3.10 pm

Deidre Brock (Edinburgh North and Leith) (SNP): It is a pleasure to serve under your chairmanship, Mr Howarth. Please excuse my voice. I hope hon. Members can hear what I am saying.

I have to admit that I was surprised when it was revealed at the end of last month that Sheffield is too far north to be part of the northern powerhouse. It struck me that Private Eye might know something about it being grim up north London—about the hardship, the economic disadvantage that sometimes seem overwhelming and the deprivation, compared with the easy street life in Yorkshire. What Government could stand idly by and see such inequality last? There was apparently no choice but to move jobs to compensate, so the northern powerhouse is powering south, like so much else in the UK, and being sucked into the black hole that is London and its surrounds.

This decision, we are told, is part of a move to streamline services, centralise staff at BIS and ensure that Ministers have easy access to the knowledge and skills of staff. Is there some difficulty with the internet reaching Sheffield, I wonder? Ministers cannot be uniquely unable to use email and other electronic communication. I bet there are enough people already in London who would be willing to give them the benefit of their personal wisdom.

If this is about cost-cutting, I really cannot understand why staff are being moved somewhere where they have to be paid the London weighting and where office space is ridiculously overpriced. Surely the sensible thing to do would be to close the expensive offices in London and centralise the staff in Sheffield, Doncaster, Leeds, York or indeed anywhere outside the south-east of England—especially, for goodness’ sake, when they are working on the northern powerhouse. That might make sense.

While we are on the subject of north and south, I hope I will be excused a little detour to point out that the northern powerhouse is not very northern. It is

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quite a bit south of my constituency, a heck of a distance south of Caithness and Sutherland, and nowhere near Shetland. In fact, Sheffield is three times further away from Inverness than it is from London. It is 140 miles to the capital of the south-east and 409 miles to the capital of the highlands—and that is if there are no diversions. We will keep in mind that it is the northern England powerhouse and forgive the oversight.

The suction that continues to take jobs south needs to be addressed urgently. About one fifth of all civil servants are based in London, according to the Library’s “Civil Service statistics” briefing paper, and another 10% are in the south-east of England. Even Scotland, which runs a whole lot of parallel systems to the UK civil service, has only 10% of the overall headcount. Scotland, of course, is very efficient, but it is clear that there is no great spread of civil service employment. Despite the rhetoric about moving civil service jobs out of London from the Government and, to be fair, their predecessors, the jobs have stayed in London—even those that should be elsewhere—and some are actually moving back to London.

The Department for Business, Innovation and Skills might be too costly to run, too complicated, inefficient and possibly even unfit for purpose, but centralising it in London cannot be the answer. If the Mayor of London is correct and London is a thriving, innovative city, bursting at the seams with businesses hungry for skilful people to work in them, surely it would simply be better for BIS to get out of the way and let them get on with it. If he is wrong and London is struggling to attract businesses, Government Departments should get out of the way to reduce pressure on office rental prices. Either way, Sheffield is surely a better call than London for a Government office.

Of course, this is what the Mayor of London actually thinks:

“the success of this city cannot be taken for granted: the jam from London must not be spread too thinly over the dry Ryvita of the regions.”

That kind of whiff-whaff helps no one. The truth is that sucking public spending into London while the rest of the UK bites down hard on austerity is damaging for every community on these islands. Superheating the London economy does not help ordinary Londoners, who are being pushed out of their own city by living costs and who see their communities destroyed to provide for affluent incomers. Pulling civil service jobs into the south-east of England does not help young professionals who are trying to get ahead and make something of their lives. There is no policy imperative or cost consideration that requires them to be sent to London, and no public good that would be fulfilled. There is no real reason at all for their being in London.

There is time and space for the decision to be reconsidered and for those staff to be located somewhere far more suited to the job they will be doing, as many Members said. Ministers have a chance to do something sensible for a change. There is time to change tack and to do something useful. Instead of running Sheffield down, build it up. Increase the staff there, give the office a boost, give Sheffield a boost with it and give London a break.

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3.15 pm

Mr Nick Clegg (Sheffield, Hallam) (LD): I am grateful for the opportunity to voice my dismay at this decision. I thank the right hon. Member for Rother Valley (Kevin Barron) for securing this debate.

As the Minister knows very well, I am the last person to object automatically to decisions relating to savings in public spending. In fact, I spent half a decade defending decisions for which many hon. Members developed a political cottage industry of blaming me personally—[Interruption.] They nod as sanctimoniously now as they condemned me then. That’s history, as we say, but that gives me a certain credibility when I claim that I look at this decision with a degree of objectivity. The political subjectivity, of course, comes from the fact that a number of my constituents in south-west Sheffield have been directly affected by it.

All of this stems from the BIS departmental settlement with the Treasury in the spending review in late November 2015. That is the origin of the decision. I want to dwell on why the decision was made in the way that it was, why the Treasury delivered cuts to BIS on such a scale, and why they cascaded down to have such a disastrous effect on Sheffield and the many dozens of BIS employees in the Sheffield office.

I thought to myself, “Perhaps it is because the new Government decided to protect more non-BIS Departments in Whitehall.” In other words, perhaps the knock-on effect—the budgetary pressure—on BIS is more remorseless than it was during the five years in which I was Deputy Prime Minister. During that time, we fought to defend a number of BIS programmes—notwithstanding a number of very controversial BIS financial savings. Actually, on closer scrutiny, I found that, far from there being additional protections, some of the protections have been relaxed. For instance, under the coalition Government, and at my personal insistence, schools spending was protected in real terms. It is now not protected in real terms under this Government. There is no wider Whitehall reason why the knock-on effect on the BIS budget should be so much greater than it was in the past.

Then I thought to myself, “Perhaps, to be very fair, this difficult decision can be justified if savings are made”—although I very much tend to agree with what was said earlier. I find it difficult to see any significant material savings from this decision, but let us give the Government the benefit of the doubt. If there are savings, perhaps they are being channelled elsewhere to protect some of the other important BIS initiatives and projects. But no—I discovered that it is part of a much wider cull. In the wider context of the other things that have been scrapped—the Business Growth Service, the Manufacturing Advice Service and the growth accelerator programme—it is more, rather than less, inexplicable. In other words, the savings in that area of the BIS budget are not being recycled to protect other areas.

I looked at the figures, which are as ever—now that I no longer have the excellent help of legions of civil servants—quite difficult to get hold of. The figures that I was able to get hold of from the Institute for Fiscal Studies and the House of Commons Library show something very revealing indeed. It is this. Under the Government of 2010 to 2015, the reductions in the BIS budget, when compared with other Whitehall Departments, put it about mid-table. Some Departments had more

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generous settlements and roughly the same number had more reductions. The reduction, which was very significant and led, for instance, to some of those agonising decisions on higher education spending, was just over 18%, according to the Institute for Fiscal Studies. In cash terms it was well below a £4 billion saving.

In the latest league table showing where, in the Whitehall jungle, money has been saved in the greatest amounts following the Chancellor’s announcement in late November, BIS leaps from mid-table to the position of having the second-largest cut. The cut of 18% under the previous Government has shot up to 26%, well over £4 billion. My central assertion is that that is a choice—not an inescapable guillotine. Perhaps I may say gently but firmly to the hon. Member for Sheffield Central (Paul Blomfield), who has done a great job of highlighting the injustice of the decision, that he was very unfair to point the finger at the permanent secretary. The decision was a political choice by the Secretary of State for Business, Innovation and Skills, who was keen to be top of the class in the Chancellor’s Whitehall fan club by delivering the earliest and biggest savings—in my view, excessive savings—to the Treasury when, as I found out over five years, Whitehall Departments are asked, as in a game of pass-the-parcel, to make savings.

That is why I ask the Minister to confirm that the genesis of what is happening was a political decision—not by him but by the Secretary of State—to do more than his duty to the Chancellor, and to deliver such big cuts from BIS that it shot from the middle to second from top of the Whitehall table. The decision was unnecessary and did great damage to a number of other important BIS programmes. It is now doing considerable damage to the livelihoods, families and fortunes of hundreds of people in Sheffield and South Yorkshire.

3.21 pm

Mr Clive Betts (Sheffield South East) (Lab): It is a pleasure to serve under your chairmanship, Mr Howarth. I congratulate my right hon. Friend the Member for Rother Valley (Kevin Barron) on obtaining the debate, and my hon. Friend the Member for Sheffield Central (Paul Blomfield), who did an excellent and thorough job of taking on the paucity of the Government’s thinking on and explanation of the decision, and their business case. In passing I would point out to the right hon. Member for Sheffield, Hallam (Mr Clegg) that the key point my hon. Friend was making was that we have not had an explanation showing any savings. We do not know that that is what has driven the decision, and it would be helpful if the Minister would explain. I also thank my hon. Friend the Member for Sheffield, Heeley (Louise Haigh) for obtaining an urgent question straight after the announcement. That was excellent, although from what I understand we do not seem to have made much progress since then.

The decision is about real people, who have lost their jobs. Darren Shepherd and his colleague Alison came to my surgery on Saturday because they are going to lose their jobs, and they are worried. They are frightened for their families’ future. They said to me, “Why is this happening, Mr Betts? Can you tell us why?” I said, “Well, I’m sorry, I can’t, because nobody has told me why.” That is not an adequate position to put people in when they work hard for the Government and the country, doing a variety of jobs. They do not know why and no

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one can explain to them. That is the fundamental question that we are asking today. As my hon. Friend the Member for Sheffield Central said, it is of benefit to the civil service to have a wider pool from which to draw talent—and it is beneficial to the Government, the people doing the jobs, and the city of Sheffield. The Government will have to work hard to convince us on any of those counts that it was the correct decision to take those jobs from Sheffield and move them to London.

I do not want to say more about the particulars of the staff and their situation, or about the diminishing of the wider pool of talent, although I look forward to the Minister’s reply on those points. I want to make a few points about the Government’s commitment to devolution. I am the Chair of the Communities and Local Government Committee, which has just produced a report on devolution. We unanimously said:

“We strongly support the principle of devolution. We welcome the fact that, at the start of this new Parliament, it occupies such a prominent position on the Government’s agenda.”

I agree with that. It is not a party political issue but a commitment to devolution. I welcome the Government’s move in that direction. We also said:

“The Devolution Bill is just one part of enabling devolution. There also needs to be an enthusiasm for it across all Government Departments and a commitment to it as the ‘default position’”

and that we

“would like to see a culture of devolution embedded in all Government Departments”,

an annual report about what Departments do, and an opportunity for local authorities to report back on the Government’s commitment to devolution and rate their experience of different Departments. I do not think BIS will get many stars from Sheffield City Council in the devolution report.

If we are to have devolution in what is the most centralised country in western Europe, it cannot be left to the Department for Communities and Local Government to do very good deals with councils including those in the Sheffield city region. The whole of Government must be signed up for it. Therefore, what we are talking about is not just a matter of substance in relation to BIS and its operation, and people’s jobs, important though those are—and I will fight hard for my constituents involved in the process—it is also symbolic of the whole Government and their attitude towards devolution. Is devolution a matter of a few deals with local government, or is it a matter of Government policy to which the whole Government, including BIS, is signed up? If it is about a balance and a few pounds of cost difference here or there, or the slightly greater inconvenience for Ministers of getting on the phone or using a video link, the balance must come down in favour of the jobs in Sheffield, as a fundamental indication that the Government are committed to devolution, to pushing powers out to the regions, and at least to keeping the jobs that already exist there.

The term “northern powerhouse” is bandied around. It started with the Chancellor, but many Ministers and MPs now use it. The fundamental question is whether it is just a catchphrase or real policy—empty words or substance. I look forward to the Minister’s convincing me in due course.

Several hon. Members rose

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Mr George Howarth (in the Chair): Order. Before I call the Front-Bench speakers, I ask them to bear in mind that I hope there will be time at the end for the right hon. Member for Rother Valley (Kevin Barron) to conclude the debate.

3.27 pm

Martin Docherty-Hughes (West Dunbartonshire) (SNP): I am grateful to be speaking under your chairmanship today, Mr Howarth. I congratulate the right hon. Member for Rother Valley (Kevin Barron) on making the debate possible, and commend him for defending his constituents’ right to be heard on a matter that I know is important for the great steel city’s community. I do not know whether the Minister or even the permanent secretary recognise this thing called an iPad. FaceTime works. I use it every day in my constituency work, and I am sure that senior civil servants and Ministers could do the same.

I am disappointed that the Secretary of State is not here. I read the urgent statement that was demanded by the hon. Member for Sheffield, Heeley (Louise Haigh)—and I congratulate her on that—and thought that if it was not so serious it would be a good laugh. It was extraordinary, and I commend the hon. Lady for making sure the statement happened.

I have a long family connection to Sheffield, and over many decades I have seen the rise and fall of British Government policy in the city, as Governments have sought to deal with the aftermath of deindustrialisation while maintaining the quintessentially British Government policy that I would title “South, south, south.” Not long ago in the Chamber the Government extolled the virtues of devolution and decentralisation to Scotland, Wales and Northern Ireland, but they fail to recognise, or perchance they ignore, the elephant in their English garden—the culture of London centralisation. Yet in “UK Cities Monitor 2008” the north’s cities, including Sheffield, were among the top 10 for locating a business, and in third and fourth places for office location. The same report placed Sheffield third for “greenest reputation” and second for availability of financial incentives. I might move there myself. What is not to like? London, the capital of oligarchs and Russian tycoons, offers nothing but the London weighting, which could not buy someone a rabbit hutch, and the prospect of a mute commute more akin to “1984”. There is the opportunity to base a civil service Department in one of the UK’s friendliest cities and to obtain all the social and economic benefits that that would bring to the entire islands.

I have no doubt about the personal commitment of the Minister for Small Business, Industry and Enterprise, the right hon. Member for Broxtowe (Anna Soubry), to her political ideology or, for that matter, about her knowledge of Sheffield itself given her local connections—it is a pity she is not here today—but I do question the political ideology that is driving this process. While cities such as Sheffield offer new, innovative approaches to growth outside the hothouse of London, offering civil servants the opportunity to move to London or, even worse, to commute from Sheffield is both unproductive in the long term and a socially and economically bankrupt approach. If a civil servant decides to up sticks, either as a single person or with a spouse, partner or family, the policy will generate a burden on London’s already overcrowded public services as well as shrinking the affordable housing market.

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Having read the response to the urgent question on 29 January, I am mindful of the point made by the hon. Member for Blackpool South (Mr Marsden), which I will quickly quote:

“It is also a huge worry…to the 12 other BIS regional offices, six of which are in the north,”—

I take that to mean the north of England—

“that they are at risk from this so-called restructuring.”—[Official Report, 29 January 2016; Vol. 605, c. 559-60.]

I call that restructuring policy the London dividend. Like the hon. Member for Blackpool South, I call upon the Minister to set out unambiguously and openly the Government’s approach to that restructuring. Will the Minister here today commit to a restructuring programme that does not drive civil service jobs from the great cultural counties of northern England to the bursting metropolis of London? If that is the policy, then, like those that were once thrown at Scotland, it will undermine community cohesion, erode civic pride and limit both opportunity and resources for cities such as Sheffield. Such cities continue to be undermined by the reality that, according to the Institute for Government, the proportion of civil service jobs in London increased from 16% in 2010 to 18% by March 2015, when there were already 80,000 such jobs in the capital.

It is critical that the Government use their powers to bring about the inclusive growth that the Scottish Government, even with its limited economic powers, have achieved. Scotland has developed a more egalitarian model, which was praised by Professor Joseph Stiglitz, the Nobel prize-winning economist, when he said:

“Tackling inequality is the foremost challenge that many governments face. Scotland’s Economic Strategy leads the way in identifying the challenges and provides a strong vision for change.”

Data from 2012-13 show that income inequality is lower in Scotland, and the gender gap in employment in Scotland has also narrowed, but this will not help the northern powerhouse, or even the city of Sheffield, to deal with so many of those matters. The British Government’s approach to growth, as seen in this debate, is short-sighted, limited and exclusionary. It fails to see the tangible assets of its great historic northern counties or the communities who choose to live there.

In finishing, I commend those communities, who, through it all, are resolute and determined to be heard in this place. I would encourage their elected representatives, who I also commend today, not to look south to London for policy answers. I say to them: I challenge you, in meeting the needs of your communities, to turn and look even further north, and consider that inclusive model which I would consider could assist you in seeing off this Government’s ideological drive to limit your cities’ and counties’ ability to be that northern powerhouse; and I challenge you to ensure that the civil service, with all due respect, is representative of the communities that it seeks to serve.

3.34 pm

Yvonne Fovargue (Makerfield) (Lab): It is a pleasure to serve under your chairmanship, Mr Howarth. I congratulate my right hon. Friend the Member for Rother Valley (Kevin Barron) on securing this important debate and pay tribute to all my hon. Friends from across the

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region, who have worked so hard on their constituents’ behalf to hold the Government to account for their perverse decision.

The announcement by the Department for Business, Innovation and Skills on 28 January 2016 to close its largest office outside London and transfer staff to London was understandably greeted with shock. My hon. Friends have highlighted the effect it has had on people and their jobs. The announcement came out of the blue. It is confused and short-sighted at best and destructive at worst. Put simply, it makes no sense, economically or otherwise, and the Opposition are calling for the Government to review it. It is bad news for the people of Sheffield and for the civil service, because of the loss of experienced staff and their valuable institutional knowledge. As we heard from my hon. Friend the Member for Sheffield Central (Paul Blomfield), it is also bad for the diversity of the civil service. Indeed, Sir Jeremy Heywood’s comment is germane here:

“talent is everywhere but opportunity is not”.

The move is also bad for the economy of the region. It will divert money from the local economy, further damaging jobs and incomes in Yorkshire. What does that tell us about the Chancellor’s rhetoric about the need to create a northern powerhouse and the importance of regional growth to rebalance the economy? It tells us that it is just rhetoric. This is really about the greater centralisation of power in London, which will create an even bigger gulf between the regions. As a proud northerner, born and bred, I can tell the Minister that that gulf exists. I feel no particular affinity towards London, but I do towards Sheffield, Rotherham and Edinburgh—the cities of the north—because they are where common-sense decisions are often made. If the Government are serious about the northern economy, they should stop moving civil service jobs to London and start providing proper support instead of empty promises. London is overheating and house prices are becoming increasingly unaffordable to ordinary people. The north needs jobs and has the talent to fill them.

The BIS permanent secretary said that the plan to create a combined central headquarters and policy centre in London is about modernising how the Department works, making it more flexible and reducing operating costs. He also claimed that the closure was part of a programme to reduce the Department’s operating costs and staff size by 2020. He said:

“Our operating model needs to be designed in a way that works for this smaller workforce with more streamlined structures.”

I will not even mention the quote about the telephone system and computers not working in the Department for Business, Innovation and Skills; I think that was effectively debunked by my hon. Friend the Member for Sheffield, Heeley (Louise Haigh).

The Minister for Small Business, Industry and Enterprise, the right hon. Member for Broxtowe (Anna Soubry), agreed with the permanent secretary, saying that the closure of the Sheffield office is part of the plan to deliver efficiency savings and contribute to the Government’s deficit reduction target—another blow for the north. However, there appears to be no evidence for any cost saving, as we heard from my hon. Friend the Member for Sheffield Central. How can transferring the work of the office to London, a significantly more expensive location than Sheffield, lead to a reduction in operating costs?

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I want to pay tribute at this point to my hon. Friend the Member for Sheffield Central, in whose constituency the office is located and who has been at the forefront of the campaign to find any convincing rationale for the move. As he pointed out, nothing approaching a business case been made for the move. The permanent secretary admitted that when he was questioned by the Business, Innovation and Skills Committee. On being probed about whether there had been any cost-benefit analysis of the move from Sheffield, he replied:

“We did not do disaggregated business cases for each of the 80 offices we now have.”

He went on to say that there was not even a copy of the board paper that initially proposed the move.

Chris Stephens (Glasgow South West) (SNP): I refer hon. Members to my entry in the Register of Members’ Financial Interests. Is it not also shocking that the trade unions were not advised prior to the announcement? What does that say about the Government’s approach to industrial relations? What does it say to the people of Sheffield, who are also seeing other proposed office closures, such as at HMRC?

Yvonne Fovargue: It is symptomatic of the Government’s approach to trade union relations that they feel that the unions are so irrelevant they can be ignored and their power reduced. Many other offices throughout the country are indeed closing, such as the HMRC offices in Merseyside, with a loss of jobs and talent.

In addition, the permanent secretary said:

“I don’t think I can point you to one specific document which covers specifically the Sheffield issue”.

So, 249 people losing their jobs was not covered even by one specific document. That is appalling. Those are weasel words: there is no business case for Sheffield to be closed. My hon. Friend the Member for Sheffield Central has tabled written questions to the Secretary of State and written to the Prime Minister asking for the business case to be published. It is still not in the public domain.

I suspect that the real reason for the move is not to save money, but simply a desire to have officials closer to Ministers in London. The phrase used by my hon. Friend the Member for Sheffield, Heeley, “water-cooler conversations”, is appropriate here—as she said, they must be pretty good conversations to cost that amount of money. The right hon. Member for Sheffield, Hallam (Mr Clegg) believes this is a political decision that has come the top; other people believe it is a decision of the civil servants. We have no documents; we do not know.

The civil service has become increasingly centralised since 2010. As we have heard, the proportion of civil service jobs based in London has increased from 16% in 2010 to 18% in 2015, when 80,000 civil servants were based in the capital. The decision to close the Sheffield office is completely unacceptable. It has not been properly thought through and it has not been explained to the people most affected—those losing their jobs—or the people who represent them, their Members of Parliament. The decision seems to be based purely on a whim, and I certainly cannot believe that it will save money. In my view, the Government have to come clean on why they are moving these 247 jobs. It is complete nonsense to move jobs to London, where salaries and office rents

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are higher. Nobody can see how it makes any sense at all. Public money paid for the 2020 report and we have a right to see it.

Too many decisions are made by people living, working and bringing up children in London, as we heard from my right hon. Friend the Member for Rother Valley. Too many decisions are made by people who have never been outside the capital and they do not draw on the varied experiences of other people from around the regions, who have a totally different experience of life. Policy needs to be developed by people with differing experiences, and the majority of people do not live in London. Will the Minister commit today to reviewing the decision in the light of what he has heard, or will the Government forge ahead and close the Sheffield office, delivering yet another blow to one of the great cities in the north?

3.43 pm

The Minister for Universities and Science (Joseph Johnson): It is a pleasure to serve under you, Mr Howarth.

I congratulate the right hon. Member for Rother Valley (Kevin Barron) on securing this important debate, the second on the subject in recent weeks. I commend all right hon. and hon. Members for being present in strength and for speaking on behalf of their constituents.

As right hon. and hon. Members are aware, the Department for Business, Innovation and Skills is committed to delivering efficiency savings and to contributing to the Government’s overall deficit reduction target to clear the deficit by 2019-20. To achieve that, we developed the “BIS 2020” programme to modernise how the Department works.

Paul Blomfield: I apologise if I am intervening prematurely—the Minister might be about to tell us this—but will he explain for the first time how much money will be saved by moving 247 jobs from Sheffield to London? It is a simple question.

Joseph Johnson: I will come to savings shortly, so if the hon. Gentleman bears with me for a few seconds, I will get to his question.

The BIS programme will reduce operating costs by 30% to 40% and deliver a simpler, smaller Department that is more flexible in delivery and more responsive to stakeholders. As part of those plans, as right hon. and hon. Members know, the Department has announced its intention to close the BIS office at St Paul’s Place in Sheffield by January 2018. Such decisions are never taken lightly, and providing the right support for and communications with staff has been a priority for the permanent secretary and the entire senior team of the Department. All staff and departmental trade unions were informed of the decision on 28 January and the statutory 90-day consultation process began shortly afterwards. All staff affected by the decision have been fully briefed.

The hon. Member for Rotherham (Sarah Champion), who is no longer in her place, asked what support had been made available to affected staff. I will give the House some detail on that important matter. We are providing comprehensive support to all those facing a potential change or loss of job, including: professional, external careers advice; professional outplacement support;

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a jobs fair in partnership with the Department for Work and Pensions; time out of the office for job-search activities; and financial advice workshops. In addition, we are exploring all routes to avoid compulsory redundancies, including voluntary exit schemes. There will be no compulsory redundancies before May 2017 as a result of the proposed closure of the Sheffield site.

Many staff will be listening to the debate or watching it on television. The BIS senior leadership wants to ensure that the package of support is comprehensive. If there are things that the Department could be doing, or ways in which we could enhance the support I have outlined, we want to know about it. We want the staff affected to let us know what more the Department can do to support them at this time. We have set up a dedicated email address for them to use, and they have already used the system to make valuable suggestions about ways in which we can enhance the support available. We have been asked by the staff to ensure that updates are regular and frequent. We will be ensuring that that happens. We have already established a dedicated section on the Department’s intranet which includes a comprehensive overview of all “BIS 2020”-related matters. We have set out exactly when our Department’s senior leadership team will be in Sheffield, so that affected staff may discuss their concerns directly.

Chris Stephens: The Minister has talked about consultation with staff. Will he tell us, first, how many meetings there have been with the trade unions affected? Secondly, will he outline how a responsive Department can be responsive when it closes offices, leading to a lack of local knowledge and no understanding of local areas?

Joseph Johnson: I will happily touch on part of that question. We are now in the 90-day consultation period. The consultation is on a range of issues, including the future of the staff in Sheffield, so—in response to an earlier question from Opposition Members—the future of staff in the city is only one of the issues being consulted upon. Legally, we may confirm the decision on closure before the end of the consultation, but I am happy to confirm that we will wait until the end of the full 90-day period before making a final decision. In response to the hon. Gentleman’s specific question, we have had regular meetings with trade union officials.

To continue, the Department needed to be restructured in line with its new business model under the “BIS 2020” framework. In answer to the question from the hon. Member for Sheffield Central, that will deliver savings of £350 million by 2020, of which approximately £100 million will fall in the administration budgets.

Paul Blomfield: With the greatest respect, the Minister did not answer my question. I presume that the matter has been looked at in considerable detail, because I am sure that no such decision would be made in any less responsible way. My question was: how much money is saved specifically by moving 247 policy jobs from Sheffield to London?

Joseph Johnson: I would fall back on the response that the permanent secretary gave to the Select Committee on that point: it is difficult to disaggregate a specific item in an overall programme change. The overall “BIS 2020”

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programme is an holistic system change of working for the Department that will deliver savings of 30% to 40%, worth £350 million overall.

Mr Betts: May I ask the question a different way around? If the Department pursued its restructuring and the “BIS 2020” programme, but left the jobs in Sheffield, how much more would that cost the Department?

Joseph Johnson: Again, I am unable to provide a disaggregated breakdown of that figure because we are talking about a system change. We must bear in mind that the Department’s current locations are legacy locations, which are the result of legacy decisions and ad hoc organisational changes over a long period of time. We are moving to a more system-based way of looking at all the various ways in which the Department works. In future, our structures need to be, and will be, designed in a more streamlined and efficient way.

To support that effort, we will be bringing down the number of locations from which we operate from about 80 to approximately seven centres of excellence, supported by a regional footprint for work at a local level. Each centre will focus on a key business activity and bring together expertise and help to build up capability. That does not mean a London-centric Department, as has been suggested by Members. Even with the movement of policy roles to London, our overall London footprint will decrease by 2020. We have, and will continue to have, many more people based outside than inside London.

Louise Haigh: I am grateful to the Minister for giving way; he is being generous. The point we were making was exactly that the Sheffield BIS office is not like other local and regional offices throughout the country; they are the only headquarters outside London where policy decision making is done. Does he not accept that this closure is a serious blow to the Government’s northern powerhouse and to devolution, which exposes that all as empty rhetoric?

Joseph Johnson: Clearly I disagree with that. We will not be losing the capabilities. We will be moving a number of the jobs, and some jobs will become available in London, so the policy expertise that resides in Sheffield at present will not be lost.

The hon. Member for Sheffield Central asked about equality. BIS is recognised across Whitehall as a leader in its support and determination to embed diversity across the Department’s workforce, and that will continue to be the case in the years ahead, notwithstanding these changes. The Department employs about 18,000 staff outside of London and just over 2,000 are based in the No. 1 Victoria Street headquarters in London.

Paul Blomfield: Will the Minister give way on that point?

Joseph Johnson: I will make a bit of progress, if I may.

We are certain that that footprint, and our BIS local capability in particular, will ensure that BIS will maintain a nationwide perspective on policy issues. The hon. Gentleman who just tried to intervene—I am responding to his earlier intervention—was concerned about our ability to maintain policy capability in the light of the expertise that resides in Sheffield. As I said, there will be opportunities for people from Sheffield to move to

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London and other places, and we are confident that we will be able to maintain the high quality of work in the higher education and other policy directorates.

As the Minister for Universities and Science, since last May I have been working closely with higher education officials in Sheffield, and I am very happy with the work that they have done. They have consistently provided excellent support, and I want to thank them very much for their work. I reiterate that the Department’s decision was not taken lightly, but I am confident that our higher education policy making capability will remain as strong as ever.

In response to the points made by the hon. Member for Sheffield, Heeley (Louise Haigh) on the northern powerhouse, the Government are completely committed to Sheffield and its surrounding area as part of the northern powerhouse. The Department for Business, Innovation and Skills, along with the Department for Communities and Local Government, has been working closely with the local council and the local enterprise partnership to produce an enhanced, landmark devolution deal, which will see a Sheffield city region mayor elected for the first time next year by voters across South Yorkshire. The mayor will have transport budgets, franchised bus services and strategic planning, plus additional devolved powers for the area’s combined authority. The mayor will also get control of an investment fund worth £30 million a year for 30 years.

Mr Clegg: I have a really friendly suggestion for how the Minister can honour the stirring rhetoric about the Government’s commitment to the northern powerhouse and to the long-term vibrancy of the Sheffield economy in particular. Will he undertake to all of us here now that he will personally make representations to the Secretary of State for Transport, the Chancellor and, if necessary, the Prime Minister to locate the high-speed railway station due to be located in South Yorkshire in—

Kevin Barron: Meadowhall.

Mr Clegg —no, not in Meadowhall, but in Sheffield city centre? The northern powerhouse is built around the vibrancy of city centres. Ignore the cacophony of different voices from the Labour party in South Yorkshire and locate the station there and, not all, but quite a lot will be forgiven.

Joseph Johnson: I am grateful to the right hon. Gentleman for raising an important point about the new transport connections that will improve the competitiveness of businesses in the north of England and the northern powerhouse area. That highlights the important point that, first of all, the northern powerhouse is about stimulating private sector growth, jobs and economic activity. It is not about preserving an aspect exactly the way things are across the whole of the state and the public sector—that is not what the northern powerhouse is about as an idea. It is about building better transport links, for instance through the creation of the Transport for the North body, and investing in things such as our science base, which we are now able to do thanks to the great science settlement we got in the spending review, which will help great institutions such as the Sir Henry Royce Institute, the Institute for Ageing in Newcastle and the National Graphene Institute in Manchester, which have all been able to come into existence in the north and help to drive productivity up in the area.

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Mr Betts: The northern powerhouse is about private investment, and that is important, but so is the symbol that the Government give about their commitment. We cannot get precise figures about the savings for the Department in moving these staff, but does the Minister agree that his permanent secretary could scope out an alternative model of how the Government would operate—with all the changes and the policy streams, but with staff remaining in Sheffield—to see what the difference is, and would he publish that, so that we can have an open and transparent consultation?

Mr George Howarth (in the Chair): Order. There is great strength of feeling here. I hope the Minister will leave time for the right hon. Member for Rother Valley (Kevin Barron).

Joseph Johnson: Thank you, Mr Howarth. I want lastly to address this false picture—[Hon. Members: “Answer the question!”]—that is being presented of jobs being sucked into the economy in the south. The north of England is one of the fastest-growing regions of the country in terms of jobs growth and employment. The north-east and north-west are seeing very strong employment growth. We are confident that our long-term economic plan will continue to deliver jobs and opportunities for all the people in the area.

This has obviously been a very difficult decision for the Department. We are listening closely to staff to see how we can improve the support available to them and we will be listening closely to them in the weeks and months ahead. I will leave time for the right hon. Member for Rother Valley to conclude.

3.57 pm

Kevin Barron: First of all, may I thank everyone who has taken part in the debate? It has been fascinating. I will quickly nip through one or two things that have been said. I did not know about the problems we have with phones in Sheffield—my hon. Friend the Member for Sheffield, Heeley (Louise Haigh) said that the workforce had been told that. I thank the hon. Member for Edinburgh North and Leith (Deidre Brock) again: we do have the internet in Sheffield and South Yorkshire, and it does tend to work. As my hon. Friend the Member for Sheffield Central (Paul Blomfield) said, modern IT is a way to brief Ministers as well. Let me relate a little to that: iPads do work, as well as the Scottish National party. I did an interview live on Radio Sheffield at twenty past eight this morning, sat in my lounge, in a house in West Yorkshire, using a landline. I said to the interviewer at the time, “Twenty years ago I would have had to have got on the bus, gone into the studio and sat in Millbank to have the interview,” because they could not have coped with what are now everyday things. The idea that we are concerned about phone lines and everything else is just a little too much.

I was interested by the issue raised by the right hon. Member for Sheffield, Hallam (Mr Clegg). This is a political decision in the end and we have to accept that. I was here yesterday afternoon when we were talking about pharmacies. The Government decided to cut £170 million from pharmacies as part of the national health service’s £22 billion of efficiency savings, and today they tell us that they will put £10 billion back. If someone took £22 from me and gave me £10 back, I would think I had lost and I would not be happy with that.

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I recognise that we do not have much time, but may I say this to the Minister? He says that the decision has not been taken lightly, but from the interaction we have had here, I can say that it has been taken without much knowledge of what the Department wants to do, and if I were a member of the workforce, I would not be very happy to have that fait accompli put in front of me. I still think there is time to reconsider the decision and I hope that the Government will do so.

Question put and agreed to.


That this House has considered the closure of the Department for Business, Innovation and Skills office in Sheffield.

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Disabilities, Poverty and Inequalities

[Sir Roger Gale in the Chair]

4 pm

Natalie McGarry (Glasgow East) (Ind): I beg to move,

That this House has considered disabilities, poverty and inequalities.

It is a pleasure to serve under your chairmanship, Sir Roger, and an honour to have secured this debate, which is on an issue that is vital to people in all parts of the country. I also thank my colleagues for coming along to consider the association between disabilities and poverty, as well as organisations such as Inclusion Scotland and Disability Rights UK, which have been so kind in assisting me in my preparation for this debate. It is my real hope that this debate will contribute to putting this issue more firmly on the Government’s agenda and that the Minister will commit today to doing more to address it.

Ours is a disabling society. Some are born impaired. Some acquire impairments, some of which are visible and others invisible. All of us at some time will feel the invisible agency of a society that is organised for the convenience of able bodies. It is a society that adds to disabilities. Poverty and inequality affect a hugely diverse range of people in every constituency represented in this Parliament, but those living with disabilities especially and disproportionately face economic hardship, which for too long successive Governments have failed to tackle effectively.

While headline poverty rates suggest that disabled people are around 10% more likely to be in poverty than the population at large, it is generally thought that those figures significantly underestimate the scale of the problem. As is so often the case, the statistics fail to take into account the acutely increased costs and pressures that disabled people can face. Indeed, we know that the link between inequality and disability is reciprocal.

On the one hand, the high costs associated with living with a disability can push disabled people and their families into poverty, as many struggle with the greater costs of care, accommodation and transport. Recent research from the disability charity Scope has shown that disabled people spend an average of £550 per month on disability-related expenses—things such as taxis, increased heating and electricity consumption and the cost of maintaining equipment. As a result, those with disabilities are twice as likely to have unsecured debt totalling over half of their income, and they have on average £108,000 fewer savings and assets than non-disabled people.

On the other hand, the health and social inequalities that are so acutely felt in more deprived areas can contribute to a higher rate of disability in the most disadvantaged communities of the country. We need to recognise that being born into and growing up in poverty can have profound impacts on a child’s health, wellbeing and fitness at birth and in later life.

Statistics from the Department for Work and Pensions demonstrate the extent of the disparities between more and less advantaged communities in the UK. It may be an imperfect measure of the total incidence of disability, but the DWP’s own figures on personal independence

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payments show that people in more affluent areas are less likely to require disability-related support. In the Prime Minister’s constituency of Witney, 405 people received PIP in October 2015. In Chingford and Woodford Green, represented by the Secretary of State for Work and Pensions, 495 claimants were paid PIP, while 680 constituents of the Under-Secretary of State for Disabled People received that support. Take as a contrast my constituency of Glasgow East, where in October 2015 1,806 people received personal independence payments. It is astonishing that my constituents are a staggering four and a half times more likely than the Prime Minister’s to be in receipt of crucial disability-related support.

Too often at my surgeries and around my constituency, I meet people whose experience of poverty has contributed to or exacerbated their disability and whose financial security is threatened every month by disability-related costs. Despite plenty of evidence that this is a deep-rooted structural issue, we have so far failed to assert the sharp focus that is so desperately required to build sustained progress for disabled people and remove the links between disability and poverty. Our collective failure to do so is harming families across the country.

Today in the UK, a third of people in poverty live in a household with at least one disabled person. One in three children in Scotland who live with a disabled adult live in poverty, compared with one in five children living in poverty who do not live with a disabled adult. Disabled people can face increased cost pressures, and families with a disabled member face disproportionately a serious social gradient.

Research for the organisation Parenting across Scotland has found that families living with disability find it even more difficult to make ends meet, with 54% of parents in Scotland with a disability finding it more difficult to pay the bills than a year ago, compared with 29% of non-disabled parents. Some 25% of disabled parents in Scotland report problems getting affordable credit, compared with 8% of non-disabled parents. Meanwhile, 26% of disabled parents were being paid less than the real living wage, compared with 10% of non-disabled parents. It is clear that families living with disability are disproportionately and unacceptably bearing the brunt of the economic inequality that increasingly defines our society.

Wealthy families in Britain are a third less likely to have a disabled child—a statistic that reveals an alarming social gradient, because those families are pushed further into poverty by the pressures of caring for those children. People with disabilities and impairments are some of the poorest and most marginalised in the country. Academics at the University of Warwick’s School of Health and Social Studies published a paper in BMC Pediatrics showing that families bringing up a disabled child are at least £50 a week worse off than those without.

A family bringing up a child with a disability will face 18% higher costs in their family budget. That is because, for example, a disabled baby needs more nappies. A family’s ability to work and find affordable childcare is a real burden. Households with disabled children will depend more on social security benefits and face the additional financial costs associated with caring for a disabled child. Fuel costs for specially adapted cars are often higher than average, and the fact that those with the most severe disabilities have to attend hospitals and clinics weekly or even daily for therapies and treatments can have an enormous impact on family budgets.

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Extra energy costs are also incurred because homes often have to be kept warmer in order to protect people with disabilities from colds and bugs, to which they are especially vulnerable. Disabled children living in poverty are often housebound due to the nature of their condition, and for those with the most severe disabilities, a warm home can truly mean the difference between life and death.

If we are ever to break the poverty-disability link, we need a long-term plan to tackle deprivation, lift communities out of poverty and ensure a decent standard of living for every single person in our country. While the UK Government’s policies are sadly taking us in the wrong direction in that respect, I know there are Members on all sides of the House who agree we need to do more to ensure a better quality of life for disabled people across the UK.

Of course, this issue affects a great many people not only in this country but in every corner of the world, and there is an important international dimension to the debate. Globally, one in seven people have a disability, and 80% of disabled people around the world live in poverty. In the developing world, we see the same reciprocal relationship between poverty and disability, only with even more striking effects. In a great many countries, people living in poverty simply do not have adequate access to the healthcare, clean water and sanitation that we in the UK take for granted. As a result, they are even more vulnerable to malnutrition and disease. They are also more likely to live and work in dangerous or disaster-prone areas, all of which means that poor people in the developing world are more likely to acquire an impairment that leads to disability.

Disabled people in the developing world, as is the case here, can also too often find themselves excluded from healthcare, education, employment and opportunities to participate in their communities, meaning that those living with disabilities often constitute the poorest people in the poorest countries on earth. The Government’s international development agenda has recognised the specific need to assist disabled people, but non-governmental organisations and charities, such as CBM UK, are telling us that more needs to be done by the Department for International Development.

Mr Virendra Sharma (Ealing, Southall) (Lab): Thank you, Sir Roger, for chairing this debate. Does the hon. Lady agree that, in the light of the sustainable development goals, which are accepted and have been adopted by 170 nations in the world—Britain is a signatory—the Minister should agree to provide support to those families and particularly disabled people so that they can have a better standard of living?

Natalie McGarry: I thank the hon. Gentleman very much for succinctly making that point, and I completely agree with him.

As we know, people with disabilities are most at risk in conflict situations, meaning that our diplomatic and humanitarian response is vital in supporting disabled people. One in five refugees in Jordan and Lebanon is affected by physical, sensory or intellectual impairment—a chilling illustration of the cost of the warfare raging in Syria today.

Internationally, the UK must champion diplomatic solutions that will help to end conflict, alleviate poverty and support disabled people in some of the most desperate

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places on earth. At the world humanitarian summit in May in Istanbul, DFID’s representatives must highlight the importance of the inclusion of disabled people as a core element of an effective humanitarian response.

However, there is so much more to do here in the UK to break the poverty-disability link as well, and although the lives of disabled people in conflict zones and the developing world can only be transformed through international co-operation on development and humanitarian assistance, here in the UK, we in this place have the primary responsibility to improve the lives of people living with disabilities. As a starting point at least, we need to make sure that people and families living with disability have the financial support that they need to get by without the fear of a life lived in poverty. We have a serious responsibility to invest more in a system of social protection that meets disabled people’s needs and tackles the pernicious inequalities that they face.

Of course, that is not in keeping with the current direction of political travel in this place. It is hard to escape the fact that the UK Government’s austerity agenda is immeasurably harming the finances of disabled people in the UK, pushing many more into poverty and making difficult lives even harder. The introduction of universal credit is hitting families with disability particularly hard, as those previously claiming the middle or higher rate of the care component of disability living allowance will no longer receive the severe disability premium.

In Scotland, 80% of households hit by the bedroom tax include at least one disabled person. Changes to incapacity benefit have cost householders on average £3,480 a year and changes to disability living allowance have cost people £3,000 a year. In England, according to estimates from the Centre for Welfare Reform, cuts to welfare, social care and other services mean that disabled people are facing an average cumulative cut of £4,600 a year.

It is simply not acceptable that disabled people are being treated as fair game for the Government’s austerity agenda and yet, further cuts to the employment and support allowance work-related activity group went through Parliament yesterday. That will further disincentivise work for people with disabilities and push thousands more people with long-term illnesses and disabilities into financial hardship.

Angela Crawley (Lanark and Hamilton East) (SNP): One of my constituents who experiences disability is unable to read some of the information that is required to make her personal independence payment application and, as a result, relies on the citizens advice bureau to support her. Does the Minister accept that some people require additional support to make their applications, and acknowledge that, rather than penalising people such as my constituent, they need assistance to live independently and make their way in the world?

Natalie McGarry: I thank my hon. Friend for making that hugely important point. In my constituency, I have also seen the lack of access to readable documents and support, particularly for people with mental health issues as well as literacy issues, and that has caused them adverse harm.

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Employment and support allowance was envisaged as a way of supporting people with limited capacity for work as a result of sickness and disability. It sought to recognise the barriers that disabled people face in seeking work—the disabling attitudes, the disabling environments and the additional costs that disabled people bear, day to day, just leading their lives. ESA extended a small measure of recognition for the inequality that our society generates, and now even that small gesture is to be torn away.

Paul Farmer, the chief executive of Mind, is reported as saying:

“People being supported by ESA receive a higher rate than those on JSA because they face additional barriers as a result of their illness or disability, and typically take longer to move into work. Almost 60 per cent of people on JSA move off the benefit within 6 months, while almost 60 per cent of people in the WRAG need this support for at least two years.”

What assessment have the Government made of the impact of this measure on disabled people?

According to a survey conducted by the Disability Benefits Consortium, almost a third of people on ESA who were surveyed said that they cannot afford to eat on the levels of ESA that they receive now. Inclusion Scotland has said that the proposals are

“a direct attack on the living standards of disabled people, their families, carers and children and will result in hundreds of thousands more being plunged into poverty and destitution”.

I hope that today the Minister can justify the Government’s approach to supporting disabled people and explain how cuts to social protection funding will take disabled people out of poverty. Unfortunately, I fear that the newest cuts will continue to do what this Government’s austerity project has already done and cause additional financial difficulties for people living with disabilities.

Poverty and disability should not have to be so closely intertwined, and with a concerted effort to reform our social security system and ensure that disabled people have an adequate income and decent, appropriate employment opportunities, we can address the severe inequalities that disabled people experience.

We know that poverty and disability can be mutually reinforcing and that disabled people have too often been let down by decisions made in this place, which in recent years has tended to make their situation worse. However, this Government’s record has too often been to deny or explain away the statistics when confronted with them, and to deny the impact that their policies are having on real people in real communities across the UK. I somewhat suspect—though I hope not—that that will continue today. I very much hope that the Minister takes this opportunity to prove me wrong.

4.17 pm

The Minister for Employment (Priti Patel): It is a pleasure to serve under your chairmanship this afternoon, Sir Roger. I start by thanking the hon. Member for Glasgow East (Natalie McGarry) and congratulating her not only on securing this debate, but on her incredibly thoughtful and instructive contribution. She highlighted a number of issues, and I think it is probably fair to say that we completely agree on 95% of those, such as her assessment of the barriers that people with disabilities face; the recognition that their circumstances are difficult, and therefore that we have, quite rightly, social security

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protections in place for them; and that there is always more that we can do. There was also her reflection on past Governments’ approaches and the failures of systems to provide the right kind of support—adequate support—for people who have been stuck in poverty and have faced barriers and inequalities. The real difficulties, hardships and challenges associated with disabilities were also absolutely recognised by her, and I pay tribute to her on that basis.

I also want to comment on the hon. Lady’s reflection on disability, inequality and poverty at an international level. She was right in this debate to highlight the significance of the challenges that communities and individuals face around the world. For many millions of people internationally—we should put this in some kind of context—particularly in the underdeveloped world and in developing economies and countries, the barriers that they face are enormous for a wide range of reasons. It is not just about access to healthcare or support; it is the fact that the development of their economies and their societies is taking a very different trajectory from ours and they do not have the type of provisions we have in place for people who are experiencing poverty, disabilities or barriers.

If I may speak in the UK context and bring this back to home, the Department for Work and Pensions and the present Government have consistently focused—as, to be fair, did the previous Government—on the fact that when it comes to tackling poverty and inequality, the aim of our welfare reforms has been to secure employment opportunities, putting into practice the principle that work is the best route out of poverty. Evidence shows that nearly three quarters of workless families who have found full employment have escaped poverty.

Specifically—I will come to some of the points that the hon. Member for Glasgow East raised—we are very much focused, in the policy changes that we our making, on helping people with health conditions and disabilities to overcome some of the clear and stark barriers that they have faced in obtaining employment, so that they can rightly benefit from having access to employment opportunities and being in work. At the same time, we are also focused on protecting people through social security. For those who are vulnerable in society, particularly disabled people—it is worth highlighting that spending on the main disability benefits went up by over £2 billion in real terms over the course of the previous Parliament—it is right that we have the right kind of financial protection in place.

Universal credit was mentioned. We have brought in new exemptions for households entitled to carer’s allowance and the UC carer element, as well as for households receiving guardian allowance, which will be brought forward at the end of the year.

This is a much wider debate on how Government policy can help to transform people’s lives by tackling the root causes of poverty, supporting people into work and helping them progress. It is not just about yo-yoing or cycling in and out of the benefits system. I refer specifically to universal credit, which will support people, whatever their circumstances, to put the right frameworks in place to help them into work. At the same time, our focus has been on supporting more disabled people into work. We have made good progress, and 3.2 million disabled people are currently in employment. That is an increase of more than 150,000 over the past year.

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My colleague, the Under-Secretary of State for Disabled People, is focusing on a huge agenda for employment, to halve the employment disability gap and—there was a debate in the House yesterday on our wider welfare reforms—by means of the Disability Confident campaign, to bring together more employers to work with us to create employment opportunities for people with disabilities, to challenge attitudes to disabilities, to help remove potential employment barriers and, importantly, to ensure that people who have barriers and disabilities have the opportunity to fulfil their potential.

It is important to highlight that many parliamentary colleagues across all parties are doing a great deal of work in their constituencies to promote and support the concept of Disability Confident and working with employers in their constituencies. I am happy to work with the hon. Lady and her colleagues to look at some practical things we can do, not just in her constituency, but in others throughout Scotland. We are working with employers to do a lot more to bridge the employment disability gap. At the same time, a lot of good work is taking place in our jobcentres to change attitudes and to work with employers and bring more together.

Natalie McGarry: I thank the Minister for the tone of her response so far. I congratulate the Government on their target of halving the disability employment gap, but in the Department for Work and Pensions the number of advisers for disabled people is disproportionately low, which is a real barrier to helping people into work.

Priti Patel: The hon. Lady touched on the employment and support allowance, which was also part of the debate in the House yesterday. Some clear reforms are taking place and we are committed to publishing a White Paper in the spring which will focus on how we can provide the right kind of support and not just financial support. We are great believers in practical support. We are making sure that advisers and the right kind of support are in place to help people with barriers and disabilities and to give them the right guidance and the support that they need. At the same time, we are investing a lot more.

In our summer Budget there was provision of at least £115 million for a joint work and health unit to improve the work and health outcomes for people with health conditions and disabilities. The unit has started work. We are also working with disability charities to look at the right way—we will have pilots around the country—to provide practical support and schemes to support people with barriers and health conditions. Mental health is a classic example. The Government are committed to a lot of funding for mental health provision. In particular, we are seeking through this unit to join up the provision and to make sure the signposting and the right sort of provision can take place.

Angela Crawley: Last week, I met employees at the jobcentre in my local area who spoke extensively about their work to support people back into employment. They raised the point that a large percentage of those who present at the jobcentre suffer from mental ill health. Does the Minister accept that these people require a longer period of support to sustain long-term employment? That may cost the Government more in the long run, but will benefit their lives.

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Priti Patel: The hon. Lady is absolutely right to highlight that. We know that the challenges and barriers facing people with mental health problems are enormous. One purpose of universal credit is to support them while they try out work and undertake employment that may stretch them in the long run, and support them in work as well. At the same time, we must do more to work with employers. The Government do not have all the answers. Employers and their organisers have great health and occupational health support, and we must look at how we can leverage that to support individuals in employment.

If nothing else, this debate has highlighted that, yes, more needs to be done and we cannot stand still. Through our White Paper and the joint work between DWP and the Department of Health, the Government are looking at how to bring resources together in the right sort of structured way to ensure that we can deliver the services that in the long run can transform lives. These people are furthest away from the labour market. Their lives have been challenging for many reasons and they need the right sort of support to provide them with motivation and encouragement to get out of the cycle of inequality, deprivation, poverty and the combined factors that have stopped them from working in the past.

I am conscious of the time, Sir Roger, so in conclusion I want to emphasise that through the reforms and our current work—a White Paper will be published—the Government are committed to enabling not just disabled people, but those with health conditions and barriers, to fulfil their full potential while protecting the most vulnerable. I look forward to working with the hon. Member for Glasgow East and some of her colleagues when the White Paper is published and hearing their views on how we can do more to support people with these conditions back into work.

Question put and agreed to.

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Crohn’s and Colitis Treatment: England

4.29 pm

Mrs Anne Main (St Albans) (Con): I beg to move,

That this House has considered the treatment of people with Crohn’s and colitis in England.

It is a delight to serve under your chairmanship, Sir Roger. I am aware that there are different treatments in Scotland and Wales, but I want to focus on Crohn’s disease and colitis in England.

I am pleased to be leading this very important debate on Crohn’s and colitis, which affect more than 250,000 people in England and 300,000 in the UK. I have been working with the charity Crohn’s and Colitis UK, some of whose members are here today. They would be delighted to meet any hon. Members participating in the debate because they would like to get some publicity for that particularly wonderful charity, which is based in my constituency in St Albans. It does a tremendous amount of work for those who live with these challenging conditions.

I am also pleased to say that I have been reading the feedback from the digital debate on Facebook. That is a new concept, and I am very pleased that the House is offering it. I wish to express my thanks to Crohn’s and Colitis UK and the Westminster Hall digital debate team for arranging the online forum. We received 1,068 comments on the forum, and the posts were shared 258 times and liked 734 times, so it has been highly informative to this debate.

Crohn’s disease and ulcerative colitis are the two main forms of inflammatory bowel disease. Both are chronic lifelong conditions that cause inflammation of the digestive system. Ulcerative colitis affects only the large intestine, whereas Crohn’s disease affects the whole digestive system. According to the National Institute for Health and Care Excellence, it is estimated that in the UK 115,000 people have Crohn’s disease and 146,000 have ulcerative colitis. That is an estimated 460 people per constituency. I keep using the word “estimated” because there is no national database. At my last meeting with the charity, it stressed that it would very much like there to be a national database and better record keeping on those people who are presenting with the disease.

The most common symptoms of inflammatory bowel disease include diarrhoea, cramping pains in the abdomen, tiredness and fatigue, and loss of appetite and loss of weight. The exact causes of Crohn’s disease and ulcerative colitis are unclear, but there is evidence that IBD can cluster in families, and having an affected family member is a risk factor. IBD is a lifelong condition, but people can get it at any age. It most commonly first presents in the teenage years and early twenties—the mean age of diagnosis is 29.5 years. About 18,000 new cases of IBD are diagnosed each year, and that number is increasing. This is not a trivial complaint. IBD can be painful, disrupt normal activities and reduce quality of life, particularly during periods of active disease. These conditions can affect the individual’s ability to work, learn, socialise and form and maintain relationships.

We British are famous for our lavatorial sense of humour, and just saying the word “bottom” or “bum” is usually enough to bring on a fit of the giggles, so it is no surprise that we, the British public, are not good at discussing bowel problems or even seeking help for

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them—no wonder IBD has been described as a hidden disease. That reluctance can lead to sufferers feeling isolated and stigmatised.

According to Crohn’s and Colitis UK, the causes of IBD are a combination of factors. Those include the genes that a person has inherited, together with an abnormal reaction of the immune system to certain bacteria in the intestines, probably triggered by something in the environment. Viruses, bacteria, diet, smoking and stress have all been suggested as environmental triggers, but there is no definitive evidence that any one of those is the cause of IBD. That is why, as I know the charity would also say, we need more research and more evidence. We need IBD to have a higher profile, as it affects so many of our constituents.

There is currently no cure for Crohn’s or colitis. The main aim of treating IBDs is either to heal the inflammation and so reduce symptoms during a flare-up or to prevent flare-ups from happening. NICE has recommended a number of different medicines for IBD, which can be taken in different ways by patients, but if individuals do not respond to medication, surgery is considered as an option—20% of people with ulcerative colitis and about 60% to 70% of people with Crohn’s disease go on to have surgery. A large number of our constituents will be forced to have surgery as a result of the disease. The lifetime medical costs for IBD are comparable to those for other major diseases such as diabetes and cancer. It is estimated to cost £900 million per annum, UK-wide. Crohn’s and Colitis UK currently funds about £500,000-worth of research every year into the causes of, and treatments and care for, people with IBD. Although that sounds like a large amount of money, in terms of the number of sufferers it is not a large amount.

There is a new research study under way from the National Institute for Health Research, called the IBD BioResource. The aim is to accelerate research into Crohn’s disease and ulcerative colitis and build on recent major advances in the understanding of the genetic basis of these conditions. The IBD BioResource is being launched for roll-out nationwide through 2016. I ask my hon. Friend the Minister how much support the Government are giving to the IBD BioResource study.

Crohn’s and Colitis UK says that there is a low level of awareness of IBD among the public, policy makers and even clinicians. It says:

“Public awareness of IBD is lower than for Parkinson’s and MS”—

multiple sclerosis—

“respectively, despite more people being affected by IBD than both diseases combined.”

Most of us will be very familiar with those two diseases.

At this point, I want to include some of the comments from the digital debate on Facebook. One contributor said:

“I’ve had Crohn’s for 18 years. For me it’s pain, fatigue and always having to explain to people what’s wrong with me and why I can’t come to work or do things.”

Another referred to:

“The Stigma of having a bowel disease. People not believing you and belittling how you feel because they can’t see it.”

Another said that we need:

“To raise more awareness of the illness! Make people more aware of what we go through on a day to day basis!”

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Another talked about:

“Having to try, and try, and TRY to make people realise that it’s a disability and that just because you ‘don’t look ill’ (in a wheelchair) you still have issues that they will never understand.”

Many made the point that the illness controls and disrupts their lives to such an extent that they are in fact disabled by it. It is a hidden disability, and many call for it to be recognised as a disability. Therefore my question for the Minister is this: what are the Government doing to increase awareness of inflammatory bowel disease, and what are they doing to measure accurately the number of people living with IBD in England?

The charity tells me that early diagnosis of Crohn’s and colitis can prevent emergency hospital admissions, which have a cost to the NHS, and can help to avoid clinical complications. Unfortunately, in a substantial number of cases, that is simply not happening. Studies have shown that 35% of people with Crohn’s and 16% of people with colitis had three or more emergency admissions before they received their diagnosis.

In the digital debate on Facebook, a sufferer said:

“I was treated for 6 months by my GP for food poisoning and/or anorexia before eventually ending up hospitalised as an emergency. The hospital did biopsies that day and confirmed Crohn’s. My Crohn’s turned out to be particularly aggressive and unresponsive to treatment and numerous surgeries.”

Another said:

“GPs need to be more up to date with IBD and stop saying it’s just a virus or IBS”—

irritable bowel syndrome. They continued:

“It took quite a few years of pain and complaining before I was diagnosed with Ulcerative Colitis.”

There is clear guidance from NICE on referral. The NICE quality standard for IBD states that people who have been experiencing abdominal pain or discomfort, bloating or a change in bowel habits, such as diarrhoea, with or without rectal bleeding, for at least six weeks should be suspected of having IBD. However, the feedback is clear that for many that is currently not happening and the guidance is not being followed.

NICE recommended faecal calprotectin testing as an option to help doctors to distinguish between inflammatory bowel diseases, such as Crohn’s and colitis, and non-inflammatory bowel diseases, such as IBS. That testing should enable quicker identification of suspected IBD and referral to a specialist, and reduce the number of unnecessary endoscopies carried out. Therefore more effective use of faecal calprotectin testing in primary care should enable quicker and more economical diagnosis of IBD patients, ensuring better and more efficient care in England.

What steps will the Minister take to improve the identification of suspected IBD? What are the Government doing to increase awareness of IBD in general practice among GPs? What steps will she take to improve the rate of referral of people with suspected IBD from primary care to the experts in secondary care? Will the Department undertake an evaluation of the uptake of faecal calprotectin testing by clinical commissioning groups, which NICE recommends, and the time taken by labs to process the results?

The IBD standards have been widely recognised throughout the IBD community, and later rounds of the IBD audit have benchmarked IBD services directly against them, but there is still a lot to do. Some 14% of services are still unable to provide people with Crohn’s or colitis

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with access to an IBD specialist nurse. Many of us would think of having access to a Parkinson’s specialist nurse, but IBD specialist nurses are few and far between, and many that have them struggle to maintain that vital service. Nearly one in four—23%—of all services have no access to specialist nutritional support despite the high level of malnutrition experienced by people suffering with IBD. Only 12% of services have a clear process to enable people with IBD to see a psychologist or a counsellor with a particular knowledge of IBD, and IBD has been described on many occasions as being a traumatising disease that leaves many people feeling isolated and unable to discuss with anyone—sometimes even their closest partners and friends—the reasons why they are often ill.

Sufferers complained online of a postcode lottery with IBD nurses. The lack of nurses was cited by many, who also said that GPs needed more training to identify people with Crohn’s and to assist in providing faster referrals or appointments when treatments need adjusting. Some sufferers found that their GP even seemed reluctant to make those referrals. Many sufferers said that employers need to have a greater awareness of the impact of IBD on their employees, especially given that flare-ups can occur at any time.

What is the Department doing to ensure the implementation of the IBD standards in England, and can the Minister give assurances to those living with IBD that they will not be forgotten on a strategic level by the NHS? What action is the Department taking to ensure that the NICE quality standard for IBD disease is being implemented across England? For those living with IBD, debilitating symptoms such as diarrhoea can occur instantly and unpredictably. Crohn’s and Colitis UK has been championing quick access to suitable toilet facilities. I hope the Minister will encourage all local authorities to evaluate the public toilet provision in their locality.

Christina Rees (Neath) (Lab): Increasing access to toilets away from home is of benefit to all groups in society but it is especially crucial for those living with Crohn’s and ulcerative colitis, who have concerns about not reaching a toilet in time. Does the hon. Lady believe that other nations in the UK can learn from Welsh Labour’s Public Health (Wales) Bill, which treats access to toilets as a public health issue?

Mrs Main: It certainly is a public health issue. In the first Parliament I was in, from 2005 to 2010, I was on the Select Committee on Communities and Local Government and we looked into the issue of toilet access. I do not think that much has improved since then and that was under a Labour Government. I am sorry to say that we have not made a lot of progress. At the time, ordinary businesses were showing and displaying signs reading, “We welcome people using our public facilities.” The evidence that came out of that Communities and Local Government Committee report was that toilet provision was not just needed for people with things such as Crohn’s and colitis—there was a vast spectrum of other conditions for which people would welcome toilet provision, but that is for another debate.

It is very obvious that more focus on the cure and cause of IBD is urgently needed. I hope the Minister will give sufferers of this debilitating disease a cause for

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hope and a better future. I look forward to her answers—I hope she can give them today—to a large number of the questions that I have raised on behalf of those who have responded to the online debate and on behalf of the charity Crohn’s and Colitis UK, which is doing such a lot of good work. Look for the purple badge.

Several hon. Members rose

Sir Roger Gale (in the Chair): Order. I think four Members wish to speak. I will not put a formal time limit on speeches but request that Members confine their remarks to about six minutes. If we are sensible, everybody should get a chance to speak.

4.44 pm

Melanie Onn (Great Grimsby) (Lab): It is a pleasure to serve under your chairmanship, Sir Roger. I congratulate the hon. Member for St Albans (Mrs Main) on securing this debate. It is most welcome, especially to those people who are suffering and feel that they have a forgotten illness. It is important to discuss this immune system-related condition and to remind those in the Government that IBD is not IBS. I previously submitted a written question to the Minister about some of the data on Crohn’s and colitis gastroenterology appointments and asked whether they were being cancelled or postponed by the provider. No data are collected on that and it seems that quite a lot of data are not collected on the illness. I welcome the hon. Lady’s comments on centralising data on sufferers. As a sufferer myself, I think it would be a particularly good idea.

The appointments issue was recognised by my local trust. First appointments after a referral by a GP were timely but subsequent appointments to consultants were frequently being rescheduled at short notice and people would not be able to see their consultant for a further six months. For IBD sufferers, the gaps between assessments and, for consultants, the gaps between monitoring, are increasingly problematic. Consultants cannot get the data they need to monitor sufferers properly.

Specialist IBD nurses are absolutely essential as a resource for between-appointment reassurance and advice for sufferers. The nurses cover not only IBD. Those at my local hospital, including Kay Foster, who has been particularly helpful to me, cover IBS and a whole range of bowel conditions. Her caseload is enormous but if someone rings her, she will always call back. If that service were available more widely, it would be greatly appreciated.

Funnily enough, I had an email from a constituent, who said that she has recently come out of hospital after being admitted with suspected inflammatory bowel disease after having a camera investigation. She was discharged from hospital after becoming very ill and having to be put on a drip because she dehydrated and collapsed. She is now on a waiting list of about six weeks for a CT scan. At the moment, she is constantly having flare-ups as soon as she eats anything. She is losing a lot of weight and is not digesting anything. Her big concern is that she is malnourished, dehydrated, weak, exhausted, in pain and constantly having to use the toilet.

4.46 pm

Sitting suspended for a Division in the House.

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4.57 pm

On resuming

Melanie Onn: My constituent is suffering with daily anxiety attacks. She has three young children, and she feels as if she cannot be a proper parent because she is so poorly. She has already signed off sick and is unable to work. She asked me to intervene to try to move her appointment forward. Of course, I recognise that numerous people will, unfortunately, be in that situation.

In my previous role as an organiser for Unison, I met a carer for older people in a nursing home. She had two young children, too, and she was struck down by the illness particularly severely. Within a short period of time, she was taken down the route of capability by her employer. Fortunately, we were able to intervene because, as a long-term condition, it falls under the Equality Act 2010. We were able to assist, but all employers should be aware and make reasonable adjustments, as they are required, including to work patterns, which can assist in supporting people.

At the moment, treatment seems to be limited to preventive measures, but that is very much about people’s physical health. It is also about mental health, because stress can form part of the illness. Continued use of steroids is not a healthy way to live and can have negative long-term effects. Many people are desperate to get control of this disease, and investment in research to try to combat the illness cannot come soon enough.

4.58 pm

Corri Wilson (Ayr, Carrick and Cumnock) (SNP): I congratulate the hon. Member for St Albans (Mrs Main) on securing this important debate. Helping to increase the understanding and awareness of Crohn’s and colitis is of huge importance to the 300,000 people across the UK who suffer from one of those complex, lifelong and potentially life-threatening diseases. It is thought that as many as 26,000 people in Scotland have Crohn’s or colitis, a higher incidence rate than anywhere else in the UK.

Living with IBD can have a huge impact on every aspect of a person’s life. It has serious physical and mental health implications, as I found out when I met local representatives of Crohn’s and Colitis UK soon after I was elected. I was surprised to find out that there were hundreds of people living in my constituency of Ayr, Carrick and Cumnock who suffer from these hidden, often misunderstood and dreadful conditions. It is vital that we try and reach out to these people, who may feel isolated or be coping badly with their health.

Living with IBD can be a daily struggle. Some symptoms of the disease can be embarrassing, which can lead to people suffering, without receiving adequate support, or feeling isolated. As we have heard, among the most distressing symptoms of IBD are diarrhoea and a constant urge to have a bowel movement. This means that people with IBD need constant access to a toilet, due to the frequency and urgency of their bowel movements. That is why the availability of clean public toilets is so crucial for those with IBD.

Understandably, these symptoms are often accompanied by a continuous anxiety about the sudden need to go to the toilet but having little time to find one. Who here can imagine the nightmare of being constantly under threat of being incontinent in public? For many individuals,

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that anxiety can have a devastating impact on their ability to engage in activities outside the home, such as working, shopping or socialising.

I am trying to help my constituents by working with the local Crohn’s and Colitis UK group on a scheme that encourages shops, restaurants and other businesses to have an open-door policy for people with Crohn’s or colitis who carry the “Can’t Wait” card. Something as simple as a sticker in a premise’s windows will allow people with these conditions to know that they can use a toilet that in other circumstances may not be open to the public. We also need to challenge the public’s attitude about disability, which is probably down to the logos that are used, and show that those with disabilities are not always in wheelchairs.

One of the things that people in my constituency who have IBD do not have to worry about is paying for their prescriptions. One of the main reasons the Scottish Government scrapped prescription charges was the benefit to people with life-long conditions such as IBD. Research shows that as a result of an unfair, outdated and arbitrary system of exemptions, many people with long-term conditions in England are severely compromising their health because they are unable to afford prescription charges. Since such charging was scrapped in Scotland, those with conditions such as IBD who need medication on an ongoing basis throughout their lives to keep them well no longer have to face making an impossible decision between paying for essential medication or feeding their family, or paying their rent or heating their home. Effectively taxing someone for having IBD or any other long-term condition is unfair and fundamentally against the founding principles of the NHS. I am proud that in Scotland we took the decision to improve access to prescriptions for all.

Although much needs to be done to improve the treatment of people with Crohn’s and colitis, I ask the Government to recognise the benefits of scrapping prescription charges for people with long-term conditions, and I ask all Members of the House to work with their local Crohn’s and Colitis UK group to help to foster the kind of environment where people suffering from these incurable and relapsing chronic conditions can feel confident to leave their homes and take part in the everyday activities that most of us take for granted.

5.3 pm

Chris Evans (Islwyn) (Lab/Co-op): It is a pleasure to serve under your chairmanship today, Sir Roger.

I, too, congratulate the hon. Member for St Albans (Mrs Main) on her outstanding speech and on bringing this important topic to the fore. I am delighted that we have had so many contributors today. I remember that when I held a debate in 2012 on employment opportunities for those with Crohn’s and colitis, I was the only speaker who was responded to by the Minister. I am glad that this issue has moved up the agenda somewhat since then.

Those with Crohn’s and colitis are often mixed up with those with irritable bowel syndrome—in fact, I admit that when I first heard of Crohn’s and colitis, I thought they were the same thing. I did not realise how debilitating and disabling they were, and how many people suffered in silence, and I really believed that it was time to shine a light on those things.

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A recent Crohn’s and Colitis UK survey of pre-employed young people with inflammatory bowel disease showed that the prospect of gaining their first job was regarded as a daunting challenge. Employability emerged as their overriding concern, and when they found themselves in work, they found that they were often too embarrassed or scared to tell their employers about their needs. When I secured that debate—four years ago, nearly—I said that all we were calling for from employers was some understanding and some respect. However, with the welfare reform changes that lay ahead, I was deeply concerned that that was not going to be the case. That is why I am disappointed that the report found that 69% of the young people interviewed felt that their IBD had prevented them not only from reaching their full educational potential, but from having any chance of employment, with over half ruling out some sort of career option.

Back in January 2014, I took on an intern for three months who has Crohn’s disease. She completed her internship and I was very impressed by her work. There was an opening in my office and I offered her a job as my parliamentary research assistant, and she has been with me ever since—although I will say that in some parts of this speech she has written “irritable bowel disease” rather than “inflammatory bowel disease”, even though she herself suffers from the condition, but I will forgive her that. I was keen to take part in the internship programme, as I valued the idea of giving a younger member of the public an incredible career experience, while also teaching politicians such as myself about inflammatory bowel disease—she has written “irritable bowel disease” again, Sir Roger.

In January 2015, I hosted the parliamentary launch of the Work Foundation’s report on IBD and employment, alongside Crohn’s and Colitis UK—I am delighted they are here today, as the hon. Member for St Albans mentioned. In the UK, at least 300,000 people, or one in 210 people, have Crohn’s disease or ulcerative colitis, which are both known as inflammatory bowel disease. That equates to roughly around 460 people in each parliamentary constituency across the UK. These are incurable and relapsing chronic long-term conditions. The symptoms can be present at any age, but most commonly in the teens and twenties.

People with IBD are high users of health services, with 50% of patients with Crohn’s disease requiring surgery during their lifetime. I know this first hand, as my parliamentary researcher, who has Crohn’s disease, as I have mentioned, has had four operations in the two years she has been working in my office. In saying that, I pay tribute to Laura for her bravery, because, for something as private and embarrassing as some of the symptoms she has suffered from, she has not been afraid to bring that to the fore. We need more people like her, not only in politics but throughout working life.

Medical treatment will often include corticosteroids and immunosuppressants, including the biological therapies that are the latest treatments offered for inflammatory bowel disease. These conditions can have a devastating and life-stopping impact on a person’s life, due to the unpredictable nature of flare-ups, together with sleep deprivation, pain and fatigue, and they can severely affect an individual’s self-esteem.

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There appears to be a low level of awareness of inflammatory bowel disease among the public, policy makers and clinicians. Public awareness of IBD is lower than it is for Parkinson’s and multiple sclerosis, as the hon. Member for St Albans mentioned, despite more people being affected by IBD than by both these conditions combined. The lack of public awareness is exacerbated by the stigma attached to the symptoms of IBD and the fact that it is a hidden illness.

Four years ago, I called for some understanding from employers. With debates such as this and events we have had in Parliament, I hope that understanding can come to the fore. If there is a message that should emerge from today’s debate from sufferers of IBD such as my hon. Friend the Member for Great Grimsby (Melanie Onn) and my parliamentary researcher, it is that there is no point in hiding IBD away. If someone is suffering, they should ask their employer for help. Most people I meet—I was a trade union official—are understanding. I have tried to be an understanding employer myself. Once people overcome that barrier, they will find that they can have a working life that is fruitful and that can lead to some great opportunities.

I had wanted to say more, Sir Roger, but I understand that there is a time limit. However, I will say this to anybody who suffers from Crohn’s or colitis: please do not hide away. If you are suffering, then speak to your employer. Speak to your teacher. Tell them what you are suffering from and they will be understanding. I genuinely believe that Crohn’s and colitis is as much of a problem for this country as dementia, whereas it is not mentioned because it is embarrassing—it is not something that we talk about. Crohn’s should be pushed up the political agenda, and I hope that with today’s debate we will do that.

5.9 pm

Dr Philippa Whitford (Central Ayrshire) (SNP): It is an honour to serve under your chairmanship, Sir Roger.

I, too, pay tribute to the hon. Member for St Albans (Mrs Main) for securing this debate, because, as we have heard in some of the contributions, there is a lack of awareness of the difference between irritable bowel syndrome and inflammatory bowel disease. Having been a doctor myself for more than 30 years, and a general surgeon for 20 of those before specialising purely in breast cancer, I know well what the outcome can be for people with IBD.

As the hon. Lady said, the rate of surgery is such that between 50% and 70% of Crohn’s patients and almost a third of those with ulcerative colitis will end up having an operation. The conditions are not trivial or embarrassing; they are life-threatening. It is therefore absolutely important that we try to get the research funding so that we can understand the cause, because that then gives us a chance of finding the cure. As my hon. Friend the Member for Ayr, Carrick and Cumnock (Corri Wilson) mentioned, for some reason Scotland has a very high incidence of such conditions. Is that genetic, or is it environmental? Looking at what is going on in different parts of the UK may help us get a handle on what is going on. Those are the things that we need to look for in the long term.

Normally when we are in the Chamber talking about a disease, we are talking about access to medicines in the major sense of not being allowed a new drug that

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would make a difference. Unusually, that is not the case here. The anti-tumour necrosis factor drugs can make a huge difference and have been passed by all the nations of the UK, but there is an issue with patients getting all the medicines that they require. If patients are on biologics, they will not pay prescription charges, but most of them are on a panoply of drugs, and for those they do have to pay. England needs to consider that Wales, Northern Ireland and Scotland have got rid of prescription charges. That move was led by Wales in 2007.

Plenty of research shows that, in general, less than 10% of the population pays for prescriptions, with half as pre-payment and half as pay-as-you-go. However, whenever surveys are done of people with chronic diseases, we find that some 75% to 85% are paying. That is because many of those diseases do not hit people once they have conveniently retired and qualify for free prescriptions. We have talked about how Crohn’s may hit people in their teens and how ulcerative colitis may hit people in their 20s and 30s, and they will have those conditions for life. They will be on different medications: methotrexate, steroids, enemas—the whole works—and they will be paying £8 an item. We talk about pre-payment, but many of these people will be in poorer jobs, because there will be times when they are not so well and when they are in and out of work as they have a waxing and waning condition. Because of that, they have to try to work out whether it will benefit them to pay £100-odd to have a pre-payment certificate. Perhaps they have a good year, perhaps they do not.

What has been shown in all the research is that approximately 35% of people report having not picked up a prescription because of charges, and approximately 30% have done that repeatedly. With all conditions we know that if someone is not taking their medication, they will get worse, but that is particularly the case with Crohn’s and colitis, which have such complications as strictures and toxic megacolon.

Working in breast cancer, we talk about “the big C”, but when I was doing general and emergency surgery I used to think of Crohn’s as “the wee C”, because it affects virtually all of someone’s life. It is debilitating and will affect everything that they do. These people are in and out of hospital, developing strictures, perforations and ischemic bowels and undergoing ileostomies, reversals and so on. It goes on and on. The hon. Member for Islwyn (Chris Evans) mentioned his member of staff, and I suggest he proofreads his speeches. She may write them, but it is his job to check them. People with Crohn’s often end up in hospital having expensive and incredibly difficult surgery. To go back into the abdomen of someone who has Crohn’s is a surgical nightmare. I have been there with the sweat pouring off me, trying to do those operations. Using the anti-TNF drugs earlier and ensuring that patients take all the medication required will make a difference in reducing surgery and, in the end, that is more cost-effective.

The other thing is access to care and trying to make it easier for people to get on with normal life. Along with Crohn’s and Colitis UK, the Scottish Government funded a two-year pilot that was looking at allowing patients to be much more linked to the clinician using e-health technology. That was carried out in the highlands to look at people living in rural areas, and in Greater Glasgow and Clyde to look at people living in a large city. The pilot developed information and support for

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patients and redesigned the services around the patients. Using the technology, the patient has an app that gives them information. They can have a two-way conversation with a clinician and they can register their symptoms. The clinician has a dashboard on their patients, and they can see whether someone is getting worse. That allows them to say, “Increase that”, or “Decrease this.” It means that patients do not always have to go and sit in the hospital if they are trying to hold down a job. If someone lives in the highlands and has to travel four hours to get to Inverness, that is a major pain when they are trying to maintain a normal life.

A new strategy is being launched in Scotland in June, and its aim is to meet the UK national Crohn’s and colitis standards. It will be the first comprehensive integrated strategy in the United Kingdom. It will create a patient portal where people can access their clinic letters and blood results so that they learn that they can manage their own disease. When we talk about the five year forward vision, or the 2020 vision in Scotland, the aim is to enable and empower patients to manage their chronic diseases as far as possible.

The last thing that was mentioned by the hon. Member for Islwyn was changing attitudes in society. Not everyone with a condition is on crutches or in a wheelchair, and we need to get past the embarrassment of talking about bottoms or going to the toilet. We need to realise that these are serious conditions that are debilitating. We simply need to make access to toilets available for everyone, whether they are elderly, incontinent or have inflammatory bowel disease. It is about trying to get past that access just being for certain people because it is important for a lot of people.

5.16 pm

Andrew Gwynne (Denton and Reddish) (Lab): It is a pleasure to serve under your chairmanship, Sir Roger. I, too, commend the hon. Member for St Albans (Mrs Main) not only on securing the debate and the eloquent way in which she opened it, but on the work she is doing to help raise awareness of Crohn’s and colitis. Although the debate is about the situation in England, we have had a valuable set of contributions from Members from Wales and Scotland. While it is right that the public health Minister is responsible for this policy area in England, there is a lot of experience and research that we should be sharing. We should also be sharing a lot more understanding of what each part of the NHS in each respective part of the United Kingdom is achieving in the work to try to tackle some of the issues.

I put on record my thanks to Crohn’s and Colitis UK for all its hard work in briefing Members of Parliament for this debate, and for all the work it has done since its inception in 1979. I will let you into a secret, Sir Roger. I am fairly new to the shadow public health role, although I have been on the shadow Health team for some time now. I must confess to not being entirely abreast of the issues facing IBD sufferers before looking at them for this debate. Frankly, what I found stunned me. More than 300,000 people in the UK suffer from Crohn’s or ulcerative colitis, and that equates to some 460 people in my constituency alone.

While that is a lot of people, IBD is not as prevalent as some of the more common long-term conditions. That means that research funding, as we have heard over the course of this debate, is thin on the ground,

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and there is not the same level of awareness in the general public at large. Put simply, it is not a glamorous cause. There are few outward signs of having the condition, but the effect on lifestyle is massive for the people concerned. Many of the problems that we discuss regularly in terms of cancer are just as pronounced when it comes to IBD, and not only include pain, fatigue, sleep deprivation and disruption to life in general, but also relate to awareness, diagnosis and psychological impact, and I want to touch on those things.

First, I want to address the problems of diagnosis. GPs need to be more aware of IBD. Every medical practitioner knows of instances of general abdominal pain and irregular bowel function being written off as IBS. As I have already said, I was not fully aware of the problem of misdiagnosis until I heard from Crohn’s and Colitis UK, so the matter does come down to awareness both among the general public and, importantly, among the medical community. Because the most pronounced symptoms of IBD are often the most embarrassing to discuss, the issue often gets swept under the carpet, even in the GP’s surgery.

Studies have shown that 35% of people with Crohn’s had three or more emergency admissions before they received a diagnosis. Frankly, that just is not good enough. I accept that some delays to diagnosis are inevitable, considering the nature of the disease, and clinical judgment should receive an appropriate degree of latitude, but we can and we must do much more.

There are some welcome signs. In 2013, NICE recommended faecal calprotectin testing as one option for doctors to help distinguish between IBS and IBD, which is welcome. There can be more effective use of that at primary care level, which would save not only money but would ensure better and more efficient care for patients: an undeniable win-win situation for all involved. How will the public health Minister improve the efficiency of the identification of suspected IBD? We also need to reduce the unnecessary use of endoscopies where less intrusive tests would do just fine.

I want to spend some time talking about the psychological impact, which Members have touched on today. Last year, the Opposition established the post of shadow Mental Health Minister, a job in which my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) is making a significant impact. Mental health is of paramount importance to the Labour party, and it is often the unseen damage that is most destructive. IBD symptoms, diagnostics and treatment can have a disastrous impact on a sufferer’s mental health. The uncertainty and sense of lost potential must be absolutely awful, and I cannot help but imagine how I would feel were one of my children told that they had IBD.

An audit in 2014 found that only 12% of services have a clear process to enable people suffering from IBD to see a psychologist or professional with knowledge of IBD. That figure may have improved—we might see that when the next audit is carried out—but however we look at it, it is not good enough. About 41% of IBD sufferers experience high levels of anxiety, and so of course we must do more because many people living with IBD feel that simply having easier access to psychiatric services at critical points would help immensely. With the Government’s laudable commitment to ensuring parity

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of esteem, which we are fully behind, what is the Minister’s Department doing to make sure that people with IBD across England have the appropriate level of access to tailored psychological support with professionals who are familiar with the very specific issues they face?

I am pleased that hon. Members have mentioned the access to toilets strategy formed by my Labour colleagues in Wales. Obviously, an episode of incontinence in public is extremely embarrassing, and with incredibly poor access to public toilets being endemic across England, a person with IBD can feel anxious even being in an unfamiliar place. Many people with IBD have seen a devastating impact on their capacity to lead normal lives when they are away from home. I am therefore pleased that the Welsh Government have led by treating access to public toilets as a public health issue.

The Welsh Assembly is now considering the Public Health (Wales) Bill, which is close to the final stages of the legislative process. Some fairly simple steps can have a big impact on the ability of Crohn’s and colitis sufferers to lead normal lives when out and about. Councils, for example, could make better use of the toilets that are already in the community, whether in public buildings or private businesses. The Bill will place a duty on every council to publish a local toilet strategy. The Welsh Government are leading the way, and I hope the UK Government will follow suit. I appreciate that it might require intervention by the Minister’s colleagues in the Department for Communities and Local Government to halt some of the public toilet closures that we have seen in recent years, but will the Minister offer to discuss this not only with her colleagues in DCLG, but with my Welsh Labour colleague, Mark Drakeford? I think there is plenty of potential here.

My thanks go to all hon. Members for their contributions this afternoon. Some incredibly astute points have been made, and I hope the Minister goes away better informed, as I know I will, as a result of this debate. We owe it to those 300,000 people in the UK suffering from Crohn’s disease or colitis to come up with some better ideas in the coming months and years. This debate has given us a good starting point, such as the need for better public toilet access, and the need for more widespread use of less invasive diagnostic techniques. About 18,000 new cases of IBD are diagnosed every year, so this is not some fringe problem, but an issue facing people in every single community across the country. I look forward to hearing the public health Minister’s response.

5.26 pm

The Parliamentary Under-Secretary of State for Health (Jane Ellison): It is a pleasure to respond to this debate under your chairmanship, Sir Roger. We have had a good debate with many first-class contributions. I hope it demonstrates to those watching and those who participated in such great numbers in the Facebook debate that Parliament is taking this issue seriously as we have filled the time available to us with various contributions. I hope to be able to respond to most of the points made. If not, as ever, I will try to respond post debate.

I congratulate my hon. Friend the Member for St Albans (Mrs Main) on securing the debate. It is always interesting for a Member of Parliament with a great charity in the constituency; the MP ends up becoming quite expert,

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and my hon. Friend has done an excellent charity proud this afternoon in raising the issues. Crohn’s and Colitis UK is the national charity campaigning on these issues. I pay tribute to its work as it campaigns tirelessly to raise the profile of Crohn’s and colitis and to provide support and advice to all those affected. My hon. Friend is a keen supporter of its work.

I will not spend time describing the diseases themselves or the number of people affected, because others have eloquently done so. Instead I will talk about some of the ways in which we are responding. A great many of our fellow citizens are affected, so it is right that we have this debate today.

Some hon. Members raised the issue of GPs, diagnosis and training. Digestive health features both as part of the undergraduate medical curriculum and GP specialty training. For GPs the required competencies include understanding the epidemiology of digestive problems as they present in primary care; how to interpret common symptoms in general practice; and how to demonstrate a systematic approach to investigating digestive symptoms such as IBD. IBD also features in the content guide for the Royal College of General Practitioners applied knowledge test, a key part of the assessment of trainee GPs, which must be passed in order to qualify.

As others have said, diagnosing the symptoms of IBD can be challenging for a GP. Even though the numbers are quite large, as we have heard, if we divide the numbers by GP practice across the country, it might be the case that some GPs are not seeing people very often. The variety of symptoms and the range of their severity differ from patient to patient. Problems may also arise owing to the fact that the symptoms of IBD, such as abdominal pain and weight loss, are shared with other more common, less serious conditions, such as IBS, which is estimated to affect 12 million people in the UK, as opposed to IBD, which affects around 300,000. However, as others have said, a misdiagnosis or a delayed diagnosis can lead to a range of further complications for IBD suffers, so it is important that clinicians have the tools and resources to help them to identify symptoms when a patient presents.

In addition to their clinical training and experience, a number of tools and resources are now available to clinicians to help them to diagnose and manage IBD. The “Map of Medicine” is an excellent free online evidence-based guide and clinical decision support tool, which is available to GPs and other healthcare professionals working in the NHS. It has published diagnosis and treatment maps for patients with IBD. The map supports GPs on issues such as differential diagnosis and helps them to identify “red flag” IBD symptoms and provide advice on appropriate diagnostics and referrals. NICE has produced a clinical guideline specifically to support clinicians in using faecal calprotectin testing to help doctors to distinguish between IBD and less serious conditions as it highlights inflammation specifically.

NICE’s role in setting standards in the diagnosis and management of a range of diseases is well known, and IBD is no exception in that regard. NICE published best-practice clinical guidelines on the management of Crohn’s and colitis in 2012 and 2013 respectively. Once diagnosed, a number of treatment options are available for patients. The Scottish National party spokesperson, the hon. Member for Central Ayrshire (Dr Whitford),

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outlined some of the related challenges and some of the treatments in which she has participated. When treating IBD, the aim is either to heal the inflammation and so reduce the symptoms during a flare-up, which is known as inducing remission, or to prevent flare-ups from happening in future, which is known as maintaining remission.

The routine monitoring and follow-up of patients is a key feature of the guidance on the management of Crohn’s disease and ulcerative colitis. It ensures that patients can access specialist care when flare-ups or relapses occur. Protocols for monitoring should be agreed locally. Various drugs are recommended by NICE and funded by the NHS, and they can help with both of those aims. Although there is currently no cure for IBD, we know that some treatments can ease symptoms and improve quality of life—we heard Members talk about a particular member of staff and bring quality-of-life issues to the fore in their speeches. Management options include drug therapy, dietary and lifestyle advice and, in severe or chronic active disease, surgery.

I turn briefly to prescriptions. In addition to medical exemption, there are extensive exemption arrangements in England, based on age and income, via various means- tested benefits. For people who need multiple prescriptions and have to pay NHS prescription charges, such as those with long-term conditions, prescription prepayment certificates are also available, and it is worth highlighting that. I take the point about the challenge of prescriptions, but not everyone is aware of PPCs. This is the fifth year that the cost of an annual certificate has been frozen, and the third year that the cost of a three-month certificate has been frozen. Next year, both certificates will remain at £104 and £29.10 respectively. There is no limit to the number of items that can be obtained through a PPC. The annual certificate benefits anyone needing more than 12 items a year and the three-month certificate benefits anyone needing more than three items in that three-month period.

The IBD quality standard was mentioned. In general, quality standards are important in order to set out to patients, the public, commissioners and providers what a high-quality service should look like. NICE issues them, and they enable services to benchmark themselves against one another. The quality standard for IBD was published in February 2015 and contained priority statements covering important areas such as specialist assessment, drug monitoring and surgery, all of which is designed to drive improvements in IBD care. Although providers and commissioners must have regard to the quality standards in planning and delivering services, the standards themselves do not provide a comprehensive service specification and are not mandatory.

The six inflammatory bowel disease standards were published in 2013 by the IBD Standards Group, an independent organisation made up of a number of professional clinical organisations and the charity itself. The standards were designed to support clinicians and commissioning organisations in the development of local IBD services. If appropriate, they may be considered alongside sources of guidance such as the NICE guidelines.

A number of important issues have been raised in the debate that are very much matters for NHS England to look into. I am sure it will be really interested to hear about the challenges that have been raised in the debate, as well as about the Scottish strategy. As the shadow

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Minister said, the consideration of best practice throughout the United Kingdom is often common, as are many research outcomes, not only throughout the United Kingdom but internationally.

Some Members mentioned the importance of nurse specialists. It was lovely to hear the hon. Member for Great Grimsby (Melanie Onn) pay tribute to the specialists with whom she has dealt and the standard of care and support she has experienced. Obviously the recruitment of staff is ultimately a local matter but, again, the NICE guidance states that local services should ensure that patients with Crohn’s or ulcerative colitis have support from an IBD multidisciplinary team, which should comprise a range of experts, including dieticians, who were mentioned, and clinical nurse specialists with particular expertise and specialist interest. That MDT care is a key feature of the quality standard, which sets out what great-quality care looks like.

The shadow Minister mentioned mental health support. It is worth noting for the record that we invested more than £400 million over the previous spending review period in improving access to psychological therapies—the IAPT programme—to ensure access to talking therapies for those who need them. That includes people with long- term conditions who are suffering from anxiety and depression. Recent positive announcements include the Prime Minister announcing £1 billion to start a revolution in mental health, which is a shared interest right across the House. No one has done enough on mental health in the past, and the matter is now much more front and centre in our thoughts. As part of that announcement, £247 million has been allocated to ensure that every emergency department has mental health support. That money reaffirms the Government’s commitment to parity of esteem between mental and physical health.

Several Members quite rightly asked about toilets. As others have said, it is essentially a matter for my colleagues in the Department for Communities and Local Government, but I will of course draw their attention to this debate. Local authorities in England are forecast to spend just over £60 million on such services in 2015-16. It is also worth noting that more than 400 local authorities and thousands of businesses have joined the national RADAR key scheme, meaning that some 9,000 toilets in shopping centres, pubs, cafés, department stores, bus and train stations and many other locations are now listed as being accessible through the scheme. I am sure that we have all seen them in our local areas. Official RADAR keys cost about £5 and can be bought from participating local authorities or Disability Rights UK shops. While noting that initiative, we must recognise that there is always more to do in that regard.

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Members quite rightly drew the House’s attention to research and the need to know more. Dealing with a disease that currently has no cure is a big challenge, and research is key. The Department of Health currently spends more than £1 billion a year on research. As for IBD, the Department’s National Institute for Health Research awarded a £1.5 million research professorship for five years from 2013 to 2018 at the University of Oxford to examine the use of molecular techniques to re-stratify Crohn’s disease, aiming to get into the detail of identifying patients amenable to new treatment approaches and to develop new therapies. The NIHR is also investing just under £1 million in a study comparing the accuracy of MRI imaging and small bowel ultrasound in assessing the extent and activity of newly diagnosed and relapsed Crohn’s disease. The final report from the study is expected to be published in September 2017, and I am sure that there will be interest in that among Members.

My hon. Friend the Member for St Albans also mentioned the IBD BioResource. It is a really exciting project that brings together the Medical Research Council and the NIHR, supporting groundbreaking studies looking at the genetics of and new treatments for IBD that have the potential to make a real difference to patients’ lives. It will undertake a major new genetic analysis based on genome sequencing, and it will keep a database of 25,000 patients with IBD.

I have tried to cover most of the points raised in the debate. I hope that I have given hon. Members a sense of the Government’s ambition to make progress on research. I again pay tribute to the charity for contributing to the research. Partnerships between Government bodies, medical research bodies and specialist charities are an important part of making progress, not least because recruiting people to studies is important, and we cannot do that without the work of the charities.

I will write to Professor Sir Bruce Keogh, the medical director of NHS England, to outline the concerns that hon. Members raised today and to ensure that he is aware of Parliament’s interest in this issue and of the challenge to the NHS that has been outlined today. I urge Crohn’s and Colitis UK, as I do all relevant stakeholders, to continue to engage with NHS England to build valuable long-term relationships. I will write to the Royal College of General Practitioners, as a number of the issues that were raised relate to it. I once again thank my hon. Friend the Member for St Albans for securing today’s debate and for making such a meaningful contribution to raising awareness of this very important issue.

5.41 pm

Motion lapsed, and sitting adjourned without Question put (Standing Order No. 10(14)).