Tuesday 1 May 2007
[John Cummings in the Chair]
Health Services (West London)
Motion made, and Question proposed, That the sitting be now adjourned.—[Jonathan Shaw.]
May I say what a pleasure it is to serve under your chairmanship this morning, Mr. Cummings?
Few institutions have the need to manage as much change as the national health service. Sometimes it feels like it has spent the past 25 years in a culture of permanent revolution. This debate is a chance to talk about some of the changes under way to health services in west London and the impact that they will have on patients and communities. I wish to limit my remarks to the future of two specialist hospitals that enjoy extraordinary support in the communities that I represent, but whose futures remain uncertain, as the cards get shuffled again in the game of power politics within the health economy of west London—a game that has so far benefited management consultants far more than patients.
Harefield hospital ought to be the jewel in the crown of the NHS. Benefiting from its long association with Sir Magdi Yacoub, Harefield is one of the best known heart hospitals and heart science centres in the world. In fact, I would argue that very few hospitals in the NHS system enjoy the same international reputation as Harefield. The heart science centre is recognised for groundbreaking advances in the regeneration of the heart in last chance cardiac patients and in the generation of human heart tissue. Surgeons in the hospital there continue to pioneer groundbreaking treatments to save lives at minimum disruption and pain to patients. Instead of building on that centre of excellence, however, the NHS has mucked it around. The Minister is aware of the story, because he was good enough to meet all three Hillingdon MPs—my hon. Friend the Member for Uxbridge (Mr. Randall), the hon. Member for Hayes and Harlington (John McDonnell) and me—and Mrs. Brett, the chair of Heart of Harefield, which is well represented here today.
Now is not the time to revisit the horrors of the Paddington health campus fiasco. The Chairman of the Select Committee on Public Accounts put it well, in his characteristically understated way, when he said in January:
“The collapse of the ambitious Paddington Health Campus project after five years was the direct result of appalling planning and forecasting of costs by the NHS Trust partners”.
Of course, this being the NHS, the partners did not pay the price; in fact, the individuals involved all got promotions. The price has been paid by the taxpayer, who will have to pay more for future refurbishments, by patients, who could have had better facilities by now, and by staff, who had to live with such uncertainty for so long.
Thanks in large part to Heart of Harefield and the clear-headed leadership of Bob Bell, the chief executive of the Royal Brompton and Harefield NHS Trust, the emperor was finally revealed as wearing no clothes and the plan collapsed. The board of the Royal Brompton and Harefield knew how it wanted to respond. It wanted greater freedom to run its own affairs, aspired to achieve what the Government say they want all trusts to achieve—foundation trust status—and received tremendous support in the community for that aim.
The Royal Brompton and Harefield had been a three-star specialist trust for two years running, with an outstanding clinical record and a strong financial position, so its application for foundation trust status should have been plain sailing. So everyone was puzzled in August 2006, when the Department of Health did not support the application. Puzzlement turned to anger when the Department had to admit that the cause of not proceeding was the need to respond to vehement, personal objections by the outgoing chief executive of the strategic health authority for north-west London, one of the leaders of the Paddington health scheme and clearly a man with a personal axe to grind. The local community was so incensed that it was prepared to go for a judicial review. However, it was reassured by the Department’s response, which was to make it clear that it supported the trust going into the next round, which it has since done, with the full support of the London strategic health authority.
We now find, however, that another rock has been laid in the road, obstructing progress towards foundation trust status. Monitor has let it be known verbally that it intends to block the application. Indeed, it took the unusual step of asking the Royal Brompton and Harefield to withdraw it, which, quite sensibly, it has refused to do. Why has Monitor taken that position? It has said that it is a result of Government reforms to the allocation of research grants, under the “Best Research for Best Health” strategy. In Monitor’s view, the Royal Brompton and Harefield is assumed to be a loser and will stay a loser—to the tune of approximately £20 million over three years.
Monitor has also taken the strangely dogmatic position that the Royal Brompton and Harefield will not recover that money in a more competitive research market, despite the fact that the trust’s research programmes are all rated as strong by the Department, most recently in January this year. Even the chief executive of the NHS has written to the chief executives of London hospitals—I have a copy of the letter with me—who had written to him expressing concerns about the new process and the plans for adjustments and transition. He wrote back robustly, saying that they should not assume that they would be net losers from the process, and that everything depended on the quality of research and competition in a more transparent market.
Monitor has continued to adopt a doomsday scenario, however. Moreover, it has refused to believe that a trust with a strong financial position operating in cardiology, which I understand to be one of the most lucrative fields in the market, will have the financial wherewithal or nous to adjust its business plan in the unlikely event of failing to win research grants. The absurdity of that position has reached new heights, as the chief executive of the Royal Brompton and Harefield has revealed that he now expects to have around £250,000 of taxpayers’ money to spend on paying consultants to help him draw up a contingency plan that he knows is not needed.
More alarming for the community that I represent is the fact that the chief executive will be forced to freeze development plans at Harefield hospital, where we had been extremely excited about his commitment to investing £20 million in refitting the hospital to make it even more fit for purpose and safeguard its future in the community. As a consequence of Monitor’s position, all those development plans will have to be put on ice. The chief executive, who has performed heroics in raising the morale and sense of permanency in a trust that had to live through five years of uncertainty about its future, now has to go through that management challenge all over again.
That all seems very strange, and must be worrying for Great Ormond Street hospital, another prestigious hospital and similarly emotive institution a little further down the track that is now in a similar situation. Surely it was not the Government’s intention to undermine those great hospitals. What is going on? A clue lies in a comment from Monitor to the Royal Brompton and Harefield. Monitor said that the trust had
“no future as a standalone Trust”.
If reported accurately, that raises concerns that Monitor may be exceeding its remit and taking views on the configuration of assets in London, at a time when it is known that both University College London and Imperial college are locked in a power game to secure a marriage with the Royal Brompton and Harefield.
In that dialogue and courtship, many compelling clinical reasons will be trotted out for such a marriage, and some of the vows may be true. But at the heart of the issue, as everyone acknowledges, is land—the Brompton site, which is valued at up to £1 billion and a source of cash for grand plans; land that the Royal Brompton and Harefield would control if it achieved foundation trust status and that it could use to fund ambitious plans to redevelop and improve services.
The consequence, intended or otherwise, of Monitor’s intransigence will be to condemn the Royal Brompton and Harefield to being stuck in a less ambitious rut and, in effect, to force it into the arms of a suitor. I am sure that the Minister shares my concern that Monitor’s activities and decisions should be entirely divorced from any commercial interest or power play within the NHS, and should be seen to be so. Will he therefore reassure me that the strict remit of Monitor is to assess applications for foundation trust status and to regulate those trusts, and not to make judgments on the future configuration of services? Will he reassure me, either today or in writing, that no person at Monitor has any formal or informal interest in the negotiations on the future of UCL, Imperial or the Royal Brompton and Harefield?
In relation to the flows of research funding, can the Minister say what impact analysis was conducted on the London hospitals affected by the changes? Can he confirm that it is not the Department’s intention to destabilise those institutions? Will he also take this opportunity to echo David Nicholson’s view that there is no reason in theory why trusts with strong research programmes, such as the Royal Brompton and Harefield, should not continue to win research grants under the new system? Can the Minister confirm whether the three-year phasing-out timetable is set in stone? If not, I urge the Department to consider a phasing period of five years. That would certainly help the Royal Brompton and Harefield to meet Monitor’s objections, but this is not just about one hospital or one trust.
I should say that there appears to be no objection to the principle and the objectives of the proposed reforms to research grant. The concerns appear to be about the timing and the thinking through of the consequences of changes that are a systematic challenge to all hospitals involved. It is not clear that the consequences have been thought through carefully enough. I am sure that the intention was not to destabilise trusts such as the Royal Brompton and Harefield and Great Ormond Street, but that seems to be the consequence.
Moving to five years would give those hospitals more time to adjust and adapt. It would also allow more time for high-class research capacity to be built up outside London. As was said to me, we should not underestimate the fact that it took 20 years for trusts and institutions such as the Royal Brompton and Harefield to build up the centres of excellence that they have developed. It would be a shame if financial pressures forced high-quality research capacity to be cut in London before appropriate capacity had been built up outside. People would not see the sense in that. A move from three to five years would not dilute the principles or direction of travel of reform, just the pace of the journey. I hope that the Minister will give it serious consideration and give us a meaningful answer in his response, either in this debate or in a follow-up letter.
Let me close with some brief comments on another specialist hospital suffering similar uncertainties. Mount Vernon is a wonderful cancer centre that is clearly the most convenient location for a universe of about 2 million potential patients in the west London cancer network. The Minister will be aware that the very controversial decision was taken to move it to a shiny new hospital in Hatfield in 2013. The community was fobbed off with the promise of some walk-in radiotherapy capacity being kept on the site. However, that option faded away as it became clear that it was a second-class service with some risks attached to it. The local community then faced the choice of going to Hammersmith or Hatfield for regular radiotherapy, involving a journey of at least 45 minutes in a car, assuming moderate traffic. That is not a distance or an imposition on a patient that I would care to choose for my family and I am sure that the Minister would not, either. It was unacceptable to the local community.
Now we know that the Hatfield project has collapsed—it was considered unaffordable—we now face a vacuum of decision making and uncertainty about the future of a Mount Vernon cancer centre. The local community’s view is clear. They ask, “Why move it? Why move it if you have just invested £23 million of taxpayers’ money in new radiotherapy bunkers? Why move it when you clearly have superb people on-site, offering brilliant treatment? Why move it if you have Hillingdon hospital, as the landlord of the site, now committed to the site, committed to turning it into a health village and providing there the adjacent specialisms that are required to complement a modern cancer centre? Why move it if you have such strong local support for the centre and the extraordinary charities that feed off it and support it? What could be more affordable than building on the excellence on the site? What could be more affordable than keeping cancer services at Mount Vernon?”
We keep being told that a heat map exists in the Department of Health. Personally, I do not believe that, but if it does exist, I urge the Minister to go back and put a large red sticker over Mount Vernon cancer centre, because the people are on the move and petitions are being signed. We are determined to send the strongest possible signal into the system that we want to keep cancer services at Mount Vernon.
I have spoken about two hospitals, but the same message. They are excellent hospitals. The message to the Department is: please support them in the same way the local communities do. Give them some stability—that is what they are crying out for—not in the interests of complacency or a quiet life, but in the name of progress, ambition and a desire to build on acknowledged excellence.
There is a slight “Groundhog Day” feel to this debate. I note from Hansard that, on 8 February 2006, the hon. Member for Ruislip-Northwood (Mr. Hurd) initiated a similar debate, in which I spoke, as did the hon. Member for Uxbridge (Mr. Randall). Indeed, I think that all the suspects are here again, save for my hon. Friend the Member for Hayes and Harlington (John McDonnell), who perhaps has other business detaining him at the moment. I am sure that the hon. Member for Richmond Park (Susan Kramer) will fill in the gap for her party in a similar fashion.
I hope that the fact that 15 months later we are in the same Chamber for the same debate does not mean that things have not moved on. Despite the comments that we have just heard, things have moved on in some respects for the better. It was reported in that debate, wrongly, that one of my local hospital trusts—Hammersmith—had a very considerable deficit, although it is true that it had a deficit. It now runs on a year-to-year basis, with a balanced budget and, occasionally, a surplus. More to do with NHS finance regulations than the efficiency of that organisation, there is still an underlying deficit of some £11 million, which is to be eliminated over the next three years. That is an improved situation.
There were rumours, which had persisted even then for a year or more, that services would be closed at Charing Cross hospital, which many of my constituents use as their regular district general hospital. Those rumours were always unfounded, but they persist, although they have become more muted, as the evidence does not support them. I note that there is a statement on the issue even today:
“There are currently no plans to close any A&E department, Charing Cross Hospital or any other site. In fact significant investment continues to be made at Charing Cross, with new mental health services; a new 72-hour day-and-stay surgery unit”—
“four new linear accelerators…£6.5m…new research facilities; and a Maggie’s Cancer support centre due to open…later in 2007, £2.5m.”
The evidence of one’s eyes, as one drives down the Fulham Palace road, is that Charing Cross is a hospital that is thriving and into which more and more investment is going.
There is perhaps slightly less good news on the progress of the White City collaborative care centre. That is an innovative LIFT—local improvement finance trust—scheme, a £50 million project, organised between the previous Labour council and the local primary care trust. I said when I spoke in the debate 15 months ago that I had great hopes for that project pushing on quickly. So far, not a brick has been laid; indeed, planning consent has not been granted. That is a great concern for me, as the centre will lie—I am still convinced that it will happen—in the White City ward, one of the most deprived wards in London or, indeed, the country. That flagship project, a building designed by the Richard Rogers Partnership, is much needed to bring not only health care but other facilities to the area.
The business case has now been approved, and I am given some assurance that we will see bulldozers on-site by the end of the year, but it is not a satisfactory situation and a good deal of the blame must lie at the door of the new Conservative-controlled council in Hammersmith and Fulham. One appreciates that, when there is a change of power, matters can be delayed, but the persistent renegotiation of the development for no good reason—in fact, for only bad reasons: to reduce the investment by the local authority in social care and to diminish the proportion of social housing on the site—has not only caused delay, but will mean that the development, when it does go ahead, will not be as good as originally planned.
I mention those matters because they deserve to be updated and to be put on the record, but the general pattern in health care, certainly in my part of west London, is of an improving situation, driven by the record investment that is going into the health service there. I could say a great deal more about each of these issues, but I want to speak only briefly today and to concentrate on one particular issue. It is appropriate that I do so today, because today marks the launch of what is an innovative and exciting project not only for my constituency and, indeed, the whole of west London, but for the country. I hope that my hon. Friend the Minister will confirm that when he responds to the debate, because consultation documents on the proposal for an AHSC are sitting in envelopes waiting to go out to all and sundry across west London as we speak.
The consultation period will run for three months, and I am confident, given the soundings that I have taken in the area over the past year, that the response will be resoundingly positive. The basic proposal for the AHSC will go to the Secretary of State in August and, if approved, will hopefully lead to the merger in October of three already excellent institutions—St. Mary’s NHS Trust, the Hammersmith Hospitals NHS Trust and Imperial college. That will result, in the first instance, in the first AHSC and, in due course, in the first academic NHS trust. As I said, that is an exciting prospect, and it comes, as I think everyone will acknowledge, after some uncertainty about the organisation of health care in west London.
Other projects are under way to ensure that the standard and configuration of health services are improved, but I hope that the AHSC will take us to a new level of excellence. That is not to say, however, that the existing institutions are not in good shape. Indeed, the “Good Hospital Guide” for 2006 ranked Hammersmith Hospitals NHS Trust and St. Mary’s NHS Trust as the second and third best in the country respectively for clinical excellence, quality and safety. It goes without saying that Imperial college is one of the largest medical institutions in Europe, and its world-class reputation was recently confirmed in The Times Higher Educational Supplement, which placed the university fourth in the world for biomedicine and ninth overall. Perhaps that is a clue that we already have world-class excellence in research, particularly at Imperial, which is already based at the Hammersmith and St. Mary’s sites. However, the new configuration and single management under an academic trust are designed to set a new standard for health care in the UK.
I hope that the AHSC goes ahead. I am conscious that it would do so against the background of the review by the eight PCTs of health care in north-west London and Professor Ara Darzi’s review of health care in London—his “The Case for Change” document, which was published last month, and his framework for action, which is due at the end of this month. All those matters are taken into consideration in the proposal that is going forward today. I have read the consultation document, and it is very good; it deals with all the bureaucratic matters and shows how the AHSC will not only provide improved research and health care for my constituents, but use the NHS network to give people across west London and beyond access to higher quality, world-class health care.
We will all, I am sure, be greatly embroiled in discussions about the process and about who will take the AHSC forward. I recently met Lord Tugendhat and Steve Smith of Imperial, who are taking the lead on the issue at present. I am extremely impressed by their proposals and, indeed, by Professor Darzi’s proposals for health care across London as a whole—this is a new beginning for west London and for London as a whole. In both cases, I am most impressed that those involved have cut through the bureaucracy that bedevils the health service—whichever party is in government—to concentrate on the outcomes for patients. I sometimes wish that health professionals would stop referring to my constituents as guinea pigs and stop rubbing their hands at the prospect of gaining access to more of them, but I know that they are well intentioned at heart.
Progress has already been made. Shortly after our previous debate last year, I visited the new renal centre at Hammersmith with the all-party kidney group, and that institution is fantastic, as are the other buildings that are going up on the Hammersmith and Charing Cross sites and, no doubt, on the St. Mary’s site. Impressive improvements have been made in care as a result simply of changes that have been made under the existing management and co-operation arrangements, but the institution of the AHSC is a once-in-a-generation opportunity to make a sea change and to improve the health care of my constituents and those across west London.
I congratulate my hon. Friend the Member for Ruislip-Northwood (Mr. Hurd) on obtaining the debate. As the hon. Member for Ealing, Acton and Shepherd's Bush (Mr. Slaughter) implied, this might well become an annual event, which would be a good thing because nothing matters more to our constituents than the provision of good health care.
I echo my hon. Friend’s comments about the Mount Vernon site. Although it is not in my constituency, many of my constituents use the facilities there and are concerned about any potential move to take cancer services away from the site. My hon. Friend told us about the proposal to move to a fictitious hospital in Hatfield, although the site had not even been identified and there was no planning permission. Although such things happen, we must move on. It is self-evident to anybody who knows someone who has suffered from cancer or who has suffered from it themselves that the last thing a cancer patient needs to do is to make a long journey in terms either of mileage or, in the case of west London, travel time. Public transport is available to take people into central London, although it can be unreliable, as we all know, but the last thing that somebody who is having chemotherapy or other treatment wants to do is sit on a crowded train. The joy of Mount Vernon is that although it is in west London—I would say it is in Middlesex—it looks over some wonderful countryside and has excellent facilities for patients and for the family and friends who take them there. We should not lose what we have there.
My hon. Friend did not mention Hillingdon PCT, but it is involved in a rather sorry tale of deficits. The three Members of Parliament for the area have tried hard to help successive chief executives of the PCT. I have lost count of how many we have had—I think that we have had more than one a year so far under the revolving-door policy that we seem to have at the PCT. Indeed, we have just lost Mr. Sumara, who has gone off to be the chief executive of the London strategic health authority, NHS London. However, I get the impression that although chief executives come and go, the problem of the deficit remains to some extent. I still have not had the answer that I would like on that issue and I do not know exactly why such a large deficit has arisen. I do not want to indulge in party politicking on the issue because it is far too important, but there is a serious problem and I doubt that the ongoing debt—that is what it is—will benefit my constituents and their health care.
My hon. Friend and I have raised the issue of orthodontics, homeopathy and other services that seem to be affected. We are always assured that they are not affected, but I am afraid that I am becoming increasingly cynical as I get older, and I am not entirely sure that I quite believe what I am told these days. There was a time when I was fresh faced, young and slim that I might have believed it, but as you see today, Mr. Cummings, things have changed somewhat.
I am afraid it will come to the Minister too; I was young and full of hope, but I must tell him that life deals a bitter blow. His will come shortly because fate has given me a lot of time to speak in this debate and there are matters that I want to raise with him.
Hillingdon hospital, which is in my constituency and is close to where I live, still manages to provide a very good service, but, as I think is recognised, the building is not quite what it should be. I remember going there as an 11-year-old, having broken my wrist playing football; even today, although there has been a little refurbishment of accident and emergency, the X-ray department is identical to what was there 40 years ago, so it is probably recognised that change is needed. We have been talking about a rebuild, and there is also talk of the private finance initiative, among other things.
It is a slight shame that the ideal location for a new Hillingdon hospital should be the RAF site. There is a very large RAF station in Uxbridge that is being sold by the Ministry of Defence, but it seems that the time scale between the departure from the site of the Ministry of Defence and the potential financing of a new build at Hillingdon hospital makes the idea impossible. It has been explored, but I have promised those involved in the Hillingdon Hospital NHS Trust and the primary care trust that I shall not keep going on about it, for fear that we shall lose the rebuilding of Hillingdon hospital, which is so sorely needed. However, it seems incredible that two Government Departments cannot get their act together sufficiently to achieve something that would provide the whole of west London with the services of a remarkable facility in the future.
There is one matter concerning Hillingdon hospital for which, to be charitable, I probably cannot blame the Minister. It is the continuing problem going back many years of an incinerator on the site. Unfortunately, it was given planning permission many years ago, when there was Crown immunity—I think that the ruling about that has now changed. Subsequently, Hillingdon hospital sold some land and made an application for residential development. The local authority turned it down, but its decision was overturned on appeal. Anyone familiar with the area would have known that the new houses would be situated right up against the incinerator, although from talking to the residents it seems to me that they were given some sort of assurance by the people selling them the properties that there was nothing to worry about and it would soon go away. Sadly, that does not seem to be true.
I am greatly concerned about the matter. I have heard recently from residents about police escorting the waste lorries as they come in. One begins to wonder exactly what is being incinerated there. We have had meetings and I am assured that everything perfectly okay and there is nothing to worry about. None the less, there is a great deal of noise and a certain degree of pollution, and I am not convinced that what people in that area are breathing in is beneficial to their health. It is ironic that such an operation is on the hospital grounds and, although not run by the hospital—it has been put out to a company—is an integral part of it. We should think about that, because when we want public support for hospitals and the health economy it is important to deal with both sides of an issue.
My hon. Friend the Member for Ruislip-Northwood mentioned Harefield hospital, which, although it is not now in my constituency, was historically in the Uxbridge constituency. It does not only serve our constituents; it is world-renowned. I should say that Harefield has a healthy future. It has been refurbished and improved and has lately benefited from a most up-to-date 64-slice scanner, which is a brilliant diagnostic aid. It cost about £700,000, which interestingly was all raised by the public. After the scandal—that is one of the mildest words that I can use—of the Paddington health campus, it is reassuring that everyone is happy to invest in the Royal Brompton and Harefield NHS Trust.
I noticed yesterday on the Hillingdon Times website that Harefield hospital had just achieved another first. Mr. Brian Everard of Stanmore was
“spared the pain and trauma of open heart surgery—to replace his heart valves—and was instead operated on through a small incision in his chest.”
Harefield hospital, as it says in the article,
“has long been at the cutting edge of heart and lung treatments and earlier this month it was announced that scientists had managed to grow heart valves from stem cells, a world first.”
It is also making incredible advances in the treatment of cystic fibrosis. I do not think that I have to make a case for what is happening at the hospital.
My hon. Friend mentioned shenanigans about trust status and said that it was not time to revisit the Paddington health campus scandal. I disagree—but only because no lessons seem to have been learned. When that project finally came to its end, all the supporters of Harefield hospital greeted the news with delight, but there was great anger about the cost to the public purse of that over-ambitious and fatally flawed project. My hon. Friend rightly mentioned a voluntary organisation that has been mentioned before in such debates: Heart of Harefield. Its members are ordinary men and women led by a very energetic person, Mrs. Jean Brett, who has shown what determination, knowledge and great skill can do. I am not sure that the scandal would have been exposed without Heart of Harefield and Mrs. Brett. We might even have reached the point of having a white elephant that would have cost the public purse millions for years to come.
Unfortunately, the public anger remains. My hon. Friend referred to a meeting about this some time ago with the Minister, who was very generous with his time. One reason for the anger is that the chief executives who were involved remain unaccountable and the Royal Brompton and Harefield NHS trust is perceived as having been unjustly denied foundation trust status. I hope that hon. Members know that I do not engage lightly in polemics—I am a great believer in a consensual style of debate in this Chamber. However, much of what has happened seems to me to be down to the actions of one of those NHS chief executives, Gareth Goodier. I believe that he has been vindictive.
The chief executive of the North West London strategic health authority was humiliated at being proved wrong on the Paddington issue. The strongest contributing factor was the withdrawal from the project of the Royal Brompton and Harefield NHS Trust, under the leadership of its new chief executive, Mr. Bob Bell, for whom I have the highest regard. Shortly after his appointment, Mr. Bell, who had experience of planning and completing a new hospital, realised that the Paddington project lacked sufficient land to make it viable. There is an obvious contrast with the inability of his supposedly senior colleague to grasp that point over a lengthy period of time.
I do not expect this place to be like a business, because they are different worlds, but I remember discussing the Paddington project in this Chamber in May 2004, when I set out, in what I thought was a calm and collected way, why the business arguments for continuing the Paddington health campus were flawed. The Minister who responded to that debate, who is now a little more senior—the Secretary of State for Work and Pensions—turned on me with a degree of unkindness and accused me of opportunism. He also accused the people who had helped and advised me and given me information of being vindictive and simply wanting to stop something that was going to be the most marvellous thing in the world. I protested that that was not the case and that I was using the little knowledge that I had acquired from 20 years in business to show that the project was a waste of public money, but I was not able to get a word in. I remember trying to make an intervention at the end but not being allowed to make it. However, but that is how things work in this place—let us be grown up about it.
Since that debate, the people who were responsible—NHS executives and Government Ministers—have never acknowledged that a mistake was made. No one has said, “Actually, you were right, and so were the people with you. A great deal of money has been saved for this country and the taxpayer, and we regret the waste beforehand.”
My hon. Friend makes an important point about learning lessons from the collapse of the Paddington health campus scheme. I recall the debate that he secured back in May 2004, in which I was the Conservative Front-Bench spokesman. The responding Minister in that debate was indeed the present Secretary of State for Work and Pensions, who subsequently repeatedly refused ever to give direct evidence to the inquiries of the National Audit Office and the Select Committee on Public Accounts into why the Paddington health scheme collapsed. That was one of the more disgraceful episodes of Labour Ministers’ stewardship of the Department of Health.
I agree with my hon. Friend. Indeed, I was going to make that point. It was not only Ministers who acted in that way: NHS chief executives did not give evidence to the inquiries by the NHS and the Public Accounts Committee. If there had been a genuine desire to ensure that the same thing did not happen again, they would have given evidence. I should like to know what reasons they gave for not giving evidence. Were they trying to hide something? I shall give them the benefit of the doubt, but there is a strange smell about people refusing to give evidence to inquiries that are intended to sort out problems and ensure that they do not recur.
The North West London SHA chief executive, Mr. Goodier, was one of the strongest supporters of the Paddington project. I remember discussing it with him. His support continued even after he was sent a letter by the Department of Health in January 2006 advising him in the strongest possible terms to write back disproving the points made in the letter. Again, nothing was forthcoming.
The Royal Brompton and Harefield NHS Trust has benefited greatly in the past six months from its association with Sir Magdi Yacoub, of whom the whole House and a great many of the public have heard. The Sir Magdi Yacoub heart science centre, which is on the Harefield site, has made groundbreaking, successful advances in the regeneration of the heart in last-chance cardiac patients using a combination of drug treatment and a ventricular-assist device. We have already heard something about what is being done at that centre. Its breakthrough in April in generating human heart tissue opened up a field that is so large in its scope to benefit patients that it is impossible for any of us to quantify.
The Heart of Harefield campaign has been mentioned a lot in this and previous debates. Before Jean Brett agreed to lead that campaign back in 2000, she had to be convinced that maintaining the bed-and-bench situation at Harefield hospital, in which the patient and research are in proximity, was of such importance that destroying that affinity would result in a loss of benefit to patients both nationally and internationally. Recent events have proved her decision to have been absolutely correct.
The trust is the UK’s largest cardio-respiratory centre. Due to its expertise and eminence it has been the largest recipient of NHS research and development funds, but recent Government changes in the allocation of such funds have caused problems. Monitor has suggested that all research funding might dry up after 2009 and has claimed that the trust’s strong financial position could therefore be jeopardised. That is a rather worrying thing for Monitor to say. The public, and probably the trust’s board, have had a surfeit of NHS organisations throwing spanners in the works while pontificating on matters that are beyond their remit. I am afraid that I hear echoes of the whole Paddington fiasco coming back to haunt us.
It is highly unlikely that the Royal Brompton and Harefield Trust or other specialist trusts will be so radically disadvantaged in respect of research moneys by the Government that all specialist trusts will therefore cease to be financially viable. It is rather more likely that the possible side effects of introducing a new research and development system were not thought through, but it is not acceptable for Monitor to take a disaster scenario approach when assessing the trust for foundation status.
In the most recent round of applications, 17 trusts applied for foundation status, of which only three were successful. Given that one of the trusts was the Royal Brompton and Harefield Trust, which is regarded by the chief executive of the SHA for London as one of the most successful, there are doubts about the efficiency of the system. The press releases at the end of March suggested that the decision had been taken some time before. The application was supposed to be under consideration at that time and the decision was to be made by 26 April, but it seemed to be a foregone conclusion. I want some openness about that decision, and Members of Parliament, members of the public and members of the trust need answers about it.
Specialist trusts should not be unilaterally disadvantaged by Monitor as a result of Government policy on cuts in R and D moneys, particularly given that decisions remain in a state of flux. There is no objection to changing the system nationally so that R and D moneys are shared more equitably throughout the country and are monitored more strictly so that they do not leak into supporting deficits, but it is not acceptable for any organisation to use the change in Government policy as an axe to disadvantage specialist trusts. The improvement of patient care and the reputation of this country both nationally and internationally depend on the fruits of specialist trusts’ research.
I raise this matter because I am genuinely angry about what has happened, and not only because one of the best NHS trusts in the country—a real jewel of the NHS—has been affected. I am angry about the lack of openness, the twists and turns and the political manoeuvring. Things have gone on that would make a senior Whip blush—the sort of strange things that go on behind closed doors about which I can only dream. At least, that is how things seem to me, a young innocent out here. All that is bad for the NHS.
If we want to improve the NHS and its systems, as I believe everyone does, we cannot have the current system of NHS executives running roughshod over common sense and the evidence and then indulging in a vindictive war against those who have dared to cross them. I dare say that I shall have to watch out if I go to hospital in the next few months, certainly in some areas, but I lay down the marker now: I know where they are, I know where they live and they know where I live.
I am conscious of the fact that my constituency is in south-west London, so I shall attempt to impose a self-restraining ordinance not to drift into that territory, because south-west London deserves a health debate of its own. I shall try to focus instead on west London issues, although as the two areas sit side by side and the boundaries are terribly unclear to most constituents anyway, many of the experiences and issues are inevitably shared.
This has been an incredibly high-quality debate, involving hon. Members who are able to talk in great detail about the particular circumstances of local trusts and hospitals. I shall therefore try to take a small step back, because lying behind our discussion is an absence of any sense of sustainable direction within the national health service. That has been the character of the past and we are all afraid that the situation may not be resolved in the future.
Many of us have been in conversation with a strategic health authority—I imagine that that is the case for all hon. Members present. I suspect that they have been excited by the basic work in Sir Ara Darzi’s “Healthcare for London: A Framework for Action”. There is a sense that perhaps there is now the possibility that someone is coherently examining the future situation across London. We are conscious of the fact that the work is being undertaken in the context of a national health service that does not meet Londoners’ or west Londoners’ expectations. In addition, productivity levels in the NHS are lower in London than elsewhere in the country—for example, doctors in its acute hospitals see 24 per cent. fewer patients than those elsewhere. We are also conscious of the fact that London is perhaps in the almost unique situation of having overcapacity in many areas and the wrong capacity in many areas. We are concerned about how all this will be resolved.
May I say, because this is shared by people of west London and south-west London, that as we examined “Healthcare for London” and the core consultation document, we saw a worrying red flag? The consultation document talked constantly about the needs of north and east London, as if those areas were in competition with west and south London. On the distribution of GPs, the document said:
“There are overall fewer GPs per head of weighted population in the east and north of London (where health need is greatest), compared to the south and west”.
I would not dispute the fact that that may be true, although the situation in areas such as Ealing probably does not look as good as elsewhere in west and south London. We are desperate for a strategy that will build all of London, not one that will siphon resources out of the west and south, where need is great, even though there might be a greater need in the north and east.
We look at this issue in the context of Mayor Livingstone’s focus, which seems constant, on pouring resources into north and east London—it is partly driven by Olympic fever, but it is also a fundamental view—while the population insists on coming to the west and south and building their homes there, no matter what the authorities would like to do to direct them elsewhere. The need of, and the resources that have to be put into, health services in west London should not be discounted by an institutional wish for a population shift. I suspect that such a shift will not occur—there is certainly no evidence of it occurring.
The Government’s response to west London’s health issues has been one of chaos. Others have talked in great detail about the Paddington health campus scheme, and I echo the comments made, although I shall not reiterate them. One would have thought that after putting hospitals such as the Royal Brompton and the Harefield into a period of such uncertainty, stress and concern, the response after the Paddington scheme fell through would have been carefully to provide genuine certainty to overcome the damage that had been done by what most people now regard as an idiotic scheme. That has not happened. We see the same thing repeated in the case of the Mount Vernon hospital cancer specialty unit. Proposals to take everything to Hatfield were abandoned and nobody knows where the programmes will be taken. That does not help the health service at all.
That kind of chaos is being increased and intensified yet again by a policy that I wish the Minister would address, because I cannot get to the bottom of it. As I understand it, there is a requirement for about 15 per cent. of health services in the London area to be provided by the private sector, with the result that the strategic health authorities have been building up independent sector treatment centres—in other words, private centres—at a time when there is overcapacity in the system and when we need such additional facilities like we need a hole in the head. We need improved, regenerated and modern facilities. The notion that we need increased facilities for increased competition in London misunderstands the whole London health environment. That is aggravated by the fact that none of us has been able to see the underlying contracts that go with these independent sector treatment centres. We are suspicious that they contain language that essentially gives guarantees of minimum numbers of patients, which translate into financial security for those private centres, while the NHS facilities face constant uncertainty and risk.
I shall give a tiny example, although it is not particularly a south-west London example. I have talked to representatives of the breast screening services at my local hospital—those services being provided by a private group within the context of an NHS hospital—and they were naively delighted to explain to me how the patient guarantee from the NHS takes away all their financial risk. That allows them to use all their spare time to seek private patients for breast screening. They said, “It is a wonderful system because we have no financial risk at all. That is carried by the NHS, so all we have to do is build our profit opportunities on the back of it. The system works extremely well. We are a wonderful and very profitable company.” I do not think that they anticipated that my reaction might be that whoever negotiated that contract for the NHS services was not adequate or up to the job. I understood that transferring the risk from the private sector to the public sector was not supposed to be the goal.
I understand that those independent sector treatment centres will not provide training for junior doctors. This week and last week, we saw the devastating impact of all the uncertainty surrounding junior doctors, yet the programme in London seems to aggravating the situation, rather than diminishing it. That brings me to the financial crisis in the NHS, whether in west London or in all of London.
The NHS deficit in London in 2005-06 was £174 million, which is proudly said to have reduced to £55 million in 2006-07. The sum is huge, and it has largely been reduced by top-slicing from the financially successful trusts, to support the ones with deficits. Much of the price has been paid by cutting NHS jobs—for example, the 900 jobs in London, plenty of which are on the front line, and we are all aware of them. People tell me that such cuts do not impact on service, but I suspect that some hon. Members present would be able to give many examples of where service has been severely damaged.
One issue that is often not flagged up is that primary care trusts, whether in west London or elsewhere, have been reluctant to move outside National Institute for Health and Clinical Excellence boundaries for the prescription of cutting-edge medication. One example of that involves the drug Temodal, which is used to treat brain cancer. As we know, NICE can be exceedingly slow in providing approvals, so we end up with a situation where we know that approval of a drug will be given, but the paperwork and the rest of the pieces take a further 12 months to roll through and be put in place. In the past, PCTs have been willing to prescribe in such circumstances, but now they are not, given the financial pressure that they face. I suspect that lives have been lost—lives have certainly been shortened—as a consequence.
Cost-shunting between PCTs and local authorities has become acute—west London suffers from that as much as anywhere else—and it is resulting in diminution of community health services in west London. One reason for the shortage of training places for junior doctors this year is that PCTs have been clawing back from their original plans and posts have effectively disappeared.
Mental health services have taken much of the brunt of such cuts, and that is as true in west London as it is elsewhere. Hon. Members will be aware of the report by the Sainsbury Centre for Mental Health in July 2006 which said that nearly two thirds of mental health trusts have been asked to cut their budgets to cover NHS overspend in other areas.
Ironically, my area is officially south-west London, such are the weird boundaries for different aspects of the national health service, and Cassel hospital in my constituency falls into the west London family of mental health services, so I can see directly in my constituency how cuts in mental services have fallen on the most vulnerable. Superb services for adolescents have been merged with adult services with the loss of 10 beds.
I suspect that part of the reason why the Royal Brompton and Harefield NHS Trust is driving so hard to obtain foundation status is that it feels that, with overcapacity, only those who can get out early and obtain foundation status early will be able to survive, and that the inevitable rationalisation, particularly from introducing more competition, will not mean that those that remain are not necessarily not the best, but that others got out first. That seems to be a nutty way of trying to resolve the issue and to obtain the best health service structure in west London.
Although there is community involvement in seeking foundation status, that creates a false feeling, because there is no democratic control of the strategic health authority. People in west London have no mechanism for making their voices heard by the Department of Health. The chaos that has arisen because local voices are not in charge of decision making will not be resolved by giving foundation status to one hospital. Real focus on genuinely devolving accountability for health services to local people is needed, and that has not happened.
London is one of the great capitals of the world, if not the greatest. It should have a first-class health service in every part of its community and, given its history, it should have cutting-edge research. That is not the picture today, and that is a failure. The Minister must give us some coherent answers.
I congratulate my hon. Friend the Member for Ruislip-Northwood (Mr. Hurd) not only on securing this debate, but on his dogged pursuit of his constituents’ interests in relation to health services, as evidenced by this debate and his debate in February last year. He will not give up on the matter; he will ensure that the services on which they rely are supported and maintained. That is all credit to him, and to my hon. Friend the Member for Uxbridge (Mr. Randall), who did likewise during his debate back in 2004.
My hon. Friend the Member for Ruislip-Northwood concentrated on the Royal Brompton and Harefield, and Mount Vernon hospitals, and I shall follow him. On the Royal Brompton and Harefield NHS Trust, I share my hon. Friends’ anger at what happened in relation to Paddington health campus, and the delays and £14 million of directly associated costs. Significant additional opportunity costs were associated with the failure of that scheme.
The hon. Member for Richmond Park (Susan Kramer) was absolutely right about what her constituents had a right to expect after the collapse of that scheme. The trust rightly called time on a project that was never, as the National Audit Office demonstrated, properly supported and organised. A simple question that must be asked in the national health service is “Who is in charge?” No one was ever in charge of the Paddington health campus scheme. The trust called time on it and had a right thereafter to expect to be able to manage its own affairs and to determine its own future. That is the point that my hon. Friend the Member for Ruislip-Northwood made. The trust has applied for foundation trust status precisely for that purpose. It wants greater opportunity and freedom to determine its own future. The London strategic health authority put the trust forward for foundation status, but Monitor has said no for the time being, principally because of the uncertainty attaching to the trust’s future income projections derived from research funding.
I confess that the NHS research and development programme and the reorientation to a number of biomedical centres makes me happy for constituency reasons, because Addenbrookes hospital in my constituency has benefited. There are winners and losers—[Interruption.] My hon. Friend the Member for Uxbridge reminds me from a sedentary position that the chief executive of Addenbrookes hospital is Gareth Goodier, former chief executive of the North West London strategic health authority and previously of the Brompton and Harefield NHS Trust. The national health service inhabits a small world. Ministers often remind us that the NHS employs 1.3 million, but it is funny how the same people keep turning up.
It is obvious, as my hon. Friends and the trust acknowledge, that there has been cross-subsidisation from money intended for research and development into service support. The plea of my hon. Friend the Member for Ruislip-Northwood is that, if there are to be substantial changes of the sort proposed under the R and D programme, the financial consequences must be subject to a reasonable transition. There must also be significant opportunities to enable those who are losers for the time being, but have high quality research projects, to win other research projects, even if they have not secured a position as a centre of excellence or biomedical centre for the time being.
At the same time, if I understand the way in which cardiac services are moving and particularly the sort of work carried out by the Royal Brompton and Harefield hospitals—it bears comparison with that at Papworth hospital in my constituency as a cardiothoracic centre—they need rapid adjustment in the payment-by-results and tariff system. There are too many instances of hospitals such as the Royal Brompton and Harefield, which have a relatively complex case mix and are likely to be tertiary referral centres, dealing with patients for whom the tariff is not well designed. The Minister will understand that the Government’s response to the turbulence caused by the introduction of the tariff has led Ministers to hold back in the latest payment-by-results consultation document. We are moving to a timetable that is a year slower than was intended.
In reality, the proper response to that turbulence is to make faster progress and to move the next iteration of the tariff. If one does not arrive at a point where there are recognised exceptions to the tariff and recognised outliers and where the cost is not better disaggregated to individual treatments—often the complex treatments provided by tertiary centres—often hospitals of a more specialist character lose out as a consequence of the roll-out of the tariff across the NHS. I am sure that the Royal Brompton and Harefield NHS Trust needs that to happen.
I am sure that it should not be Monitor’s job to seek to engage in reconfiguration as part of its authorisation process. That should not happen. It is Monitor’s job to encourage as many hospitals as possible to secure the financial status that allows them to become more independent. Configuration is much more a matter of the relative choices of commissioners. I am sure that the Royal Brompton and Harefield NHS Trust would not complain if, in the long term, it had to begin a reconfiguration of its services because of a change in demand for its services. Anyone working in cardiac services at the moment knows that they have shifted from cardiac surgery to cardiology and intervention in a way that is redesigning services. The trust knows that it must do that, but it is doing so in response to demand and changes in technology, not as a result of a top-down process.
I must confess that I remain sceptical about the benefit of the strategic health authority—through Sir Ara Darzi—engaging in trying to determine the future configuration of services before GPs and local commissioners have had the opportunity to determine where they want services to be. I suspect that access and specialist centres will be lost, which would not happen if decisions were left to local commissioners.
The hon. Member for Ealing, Acton and Shepherd's Bush (Mr. Slaughter) made a helpful speech. I do not necessarily share his immediate optimism about Sir Ara Darzi, but I share his optimism about the coming together of Imperial college and St. Mary’s, Hammersmith and Charing Cross hospitals. In the health service of the future that we all want to see, in which patients increasingly make choices and GPs and local commissioners make choices, hospitals will begin to make their way in the NHS on the basis of reputation, results and outcomes for patients.
An academic centre with the foundation status that Imperial and the two trusts—St. Mary’s NHS Trust and Hammersmith Hospitals NHS Trust—propose could be precisely the kind of major centre that attracts demand from within the NHS, makes its way in the NHS and becomes a world-class centre. We need to establish such world-class centres in this country. Cambridge is aiming for one, and west London can achieve one through such a merger.
Like the hon. Gentleman, I met Professor Steve Smith and Christopher Tugendhat, and I very much share the hon. Gentleman’s enthusiasm for their vision. However, I caution against their allowing it to become wrapped up in the strategic health authority reconfiguration proposals. Their vision stands on its own merits; it is not designed to achieve a certain reconfiguration effect throughout London. The two must be kept entirely separate.
My hon. Friends the Members for Ruislip-Northwood and for Uxbridge made a perfectly straightforward, rational and passionate case for Mount Vernon hospital to be allowed to get on with its job in a place and in circumstances that the local population, GPs and commissioners support.
We have picked on one London primary care trust, Hillingdon, but it is in serious trouble. It had an accumulated deficit of about £59 million at the end of the financial year just gone, and it clearly requires strong change. How should change be achieved? The Minister might like to tell us whether there is any prospect of the PCT taking advantage of the framework for external commissioner support, which the Department set up through its tendering process. The outsourcing of commissioning is one option. It may have some advantages, but even more importantly, responsibility must be transferred rapidly into the hands of GPs—the primary care commissioners.
Primary care trusts, of which Hillingdon is one, have demonstrated that there are serious dangers if they fail to do their job well. If we disaggregate budgets and ensure that the individual local commissioners—GPs—have greater control over them, we will bring together clinical decisions and budgetary responsibilities. The problem of Hillingdon PCT’s deficit must be tackled. It is not fair to try to transfer the deficit into the hands of commissioners under practice-based commissioning, although that is not the Department’s intention. One cannot expect commissioners to discharge their responsibilities on the basis of such a large deficit.
The Government must contemplate the transition that my hon. Friend the Member for Ruislip-Northwood discussed, involving changes throughout the system. There may be three financial years of transition ahead—not only this year, but the two beyond—for PCTs in the worst circumstances. Hillingdon may be in that position, and it would be helpful to know whether the Minister has received a request from Hillingdon for a plan that spans such a period.
I endorse what my hon. Friend said on behalf of the hospitals in his constituency. It is important that we address the issues in practical terms now. He has done so, and I very much endorse what he has said.
I, too, pay tribute to the hon. Member for Ruislip-Northwood (Mr. Hurd) for securing the debate and for the way in which he made his remarks. I have no doubt about his personal interest and commitment to ensuring that his constituents receive the highest quality health care. I include the hon. Member for Uxbridge (Mr. Randall) in that tribute, as well.
I am pleased that my hon. Friend the Member for Ealing, Acton and Shepherd's Bush (Mr. Slaughter) joined us in today’s debate. It is the second time in recent history that we have debated the matter, but health care in west London arouses huge interest, perhaps because west London contains some of the most pre-eminent names, both of individuals and of institutions, in health care in the world. It is normal and natural that the subject always arouses huge interest. On a personal level, my family recently benefited hugely from the services of the Royal Marsden hospital, which is a fantastic institution. It is truly humbling to see the staff’s commitment to their jobs. All of us want to strengthen, develop and build upon such excellence in health care; there is no political difference on that point.
In many ways, our debate has touched on all those matters. Sometimes, the debate focuses on exactly how to make such changes, and although the hon. Member for Uxbridge used the word “vindictive”, as far as I can see, everybody is trying their best when they make judgments. NHS management are sometimes unfairly caricatured, and although we may not always agree about the right judgment, the vast majority of people are rowing in the same direction.
The hon. Member for Ruislip-Northwood began by saying that in west London, there had been a period of almost permanent change. In that sense, I suppose that the title of Sir Ara Darzi’s first publication, “The Case for Change: Healthcare for London”, depresses the hon. Gentleman. However, we will constantly return to such issues because there will always be a need to review and to change, particularly when we are discussing some of the leading health services in the world.
The hon. Member for Uxbridge was absolutely right to raise the profile and our awareness of the fantastic developments at Harefield hospital. Because the health economy is bringing some of the most advanced changes to us very quickly, there will need to be constant consideration of whether services are up to date and of sufficient quality.
Sir Ara Darzi’s document includes the phrase:
“Local urgent care is not good enough.”
That is a bold and clear statement, and I guess that all London Members of Parliament want to see changes off the back of it. Another paragraph in the document says that
“out of the thirty hospitals in London providing stroke services, only four treated over 90 per cent…in a dedicated unit, and, whilst patients should receive a CT scan within three hours, only in seven hospitals were 90 per cent of patients getting a scan within a less-than-ideal 24 hours.”
People like me are sometimes accused of always saying that everything is marvellous and fantastic, but one cannot read such figures from someone as eminent as Professor Sir Ara Darzi without agreeing that there is a case for change. There is a constant onus on us all to see whether we can do better in providing health care for our constituents.
I shall now address the issues that the hon. Member for Ruislip-Northwood put before us. The vital context of today’s debate is specialist services and the extent to which we enhance and improve them. Ara Darzi discusses his reasons for change and devotes the body of the document to the need for more specialised care. I hope that the hon. Gentleman is encouraged by that. Ara Darzi makes his assessment of health care needs in London in that context. If I were the hon. Gentleman, I would take considerable comfort from that, having raised two issues relating to institutions today. What is important is improving the excellence in the west London health economy.
I turn to the specific issues raised by the hon. Gentleman. I, too, enjoyed our meeting last year to discuss the Royal Brompton and Harefield NHS Trust, and I, too, pay tribute to Jean Brett, who has done a superb job of raising the profile of the trust and the arguments that it wants to advance in this debate. The hon. Gentleman and I are absolutely at one on that. I would go further and say something else, which I probably said at the meeting, which the hon. Member for Uxbridge also attended. I argue that the foundation trust model does provide an answer.
We had a huge and impassioned debate in the House, particularly on the Labour side, about whether the foundation trust model was right. I am trying to remember, but I think that the Liberal Democrats opposed the model. I remember debating with the hon. Member for South Cambridgeshire (Mr. Lansley) at the time, and I do not think that we disagreed. I remember that he supported the principles of the foundation trust model. For me, it is the natural fit for a trust such as the Royal Brompton and Harefield NHS Trust. I fully endorse the trust’s efforts to realise its aspiration to achieve foundation status.
The hon. Member for Ruislip-Northwood used a phrase to the effect that it was Monitor’s intention to block the application, but that is a misrepresentation of the current position. As I said, the application went forward to Monitor with the Secretary of State’s support. That brings me to the role of Monitor. First, let me say what its job is. Its job is to make a hard-headed assessment, without fear of unpopularity, of the business case that underpins foundation status.
My local trust—Wrightington, Wigan and Leigh NHS Trust, which includes a specialist hospital in Wrightington hospital—went through the process too. Monitor found out things about the trust’s financial rigour and framework that have been helpful to its planning for the future. All of us at different times call for that rigour in the finances of the national health service. If the hon. Gentleman’s call was for leniency and for us to get all the trusts through the process, that would be wrong and would not serve his constituents’ interests or the health service in general. As anybody who has been through it will testify, the process is rigorous.
Monitor should always base its judgment on the information available at the time. That is what it does—it takes the trusts through the process and alerts them to potential risks that it may feel have not been adequately addressed in the trust’s business plan.
The hon. Member for Ruislip-Northwood used what we might call an anonymous quote to the effect that the trust has no future as a stand-alone trust. Let me say it clearly: that is not the view of the strategic health authority, NHS London. I put it clearly on the record that NHS London says that it thoroughly supports the trust’s foundation trust application and, provided that it can work through the problems raised by the reduced R and D funding, the trust has a positive future. The Government very much share that view.
It is not for Ministers in any such situation to say, “This trust can go forward and that one can’t,” and it is not the role of Monitor to say what is the right configuration in any one area. That is properly the responsibility of the strategic health authority and local commissioners. Let us be absolutely clear about the strategic health authority’s view. I hope that we can have a period of intensive discussion about some of the potential problems that have been highlighted and then get the application back on track so that it can be considered again shortly.
The hon. Gentleman talked about the three-year phase-out of transitional funding under the new arrangements for R and D funding. It is worth putting on record that in the last financial year, the trust received £28.6 million as part of that funding. This year, it will receive £24.6 million and in 2008-09, we expect it to receive something in the region of £4.8 million, although that has yet to be fully confirmed. That transitional timetable is not to be reviewed and is set in stone. That is a fair basis on which trusts can plan for the new world of R and D funding.
A number of hon. Members commented on the R and D funding regime. It is important to say that the NHS budget for research and development for this financial year is £776 million. I hope that hon. Members accept that the Government have made a significant contribution and commitment to research and development. As in other parts of the national health service, under the new regime people will no longer be paid for historical reasons or for what they have always done. The new regime is about being transparent so that people can bid for funding on the basis of the quality of what they do. I expect an organisation of the quality of the Royal Brompton and Harefield NHS Trust to benefit under the regime like any other such trust.
I do not believe that that is the case. A three-year funding phase has been agreed and, as I say, there is the opportunity to bid for new funds under the new regime.
Let me address the question of the academic health science centre. I confirm to my hon. Friend the Member for Ealing, Acton and Shepherd's Bush that today the strategic health authority has initiated a consultation on whether the three confirmed organisations will be able to go forward to create the UK’s first academic health science centre. It could be an incredibly exciting proposal and vision for health services in west London, and my hon. Friend will agree that as the clinical research translates into NHS services the benefits to his constituents could be huge. I am pleased to hear that at this stage, knowing what he does, my hon. Friend is supporting the proposal.
The hon. Member for South Cambridgeshire was right to say that the issue should not become wrapped up in debates about reconfiguration. The proposal should stand on its own merits and go forward with cross-party support so that we can see whether we can create an institution that would begin to rival the academic and health service institutions that are seen in the United States. Obviously, I encourage my hon. Friend to play a full part in the consultation. We will see whether we can turn the vision of Professors Sir Ara Darzi and Steve Smith into reality. I pay tribute to them for their personal commitment.
In the time that I have, I want to mention Mount Vernon hospital. I hope that the hon. Members for Ruislip-Northwood and for Uxbridge accept that there has been recent investment in the improvement of cancer services at Mount Vernon hospital. No one can ever say that something could never be reviewed or changed, but we should look at the reality on the ground. As a result, we see a trust whose services are being invested in and improved. That is the important thing that matters to local people.
The hon. Member for Uxbridge raised the issue of Hillingdon hospital. I believe that an outline business case is about to be put to the strategic health authority, and I hope that it will reach me soon.
Scotland and the Union
I am delighted to have secured this debate, particularly at a time when the future of the United Kingdom is at stake because of the forthcoming elections in Scotland. It might be appropriate to remind colleagues that this Labour Government’s policy on Scotland and the Union delivered the settled will of the Scottish people through the devolution of a range of important issues to the newly constructed Scottish Parliament. I shall return to that issue later. That Parliament has delivered on its promises and introduced progressive policies that have enhanced the quality of life for the vast majority of its people. So successful has it been that even those who wish to break up the UK are reluctant to debate the issues that are relevant to that Parliament.
Scotland is stronger because of the Union and the Union is stronger because of Scotland—not because of North sea oil, but because the Government believe that, by focusing on the future and not reliving old battles and prejudices, we can all make progress and, together, face up to the challenges of an ever competitive global economy.
Today’s UK is a democratic country that is the envy of the world. That hard-fought tradition should not be destroyed by short-term separatism. That is a probability that even the London leader of the Scottish National party has acknowledged. He suggests that Scotland should vote in the forthcoming elections in the knowledge that, if it does not work out, we will just regroup and move on. Such deceitful politics is dangerous and irresponsible. It takes for granted the views of the other countries that make up the UK, surmising that they will just wait around for the self-indulgent activities of the SNP.
The vast majority of the Scottish people—and the rest of the UK—do not want to break up Britain. I would liken such an act to a student sabbatical, but one where the student does not want to give up their room. The financial costs of breaking up the UK would soar into billions of pounds. Likewise, if we were to regroup—provided the rest of the UK wanted us—those billions of pounds could and should have been spent on improving the lives of all our constituents. Constitutional wrangling would sever the relationship between Holyrood and Westminster, which would generate a blame culture that would foster nothing but hostility and conflict. Exploiting people’s prejudices, especially anti-Englishness, lies at the heart of the SNP, despite its national leader’s attempt to downplay that. There are historic examples worldwide of similar nationalism that has led to unnecessary conflict and irreparable damage. Some would argue that that might be an exaggerated risk, but is it a risk worth taking?
I turn now to the defence of the UK and, in particular, the valuable jobs associated with the defence industry. As an island, we are heavily dependent on securing our shores, whether from those who wish to harm our people, to enter the country illegally, to exploit our shores or to carry out organised crime involving drug or human trafficking. Our service personnel work tirelessly to protect us, coupled with the other agencies that work together to collect and share information and surveillance. We owe them all a great deal of gratitude. That would be put at risk if we were to break up the partnership. Investment could be affected and jobs could be lost. Paradoxically, some areas in Scotland are heavily dependent on a UK defence presence yet choose to elect people who would, if they come to power, put that investment at risk.
The hon. Gentleman is absolutely right. Is it not the envy of the world that the British military is the best we can have? It is British. Does the hon. Gentleman agree that if the Union were to break, we would have an English army, a Scottish army and whatever else, and that that would be a disaster for the United Kingdom?
The hon. Gentleman makes a valid point. If that were to happen, we would have no more than some sort of “Dad’s Army”, which would be absolutely no use in the modern world.
Equipping our service personnel with the tools and technology that they need to carry out their dangerous tasks is important to the British manufacturing base. Shipbuilding in the UK was on its knees before the Government came to power, but it has been turned around by a mixture of forward thinking by the defence companies and hard work by the employees. That would all be scuppered by the break-up of the UK.
My hon. Friend, like me, has many constituents who work in shipbuilding on the Clyde. Would he care to speculate about how many aircraft carriers an independent Scotland would need if the Union was broken up and about whether England, as a foreign country, would place its orders for aircraft carriers in an independent Scotland? How realistic does he think that either of those eventualities would be?
I doubt whether there would be any aircraft orders in an independent Scotland. Any aircraft that were ordered would probably be made using Airfix glue, and that would most likely be the only thing that we could produce in an independent Scotland.
The important thing about shipbuilding is the valuable skills that would be lost. Apprenticeships would be sacrificed, simply because some people in Scotland want to create superficial borders that are unnecessary and unwanted. As someone who has spent a significant period of my working life in the shipyards, I feel confident that I reflect the genuine concerns of workers in that industry.
Does my hon. Friend agree that the fact that we are members of NATO gives us great defence security? Small countries in Europe, such as Iceland, Estonia, Latvia and Norway, are all strong members of NATO. Does it not seem utter folly that we should consider leaving it?
My hon. Friend is absolutely right. It would be folly for us to even contemplate leaving NATO. We all need to remember that we are an island and that we need to be protected as such. It would be folly if the scenario that she painted were to come to light.
As I said at the beginning, there is a school of thought within the nationalist ranks that North sea oil will be a panacea to all their whinges. If we scrape away the rhetoric and take a serious look at the economics, the figures do not add up. Well-respected financial experts, such as those at the Financial Times, warn that North sea oil revenues will dry up within the next 10 years, thereby placing a potential tax increase on Scottish people if they vote for independence and still aspire to retain the public service that they have now. That will not only impact on the Scots but could influence inward investment from other countries in the UK and beyond.
This coming Thursday, there will be a choice. Scotland faces an historic decision: the choice between two very different futures. We must recognise that there is a lot to lose. The onus is on those who want to trade education for separation and economic stability for economic risk to choose between building up Scotland and breaking up Britain. The nationalist plans for independence come at a cost, and the people and businesses of Scotland will be asked to pay the hefty price.
With economic policies helped along by “fiscal fairy dust”—not my words, but those of the SNP enterprise spokesperson, Jim Mather—the SNP is asking Scots to trade in hard-won economic stability for a risky wager on declining oil revenues and a corporation tax cut that Europe could cut back.
My hon. Friend makes powerful points about the benefits for Scotland of being in the Union in terms of its economy and the defence and security of our nation and jobs, but does he agree that there is also a school of thought among the nationalists that says that, if people think that it is better for Scotland to be part of the Union, they somehow love their country less or are less patriotic? Does he agree that that is a complete fallacy, and that those of us who see the benefits of being in the UK love Scotland just as much as any other Scot?
My hon. Friend is absolutely right. Some in the SNP claim to speak for Scotland, but today’s performance shows that only one member of the Scottish National party is present. Indeed, the London leader of the SNP, who claims to stand up for Scotland, could not even find the time to attend this debate.
On the cost of the SNP, the United Kingdom is a Union that has served Scotland and its other nations well. By pooling our resources, we achieve much more together than we would apart.
I do not know whether the hon. Gentleman heard the actor Robert Carlyle on this morning’s “Today” programme. He said that, as a lifelong Labour man, he was going to vote SNP, but that he did not favour an independent Scotland. He said that he was voting SNP only because it was his last chance to give the Prime Minister a kicking before he goes next week.
The hon. Gentleman makes a valid point, but I think that Mr. Carlyle, like a number of my colleagues, might be somewhat confused about what this Labour Government have done for Scotland in terms of jobs. If Mr. Carlyle wishes to give the Government a kicking, that is entirely up to him, but there are consequences—independence and the break-up of the UK. People need to understand that independence comes at a cost.
Scotland represents just over 8 per cent. of the UK population, one third of its land mass and one half of its coastline. Government officials, independent experts and informed commentators agree that the UK’s way of financing public services spending across Britain is based on equality of service provision. On that basis, Scotland benefits from a Union dividend that recognises the distinctive nature of service delivery to the Scottish people.
In each of the last eight years for which official figures are available, public expenditure in Scotland exceeded revenue. The SNP would give up the Union dividend, which benefits Scotland by more than £11 billion. Outside the UK, it would lose that dividend. Revenues from North sea oil and gas cannot fill the SNP’s financial gap. Even assuming the highest possible share of North sea revenues in Scotland when oil prices are high, those revenues cannot plug the SNP’s fiscal hole, and production is already in long-term decline.
The SNP’s plans to break up Britain, and its incoherent tax and spending plans, would leave the party with a net deficit of more than £12 billion, equivalent to well over £5,000 per household per year. Independence is not only a risky business, but an expensive one, too. I hope that the Mr. Carlyles of this world will understand that.
I do not know whether the hon. Gentleman saw the opinion poll this morning that showed that only 19 per cent. of the Scottish people believe that nonsensical £5,000 figure. Some 51 per cent. thought it was a load of rubbish. Is it not the case that nobody believes a word that the Government and the Prime Minister say anymore?
If the SNP wishes to discuss the economics of its policy, it is free to do so, but it should come to the table with honesty and integrity.
The SNP proposes to raise income tax in Scotland initially by 3p in the pound. That would make Scotland the highest taxed part of the UK, place new cost burdens on businesses, fuel wage pressures and return Scotland to the bad old days of the brain drain. Despite what the nationalists claim, local income tax will not help the poorest pensioners, who currently qualify for council tax benefit. They will continue to have to pay sewerage and water rates. The SNP will tax only earned income, not shares, savings or property, so a very rich person in a £1 million home living off shares and savings will pay no local taxes to help fund local services.
On the SNP’s policy of introducing a local income tax, does not my hon. Friend think that it is yet another example of the fact that, although the SNP might claim to be progressive, when it comes to the crunch, it does not put the interests of ordinary families in Scotland and of Scotland’s poorest at the top of its agenda? Does he also agree that the SNP’s recent decision to drop policies on bringing the railways under public control and regulating bus services in Scotland might have something to do with the recent large donation that it received from Brian Souter?
My hon. Friend is correct. It is strange that nationalist policies on transport have changed since the donation from Mr. Souter, raising the question of cash for policies. On council tax, it is a rather strange, tooth-fairy world in nationalist politics. The idea that one can pay nothing and get the same public services is just untrue, as the figures confirm.
On the potential conflict, the SNP has made it clear that it will table a motion for an independence referendum in the first 100 days. By stating that a referendum on independence would happen in 2010, it is attempting to convince the Scottish people that they can defer the constitutional question for four years, but the SNP strategy for tax and turmoil would leave Scotland facing instability and uncertainty from day one.
From day one, the SNP intends actively to seek out and create conflict with Westminster. The SNP has made it clear that it seeks power in the Scottish Parliament for one purpose only—to take Scotland to the brink of independence and beyond. It will pick fights to use the Scottish Parliament as a battering ram to bring about dispute and discord.
Within 100 days, the SNP would introduce an independence Bill. It would tear up the Treasury rule and discipline that have brought economic stability to Scotland, re-create the battles of the 1970s for oil and gas and use every issue from gun laws to Olympic athletes to create tension between the north and the south. The SNP sees every fight within the UK Government as a way of building the case for independence. One SNP insider pointed out last month that the election will give the incoming Government a mandate to open talks with Downing street, saying, “If we don’t get what we want, what better case could there be for independence?”
Within 100 days, the SNP will begin squabbling with London over who owns the oil and gas in the North sea. Taking a step back in time, it wants to re-create the arguments of the 1970s. It is time that the SNP understood that Scotland has moved on.
On revenue from North sea oil, it is interesting to note that the SNP liked what the Financial Times said about the current price of oil and gas—that Scotland would have a surplus this year if it got 95 per cent. of the revenue. But in future years, when gas is a bigger part of the North sea flow and prices come down, there would be a clear deficit in the Scottish budget if Scotland relied upon even 95 per cent. of the revenue from oil and gas. Is it not a false economy to make such plans when it is quite clear that prices will come down, the flow will slow and the revenue will not be there?
My hon. Friend is absolutely right. To base a whole country’s economy on such a volatile product is irresponsible. There is a danger in it, and the people of Scotland must understand exactly what that danger is.
I could go on about the SNP’s policies on independence, but I am sure that some of my colleagues who have kindly come today are more than capable of doing so. As someone who is deeply proud of my Scottish roots, I am equally passionate about my Britishness. That is why I firmly believe that we are stronger together than apart. Unity is strength, as they say in the trade union movement, and that is equally relevant for the Union of the United Kingdom.
I congratulate the hon. Member for Paisley and Renfrewshire, North (Jim Sheridan) on securing such an important debate on such an inauspicious day. I was almost detained in getting here today, trying as I was to get through the cheering, flag-waving crowds. Everybody is out celebrating the coming together of our two great nations.
More importantly, the hon. Gentleman secured this debate in what is likely to be one of the most dramatic and significant weeks in Scottish politics. You have probably not been to Scotland much in the past few weeks, Mr. Cummings, but one can sense the feeling there that change is coming. Scotland is about to move forward with hope, aspiration and ambition.
I will give way, but I would like to tell Labour Members that I will not be up and down like a jack-in-the-box, taking tedious, depressing and negative interventions. My contribution will be the only one that hon. Members will hear this morning from this side of the debate, and they will have plenty of time to catch your eye, Mr. Cummings. I will take the intervention, but could I plead with the hon. Lady to say something positive this time around? I challenge her to do so—go on.
The hon. Gentleman is well aware of the fact that I often make very positive contributions. He has already quoted opinion polls this morning, and I have no doubt that he will refer to other opinion polls in the rest of his contribution. However, the most recent opinion poll on independence for Scotland showed that only 22 per cent. of the Scottish people are in favour of it. Does he not agree that it would be completely inappropriate for the Scottish National party to proceed with their policy on a referendum if such a small minority of the people are in favour of independence?
I knew that it would be a task too far for the hon. Lady to say something positive, but I commend her for raising a point about opinion polls. The last opinion poll was issued by ICM on Sunday, and it showed that 41 per cent. of the Scottish people are in favour of independence. Curiously, it found that 56 per cent. of the English people are also in favour of it. It would seem that the English people are way ahead of the English political parties in this debate, and it seems curious that that is not reflected at all in the policies of many major parties in Westminster.
I am a Scotsman who represents an English seat in Somerset. I can assure the hon. Gentleman that that is not the case—the Scottish question does not raise its head at all. My constituents know my background; they know who I am. I am sorry to say that, as usual, he is talking through his hat.
I do not doubt the hon. Gentleman’s Scottish credentials, but the question was put to English people by ICM, and 56 per cent. said that Scotland should be independent. That is what the survey found, and it is consistent with several opinion polls that canvassed the people of England on the matter. It seems that the English people are way ahead of the hon. Gentleman and his party.
Getting back to the debate about Government policy on Scotland, which I am sure you are keen for us to do, Mr. Cummings, it is clear that the Scottish people have decided that it is time to move on. It is time to put an end to the mediocrity that has been a feature of the Scottish government since its inception. It is time to remove the dead hand of the Labour hegemony and Labour politics in Scotland. Fifty years of the dead hand of Labour is coming to an end—it will be part of history. Scotland will move on to a new chapter of its story that will be characterised by hope, optimism, ambition and aspiration.
Will the hon. Gentleman give way on that point?
I have nothing but respect for my Liberal colleagues. I have long been an admirer of their long-standing principles—a person knows what they will get with the Liberal Democrats. One could not hope to find a finer bunch of people in Scottish politics, and we are very much looking forward to coming to some arrangement with our Liberal colleagues in the next few days.
What we are saying in the debate about Government policy on Scotland is that it is time to move on. If the debate can be characterised by having been for and against anything in the past few years—[Interruption.] I welcome my hon. Friend the Member for Dundee, East (Stewart Hosie).
The debate has been about hope and fear. On the one hand, there is a positive vision of Scotland. The SNP has an innate belief in the Scottish people and their abilities, talent and creativity. It takes the view that Scotland could be so much better than it is, that it could aspire to greater things and do so much more.
Compare and contrast our vision with the doom and gloom that we have heard from Labour Members. Their comments are negative: Scotland cannot do that, that is not possible, Armageddon will come if they do that, and the deficit will be bigger than that of the Gaza strip. They have tried to suggest that the Scottish people, almost uniquely among the European peoples, would make a failure of running their country on their own.
Call me old fashioned, but if a party wants to win an election, it should try its best to gear itself to the electorate, not disparage and insult them, which is exactly what Labour Members have been doing. That is why they will take such a hiding this week. Their campaign of negativity has been a disaster for them, and they are likely to realise that on Thursday.
Some of the things that I have heard have been truly outrageous and quite hysterical. Do you remember, Mr. Cummings, when Labour came to Oban a few months ago? There was a massed chorus of doom and gloom. The funniest comments that weekend came from the Home Secretary, who portrayed a Scotland infested by al-Qaeda members who happened to get over the barbed wire and evade the border guards that he believed would be installed.
The other hysterical incident was when the Prime Minister walked into the classic trap that we set. He came to Scotland one morning and managed to insult and disparage one of Scotland’s most successful businessmen. He described George Mathewson, who was responsible for the success of the Royal Bank of Scotland, Scotland’s most important financial institution, as self-indulgent and, I believe, egocentric because he dared to present an opposing political opinion.
I wish to correct the hon. Gentleman. That was the story reported by the press, but the full statement was nothing like that. In fact, the Prime Minister praised Mr. Mathewson for all that he did in business but said that his decision to support the SNP was egocentric and, in fact, out of character. The full statement was not about him as a person or his business ideals. Like many people, I believe that people are being self-indulgent and gambling with Scotland’s future by thinking that the SNP could lead the country better than the Labour-Liberal coalition has led it.
The hon. Gentleman prayed in aid the support of George Mathewson, as his party has done incessantly throughout the campaign. Mr. Mathewson did play a large, important and significant part in building up Scotland’s financial services sector. Would the hon. Gentleman reflect on and care to comment on what part George Mitchell, Sir Peter Burt and Jim Spowatt played? Did they play any role whatsoever in building up Scotland’s financial services industry, or were they just bit-part players? If they played any role at all, what is the hon. Gentleman’s view on their opinion that separating Scotland from the UK would be a disaster for financial services institutions in Scotland?
Of course those people are entitled to their opinions, and I hope that they make them clear. We want to hear the opinions of business people throughout the course of the debate. However, there is no way that members of my party would get into the game of insulting such people, unlike the Prime Minister, who spoke about George Mathewson. I shall not disparage and insult the people whom we saw this morning, for example. They are entitled to their views. We will leave such actions to the Prime Minister, if the Minister does not mind.
As I said, the Prime Minister is back in Scotland today. We know how bad it is for the Prime Minister because when he last came to Scotland, he pleaded with the Scottish people not to give him one more kicking. “I am going away,” he assured them, and for that they will be eternally grateful. “Do not give me one last kicking,” he said.
We Scots are a reasonable people, and, as far as possible, we would like to oblige and indulge the Prime Minister. However, we will give him one hell of a kicking on Thursday. The Scottish people will have their say about him, and it will not be a pretty sight. It will not be a pretty sight for the Prime Minister and it will not be a pretty sight for the Chancellor, who is probably now even more unpopular than the most unpopular Prime Minister since records began. The elections will be a disaster for the Chancellor in his own back yard because he will be defeated. What type of Prime Minister will he be then?
I make a plea to Labour Members: please keep the Prime Minister in Scotland until Thursday. We want to ensure that we get our vote out so that we have as large a majority as possible. Will they keep the Prime Minister in Scotland for as long as they can? His presence in Scotland has focused attention on the Government’s policy in Scotland. Why has the negativity failed this time? Labour Members thought that they simply needed to put the frighteners on the Scottish people one more time and they would all fall into line. That will not happen and there are two very good reasons why it will not. First and most important, the Scottish people do not believe a word that this Government and the Prime Minister say anymore. If this Prime Minister and the Government are prepared to tell untruths—I will not go into why—about why this country went to war, which is the most important fundamental decision that a Government can make, why should the Scottish people believe them about anything else? Why should they believe what the Government say about the details and features of our policy to replace the hated council tax when they tell such huge whoppers about going to war? Of course, people do not believe a word that the Government say anymore.
The hon. Gentleman’s comments are synonymous with exactly how the election campaign is going. Not once has he mentioned any of the issues that will be pertinent on Thursday—health, education, law. All he wants to talk about is what is happening at Westminster. The elections on Thursday are not about issues at Westminster.
The hon. Gentleman is generous in giving way. He spoke about council tax and what he claimed was a misrepresentation of his policy. Will he answer a simple, clear question with a figure rather than windy rhetoric? How much would a two-income couple in a band D property—not a band F property—have to earn before they paid more in local income tax than in council tax?
It is strange that the debate about the future of local government finance has become the predominant parliamentary issue in the elections. In the debate about the future of council tax versus local income tax, the First Minister himself could not even come close to saying that the current council tax policy is fair. We believe that our policy is fair and the Scottish people believe that the policy is fair. The Scottish people will have a decision and a choice to make on Thursday: continue with the Labour party and its unfair council tax or move to a much fairer local income tax, as suggested by the Scottish National party. The second reason—
In addition to the Scottish people not believing one word that Labour Members say, the second reason why the Scottish people will not believe in the negativity this time is that they are much more confident and self-assured. The Scottish people have had eight years of running their own Government and Parliament, and they know what it is like to do that. Labour Members suggest to the Scottish people that they can confidently run issues such as health and education—as the Scottish people have done already—but that they cannot somehow run defence, foreign affairs or pensions. The Scottish people are saying that that does not chime with their experience and, in that respect, a negative policy does not work anymore.
If the hon. Gentleman wishes to put in an application to join my party, it will be considered in due course. That is how he can become my hon. Friend.
Will the hon. Gentleman explain why his party thinks that an independent Scotland would not be capable of having its own currency or setting its own interest rate?
We can have a debate about that if the hon. Gentleman wishes to, but the most important point is the suggestion that the Scottish people would not be capable of having their own currency. That issue also relates to those Labour Members who have said that the Scottish people are incapable of putting together their own armed forces. Those remarks are nonsense, ridiculous and disparaging. Once again, Labour Members are talking Scotland down. The Scottish people are, of course, capable of doing such things. I believe that the hon. Member for Orkney and Shetland (Mr. Carmichael) thinks that the Scottish people would be able to do those things on their own.
I will not give way again as I want to try to make some progress.
When Labour Members move away from the negativity and try to be positive, it does not get much better for them because they insist on talking about what they call the Union dividend, which is the added value that the House is supposed to give the people of Scotland.
Let us consider the big reserved issues that the House is still responsible for in Scotland—foreign affairs, defence, pensions and the macro-economic management of Scotland. Let us start with foreign affairs. The defining issue for the House in Scotland in relation to foreign affairs is the Iraq war, which was overwhelmingly opposed in Scotland—not just by the vast majority of people, but probably by everyone. That is part of the Union dividend provided by the House.
No, I will not give way because, as I said, I am trying to make some progress.
Let us consider defence procurement. I know that hon. Members like to discuss defence procurement, but the defining decision that the House has taken about defence over the past few months and years is the renewal of Trident, which is £50 billion-worth of weapons of mass destruction placed just miles from the most populous city in Scotland. It was overwhelmingly opposed by the people of Scotland, campaigned against by all civic society and voted against by Scottish Members of the House. That is the Union dividend in relation to defence in Scotland.
No, I shall not give way as I have done so enough times already.
The Union dividend for pensions is the pensions fund raid, which has cost every Scottish family £3,700. That is the Union dividend on pensions. Let us consider the issue that Labour Members like to crow about most: macro-economic management from London. Right, okay, there is growth; but not in Scotland. We have underperformed compared with the rest of the UK since Labour came to power. We should not even bother considering the small European independent nations that would be Scotland’s normal comparators. Compared to Scotland, those nations are economically in another stratosphere because of the dead hand that this House has dealt with the macro-economic management of Scotland.
This debate is also called the Government’s policy on the Union. I did not know that they had a policy on the Union other than they were for it and we have heard more about that today. I will make our policy clear: we want to offer a referendum to the people of Scotland on the future of the Union. That is the fair and democratic way to proceed. Constitutional debate has been a feature of Scottish politics since Winnie Ewing’s magnificent triumph in 1967, and the question regarding the Union should be put to Scotland. As democrats, we should be in favour of something as fundamental as letting the Scottish people choose. [Interruption.] The hon. Member for Paisley and Renfrewshire, North asked “When?” from a sedentary position. My hon. Friend the Member for Banff and Buchan (Mr. Salmond) has made that clear. It will be in 2010. We will have the opportunity to prove what an SNP Government in power can do and then we will put the question on the Union to the Scottish people.
Some Labour Members have suggested that the election on Thursday is a referendum on the Union, but it is not. Every week and month, Labour Members say that the SNP talks only about the constitution, but Labour Members have discussed nothing but the constitution in this debate. The hon. Member for Paisley and Renfrewshire, North asked about health and education, but I have hardly heard a peep from the Labour party about those issues. All the First Minister talks about is the constitution, the constitution, the constitution. Scotland will have its choice on the constitution. Hon. Members from the Labour party are frightened of a referendum that will happen in three years time. People will have the choice at that point.
I have detained the Chamber for too long. On Thursday, the people of Scotland will have a choice between hope and fear, the positive and the negative, and the “can do” and the “cannot do”. That is the choice that will be put to the Scottish people on Thursday, and I have no doubt about the decision that they will make. One last thing to Labour Members here today: after 50 years, go back to your constituencies and prepare for defeat.
I shall try to keep a straight face after listening to that.
I pay tribute to my hon. Friend the Member for Paisley and Renfrewshire, North (Jim Sheridan) for winning this important debate. Fifty-nine years ago—in a fortnight’s time—I was born in the Lanarkshire mining village of Lesmahagow. I was born and bred a Scot and have had the joy of spending 40 of those 59 years living in Scotland. For 19 years, I lived and worked in a Nottinghamshire coalfield as a miner—a coal face engineer.
In 1968, when Scottish miners were chasing jobs owing to the world dependency on cheap oil, I was one of those industrial gypsies forced to seek a better standard of living in England. With my family—my wife and baby son—I had to up and move to the Nottinghamshire coalfields. In 1987, I returned as Member of Parliament for Clydesdale. In my maiden speech, I likened that experience to that of the salmon returning from the sea to the fresh water. However, those 19 years spent living in England, where my daughter was born, and where I now have two grandchildren, provided an invaluable life experience.
I begin with that small tour of my personal history to make a point that is central to my fundamental beliefs: I am proud of my place of birth and of the mining stock from whence I came, and to have been born and bred in a country that taught me community, brotherhood and humanity. It did not instil in me negativity and insecurity, or the belief that I am a better person for having been born on a certain side of the street, river or border.
We live in a Europe that has seen the scourge of war fired by sectarian nationalism. Surely, if we have learned anything from that dark history it is this: that we achieve more together than we do apart, and that imposing divisions based on the road, the river or the map promotes not brotherhood or humanity, but a sectarian divide that says, “We on this side are better than you on that side.”
I reject the politics of envy and grievance that encompass the worst extremes of nationalism. I make no apology for my description and analysis of the politics of such elitist nationalism in Scotland today—the smarmy arrogance that all too often accompanies nationalism and its politics of grievance and untruths. It is truly unpalatable. I go further than that and have a message for those in the media who flirt with nationalism: “You, in the comfort zone of your cosy, chattering-class environment, purvey half-truths and myths to serve a nationalism that has little history of defending freedom.”
I now turn to the European Union. We are told that Scotland will become a member of the EU when it is divorced from the United Kingdom. I have almost 20 year’s experience of working on EU treaties and the European Scrutiny Committee, so I know that it is simply not true that Scotland would be welcomed by the EU as a member state. The SNP knows that. Before there can be further EU enlargement, there must be a treaty change and a unanimous vote by the 27 members of the European Council, which includes many states, such as Spain, Germany, Belgium and France, that would veto any such proposal. The SNP says, “It is not enlargement,” but that is not true. Scotland would need to change the relevant treaty to get a commissioner, a seat on the European Council, and representation on the European Court of Justice and the European Court of Auditors. EU membership is just another incredible SNP policy resulting from its huge gamut of presumptions and distortions.
My hon. Friend has far more knowledge of the EU than virtually any other Member, with the possible exception of our hon. Friend the Member for Linlithgow and East Falkirk (Michael Connarty). As I understand it, a new treaty of enlargement would require a referendum in certain countries—France, in particular. Is the logical conclusion of the SNP’s policy, therefore, that Scotland’s future membership of the EU, and the jobs, prosperity and trade that go with it, would be placed in the hands of the French electorate, which could then decide whether Scotland re-enters the EU? Is that in Scotland’s best interests?
Not only the French electorate; half of the member states would need referendums. For example, let us take Spain, which has its own problems with separatism. Is Spain going to allow a member state to break into its constituent parts with each part keeping equal status as a member of the EU? Of course not.
I was not planning to intervene because I was hoping to make a speech if I could catch your eye, Mr. Cummings. However, what does my hon. Friend think is the likelihood of those European nations voting Scotland into the EU? They might think, “Well, what happens if its policy is to change its mind if things do not go exactly as it wants?” Would we vote such a country into the EU?
That is the whole point of my contribution. It would be impossible.
One of my biggest criticisms of the SNP is that it has not even started to discuss the problem. It always runs away from it. Has it explained how Scotland would become a member of the EU? Currency is a good example. The hon. Member for Banff and Buchan (Mr. Salmond), when put in a corner and asked who would fix interest rates, says that the matter would stay with the Bank of England and then move into the single currency arrangements. No way, José! And the SNP knows that. The fact that it knows it and still allows people to assume otherwise poses a question in itself.
Speaking as a former deputy leader of the Conservatives in the European Parliament, I can say that as a prerequisite to successfully negotiating accession to the EU, Scotland would have to join the euro. Devolution would mean joining the euro and therefore devolution not from London to Edinburgh, but from Edinburgh to Frankfurt, where important economic decisions affecting Scotland would be made.
The prerequisite would be a unanimous vote in the European Council, which would be impossible.
A divorced Scotland would be the highest-taxed country in Europe. The Bank of England would set its interest rates and the value of its currency. Flows of investment would go one way—out, not in. Scotland’s thriving financial services industry, which can rival that of anywhere in the world, would take its money to London, Zurich or anywhere else. Certainly Scotland would not remain in its current excellent condition if it were separated from the United Kingdom.
My hon. Friend makes a very serious point about the financial services market. Even worse, if Scotland were separate, the Bank of England would base its analysis and decisions on the market in the rest of the United Kingdom and ignore any significant economic factors affecting Scotland, such as the inflation rate or its rate of joblessness. The Scottish economy would accordingly face much greater risks, which would again have a serious effect on Scotland’s ability to attract the financial sector.
The point is that an independent Scotland would be leaving its monetary policy to be set by a foreign country. That is the reality.
I am mindful of the time and the fact that other hon. Members wish to speak, so I will conclude. On Thursday it will be deal or no deal for the people of Scotland, as those of us who watch the Channel 4 programme in the afternoon might say. Will they be fooled by the banker-bookie, the hon. Member for Banff and Buchan, or will they be true to their Scottish instinct for canniness and keep what they have, putting the education of our children before the separation of our country? Who will win on Thursday? Will the bankers and bookies of the SNP win on a deal for a separation or will Scotland say, “No deal”?
I congratulate my hon. Friend the Member for Paisley and Renfrewshire, North (Jim Sheridan) on securing this debate with precision timing. Today is also labour day, 1 May, which is a good day to have such a debate.
In less than 48 hours, polling stations all over Scotland will open their doors. Many of the polls predict a wind of change. The people of Scotland are willing and able to embrace change, but Scots will not be deluded into making changes that will cause the modern progress that the country has made in the past 10 years to be obliterated. I believe that the people of Scotland are confident in their national identity as part of the UK.
Just last week, 150 business leaders from throughout the country, men and women, put the case for Scotland’s economic and social progress as part of the Union. Like me, they believe that Scotland’s best opportunities for investment, jobs and prosperity lie in being part of Britain. From prosperity emanates a love of culture and sport. That is precisely why some of our most famous sporting heroes—all Scottish patriots—have put the case for Scotland as part of Britain.
During this election period, it is time to remind ourselves of the depth of the long-term ties that bind Scotland to the United Kingdom. The shared values that underpin the economic networks, financial connections and business alliances in the UK are fundamental to Scotland’s success. They make us stronger together, and we would be weaker apart. They make a multinational Britain a model for a new and interdependent world.
If the people of Scotland do not want independence on Friday morning, they cannot vote SNP on Thursday. Independence is the threat facing those people in Scotland who do not vote or who choose not to vote for a party that is committed to devolution. The SNP may want to give the impression that all the big questions will be postponed until a possible referendum years down the line, but its real strategy is for conflicts over powers from day one of an nationalist Administration. The leader of the Scottish nationalists has publicly threatened that the four-year war of attrition with Westminster will start on 3 May if his party is elected to rule.
The break-up of Britain would not only start to undermine shared family connections and economic relationships and the values that we all hold in common, but would, from day one, be a recipe for division and instability and put our prosperity at risk. East Lothian, the constituency that I represent, has like the rest of Scotland fared well within the Union in recent years. Last week’s employment figures showed more people in work in Scotland than ever before, with 50,000 more people in employment in one year alone. For the first time in half a century, Scotland can contemplate marching towards full employment if we make the right long-term decisions. Scotland not only has its highest share of working age people in employment since records began, but its employment rate, currently at 76.3 per cent., has been around or above the UK rate since 2003, among the highest in the EU 25 and better than that of every G7 country. That contrasts with the position in 1997, when the Scottish employment rate was 2.5 per cent. lower than the UK rate. Far from lagging behind, Scotland has experienced higher growth in gross weekly earnings than the UK in three of the past four years.
Devolution gives Scotland both stability and mutual support. Rising to the challenge of globalisation means nothing less than equipping each and every Scot to meet the competitive challenge. In the next 10 years, a transformation of our education and skills base is essential. That is what we must focus on, not unnecessary constitutional wrangling. Labour in Scotland will, for the first time ever, guarantee education to Scots from the ages of three to 18. That priority was identified under the devolved policy and can be delivered only by a devolved policy. However, we will succeed only if we also secure and entrench stability as the foundation of all that we do.
It is time for some brutal truths about the new global economy. Investment will flow to those countries that are stable. In the same way, it will move quickly and decisively from those that are unstable. Stability is our watchword—yesterday, today and tomorrow—so Scotland must build and cement the economic stability that is the foundation of any country’s success, not jeopardise or take risks with it. For those reasons—for the sake of the stability that we have enjoyed and need to continue to enjoy, and for the investment in innovation and education, which are the keys to the future, to flourish—we reject absolutely the policies of the nationalists.
To reject the nationalists and independence, we must look at their failure to be honest about their policies, and start with just one example of their inventions and falsehoods. The SNP’s whole financial policy is based on a series of errors and exaggerations. The nationalists have built their whole case on one volatile commodity—oil—but they have refused to face the facts about the real scale of revenues from the North sea. Almost every credible economist now confirms that the nationalists have got the oil price wrong, the oil production numbers wrong and Scotland’s potential share of North sea oil and gas wrong.
I thank my hon. Friend the Minister for his intervention. One word would characterise the nationalists’ approach: dishonesty. They have also invented an oil fund surplus that cannot exist. That is why they say that they will not update their figures until July, weeks after the election.
The figures are not small or incidental for a country such as ours. The £2 billion oil gap alone is the equivalent of the entire budget for universities and colleges. However, despite being billions of pounds out on oil and with less money to spend, the nationalists keep adding to their tax and spending commitments day by day, thereby creating a black hole for every year of a first-term Administration, and before we add the costs of independence. New SNP spending commitments would cost an average of at least £2 billion each year, equating to a massive £8 billion over the four years of a term of office. Those commitments include tax and spending promises on pre-school education, free school meals, micro renewable generators for homes, higher education, the first time buyers grant, housing debt, farming, international aid, the Edinburgh festival Expo fund, local income tax and freezing council tax.
As my hon. Friend will be aware, one of Scotland’s distinct features is our strong system of local government, which we have had for many years. As one of those of us who believe in local democracy, does she not consider the setting of a central rate for income tax strange, as it will make local authorities virtually powerless to provide the individual services that their local communities demand?
Absolutely not. [Interruption.] I do not care; I have no intention of giving way.
The SNP has made pledges in areas that are currently reserved. That is the key. I am referring to a citizen’s pension at a cost of £1.2 billion and a change to corporation tax costing £600 million—a total cost of £1.8 billion. On top of that, we estimate the cost of the trappings of an independent state—new Ministries, new embassies and new commitments—at £1.5 billion. The SNP published tax plan would mean an immediate rise in income tax, yet there are pledges to lower taxes. I am totally confused; I just hope that the shrewd and astute people in Scotland will see through that nonsense.
The nationalists, as we have heard, say that they could join the euro, but they do not meet the criteria on either the exchange rate rules of the euro or the fiscal rules—the confusion mounts. To avoid doubt, I should, however, make one thing clear. Although the SNP says that it will make a claim for oil revenues in the first 100 days of power if it is elected, it also intends to retain the benefits of Barnett money. That is an absolute joke.
In a global economy in which stability is at a premium and investment can so easily come and go, businesses and individuals need to be certain of the monetary and currency arrangements, or they will question the wisdom of investing when an Administration who want all the trappings of a separate state cannot begin to articulate what they would do with the currency inflation interest rates and the management of the economy.
I welcome you to the Chair, Mr. Atkinson. I congratulate the hon. Member for Paisley and Renfrewshire, North (Jim Sheridan) on securing a debate that, if nothing else, has served to remind us all why we should be grateful that it is some years since the Scottish Grand Committee met.
I listened to the slightly misty-eyed and breathy rhetoric of the hon. Member for Perth and North Perthshire (Pete Wishart) about how it was time for us to be free and I thought I heard an echo of a distant campaign. I thought at first that perhaps it was that glorious campaign in 1992—no doubt hon. Members remember the slogan, “Scotland free in ’93”. But no, it was not that one. It was an echo of the glorious Scottish summer of 1978, when we were all on the march with Ally’s army—we were going to win the World cup. Of course, as the hon. Gentleman will know—he should remember this and be careful—in Scotland one can often go from spring to winter without enjoying a summer or an autumn. He should be a bit more cautious as he anticipates the wishes of the electorate as they will be expressed on Thursday.
Lord Robertson of Port Ellen said a number of years ago that devolution would be the death of the Scottish National party. I think that he was right, and the justification for that view has been seen in the election campaign in the past few weeks. One has to consider where independence is in the Scottish National party campaign—it is something that we might at some stage over the next four years get a say on in a referendum. We are not being told that it is something that is so good for us that we have to have it now. We are being told that we will have a go with devolution for three and a half years, or perhaps four, and then we will think about it.
One can see the change in the position of the Scottish National party. The hon. Member for Banff and Buchan (Mr. Salmond) famously told us in a “Newsnight” debate that an independent Scotland would keep sterling as its currency and that we would continue to have our interest rates set by the Bank of England. I just do not understand the logic of the position that we will keep those things but we will, by virtue of some sentimental desire and a drive for independence, remove ourselves from all influence on them. As the hon. Member for Glasgow, North (Ann McKechin) said, we will remove Scotland from the consideration of those matters. It is bad enough sometimes that Scotland’s economy can be affected by a greater set-up in which our needs and wishes are not at the forefront, but at least they are there and being considered. The SNP will give us a situation in which we will be subject to the diktats and decisions of others, but we will have no say and they will not have to consider our position at all.
To take up the thread of the hon. Gentleman’s remarks, and referring to the comments of the hon. Member for Lanark and Hamilton, East (Mr. Hood), may we take it that when it comes to discussions between the Liberal Democrats and the SNP, it will indeed be no deal?
We will all sleep much better in our beds knowing that that is not my decision. I say to the hon. Gentleman, as I have already said to the hon. Member for Perth and North Perthshire, that I will not prejudge the decision of the people on Thursday, and that is the point at which we start to speak about coalitions.
The real weakness of the independence position was best demonstrated this weekend, when again the hon. Member for Banff and Buchan told us that independence was not a one-way street. That is a very, very dangerous line to take. I cannot believe for one second that the hon. Gentleman said that without having first given it the most careful and closest consideration, but that statement is as close to being misleading as any hon. Member of this House could come because it fails to take account of the role of the rest of the United Kingdom in all this. We might well try independence for a few years with the Scottish National party, but if we then decide that things are not so nice on the outside and we want to come back in, other people—the people of England, Wales and Northern Ireland—will want to have a say. Looking at recent history, I have to say that I do not see why on earth they would want to have us back.
Constitutional settlements are dynamic. Over the past 300 years we have seen the balance change between monarch and Parliament. Within Parliament in the past 100 years we have seen the balance change between the Commons and the Lords. I do not believe—this has been a weakness of the Government’s position in recent months—that we should think that constitutional development in Scotland stopped on 1 May 1999, when the first Scottish Parliament was elected. That must be an organic and evolving process.
One area that requires consideration is the way in which the budget of the Scottish Parliament is raised. A weakness of that institution is that it is, in effect, a one-sided equation, if there can be such a thing. Politics is a two-sided equation: it is about how we raise the money and how we spend it. The absence of one of those sides—the raising of the money—has distorted political debate in Scotland for the past eight years. That will need to be addressed. I repeat the leader of my party’s call today for a new constitutional convention to establish a consensus across the political parties and civic society in Scotland on how best we can evolve the constitutional settlement.
I will not prejudge the verdict of the voters on Thursday, but I will say that if we do end up with an SNP Administration or an SNP-led Administration, that will not be a reflection on SNP policies; nor will it reflect a thirst for independence. The Government will have to share some part of the blame if that happens. In recent times, they have here resisted progress in the constitutional debate. They have refused to speak about reform and they have insisted on continuing with the institution of the Scotland Office and with the Office of the Advocate-General—offices that, frankly, in their current form have long outlived their usefulness.
The hon. Member for Perth and North Perthshire prayed in aid the Iraq war, but he did not take my intervention on the issue because he knew what I was going to say—that in fact the Scottish Parliament voted in favour of the Iraq war. With a few honourable exceptions, Labour and Conservative MSPs voted for it, just as Labour and Conservative MPs did, and they did so days before it started. The nationalists also talk about Trident, but when the Scottish Parliament debated Trident, it made no decision at all—all the options were knocked down.
That takes us to the problem with the Scottish National party. I believe that Scotland and the United Kingdom can be improved through the application of my political principles as a Liberal, and no doubt the Conservative and Labour parties believe the same about their political principles. However, the Scottish National party seems to believe that it can improve Scotland simply by drawing lines on the map, and that is a dangerous attitude, because if we draw that line on the map and still have problems, who will we blame then?
Thank you for calling me, Mr. Atkinson. As a Member whose constituency borders Scotland, you will be familiar with the world of Scottish politics.
I am pleased that the hon. Member for Paisley and Renfrewshire, North (Jim Sheridan) secured the debate, although I would have been more pleased had any Scottish Labour MP signed the early-day motion that I tabled in the House to celebrate the Act of Union, as some of their English colleagues felt able to do. I would have been happier still had the Government backed my party’s calls to celebrate the Act of Union throughout the United Kingdom, rather than marginalising it by simply holding an event to introduce the new £2 coin to which the Chancellor did not even bother to turn up and which the Secretary of State graced for only five minutes.
We would not have had this problem had the Labour and Liberal Democrat Administration in Edinburgh not failed so miserably over the past eight years—that is the point that has been missing from the debate so far.
I agreed with virtually everything that the hon. Member for Paisley and Renfrewshire, North said in opening the debate. Indeed, it reflected half the State of the Union address that my colleague Annabel Goldie gave last week, which set out the argument for the Union.
I have never described colleagues in that way, but there is no doubt that the public perception in Scotland is that the Scottish Executive have failed to deliver over the past eight years, and it is interesting that none of the Labour Members who have spoken has acknowledged that failure.
Let us be quite clear that if the Scottish National party increases its numbers in Thursday’s elections, that will not be because there is a clarion call for independence—as others have said, the polls do not indicate support for independence—but because of dissatisfaction with the Labour Administration and, indeed, with the Liberal Democrats, who are now clearly willing to swap camps.
I have only a short time in which to speak, given how long others have spoken.
The Conservatives offer a third way because they offer an opportunity for change but without all the risks that a Scottish National party Administration would bring to the Scottish Parliament, as many hon. Members have eloquently said. Let us be quite clear, however, that there will be no Scottish nationalist Administration in Holyrood without the Liberal Democrats—it is they who will deliver the Scottish National party to the people of Scotland. I am sure that other hon. Members present know the arithmetic and that the Scottish National party cannot get a majority in the Scottish Parliament on its own. It will therefore require Liberal Democrat support to pursue any of the hare-brained ideas that it has suggested, which the hon. Member for East Lothian (Anne Moffat) eloquently described.
The hon. Gentleman again demonstrates very well the problem that he succinctly highlighted in his memo: the Conservative party in Scotland has no thinkers. However, he speaks absolute nonsense when he says that the Liberal Democrats would be required to put the SNP in power. Surely, the SNP can form a minority Administration if it chooses to do so; indeed, if the Conservative party’s policy is to have nothing to do with any coalition with any party, that will be the inevitable consequence.
Previously, the hon. Gentleman did not wish to predict the outcome of the election. However, it is very unlikely that the Scottish National party could achieve the necessary numbers, and past form suggests that the Liberal Democrats might do a volte-face on virtually every issue on which they stand in the election, as they have on issues ranging from tuition fees to genetically modified crops. Despite what the hon. Gentleman said in the debate, the possibility of an SNP-Liberal Democrat coalition in Holyrood is very much open, and that will be bad for Scotland because a Scottish nationalist-led Administration will bring about the instability that we have discussed.
However, this week’s vote will not destroy the Union because the election is not about the Union per se. I am happy to join Labour Members and Unionists across Scotland to fight the Union’s cause, but like my right hon. Friend the Member for Witney (Mr. Cameron), I want to make a positive case for the Union. My right hon. Friend does not want to take the clunking-fist approach of the Chancellor, who is trying to scare everybody into thinking that Scotland would somehow be totally diminished and impoverished if it were not part of the Union; he wants to make a positive case for staying in the Union, as he did yesterday in Buchanan street in Glasgow, where he was so well received. The Labour party has made a serious mistake in fighting such a negative campaign in the election. I am relatively objective in the debate between the Labour party and the SNP, but I have not heard Labour policies being set out. Indeed, when Mr. McConnell was pushed this weekend, he could not answer questions about Labour’s policies on local income tax and council tax.
People in Scotland will have a choice on Thursday and will be able to choose the change that they desperately want. I include the Liberal Democrats in those changes, because they have gone along with every policy of the Labour Administration, and it is incredible to see their leader, Nicol Stephen, trying to distance himself from decisions to which he was party. However, there is a chance for change and there is a party that offers delivery without divorce, which is why I urge people to vote for the Scottish Conservative party on Thursday.
It is a pleasure to serve under your chairmanship, Mr. Atkinson, in this debate on the Government’s policy towards the Union. It may have escaped your notice that there is an election going on in Scotland at the moment. It is not unnatural that in a debate on the Union at a time when a momentous decision on its future is to be taken in 48 hours we should focus on the choice faced by the people of Scotland. However, before I move on to that, I want to say one thing about Scotland’s position in the Union.
Scotland helped to make the United Kingdom what it is today. The United Kingdom has been and continues to be one of the most successful countries in the world—and in the history of the world. If it were not for the ingenuity, drive, inventiveness and scientific genius of Scots, the United Kingdom would not have become what it is today. Scotland has played an invaluable part in creating this country, and I look forward to the next 300 years of Scotland’s membership of the Union.
There is an important decision facing the people of Scotland, which has wide-ranging ramifications not just in Scotland and the United Kingdom but around the world. There could not be a more important decision. The debate this morning has been a microcosm of the entire election debate. When any difficult or detailed policy question is put to those who advance the idea of taking Scotland out of the UK, answer comes there none. Instead, those who advocate breaking up the United Kingdom wrap themselves in the Saltire, close their eyes, and say, “If you just love Scotland enough, everything will be fine.” Well, it will not. That simply will not do.
When there are important questions on fiscal policy to be answered, why is the Scottish National party not to update its anticipated revenue from North Sea oil until July? It is an insult to the people of Scotland to go to the polls without giving them any idea about how much the SNP thinks it will get in oil revenue. That is calculated deceit of the people of Scotland, and the SNP should be ashamed of itself.
As for monetary policy, when serious questions are put about who would set interest rates for an independent Scotland and what prevailing economic conditions would be taken into consideration in the setting of an interest rate, no answer comes from the SNP. My hon. Friend the Member for Glasgow, North (Ann McKechin) set out the questions eloquently, but no answers have come from the SNP either in this debate or the four or five weeks of the election campaign.
No, but I will happily give way to the hon. Gentleman so that he can explain this: why should an independent Scotland, with a separate Scottish economy and separate prevailing conditions for growth, gross domestic product and unemployment, have its interest rates and monetary policy decided by a foreign country?
No answer. Not only is this hour-and-a-half debate a microcosm of the election campaign, but so is this one exchange. There are no answers on fiscal or monetary policy.
I asked the simplest question about council tax policy. I did not ask for the entire projection of all revenues across Scotland, or what the impact on services would be. I asked the simplest question: how much will a two-income couple in a band D household have to earn before they pay more in local income tax than they do in council tax? The hon. Gentleman completely failed to answer the question. I shall give him an answer: about £34,000. If he disputes that or thinks that my sums are wrong, and that a couple living together and each earning £17,000 will pay less under his policy, let him tell us. He cannot do it.
My hon. Friend the Member for Paisley and Renfrewshire, North (Jim Sheridan), whom I belatedly congratulate on securing the debate, set out detailed points about defence procurement. When 20,000 Scottish jobs rely on the defence industry in Scotland, the hon. Member for Perth and North Perthshire (Pete Wishart) did not even have the courtesy to give an approximation of the number of those jobs that would be retained in an independent Scotland. It is an insult to the people who work in those defence-related jobs and to the people of Govan, whose local industry is so dependent—
And, indeed, Scotstoun; perhaps my hon. Friend will forgive me if I focus on Govan for a second. Local industry there is so reliant on the massive number of jobs in the shipbuilding industry secured by the Government, that people there will want an answer to the questions my hon. Friend put. It is not good enough to be told that if they wrap themselves in the flag and say they love Scotland, everything will be fine. That is an insult to the people of Scotland.
I have been in Scotland taking part in the election campaign, and when I saw the hon. Member for Perth and North Perthshire here today I wondered why he has not been there doing the same. Now we know. They dare not let him. His speech was a gaffe-strewn disaster, a one-man Sheffield rally. The message has not got to him that he is not supposed to be gloating or cracking open champagne bottles before even one vote is cast. He is showing ugly arrogance taking the people of Scotland for granted, and the smirk will be wiped from his party’s face when the people of Scotland go to the polls in 48 hours.
The mask slipped from the Scottish National party during the hon. Gentleman’s speech. It has been sweetness and light during the campaign. Mr. Salmond, or rather the hon. Member for Banff and Buchan (Mr. Salmond)—he is standing in Gordon, he is standing in the list, and he wants to be an MP in Westminster, so I can be forgiven for forgetting what title to refer to him by from time to time—has been going around saying, “Gloat, me? Smarmy, moi?”—in no circumstances would such a thing cross his mind. However, today we see the true face of Scottish National party triumphalism—the utter contempt in its treatment of the people of Scotland, in presuming to know how they will cast their votes in two days’ time. I sincerely hope that the hon. Gentleman will repeat his performance in Scotland, so that more people can see the ugly arrogance of a party that thinks that it has the voters in its pocket.
In the few minutes that I have left I want to deal with key issues, and perhaps I can draw together some of the comments that have been made. My hon. Friend the Member for Lanark and Hamilton, East (Mr. Hood) set out in incontrovertible detail the point that if Scotland secedes from the United Kingdom, it leaves the EU. That is a fact. If it wants to get back into the EU it must reapply. It must join a queue, behind Turkey and other nations, and there would have to be an enlargement treaty. The hon. Member for Perth and North Perthshire shakes his head, but if he has any facts to disprove that, let him state them.
However, Scotland would not only be out of the EU, with the disastrous ramifications that that would have for Scottish jobs, industry and inward investment. An independent Scotland that left the United Kingdom would also leave behind the G8, permanent membership of the United Nations Security Council, and NATO. What other country is leaving NATO when others around Europe are lining up to join it? That is the vision of the SNP for Scotland: isolated, irrelevant and defenceless. It is not my vision for Scotland, and it is not Labour’s.
We have today seen the duplicitous way in which the SNP turns every criticism of it into criticism of Scotland. I am here not to criticise Scotland, but to criticise the SNP and its ruinous vision for Scotland, which would destroy jobs and put our monetary policy in the hands of a foreign country, and which has no credibility in fiscal policy. Our vision is of a Scotland that will, within a dozen years, have the best education system in the world, because in the knowledge-based economy of the 21st century the investment that we put into people by way of education, skills, learning and training will bring us to pre-eminence. [Interruption.] The hon. Member for Perth and North Perthshire is now chuntering away from a sedentary position. We are now fourth best in the world; we are in striking distance of being the best-educated country in the world, and we have set ourselves the target of doing it in a dozen years.
We will achieve that under Labour, but if we spend the next three years in turmoil and instability, telling any potential investors, “Do not come to Scotland, because we do not know what our currency will be, whether we will be in the EU or what our monetary or fiscal framework will be,” how on earth will we attract the brightest and best to come and stay in Scotland? How can we continue to reverse the brain drain, as we are now doing? Just last week, we learned that the population of Scotland has increased for the fourth year in a row. That is a tribute to the success of the Labour-led Scottish Executive, and I am convinced that people will see that and vote for education and not separation on Thursday.
UK Armed Forces (Operational Direction)
I have been applying for this debate for several months, so it is somewhat ironic that I have secured it so soon after Thursday’s debate in the House on defence in the United Kingdom. That is, however, extremely convenient, because it enables me to enlarge on what I have said previously about the war on terror and how the UK is dealing with insurgency. We should not doubt that our troops are engaged in two of the most difficult and deadly wars against ruthless enemies. We all regret the loss of life in those wars, but we support fully the people who serve in those theatres on the UK’s behalf.
It is a great pity that a debate on such an important issue should be held in Westminster Hall rather than in the main Chamber with many Members of Parliament present. However, as a Back Bencher, I have to use any means in my armoury to draw attention to these vital matters. It feels quite lonely to be standing here with just the Minister and his Parliamentary Private Secretary present, but, never mind; we shall fire on all cylinders none the less. Having been briefed twice by the Ministry of Defence in recent months, I know that the Minister and his team take these debates seriously.
In military procurement terms, the fall of the Berlin wall in 1989 and the collapse of the Soviet Union were not so very long ago. Much of our military hardware was designed for that era when the battleground was northern Europe and wars would be short, sharp and fought over limited distances, leaving our forces either defeated or victorious. Army vehicles, in particular, were never intended to travel vast distances in inhospitable conditions where constant maintenance is required, consequently imposing a heavy demand for spare parts.
Our troops today, particularly those in Afghanistan, operate with equipment that was designed for use in northern Europe in another age but that is now expected to fulfil a different—indeed, contrary—role to that for which it was originally destined. All the nations operating in Afghanistan are finding the maintenance of equipment and the supply of spares to be a nightmare. Surely, what is required is equipment that is not too technical, that can be maintained and repaired in the field and that can stand up to the rugged terrain and extreme temperatures. It is no good having manpower tied up in the field with equipment out of action because of problems with supply and spare parts.
With the future rapid effect system programme, about which I have serious misgivings, considering armoured vehicles, the powers that be should bear in mind that what is required is basic, practical, simple and rugged equipment for which maintenance costs will not be greater than acquisition costs. I trust, too, that European Union health and safety laws, emissions standards and the like will not apply to military vehicles. The authorities must understand that the Ministry of Defence is not social services, but has two wars on its hands that must be won.
In the past two decades, military thinking on procurement has been split between the integrationist European Union approach to defence and our link with the United States of America. As a result, billions of pounds of taxpayers’ money have been wasted by this and previous Governments on projects such as the joint US-UK TRACER-FSCS programme to develop a tracked armoured reconnaissance vehicle to replace the British Army’s ageing Scimitar. The MOD pulled out of that project in 2000, before the first prototype was ready, in order to pursue a European project, losing at least £131 million for absolutely no gain.
Another example of waste concerns the Italian-built future command and liaison vehicle, the Panther, which costs £413,000. Those vehicles were supposed to carry out some of the roles of the TRACER, but are useless for patrolling or undertaking other functions in either Iraq or Afghanistan. Their cost—£166 million for 401 vehicles—is therefore dead money.
The German-built Cobra anti-battery radar is high-tech equipment made to detect the source of artillery shells, mortars and rockets. Ten sets were procured at a cost of £17.8 million each, but US-built Firefinder systems could have been bought at less than £10 million each, which would have saved £82 million and would have given the Army a perfectly acceptable anti-artillery capability.
The TRIGAT projects on medium and long-range anti-tank missiles are yet another case in point. British participation in those European projects, which were appropriately developed by Euromissile, cost the UK more than £314 million before we had to pull out when the systems failed to deliver. That money was a total loss and the MOD had to make a rushed purchase of US-built Javelin missiles to equip the Army.
Another example is the multi-role armoured vehicle project, the Boxer. The MOD pulled out of that joint German, Dutch and British venture, which was managed as a European project, after the vehicle proved to be too big and heavy for the RAF’s fleet of Hercules transporters, with a total loss to the defence budget of £48 million.
The MOD has either spent or committed to spend £1.045 billion on developing unmanned aerial vehicles—first with the Phoenix, on which £345 million was lost, and now with the Watchkeeper, which is to be built by the French-owned company Thales. Despite that extraordinary expenditure, however, the MOD has no UAV capability in theatre other than the Desert Hawk, which is a mini-UAV, and is having to spend more than £60 million on buying or leasing US Predator UAVs. Had the UK bought that system in the first place, it might have saved more than £400 million.
The MOD has already bought 22 Westland-Agusta Merlin HC3 transport helicopters and will now buy another six. Working out their purchase price is well nigh impossible, but given that they are estimated to cost £30 million each, US equivalents would have been less than half price. Alternatively, the RAF could have bought Chinooks at £25 million each, thus saving £110 million and considerably more on maintenance. I am sure the Minister will know that the Merlins are currently exceeding expected maintenance costs by more than 200 per cent.
The Eurofighter aircraft, which cost more than £60 million each, are an acknowledged cold war relic. Although they are rated highly as interceptors, current versions have no ground-attack capability. The US-built F-16s are adequate fighters with proven ground-attack capability and would have cost about £20 million each. With 232 notionally on order, the MOD could have saved more than £10 billion.
Money has also been wasted on weapons. The European designed Storm Shadow air-launched cruise missiles cost an amazing £1 million each—yes £1 million—for what is effectively a 1,000 lb bomb. The MOD has bought 900 of them, but it could have saved more than £830 million if it had bought the US equivalent, the joint air-to-surface stand-off missile. The Eurofighter is also to be equipped with European-designed air-to-air missiles that are known as Meteor. Given the total costs of more than £1.4 billion, purchase of US-designed Raytheon missiles, which have been bought anyway as a stop gap until Meteor is ready, would have saved the MOD a cool £900 million.
Then, in the rush for harmonisation, the MOD joined the French and Italians on the Horizon programme for a common frigate, which was formalised in 1992. The UK eventually pulled out of it in April 1999 after failure to agree a common specification and amid complaints of “unfocused management”. The estimated loss was £537 million, and the French and Italians were left to continue with the project—I hope that they can afford it.
Co-operation did not end with the Horizon project. Although the MOD decided to go it alone, with the platform emerging as the Type 45 destroyer, the ship is largely equipped with European-designed missile launchers and missiles. They largely account for the huge cost of £1 billion per ship, which is some £400 million more that the Australians were considering paying for the more capable US-designed Arleigh Burke class missile destroyers. I understand that the Australians are now considering a version of the Spanish Fl00 air defence destroyer, thereby shaving another 1 billion Australian dollars off their projected costs. As five ships are planned for the Royal Navy, the UK could have saved at least £2 billion had it followed a similar path.
For the Type 23 anti-submarine frigates, the UK developed its Type 2087 sonar, at £9 million per set. The development costs were an additional £300 million, given virtually as a free gift to the French company that bought the UK manufacturer, leaving it free to sell cut-price versions to the French navy. Had the UK bought from the Americans, it could have saved that £300 million.
Finally, I turn to the EU’s Galileo satellite navigation system. By the time that that is fully operational, the UK will have paid £400 million towards its development and commissioning costs. The system is then to be used to underpin the European rapid reaction force. However, the US Navstar global positioning system is already available and is totally free of charge, thus the £400 million is a total waste of money for what is merely a duplicate system.
Pulling together all these costs, excluding those of Eurofighter, which is a special case, the excess payments amount to £8.8 billion, and that, I repeat, for no gain whatsoever. That is considerably more than is spent in one year on procurement and, to put it in context, would buy 35,000 RG31 mine protected vehicles or 350 Chinook helicopters and goodness knows how many Hueys—the Bell 212 aircraft.
That is the measure of the waste of valuable resources on defence projects and those figures make a mockery of those who say that the military is underfunded. When the Prime Minister called for a debate on defence, like many others I welcomed the suggestion, because the direction in which the UK is heading clearly needs to be defined. It is, for example, simply no good having equipment to wage war in the future when that equipment is not compatible with that of the Americans. The UK as a nation has neither the financial nor the military capability to divorce itself from reality. If we believe that the war on terror is our most serious threat, the MOD should be planning to procure the right equipment for our troops, rather than throwing them into situations where they have not been best served by their kit.
In last Thursday’s debate, I tried to drive home the fact that technology can be of great assistance, but simple platforms are often the best for delivery. They are easy to maintain and they save on non-combatant manpower and spare parts, thereby proving not to be horrendously expensive. A good example of that is the Iraqi air force Sama light aircraft, which is doing the same job on surveillance as the Future Lynx helicopter will do. The RAF has as its trainer the Tucano T mark 1 aircraft, and there is now a ground attack version ideally suited for the extreme hot and cold conditions in Afghanistan. It could give all-round close air support to our troops, as opposed to the present situation in which an aircraft has to be called up, possibly even has to take off, arrives too late in theatre and then is unable to deliver because of the close proximity of insurgents. We should perhaps recall the hard-won lessons of Vietnam and Korea, and of even the second world war: it is a fact that the smaller the fixed-wing aircraft, the less likely it is to be shot down.
There should be a complete rethink about how we approach such operations. Overspending can create a problem by providing over-complicated pieces of equipment. The MOD and the military chiefs need to get back to the basics. To prove the point, I should ask, tongue in cheek, whether the Minister can tell me how many pack animals are being used in Afghanistan—after all, one cannot get more basic than that. It gives some idea of the type of terrain faced by our troops serving out there.
I welcome the recent announcement on, of all places, the European Defence Agency website, of 180 medium protected patrol vehicles for delivery in 2009, the contract value of which will be in the region of £20 million to £100 million. Will the Minister tell me when the actual order will be placed, and why the announcement was not made on the MOD website? It is not one of the most brilliant websites, but it would have been considerably enhanced by this news. Surely that is where any announcement should first be made; after all, the Minister is not trying to bury bad news, but to give some rather encouraging and welcome news for a change.
I am convinced that debates such as this one, poorly attended as it is, can have an influence on the direction of the MOD, and that the issues raised are being taken seriously because, slowly but surely, military thinking and direction is changing. However, I cannot make out whether the MOD, the defence chiefs and top civil servants are co-operating closely or as well as they could, and which constraints appear to be limiting their effectiveness. Unless change takes place quickly, the UK will fail to give its service personnel the proper support that they need to win the war on terror, and there will be little or no chance of winning insurgency wars either now or in the future.
Before I respond to the points made by the hon. Member for Congleton (Ann Winterton), may I regretfully announce that another soldier has died in Iraq since the Minister of State, Ministry of Defence, my right hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow (Mr. Ingram) and I addressed the House last Thursday? On 29 April, Rifleman Paul Donnachie of the 2nd Battalion, The Rifles was killed by small-arms fire in Basra. I am sure that the hon. Lady will join me in sending our sympathies and condolences to his family and friends.
I congratulate the hon. Lady on securing this debate on what she rightly says is an important subject, on which she has a great deal of knowledge, and as we heard last week, she gives a considered speech on the issues about which she feels passionate. I hope to respond to a number of those issues today, as well as to set out the wider context of the equipment programme and the operational direction of our armed forces.
I am sure that hon. Members will join me and the hon. Lady in paying tribute to our armed forces for the courage and professionalism that they show—day in, day out— in Iraq, Afghanistan and elsewhere. I welcome the opportunity to debate the direction in which we are taking our forces. The Government have a very clear vision for ensuring that we deal with today’s operational requirements and prepare for the future.
It is important to set out the context of two of our current operations—those in Iraq and Afghanistan—by talking about the challenges we face today. In both those places, our service personnel are performing outstandingly in the most difficult of conditions.
Our forces remain in Iraq under the authority of UN Security Council resolution 1723, as part of a 26-nation coalition and at the request of the democratically elected Government of Iraq. The situation remains difficult—we understand the issues and challenges that we face. The hon. Lady talked about the serious insurgency that is taking place, although it is lesser in Basra than in Baghdad. It is worth stating that, although the current level of violence in Baghdad and surrounding provinces is of grave concern, the security picture elsewhere in Iraq is not as bleak, with the majority of attacks—about 80 per cent.—confined to four of the 18 provinces.
Much progress has been made by our armed forces, working in partnership in Iraq. A new Iraqi Government and an ambitious programme of security sector reform are resulting in Iraqi forces increasingly taking the lead, with the handover of four provinces to Iraqi security control, most recently Maysan on 18 April.
Our commitment to Iraq is long term, and our goal remains an Iraq that can govern itself, with a functioning economy and capable security forces. Our forces will remain to provide support and training even after we have handed over security responsibility for all the provinces in the south-east, which we hope to do later this year.
I shall touch on Afghanistan before responding to the more substantive issues raised by the hon. Lady. In Afghanistan, we are part of an international effort, backed by the UN, to support the democratically-elected Afghan Government. Afghanistan was a base for international terrorism, and we cannot let it become that again. It is in our national interest to be there.
The campaign is not a traditional battle, and the hon. Lady made that point. Demonstrating progress is not as simple as being able to point to towns being liberated, ground being taken or enemy killed. Progress can be measured by milestones, such as democratic elections—there were successful ballots in 2004 and 2005—and social indicators, such as the increase in the number of girls attending school and the nearly 5 million refugees who have been able to return. When there is security, construction and development follows.
International assistance on security, governance, development, justice and economic reform has brought about great progress. The UK has, of course, played a central role, which we are rightly proud of. However, there is more to do, particularly in the south. Achieving our objectives in Afghanistan will take time, and we are committed to the task, but we must be patient. Our mission in Bosnia, which is a relatively prosperous and developed country, has taken 15 years, and there is still more to do.
We are under no illusions that, in both Iraq and Afghanistan, we face difficult and dangerous insurgencies. The safety of our personnel on operations is a prime concern, but there is no such thing as perfect protection. Military operations are inherently risky, and if our troops are to fulfil their mission in places such as Iraq and Afghanistan, they must expose themselves to danger, precisely because of which we treat the protection of our service men and women so seriously.
We have used the urgent operational requirement process to procure a fleet of new, protected patrol vehicles to supplement the vehicles already in theatre. Mastiff, Vector and Bulldog are already on the streets, saving lives and proving hugely popular with troops. We have invested hugely in new equipment to meet the specific circumstances and evolving threats of conflicts. About £6.6 billion has been provided for those theatres since 2001. That has been new money from the reserve; it has not come from the defence budget, or at the expense of spending on future needs and assets. It includes £700 million spent through the UOR process on new force protection equipment for those theatres on everything from body armour to electronic countermeasures. There is a whole range of issues, and we have made progress in force protection and support in our operations.
Those UORs complement the equipment programme, which is funded from the defence budget and is designed to deliver the long-term core capabilities that our forces need. Both the National Audit Office and the Public Accounts Committee have acknowledged how good the UOR process is at rapidly delivering to the front line the battle-winning capability required by our armed forces. However, equipment alone is not the answer to countering insurgency. Training, tactics and procedures are also most important. They are kept under constant review by the services to evolve and to meet changing needs.
I can reassure the hon. Lady that our service personnel in theatre are equipped and prepared for their current tasks. It is simply wrong to suggest that the Government would deploy our armed forces if they were unprepared for the threats that they might meet. We have introduced a range of new systems over the last few years that have significantly enhanced our forces’ capability to conduct counter-insurgency operations, including underslung grenade launchers, head-mounted night vision equipment, new light machine guns, ballistic eye protection, and a range of other offensive and defensive systems, including armoured vehicles and the helicopter uplift.
The hon. Lady spoke about equipment and support. We have delivered equipment valued at more than £10 billion to the armed forces in the past few years, and we have given priority to equipping our people. My experience from when I visited Afghanistan and Iraq and talked to many hundreds of service personnel is that they believe that their personal equipment is the best that they have ever had. Equipment and equipping people properly is a priority.
On procurement of equipment, the defence industrial strategy sets the framework for a better relationship between the Ministry of Defence and industry. It will help to deliver the capability that our armed forces need with best value for money for taxpayers. We have successfully merged the organisations that procure and support military equipment and create defence equipment and support. That establishes a unified approach to the procurement and through-life support of equipment from the factories to the front line, thus improving capability and reducing costs.
I remind the Minister gently of my two specific questions, to which I would like a reply before the end of the debate. First, why did the recent announcement appear on the European Defence Agency website and not the MOD website? Secondly and more importantly, when will the order for the 180 medium-protected patrol vehicles be placed?
I will write to the hon. Lady on those two specific points.
It is important, for the reasons expressed by the hon. Lady, to accept that there have been procurement mistakes, but we want to learn from those and to ensure that we develop and produce high-quality, battle-winning equipment at the forefront of technology. We continue to make progress, but when things go wrong, we acknowledge that and want to put them right.
Referring back to the title of the debate and operational direction, it is important to remember that our nation has a proud history of responding to the challenges of an uncertain world, and we must continue to do so. We recognise that the major security challenges are those posed by international terrorism, by the proliferation of weapons of mass destruction and by failed and failing states. Our armed forces are proving that they can meet those challenges. However, while our focus remains heavily on current operations in an uncertain world, we must also be ready to meet tomorrow’s threats and challenges. We cannot assume that they will be the same as those facing us today. Let us just look at the range of operations that our forces have faced in recent years. Sierra Leone, East Timor, Kosovo, Bosnia, Lebanon, disaster relief in Pakistan and the Indian ocean, and the early stages of the campaigns in Iraq and Afghanistan had little or no counter-insurgency element, but there is no guarantee of whether the next ones will.
Other fast-accelerating trends are complicating the picture. Issues such as climate change, changing demographics and new technologies may further exacerbate existing security problems or present security challenges of their own. For example, changes in the geopolitical balance might even result in the re-emergence of state-on-state warfare in the longer term with an impact on our interests, especially in an increasingly globalised world. We cannot predict whether and how those developments will evolve and interact, or how they will affect us. It would be irresponsible not to maintain armed forces that are balanced, agile and adaptable. That provides some insurance against the inherent uncertainty of the future.
We need balanced forces capable of responding to a broad range of scenarios, and we must acknowledge that, once a capability is removed, it takes many years to get it back, if it can be restored at all. Nor can we rely on our allies to provide the capabilities that we need in the circumstances that we need them. However, I accept the hon. Lady’s important points about our relationship with the United States and our other partners.
Against that background, we must maintain the capability to undertake conventional hard-war fighting, counter-terrorism, intelligence gathering, peace-enforcement, peacekeeping and humanitarian operations. To prepare for the future, we must sometimes preserve capabilities that might be more likely to be used tomorrow than today. But we should not forget that major platforms, such as aircraft carriers, Typhoon and nuclear submarines, have a role to play in today’s operations.
Typhoon will provide the RAF with a world-class, multi-role aircraft for use on expeditionary operations. Our Astute class nuclear submarines, such as those currently in service, will be equipped with land attack missiles that are capable of delivering effect many hundreds of miles from the sea, as they did in Kosovo, Afghanistan and Iraq. New aircraft carriers allow us to project force across the world in a range of scenarios from diplomacy and persuasion to war fighting, just as their predecessors did in Sierra Leone, Kosovo and Iraq. We shall make an announcement on carriers when the time is right. We must continue rigorously to examine our relative priorities to allow focused investment in those that we need most, and we do so.
The hon. Lady was right to draw attention to the need to ensure that we have the balance right between meeting the very demanding operations that our forces face now and the less predictable challenges of the future.
Lone Parents (Employment Opportunities)
I am very pleased to have secured the debate, but I shall begin with some important caveats, because recent media coverage has demonstrated that the politics of parenting and of parenting and work remain highly contentious. Raising a family is one of the most important, rewarding and demanding roles that life has to offer, and raising children alone is equally challenging and even more demanding than raising children in a couple. Everything that the Government do should be geared towards helping families and supporting children. For that reason, work will not be the right answer sometimes, or it will be an answer that must wait. For all those caveats, however, poverty is one of the most damaging things that can happen to a family, and work is a central route out of poverty. The Government and employers must ensure in partnership that we strike the right balance financially, personally, socially and culturally.
Taken overall, the lone parent employment rate has been a success story for this Government. It has risen by 11 percentage points in a decade, largely thanks to a voluntary and supportive approach at a time of economic growth. However, there are serious challenges ahead, and some prescriptions on offer are wrong. They must be rethought if we are to deal with the problems of London, on which I shall focus most of my comments, and the problems of the most disadvantaged groups—the groups that are furthest from the labour market—elsewhere. The practical steps that could be taken would have a positive impact, but some of them deserve greater attention than they have received to date.
I shall concentrate on the London experience, not least because it is what I experience as a constituency MP with some of the most deprived wards in the country, despite the leafy sounding title of my constituency of Regent’s Park and Kensington, North. In the ward of Westbourne, 83 per cent. of children are growing up in workless households. That is the highest percentage in the country, despite the ward being only a couple of miles from the west end, with all the opportunities that the labour market has to offer there.
It is clear that the strength of London’s economy has demonstrably not spread fairly and equally among all sectors of the population. Child poverty is acute in London—especially inner London—and it can largely be explained by the issue of labour market access. In London, employment for parents in all families is low compared with that for non-parents. In the rest of the UK, lone parent employment rose from 45 per cent. to 58 per cent. between 1995 and 2005. The rise that took place outside London is even more impressive than the national figures that are usually cited. In London, there was a much smaller rise from a much lower baseline—38 per cent. to 43 per cent.
Children in London are more likely to live in households where no one works and less likely to live in households where someone works, compared with other regions. Indeed, disparities in employment among parents account for most of the London-UK employment gap overall, which is growing. If we take account of individual characteristics, the lone parent employment rate in London is 12 percentage points lower than the rate in other metropolitan areas—up from 10 percentage points in 1997-98. With individual characteristics accounted for, that labour market phenomenon seems to be specific to London, and the tax and benefit system is very much a part of the problem. The relatively low employment rate among lone parents in London is not a city phenomenon writ large, and it is not due to differences in characteristics, such as ethnicity, between lone parents in London and in other cities.
Returning to the national picture, there is a differential rate of job retention between parents and non-parents. In other words, it is less a question of a lone parent finding work than of them keeping it. Despite the popular image, which the media often support, the issue is not about the beloved stereotype of the teenager having babies on their own to obtain a council flat and enjoy 20 years on benefits. Lone parents, who can be alone for any number of reasons, are just as likely to try for employment as anyone else. Job entry rates for lone parents generally have converged with those for the rest of the working-age population.
The main employment problem for lone parents is that job exit rates remain much higher. They have come down a little, but they are still much higher. About 10 in every 100 employed lone parents leave a job each year, compared with about 5 per cent. in the rest of the population. The heart of the matter is that if lone parents had the same job exit rates as the rest of the population in the same way that they now have the same entry rates, the 70 per cent. lone parent employment target would have been hit by now. There is not any basis for assuming that lone parents are less likely to take up work than the population as a whole, but there is good reason to believe they have more difficulty staying in a job, which explains their relatively low employment rate compared with other groups.
That analysis challenges one of the key elements in the recent Freud review, which suggested—among many ideas—that lone parents should be moved off income support and on to jobseeker’s allowance when their youngest child turned 12. First, 69 per cent. of that group are already in work. Secondly and more importantly, the JSA regime is poorly designed for the more subtle purposes of supporting sustained employment among people facing complex barriers, providing care and support for adolescent and teenage children, and skill shortages.
Another Freud proposal seems to be aimed at addressing the job retention problem, but many of us are still deeply sceptical about it. On one level, it sounds sensible to reward contractors not only for getting jobseekers over an employer’s threshold for a week or so, but for keeping people in work for three years. However, the strategy would involve long-term, seven-year regional monopolies in which everyone who had been on benefit for more than one year in London, for example, would pass from Jobcentre Plus to the provider. The provider would then be paid on the basis of how many more clients went into jobs than would have done otherwise. There would be a monopoly rather than a competition, and large amounts of public cash would be determined by estimates of what might have happened in an entirely different and unpredictable set of circumstances. Among other things, it is not at all clear how one would avoid rewarding providers for what others have done: for example, lone parent rates could go up because of the availability of more subsidised child care, or because of changes to the tax credit regime.
Given what we already know about the complex needs of lone parents in the most disadvantaged groups throughout the country and particularly in London, such an approach would be insufficiently flexible and integral. We need instead to develop devolved models that can deliver to targeted groups and respond swiftly to changing circumstances.
What do we need to do? Basically, we have succeeded in improving access to jobs for lone parents, but we have failed to do enough to make employment sustainable. The strongest factor associated with job exit is low pay, especially for part-timers. Among lone parents leaving the new deal, it has been reported that 18 to 20 per cent. are back on income support within six months, 29 per cent. within a year and 40 per cent. within two and a half years.
The reason for the phenomenon is that compared with other regions, simply living in London reduces the chances of job entry for lone parents independently of other factors, and it slightly increases the chances of job exit. The phenomenon implies that, by London standards, part-time work is particularly low paid and keeps the entry rate down. The impact on job entry is compounded by higher living costs in London and the tax and benefit system.
If we assume, as it is surely reasonable to do so, that the gain from work has to be higher in London to compensate for higher prices, parents will need a higher income to be as well off as parents elsewhere. However, increased hourly earnings do not translate into higher incomes, because there are withdrawal rates for benefits and tax credits. To be as well off in real terms as lone parents in lower cost areas, lone parents in London must earn a great deal more. If the difference in living costs is 10 per cent., earnings need to be 33 per cent. higher—even without taking housing benefit into consideration. When housing benefit is factored in, the situation obviously becomes even more difficult.
Something needs to be done to equalise work incentives in London and elsewhere. In the past year or so, the Treasury and the Department for Work and Pensions have recognised the requirement in principle, and the in-work credit for London was increased to £60 in the recent Budget. That is great news, but it is demonstrably insufficient to bridge the gap that we have identified. I am not being in any way ungrateful, because the recognition in principle is a good step, but it must be regarded as one among many. We need to ensure that the tax and benefit system does not continue to freeze people—particularly those who do entry-level work—out of the job market.
We also need more specific measures to accommodate specific challenges; I know that my hon. Friend the Minister is aware of my views on that. I put in a further plea for extending measures to boost work incentives among such vulnerable groups as homeless families in temporary accommodation. I am very aware of the “Working Futures” model in Newham, and it is a sensible one. It treats the higher rents for families in temporary accommodation through block grants, as if they were paying a comparable rent in social rented housing, and thereby removes the benefits trap that catches people in high-rent accommodation.
Given that there are 3,000 households, many of them lone parent households, in temporary accommodation in my borough, and that research demonstrates that unemployment is at 90 per cent. among families in temporary accommodation—compared with 60 per cent. among social housing tenants as a whole—the case is made to extend “Working Futures” swiftly and extensively across the whole capital for households in temporary accommodation. I am completely baffled about why—I see no sensible argument for it—we should run merely one very small pilot in one low-cost area of London and wait for two years to evaluate the results.
We also need to consider how to boost part-time work opportunities at reasonable pay rates in London. Of course, our ability to influence that in the private sector is limited, but we do nothing like enough to examine job opportunities in the public sector, particularly in respect of contracted services, which provide us with a useful opportunity. In that context, we need to consider again the implications of the Gershon review and the movement of public sector jobs out of London. A recent story, linked not to Gershon but to some of the year-end pressures on the health service, revealed that part-time jobs in health care had taken the brunt of job losses in the health service. That is exactly the kind of thing that has a differential impact, particularly on lone parents and particularly on lone parents in London; they need such jobs to have any real prospect of entering and staying in the labour market.
Despite the achievements in improving employment rates for lone parents across the UK as a whole, there are still serious problems in London and in job retention rates generally. There are well documented examples of discrimination against parents in the work force generally. The recent report by the Equal Opportunities Commission demonstrated the impact of such discrimination. The situation demands yet more action from the Government and employers in getting real about the importance of the work-life balance and developing family-friendly employment policies. It is no one’s interests—not those of employers, taxpayers or the Government—to trap hundreds of thousands of people out of sustainable employment, with all the social and economic costs that such unemployment puts on the state. If further changes were made to make employment family-friendly, we would be able to draw such people back into employment.
As was devastatingly demonstrated in the Joseph Rowntree Foundation report released yesterday, there is plentiful evidence of discrimination against particular groups of black and minority ethnic communities. Bangladeshis were found by the report to be most discriminated against in employment terms and most likely to be trapped in poverty. It is reasonable to say that Bangladeshi women and Muslim women generally most need targeted support to help them come back into sustained employment. The work done by Jobcentre Plus and the contracted providers needs to continue to bear down on those hard-to-reach groups, and we need to continue to bear down on the discriminatory practices that lock people out of work.
Fundamentally, the issue for lone parents is one of making work pay, and that applies in London more than elsewhere. Without sustainable job opportunities, we have no chance of making inroads into London’s deplorable levels of child poverty, and without improvements in London, we cannot hit the target for the country as a whole. There have been real achievements country-wide and recognition of the special factors in London. However, I am afraid that, on the evidence so far, there is no sign of policies likely to lead to the breakthrough that we require.
The Government have a target of halving the rate of child poverty that they inherited by 2010, but we are simply not going to reach it unless we build on what we have achieved and take further radical steps—some small and modest such as “Working Futures”; others more radical such as changes to the tax and benefit system—to raise those employment rates.
I congratulate my hon. Friend the Member for Regent's Park and Kensington, North (Ms Buck) on securing this important debate. Her work on the London Child Poverty Commission means that she has a particular insight into the challenges facing families on low incomes. She has amply demonstrated that in how she has spoken this afternoon.
The report that my hon. Friend helped to launch in February stressed, among other things, the importance of increasing employment among parents on lower incomes as one of the essential measures for reducing child poverty in London. She raised important points about job retention among lone parents who have moved into employment and, rightly, she focused on the issue of the relative disadvantage in London in terms of costs and earnings. She also raised her concerns about the extent of the “Working Futures” pilot, on which she and I have already corresponded.
I particularly want to reassure my hon. Friend that when we consider broader issues of labour market reform and further steps in reforming the welfare system, we Ministers at the Department for Work and Pensions are fully apprised of the specific set of factors that bear on London. I assure her that we have clearly identified the London-specific issues that we must consider. If we are to succeed in meeting our child poverty reduction targets, as my hon. Friend wants us to, we have to think specifically about certain things that need to happen in the capital, where the problems are tough. We are very focused on that.
We all know that children in lone-parent households are almost twice as likely to live in poverty as those in couple households, and that they make up 40 per cent. of all children living in poverty. The best way to tackle that is to support lone parents into work, which we do through work-focused interviews and the new deal for lone parents, which has already helped more than 482,000 lone parents into work, including more than 55,000 lone parents in London. Furthermore, the vast majority of those who have gone through the new deal for lone parents and into work have moved into sustainable employment. None the less, we are realistic about the challenges that lone parents face in getting back to work—and, as my hon. Friend says, in staying in work once they get it. We know that those challenges can be even greater in London, given that, as she rightly pointed out, housing and living costs are higher.
The present set-up means that many lone parents can exist on benefits for many years without any experience of being in work or developing any of the new skills that they will require when they return to work. That makes it hard for them to compete for jobs and may mean that some of those who enter jobs do not have the skills base to sustain employment once they have made that move.
The UK is out of step with many other countries in what we expect of lone parents who claim benefits when they have older children. That is why we will consider whether a switch to jobseeker’s allowance for that group, with its increased focus on looking for work, will improve the chances of their getting back to work and of that work being sustainable. My hon. Friend mentioned the Freud report. Let me reassure her: Freud has suggested we ask lone parents to start looking for work when their youngest child is 12. We are considering that recommendation and will report our conclusions in the summer.
As my hon. Friend said, we have achieved a good deal so far. Ten years ago, more than 1 million lone parents nationally and around 190,000 in London were on benefit. Those figures are now down by 230,000 nationally and by more than 27,000 in the capital. Fewer than 700,000 lone parents nationally were in work 10 years ago; now more than 1 million are. In London, fewer than 85,000 lone parents were in work 10 years ago and now nearly 130,000 are.
The national employment rate among lone parents 10 years ago was about 45 per cent. It is now about 56 per cent. In London, that employment rate has risen from a much lower base—about 37 per cent.—to about 45 per cent. There is still a considerable gap between the rate of improvement in the country as a whole and that in London. That is why we have to address specific policy challenges in the capital.
Overall, there has been an achievement. However, we aim to increase the lone parent employment rate to 70 per cent. by 2010 and to do that we would need about 300,000 more lone parents in work across the country. We can do that only by helping to create conditions which make work pay, make it possible to attain and make it easier to sustain. We are rolling out more work-focused interviews for lone parents, which will give them the chance to talk to experienced advisers about the problems they face in getting back to work.
No parent is going to work if they are not certain that their child or children are in safe care. That is why Freud—and Lisa Harker in her report—highlighted the importance of wraparound child care provision. That is one of the most significant concerns for all working parents and it is raised continually with us by lone parents when we discuss what else needs to happen to reduce further the barriers to employment.
By 2010, there will be a Sure Start children’s centre for every community—3,500 in total. For parents with older children, we have the extended schools programme, which by 2010 will be available from 8 am to 6 pm throughout the year, including school holiday periods. We are also making work a more realistic financial option. From April last year, we increased to 80 per cent. the proportion we pay towards child care costs for parents on a low income That increases child care affordability for vulnerable groups, particularly lone parents. Support is available to meet the costs of child care at rates of £87 a week for one child and £150 a week for two children or more.
We have recently announced the continuation of in- work credit, which helps eligible lone parents to leave benefits for employment with the payment of an extra £40 a week for a year. More than 40,000 people have already taken up the in-work credit, including more than 12,500 in London. We are also rolling out our pathways to work programme across the country to give even more help to those on incapacity benefit—like lone parents, that group was not given the help that it needed in the past.
London has particular issues that need to be addressed and we have already begun to do that. The new deal for lone parents has helped more than 55,000 lone parents in London into work. In April 2004, employment zones for lone parents were introduced in Haringey, Newham, Brent, Southwark and Tower Hamlets. They have helped 3,300 lone parents in those boroughs back into work. However, as my hon. Friend says, there is still a great deal more to do. We will roll out the new deal plus for lone parents to all London districts by April 2008. That will test whether a package of measures combining good, affordable child care availability with a work focus and a strong financial incentive, like the in-work credit, will move lone parents closer to the labour market and into work.
From July, we will increase the in-work credit payment in London to £60 a week when lone parents leave benefits for employment, as my hon. Friend has mentioned. The Government will also contribute £11 million in funding to the child care affordability pilot to offer 10,000 new child care places across the city. The pilot is the largest region-specific initiative for a subsidised child care programme of its kind in the country.
In addition, London is benefiting from our city strategy of investing more in deprived areas to tackle worklessness and child poverty. I hope I can demonstrate to my hon. Friend that we agree with her about the challenges in London, particularly in some—albeit not necessarily all—of the boroughs. Those challenges include the cost of housing and living, and issues to do with skills and child care. We can see from the Department’s analysis of all aspects of the London labour market that London has distinct characteristics. We understand that that means that reforms designed for national application will not necessarily have the same bite or impact in the capital.
As we work through our assessment of the circumstances that pertain in the capital, we will take on board many of my hon. Friend’s points, which will inform our thinking on how we can go forward through our policies in London. We have seen the report that she helped to publicise in February, which raised many of the same points. The recent reports from Freud and Lisa Harker have also highlighted London-specific issues.
I hope that I have reassured my hon. Friend that the important issues that she has identified about London are on the Department’s agenda. The work that we are doing to reform welfare and the labour market needs to be combined with policies to ensure that we continue to have a strong economy, which will be important for the capital as well as the rest of the country, so that they result the continued creation of more employment opportunities for lone parents, more children being lifted out of poverty, and a prospect of ensuring that the cycle of deprivation that runs through generations is not extended any further than it has to be in London and the rest of the country.
Leeds Children’s and Maternity Hospital
I am grateful for the opportunity to debate a crucial issue for Leeds, West Yorkshire and beyond.
A stark fact, which we are not at all happy about, is that Leeds is the only major city in this country without a dedicated children’s hospital. The experts have said for 18 years that we need one; leading consultants have made the case for 15 years, and parents have campaigned relentlessly in recent years. The city and its people want to change the situation and the campaign for a new hospital has the support of all Leeds and regional MPs, the city council and councillors of all parties. Yet, on 17 March this year, the parents and children of Leeds received a terrible blow. The development of the dedicated children’s and maternity hospital for which they had campaigned so hard only a few years before was to be shelved, possibly indefinitely.
The Leeds Teaching Hospitals NHS Trust’s official statement confirmed that plans for the hospital will be severely delayed, blaming a lack of money, as well as the rising costs of the project. The trust stated that the project’s affordability had not been proven, and that it felt that it would be unable to make the required repayments for the hospital under the proposed private finance initiative scheme. As the news reverberated around the community, it confirmed many people’s fears that the appalling NHS situation in Leeds has had a devastating impact on health services and has led to the hospital being cancelled.
Geoff Stagg, father of 14-year-old brain cancer sufferer Craig and campaigner for the new hospital, summed it up:
“I feel totally let down. We thought the hard work was over in getting the Government to agree”
to the hospital;
“to be told now that there’s no money for it is a huge blow”.
The Leeds children’s and maternity hospital was due to open its doors in 2012, as a dedicated state-of-the-art, 370-bed facility for treating children and providing maternity care. It would have centralised services for children that are currently provided predominantly by two sites, as well as others, across the city. It was also due to include one of only three children’s liver units in the country and to become the biggest centre for transplants in England. Now it is unclear when—or, crucially, if—the facility will open, and children in Leeds and the wider area are left without the dedicated facility that they so urgently require.
Three years ago, the go-ahead for the hospital was finally granted, marking the culmination of a long and hard-fought campaign, led since 2002 by parents Jonathan Abbott and Carol and Dean Maddocks after they witnessed the conditions in which the dedicated and excellent staff on ward 10 of St. James’s university hospital in Leeds were forced to treat young children. Jonathan Abbott has described the crowds of ill, grey adults standing around the entrance of the hospital smoking, as he wheeled in his young son Josh, who suffered from a rare form of cancer, and the complete absence of privacy on the ward. At the end of Josh’s treatment, he removed his son from the ward, so that he could die in a place where he felt comfortable.
Carol Maddocks talks of similar problems when her daughter, Alice, was being treated in 2002 for aplastic anaemia, now thankfully in remission. Carol’s memories of that time are of cramped conditions and of having to take Alice, already suffering from the after-effects of her treatment, on long and draining journeys across Leeds between St. James’s and the Leeds general infirmary, so that her treatment could continue.
Jonathan Abbott and Carol Maddocks made a promise that they would not let other children go through what their children had experienced. With Carol’s husband, Dean, they launched the campaign to improve children’s facilities in Leeds. Their campaign was taken up by other parents and local organisations, such as Candlelighters, which does so much for children with cancer in Leeds. Politically, it gained the full support of Leeds MPs and Leeds city council. It was backed by the Yorkshire Post, the Yorkshire Evening Post and other local media and, most importantly, received huge support from members of the local community, 3,000 of whom signed a petition.
Despite what has happened, I must take this opportunity to praise Carol, Dean, Jonathan and all the extraordinary people who led that successful campaign and inspired Leeds and its citizens to stand up for our children. It was a remarkable campaign, and on 27 July 2004, it finally reached a conclusion when the former Health Secretary, the right hon. Member for Airdrie and Shotts (John Reid), gave the green light for funding for a new dedicated children’s and maternity hospital in Leeds. The decision was greeted with joy throughout the city. Trust executives issued a statement heralding the development as vital to providing children across Yorkshire with the care that they need. Neil McKay, chief executive of the trust at the time, called it “fantastic news”. It is not surprising that Jonathan Abbott, Carol and Dean Maddocks and everyone else who fought so hard have been utterly shattered by the news that the children’s hospital will not be going ahead as promised.
Why, with all that support and political will, has the project been shelved? According to the trust, the major reason for the delay in the development of the hospital, which was due to commence at the site of St. James’s university hospital, is the trust’s current and projected debt. The trust also says that the projected costs have spiralled from £230 million to £650 million—an almost threefold increase. It is unclear why costs have risen so dramatically. However, when questioned, sources at the trust have pointed to a need to refurbish existing adult facilities, a need for new facilities not included in the original plans, such as a car park, and the fact that the required contingency fund for the hospital has risen to £213 million—almost the entire cost of the original plan. That raises questions about the suitability of the original plans. Jonathan Abbott has questioned why there was a three-year consultation period costing an unknown sum if the plans were simply to be shelved. There have also been suggestions that the trust has proposed a top-of-the-range option, including the car park and rebuilt trust headquarters. The matter must be clarified as soon as possible.
How did the trust suddenly arrive at the hugely inflated figure of £650 million? Is it indeed the most expensive option and, if so, can less costly options be brought back to the table that would still deliver the necessary fundamental change in care? But the key question for the Minister and her colleagues to investigate and answer as a matter of urgency is why there is such a significant difference between the figures presented originally, which were current until a few months ago, and the costs now being presented by the trust.
How the decision was taken and announced has also caused an uproar. Very senior medical representatives were not told until after the news leaked out, and campaigners found out from newspapers. It was described by Dr. Richard Vautrey, medical secretary of the Leeds local medical committee, as
“a bolt from the blue”.
Our serious concern is that the decision was taken by an interim chief executive in an informal meeting and without consulting the senior medical professionals in charge of delivering children’s and maternity services, never mind general practitioners, campaigners, parents and the wider community. That is not an acceptable way to run the NHS. I ask the Minister to investigate how the decision was taken, why it was taken and how it was communicated.
It is absolutely correct that the hon. Gentleman has identified when the decision was allegedly taken to delay the process, but in the interests of clarity, can he confirm that any attempt to say that the Government—that is, Ministers—have axed the hospital would be highly inaccurate?
I shall go on to say that. I have made it clear that we do not know what the decision is, which is why we need a proper inquiry by the Department into how it was taken and, more importantly, why. There is much anger about the way that the trust has behaved, and rightly so, but it is also clear that the decision to shelve the plans is, unfortunately, symptomatic of the massive financial difficulties in which trusts in Leeds and across the country have found themselves in recent years.
Estimates vary, but according to its own figures, the Leeds Teaching Hospitals NHS Trust is seeking to reduce a deficit projected to reach £9 million by the end of the year, as part of a £30 million to £50 million deficit faced by the city as a whole. The Secretary of State for Health has obliged trusts to make savings of 2.5 per cent. each year. In an organisation with a turnover of more than £700 million, that is a considerable amount. It has led to a number of closures and cuts in the Leeds area, including ward closures and cuts of about 430 posts as part of a cost-cutting plan aimed at saving £84 million in the next three years, and has instigated a recruitment freeze.
What the hon. Gentleman just said appears completely to contradict comments that he made just this week in the Yorkshire Evening Post, where he suggested that Leeds MPs, apart from himself, had been wrong to suggest that anybody other than the trust was responsible. In the 25 years that I have been involved with the NHS, the Leeds Teaching Hospitals NHS Trust has always had a deficit. It had a deficit in 2004, when permission was given to do the detailed planning for the hospital, not for it to go ahead. It continues to have a deficit, and many of us have asked almost monthly whether that would impinge on the ability ultimately to submit the bid for the hospital. The answer that we have been given was no. Does the hon. Gentleman accept therefore that much of the responsibility for the issue actually rests with the trust itself?
Of course I do, and that is why I have asked the Minister to review the overall management of the hospital service in Leeds. The problems are abundantly clear. However, it is regrettable that the hon. Gentleman wants to move away from the unity that we have had on the issue.
I need to make some progress. I will come back to the hon. Gentleman shortly.
Why do we need the hospital in Leeds? Medical experts in the city agree with each other and issued a joint statement in which they expressed fundamental concern over the
“current and future failings in the provision of care for children”
in the city. They stated that
“the present state of children’s services in Leeds is not fit for purpose.”
That is shocking and appalling. The fact that children are at risk in our hospitals should be our immediate and primary concern.
At present, there are two paediatric departments within three miles of each other. Given the complexity of paediatric medicine, children are therefore not getting the service that they require. For example, Dr. Sally Kinsey, consultant paediatric haematologist, stated:
“In the very recent past, a young girl had to wait seven hours to be transferred from St. James’s to the infirmary. She was having a torrential life-threatening nose bleed and the only out-of-hours services were at LGI.”
Not only is patient care compromised, but the other side of the coin is that the current situation does not make economic sense. There is duplication of services, and the two sites require multi-layers of middle-grade staff. That is a huge expense to the trust. As Professor Thomas said,
“the duplication of expertise in two paediatric intensive care units is the finances of a madhouse.”
It is important to make it clear that all assessments and accounts from patients, parents and senior health professionals show that the ability of our excellent teams to deliver children’s and maternity services is being undermined. In the words of one consultant, the teams
“can't treat as many people as they would like in they way they would like to.”
What will happen to children’s and maternity services in Leeds? We have had some back-pedalling from the trust, which is now making much of the fact that work on the new hospital has been postponed—albeit indefinitely—not cancelled, but the reality is that a hospital that was given the go-ahead in 2004 has been shelved indefinitely. It is also clear that there is little prospect of that changing without high-level political involvement and a radical overhaul of the financial position of the NHS in Leeds.
I am sorry, but I have only two minutes.
As for alternative solutions, it is clear that there is no plan B. I want the Minister to be in no doubt that medical as well as public opinion is clear that we need a single-site, purpose-built children’s hospital at the St. James’s site. Only that would allow key services to be located together, including a large, equipped paediatric intensive care unit and an out-of-hours service. It would end the need for children to be shuttled around various health care sites and to be treated in unsuitable conditions.
Dr. Keith Brownlee, paediatric consultant, has stated:
“We feel very strongly that without that provision”—
“it’s difficult to be confident that we can keep these children safe from cross infections.”
Dr. Richard Vautrey has stated:
“GPs and consultants are united over the need for a new dedicated children’s hospital.”
But Carol Maddocks puts it most powerfully of all. She says that anything other than a new, dedicated hospital would be
“like putting a sticking plaster over a gaping wound”.
As her fellow campaigner, Jonathan Abbott, said,
“Leeds Teaching Hospitals NHS Trust must reverse this decision—otherwise they will place a death sentence on our children’s medical care in Yorkshire.”
The purpose of this debate is to point out the need for the Department of Health and the Government to address the problems with the running of hospital services in Leeds. The Secretary of State for Health must admit that “the buck stops here” if people are being failed in our hospitals. First, the Government must determine why Leeds services are in such a mess, with neither local people nor health professionals having any confidence in how hospital services are run. Ultimately, the only thing that people in our city will accept is a new children’s and maternity services hospital in Leeds. It has support across the political spectrum of the public, the media and the business community. The people of Leeds have been waiting too long.
The hon. Member for Leeds, North-West (Greg Mulholland) is to be congratulated on securing this debate. He will probably be aware that other Leeds Members—my hon. Friends the Members for Elmet (Colin Burgon), for Leeds, North-East (Mr. Hamilton), for Pudsey (Mr. Truswell), for Leeds, West (John Battle) and for Morley and Rothwell (Colin Challen) are here today—have also helped to ensure that Ministers are aware of the strength of feeling about this important matter. As someone who lives in Doncaster, not too far away from Leeds, I obviously have an interest, too.
I know that my hon. Friends from Leeds had several discussions with the chief executives of the trust, the PCT and the strategic health authority to express their concern before taking the matter to Ministers. The hon. Member for Leeds, North-West may be aware that several of my hon. Friends who represent Leeds constituencies have already met the Minister of State, Department of Health, my hon. Friend the Member for Leigh (Andy Burnham), to discuss the issues. My hon. Friend the Member for Pudsey also led a deputation including parent campaigners Carol Maddocks and Jonathan Abbott and the consultant at the forefront of the campaign, Dr. Ian Lewis, to meet my colleague the Minister of State. On the same day, the Minister of State also met my hon. Friend the Member for Pudsey, senior NHS executives from Leeds and the chief executive of the strategic health authority, Margaret Edwards. My hon. Friend the Minister of State was planning to visit Leeds as a result of those meetings, but he has had to make allowances for the pre-local election purdah.
I have listened to what the hon. Member for Leeds, North-West said about the concerns of parents and families living in Leeds and west Yorkshire. The key message of the parents’ campaign is that very ill children, their families and dedicated health professionals are fighting terrible illnesses in a clinical environment that does not always help them to deal with the physical and emotional trauma involved. The services are scattered between different sites, requiring youngsters who are often in great distress to be shuttled about. As a mother of three, I count my blessings that I have never had to deal with such a situation. Children are treated in areas that lack the necessary privacy, and there is inadequate accommodation for parents, whose constant presence is an essential part of their children’s battle against life-threatening conditions. Those concerns have been recognised and the debate on dealing with them has been won, which is why we are in the middle of a process to provide the best possible services.
Before today’s debate, my hon. Friends from Leeds made me aware of the Yorkshire Evening Post campaigns—the one in 2004 and the one now—that have so graphically portrayed in human terms the case for a children’s hospital. The newspaper is to be commended for enabling young patients and their parents to make their own case, in their own words, as to why Leeds and west Yorkshire need services that are much more child-centred. Those profound messages have been heard, loud and clear, and we want to act on them.
My colleagues in the Department of Health and I were concerned to hear from campaigners, consultants and hon. Friends, and from the hon. Member for Leeds, North-West today, about the dismay at the way in which the matter has been handled. I fully appreciate the consternation that that has caused in Leeds and west Yorkshire. I understand that reassurance has been sought from the trust about its financial position and that it would not impinge on the “Making Leeds Better” bid, and that that assurance has been given.
My hon. Friends said that had the issues been raised with them before the announcement was made, they would naturally, in the circumstances, have wanted immediate meetings with senior NHS managers in the city and with Ministers to raise their concerns and discuss possible alternative action. We are addressing that issue. Things change over time—building costs and other factors change. I understand that there has been talk about the car park and the council’s requests concerning it.
Let us remember that the children’s hospital bid is not due to be submitted until December 2008, following the detailed consultation that must take place. That is 20 months away. I share my hon. Friends’ feelings that they would have expected any problems to be talked through with those most closely involved in the project, such as parent campaigners, clinicians, health professionals, local MPs, the local authority and other agencies. Clearly that was not done in the most open and appropriate way. I would also have expected the strategic health authority to be informed prior to any announcement regarding the bid, and for the Department of Health to be notified. That is why I found it disturbing to say the least when I read the following headline in the Liberal Democrat’s “Focus” leaflet: “Children’s hospital axed”. The article goes on to state:
“The Labour Government has axed plans to build a new £204 Million Children’s Hospital at St. James’s.”
That is taking political grandstanding too far. The article is not true; it is a complete misrepresentation.
It is extremely regrettable that the Minister is using an issue that clearly has the support of all MPs to score petty party political points. [Interruption.] As the muttering from hon. Members suggests, I find it extraordinary that we have a Government who claim to have saved the NHS but who will not take responsibility for hospital services in Leeds and the NHS as a whole.
We have trebled the amount of money that we provide to the NHS, which is why we can discuss how to make the changes that are needed. For example, funding in Leeds is to increase by 17.4 per cent. between 2006 and 2008. A new £220 million oncology wing on the St. James’s university hospital site will receive its first patients next year. Four excellent local improvement finance trust schemes, on which £20 million has been spent, have brought services closer to the community. Those services are already open to patients and their families. The children’s hospital proposal is part of looking to the future and deciding how we can meet the needs of families now and in the years to come. It is only right that I correct any misrepresentation of the facts, because such misrepresentation does not help politicians or the reputation of politics, and it certainly does not help the people on the ground who have campaigned for this service.
Does my hon. Friend the Minister share my concern that although the hon. Member for Leeds, North-West (Greg Mulholland) is trying to present an all-party approach to the Minister, he rejected my request for two or three minutes to speak on behalf of myself and my colleagues?
I shall give way to the hon. Gentleman in a moment. Mr. Atkinson, you will be only too well aware that during Adjournment debates on a local issue that many hon. Members have taken up, other hon. Members can usually ask the MP who has secured the debate for some time in which to speak. My hon. Friend the Member for Pudsey makes an important point. If this is an issue on which people can work together—and I believe that it should be—the hon. Member for Leeds, North-West has missed an opportunity.
The hon. Member for Pudsey makes an extraordinarily disingenuous point. I made it clear that although this is a 15-minute debate, I would welcome interventions from other MPs from Leeds—particularly if they were constructive interventions, which I must say they have not been. When a meeting was arranged with the Minister of State, I was not invited to attend by the hon. Gentleman, so his point is rather hypocritical.
On a point of order, Mr. Atkinson. Will you clarify a couple of points for me? First, is it not the case that when a Member secures an Adjournment debate, he or she is not restricted to 15 minutes? Secondly, is it not entirely at the discretion of the hon. Member who has secured the debate to allow other Members to contribute?
The answer is yes to both of those questions. The debate is a half hour debate and if the hon. Member who has raised the topic wants to speak for the entire time, they may do so—although obviously in that case they would not receive a response from the Minister. And, as the hon. Gentleman rightly says, it is up to the Member who introduces the debate to decide whether to allow another Member to contribute.
On a point of order, Mr. Atkinson. I raised that point with the Table Office and that was the advice that I was given. However, I also note that the hon. Member for Pudsey could not answer my question about why I was not invited to the meeting with the Minister of State.
As I was saying, I would have expected the strategic health authority to be informed before any announcement was made regarding the bid and the Department of Health to be notified. It is unfortunate that that was not done, but the strategic health authority and the Department of Health are now helping to make sure that we get the figures right. The officials in the Department and the strategic health authority are playing a constructive role, which is a world away from the very party political basis of some campaign literature issued during the local elections. In the “Focus” leaflet to which I have referred and, I understand, in other leaflets and letters the headline has been that the Labour Government are axing plans. That is a complete misrepresentation and is disgraceful.
Children’s services in hospitals and in communities are a major priority for us. On 15 March, the Minister of State, Department of Health, my hon. Friend the Member for Leigh, announced a consultation on the future of payment by results. That will look at the future financing of specialised services, including children’s services, under payment by results. That is important because it will set out what currently happens, but also seek to ensure that services that are so important to children and their families, and to clinicians who provide their expertise and devotion, are rewarded fairly. The consultation will also set out future options to ensure sustainability. As well as having buildings, it is important that there is the finance and throughput to ensure that services can be developed and invested in.
The consultation will touch directly on services such as those that Leeds aspires to provide through a dedicated children’s and maternity hospital. We want to look at how that aspiration can be converted into reality for the children and parents of Leeds and west Yorkshire. With our colleagues at the strategic health authority, we will look at some of the figures that the trust has identified to determine how realistic they are. We will identify ways in which we can be clear about what are extra costs and what can be dealt with in other ways.
Does my hon. Friend agree that the only way to get a children’s hospital in Leeds is to stop trying to use the issue to score party political points? Opposition parties in Leeds should refrain from doing that and work together with the rest of us to achieve that goal.
I agree with my hon. Friend. These are not impersonal issues. I imagine and know the daily pain that campaigners are experiencing as parents of sick children—they are not detached from the issue. We must be careful in the language that we use and the impression that we give as it may unduly create fears and distract us from getting on with the job, which is to sort out the figures with the trust and ensure that they are correct and fit for purpose. That is the constructive approach and, dare I say it, the responsible approach to tackling complex issues, which should not be made more complex, frightening or stressful for those who are most closely involved.
Ultimately, the people on the ground in Leeds must be the ones who make the plan work. The rigorous process that the strategic health authority has now launched is one that should have been undertaken locally before any unexpected announcement was made. That point has been clearly made. Discussions should have been held with parents, health professionals and all the other people who are committed to the project. I have no doubt about the huge amount of support among those people.
I know that there is some concern among parent campaigners that the project has grown well beyond the original children’s hospital scheme that was presented in 2004. Part of the job that we now have is to work out how much of that was bound to happen because that is what happens with such projects, and how much relates to other issues that may need closer attention. The plan includes changes to a wide range of adult and community services in the city. The trust says it has also included a huge car park to meet the concerns of the city council. There is a sizeable extra amount included in its figures to cover possible changes in costs over time, which is also the subject of some debate. All those aspects need to be fully examined. The NHS in Leeds will be doing its job to ensure that it meets its next deadline for the outline business case approval by the end of next year.
Plans for a Leeds children’s and maternity hospital have not been cancelled. It is the ambition of the strategic health authority, the Leeds Teaching Hospitals NHS Trust and Leeds primary care trust to centre children’s services on one new site in the city. Those are the stated aims of the “Making Leeds Better” programme and I understand that that remains the case. Only after full public consultation will a final decision be taken on the future of services in Leeds.
It being Two o’clock, the motion for the Adjournment of the sitting lapsed, without Question put.