“adversarial nature of the system for families”.

The Green Paper offered an opportunity to join up assessments and services for all disabled children. However, the draft SEND clauses that followed focused too heavily on education-related services and did not provide an adequate framework to draw health and social care services into the system of support for children with SEN. The Education Committee recommended that the

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Government broaden the scope of the clauses to reflect the aspirations of the Green Paper. Ministers have not taken its advice. As a result, it is unlikely that the Bill will bring about the integrated assessments and care that the Government have promised. Unless that is addressed, the Bill will simply replicate and reinforce the fragmentation in the current system.

Research has estimated that about 25% of disabled children do not have SEN. Similarly, there are children who have specific health conditions such as cancer who would benefit significantly from a single plan and jointly commissioned services. However, those children would not meet the requirements for an SEN statement. At a time when local authority budgets are under increasing pressure, I seek assurance from the Government that they recognise the impact of local cuts on SEND services.

Local authorities will need considerable support and resources to ensure that the reforms can make a practical difference at a local level. To ensure that the Bill realises the aims of the Government’s original Green Paper, its focus should be widened to include all disabled children, including those without a statement of SEN. It should make clear what disabled children can expect from local services, through a duty to provide and a national framework for local offers. The entitlement to education, health and care plans should extend to all disabled 18 to 25 year olds, including those no longer in education. The duties on the health service to contribute to integrated assessment and delivery need to be clearer and more explicit, and the Bill’s focus should be widened to include all disabled children.

Despite the Education Committee’s recommendation, the Government have chosen not to include disabled children without an SEN statement in the scope of the Bill. That means that disabled children who do not require support in school, or who are not in education or training, and their families, will not benefit from more integrated services despite the significant time and effort that many have to commit to securing the care and support that they need. I urge the Government to adopt the measures that I have suggested, as they would have a considerable positive impact on a vast number of families.

9.25 pm

Dan Rogerson (North Cornwall) (LD): It is a pleasure to speak in this debate and to follow the hon. Member for Rotherham (Sarah Champion), who is already making a huge contribution to the business of the House.

As others have said, this is a huge Bill. It covers a broad range of topics, but there are a number of features that unite them. The first is that all aspects of the Bill are intended to meet a demand that has been out there for some time, which those outside the world of politics have been calling for to be met. They relate to problems that are brought to us as constituency MPs time and again, and we have heard some examples today, some of them quite harrowing, of what we hear from constituents and from the many organisations that represent people who are going through tough times.

The Bill has been brought forward from a perspective of trying to solve problems in a way that will stand the test of time. In some areas, we have not had new legislation for a long time, so the Bill is significant. It is

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intended to overcome the disadvantages that some people have faced and to better support, for example, looked-after children and those who are seeking adoption. We perhaps hear more often from families who want to adopt about the barriers that they are facing, but the process must focus on the young people concerned, who have every right to expect a loving and supportive family in which to grow and do well.

The Bill also includes the proposals for greater flexibility in the workplace, which my right hon. Friend the Deputy Prime Minister and the Under-Secretary of State for Business, Innovation and Skills, my hon. Friend the Member for East Dunbartonshire (Jo Swinson), who is in her place, have talked about for some time. Other hon. Members have covered those proposals in greater detail. I pay tribute also to my hon. Friend the Member for Brent Central (Sarah Teather), who is no longer in her place, for the work that she did in bringing forward the proposals on special educational needs, and to the other former Ministers from whom we have heard, who made a great contribution to getting us to where we are today.

The process has been one of listening, as all right hon. and hon. Members who have spoken have pointed out. Opposition Members have been keen to point out where they would like the Government to change things further, and we have the process of Committee and Report and the detailed debate in another place to go through yet, but they have also said that the Government have set out their proposals, listened and sought to meet the concerns that have been raised.

There has been broad welcome for a special educational needs system that will now go from birth to 25, as that will overcome the problem of crucial periods of change, such as at the ages of 18 and 16. The Bill will ensure that there is greater support for those considering further education, as the hon. Member for Scunthorpe (Nic Dakin) said, and for those who are considering apprenticeships and wider training opportunities.

The Bill is intended to deal with the parental concerns, about which we have all heard a great deal, about many different agencies providing services to a family. Families are having to jump through separate institutional hoops, sometimes at a time of stress when they need the most support, and the plans that the Government set out in the Bill are a huge step in the right direction towards bringing those services together and providing one point of contact for families to ensure that we get things right.

Hon. Members are, of course, concerned about the local offer, as are organisations on behalf of parents outside this place. We should not, however, be too prescriptive and must consider existing levels of support. The hon. Member for Hayes and Harlington (John McDonnell) mentioned some specific services—educational psychology, speech and language therapy and so on—but equally, at a time of stretched budgets we do not want services that become costly and might not meet the needs of individual young people. As with other services, we must ensure that what is on offer meets the needs of the young people concerned, and that services are shaped around them rather than sat on a shelf waiting for a need that may or may not arise. We must get the balance right between those two aspects.

Flexible parental leave is another step in the right direction of ensuring that everybody is able to contribute in the workplace. Employers can benefit from the skills

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of women who have hitherto perhaps spent longer out of the work force, but who might be able to come back to work if they have a supportive partner who is willing and keen to spend more time with their children. Leave entitlement should be used more flexibly so that it is split between the couple and also between two employers—employers will welcome that once the system beds down and we must ensure that we get it right.

A number of Members have mentioned adoption and I will not dwell on that except to say that the Government have set out their concern that the process should continue to focus on the child and be rigorous from the perspective of parental approval. It must also ensure that young people are placed with the right family as speedily as possible and in the interests of the young person concerned. We have heard about family justice and the family court, and we must ensure that the key principle of a child-centred approach is still there, and that the child does not become a pawn in a game between two parents. Both parents must be aware that they need to make room for the other parent in that child’s life. The process should support that and keep the case out of court wherever possible.

The Bill contains measures on child care and the role of the Children’s Commissioner, and I hope Ministers will address the concerns felt by childminders that the proposed agencies will enable them to get on with the job and are not about forcing them into a new straitjacket or seeking to bring them together into a large privatised agency. I am sure the Government will seek to correct that concern. In essence, the Bill seeks to do a huge amount and sets out approaches that will tackle the problems mentioned today.

9.33 pm

Caroline Nokes (Romsey and Southampton North) (Con): I am grateful for the opportunity to contribute to this interesting debate. I wish to focus on one aspect that many hon. Members have already raised—special educational needs—and I particularly welcome the Minister’s commitment to those most vulnerable children in our society. The Bill aspires to improve support and create a smooth pathway for all young people on their transition to adulthood.

My hon. Friend the Member for South Swindon (Mr Buckland) referred to the cliff edge that some young people face as they move between child and adult services. As that person moves into adulthood, support that has been good throughout childhood can become rocky and disjointed and it is not always as easy a transition as we would hope. Teenage years can be difficult for any young person, but for those with special educational needs they are that much harder. This Bill is an opportunity to address the cliff edge that is a cause of concern for both parents and their children. Currently, however, the Bill does not adequately explain how that might be managed.

Ambitious about Autism, the national charity for children and young people with autism, has suggested that the Bill should include a duty to offer an adult social care assessment and complete a transition to adulthood plan for a young person before an education health and care plan can cease to be maintained. It is an expert in the field and runs not only the TreeHouse school in Muswell Hill, where young people with autism between the ages of four and 19 receive specialist education,

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but also Ambitious Support at Barnet college, which caters for 19 to 25-year-olds. That attracts young people from across north London.

Because of its considerable experience, Ambitious about Autism understands the challenges of supporting young people through that difficult transition. It has a pragmatic and realistic approach to the likelihood of dropping out and seeking to restart education. It is easy to understand that young people with autism will take time out of education—they do so for a range of reasons, including health issues, exclusion from college, or self-exclusion owing to a lack of appropriate support. Equally, young people with autism might commence an apprenticeship or work placement but find it unsuitable and seek to return to college.

Ambitious about Autism is concerned that the Bill means that those young people could lose their package of support and struggle to be assisted back into education. I regard such assistance as an absolute imperative. All hon. Members know that young people often find it difficult to settle on one path. It is essential that those with special educational needs are given the safety net of being able to find their way back into education, and that they have the appropriate support to do so.

The Government suggest that regulations could make provision to support such young people. I urge my hon. Friend the Minister to ensure that they are explicit on the need to protect education, health and care plans for young people. I also urge him to review support for young people with special educational needs between the ages of 19 and 25, should they fall out of education, employment or training for any reason. We should have a view to supporting them back into education when that best meets their needs.

Ambitious about Autism’s Finished at School campaign found that just one in four young people with autism access education beyond school. For some, that will be through choice, but others would stay in education if only they could access courses and colleges that are capable of providing appropriate support. I welcome the steps the Government have taken to improve the 16-to-25 elements of the Bill, but we need a clearer definition of post-16 education and training institutions. Regulations setting out the definition should be published before Committee and ensure that young people have the broadest possible options for further education.

9.37 pm

Andrea Leadsom (South Northamptonshire) (Con): I am desperate to speak in this debate, because I really want to be on the Public Bill Committee, where I will be able to make the speech I am unable to entertain hon. Members with this evening.

I want briefly to say that the greatest potential for supporting families and children is in the perinatal period, from conception to age two. That is when we have the greatest potential to get the society we want, with resilient babies who grow up to become socially responsible adults.

I have a couple of suggestions for the Government on amending the Bill to make a significant difference instantly. First, they could take up the suggestion of the right hon. Member for Birkenhead (Mr Field) of having all births registered at a children’s centre rather than a registry office. That would destigmatise children’s centres, which would be an instant access point for all families.

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They could go into the realms of a children’s centre and get the support they need. The centres would also provide a chance of support for those with post-natal depression.

Secondly, I would like the Government to adopt my ten-minute rule Bill, which deals with children born on to the child protection list. When there is no plan to take the baby away, the mother would be allocated talking therapies when she became pregnant. In that way, she can improve her maternal attunement towards the baby. The sting in the tail is that, if the baby reaches six months and there is no improvement in the mother’s ability to parent, a decision should be taken at a case review to take the baby away. There is a pitifully short window of opportunity for the baby. If the Bill is all about the children, we should seriously consider more radical solutions to ensure that we are not wasting their valuable time.

Finally, if women were offered an ante-natal interview that assesses problems such as attachment, maternal attunement and depression, and that predicts future depression, we would be in a position to know the magnitude of the problem and introduce measures to resolve it.

9.39 pm

Lisa Nandy (Wigan) (Lab): We welcome the coalition’s first Bill to focus on children and families. We especially welcome the fact that the Bill focuses on some of the children who are facing the greatest challenges, such as those with special educational needs and those in the care system.

We believe that the provisions on shared parental leave that build on the maternity and paternity leave entitlements of the last Government, and the measures to improve post-adoption support, are an important step forward for children, and we warmly welcome the introduction of child arrangement orders. However, we have heard considerable concerns from hon. Members throughout the debate about the real-world effect of some of these measures, and they need much greater scrutiny before the Bill becomes law. That is particularly true of the provisions on special educational needs, as highlighted by the hon. Member for Blackpool North and Cleveleys (Paul Maynard) and my hon. Friend the Member for Stockton North (Alex Cunningham); the exclusion of children with disabilities from care plans; and the potential postcode lottery of the local offer.

We share concerns raised by the Select Committee on Adoption Legislation in the House of Lords about the practical implications of removing the requirement to consider ethnicity when placing a child for adoption; about prescribing children’s best interests in primary legislation; and about the unusual, if not unique, attempt to impose strict time limits on care proceedings in primary legislation. The needs of individual children must remain paramount, both in principle and in practice. While we welcome the efforts made by the Minister so far to accommodate the concerns that have been raised with him, we believe that the Bill can be significantly improved in those areas and we will seek to work with Ministers to achieve changes as the Bill makes progress.

As my hon. Friend the Member for Liverpool, West Derby (Stephen Twigg) outlined, the Bill contains some good measures, but we believe that it will come to be

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characterised less by what is in it and more by what is not. It is a Bill about vulnerable children and families, but it says nothing about the problems facing young carers, trafficked and migrant children, and children who have been abused and ill-treated. We know that action is needed in these areas, but where is the action and urgency for those children? In the words of 10-year-old Paige, as reported by Save the Children:

“It doesn’t get any better. It gets worse and worse as the days go on.”

Where is the strategy for children such as Paige, after the dismantling of the Every Child Matters framework?

In line with the points made by my hon. Friend the Member for Stockport (Ann Coffey), we will consider how to ensure that the Bill introduces more support for children who have been abused and ill-treated, and who face the prospect of the courts. We will consider how to ensure that the needs of children in the wider care system are not neglected. We are concerned that the Bill is unbalanced. The focus on adoption is welcome, but it should not come at the expense of attention on other children in the care system, the majority of whom are in foster care placements, at a time when we have a shortage of nearly 9,000 foster carers. We share the concerns of my hon. Friend the Member for Bristol East (Kerry McCarthy), who spoke compellingly about the situation facing children for whom kinship care is and should be the right option.

We want to know what the Government intend to do to ensure that children can remain with their birth parents where that is in their best interests. We are very concerned about the stripping away of support for those children at a time when families are under huge pressure up and down the country. My hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) has uncovered the huge cuts that have been made to the early intervention grant and she highlighted the disappearance of more than 400 Sure Start centres since the last election. Recently, the Government took even more of the early intervention grant to pay for their adoption reforms, as my hon. Friend the Member for Manchester Central (Lucy Powell) pointed out. For some children, remaining with their birth family is the right option: where is the support for them?

The Bill fails to address some of the stark challenges that children face. This is their Bill—it is not our Bill or the Government’s Bill. It is for and belongs to the one in five children who go to school hungry, without decent shoes, without decent clothes and without basic essentials; for the estimated 1.5 million children who, according to Action for Children, are growing up in neglect; for the record numbers of children in the care system; and for the nearly 9,000 homeless families, 2,000 of whom are languishing in bed and breakfast accommodation, up by 51% in the past year.

At a time like this families need support more than ever, but the safety net is being eroded, creating a perfect storm for some children. The Bill is completely silent on the wider problems. The cuts to local authorities are particularly important, because parts of the Bill require social workers to take on an even bigger and more responsible role—for example, in the court process, and in deciding to place children in fostering for adoption arrangements before the court has made a decision. Those are crucial decisions for children, yet nearly eight in 10 social workers say that they are overburdened. The

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situation for independent reviewing officers—often the voice of children—is just as difficult. Without action from Government, the reforms could easily work against, not for, children’s best interests.

That is why we warmly welcome the strengthening of the role and remit of the Children’s Commissioner for England. At a time when the reality for some children is very bleak indeed, as illustrated by the bedroom tax, and their needs are easily overlooked by other parts of Government, children need a strong voice. We therefore support the Government’s measures to strengthen the role of the Children’s Commissioner. We will seek in Committee to further strengthen its powers, its remit and its independence.

While we welcome some of the measures in the Bill that help the people who matter most to children—the key adults in their lives—through the shared parental leave provisions and the post adoption support provisions, we have concerns about the capacity of an overstretched, hard-working children’s work force to meet those rising needs. We will therefore seek to improve the Bill in Committee, so that the system gives more support to families—not just to parents who have children with special educational needs, but to siblings and others who play an active role in helping a child at home. We want to be sure that the pathfinder schemes for personal budgets provide concrete proof that they will result in better outcomes for children before they are rolled out. That is our key test for the Bill: does it improve the situation of the children whom it seeks to help?

We are concerned that too often the Government are not child-focused; that too often they see children through the eyes of adults, not adults and adult systems through the eyes of children. It is why we are concerned by measures—for example, the time limits on court proceedings, as we heard from the Chair of the Justice Committee—that seek to prescribe the solution for individual children. We have heard a great deal about them in the course of the debate. It is important to retain individual flexibility for individual children, and we will seek to press the Government on that point in Committee.

We heard concerns from all parts of the House about attempts to define children’s best interests in law. We heard a welcome assurance from the Minister that that is not about seeking to define parents’ rights against children’s rights, but our concerns remain. We share the concerns of the Children’s Commissioner, and many of the organisations working with children, that this sends a dangerous signal that the paramountcy of children’s welfare is being diluted. While we agree strongly with the Government that parental involvement is in the best interests of children, so too are other relationships with grandparents, siblings, step-parents and friends. That is what children say matters to them, and we believe that they ought to be listened to and treated as individuals when decisions that affect them are made.

We will seek to give children a long overdue voice and ensure that the Bill reflects their priorities, not the Government’s, and the stark reality of the situation they face. While we will support strongly the Minister’s efforts where they improve the lives of some children, today we are laying down a challenge to the Government: work with us to improve the lives of more children. At present, many children are silent and invisible in the Bill, and do not have the childhoods that they, or we,

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would wish or expect. We lay down a challenge to Ministers to work with us during the passage of the Bill to do better by them.

9.49 pm

The Parliamentary Under-Secretary of State for Business, Innovation and Skills (Jo Swinson): I am delighted to respond to this debate and, alongside the Under-Secretary of State for Education, my hon. Friend the Member for Crewe and Nantwich (Mr Timpson), to be introducing legislation on issues about which I am so passionate. It is a pleasure to have heard all the contributions by hon. Members from across the House, and I welcome the general warmth and support for the Bill. Its measures are diverse, but they are united by the guiding principle of bringing about real, radical and positive change for children and families.

In the time available, I will respond to some of the specific points raised but, as, wonderfully, we have heard from 34 Members, I will not be able to address every point. We may perhaps hear further from some Members in Committee, including my hon. Friend the Member for South Northamptonshire (Andrea Leadsom), who was so concise in her remarks. Clearly, the House contains a lot of expertise on these issues and we will have interesting discussions in Committee.

Many hon. Members spoke about the reforms to special educational needs, and I, too, wish to pay tribute to my hon. Friend the Member for Brent Central (Sarah Teather) for the work she did to start this reform process, which has of course been continued by the Under-Secretary of State for Education. I also thank all those who got involved in pre-legislative scrutiny, particularly the Education Committee, as that process was a good example of how the House can improve legislation before it becomes a full Bill. I welcome the broad consensus on many of our SEN measures, particularly the support for a statutory framework that works for children and young people from birth to 25. We, of course, look forward to further discussions in Committee, but I wish to say that if any hon. Member was in any doubt about the intention of the Bill, they should look at clause 19 for the key founding principles on which the SEN provision will be based.

The Chair of the Education Committee, my hon. Friend the Member for Beverley and Holderness (Mr Stuart), made specific mention of the local offer and the Under-Secretary’s use of the term “common framework”. The regulations will provide the common framework for local offers, setting out all the things they should contain. That will bring consistency and will enable provision in local areas to be compared, and I am sure that will be welcomed. As my ministerial colleague has mentioned, we will be providing indicative regulations for the Committee, so that we can have a fuller discussion at that time.

On the issues of family justice, we heard from the Chair of the Justice Committee, my right hon. Friend the Member for Berwick-upon-Tweed (Sir Alan Beith), and from the former Home Secretary, the right hon. Member for Sheffield, Brightside and Hillsborough (Mr Blunkett), who brought us his personal experience, memorably talking about the nightmare of the family courts. It is important that we hear that direct experience. I also note the comments by the former children’s Minister, my hon. Friend the Member for East Worthing

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and Shoreham (Tim Loughton), who eloquently put the case that the needs and welfare of the child remain of paramount importance. I know that some hon. Members expressed concern that the paramountcy principle will be undermined, but I wish to reassure the House that the relevant clause has been drafted with the express intention of not diluting that principle, which is so important, as has been said.

The hon. Member for Stockport (Ann Coffey) raised the horrific example of the experience of a young child victim of abuse giving evidence and the traumatic way in which that took place. We take this issue very seriously, and we will certainly bring that to the attention of Ministry of Justice Ministers in order to raise the point she makes. Such issues have been discussed recently; the Under-Secretary has been holding round table meetings on tackling child sexual exploitation. So we are aware of those issues and she is right to raise them.

The hon. Member for Liverpool, West Derby (Stephen Twigg) asked for reassurances about the details of our plans for childminder agencies. We will be setting out more detail, including some draft regulations, in Committee. Introducing agencies is about increasing choice for parents; no childminder will be forced to join an agency and parents will vote with their feet, choosing the childminders or other child care offering the best quality and value for money. Let me just set out the context. In the past two decades the number of childminders has almost halved. That is a real problem on the provision we need to secure for parents. Agencies will help us to increase that provision, which is much needed, and, especially, to give the greater flexibility that many parents increasingly need for out-of-hours child care provision, too.

The hon. Member for Hackney South and Shoreditch (Meg Hillier) raised the issue of the sufficiency duty, and I wish to clarify the position in case there has been any misunderstanding. Our proposal is to repeal the requirement for local authorities to conduct an assessment of the sufficiency of child care in their area in very specific terms. However, the duty to secure sufficient child care remains—it is in section 6 of the Childcare Act 2006—and to meet that duty, authorities will need to collect data on supply and demand. We are repealing the bureaucratic requirement to create a specific document and publish it.

The issue of staff-child ratios in child care is not dealt with in the Bill, but as it was raised by more than one Member today, let me say that our focus is on quality rather than quantity. We are consulting on the proposal, and in particular on what levels of qualification would unlock higher ratios. I encourage the hon. Member for Hackney South and Shoreditch, and any others who are particularly interested in the subject, to contribute to the consultation.

While welcoming the Government’s plans to extend the right to request flexible working, the hon. Member for Manchester Central (Lucy Powell) expressed concern about the move to guidance. Let me reassure her, and other Members, that we want to make the process simpler and less bureaucratic for employers and employees alike. I was rather horrified when, having arrived in the Department and asked what the procedure was, I was shown a flow chart featuring eight separate steps with periods of 28 or 14 days elapsing between them, the total amounting to 84 days. Far too much bureaucracy

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was involved in what should be a straightforward and simple set of discussions between employers and employees. We are replacing that with two pages of common-sense, straightforward guidance, so that everyone will know where they stand. I think that that move should be welcomed.

These reforms are long overdue. They address systems that are old-fashioned and out of step with the needs of children and the wishes of modern parents. The needs of children will be put where they rightly belong, at the heart of the services that support them. In the Children’s Commissioner, children and young people will have a strong and independent champion. Children for whom adoption is the right option will be settled more quickly in a safe and loving home. Unnecessary and damaging delays will be driven from the family court system. The most radical reforms of the special educational needs system in 30 years will raise aspirations and put children, young people and their parents at the centre of decisions. Child care will be more widely available and of better quality, helping parents to juggle their work and family lives.

Perhaps because there has been general agreement on the subject, we have not heard a great deal today about the shared parental leave plans, but they constitute a radical reform. Mums and dads will have freedom to choose how they share time off after having a baby or adopting. As every parent knows, having children brings both joy and plenty of challenges. Our changes will let families get on with sharing the care responsibilities in whatever way works for them, replacing rigid rules based on an outdated stereotype that assumes that men are the breadwinners and the role of women is to stay at home and look after children.

By extending the right to request flexible working to all employees, we will help families in the widest sense, while also removing some of the workplace resentment about the different rights that exist for parents and those without children. We will also help the economy to benefit from a more flexible, committed and productive work force. Changing the culture of United Kingdom workplaces to embrace flexibility is good for employers and good for workers.

At the heart of the Bill are two simple changes. We are giving families real choice and flexibility in relation to the decisions that affect them, and we are ensuring that services focus consistently on the best interests of the children who need them. This is a Bill that will make real, long-lasting changes, and I commend it to the House.

Question put and agreed to.

Bill accordingly read a Second time.

Children and Families Bill (Programme)

Motion made, and Question put forthwith (Standing Order No. 83A(7)),

That the following provisions shall apply to the Children and Families Bill:

Committal

1. The Bill shall be committed to a Public Bill Committee.

Proceedingsin Public Bill Committee

2. Proceedings in the Public Bill Committee shall (so far as not previously concluded) be brought to a conclusion on Tuesday 23 April 2013.

3. The Public Bill Committee shall have leave to sit twice on the first day on which it meets.

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Considerationand Third Reading

4. Proceedings on Consideration shall (so far as not previously concluded) be brought to a conclusion one hour before the moment of interruption on the day on which those proceedings are commenced.

5. Proceedings on Third Reading shall (so far as not previously concluded) be brought to a conclusion at the moment of interruption on that day.

6. Standing Order No. 83B (Programming committees) shall not apply to proceedings on Consideration and Third Reading.—(Nicky Morgan.)

Question agreed to.

Children and Families Bill (Money)

Queen’s recommendation signified.

Motion made, and Question put forthwith (Standing Order No. 52(1)(a)),

That, for the purposes of any Act resulting from the Children and Families Bill, it is expedient to authorise the payment out of money provided by Parliament of—

(1) any expenditure incurred by a Minister of the Crown or a government department by virtue of the Act, and

(2) any increase attributable to the Act in the sums payable under any other Act out of money so provided.—(Nicky Morgan.)

Question agreed to.

Children and Families Bill (Ways and Means)

Motion made, and Question put forthwith (Standing Order No. 52(1)(a)),

That, for the purposes of any Act resulting from the Children and Families Bill, it is expedient to authorise—

(1) provision in connection with residence and contact orders being replaced by child arrangements orders; and

(2) the payment into the Consolidated Fund of any increase attributable to the Act in the sums payable into that Fund under any other Act.—(Nicky Morgan.)

Question agreed to.

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Business without Debate

Deferred Divisions

Motion made, and Question put forthwith (Standing Order No. 41A(3)),

That, at this day’s sitting, Standing Order No. 41A (Deferred divisions) shall not apply to the Motion in the name of Secretary Michael Gove relating to the Children and Families Bill (Carry-over).—(Nicky Morgan.)

Question agreed to.

Business of the House

Motion made, and Question put forthwith (Standing Order No. 15),

That, at this day’s sitting, the Business of the House (26 February) motion, in the name of Mr Andrew Lansley, may be proceeded with, though opposed, until any hour and Standing Order No. 41A (Deferred divisions) will not apply.—(Nicky Morgan.)

Question agreed to.

Mr Speaker: I am sure that the hon. Member for Cardiff West (Kevin Brennan) is not cavilling about this matter from a sedentary position, his meaning not being entirely clear as the House reaches 10 o’clock.

Children and Families Bill (Carry-Over)

Motion made, and Question put forthwith (Standing Order No. 80A(1)(a)),

That if, at the conclusion of this Session of Parliament, proceedings on the Children and Families Bill have not been completed, they shall be resumed in the next Session.—(Nicky Morgan.)

Question agreed to.

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Business of the House (26 February)

Mr Speaker: I inform the House that I have not selected the amendment in the name of Mr Christopher Chope.

10 pm

The Leader of the House of Commons (Mr Andrew Lansley): I beg to move,

That at the sitting on Tuesday 26 February, notwithstanding Standing Order No. 20 (Time for taking private business), the Private Business set down by the Chairman of Ways and Means may be entered upon at any hour, and may then be proceeded with, though opposed, for three hours after which the Speaker shall interrupt the business.

You will recall, Mr Speaker, that on Thursday 14 February I confirmed to the House that the business for tomorrow, 26 February, would be the remaining stages of the Groceries Code Adjudicator Bill followed by opposed private business. Tonight’s motion seeks to ensure that the House can spend the planned amount of time on each of those items of business.

Mr Peter Bone (Wellingborough) (Con): Will my right hon. Friend make it clear that if we agree to the motion it is likely that we will spend three hours after the moment of interruption in a debate that goes very late into tomorrow night?

Mr Lansley: All I can confirm to my hon. Friend is that if we agree to the motion we will protect the time available for the debate on the Groceries Code Adjudicator Bill and ensure that the House has the time intended—that is, three hours—to discuss opposed private business. As my hon. Friend and the House will recall, the programme motion for the Bill allows up to four hours for consideration on Report and Third Reading. The motion would then permit opposed private business to run for up to three hours following the conclusion of our debate on the Bill.

Mr Bone: I might have misunderstood, but I thought that the House’s view was that tomorrow’s business on the Groceries Code Adjudicator Bill should run until the moment of interruption. I think that the Leader of the House is talking about a variation to the programme motion that has not yet been put before the House.

Mr Lansley: I am sorry to have to disagree with my hon. Friend, as it is rare for us to do so, but in this instance I am afraid that he is wrong. The programme motion for the Groceries Code Adjudicator Bill allows up to four hours for Report and Third Reading.

The motion is needed because even without any statements, four hours of debate on the Bill would take us beyond 4 pm, which is the normal time for commencing opposed private business on a Tuesday. It will also therefore allow the House to sit beyond the moment of interruption—that is, 7 pm. Although the amendment tabled by my hon. Friend the Member for Christchurch (Mr Chope) was not selected for debate, it would have prevented opposed private business from being taken if it were reached after 4 pm. As I have just said, we do not expect business on the Bill to conclude before 4 pm and the opposed private business is likely to be reached after that. The amendment would therefore have obstructed

25 Feb 2013 : Column 136

the opposed private business tomorrow. I know that my hon. Friend takes a particular interest in such business and I am surprised that he would have sought to do that.

If the motion is passed, we will be able to debate the Bill and opposed private business as planned. I do not believe that the House would want to obstruct the business that the Chairman of Ways and Means has set down for tomorrow in accordance with Standing Orders, so I commend the motion to the House.

10.4 pm

Mr Christopher Chope (Christchurch) (Con): I hesitate to call the remarks of my right hon. Friend the Leader of the House disingenuous, but that is probably the only proper description of what he has just enunciated. Standing Order No. 20 provides that private business should be given three hours between the hours of 4 o’clock and 7 o’clock. The Leader of the House has all the rest of the parliamentary timetable to play with as he wishes, so surely he should respect the right of people who put private business before the House to do so with some certainty as to when that business will begin and conclude. That is the whole purpose of Standing Order No. 20.

If there was no Standing Order, we would be treating private and public business in exactly the same way. As Members know, I take a keen interest in private business, and I think it is important that we do not tear up our Standing Orders on an ad hoc basis. It is almost invariably the case that the Leader of the House tables a motion to try to vary the convention under Standing Order No. 20 that private business should be dealt with for a specified three-hour period.

If I was speaking on behalf of the promoter of a private Bill, I should wish to have certainty; it is unwhipped business, so to ensure that it can proceed it is important that the Member in charge of the Bill can tell colleagues to come along to the debate because at 7 o’clock there may be a vote. Instead of that situation being crystal clear for everybody, tonight’s proposal will mean that nobody will be quite sure when business on the City of London (Various Powers) Bill will be concluded, assuming that it extends for a three-hour period.

In my submission, the City of London (Various Powers) Bill is very important. Obviously, this debate is designed to ensure that we have three hours between 4 o’clock and 7 o’clock tomorrow afternoon dedicated to dealing with the Bill. In paragraph 7 of the statement by its promoters, they state that progress on the Bill, which was introduced in Parliament in November 2010,

“was delayed as the Promoter sought to address Government concerns as to the compatibility of certain of the Bill’s provisions with the EU Services Directive. The Promoter obtained an opinion of leading Counsel supporting the inclusion of the provisions and passed this to BIS in February 2012. BIS, having reserved its position to the Second House while it considered the issue…has now indicated that it has not altered its original view”.

The Department for Business, Innovation and Skills therefore does not agree with the opinion of leading counsel obtained by the promoters of the Bill. Those of us who discussed the last set of private Bills will recall that the EU services directive is a very controversial measure. [Interruption.]

I shall not talk more about the Bill now; I simply emphasise that it is significant and should be of interest

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to a wider group of parliamentarians, particularly those concerned about the implications of the implementation of the EU services directive.

[

Interruption.

]

Mr Bone rose—

Mr Speaker: Order. Before the hon. Member for Christchurch gives way, I gently note that quite a lot of rather noisy private conversations are taking place on both sides of the Chamber. The hon. Gentleman must be heard—[Hon. Members: “No.”] Indeed, he must be heard with courtesy. I think the hon. Gentleman was giving way.

Mr Bone: Will my hon. Friend make it clear to the House that one reason why we are having this short debate—and possibly a Division—is to stop us debating important private business between the hours of 7 pm and 10 pm tomorrow night? What we are doing tonight is trying to prevent the House from sitting late tomorrow.

Mr Chope: My hon. Friend is, of course, absolutely right. If there are hon. Members present who would rather I was not speaking, I would point out to them that it was open to them to vote against the 10 o’clock motion. Indeed, I am rather surprised that they did not do so, if they wanted to get home promptly.

Jacob Rees-Mogg (North East Somerset) (Con): Does not my hon. Friend think that people voted in favour of the extension motion because it is always such a pleasure to sit late—to sit late tonight, and to sit late tomorrow night? Perhaps we could sit late on Wednesday as well.

Mr Chope: At a time when productivity in so many parts of our economy is in question, it is important that the House should set a good example by being very productive. I am sure that no one would wish to suggest concluding our proceedings unnecessarily early.

This issue should not be treated with levity. The whole purpose of Standing Orders is that we should maintain and stick to them. If, whenever we had private business, the Standing Orders were invariably set aside, they would be brought into disrepute. In the absence of a written constitution, the Standing Orders are our ultimate defence of liberty. That is why I take very seriously attempts by the Government to undermine the Standing Orders.

Let us look at what would happen tomorrow if the business of the House motion were not carried. The sitting would start with questions. Then there would be statements, though we do not yet know whether there will be any urgent questions or statements tomorrow. Then we would get on to the Groceries Code Adjudicator Bill. If discussion on that Bill had not finished at 4 o’clock, we could continue discussing it at 7 o’clock. What is so unreasonable about that? It seems a sensible way of proceeding.

Let us remember that in the past the Government would not normally have given half a day for Report and Third Reading of a major Bill; they would have allocated a whole day. Indeed, that is what they did originally in the programme motion that was carried by the House on 19 November last year, in which it was agreed that Report and Third Reading of the Groceries Code Adjudicator Bill would have a full day. As the

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Government want to curtail debate on the Bill, they have tabled a motion among the remaining orders to restrict the length of Report and Third Reading, and they are compounding that felony by saying that they wish to push private business to later on in the day, so that the Bill can be accommodated before private business.

Anyone would think that the Government were not in control of their business. Why are we having to debate this at 10 o’clock on a Monday night? It seems as though they run their business on a rather hand-to-mouth basis. Why did they not decide on this several weeks ago? I hope that the Leader of the House will address that issue when he responds.

I have tabled some new clauses and amendments to the Groceries Code Adjudicator Bill, and I see no harm in splitting consideration of the Bill, with our debating it until 4 o’clock, and starting again at 7 o’clock. [Interruption.] I see that the hon. Member for Cardiff West (Kevin Brennan) thinks that would be a good idea, and I hope that, in due course, that will be reflected in the way he votes in any Division that takes place.

We do not need to make a great meal of this. It is important that we should stand up for the rights of the House. We should make it clear to the business managers that they cannot just push stuff though on the nod, and that there will always be some of us who will want to raise questions and not be pushed around, as we feel we are being pushed around now.

I hope very much that the House will support the proposition that under Standing Order 20 private business should be dealt with for three hours between 4 o’clock and 7 o’clock tomorrow and that any other Government business should be fitted in around the private business, rather than the private business being kicked into the long grass—relatively speaking—for consideration later in the day. That is my proposition, and that is why I tabled the amendment, which was not selected. That would have been a slightly academic amendment, as reflected in the Speaker’s decision not to call it, because I see no prospect whatever of the Groceries Code Adjudicator Bill being finished before 4 o’clock tomorrow afternoon. The issue before the House is a straight one: do we accept the motion on the Order Paper or do we not?

10.15 pm

Mr Peter Bone (Wellingborough) (Con): Tonight we are discussing a significant point of principle. We are lucky to have a benign Leader of the House, but that will not always be the case.

Yet again we see the Executive abusing their position by getting rid of Standing Orders, or abandoning them for the day. It is clear, as my hon. Friend the Member for Christchurch (Mr Chope) said, that on Tuesday, if private business has been laid down by the Chairman of Ways and Means, it should be debated between 4 o’clock and 7 o’clock. That is specified for certainty, so that we will not be discussing important legislation late at night just because it is private. Of course, there might be an emergency debate under Standing Order No. 24, which would take precedence, but otherwise Standing Order No. 20 requires private business to be taken between 4 o’clock and 7 o’clock.

On 19 November 2012 the Groceries Code Adjudicator Bill programme motion clearly stated:

“Consideration and Third Reading

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4. Proceedings on Consideration shall (so far as not previously concluded) be brought to a conclusion one hour before the moment of interruption on the day on which those proceedings are commenced.

5. Proceedings on Third Reading shall (so far as not previously concluded) be brought to a conclusion at the moment of interruption on that day.”

Nowhere in that programme is there discussion of a four-hour rule. I am sure the Leader of the House is about to correct me.

Mr Lansley: I will correct my hon. Friend to this extent: if he looks at the Remaining Orders and Notices on the Order Paper today, he will see that No. 4 is the Groceries Code Adjudicator Bill [Lords] (Programme) (No. 3) motion, which sets out that proceedings on consideration shall be brought to a conclusion after three hours and on Third Reading after four hours, so the nature of the programme motion intended to be attached to the debate on the Bill tomorrow is clearly set out on the Order Paper.

Mr Bone: I am very grateful to the Leader of the House for the apology for what he said earlier, but I believe I am still correct in saying that what the House voted for, and the position tonight, is the programme motion of 19 November. The Leader of the House may wish to table a programme motion tomorrow to curtail the debate on the Bill.

We have two things going wrong here. We have a reduction of scrutiny of the Bill and at the same time we are pushing back—it could be very late, because we do not know if there will be any statements or urgent questions tomorrow—discussion of private business. It is really a bit of a dog’s ear—

Mr Alan Campbell (Tynemouth) (Lab): A pig’s ear. Or did the hon. Gentleman mean a dog’s breakfast?

Mr Bone: Whatever. It is late at night. The comment from the Opposition Front Bench is spot on. That is what happens late at night when we are trying to discuss important business. That is why we should not be debating private business late tomorrow night. I am thankful for that helpful sedentary intervention.

There is a serious principle here: we are reducing the scrutiny of an important Bill and removing the fixed time at which private business is heard, and simply for the convenience of the Executive, not that of Parliament. We are reducing scrutiny and removing certainty, and that is against the interests of every Member sitting here tonight. [Interruption.] Members might boo and grunt because this is going on, but I notice that most of them are members of the Executive. In my view, they are not necessarily here representing Parliament; they are representing the Executive.

While we have a very nice and benign Government, this is probably okay, but I ask the Leader of the House to imagine what the other lot would do if they were sitting on the Government side of the House. What sort of nasty things could they get up to? They would then refer to what is happening here tonight as the precedent.

The whole point of this debate is to stop us sitting late tomorrow night. I hope that when the House divides—[Interruption.] In fact, I hope that the House does not

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divide, because I am sure that the Leader of the House, having heard these short arguments, and the much more powerful speech from my hon. Friend the Member for Christchurch, will withdraw the motion.

Mr Speaker: Does the Leader of the House wish to respond? He is not obliged to do so, but he can.

10.20 pm

Mr Lansley: I will gladly respond, simply to say, in response to my hon. Friend the Member for Christchurch (Mr Chope), that we are debating this now because an objection was taken to the motion providing for opposed private business tomorrow that was on the Order Paper and considered after 10 o’clock, the moment of interruption, on 13 February. I am sure that the House is quite amused by my hon. Friend’s support for the promoters of the private Bill and the certainty they require about its progress; with that solicitude from him, they must feel a little like someone in the embrace of a particularly large boa constrictor—[Interruption.] I would never impute any negative motive to my hon. Friend, that is for sure.

I think that I might reassure my hon. Friends the Members for Christchurch and for Wellingborough (Mr Bone) that the intention is not to do any serious damage to the time at which the opposed private business is to be taken on a Tuesday. The intention tomorrow will be to ensure that the House considers the Groceries Code Adjudicator Bill and agrees the time that is available for it. I am sure that the usual channels have made sure that the House has an opportunity to consider the Bill to the necessary extent. Therefore, if the programme motion is agreed to and consideration of the Bill is concluded after four hours, the House is likely to start considering the opposed private business at about 4.40 pm, if there are no urgent questions or statements—[Interruption.] I must say to my hon. Friend the Member for Wellingborough, who says “Ah” in that way from a sedentary position, that we are always subject to the question, as he rightly said, of whether there will be a Standing Order No. 24 motion, whether an urgent question will be sought and granted and whether a statement will be made. Those matters will inevitably give rise to a degree of uncertainty, so although my hon. Friend the Member for Christchurch is talking about the certainty that is required, very rarely in this place do we have absolute certainty about the timing of proceedings.

Mr Chope: Will my right hon. Friend give way?

Mr Lansley: I will, because I always want to be helpful to my hon. Friend, but then I must conclude.

Mr Chope: I am going to practise my snake-charming, Mr Speaker. Does my right hon. Friend agree that the doctrine of reasonable expectations is now being regularly undermined by the Government, because when the House voted to change the sitting hours the expectation was that it would rise on a Tuesday, subject to the Adjournment, at 7 o’clock? Now it almost invariably sits much later than that. It is almost as though the Government were changing the policy.

Mr Lansley: I am afraid that I must disagree with my hon. Friend. On the contrary, I think that we are meeting our expectations with regard to the sittings of

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the House with considerable regularity and certainty. On that basis, the worst-case scenario tomorrow, without urgent questions or statements, is that business will conclude at 7.40 pm. Of course, he must remember, and Members will be aware, that the programme motions and this motion show a maximum amount of time. The motions do not require us to debate the Groceries Code Adjudicator Bill for four hours, nor do they require us to debate opposed private business for three hours—we can choose to debate for a shorter period.

While debating the City of London (Various Powers) Bill and its important measures tomorrow, I urge my hon. Friend the Member for Christchurch and others to remember their urging tonight that the House should conclude its business at 7 o’clock—and it may be in their gift to do so.

Question put and agreed to.

Business without Debate

estimates

Motion made, and Question put forthwith (Standing Order No. 145),

That this House agrees with the Report [12 February] of the Liaison Committee.—(Nicky Morgan.)

Question agreed to.

financial assistance to industry

Motion made, and Question put forthwith (Standing Order No. 118(6) and Order, 7 January.)

That this House authorises the Secretary of State to undertake to pay, and to pay by way of financial assistance under section 8 of the Industrial Development Act 1982, sums exceeding £10 million and up to a cumulative total of £40 million in respect of Funding Circle and BOOST&Co as part of the Business Finance Partnership.—(Nicky Morgan.)

Question agreed to.

communities and local government

Ordered,

That Bill Esterson be discharged from the Communities and Local Government Committee and Mrs Mary Glindon be added.—(Geoffrey Clifton-Brown, on behalf of the Committee of Selection.)

25 Feb 2013 : Column 142

Ankylosing Spondylitis

Motion made, and Question proposed, That this House do now adjourn.—(Nicky Morgan.)

10.26 pm

Huw Irranca-Davies (Ogmore) (Lab): Let me begin this debate by posing what may seem a little like a pub quiz question. What do all the following people have in common: Mick Mars, the guitarist for rock band Mötley Crüe; Vladimir Kramnik, the Russian world chess champion; Mike Atherton, the English cricket player; Jens Stoltenberg, the Prime Minister of Norway—and, not forgetting, me? We all have a condition called ankylosing spondylitis—athletes, chess champions and rock gods and Members of Parliament: we can all get it, along with around 200,000 other people from all walks of life across the UK.

Ankylosing spondylitis is not a condition we hear a lot about, yet the 200,000 people with this condition are roughly twice the number who have Parkinson’s disease or multiple sclerosis. Perhaps it is the very name ankylosing spondylitis, which does not lend itself to easy headlines or easy campaigning, although it may also be due to the historical lack of awareness, including among GPs and clinicians, of the condition. AS is often overlooked and misdiagnosed, but it is a type of arthritis that can start when people are young—often between 15 and 35 years of age. It is a type of chronic, long-term arthritis that affects parts of the spine, including bones, muscles and ligaments. The condition can be severe, with around one in 10 people at risk of long-term disability. It is often misdiagnosed or diagnosed late—typically 10 years late—and that was certainly the case with me.

Let me begin by setting out drily and coldly the standard description, and I would like to thank the National Ankylosing Spondylitis Society for its help with that. It says:

“AS usually starts in the late teens and early twenties and can cause lifelong pain and stiffness. There is no cure for AS. It’s a form of inflammatory arthritis mainly affecting the spine and hips, which may fuse over time. Ankylosing means fusing together and spondylitis means inflammation. It can also cause inflammation in other areas of the body, including the heart, the bowel and the eyes. Unless treated and managed effectively, AS will lead to great pain and can render people immobile and unable to work”—

and so on. It is worth using the words NASS has collated to illustrate what this means practically. People with the condition have described the type of task that can cause difficulty. One person says, for example:

“Opening and closing the boot of my car is a nightmare for me and makes it so much harder for me to get out and about with my 2 year old and my 5 year old.”

Another draws attention to the problems of simply

“sitting on the grass having a picnic.”

Another says that

“washing my hair and putting on tights”

is a problem. Others refer to

“pouring water out of the kettle”

or

“reaching high shelves or cupboards”,

and so on. NASS notes that

“people with AS deal with constant pain and stiffness, along with high levels of fatigue. In the early years it is an ‘invisible’ illness with bodies showing no outward signs of the pain and suffering, making it difficult for others to understand what they are experiencing.”

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It is worth turning to some of the words that people with AS use to describe themselves. One person says that they feel

“isolated, lonely, fed up with pain, envious of”

what they say are “normal people”. Another says:

“I have low self esteem, feel isolated, depressed and in constant pain. I am fed up of swallowing all the tablets and sticking a needle in my leg…I hate the shape of my back and the position of my head. But people always say I have a smile on my face and look so well.”

Another says:

“I feel overly tired most days. Outside of work my participation in activities has been reducing. I don't spend as much time as I used to socialising with friends and family. I used to be very active and go out in the evenings but now I have early nights instead.”

Every single person with AS will have a different experience, but here is mine. I, like many others, was diagnosed very late in life. In my late teens, I played first division and county badminton, and competed in national competitions. My tennis was not too bad either, and I was a pretty keen leg-break bowler for my school, though my rugby had long gone. But during and after matches I would experience real stiffness and soreness in the neck and the spine. I found it increasingly hard to look up towards the shuttlecock as it descended. However, I thought that this was just routine, as I was extremely fit and active. As the years went by, the stiffness became more routine and more painful, and progressively the flexibility in my spine and my neck grew less and less. At the time, I was working in sports centres, I was coaching sport, and I was still actively playing many sports myself. I thought that it was just part of a sporting life: you end up creaking a little bit.

By my late twenties, the stiffness and the pain were periodically debilitating, and affecting my sport and my general health. I had been to see GPs over the years since my teens. I had been given strong painkillers, sometimes steroids. I had been to see masseurs and chiropractors who had stretched and crunched me, worked out the knots in my neck, and applied various odious potions to me. I had resorted to homeopathic medicines, including a vile concoction involving exotic mushrooms from Russia, complete with a handbook on how to use it, and various mail order medicines. Some of these were harmless but utterly useless. Others were probably directly detrimental to my health and even antagonised the condition.

Jim Shannon (Strangford) (DUP): I thank the hon. Gentleman for bringing this very important matter to the House. This debate will raise awareness, but does he agree that there is also a need for awareness in the benefits system, because I know people in my constituency who have difficulties in getting disability living allowance for this condition?

Huw Irranca-Davies: That is a very important point. People often refer to it as a bad back, growing pains, and as an assortment of other things, but that is a classic case of misdiagnosis. If somebody has AS, it does not go away. It is long term and debilitating and unless diagnosed, it will get worse and worse. The hon. Gentleman is absolutely correct.

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At that stage of the development of the condition in me, no one had diagnosed it, so I was trying anything and everything. Then, as luck had it, in desperation I had an appointment with a different doctor because my usual one was away. He suggested that I visit a rheumatologist, and that is where I first heard of the condition called ankylosing spondylitis. There started the beginning of a more coherent diagnosis and a programme of treatment involving appropriate physio- therapy and, when needed, oral steroids or, when the problem was severe, steroid injections directly into joints. By this stage, in addition to the fluctuating but regular stiffness and pain, every few months I would have a major flare-up when my joints, especially ankles, knees and hips, would swell like billy-o and scream with pain. Yet—this is a common refrain from AS sufferers—I would just carry on. Sufferers get our heads down and carry on. We build a tolerance to pain and a dogged determination. It is far from heroic; it is just pragmatic. We have bills to pay, places to go and people to see. We just do not give up very easily.

My situation came to a head here in Parliament. The story I am about to tell will be disbelieved by many, because it reveals—wait for it—the compassion of the Whips Office. Back in 2003, I had been struggling along and getting by, but this was the mother of all flare-ups. I have the acute form of AS, which I sometimes feel makes me fortunate, although I guess that others who have it may disagree. Rather than enduring constant pain and discomfort, I could go for months without problems, then—bang!—when it hits, it hits big.

The early-warning aches, throbs and fatigue started about a month before the crunch. After hobbling slowly for a couple of weeks, I resorted to using a stick, then two sticks, and then switched to crutches a few days later. Progressively, I also looked like I felt—like I had been through 10 rounds with Mike Tyson after a week without sleep. Finally, for one particular vote it took me nearly 15 minutes to walk from one end of the voting Lobby to the other, which is the length of this Chamber. I was in so much pain. At that point, a friendly Government Whip whispered to me, “Huw, get yourself home.” Although that reveals the compassion of the Whips, the following sentence was telling: “Get yourself better, ’cos we need you back in two weeks for a crunch vote.” Still, I take compassion wherever it comes from and whatever the motive.

That episode finally got me on to the treatment that has transformed the quality of my life over the past decade and—touch wood—has meant that I have not had a major flare-up in all that time. I was fortunate to be referred, finally, to an AS specialist and was put on to an innovative and then experimental treatment called anti-TNF—anti-tumour necrosis factor—which is an immunosuppressant that has helped control the condition. It is not without the risk of side effects and I would prefer not to be on medication for the rest of my life, but my quality of life has been transformed. Anti-TNFs, which are now moving on to new generations that can target specific types of AS, will not be right for everyone, but I say to the Minister that, where appropriate, they really must be made available, and investment in research must also be maintained.

People such as me have much to thank Arthritis Research UK for its research in London in the 1990s, which led to successful trials of anti-TNF therapy.

25 Feb 2013 : Column 145

Andrew George (St Ives) (LD): As the hon. Gentleman knows—we have discussed this on a number of occasions—I also suffer from AS and many of my experiences mirror his, although I have never experienced the compassion of those in the Whips Office. Although the condition affects many esteemed people, it also affects many humble people such as me. I was also involved in the campaign for anti-TNFs. Does he agree not only that proper and effective diagnosis is critical, but that it is vital that medicines are properly prescribed and made freely available to those who are suffering very badly from the condition?

Huw Irranca-Davies: That is absolutely right. The hon. Gentleman makes a very important point and I will touch on it when I describe my mini manifesto for how we should move forward on AS. Different sorts of treatment will be appropriate for different people with AS.

Arthritis Research UK is currently funding research into other aspects of AS, including the award of more than £1.3 million to seven experimental arthritis treatment centres that aim to fast-track the most promising treatments to market, research into the genetic factors of AS, and even education resources to help families affected by AS. It is tremendously commendable work.

The Minister is not here just to listen to my or anybody else’s sob story, or to help me regain my prowess on the badminton court or at the cricket crease. I want the Government to help other people with AS, now and in the future, to get the best care, so here is my wish list.

First, we should increase the awareness and recognition of AS. AS has always had a low profile among both the medical profession and the public. Because back pain can have a number of causes, it is easy for AS to be misdiagnosed or to go undiagnosed.

Secondly, we should improve the way in which people with AS are referred. GPs may focus on trying to manage people with lower back pain and not consider referring them on to appropriate specialists such as rheumatologists.

Thirdly, please can we use MRI, not X-rays, for early diagnosis? Clinicians now agree that MRI scanning is a far better option because it can pick up the early joint damage due to AS before it is evident on an X-ray. X-ray changes because of AS may take years to show up.

Fourthly, we should improve access to the right specialists. Experts in other forms of spinal pain are not necessarily skilled in treating inflammatory back pain and associated conditions. For the best outcomes, it is vital that people with AS are managed by the right specialists as part of a multidisciplinary team.

Fifthly, we should improve access to the best medical and surgical treatments. The last decade has seen much improvement in imaging, which is vital to improving the safety and effectiveness of surgery, and treatments that offer better symptom control and quality of life. Early access to those is critical.

Sixthly, we should implement long-term follow-up and management. For the right decisions to be made at the right time, people with AS need long-term monitoring by appropriate experts and ready access to advice or treatment when necessary.

25 Feb 2013 : Column 146

Seventhly, we should develop quality standards and clinical guidelines for AS. In the absence of those, perhaps the Minister will say what can be done now to focus local clinical decision making on AS.

We also have a range of things that we want from GPs. We want them to consider AS as a possible diagnosis if patients have symptoms of back pain and stiffness that are not improving. GPs should refer patients to a rheumatologist as soon they suspect AS. MRI scans should be part of that process. There should be access through GPs to specialists, including rheumatologists, physiotherapists and specialist nurses. There should be access to physiotherapy sessions, either as part of a group or individually. Information should be provided in GP surgeries. There should be access to expert surgical assessment and treatment for people with severe spinal deformity who may wish to have surgery to correct it. There should be regular follow-up appointments and ready access to expert reassessment, including monitoring for bone health, osteoporosis and cardiovascular risk. Finally and critically, there should be information on, and access to, sources of support including physiotherapy, financial advice and psychosocial services.

I say to the Minister, on behalf of 200,000 people who have AS, that that is our manifesto for improved diagnosis, improved treatment and improved quality of life. Despite my late diagnosis and early mistreatment, I am pleased to say that thanks to great, if late, support from tremendous NHS clinicians and staff, I am currently active, sporting and able to be a thorn-in-the-side— or should I say constructive critic—of the Government whenever the need arises.

I am part of a team alongside great friends and campaigners such as Gillian Eames who are taking part in the worldwide “Walk Your AS Off” event for the next month promoting exercise as part of the self-management of the condition. On 1 and 2 April, I will be walking 50 miles at the age of 50 to raise awareness of AS and funds for the National Ankylosing Spondylitis Society. I invite the Minister to join us. Take a walk in our shoes, as people say, and we will show how a little support goes a long way, reduces health and social care costs, helps people to stay active and in work for longer, and gives people a far better quality of life. If he cannot make the walk, perhaps he will agree to meet me and a delegation from NASS and Arthritis Research UK to discuss further our ideas. I thank the Minister for listening and hope for a positive response.

10.43 pm

Michael Connarty (Linlithgow and East Falkirk) (Lab): I thank my hon. Friend the Member for Ogmore (Huw Irranca-Davies) for allowing me to make a short speech.

When I was growing up, it was a role in my family that when the big brother went off to high school, the next brother was sent to live with my grandmother because she was in a wheelchair. She had always been in a wheelchair. Every morning, we had to get her up, and she was a big woman. She had been 6 feet tall when she was a young woman, and she had twisted feet and hands. We had to dress her in the morning, and it was difficult to do. I have memories of climbing on the bed, hauling her up and swinging her legs out to get her in the wheelchair, and getting her dressed. We did not know what it was—we just thought it was serious arthritis.

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You may have recently heard me talk, Mr Speaker, about an uncle who was killed in McGurk’s bar. His sister is still living, and I go to visit her in Belfast. I have discovered that her son Joseph has had to retire from the civil service because he cannot move his neck at all. He explained to me that he had ankylosing spondylitis, and I had never heard of it before. He said that he had two cousins in the north—it is good that Members from Northern Ireland are here to listen to the debate—who were suffering from the same thing. He was diagnosed in his 40s, and he now knows that he will not be cured as he could have been if he had been diagnosed when he was young. Like my hon. Friend, he felt aches and pains, and he thought he was getting them from playing in the civil service football team, but it was actually the growth of the same problem in his body. Recently, a 38-year-old nephew, Paul, from Scotland, had a titanium hip joint replacement because the growth of the bone had basically broken his hip. Hon. Members talk about inflammation, but they seem to have a form of it that deals with bone growth. Their bones fuse early and grow in such a way that means they would end up cripples without treatment.

I fully endorse the campaign that my hon. Friend talked about, and I have spoken to the people from the National Ankylosing Spondylitis Society. One problem for my nephew was that he could not convince the people in the health service in Scotland that he had AS. In fact, he had a hip joint replacement that he might not have required if his AS had been diagnosed early enough and he had been treated for what I believe is a genetic disorder that runs in part of my family. Anything that the Government can do to make the matter a priority will save thousands, if not millions, of pounds and will save many people great pain.

10.46 pm

The Minister of State, Department of Health (Norman Lamb): I congratulate the hon. Member for Ogmore (Huw Irranca-Davies) on securing the debate, and I was also delighted to hear from the hon. Member for Linlithgow and East Falkirk (Michael Connarty). I am conscious that, having allowed an additional speaker, we are quite short of time, but if I cannot deal with all the issues that have been raised, I will be happy to write to hon. Members who have participated in the debate to answer their questions.

I know that the hon. Member for Ogmore has worked tirelessly in this cause and speaks with great personal experience. One of the great values of debates such as this is that they focus our minds on subjects that otherwise do not get the attention that they might deserve, and we all benefit from that. I am grateful to him for that.

The Government fully recognise the importance of early diagnosis, of differentiating ankylosing spondylitis from other causes of back pain and of effective drug treatment. The hon. Gentleman spoke movingly of the impact that anti-TNFs have had on him, and the transformation that they have made on his life, along with regular exercise to maintain mobility, has clearly been quite remarkable. He is putting his words into action with his 50-mile walk. I would love to join him, and I would really enjoy his company, but sadly I do not think it will be possible. However, I absolutely

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agree to the meeting that he asked for as an alternative —it is an attractive alternative, and I look forward to it.

The Government also understand the importance of accessible information and support so that people can take care of their own condition. The ability to self-care is critical, as is regular follow-up by specialised practitioners. I welcome the lead that the National Ankylosing Spondylitis Society has taken in publishing its good practice guide, and I recognise that there is still too much variation within the NHS in the provision of services for AS and for musculoskeletal conditions in general. The question is what should be done to remedy those deficiencies.

The last Administration sought to improve the quality of care for a number of major conditions by means of a rather top-down improvement model, and I totally understand why. It involved a combination of national standards, a uniform national programme with target dates for achieving standards, ring-fenced funding for specific improvement initiatives, demonstration programmes and top-down performance management to ensure that the NHS delivered. The programme was clearly well intended, and we recognise that it achieved demonstrable improvements in a small number of major conditions—coronary heart disease and cancer, for example. However, that model of quality improvement would be totally impracticable and unsustainable if we attempted to replicate it across hundreds of less common conditions.

I recognise that 200,000 people have this condition—as the hon. Gentleman said, that is more than have Parkinson’s and MS—and such a move could overwhelm the capacity of NHS management, not to say that of national bodies such as the National Institute for Health and Clinical Excellence. The entire NHS budget could be tied up with rather inflexible packages of ring-fenced funding. It therefore seems that we need a general model of quality improvement that recognises that real people are different in all sorts of ways, and that increasingly people suffer from more than one long-term condition and need holistic, not atomised, care that meets their particular needs.

Given that time is tight, I will turn to the specific points raised by the hon. Gentleman. I agree completely about the importance of raising awareness of this condition among GPs, especially given the importance and difficulty of early diagnosis. The hon. Gentleman mentioned his long and winding road to finally getting a diagnosis after 10 years, which, as he said, is the experience of many people. I salute the valuable work done by the society’s GP awareness campaign, but we must also recognise that in their day-to-day work GPs have to deal with and recognise a vast number of different conditions and may meet a new case of ankylosing spondylitis only once every few years. There is no easy answer to that dilemma although in future computerised decision aids such as clinical knowledge summaries may help to prompt GPs to recognise or at least suspect more serious but rarer conditions such as AS.

The hon. Gentleman drew attention to the society’s recommendation that MRI scans should be used in the diagnosis of early AS, rather than waiting for damage to become apparent on a X-ray. I understand that a consensus for that proposal is developing among clinicians, but I am not sure whether there are any further actions that the Department or Commissioning Board could usefully take at this stage to promote a

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greater uptake of such an approach. In a sense, word is spreading among clinicians about the potential value of such a move.

The hon. Gentleman asked whether we should commission NICE to develop a quality standard or clinical guidelines for ankylosing spondylitis, but I am afraid I cannot offer a lot of comfort. As he may be aware, we have recently published a list of all quality standards that we currently expect NICE to develop, following extensive consultation with professional and patient organisations. The list includes a number of the more common musculoskeletal conditions but not AS. In future, the NHS Commissioning Board will be responsible for requesting NICE to develop additional standards. In the meantime, it is open to the National Ankylosing Spondylitis Society to propose to NICE that the quality standard for chronic pain should include a statement on the need to consider other serious conditions for patients presenting with chronic back pain. That might be a valuable thing to do.

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The hon. Gentleman drew attention to the importance of support for self-help in managing this condition, and he leads from the front in that respect. As I have made clear, we are in complete agreement on that point, and the model of care to which I have already referred—which of course applies to other conditions and not just AS —will strongly promote that approach.

Finally, the hon. Gentleman invited me on his walk. I wish him well and hope that he gains great fitness as a result of it. I also think that a meeting would be of great value. I am delighted to have had the opportunity to debate this important issue, and I pay tribute again to the eloquent way in which the hon. Gentleman made his case for better care for people with AS. I hope that this debate will help to bring those issues even more into the public spotlight.

Question put and agreed to.

10.54 pm

House adjourned.