was then transformed into a unitary authority. I entirely concur with previous comments that unitary authorities are the way forward, and I would like to see the Government make more positive moves in the right direction. I also entirely agree that it is desirable for those authorities to be led by an elected mayor. Mayoral positions attract those who have not previously been drawn into local politics. That is good, because it enlarges the pool of talent that is available, and it provides necessary links between business and politics. In the short time available, I want to add one or two points to what my hon. Friend has said.

In Lord Heseltine’s excellent report, he talks considerably about a sense of place and local identities. I know that the Government, like the previous Administration, are drawn to city regions and the boost to a local economy that they can give, and they are even, I believe, considering the possibility of elected mayors for those regions. Although I support that, the city region itself must have a sense of place. My area of Humberside most certainly

9 Jan 2013 : Column 105WH

does not. I, and many others, spent 20 years of our political lives fighting the previously imposed county of Humberside. There must be a clear sense of identity.

We can move on from the lost mayoral referendums of last year. I hope that areas such as my own in north-east Lincolnshire can steal a march on the cities that rejected mayors by grasping the nettle, moving forward and going for an elected mayor themselves. That is why I very much support my hon. Friend’s comments that we must bypass local councils and local councillors, who are a blockade to that; for various reasons, they oppose it. Therefore, I would very much support moves to reduce the threshold and give local activists and local people opportunities to move forward in that direction.

11.20 am

The Parliamentary Under-Secretary of State for Communities and Local Government (Brandon Lewis): I congratulate my hon. Friend the Member for Carlisle (John Stevenson) on securing the debate and I am grateful to him for giving us the opportunity to air a hugely important issue. I join colleagues who have congratulated him not just on today’s debate, but on the way he has brought up the topic over the past few years. It is a key issue. He is right about that. Effective local leadership is vital and possibly more important today than it has ever been. Up and down the country, areas face huge challenges in local government. Service delivery is becoming increasingly complex. An ageing population presents areas with real challenges. Efficiency savings are required. Partnership working needs good, strong, clear leadership. Another challenge involves community engagement, particularly now that we are in a social media-led environment. I shall come back in a few moments to my hon. Friend’s comments on digital issues.

We face real challenges, particularly in ensuring economic growth. We believe that the best way to do that is for it to be driven locally. The key to dealing with those challenges comes from our towns and cities. It is about strong, inspirational leadership that can take the challenges on, and not just see them as challenges but make them into opportunities.

I disagree to an extent with the comments of the hon. Member for West Lancashire (Rosie Cooper) about the leadership gap when we lose chief executives. We need to be clear that in some areas and particularly some small districts, the days of big, expensive, silo management teams are gone. Just financially, they are history. People have to work together and share good chief executives to get the good management that has been commented on. I agree with the hon. Lady that good political leadership, with good management, gives that magic option, but I have to make it clear that my view is very much that the leadership of a council for an area should come from the political leaders. If we go down the road of saying that a chief executive is part of the leadership, that can only be because our councillors are not doing their job. Our councillors are there to make decisions, to deliver, to lead and to represent their community. Our officers are there to give good advice and to implement the decisions made by councillors.

The comment about directly elected mayors, which I will come to in a second, highlights the importance of leadership from the political leaders. We must never

9 Jan 2013 : Column 106WH

underestimate that, and we must congratulate those leaders throughout the country who put so much time and effort into their communities. Actually, that applies to all councillors, but I am thinking particularly of the leaders who step to the forefront, take that leadership seriously and move their communities forward. Whether they are mayors or just elected leaders, they do all our communities and our country a great service.

Cities are a good example of where the Government are recognising this leadership. Our belief in strong local leadership has meant that it is one of the asks for the city deals. We have made it clear that if cities want significant new powers and funding streams, they need to demonstrate clear, strong, accountable leadership. Cities with directly elected mayors have clearly shown that.

Several hon. Members have spoken in favour of mayors. My hon. Friend the Member for Carlisle has regularly made comments about directly elected mayors. Particularly in the case of single-tier authorities, they can be a hugely beneficial step forward, with real power and real ability to deliver on the ground for their communities. I share my hon. Friend’s view—I can answer that question directly—that it would be good to see more of them around the country. I am interested in looking at how we can motivate people and encourage more of that to happen. I shall come to my hon. Friend’s three specific asks in a moment.

I am pleased that we are at one on this particular issue. Directly elected mayors can and generally do provide good, strong, clear and visible local leadership. My hon. Friend highlighted that very well in his description of the meeting at the school. He makes a very strong point about the accountability of the role of mayor. A directly elected mayor does seem to have recognition in a community that goes beyond that of an elected councillor. There is, therefore, increased—clear—accountability. People understand exactly who is in charge, who is making the decisions, who is accountable. That transparency fits perfectly with the localism agenda with which we are moving forward.

There is a very strong case on this issue. Research undertaken in 2005 shows that the democratic mandate provided by directly elected mayors has

“provided a basis for a stronger, more proactive style of leadership than other models.”

We have seen how mayors around the world have reinvigorated their cities. I am thinking of places such as Frankfurt, New York and Lyon. That has also been the case on our own doorstep, in London. The mayors—the office holders—become very well known. That highlights again the clear accountability and understanding of who is responsible—who is in charge. The Mayor of London, particularly, I would say, over the past four years, has transformed the city. In the 12 years of its existence, the London mayoral office has been hailed across the world for its influence in raising the profile of the capital and for securing major projects that the city needs, from Crossrail to the Olympic games.

Of course, in addition to the Mayor of London, we now have, as my hon. Friend said, new mayors in three of our biggest cities: Leicester, Liverpool and, most recently, Bristol; I have already met the mayor of Bristol a few times. In our “Mid-Term Review”, published on

9 Jan 2013 : Column 107WH

Monday, hon. Members have seen that we are proud to record that we have enabled the people of those cities to join London in choosing a directly elected mayor.

My hon. Friend the Member for Carlisle has outlined a number of measures that he feels would make it easier for communities to bring about mayoral governance in their area and to see that happen from the local community up, rather than central Government deciding that an area should have a referendum. I am attracted to any measures that will allow areas to adopt good, strong, effective leadership, which an elected mayor can provide and which is vital to their success.

Let me deal with my hon. Friend’s three points directly. The first concerns the petition for governance and the idea of a change in the threshold. He is right to say that we can change that by amending existing secondary legislation, so it is not difficult to do. I shall do some further work and invite my hon. Friend to come and have a conversation with the Department about that. I am cautious about it, but I am open-minded. Let me explain why I feel some caution about it. We want to make it easy for people, when there is a genuine need and desire in a community to see clear accountable leadership, to move forward and have a vote for it. We also need to avoid small interested parties being able too easily to get something that does not have full community support. There is a balance to find on the size—the proposal is to move from 5% to 1%—and the implication that that would have in different areas. As my hon. Friend says, having to find 20,000 votes is different from having to find 1,000 votes. That depends on whether it is happening at the level of a small authority, county level or whatever it happens to be. There is a bit of work to do on that. I am happy to look at it, but I shall work with my hon. Friend to see whether we can come up with something that might deliver what he wants without going too far and getting the wrong result in the wrong areas.

9 Jan 2013 : Column 108WH

My hon. Friend’s second query was about the time frame for collecting signatures. Again, I am willing to look at that, but I think that it goes in tandem with point one, in that I suspect that if we were looking at a lower threshold, there would be less need to expand the time frame. If we do not lower the threshold, there is a stronger argument for widening the time frame. It is probably one or the other. We can consider those points in tandem. As I said, I shall work with my hon. Friend on that.

With regard to e-petitions, I can be slightly more direct and positive, in that I think my hon. Friend makes a very good point. I think that we are moving towards those days when far more things will be, whether we like it or not, done online. We certainly should be looking at how we can move forward with that. The coalition’s e-petition website has already had 17 million visits, with a total of 36,000 petitions submitted and almost 6.5 million signatures. That equates to roughly 12 people signing up every minute since it came into force. I support my hon. Friend’s suggestion of allowing electors to support a petition online, and we can look at how we deliver that—how we can make it possible. It was a very good point that we should look to move with.

I agree with my hon. Friend that leadership in a local community is vital. We should give great credit to the leaders who provide that around the country for their communities. They do a great job, as do all councillors who go out and work for their communities. Where we can move forward to make that more accountable and more transparent and have clear accountability through directly elected mayors, and where that would be practical for communities and is something that they want, it could be a very good move forward for them. I am happy to work with my hon. Friend to see whether we can deliver that to strengthen our democracy and our local communities.

11.29 am

Sitting suspended.

9 Jan 2013 : Column 109WH

Living Wage

[Mrs Anne Main in the Chair]

2.30 pm

Teresa Pearce (Erith and Thamesmead) (Lab): It is very welcome to be serving under your chairmanship, Mrs Main. I think that this is the first time that I have done so. I thank everyone for attending what I believe is a timely debate.

The campaign for the introduction of a living wage unites many organisations, charities and people in pursuit of social justice. There is a clear moral case for a living wage: as a society, we should ensure that the minimum wage that workers are paid allows them to lead a decent life, a life with dignity, and does not require people to have, as some in my constituency do, two or three jobs to try to make ends meet, leaving them no time for their children or the rest of their family, or to contribute in any other way to society.

At the same time, there is increasing recognition of the business benefits that being a living wage employer can bring. Many living wage employers see it as almost a fair trade mark: it marks them out as separate from other employers and indicates that they are employers of choice. I think that that is very welcome. A living wage employer also attracts better-quality staff and gains a reputation for good corporate social responsibility. Paying the living wage also reduces absenteeism and staff turnover. It is about giving workers the respect and the pay that they deserve for the work that they do.

I am pleased to say that many people are now paying the living wage, including some councils, such as Lewisham council and Birmingham city council, and private sector employers, such as Aviva and my old employer, PricewaterhouseCoopers, as well as KPMG. They have already volunteered to adopt the living wage and, if the press reports from late last year are correct, three Departments are also now considering introducing it. Late last year, Labour said that it was looking at making public sector contracts conditional on workers being paid at least the living wage and possibly naming and shaming companies that pay their workers less. More MPs are also advertising internships that pay the living wage, which is a very welcome development, as we should be leading the way on fair employment practices. We should lead by example. I do not want to be part of an organisation that says, “Do as I say, not as I do.” For that reason, I do not use unpaid interns and always pay interns at least the living wage. I am very pleased that that is now becoming the practice in the House. Those have all been welcome steps towards making the living wage the norm in our labour market and they make the debate particularly timely.

However, there is one angle to the debate about introducing the living wage that I think needs to be given greater consideration and discussed. If one of the large and vastly profitable supermarket chains or fast food chains had their electricity bills paid by the taxpayer or their advertising costs greatly subsidised by the general public—the same general public who purchase goods in their stores and from whom they make their massive profits—we would expect tabloid headlines and a massive public outcry at the unfairness of it. However, week in,

9 Jan 2013 : Column 110WH

week out, such companies get an enormous subsidy to help with one of their major overheads—staffing costs. That is because many employees—often the majority—in these large and successful companies are paid only the minimum wage, and because the current minimum wage is not a living wage, nearly everyone on it has to claim tax credits to be able to make ends meet.

The number of working families receiving tax credits to top up their meagre incomes has risen by 50% since 2003. A Joseph Rowntree Foundation report estimates that 3.3 million people now have to claim tax credits to top up their wages because they are on the minimum wage. Those tax credits are funded by the Government—by the taxpayer. That means that the public purse has to subsidise the low-paid employees of many of our household names so that they make their high profits rather than pay their workers a decent wage.

Mr David Lammy (Tottenham) (Lab): My hon. Friend is making a fantastic point. She will recognise also that there are some supermarkets where the CEO is on 500 times more than the individual on the shop floor. That must be unacceptable if they are not paying a living wage and are expecting the state in effect to pick up the bill.

Teresa Pearce: I thank my right hon. Friend for his intervention; I totally agree. When we compare the top and the bottom level of pay, there is often a massive difference. We need to look at getting that balance right. If a company is making that sort of profit, it is inexcusable for it not to pay a decent wage and for the taxpayer to have to subsidise its wage bill.

I am not against tax credits, but I think that more people need to understand that in many sectors the taxpayer is subsidising the wage bill of some of the biggest employers. We need a national living wage to put an end to the deeply unfair situation in which we are all subsidising poverty pay and the profits of large—often global—companies. The Secretary of State for Work and Pensions recently wrote an article about in-work benefits in The Daily Telegraph. He was blaming Labour’s payments to supplement working families’ incomes for the fact that the public finances are at “breaking point”. Although I agree that the Government should not have to subsidise low wages and in effect subsidise the profits of large companies, I disagree that the solution is to cut the only payment standing between many low-paid workers and destitution. There have been many debates in the House, and I am sure that there will be many more, about why the public finances are the way they are. Is it because we have had to bail out the banks? Is it the Government’s politics of austerity? Is it the lack of growth? Whatever side of the argument we are on, I think that we would all agree that it is not the fault of the worker in my local supermarket or the waitress in the pizza restaurant. We are not in this situation because the Government intervened to prop up poverty wages. It is not the fault of tax credits.

Nevertheless, there is some agreement across the parties that the situation needs to change, even if very different solutions are proposed. We could do as the Government plan to do and place a cap of 1% on uprating benefits such as working tax credits, far below predicted inflation, which will tip thousands more families and children

9 Jan 2013 : Column 111WH

into grinding poverty; or we could consider raising the national minimum wage to a level at which the extensive use of working tax credits would not be necessary.

A recent report by the Resolution Foundation and the Institute for Public Policy Research estimated that widespread use of a living wage could save the Government £2 billion a year. About £3.6 billion of the extra money paid out in higher wages under a universal living wage would go straight to the Government, in the form of extra income tax and national insurance payments, along with reduced spending on benefits and tax credits for the lowest-paid. As some of those workers would be in the public sector, their wages would cost the Government an extra £1.3 billion. However, that would still leave the Treasury with an extra net income of £2 billion.

The living wage should be adopted sooner rather than later as the national minimum wage. I do not think that it is too much to ask that workers at the bottom of the income ladder should at least be able to make ends meet. A legal minimum living wage is necessary, because although campaigners have been successful in increasing voluntary take-up, the numbers of people affected by what we are discussing are so high that they warrant more drastic action. About 5 million people are paid less than the suggested living wage and 3 million households contain at least one adult who is paid below that level. The Institute for Fiscal Studies predicts that a further 1 million children will fall into relative poverty by 2020, and that prediction was made before last night’s vote. With a living wage, we could at least try to undo some of the damage.

I realise that many people will object to what I am saying. They will say that I am anti-business. I am not, but I am anti-exploitation. If a business depends on cheap labour while making massive profits for its shareholders, there should be a mechanism—I do not think that it is beyond the wit of man to come up with one—whereby the numbers of minimum wage jobs at a profit-making company are reported to Her Majesty’s Revenue and Customs and a levy can be charged via the tax system to refund some of the subsidy. There is an argument for helping small firms or those that provide a necessary public service, but I do not believe that supermarkets and giant retail companies, which are making billions of pounds each year in profits, deserve or warrant state subsidy, because that is what this is.

People will say that I am anti-jobs, but that is nonsense. I ask them to consider the proposition that the next time one of these firms issues a press release saying that it is creating 5,000 jobs, what it really means is that it is creating increased profits while the rest of us pay part of the staffing cost for those 5,000 jobs. If a business is being operated in a modern European democracy, the people working for it and helping it to make that profit should surely earn enough to be able to live in that modern European democracy without relying on state benefits.

People will say that I am anti-free market on the basis that if employers are forced to pay decent wages, they will go out of business, but if we are realistic, we will admit that we do not really have a free market economy when companies need to be subsidised by the benefits system, when institutions such as banks are not allowed to fail because of the effect on the UK economy and

9 Jan 2013 : Column 112WH

when private companies contracted by Departments to provide services fail and have to be propped up financially to ensure that essential services are protected. Companies are taking the profit without bearing the risk. That is hardly a free or fair market.

Profitable employers who say that they cannot afford to pay a living wage or who depend on cheap labour do not have the business model on which we can build a recovery. We need proper, clear, informed, rational discussion. The public need to understand the extent to which such companies are helped by public funds. We need to stop calling them wealth creators and start calling them state-subsidised industries, because that is what they are. If we are serious about making work pay, the first step is to get those making and taking the profits to pay the wage bill of their own workers, who are often the true, unsung wealth creators.

2.40 pm

Mr Christopher Chope (Christchurch) (Con): It is a pleasure to participate in this debate. I congratulate the hon. Member for Erith and Thamesmead (Teresa Pearce) on securing it. I am delighted that the Minister of State, Department for Business, Innovation and Skills, my right hon. Friend the Member for Sevenoaks (Michael Fallon), is responding, because he and I belong—or belonged—to the school that believes that it is much better to leave such issues to the market than allow Government intervention, let alone legislation or regulation.

The starting point is that, if people want to prescribe a living wage and some employers wish to pay what they describe as a living wage, they should be free to do so in a free market. There is no issue. The agenda that underlies the hon. Lady bringing forward the debate is that she would like the Government to specify and introduce what has been set out as a living wage.

Mr Lammy: Did the hon. Gentleman advance the same arguments on the minimum wage when it was introduced a few years ago?

Mr Chope: I have consistently articulated the same arguments on the minimum wage. I had the pleasure of introducing the Employment Opportunities Bill, fundamental to which was the principle that people should be able to opt out of the minimum wage, thereby increasing the number of employment opportunities. I have been consistent. In fact, I argue that I have probably been more consistent than my party in saying that in this area we should allow individuals and the marketplace to do what they wish to do and we should not intervene.

I make only one concession. The argument about the living wage in a sense embraces one of my criticisms of the minimum wage. The living wage is supposedly £1 or £1.50 higher in London than it is outside London, and yet people, and the party of the right hon. Member for Tottenham (Mr Lammy) in particular, espouse the idea that a national minimum wage needs to be the same across the country. It is recognised that the living wage is different in London. The costs of living in London are higher, so the living wage in London is higher than the living wage outside London. In a sense, the argument opens up the debate about whether to have national regulation or, if there is to be regulation at all, allow

9 Jan 2013 : Column 113WH

regional variation. I am pleased to see some recognition on the part of the Labour party that regional variations are important.

Whether a wage is a living wage depends on who receives the wage. I would like to draw Members’ attention to Donald Hirsch’s “Working paper: uprating the out of London Living Wage in 2012”, which updates the Centre for Research in Social Policy calculations on the living wage outside London. It uses the basis first set out in 2011, produced at the request of the Living Wage Foundation, and draws on the minimum income standard for the United Kingdom. It explains the basis for the outside London living wage level announced by the Living Wage Foundation on 5 November 2012, coinciding with the updating of the London living wage as calculated by GLA Economics.

I will not take Members through all the calculations, which start by calculating minimum living costs in 2012, translate that into a wage requirement, and consider the application of a cap limiting the increase in an applied living wage in any one year. When one looks in detail at the calculations, one sees the fallacy in the hon. Lady’s argument. After carrying out all the calculations for the different types of family, living in different types of accommodation, with differing child care needs, it concludes:

“The following summarises the composition of the costs as set out above, and how this translates into wage requirements”—

in other words, what the hon. Lady would describe as a “living wage”. The hourly wage requirement is £8.38 for a single person and £6 for a couple without children or dependants—significantly below the national minimum wage.

Mr Lammy rose—

Mr Chope: The paper then calculates the figures for lone-parent families with one child, with two children and with three children. A lone-parent family with three children, according to the research, has an hourly wage requirement of £18.57.

Mr Lammy rose—

Mr Chope: I am not sure whether it is the policy of Her Majesty’s loyal Opposition for lone parents with three children to be entitled to £18.57 an hour.

Mr Lammy rose

Mrs Anne Main (in the Chair): Order. Will the right hon. Gentleman sit down?

Mr Chope: As soon as we look at the figures, we can extrapolate that an individual needs a wage at a particular level in order to live. That may be so, but a wage is determined in the marketplace, which is why single parents in this country have very low—relatively speaking —labour market participation. It is not worth their while to go out to work, because their wages will not be greater than their living costs or the benefits they receive. One good thing that the Government have done is adopt a policy designed to ensure that work pays and is worth while. If we take two equivalent families—one in work and the other not—the one in work will receive more than the family not in work.

9 Jan 2013 : Column 114WH

Mr Lammy: Will the hon. Gentleman give way?

Mr Chope: I will not give way to the right hon. Gentleman again, because lots of people want to participate in the debate.

Even the figures produced by supporters of the concept of a London living wage demonstrate the variation in living wage—£6 an hour each for members of a couple with no dependants, rising to £18.57 for a single parent with three dependant children. That is an annual wage requirement of £36,319 a year—pretty close to the level at which they would have to pay higher rate tax and lose their child benefit under the wholly misguided benefit arrangements the Government have introduced. That is a side story to what we are discussing.

If an individual wishes to employ someone, they offer a wage for the job and it is up to individuals applying for the job to decide whether it is worth while to undertake it at the wage offered. I hope the Minister will endorse that in his summing up. If employers just offer wages in line with the national minimum wage, they cannot differentiate between the person one might describe as the “honest plodder” and the person with a little more enterprise, flair and, potentially, loyalty to the organisation. That is why it is often in the best interests of a company to offer higher wages, and indeed why I offer gap-year students in my office significantly more than the minimum wage. I recognise that in that way I am more likely to get gap-year students who will stay the course, be conscientious and turn up for work on time than if I offer either zero wages or an internship rate.

I operate in a marketplace myself, and all I am suggesting is that other employers should be encouraged to operate in the marketplace. We should not sleepwalk into having a system of nationally set minimum wages that supposedly amount to a living wage.

Ian Lavery (Wansbeck) (Lab): Will the hon. Gentleman give way?

Mr Chope: I will give way once to the hon. Gentleman.

Ian Lavery: The hon. Gentleman peddled a lot of information about the national minimum wage that was completely unfounded, and he appears to be doing exactly the same now. Does he not agree that the living wage is good for business, society and people in the workplace?

Mr Chope: The living wage may, in certain circumstances, be good for employers—I have just conceded that—and for employees, because they will receive more money than from another employer. I am much less certain about the overall benefits for society as a whole. Dramatic statements have been made about how, if everybody had the living wage, it would increase the amount paid to the Exchequer and therefore increase the amount of money available to fund public expenditure, but that analysis does not bear detailed scrutiny.

My point is that wages should be left to the marketplace. It is for an individual to present himself, and if he wishes to take a job for £4 an hour—[Interruption.] The hon. Member for Wansbeck (Ian Lavery) shows his scepticism, but a large number of graduates, who are out in the marketplace, are being presented with a stark

9 Jan 2013 : Column 115WH

choice: they either work for nothing—as an intern, basically—or do not receive the minimum wage because that is regarded by employers as unaffordable. Therefore, if an individual said to a potential employer, “I’m prepared to work for £4 an hour,” it would create an illegal situation. The purpose of my Employment Opportunities Bill was to enable people voluntarily to opt out of the requirements of the minimum wage should they so wish. I would have thought that that was pretty fundamental in an open, democratic society, but obviously the control freaks in the socialist party do not like giving people the freedom to do that.




Mrs Anne Main (in the Chair): Order. There is too much chatter on the Back Benches.

Mr Chope: There is a chasm between what is articulated by those who support the living wage and—

Ian Lavery: Will the hon. Gentleman give way?

Mr Chope: I will give way a final time, but I will then sit down, because several others want to participate.

Ian Lavery: I thank the hon. Gentleman for giving way a second time. Is he really suggesting that the marketplace should determine wages? Would he accept people working for £1 an hour?

Mr Chope: In countries overseas, many people work for less than £1 an hour, and some of them have taken jobs that would have been available to people in this country, because those jobs have been outsourced overseas. Some of the work done shows that companies based in, say, London may want to pay all their staff high salaries, which is fine, but often outsource more menial jobs to overseas locations where people are paid much less than the minimum wage operating in this country. That is an area where the market should operate.

The market for labour in Cornwall or north-east England is different from that operating in London. The market for a young single person is different from that for someone with a lot of dependants. I have constituents, as I am sure does the hon. Gentleman, who have recently been made redundant but have so many commitments that they cannot afford to take a job at a significantly reduced salary, because they would be unable to meet all those commitments. That is part of what I describe as the operation of the marketplace.

I do not feel that I am out on my own on the living wage, but we should not lose sight of the importance of allowing the market to operate in this area. Whether we call it a moral case or whatever, I do not think that someone employed at £6 an hour—taking the figures I gave earlier—should be prevented from being employed because somebody comes along and says that there shall be a national living wage in excess of £6 an hour, with employers shedding employment as a result.

Hundreds of thousands of people are self-employed. They work for far less than the minimum wage or what people might describe as a living wage, but they work hard and for long hours as self-employed people. Why should we condemn what they do, if they are operating in their own marketplace? Why should we base a living wage on a week of 37 and a half hours when, to increase their wages and standard of living, many people

9 Jan 2013 : Column 116WH

choose to work more hours than that? Why arbitrarily choose that number of hours as the basis for assessing a living wage, because a living income may be based on people working a lot more than 37 and a half hours?

This debate has the potential to be quite interesting. I am grateful to the hon. Member for Erith and Thamesmead for introducing it. I hope that, in summing up, my right hon. Friend the Minister will leave no room for doubt that the coalition Government are absolutely opposed to the living wage and more regulation.

2.57 pm

Jack Dromey (Birmingham, Erdington) (Lab): It is a pleasure to serve under your chairmanship, Mrs Main. I congratulate my hon. Friend the Member for Erith and Thamesmead (Teresa Pearce) on initiating this very welcome debate.

I have always believed in the dignity of labour and of work, but for millions in work and living on low pay, life can be a precarious existence that involves counting every penny. Under Labour, great progress was made. The national minimum wage transformed the lives of millions. In my former being as deputy general secretary of the Transport and General Workers Union and then of Unite, I heard heartbreaking examples of people who, having gone to work for 40, 50 or 60 hours a week, were given their wages slip and saw that they had been paid £1.50 or £2 an hour.

If it is true that the national minimum wage transformed the lives of millions, it is also true that life on the national minimum wage could be very tough, which is why the notion of the living wage was born. It was born in the east end of London, initially by TELCO—the East London Communities Organisation—which was formed by faiths and community groups, as well as by a parents’ movement, about which I shall say more later.

When I was elected deputy general secretary in 2003, one of the first things that I did was to sit down with those excellent people, and together we mounted a highly effective campaign to end poverty pay, initially in Canary Wharf and the City of London. It was nothing short of obscene that good men and women from all over the world cleaned boardrooms and toilets in those giant tower blocks—in which average wages were frequently £150,000, £200,000, £500,000 or £1 million a year—on the national minimum wage, with statutory sick pay, no pension and the basic minimum entitlement to holidays. That powerful movement changed the lives of 4,000 cleaners in Canary Wharf and the City of London.

Interestingly, an alliance of organised labour and faiths initially drove the process, but as we broke through, first one and then the other, we had more and more employers coming out and saying, “This is right, and we should have done it earlier.”

Gloria De Piero (Ashfield) (Lab): I just want to put it on the record that it is right to praise people and organisations such as Barclays, KPMG and the many Labour councils across the country, including my own Ashfield district council, for introducing a living wage.

Jack Dromey: More and more employers are embracing the living wage. The next landmark in our campaign was the organisation of the first strike in the history of the House of Commons—it was of the cleaners. I have

9 Jan 2013 : Column 117WH

the manifesto that was produced by those cleaners. Let me remind Members of where we were just four years ago. We were talking about wages of £4.85 to £5 an hour, 12 days holidays plus statutory days, statutory sick pay only and no pension. I am pleased to say that, with the support of MPs from all parties, we broke through and now those cleaners earn the living wage.

More than 130 employers in London have embraced the living wage, and that is increasingly happening elsewhere in the country—in areas such as Ashfield. In London, all three parties in the Greater London assembly have supported the living wage, and as a result, tens of millions of pounds have gone to the low-paid.

Let me put the case for the living wage. First, it is good for business. There is no question but that it has a substantial impact on productivity. Indeed, in surveys of employers that have introduced the living wage, some 80% have said that there was a discernible improvement in the quality of work and that absenteeism fell by 25%. Two thirds of the employers said that they had seen dramatic improvements in recruitment and retention, with far less churn in their work force than previously, and 70% said that it had been good for the standing and the reputation of their company. Frequently, employers seek to sell themselves as being reputable and ethical, and the fact that they are living wage employers contributes to that. As for the business case, job quality, productivity, service delivery and reputation have all been improved, with a relatively minor increase in costs on the part of those companies.

A living wage is good for the individual, because dignity in work is enhanced by a living wage. Interestingly, in the surveys that have been done of employees in living wage companies, 50% have said that they have been much more willing to embrace change within their companies as a consequence of the fact that, at last, their labour is being recognised by way of the living wage.

The living wage is good for society. Returning to the origins of the living wage campaign in east London in 2001, 2002 and 2003, the parents’ groups were a powerful driver. They argued that having to take on two or three jobs to be able to pay their bills was an enemy of family life. The evidence is that, in London alone, 15,000 families have been lifted out of poverty by the introduction of a living wage. If we look at the principal beneficiaries, we see that 88% are women. A living wage is also good for the taxpayer. By definition, if people are getting a living wage, they are less likely to need to depend on benefits and tax credits.

I am proud to say that Birmingham, like Ashfield and many other local authorities, is now driving forward with the living wage. It was the first pledge to be honoured by the incoming Labour administration last May. There were three stages. The first stage took in the 3,000 directly employed employees in Birmingham, such as the wonderful Elaine Hook. They were previously paid just a penny above the national minimum wage of £6.19. They then received a £1 an hour increase, putting up the wage to £7.45 an hour. Time and again, Elaine Hook has said that she cannot describe the difference it has made to the quality of her life.

The second stage, which is under way right now, relates to the council’s procurement power. I have a strong view that taxpayers and council tax payers are entitled to feel confident that contracts are let to decent

9 Jan 2013 : Column 118WH

and reputable employers—employers who pay the living wage. Such a policy is now being rolled out in Birmingham, but not just by way of insisting that any contract let includes the living wage for goods or services. The council is also building Birmingham’s business base by maximising the letting of contracts in the area and following other noble objectives, such as more employment opportunities for disabled workers.

The third stage is the leadership that we give in the city as a whole and the power of advocacy, working with a wide coalition of interests. Put simply, the argument is that Brummies are worth more than the minimum wage; every one of them is entitled to the living wage.

We are also talking about the sort of society that we are. It is wrong simply to see this as a moral issue. From my own experience in the world of work, I know that there is a powerful business case for the living wage. There is also a powerful economic case, because low-paid workers who move on to a living wage do not salt away their money in tax havens; they spend it in local shops and local businesses.

None the less, there is, unashamedly, a moral case. As part of the great drive for the living wage in Canary Wharf and the City of London, we had, for four consecutive years, multi-denominational faith events in Westminster cathedral. Hosted by the Catholic Church, the events had all the churches, mosques and synagogues coming together. Some 4,000 people would turn up on the feast of St Joseph the Worker, or May day. On one occasion, Cardinal Cormac Murphy-O’Connor and Canon John Armitage, the chair of London Citizens, gave two magnificent sermons. They summed up the history of the drive of the faiths and organised labour for the dignity of labour, going back to the 1889 dock strike for the dockers’ tanner. They said that there is a powerful moral case for the living wage. As John Armitage said, markets without morality contain the seeds of their own destruction. The time for the living wage has come.

Mrs Anne Main (in the Chair): There is just over 30 minutes before the start of wind-ups, and six Members wish to catch my eye.

3.8 pm

Kwasi Kwarteng (Spelthorne) (Con): I am pleased to serve under your chairmanship, Mrs Main.

I agree with many of the remarks made by my hon. Friend the Member for Christchurch (Mr Chope), who put his case trenchantly. We are having a very simple argument: it boils down to whether we want free enterprise and a free market system or whether we think that state intervention is the way to achieve better economic outcomes for the people of this country. It seems to me that this debate has been taking place for years in Britain. Until recently, there had been a general presumption in favour of the markets.