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Commons Chamber

Volume 462: debated on Wednesday 4 July 2007

House of Commons

Wednesday 4 July 2007

The House met at half-past Eleven o’clock


[Mr. Speaker in the Chair]

Committee of Selection


That Mr. Bob Ainsworth and Mr. John Heppell be discharged from the Committee of Selection and Mr. Nicholas Brown and Liz Blackman be added to the Committee.—[Mr. Nicholas Brown.]

Oral Answers to Questions


The Secretary of State was asked—

Single Farm Payments

1. What discussions he has had with the Secretary of State for Environment, Food and Rural Affairs to resolve the payment of outstanding single farm payments to cross-border farmers. (146371)

I am pleased to say that my right hon. Friend the Secretary of State and my predecessor, to whom I pay tribute, have held regular discussions with ministerial colleagues on matters affecting Wales, including farming. I understand that of the 518 cross-border claims under the 2006 scheme, all but 25 have been processed for full or part payment.

May I be the first person on the Conservative Benches to congratulate the Minister on his elevation? In view of the Secretary of State’s multi-tasking, I expect that he will have a heavier load than usual. I am grateful for his answer. Will he please ensure full co-operation between the National Assembly for Wales agriculture department and the Rural Payments Agency for farmers whose farms straddle both sides of the border? My constituent Mrs. Christine Jones of Llanfairwaterdine did not receive her 2005 payment in full until the end of last month.

I thank the hon. Gentleman for those kind words of introduction to the Dispatch Box and I am sure that I will greatly enjoy the role. My right hon. Friend the Secretary of State did outstandingly well when he was Secretary of State for Northern Ireland and I have no doubt that he will be equally good in command of the Department for Work and Pensions. On the substance of the question, I can assure the hon. Gentleman that there will be close co-ordination between the Department for Environment, Food and Rural Affairs, the Rural Payments Agency and the Welsh Assembly Government. Just to bring the House up to date and to be clear, in Wales, for 2006, 315 of the 323 farmers on the Welsh side of the border have been full or part paid, and, in England, 178 out of 195 have been full or part paid. We will make sure that we work closely together to ensure that everybody receives their payment.

May I say, llongyfarchiadau i’r gweinidog newydd? The real scandal of the single payment is that it costs the average family in Wales £450 a year in farm tax. Is not the problem that the single payment is almost a payment for life for farmers, even if they stop farming altogether? One farmer in Wales recently left farming and sold his single payment allocation to a speculator. Should we not stop that scandal and make sure that the single payments, which are rip-offs for the taxpayer, are phased out?

I thank my hon. Friend for his kind words of llongyfarchiadau, which for the purpose of the translators is “congratulations” in Welsh. Diolch yn fawr iawn—thank you. I can confirm that the complete amount paid for the single farm payments is, for 2006 alone, more than £219 million. We are on track and on target with that. Although I cannot wholly disagree with his comments, I assure him that we will work to make sure that the farming community and the wider rural economy in Wales is protected for the future and safeguarded.

Neighbourhood Policing

4. What recent discussions he has had with the Home Secretary on neighbourhood policing levels in Wales; and if he will make a statement. (146375)

I thank my right hon. Friend for that answer. There are 22 community safety partnerships in place in Wales. Does he agree that those partnerships are having a real impact on our local communities by tackling crime and antisocial behaviour? Can he give an assurance that the funding for those partnerships will be safeguarded?

I agree that the multi-agency approach has a big impact on local crime. Record amounts of funding are going in, as they have done throughout our period of government—unlike the Conservative record in government. The figures speak for themselves. Recorded crime in Wales is down 3 per cent., total violent crime is down 1 per cent., burglary is down 10 per cent., theft and the handling of stolen goods is down 5 per cent., and theft of and from vehicles is down 3 per cent. The only thing that is up is detection rates.

Will the Minister join me in congratulating the neighbourhood policing teams in my constituency and across Wales? They are not only making our streets safer through high-profile policing, but are working together with agencies such as the county council and Communities First to tackle the causes of crime and are developing things such as the multiball centres in Llwynhendy and the Morfa. Will he make sure that we have adequate talks with Home Office Ministers to ensure funding for our neighbourhood policing teams across Dyfed-Powys?

I will certainly do all that I can and I hope that my hon. Friend will support that. I am pleased to inform her that the Dyfed-Powys police force is on track to have a dedicated neighbourhood policing team embedded in every area by April 2008. I congratulate her on her work to support such initiatives.

Does the right hon. Gentleman realise that as the funding settlement for the police in Wales is 3.6 per cent. this year, yet police inflation is 5.1 per cent., there is an obvious funding gap? As is typified by the situation in north Wales, that will lead to a recruitment embargo, or stop, for at least three years. Neighbourhood policing partnerships have been very successful, but will he please ensure that they can continue to be so and that the funding gap is addressed?

The hon. Gentleman will be aware that unlike under the Conservatives, there will be total funding of more than £450 million this year, which is up 17.3 per cent. in real term terms since 1997. Owing to that funding, we have 677 police community support officers, including in north Wales, and 1,000 police officers, including more in north Wales. That is why crime is falling and people feel safer in their communities.

I congratulate the Secretary of State on his reappointment and look forward to working with him and his Minister on the new powers that have been devolved to the Assembly. Does he still support the amalgamation of the four Welsh police forces?

Before I answer that question, may I congratulate the hon. Gentleman on his appointment? I also pay tribute to his predecessor, the hon. Member for Montgomeryshire (Lembit Öpik), who is sitting behind him, who carried out his long stint in the job very well. May I also pay tribute to my former deputy, my hon. Friend the Member for Carmarthen, West and South Pembrokeshire (Nick Ainger)? He did an outstanding job and is one of the most popular Members in the House on a cross-party basis.

The amalgamation of all four police forces in Wales is not on the Home Secretary’s agenda, and I am quite happy with that.

Eighteen months ago, four of my constituents—Maurice Broadbent, Dave Horrocks, Wayne Wilkes and 14-year-old Tom Harland—were killed in the worst cycling accident in UK history. My right hon. Friend visited the site of the accident and met parents and the North Wales police to discuss the inquiry. Coroner John Hughes concluded his inquiry last week and was highly critical of North Wales police and Conwy county borough council’s gritting department. Will my right hon. Friend ask to meet Conwy council and North Wales police to discuss the results of John Hughes’s coroner’s inquiry?

I will certainly be happy to explore the matter with my hon. Friend and to work jointly with him to address the situation. He is right that I visited the site of the accident with him. The accident was one of the most appalling and tragic that I have ever had the misfortune to experience afterwards. The Rhyl cycling club is a fine club involving youngsters and many others. It has high standards and traditions, and it is devastating that it has been affected in such a way.

May I associate myself with the remarks made by the hon. Member for Vale of Clwyd (Chris Ruane), since the accident happened in my constituency?

The Secretary of State will appreciate that additional demands are likely to be made of the police in the light of the security situation. On Monday, his right hon. Friend the Home Secretary gave a commitment to the House that she would work with police forces throughout the country to ensure that adequate funding was made available for dedicated security posts. Will the right hon. Gentleman confirm that he will make representations to the Home Secretary with a view to ensuring that any diversion of resources to security policing will not impinge adversely on the community policing budgets of Welsh police forces?

There is no intention that that will happen; both functions are equally important. At this sensitive and critical time, especially, we must ensure that all necessary resources are diverted towards dealing with the security threat. However, of course, community and neighbourhood policing, which is especially strong in north Wales, must be protected at all costs.

Does my right hon. Friend agree that the key to the success of neighbourhood policing is likely to be the work of police community support officers? The key reason why their introduction has been a tremendous success is that they, unlike fully-trained police officers, are not continually pulled off for other duties. Will my right hon. Friend speak to the Home Secretary to ensure that police community support officers and their work are not diluted by giving them other tasks, or taking them out of the local communities to which they have been allocated?

I will certainly write to my right hon. Friend about that, and I pay tribute to the work that he did in the Home Office right at the beginning of our time in government in getting police community support officers on track. It was an innovative Labour policy that has proved hugely successful and popular across the country.

Is the Secretary of State not a little bit concerned that evidence is already emerging that police officers who are part of the very worthwhile neighbourhood policing initiative are being diverted to other urgent, important police tasks? Is there not a risk that the enthusiasm shown at the launch of the neighbourhood policing initiative will dissipate quickly, as policemen are diverted elsewhere? Is that really sustainable?

I do think that it is sustainable, because the officers’ primary purpose is to assist in neighbourhoods, and to be a visible presence on the streets. They are meeting that purpose very effectively and are giving reassurance and support to local communities, as was the original objective. Obviously, if there is an emergency or a crisis, it is all hands to the pump, as the hon. Gentleman would expect.

Defence Training Academy

3. What recent discussions he has had with the First Minister on the impact of the defence training academy on the south Wales economy; and if he will make a statement. (146374)

I have regular discussions with the First Minister on a range of issues, including the defence training academy, which is the single biggest investment in the history of Wales. It is the result of a strong partnership between our Government in Westminster and our Assembly Government in Cardiff, and the result of the work of colleagues such as my hon. Friend, who has worked tirelessly in promoting the merits of St. Athan.

I thank my right hon. Friend for that reply. Is he satisfied that everything is being done to ensure that the south Wales economy gets the maximum benefit from that record-breaking investment? In particular, does he remain confident that the road transport infrastructure for the academy will be in place by the time of its opening in 2012 or 2013?

It is important that the road access is in place, and I hope that it will be. I know that the Welsh Assembly Government and Transport Ministers are working hard on that, along with others. There will, of course, be a full transport impact assessment as part of the planning procedure relating to that important investment. My hon. Friend is absolutely right that the project will be a huge boost to the local economy. It is estimated that it will bring 5,500 jobs, and 1,500 jobs during the construction period. The spending input will mean about £58 million extra for the local economy over the life of the project, which is a long period.

Given that the right hon. Gentleman stood at the Dispatch Box at the beginning of March and criticised Plaid Cymru in the strongest terms for its hostility to defence-related investment in Wales, will he explain why his party in Cardiff bay is negotiating a grubby deal with Plaid Cymru, and will he tell the House what steps—

Does the Secretary of State agree that all-party support for the project was vital to securing it for Wales, and will he agree to work with the Department for the Economy and Transport Ministers in the Assembly, whether they belong to my party or his, so that we can get the maximum benefit to which the hon. Member for Vale of Glamorgan (John Smith) referred?

Of course we must all pull together to make sure that the project is a spectacular success for the south Wales economy, and not just for the constituency that my hon. Friend the Member for Vale of Glamorgan (John Smith) so ably represents. Of course all parties must work together. Speaking of who might be the Minister with responsibility for the economy, at least we were not negotiating a grubby deal with the Tories.

I have the hon. Lady’s name down to ask a question now. Perhaps the Whips will keep me informed of what question the Front-Benchers want dealt with. I call Mark Pritchard.

Thank you, Mr. Speaker; I welcome this opportunity. In addition to the problems that the road infrastructure projects are causing for the future of the defence training academy, the Secretary of State will know that many of the defence training personnel from RAF Cosford, whom he hopes will relocate to RAF St. Athan, are unable to do so because of the differential in house prices. How does he think that that will affect the future of the project?

Clearly, it is important that those who are transferring to St. Athan bring their skills and their opportunities. It is a great place to live and to work. The whole area is a wonderful place to live. The regeneration of south Wales following the decline of coal mining and heavy industry provides a marvellous location for people to work and to enjoy a quality of life that is among the highest anywhere in Britain.

Whatever one’s private thoughts about Welsh nationalism may be, it is surely right that there has been universal support for the deal in St. Athan from all the political parties, including the independent Member of Parliament—

Order. What has that got to do with the matter before us? Nothing. It has nothing to do with it.

Welsh-speaking Workers

5. What recent discussions he has had with ministerial and Assembly colleagues on measures to safeguard the rights of Welsh-speaking workers. (146376)

I can confirm that my predecessor had regular discussions with colleagues in both the UK and the Welsh Assembly Governments on a wide range of issues, including the Welsh language, and I intend to continue such discussions.

I am grateful for that answer. Thomas Cook is the latest in a long line of companies to blunder into bad personnel decisions and public relations disasters on the language issue. As the company states in a letter to me, it never intended to ban the use of Welsh, but at the same time it says that the preferred language in some cases is English. The private sector is clearly confused about the matter. Does the Minister agree that the Welsh Language Act 1993 needs to be reviewed and reformed, if only for the benefit of the private sector?

The hon. Gentleman is aware that the First Minister announced a legislative programme on 6 June and also announced that there would be an Order in Council on the Welsh language in the autumn. In the Wales Office we are closely monitoring the situation with Thomas Cook, and we know that the Welsh Assembly Government Minister responsible has requested a meeting with the company. I also know, and I am sure the hon. Gentleman is aware, that Thomas Cook has entered discussions with the Commission for Racial Equality and the Welsh Language Board in relation to its Welsh language policy. All hon. Members will welcome that approach.

Mr. Speaker, I apologise for any misunderstanding with the Chair.

May I congratulate the Secretary of State on keeping not one but two jobs in the Cabinet, and say diolch yn fawr to the hon. Member for Carmarthen, West and South Pembrokeshire (Nick Ainger) for his courtesy to me during his time in office. May I also say half a goodbye to the hon. Member for Montgomeryshire (Lembit Öpik), and extend a warm welcome on behalf of the official Opposition to the Under-Secretary of State for Wales, the hon. Member for Ogmore (Huw Irranca-Davies), and the hon. Member for Brecon and Radnorshire (Mr. Williams) to their new positions on the Front Bench for Wales.

Does the Minister acknowledge the importance of the Welsh Language Act, which has done so much to protect and enhance the position of the Welsh language, and also acknowledge the main advocate and architect of that Act, my right hon. Friend Wyn Roberts, the noble Lord Roberts of Conwy? Will the Minister join me in paying tribute to the dedication that Lord Roberts has shown to Wales throughout his long and distinguished public service career, and wish him a long and happy retirement?

I add my sentiments to those of the hon. Lady and welcome her back to her position. I am sure that my right hon. Friend the Secretary of State would echo the sentiments as well. Yes, there has been a great deal of cross-party support for the Welsh language. It is worth remembering the successes, which include the fact that since 1993 Government Departments and public bodies have introduced 423 statutory and 53 voluntary Welsh language schemes. Over 37 per cent. of children between the ages of three and 15 speak Welsh, and there is an 80,000 increase in the number of people in Wales who can speak Welsh. That is to be applauded.

Prison Overcrowding

6. When he next expects to meet representatives of the Prison Service to discuss prison overcrowding in Wales. (146378)

My right hon. Friend the Secretary of State and my predecessor have held regular discussions with ministerial colleagues on matters affecting Wales, including prisons. The Government have announced further plans to ensure that there are enough prison places throughout England and Wales.

I congratulate the Minister on his new appointment. Is he aware that very large numbers of Welsh prisoners are starting their sentences as mild drug abusers but coming out of prison as hardened drug addicts? What assessment has he made of the impact of overcrowding on the capacity to deliver effective rehabilitation programmes?

We are monitoring the situation closely. To clarify, this is an area of retained powers, not a devolved matter. Since 1997, the Government have increased prison capacity by nearly 20,000 places, and in 2007, capacity will increase further by 2,200 places. On top of that, a new capacity-building programme will deliver 8,000 new places by 2012, so we are well on the way to addressing the issue of overcrowding.

When I met offenders recently in Rossett churchyard, it was clear that they were carrying out purposeful work in tidying up the graveyard for the benefit of the local community. Does my hon. Friend, whom I welcome to his new position, agree that the key to reducing the prison population in Wales is to impose tough, non-custodial, alternative sentences, so that the local community can benefit from those who commit crime in the longer term?

My hon. Friend speaks a lot of sense, and I pay tribute to those involved in the scheme that he mentioned. It is undoubtedly right that a progressive agenda must look at the issue of non-custodial sentences as well. We must also consider the issue of driving down crime. As my right hon. Friend the Secretary of State said, in Wales recorded crime is down 3 per cent., violent crime is down 1 per cent., burglary is down 10 per cent., and theft from vehicles is down 3 per cent. Only detection rates are going up.

Is the Minister aware that South Wales police are having to transport, house and feed at least seven prisoners a day because of prison overcrowding, a total of 570 since the start of the year, at a cost of over £250,000? What impact will that have on the ability of South Wales police to tackle crime and antisocial behaviour?

The hon. Lady draws attention to the use of police cells for the custody of prisoners. It is not ideal, but Operation Safeguard is a well-established and tried-and-tested agreement between the National Offender Management Service and the Association of Chief Police Officers to hold prisoners in police cells instead of prison custody at times of high population pressures. It is a pragmatic approach, but the answer to overcrowding is, as I have already said, to tackle the root causes of criminal activity and to build new prison places, which we are doing.

Train Services

7. What discussions he has had with First Great Western trains on the December 2007 timetable consultation. (146379)

I pay tribute to my hon. Friend who has been tenacious in pressing the concerns of First Great Western's customers—especially those living west of Cardiff. My predecessor met First Great Western on 20 June, and I will continue to follow developments closely.

When my hon. Friend meets First Great Western, will he ensure that the consultation being undertaken is a real one, not a paper exercise? For too long in south-west Wales, we have fed information to First Great Western, but nothing happens. We are a little tired of that and we want consultation to take into consideration our needs and aspirations.

My hon. Friend continues to be a powerful advocate on behalf of rail passengers in Wales, and I can assure her that we will press hard for this to be a meaningful consultation. My right hon. Friend the Secretary of State has written to First Great Western, seeking assurances on these issues, and our talks with First Great Western will continue. We intend to ensure that the consultation is meaningful.

The fourth prize in a recent charity auction in my constituency was a pair of First Great Western first class return tickets to London. I do not think that I dare travel First Great Western, but if the Minister would like them, I will gladly give them to him.

I do travel regularly on First Great Western—every week—and on Arriva trains as well. It is unacceptable that First Great Western’s performance in the third quarter of 2006-07 was the lowest of all the long-distance operators. In a recent passenger focus survey, 72 per cent. of First Great Western passengers expressed their dissatisfaction. However, First Great Western has given commitments, and we will continue to press it for massive investment in the routes that it serves through to south Wales and look for the results. Let me also pay tribute to the Welsh Assembly, which, among other things, is investing more than £50 million to enhance capacity in the Valley Lines network. We must not forget about the feeder network either.

Prime Minister

The Prime Minister was asked—


With your permission, Mr. Speaker, before listing my engagements I am sure that the whole country will welcome the news that Alan Johnston, a fearless journalist whose voice was silenced for too long, is now free. I want to thank all those who contributed to the diplomatic and other efforts to secure his freedom.

This morning I had meetings with ministerial colleagues and others. In addition to my duties in the House, I will have further such meetings today.

I congratulate the Prime Minister on becoming the leader of our country. He said—[Hon. Members: “More!”] He said that he would, unlike his predecessor, listen to the people of our country. With that in mind, can I inform him that the great men and women of Shrewsbury have spoken, and they have voted overwhelmingly against unitary authority status for Shropshire? Four out of the five district councils are against it, as am I, as is my hon. Friend the Member for Ludlow (Mr. Dunne). Will the right hon. Gentleman listen to the people of Shrewsbury and please not impose this ghastly unitary authority status on us?

Of course we will listen. As I understand it, Shropshire county council—a Tory council—proposed these measures. I also understand that the hon. Gentleman’s local council at Shrewsbury is against the measures, and that it has taken judicial action to try to have a review of them. Of course, I cannot comment on that judicial action, but the Secretary of State for Communities and Local Government or I will be pleased to meet him after that action to discuss the next step forward.

Will the Prime Minister press the international community to develop financial instruments for the protection of tropical forests to ensure that the 20 per cent. of greenhouse gas emissions that are going up into the atmosphere from the destruction of those forests does not continue?

I thank my hon. Friend for the work that he did as a Minister in this Government to deal with the issues of tropical forests. I welcome the fact that he is now going to take a major interest in trying to ensure that the tropical forest in the Congo basin is reforested, that jobs are protected, that livelihoods are ensured and that the £50 million investment that we are supervising for that forest actually takes place. Let me congratulate him on becoming a special envoy for the Government in this task.

First of all, I agree with the Prime Minister about Alan Johnston. It is fantastic news that he is on his way back to his family.

Recent attempts to cause massive loss of life in London and in Glasgow remind us of the very real threat that we face in this country. There are a number of measures that we believe would make a difference. First, we support the use of telephone tap evidence in court so that we do not just catch these people but convict them and lock them up. Six weeks ago, the Government agreed to our proposal for a Privy Council review of this issue. Can the Prime Minister tell us how soon they will publish the names, when it will meet, and when it will report?

I am grateful to the right hon. Gentleman. I hope that, right across the House as right across the country, there can be unity in our determination to fight terrorism. I want to remind people of just how brave and courageous the explosives experts in London and those who tackled the terrorist activity at Glasgow airport were. I hope that we can continue on an all-party basis to agree measures that are necessary in this country to deal with the terrorist threat. On the specific question of intercept, I can tell him that we will go ahead with our investigation, carried out on Privy Council terms, and of course I shall consult him and the leader of the Liberal party on the names of the people who will conduct it.

I hope that we can make progress. It is a complicated issue but setting up a committee is not complicated and that should happen without delay.

We need to act against groups which are seeking to radicalise young people. Almost two years ago, the Government said that they would ban the extremist group, Hizb ut-Tahrir. We think it should be banned—why has it not happened?

Of course, with all those details—I have had to tackle the matter at the Treasury when dealing with terrorist finance—one has to have evidence. It is precisely to examine the evidence that we instruct several investigations.

Let me tell the right hon. Gentleman what we will do. We will expand the watch list on potential terrorists, which is the means of co-operation across the world, from Europe to the Arab states. We list them in such a way that authorities in different countries can be warned. We will expand the background checks that are being done where highly skilled migrant workers come into the country. Where people sponsor them, we will ask them to give us their background checks. As a result of what has happened in the national health service and because of what we know has happened in the past few days, I have asked Lord West, the new terrorism Minister, to conduct an immediate review of the arrangements that we must make for recruitment to the NHS. Finally, we will want to sign new agreements with other countries around the world so that we act together to deal with the potential terrorist threat and we can deport people to countries where they should be rather than this country. Again, I hope that there can be all-party agreement on the measures that we are taking to ensure the security of British citizens and to work with other countries in the fight against terror.

A very interesting answer, but I asked a specific question. The Prime Minister said that we need evidence about Hizb ut-Tahrir. That organisation says that Jews should be killed wherever they are found. What more evidence do we need before we ban that organisation? It is poisoning the minds of young people. Two years ago, the Government said that it should be banned. I ask again: when will this be done?

We can ban it under the Prevention of Terrorism Act 2005. Of course—[Interruption.] The Leader of the Opposition forgets that I have been in this job for five days. [Interruption.]

I have agreed that we will look at the issue, but we need evidence, and it cannot be just one or two quotes. We must look in detail at the evidence and I hope that the right hon. Gentleman will agree that we should approach those matters in a sustained and calm way; that we should not jump to conclusions but consider all the evidence. That is the basis on which the Government will proceed.

But there has been a lapse of two years since the Government said that they would ban the organisation. People will find it hard to understand why an organisation that urges people to kill Jews has not been banned.

As well as preventing radicalisation and stopping future dangers, we need to protect ourselves against present dangers. Does the Prime Minister agree that the time has come for a national border police force?

I am prepared to look at that. I have, of course—when I was Chancellor of the Exchequer—looked at how the Customs and Excise authorities can work better with the police to secure border arrangements. However, I have to say to the right hon. Gentleman that everyone who looks at the issue, including Lord Stevens, who considered it for him, has concluded that the need for identity cards is complementary to a border police force. [Interruption.] It is his party that continues to oppose identity cards. The new shadow terrorism Minister, Lady Neville-Jones, whom he appointed only a few days ago, also said that identity cards are complementary to the other measures that are necessary to protect our borders. I hope again, in the spirit of bipartisan co-operation, that he will reconsider his views on the need to introduce identity cards.

If the right hon. Gentleman wants to trade quotes on identity cards, perhaps he will try this one from the Chancellor of the Exchequer:

“Identity cards are unnecessary and will create more difficulties than they will solve…I do not want my whole life to be reduced to a magnetic strip on a plastic card.”—[Official Report, 2 March 1992; Vol. 205, c. 70.]

Identity cards did not stop the Madrid bombings. After the 7 July bombings, the then Home Secretary said that they would not have helped in the UK, that they would not come in for years and that they would cost billions of pounds—money that should be spent on things such as border police.

Let me come back on the border police. The Home Affairs Committee supported a border police, the current Metropolitan Police Commissioner supports it, and Lord Stevens, as the Prime Minister said, is conducting a review for us now on the need for a border police, which he fully supports. The Prime Minister has said that he is open to this suggestion. Will he tell us exactly what he will do and when he will make an announcement about a national border police force?

First, I may say to the right hon. Gentleman on comments made about identity cards in the past that we have got to take into account what is actually happening now. It is because the situation has changed that more and more people have come to the view taken by his security expert and Lord Stevens that we need identity cards—and I know that many on the Conservative Back Benches believe exactly the same as we do.

As for the border police, I have said that I will look at this issue. We have already brought Customs and Excise and the other authorities together to work in closer co-operation. I have to look at that in the context of the available finance and of other measures that we are taking, including electronic borders, to step up security, but I can assure the right hon. Gentleman that this Government will ensure that the security of the British people is protected, and we will take all measures that are necessary for the safety of the British people. Again, I hope that there will be bipartisan co-operation on these issues, so that we can show the world that Britain is protected against terrorism.

Convicting terrorists by using phone taps, banning the extremists who radicalise young people in our country and, vitally, securing our borders—are they not three of the practical steps that are absolutely vital parts of the unity that the Prime Minister needs to build so that we can all ensure that the terrorists will never win?

We can co-operate on the issues ahead, but the right hon. Gentleman has to look at the policies that he has been putting forward and examine whether they are the right things for this time as well. I also have to make the point to him that the unfunded change is no change at all. If he is not prepared to support with financial resources the policing, the law and order and all the public services that are necessary, we will not be able to agree on the way forward.

In the light of the events of the last few days, I hope that the country can come together and agree these measures. I have offered conversations with the right hon. Gentleman on a number of issues, including intercept, and on other issues we are prepared to co-operate not only with the Leader of the Opposition but with other parties. It is vital that the message be sent out to the rest of the world that we will stand strong, steadfast and united in the face of terror.

The dust has hardly settled at Glasgow airport and already there are some siren voices in Scotland seeking to divide our investigative and inquiry teams. May I therefore ask my right hon. Friend to assure the House that any terrorism in this country is a British problem which requires a British solution?

I agree. Let me add my thanks for the work done at Glasgow airport. Not only did a number of employees at the airport come to the rescue and take action against those who were later arrested, but as a result of the determination of the British people to send out a message that terrorism will not disrupt our way of life, the airport returned to normal within 24 hours. I will certainly take on board my hon. Friend’s comments.

Like everyone else, I am delighted at the release of Mr. Alan Johnston. I am sure that I am not the only one to be impressed by his remarkable dignity and composure while being interviewed this morning.

The Prime Minister entered No. 10 Downing street with a promise of change. Will he now set a target for the withdrawal of British troops from Iraq; will he order the reopening of the investigation into allegations of corruption in relation to arms sales; and will he renegotiate the one-sided extradition treaty with the United States?

As I said yesterday, my door is always open to the right hon. and learned Gentleman. On these issues, let me tell him this: it would be wrong to set a timetable at this stage. What we have done is reduce the number of troops from 44,000 to 5,500, and move from combat to over-watch in three provinces of Iraq. What we await is a decision to move to over-watch in the fourth province of Basra, but we have obligations, which we have accepted, both to the United Nations and the Iraqi Government, and we are not going to break those obligations at this stage.

As for the right hon. and learned Gentleman’s two other questions, I have made it clear that decisions on prosecutions are not for the Prime Minister or the Government, and the extradition treaty with the United States is a matter for continuing discussion.

When I look at the Prime Minister’s door it appears to be more of a trap door than anything else—so there is not much evidence of change there. Will the Government now abandon their headlong rush towards a new generation of nuclear power stations? Will they undertake to tax pollution more than earnings? Finally, will they abolish the unfair and regressive council tax?

Surely the events of the past year should make it clear to everyone that we cannot rely on an energy policy that makes us wholly dependent on one or two countries or regions across the world. That is why we have made the decision to continue with nuclear power, and why the security of our energy supply is best safeguarded by building a new generation of nuclear power stations. On the council tax, let me remind the right hon. and learned Gentleman that he got very little support from the electorate for his policy of local income tax.

May I congratulate my right hon. Friend on taking on the stewardship of this country and commend the cool and steadfast way in which he and the new Home Secretary have handled the recent difficult circumstances? In relation to the question from the Leader of the Opposition, I confirm what the Prime Minister said: we have recently carried out two reviews of Hizb ut-Tahrir and we have decided that there is insufficient evidence to ban it. I therefore ask the Prime Minister to stay absolutely on the course that he set today, and to stick by the law and the evidence and not to be swayed by any arbitrary political advantage that he thinks might be gained. May I also tell him—[Interruption.]

Nothing would be more politically disadvantageous than taking on a case without evidence and losing it. That would confirm all the accusations made against us by our opponents.

I thank my right hon. Friend for the work he did as Home Secretary, and particularly his work on setting up our new arrangements for dealing with terrorism. I agree that, however distasteful remarks made by organisations are, we must proceed on the basis of evidence and work within the law. The Government will make no panic reactions; we will work in a strong and steadfast manner and within the law.

The Secretary of State for Defence is doing a full-time job. [Interruption.] Someone pointed out to me the hon. Gentleman’s website this morning—[Interruption.]

They do not want me to tell them that the hon. Gentleman’s website says:

“Conservatives must be relentlessly positive.”


The Defence Secretary is working with our troops in Afghanistan and Iraq. He is working to draw up future defence estimates, and he is doing a magnificent job on behalf of this country.

Q3. Will my right hon. Friend extend his praise to the year 5 boys at Middlethorpe primary school in Cleethorpes for their wonderful “bully-buster” initiative, and will he tell the boys at that school what his Government will be doing to ensure that local councils and organisations such as ChildLine are well funded to tackle bullying in our schools today? (147226)

Let me thank my hon. Friend for the work that she is doing in her Cleethorpes constituency, and offer thanks for the work being done by the “Beat Bullying” campaign. I was fortunate to attend with Kelly Holmes the launch of the anti-bullying week, and I am very grateful to all the organisations that are trying to stamp out bullying not just within schools but outside schools, and to all the teachers and parents involved in this. It is a measure of the importance that we attach to every child having a decent childhood that we will extend the funds available to ChildLine. The Secretary of State for Children, Schools and Families is announcing today a £30 million budget for ChildLine over the next two years, which will enable it to improve its services both to young people affected by bullying, and to all children who need the service of ChildLine. They do need it, and it is a great service.

When EDS agreed to pay £71 million in compensation to Customs and Excise, £44 million was up front, with a further £26.5 million in staged payments. However, at the present rate of progress, it would take 106 years for the Exchequer to receive the money it is due. Does the Prime Minister think that a satisfactory rate of progress, and if not, what is he going to do to get the money owed to the taxpayer?

We are talking about a commercial arrangement between a firm and the Government—a commercial arrangement that was then renegotiated. The Public Accounts Committee or any other organisation is welcome to look at it, but I am satisfied that we have done what is right in the public interest.

Q4. The 5,000 families in housing need in the city of Chester have welcomed my right hon. Friend’s announcement that the provision of affordable housing will be a key priority for his Government. What message does he have for those Tory councillors in Chester who are trying to block the development of homes for local people on the site of an old Victorian psychiatric hospital that has been in the local— (147227)

It is right that we now build more houses in this country. It is also right that we seek to make housing affordable for thousands of people who cannot at the moment afford housing because of house prices. That means that we will have to build more houses, and that local authorities, including Conservative local authorities, will have to look at how they can release land to be able to do so. That is why I am disappointed that the new Conservative shadow housing Minister has said,

“you cannot build your way out of a housing crisis.”

We need to build more, and I hope again that there will be all-party support.

Q5. May I express my sadness at the recent deaths in Iraq and Afghanistan, including that of Private Kennedy, who was from my constituency? The Prime Minister will no doubt be aware of my constituent, Steven Johnston, who spent 10 years in prison for murder before his conviction was quashed last year. Since then, Steven has received no specialist professional psychological support and very poor after-care in general. The guilty are treated better. Will the Prime Minister investigate the specialist support provided to these victims, to ensure that they are given every chance to live as normal a life as possible? (147228)

I am grateful to the hon. Gentleman, whose constituency neighbours mine. However, I have to say to him that the conviction is a matter for the Scottish courts; any compensation would have to come from the Scottish judicial system. As far as the services available to individuals who need either special care or special attention are concerned, I shall look at the points that he made.

Does my right hon. Friend agree that, in order to tackle terrorism, we need the Muslim community to provide strong leadership from within that community? Does he also agree that the experience of Northern Ireland bears out very strongly his belief that we need a bipartisan approach if we are to succeed in resolving these problems?

I am grateful to my right hon. Friend, a member of the Intelligence and Security Committee with great experience as a former Minister in Northern Ireland. He is absolutely right that all sections of the House should appeal to all faith communities in this country. I want to see a stronger inter-faith dialogue where people find the common ground that exists between the different religions and communities of our country. There are more than 200 inter-faith groups throughout our country and I would like us to be able to finance and help the development of inter-faith groups in every community. I agree that that would make a huge difference to community relations. I hope to be able to talk to other party leaders about how we can move this forward.

Q6. The Prime Minister is a Scot, who has made it clear that he cherishes our shared Britishness. As an Ulsterman, I, too, value that Britishness. What plans does he have to ensure that people in each part of the United Kingdom can see the enduring benefit of building again a great nation that prevails over terror and adversity, whether domestic or international? (147229)

I am grateful for the hon. Gentleman’s words about the unity of the United Kingdom. I hope that the work we started yesterday on a statement of rights and responsibilities in our country will yield fruit and I hope that all parties in the House will join in that work. As a result of that work and the hearings to be held by my right hon. Friend the Secretary of State for Justice, I hope that we will see how the United Kingdom can move closer together.

Q7. My right hon. Friend has spoken often of his commitment to improving patients’ access to NHS services. Does he have any further information on plans to develop services on the Ormskirk site of the Southport and Ormskirk hospital, with special regard to the urgent care centre and recognising the benefit of providing the right local services in local settings? (147230)

I appreciate the work that my hon. Friend does as a local MP in pushing for an improvement to health services in her area. There will be a statement in a few minutes from the Secretary of State for Health, who will be outlining the Government’s plans to improve primary care services, personal care services in hospitals, investment in future health care and the treatment of diseases, and to make sure that the health service in this country is best for cure and best for care for all the people of the country.

Q8. As a Scot and, like the Prime Minister, a son of the manse, I was concerned by his reply to my hon. Friend the Member for Reading, East (Mr. Wilson). The Secretary of State for Defence is fully employed in Iraq and Afghanistan, with more troops deployed than at any time since the second world war. Given that, how much time will he be able to devote to his duties in Scotland? (147231)

The Secretary of State for Scotland does not bring legislation before the House in normal circumstances. He is a Minister of State, who will be carrying out his day-to-day duties on a full-time basis. I think that the hon. Gentleman would agree that the Secretary of State for Defence is doing an excellent job and that the relationships between the Secretary of State and the Army, the Air Force and the Navy are very good. I hope that the whole House will support the Secretary of State for Defence in his work.

Seven of our brave soldiers died in the first five years that we were in Afghanistan, mostly as a result of accidents. In the past 14 months, 56 soldiers have lost their lives, and there has been little progress on reconstruction and no progress on drug eradication. Is it not time to look again at the purpose of the mission in Helmand province?

I have visited Afghanistan and have talked to our brave troops who are doing an excellent job on behalf not just of this country, but of a combined NATO exercise that involves more than 30 countries in putting troops and support on the ground in Afghanistan. The House must remember that Afghanistan is the front line against the Taliban, and if we allow Afghanistan to become a weaker country again, the Taliban will be back in the way that we saw before the events of 11 September. I have nothing but praise for our brave troops. I know that there have been casualties and I am sorry that a number of people have lost their lives only in the last week, but there is immense international support within and outside NATO for continuing this fight. The way it is going to be fought is on three levels: first, to improve security in Afghanistan; secondly, to ensure that there is political reconciliation; and thirdly, as my hon. Friend rightly says, we have to give people a stake in the future of Afghanistan. That is why we are discussing, as a matter of urgency, economic measures that can help the Afghan people.

Q9. Will the Prime Minister join me in extending our sympathies to all those who have been flooded across the country, but particularly in Yorkshire? I understand that several flood defence schemes that would have gone ahead were cut, because of the single farm payment disaster and the Environment Agency budget being cut. Those included defences that would have helped Sheffield and Doncaster. Is he also aware that his Government are, for the first time, introducing a financial assistance scheme to help business communities? I am sure that that will be most welcome, but will he ensure that north Yorkshire businesses qualify as well as south Yorkshire businesses? (147232)

I am grateful to the hon. Lady for raising the question of floods. The loss of life is to be regretted and we will do everything that we can to support those people who have been moved from their homes and are homeless. I have telephoned the leaders of the local councils in the areas and said that we will do what we can to give them support.

I must correct the hon. Lady on the issue of the prevention of floods and coastal defences. The budget for that will rise over the next few years—[Interruption.] Oh yes. The budget will rise from £600 million a year to £800 million a year over the course of the next few years, so that we may have in place proper flood defences in our country.

NHS Next Stage Review

With permission, Mr. Speaker, I wish to make a statement about the NHS. Next year marks the 60th anniversary of the creation of the national health service. If the welfare state represented the crowning achievement of Attlee’s post-war Labour Government, the NHS was the jewel in that crown—one of the great civilising influences of the 20th century.

After the carnage of the second world war and the poverty and deprivation that went before, the advent of the NHS heralded a new era of equity, with medical care available for all—the weak, the sick and the vulnerable, as well as the wealthy and privileged. Nye Bevan said that the NHS made society

“more wholesome, more serene and spiritually healthier”.

That is as true today as it was in 1948. However, great change has occurred in the intervening 59 years, presenting new challenges for that cherished institution.

We are living longer, partly thanks to the NHS and partly owing to incredible scientific advances, with groundbreaking research emerging every day, bringing new cures but also extra costs. We are more discerning as consumers: we have gone from the old ration-book culture to a new iPod age, in which we increasingly expect choice and convenience. And we are more prosperous, with a range of goods and devices—at one level improving our quality of life, but also leading to an increase in lifestyle diseases, such as obesity and diabetes.

Society cannot stand still in the face of scientific and social change, and neither can the NHS. We have trebled spending to £90 billion a year, so there are now 80,000 more nurses and 36,000 more doctors. That unprecedented investment has been matched by new ways of working, from practice-based commissioning to NHS Direct and foundation hospitals.

On most objective measures, the NHS is performing better than ever, with more than 1 million extra operations taking place every year. Waiting lists are down, while satisfaction levels are up. Ninety two per cent of patients describe the treatment that they receive as “good”, “very good” or “excellent”. Only a few weeks ago, a global study by the Commonwealth Fund ranked the NHS first in a comparison with five other developed countries, including the US, Canada and Germany.

Yet, subjectively and anecdotally, there has been confusion and frustration in the NHS. The public are rightly concerned to know that their taxes are being wisely spent to build a health service that will meet their needs. Doctors, clinicians and nurses complain that they are fed up with too many top-down instructions, and they are weary of restructuring. They want a stronger focus on outcomes and patients, and less emphasis on structures and processes. That lack of confidence matters, because of the impact that it has on the operational capacity of the service. If the morale and good will of the profession is dissipated, our capacity for bringing about improvement for patients diminishes.

Restoring the NHS was one of the Government’s top priorities and, following almost two decades of neglect, a huge amount of reform in a short period of time was unavoidable. That was, as it were, the “emergency room” approach and, in the early stages it brought about substantial achievements. However, we now need to forge a new partnership with the profession.

Having addressed the funding shortfall, and put the necessary reforms in place, we will give the NHS the sustained period of organisational and financial stability that it requires. I can announce today that there will be no further centrally dictated, top-down restructuring to primary care trusts and strategic health authorities for the foreseeable future.

But we need to do more to make sure that the NHS keeps up with the changing demands and expectations of patients. New drugs, new medical technologies and better clinical practices provide huge opportunities, while lifestyle diseases and an ageing population present major challenges. To set us on the path to the next stage of the transformation of the NHS, my right hon. Friend the Prime Minister and I have asked Professor Sir Ara Darzi, one of the world’s leading surgeons, to carry out a wide-ranging review of the NHS. This is a once-in-a-generation opportunity to ensure that a properly resourced NHS is clinically led, patient-centred and locally accountable.

The review, the first of its kind, will directly engage patients, NHS staff and the public on four critical challenges. First, we want to work with NHS staff to ensure that clinical decision making is at the heart of the future of the NHS and of the pattern of service delivery. Secondly, we want to improve patient care, including providing high-quality, joined-up services for those suffering long-term or life-threatening conditions, so that patients are treated with dignity in safe, clean environments.

Thirdly, our aim is to ensure that more accessible and convenient care is integrated across primary and secondary providers, reflecting best value for money and offering services in the most appropriate settings for patients. Fourthly, we will establish a vision for the next decade of the health service that is based less on central direction and more on patient control, choice and local accountability, and which ensures that services are responsive to patients and local communities. The terms of reference for the review have been placed in the House of Commons Library, and I have written today to all NHS staff to explain the importance of this new approach.

Professor Darzi will complete an initial assessment in three months’ time to inform the comprehensive spending review. He will produce his full report in the new year, setting out a new vision for a 21st-century NHS, coinciding with the 60th anniversary celebrations.

I know that the review will not succeed if it is controlled from above: the best of the NHS sits not at the top of the organisation but in the millions of complex and diverse relationships that exist across the country between dedicated, devoted professionals and their patients. The success of the review will depend on gaining access to those relationships and stimulating a range of lively, local, provocative debates. The scale of our discussions with staff, patients and the public will be unprecedented, harnessing Professor Darzi's wide experience of building engagement as part of his work in London and elsewhere.

Patients must have the chance to shape the kind of NHS they want, to say how they wish to access services as they manage increasingly complex lives, juggling competing demands. They should have the chance to say how they feel about services delivered through pharmacies, the internet and other new technologies. We must respond by ensuring that they have more convenient services, open when they need them, making it easier to book timely appointments. Patients should also have the chance to say how we can make services more personal to them, particularly in long-term care.

Although it is right that we look forward, we must also deal with the problems at hand. A major immediate concern for patients is the cleanliness of hospitals. Last year, NHS staff successfully brought about a reduction in MRSA bloodstream infections as well as stemming the increase in C. difficile reports. Today, I am providing funding for each director of nursing in every strategic health authority to work with front-line nurses to ensure that they get the support they need to provide clean, safe wards. I am also doubling the size of the infection improvement teams, so that all trusts struggling to meet the MRSA target can have access to doctors and nurses who are experts in infection control, to help them get back on track.

Public services cannot be transformed by going against the grain of public service, or without support from the professionals who know the NHS best. As Secretary of State, I am determined to establish a new, closer, more robust social partnership between patients, practitioners and policy makers, based on trust, honesty and respect. That is why Professor Darzi is leading the review, supported by a team of leading clinicians across the country. He will engage directly with front-line staff, not just the great and the good of the health world, but those working in every primary care trust and hospital trust up and down the country.

As part of the review, we must look at how we make decisions on the shape and location of hospital services. The way we do so must be transparent, open and accountable. People need to know that decisions are being made for the right reasons by clinicians, and are based on the best available medical evidence. While the review is under way I will, as a matter of course, ask the independent reconfiguration panel—our expert clinical group—for advice on any decisions made at local level that have been referred to me by overview and scrutiny committees. I will make sure that any changes made are made on the basis of clinical need and patient care.

At the end of the review, we will consider the case for a new NHS constitution, with respect for the needs of patients and the judgment of professionals at its heart, ensuring that power is devolved to those who know the service best. That will ensure that the service is genuinely led by the needs of patients, providing value to the taxpayer as we move to the next stage of improvement. It will protect the enduring, cherished principles of universal health care, free at the point of need, which lay behind the establishment of the NHS, and ensure that this precious institution continues into the 21st century in ruder health than ever. I commend the statement to the House.

I thank the Secretary of State for advance notice of his statement. But is that it? The NHS an immediate priority for the Prime Minister? And what is the immediate priority? An 11-month review. If the Secretary of State really thinks we shall leave him alone for a year while he finds out what is going on in the NHS, he has another think coming.

It is 4 July today: I thought that it would be NHS independence day, but it did not turn out to be. I was disappointed by what I heard, and—notwithstanding a letter from the Secretary of State—NHS staff, along with the public, will be disappointed.

For a start, we need to know what on earth is going on. A fortnight ago, the NHS chief executive said in his report:

“in the autumn we will set out a clear, strategic direction for the NHS going forward”.

That report is now so much chip paper. The Secretary of State has started with the same self-congratulatory material as we got from his predecessor. He cited the Commonwealth Fund report. I hope that he has read it; yesterday, this incoming Secretary of State did not seem to have read much.

The Commonwealth Fund report compares Britain with only one other European country. On page 9, it says that the UK is worst on hospital-acquired infections; contrary to the Secretary of State’s self-congratulatory statement, levels of C. difficile have not been stemmed, but are continuing to rise. On page 15, the report places the UK worst on access to out-of-hours GP services and worst for waiting times. On page 21, it states that the UK has the highest mortality rates after adjusting for factors unrelated to health care—[Interruption.]

Perhaps the Minister of State, Department of Health, the hon. Member for Exeter (Mr. Bradshaw) has read it, if the Secretary of State has not. He says that the UK comes out best overall. Does he know why? The report puts into the equation what it regards as an efficiency measure, which it calculates on the basis of how much is spent. It adjusts the whole table on the basis of the fact that we spend less in the United Kingdom than Germany, Canada, Australia or New Zealand. Spending less is the main reason why the Secretary of State and his Ministers think that UK health care is best.

The only thing that the Secretary of State seems genuinely to have understood is that morale in the NHS is at rock bottom. In a recent Health Service Journal survey, NHS staff were asked whether morale was good or poor: 4 per cent. said that it was good, 0 per cent. said that it was excellent and 66 per cent. said that morale was poor or very poor. What on earth have we heard in the Secretary of State’s statement that would change any of that? We know what has to happen. We have published a White Paper that sets out direction and leadership. If the Secretary of State would only look at that, he would find things that clearly need to be done.

First, the core principles of the NHS need to be entrenched in statute. We are prepared to do that; apparently, the Secretary of State’s predecessors were prepared to as well, although with the exception of the principle that public funds for health care should be devoted solely to NHS patients. We subscribe to that principle. Will the Secretary of State now say that he will do the same?

Secondly, we need no more pointless organisational upheaval. My right hon. Friend the Member for Witney (Mr. Cameron) has been saying that for a year, and finally Ministers have accepted it, so we can put that one down. Thirdly, the Government need to set the resources and objectives, but not to interfere in the day-to-day decisions of the national health service. In a recent poll, 67 per cent. of NHS staff and 71 per cent. of the public agreed with that proposition. Where is that today? If there were such an acknowledgement by the Secretary of State, he would scrap targets immediately.

Fourthly, we need to take decisions close to patients. I am astonished that the incoming Secretary of State said nothing today about the centrality of the family doctor service and primary care, having a primary care-led service and strengthening commissioning. Fifthly, we need independent regulation of health care providers; even his predecessor acknowledged that we needed independent regulation. We need not a review but legislation in the next parliamentary Session to achieve those things.

I have mentioned five long-term reforms, of which the Secretary of State has acknowledged only one. The NHS desperately needs leadership and direction. Reform in the NHS is confused and incoherent, and on its own admission, the Department of Health has no vision of where the NHS is going. We set out a blueprint. Come on, Secretary of State, steal our clothes! We need to show the NHS that politicians can work together for the long term to give it the framework that it really needs. Only if there is that long-term framework can we deal with the real challenges of demography, technology, productivity and improving public health outcomes.

The Secretary of State said that he was dealing with immediate issues, but he mentioned only one, with something that should have been done years ago. Will he abolish the top-down centralised targets that stop NHS professionals doing their jobs and distort clinical priorities? Will he make the allocation of NHS resources fair and independent? We have asked for that, the Health Committee has asked for it, and two weeks ago his predecessor said that she thought it was the right thing to do.

Will the Secretary of State stop major service reconfigurations? He is apparently going to put a brake on them and use the independent reconfiguration panel. When he goes to his new colleague, Sir Ara Darzi, and mentions that he is going to do that, Sir Ara Darzi will be amused, because in Hartlepool he was used by Ministers to bring forward proposals on reconfiguration, which were promptly overturned by the independent reconfiguration panel. That is not much of a recommendation for the policy-making skills of Sir Ara Darzi.

Will the Secretary of State tell the House how it can be right, in terms of clinical need and patient care, for accident and emergency departments in Surrey and Sussex that treat up to 300,000 people to be shut down, while in Bishop Auckland hospital in Durham, which serves the former Prime Minister’s constituency, an accident and emergency department that treats 125,000 people is apparently absolutely fine?

Will the Secretary of State create additional training posts and assure well-qualified UK-based junior doctors that they will have an opportunity for specialty training? How can an incoming Secretary of State for Health not recognise that the crisis in junior doctor training is an immediate issue to be tackled? If the Secretary of State is so keen on a review, will he today initiate the independent review that we have called for on NHS IT—one that really listens to the people working in the NHS?

Five long-term reforms are required. There are five urgent issues. What have we got? Two. Two out of 10: those are the Secretary of State’s marks so far. We would give the NHS the priority that it really needs by taking the action required. Where is the immediate priority that the Prime Minister promised? Where is the autonomy and accountability that the NHS is calling out for? Where is the leadership and the direction that the NHS so badly needs? The NHS is there for us. Why will not the Government trust NHS staff to deliver?

I am tempted to ask—to echo the hon. Gentleman’s predictable response—“Is that it?”. It is a shame, because he thinks about these things, and he sent me a letter about having a dialogue on resolving these issues. His response will not be shared by NHS staff. NHS staff right across the country will be pleased that we are initiating the biggest consultation exercise we have ever had—a genuine dialogue about how we move to the next phase of the NHS. The hon. Gentleman said that we were asking Members on the Opposition Benches to sit silent for a year—but as I said in my statement, we are asking Ara Darzi to report first in October. The second part of the report will be next year, but certainly not 12 months away.

The hon. Gentleman said that he thought this was going to be NHS independence day. I take issue with him about the Conservative party’s policy on independence for the NHS. It is a fundamental central plank—

That was yesterday. I have had time to read it overnight, and I am deeply unimpressed. There is some tinkering around with detail that I would be pleased to talk to the hon. Gentleman about—particularly in the context of GP practitioners, which is an important issue—but the central plank of Conservative party policy is that we ought to hand the NHS over to some kind of 1960s public corporation, and it should be run completely independently by that huge quango. That will not work. I cannot think of a worse recipe for addressing the problems that we have in the NHS, which are about the work force believing that their views have been completely ignored in the context of the issues that have led to change, and that they are being talked down to by Whitehall, rather than their having a role in deciding the issues, based on clinical need, and patient care being an absolute priority.

The hon. Gentleman said that morale had reached rock bottom. I doubt whether it has reached as low a level as it reached during the 1980s, but I accept that morale is low. He cannot make up his mind whether he wants things to be top-down or locally decided. He quotes the example of A and E reconfiguration in Sussex. That is a local, clinically-driven decision happening in that area. It is absolutely right that we should allow those proposals to go on. Incidentally, nine out of 10 reconfiguration proposals are decided and agreed locally, and do not even get referred to me for decision by the overview and scrutiny committee.

We are not saying that the statement solves all the problems in the NHS. Of course there are problems in relation to junior doctors and problems to be tackled in a whole range of areas, but I hope that when Members on the Opposition Benches have had time to reflect, they will agree about using a team of highly respected clinicians who work in the NHS day in and day out. Incidentally, Professor Sir Ara Darzi will continue with his practice for two days a week, even while he is a Minister. It is right that he is a Minister, because if we handed the review to someone outside the NHS, and then outside Government when the review was delivered, that would be far less powerful than having someone conducting the review and being in government to ensure that the review is implemented.

The Conservative party has crossed the Rubicon. You have crossed the Rubicon in relation to getting rid of the patient passport. You have crossed the Rubicon in making the NHS a priority—

Order. The Minister should be careful when he uses the term “you”, because some people might think that he is talking about me.

I apologise, Mr. Speaker. I should say that the Rubicon has been crossed. Core principle No. 7 of the NHS core principles, which the hon. Gentleman’s party has now signed up to, says:

“Public funds for healthcare will be devoted solely to NHS patients”.

We remain committed to that. It is a big change for the Conservative party to follow us across the Rubicon, and the hon. Member for South Cambridgeshire (Mr. Lansley) has left some Members behind on the other side. Sitting behind him is the hon. Member for Wellingborough (Mr. Bone), from the Cornerstone group, who still has to cross those perilous waters. Now we can decide together how we will take the NHS on to its next stage.

I thank my right hon. Friend for his statement. I am sure that the Health Committee, of which I am a member, will want to look in some detail at what has been placed in the Library. My right hon. Friend said that society cannot stand still. Does not most of what was said from the Opposition Front Bench disprove that theory? Most of the time the Conservatives do want to stand still and not to move on. If the review is to look at targeting, will he make sure that targets set—whether at local or national level—in order to get rid of health inequalities are not removed, but are improved, so that we can address health inequalities in a serious way and have a national health service that deals with that matter better than it has in the past?

My right hon. Friend is right, particularly when he describes the conservatism of Members on the Opposition Benches, which is hardly surprising. We needed to be top-down and to set targets to transform the situation in the NHS, particularly in relation to waiting lists. My right hon. Friend has a long and proud record of standing tall for the NHS and of arguing for the necessary changes. The point that I made both yesterday and today is that the NHS needed to be, in effect, in intensive care. It is now on the road to recovery. We need a different approach, and we need that to be formulated into a new constitution for the NHS that can make it fit for the 21st century.

I thank the Secretary of State for the advance copy of his statement. As an aside, the new Government, under the new Prime Minister, have said that they want to strengthen Parliament. May I suggest that providing copies of statements a little earlier than traditionally happens would be a sensible reform? That would mean that there could be a much more informed debate, rather than Members trying to come up with an intelligent response in the 35 minutes before the statement is made. I would be grateful if that could be considered.

The statement is surely something of an admission of failure, given that after 10 years of the Government’s stewardship of the NHS, they are still searching a strategic direction. It comes after the Cabinet Office’s review of the Department, which was pretty scathing about the leadership offered and the lack of strategic direction. Nevertheless, I give it a cautious welcome, provided that the Government are prepared to examine fundamentally the serious weaknesses in their stewardship of the NHS, primarily the far too great centralisation of the way in which the service is run. I welcome the fact that consideration will be given to a constitution, because that approach seems entirely sensible.

I am worried that it appears that the process will be entirely led by clinicians and health professionals. Will it involve patient representatives, other groups with a direct interest and the public? I appreciate that the public will be consulted, but will only clinicians and health professionals make all the decisions and recommendations?

There are some fundamental weaknesses regarding the four areas that the review will examine. I was amazed that no reference was made to health inequalities and fairness. I raised that point during yesterday’s debate. Health inequalities have increased under the Government in recent years, not reduced, despite the Government target on cutting such inequalities. Will the Secretary of State reassure me that even though there was no reference to health inequalities in the statement or the terms of reference, the review will examine them as a central issue?

The proposals are pretty thin on the question of productivity. More and more people tell me that despite the enormous record investment, which we supported, money could be used much more effectively to achieve outcomes for patients who need help. Will there be a central look at how to improve productivity in the NHS?

There has been a series of contradictory reforms over the past 10 years. Structural changes have subsequently been reversed, so I welcome the fact that there will be no more such changes. However, will the review address something that the former Secretary of State recognised in a speech that she made just before she stood down: the local democratic deficit in the NHS? She said that there was a need to strengthen local accountability. Yesterday, the Prime Minister said that he would look to devolve power genuinely. How seriously will the review address providing genuine democratic accountability locally in the NHS?

The Secretary of State said that existing problems needed addressing, but he referred to only one: hospital-acquired infections. He said that he would commit additional resources to tackling that problem, but how much extra will he provide for the strategy? Will this not be, again, too much of a top-down approach, and will it sufficiently engage staff? The Department was supposed to be producing a guidance note on the use of antibiotics, which is critical to tackling hospital-acquired infections, but so far that has not appeared.

Finally, a number of existing problems need to be addressed, especially regarding out-of-hours care and access to NHS dentistry. Will the review examine those problems, too?

I am very grateful for the hon. Gentleman’s positive comments. I will consider whether, as part of this great new world in which we are living, we can give out statements much earlier. This statement was not finalised until 11 o’clock, but he makes a fair point. I hope that hon. Members accept that there was nothing about the statement in this morning’s newspapers or on the “Today” programme. We tried hard to ensure that the statement was heard by Parliament first.

The hon. Gentleman asks whether this is an admission of failure, but that is not the case at all. The Government have to be big enough to recognise the problems in the NHS, which have not been caused by a failure in investment, resolve, additional staffing, or reducing waiting lists. Staff feel bemused and dazed by the fact that many changes have taken place over a short time, so it is important that we tackle that. The hon. Gentleman referred to the speech made by my right hon. Friend the Member for Leicester, West (Ms Hewitt) to the London School of Economics the week before last. That bears reading because she was pointing in that direction. Indeed, she mentioned the important point raised by the hon. Gentleman about the democratic deficit.

The hon. Gentleman raised many important issues, but let me pick out one: health inequalities. The matter is crucial to the Government, although it was virtually ignored before when there was no focus on health inequalities. Although elements of the Darzi review will relate to the issue, it is too important for us to wait for that review, so I assure him that we will crack on with that as an absolute priority.

Let me make a point about the role of the patient. I said in my statement that the patient is crucial. The first part of the review will involve Professor Darzi’s team of clinicians listening to patients as well as staff. Patients are as important as any other group because their buy-in and commitment to the NHS really matter to its health in the future.

Order. If this is not stating the obvious, may I just say to the House that the opening exchanges have been very extended? Protecting Back Benchers is the job of the Chair, but equally, I hope that Back Benchers will help the Chair to get as many people in as possible. I ask that questions be brief and that answers be concise.

I welcome my right hon. Friend to his new post. Despite increased funding and better facilities, a recent report showed that the health of people in my constituency was still well below the average of those living in other constituencies. Will my right hon. Friend not lose sight of the fact that our party has a commitment to moving the outriders with well below funding up to the average for the rest of the country?

I recognise the problem that my hon. Friend raises, which also affects the city that I represent. I assure him that that is one of the major priorities that we must tackle, but it can be addressed only with a bottom-up, rather than top-down, approach. That is the reason why we must ensure that local health authorities are able to tackle the problems in their areas. The problems in Kingston upon Hull will be different from those in Kingston upon Thames, while those in Bolton will be different from those in Bradford. That is an essential reason why we must have a bottom-up process.

In the light of fact that the Secretary of State said in his statement that he wanted more “patient control, choice and local accountability”, what encouragement can he give to patients who are fighting to retain services at their local community hospitals, such as Doddington hospital in my constituency? Are those words about patient choice as empty as his predecessor’s?

The important point about any reconfiguration involving community hospitals is that there should be local dialogue with the patient voice included in the locally driven process. I remind the hon. Gentleman that we put £750 million of capital into community hospitals. Some closures have been agreed by local health service professionals, but every time that that has happened, there has been an insistence that a new service be provided. Sometimes that service is much closer to patients’ homes and is a community resource. The health service that we inherited 10 years ago, let alone that of 60 years ago, cannot ossify and be set in aspic. It is important that such changes happen, but the patient voice is absolutely crucial when there is any change.

My right hon. Friend said that he would ask the independent reconfiguration panel to consider any decisions about hospital changes that are referred to him while the review is under way. Will he look into some of the reviews that are now under way? The “fit for the future” review has major implications for hospitals in north-east London, but I do not believe that it has been carried out in the transparent and accountable way that he suggests is needed, or that front-line staff have had serious involvement with patients. It seems highly unlikely that any recommendations arising from the review will fit the criteria that he says he wants to apply.

The important thing is that if there has not been transparency in the procedures locally, that is a reason for the overview and scrutiny committee to refer the decision to the Secretary of State, and it is one of the things that the independent reconfiguration panel will consider; specifically, it will look at whether there has been a proper consultation, and what that means for patient care, so I think that I can reassure my hon. Friend. I want clinicians, not politicians or bureaucrats, to make decisions, on the basis of what is best for patient care.

The Worcestershire Hospitals Acute NHS Trust will shortly come forward with proposals, which we expect will include the axing of maternity and paediatric services at the Alexandra hospital, which serves my constituents and those of the Home Secretary. Bearing in mind that the cuts are very unpopular locally and could lead to future questions about the hospital’s accident and emergency unit, and bearing in mind that the cuts are motivated by the fact that the Alexandra is an NHS hospital, and the Worcestershire Royal hospital is a private finance initiative hospital that cannot be touched, may I take it from the Secretary of State’s statement that if such changes are proposed in the near future, they will be put on hold while the review is undertaken?

No, sadly not. I always like to say something encouraging to the hon. Lady, but I cannot say that we will put the measures on hold. Indeed, it would be betraying the patient if we put all change on hold, because many of the changes taking place across the country are necessary. There must be a process of local consideration, and I am not going to stop that consideration taking place. If the case is referred to me by the overview and scrutiny committee, I promise the hon. Lady that I will refer it on to the clinicians on the independent reconfiguration panel.

The Secretary of State is absolutely right to stress the importance of making the NHS and its doctors more accountable to the patients whom they serve. He will be aware that performance, in terms of both clinical outcomes and productivity, varies enormously from one doctor to another. Will he ask Professor Darzi to talk seriously to the royal colleges about how to address those inconsistencies of performance, and how to publish information in a way that the public will understand, so that the public have a say on the quality of care that they receive from the doctors whom they visit in the NHS?

As Professor Darzi is a member of almost all of the organisations that my hon. Friend mentions, I am sure that he will talk to them about the issue. Indeed, the issue of the disparity between services in different parts of the country is a major part of the review.

The Secretary of State said that he would double the size of infection improvement teams, so that all trusts could have access to an infection control nurse or doctor. According to his predecessor, that was already happening. If the Secretary of State wants to know how to keep wards clean and how to stem MRSA increases, he should look no further than the Royal Marsden hospital, which was mentioned by his predecessor when she was at the Dispatch Box. At the Royal Marsden, no nurse is allowed to travel home in uniform, and all uniforms are laundered on site. Stopping MRSA and keeping wards clean is not brain surgery; I suggest that there be no review, and that he look at the Royal Marsden instead.

Even I would not get brain surgery mixed up with the measures that the hon. Lady mentions. I am pleased by her remarks about my predecessor, who did indeed say the things that the hon. Lady said she did, and who put in place the improvement teams. We are now doubling the number of those teams. I am happy to praise the Royal Marsden, and indeed Kingston hospital, which I visited on Saturday, which has had tremendous success in tackling MRSA. We need to ensure that that success is replicated elsewhere.

I welcome today’s statement, which will build on the improvements that I have seen to the local health community in Blackpool. My right hon. Friend will recall last year’s White Paper, “Our health, our care, our say”, which mentioned the importance of social care services working with health services to deliver the Government’s public health agenda. Will he take this opportunity to reconfirm the central role played by such services, so that patients can be considered as a whole and get the services that they need?

I can give my hon. Friend the assurance that she seeks. Social care will not be a specific part of the Darzi review, as Darzi is looking at the national health service, but he will talk to social care providers to get a feel for their concerns. I will discuss the matter with the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis), who is responsible for social care, because I understand the issues relating to social care, the need to ensure that we keep our partnership with local authorities, and the need to improve the quality of social care.

Given that the lifetime cost of untreated communication disorders is estimated by the educational charity I CAN to be no less than £26 billion, how, in practical terms, does the Secretary of State intend to work with the Secretary of State for Children, Schools and Families to ensure that all children with such conditions get the help that they need, and do not suffer the irretrievable damage, for themselves and the country, that will otherwise result?

The hon. Gentleman has consistently and eloquently raised the issue. He raised it with me when I was in the Department for Education and Skills and, if it is not revealing any secrets to say so, he sent me a note saying that the issue is equally important to the Department of Health. I invite him to come and speak to me so that we can have a discussion on the subject, and on how best we can integrate the work of the two Departments on speech and language therapy, because I recognise the importance of the issue.

My right hon. Friend rightly referred to the need to value NHS staff, but the NHS contains a large number of staff who are not doctors or nurses. I seek an assurance from him that our valuable support staff will be involved in the process. Will he seriously consider implementing the recommendations of the Fryer report on widening participation in learning, so that support staff get the training that they need and are valued for the contribution that they make to the NHS?

Yes. My speech did not leave out ancillary staff such as hospital porters—I made the point that everyone who works in the NHS will be involved in the exercise. The group that my hon. Friend mentions is particularly important, as is the training element to which she referred. That is why the social partnership forum action plan, which was launched in April with the support of all the unions, the education sector, the Department of Health and the strategic health authorities, has been well received, but we need to build on it. I understand the issue that my hon. Friend raises.

I welcome the promise of stability and of consistent use of the independent reconfiguration panel for all contested reconfigurations. In view of the transition from patient forums to local involvement networks—LINks—how will the Darzi review select the patients and members of the public to whom it will talk?

That level of detail is being worked out by Professor Darzi and his team across the country. I will ensure that the hon. Gentleman’s point is raised, so that we do not fall between two stools. It is important that we hear the patient’s voice, and that it is accurately recorded. I am sure that on future occasions the hon. Gentleman will have opportunities to question me on how that is going.

Has my right hon. Friend any news of the proposed second wave of independent sector treatment centres, six of which have been cancelled, according to this morning’s edition of the Financial Times?

Well, hon. Members should not believe everything that they read in the Financial Times. All that I can say to my hon. Friend is that every single ISTC proposal has to be cleared, not just by my Department but by Her Majesty’s Treasury, on the basis of whether it is cost-effective, and whether it provides capacity that does not exist. The whole point is to get more MRI scanners and more cardiothoracic centres, and to bear down on the issues so that we attain that precious objective of patients waiting only 18 weeks from referral to treatment. We cannot put that on hold, and that is why the Financial Times story is inaccurate, but we can ensure that at every stage we get value for money and add to capacity. That is the whole point of using the independent sector.

Following on from that question, may I ask the Secretary of State what the Government’s general view on the second wave of independent sector treatment centre contracts is? In particular, will he say when he is likely to sign a contract for Cirencester hospital, which I gather is on his desk or his Minister’s desk? I am sure he would agree that prolonged uncertainty does nothing for the morale of the staff and the clinicians in that hospital.

I have not had a chance to look at that, but now that the hon. Gentleman has raised it, I will look specifically at his scheme.

I welcome the Secretary of State’s statement and the fact that he is in listening mode. I will bring him many of the local issues that I wish to discuss, such as GP referrals and GP out of hours services at walk-in centres. It is important that the review is not just hospital led. Does my right hon. Friend agree that public health, especially challenging lifestyles, will be the most important thing that we do? Obesity is reckoned to cost the country £8 billion a year. Will he work across Departments, as he has done in his other roles, to ensure physical activity, sport and so on play a crucial role in developing and delivering many of the lifestyle changes that are needed to reduce health inequalities?

My hon. Friend is right. I can give him the assurance that public health will be a central part of what we are examining. We are some way off our public service agreement target on obesity. As I mentioned in my statement, these are the new problems that we are dealing with. Lifestyle changes have brought about a whole set of new problems that did not exist back in 1948. Malnutrition, rather than obesity, was the problem then. We need to tackle that and face up to the challenges presented by demographic and lifestyle changes. That is one of the basic reasons for the review.

This morning the National Audit Office published a strong and critical report on the diagnosis and treatment of dementia in the United Kingdom, comparing us unfavourably with the rest of Europe. Given that the second of the review’s objectives is dealing with long-term debilitating illnesses, may I ask the Secretary of State whether, in the first three months, he will be able to use the review to come up with a strategy to respond to the NAO’s criticisms?

I am not sure whether I can set a time scale, but that was an extremely important report. We need to study it carefully and work with the Alzheimer’s Society to see how we can resolve the problems. The review is crucial. The right hon. Gentleman will have a chance to see the terms of reference in the House of Commons Library, but as I mentioned, Professor Darzi will look particularly at the new challenges of an ageing population.

I welcome my right hon. Friend’s desire to go deeper than the professors. In Newcastle, at the university of Northumbria we have an expanded group of physiotherapy graduates with no jobs to go to, and a huge need to raise the quality of physical activity and deal with avoidable pain and discomfort. The north-east health authority, which is responsible for planning and training, has a surplus of £60 million. Will my right hon. Friend knock heads together and get that sorted out?

I will look at that problem. It needs local partnerships to tackle those issues in their locality. Once again I say that that is why we need a bottom-up national health service, rather than a top-down one. I am willing to discuss with my hon. Friend the specific matters that he raised, should he wish to come and see me.

May I congratulate the Secretary of State on his promotion, but say to him that I am astonished that Professor Darzi is working only two days a week on the project? I thought that it was urgent. Surely he should be doing more. May I alert the right hon. Gentleman to a potential problem at his Department of which he may not be aware? There are two important reports on the regulation of Chinese medicine and herbs by Professor Pitillo and the late Lord Chan. He must act on them because European legislation is round the corner, and it would be very much in the mode of Aneurin Bevan, who had a homeopathic doctor and wanted a fully integrated health service.

Well, well, if it was good enough for Nye, it is good enough for me. I will look into that, but may I clarify the fact that Professor Darzi is working two days a week for the NHS? He is an esteemed surgeon, and he does that free of charge, incidentally. It is important that he carries on his practice. I know that the Opposition will not appreciate this. I heard their comments from a sedentary position about his being a Minister, but I think it is right that he is a Minister and that he continues to practise. That gives him a special focus. He is already hugely esteemed and highly valued in the profession, but taking away one or other of those aspects would not make his role any easier and, indeed, would diminish it.

In relation to the shape and location of hospital services, may I tell my right hon. Friend that our most pressing need in Northampton is for a new acute hospital? Will he ensure that when the proposals for that are drawn up, they will be expedited through the Department and given financial support—I see our new Chief Secretary to the Treasury on the Front Bench—so that my constituents in a growing town can have the quality of hospital that they deserve for the 21st century?

The Chief Secretary to the Treasury knows a thing or two about those aspects of the national health service. I can assure my hon. Friend that we will expedite the matter and make whatever decisions need to be made very quickly.

The Secretary of State spoke about a more robust partnership between patients and policy makers based on trust, honesty and respect. With reference to rationing, which means that some effective treatments are not available on the NHS, will he be the first Minister to accept that rationing is taking place and that that needs to be done transparently and rationally, as the National Institute for Health and Clinical Excellence seeks to do?

I do not know whether I would be the first Secretary of State to accept that that is the case, but I do. That is the reality of how the system works. We set up NICE to take those decisions out of the hands of politicians, and NICE is now world respected. In many countries there are attempts to replicate it. The hon. Gentleman makes an important point.

I welcome my right hon. Friend’s resolve to tackle health inequalities. He will be aware that my primary care trust is underfunded by some £11 million compared with what its funding should be, according to the Department’s formula. May I press him to give an assurance that in the next comprehensive spending review he will make substantial progress towards eradicating funding inequalities so that primary care trusts have the resources to tackle those inequalities?

I thank my hon. Friend for those remarks. The report by Professor Darzi and in particular his extensive consultation right across the national health service, including on issues such as funding and inequalities in funding, will form a major part of our decision on the CSR. In that respect, I can give my hon. Friend the assurance that he requires.

Whatever the Secretary of State’s intentions, my constituents will be worried by yet another review of the NHS, just as they will be worried by the absence from his statement of any reference to the story in the Financial Times that the previous Chancellor of the Exchequer, in his last act, cut by a third the NHS capital budget. Will the right hon. Gentleman reassure my constituents that neither the review nor that policy change will have any bearing on the approval of the new Pembury PFI hospital in my constituency announced by the current Chief Secretary three months ago? Can he reassure us that that will be unaffected by his statement and that policy change?

I can give the hon. Gentleman the reassurance that he seeks. I take the opportunity to say, while the Chief Secretary is on the Bench, that the Chief Secretary wrote to the Financial Times about the story about £2 billion of funding being taken out and made it clear that all we were doing was looking at how much money was spent that year in the NHS. The extra money is still available to be spent this year.

I warmly welcome my right hon. Friend to his new position and in particular the powerful way in which he spoke of the need to address health inequalities. Does he agree that health visitors are some of the most important people in our health service as they are able to reach out to some of the poorest families and most disadvantaged groups in our communities, and that the value that they bring to the health service by addressing those inequalities from an early age is of primary importance?

I agree with my hon. Friend about the importance of health visitors and health visiting, which is why we have recently had a review and are considering its recommendations, and I am sure that my hon. Friend, as always, will be following this with great interest.

How will the Secretary of State’s statement help my constituent, Mrs. Ruby Waterer, a 79-year-old, who went to hospital with an eye complaint only to be told that she would go blind if she did not have three injections? When Mrs. Waterer asked when she could have those, she was told that she could not have them on the NHS, but that she could go down the road a couple of miles and have them done privately for £3,300. That is not the Government’s intention, so how will the Secretary of State help Mrs. Waterer?

Various comments are being made by my hon. Friends about the hon. Gentleman raising this matter yesterday and his article—

I doubt if I can answer it today, but, with respect, I care more about the hon. Gentleman’s constituent than I do about him. It sounds to me as if she has an issue that we need to tackle, and if he writes to me about it, I will look into it.

I welcome the review, but it is surprising that so far we have not touched on carers, particularly of people with dementia, which has been mentioned. Those carers are the experts, with whom the NHS must deal. Can my right hon. Friend assure me that in this important review, carers will be listened to, particularly the expert carers, such as those handling dementia?

My hon. Friend raises an important point. Alongside the Darzi review is a comprehensive review of carers that was announced recently by the Prime Minister. We are looking to see what extra help we can give to carers, having already done a lot in respect of pensions and the right to request flexible working, but we need to take a series of other measures, because carers save the Government a lot of money, which can be spent elsewhere in the health service. We are probably the first Government to recognise their importance, and we will ensure that the review is completed speedily.

To what extent will some of the long-term financial pressures within the NHS be examined in the review, in particular the affordability of PFI-funded hospitals, when Professor Darzi may well come up with models of care that direct patients away from those hospitals, and therefore direct some of the income for those hospitals away from them, challenging their ability to pay the underlying PFI costs that are already entrenched within the system?

We will have to deal with Professor Darzi’s recommendations when they come up, but we could never have embarked on this huge programme of rebuilding hospitals without PFI. When we came into Government, most of the NHS estate was built before the NHS was created. Now only a fifth of it was there before 1948, and that is because of the biggest hospital building programme ever in this country, and probably one of the biggest in the world. PFI was necessary to ensure that we did that.

Palliative Care

I beg to move,

That leave be given to bring in a Bill to make provision for palliative care for persons who are suffering from a terminal illness; and for connected purposes.

In another place, Baroness Finlay has steered through a similar Bill, without amendment, so it is with that which I wish to continue in this House.

Palliative care is part of supportive care and it embraces many elements of supportive care. It has been defined by the National Institute for Health and Clinical Excellence as affirming life and regarding dying as a normal process; providing relief from pain and other distressing symptoms; integrating the psychological and spiritual aspects of patient care; offering a support system to help patients to live as actively as possible until death; and offering a support system to help the family cope during the patient's illness and in their own bereavement.

As at January 2006, in England, Wales and Northern Ireland there were 193 specialist in-patient units providing 2,774 beds, of which 20 per cent. were NHS beds; 295 home care services—this figure includes both primarily advisory services delivered by hospice or NHS-based community palliative care teams and other more sustained care provided in the patient's home; 314 hospital based services; 234 day care services; and 314 bereavement support services.

Everyone facing a life-threatening illness will need some degree of supportive care in addition to treatment for their condition. NICE has defined supportive care for people with cancer, and with some modification the definition can be used for people with any life-threatening condition. For example, I should like it to be extended to cover sufferers of motor neurone disease.

About 5,000 people are estimated to be living with motor neurone disease in the United Kingdom, and half of those with MND die within 14 months of diagnosis. Many people with MND are unable to access the palliative care services that they require. In a survey carried out by the Motor Neurone Disease Association in 2005, only 39 per cent. of people with MND had been referred to specialist palliative care services. In addition, there are unacceptable geographical variations in the quality of service provision and that can have a negative impact on the quality of life of people with MND and their families. Not surprisingly, the association believes that specialist palliative care services should be available to everyone with MND, in a setting and at a time of their choice.

My Bill seeks to broaden the scope of palliative care to cover all those with a terminal illness. It also aims to cater for the needs of those suffering from a terminal illness in allowing them the choice of where to die. In December 2005, a report by the NHS Confederation highlighted the real need to improve end-of-life care for the terminally ill. The report showed that 56 per cent. of terminally ill patients would prefer to die at home, but only 20 per cent. do so. Alternatively, only 11 per cent. of people want to die in hospital, yet 56 per cent. do so. Better co-ordination between service providers is urgently needed if we are to improve end-of-life care for the terminally ill.

We also need better access to palliative care services. According to Marie Curie Cancer Care, more than 155,000 die of cancer every year, yet Help the Hospices points out that only 3,250 hospice beds are available, and 2,489 are supplied by the voluntary sector. I have campaigned for many years, urging the Government to increase funding to hospices, particularly children’s hospices such as Derian House based in my constituency, which is a leader in child care. We must ensure that the Government release more funding. It is alarming that children’s hospices are the poor relation in palliative care.

First, there is an acute shortage of paediatric palliative care medicine consultants. Secondly, children's hospices receive only in the region of 5 per cent. of funding from official sources, compared with 30 per cent. for adult hospices, so we can already see the vast difference in funding from the NHS. I want that anomaly to be addressed, in addition to the clear postcode lottery that exists with palliative care. Terminal illness places great strain on families and loved ones. The least they can expect is to have the necessary support and help in making those final days as comfortable as possible. Extending palliative care would not involve a huge increase in expenditure—it mainly requires specialist knowledge in the use of pain-relieving drugs and holistic care to ease the dying process. Marie Curie Cancer Care, in its report "Dying at Home", states that for every £1 invested in home palliative care services, £2 will be freed up for the NHS. Despite that, 80 per cent. of resources are allocated to hospital-based care. We need to shift the emphasis in the funding streams.

In recent years, great strides have been made in palliative care—we all recognise that. Our hospices do a wonderful job in supporting the terminally ill and their families. However, we need to do much more to support the terminally ill. We must ensure that their needs are catered for and that access to treatments, help and support are equal regardless of postcode. The answer is not to legalise euthanasia or assisted suicide. Everyone has the right to life and the right to palliative care. That is what my Bill aims to achieve and I commend it to the House.

Question put and agreed to.

Bill ordered to be brought in by Mr. Lindsay Hoyle, David Taylor, Jim Dobbin, Mr. David Crausby, Geraldine Smith, Mr. David Amess, Mr. Julian Brazier, Mr. Ben Wallace, Mr. Nigel Evans, Simon Hughes, Dr. Brian Iddon and Mr. Bob Laxton.

Palliative Care

Mr. Lindsay Hoyle accordingly presented a Bill to make provision for palliative care for persons who are suffering from a terminal illness; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 19 October, and to be printed [Bill 138].

Orders of the Day

Child Maintenance and Other Payments Bill

Before I call the Secretary of State, I must tell the House that the Order Paper should have included a tag referring to the Fourth Report of the Work and Pensions Committee on Child Support Reform and the Government’s response.

I beg to move, That the Bill be now read a Second time.

The Bill provides for a new system of child maintenance in Britain. At its heart is the commitment to ensure that whatever happens to the relationship between two parents, the interests of children must always be paramount. However, the Bill also learns from the lessons of the past. It makes tackling child poverty the No. 1 priority for the child maintenance system by ensuring that more of the maintenance paid goes directly to the children and by maximising the number of children living apart from one or both of their parents for whom effective child maintenance arrangements are in place.

The Bill actively promotes parental responsibility by removing the barriers that prevent parents from reaching their own voluntary agreements. Never again will mutually agreed maintenance arrangements be forcibly overturned by a compulsion for parents with care receiving benefits to use the Child Support Agency. The Bill embeds the principle of choice whereby those on benefits should have the same choice as those not on benefits to make their own arrangements or to utilise the new child maintenance and enforcement commission—CMEC—to access the statutory scheme. For the first time, the system will no longer discriminate against people simply because they are poor.

I appreciate and support what the Secretary of State is saying. The Law Society of Scotland has pointed out that under the terms of section 4 of the Child Support Act 1991, a voluntary agreement will be restricted to a 12-month period. Is that the Government’s intention? If not, will he consider the fact that many families need the assurance that an agreement will last longer than just 12 months?

That is not the interpretation that I would put on it, but I will certainly consider the hon. Gentleman’s point. We are seeking a durable, long-term basis not only for the children, but for the parents. There is no desire on my part to create, perhaps inadvertently, the situation that he describes.

It is a laudable aim to encourage parents to make their own arrangements. However, is the Secretary of State confident about the position of lone parents on low incomes, perhaps where the split has not been amicable, the non-resident parent is no longer around, income cannot be determined and is opaque, or payments are not being received at all? Given that the CMEC will often be required to act as a last resort in terms of assessment and enforcement, does he have any estimate of the number of cases that might arise, and will the CMEC have the resources to deal with them?

My hon. Friend makes a reasonable point. In these situations, people on low incomes are the most vulnerable and the children are therefore doubly the most vulnerable. The CMEC will have a very important role. However, a significant proportion—I think a third—of those involved would like to make their own voluntary arrangements, but are prevented from doing so by the current structures. We want to facilitate that, but we certainly intend to guard against the situation that he describes. There is the fall-back that the commission has a statutory obligation to act in the way provided for by the Bill, and that will happen.

Further to the Secretary of State’s answer to the hon. Member for Angus (Mr. Weir), may I impress upon him the importance of not undermining the very effective system that we have in Scotland of minutes of agreement, which are entered into after legal advice by both parties and are then registered in the books of council and session, which means that they are summarily enforceable? If those minutes of agreement can be overturned after 12 months, as seems to be the case under the Bill, there may be less incentive for people to enter into them. Will he consider removing the 12-month limit or at least extending it to something in the region of 48 or 60 months?

We are trying to put in place a more sensible and flexible alternative, and I think that there is widespread cross-party support for that objective. If such arguments are put persuasively in Committee we will obviously want to take account of them. We are not seeking to impose anything, but to make progress. I shall want to bear in mind the points that Scottish Members of Parliament have raised so far.

I hope that the whole House agrees that, where possible, people should come to their own sensible arrangements that they police themselves without involving any state authority. However, is there not a danger that the taxpayer may get lost in all this? The Henshaw report said that if we almost entirely disregarded benefit income, the number of people who made private arrangements would be a mega-number, and therefore the numbers going to the commission would be very small. Fortunately, the previous Prime Minister intervened to prevent the Henshaw doctrine having force immediately. When will the right hon. Gentleman be able to tell us how much benefit income will be disregarded for people who come to private arrangements?

We are still carefully researching incentives to work—an issue that my right hon. Friend has continually, and rightly, pressed—in order to get this right. I welcome his question, as he has been a missionary in this whole initiative from a very long way back. The commission will have a very important role. It will deal with a significant number of cases; it is not designed to be put into some kind of longstop role. However, as he says, if we can get in place private voluntary arrangements that people want to make, overwhelmingly, in many cases, that is the preferable alternative.

I am grateful for the Secretary of State’s comments. However, let us suppose that the Government decide that £100 of benefit income will be disregarded. There would then be a huge push among families to say, “We’ve come to a private arrangement.” The carer would say, “I’m keeping £100 of taxpayers’ money, so it does not really matter what else the other partner contributes.” The loss to the taxpayer would be considerable, and ordinary working class families who are sticking together, and where there are two parents, would feel, “Gosh, yet again the rules are being rigged against those of us who are decent citizens.”

My right hon. Friend makes a fair point, as always. However, balanced against that is the need for arrangements to tackle child poverty, which is what the new commission is designed to achieve. As I am about to explain—when I get a chance—that is the Bill’s overriding priority, and I know that my right hon. Friend shares the ambition of pursuing that matter as a priority.

We must strike the right balance. We want to increase the disregard above the £10 that is provided for—in itself, it makes the families and children involved £10 a week better off, and that is welcome. But although we want to increase the amount, we must get the balance right and examine the impact that my right hon. Friend described and the danger of causing resentment among hard-working families, who are worried about other ways in which the benefits system works.

I appreciate, as I am in the same position, that the Secretary of State is new to the job. None the less, the previous Secretary of State said on 24 July last year—almost 12 months ago:

“we intend significantly to increase the level of the current disregard of £10. Details will be confirmed later this year.”—[Official Report, 24 July 2006; Vol. 449, c. 598.]

Why has it not been possible to present those details, not only last year but almost 12 months later, by the time of Second Reading? Will he assure the House that the information will be provided to the Committee before its proceedings start?

We must get the matter right, for the reasons that my right hon. Friend the Member for Birkenhead (Mr. Field) outlined. I do not want to establish an artificial timetable. [Interruption.] The Committee will be important and its proceedings will be studied carefully.

Clearly, creating a position whereby parents can reach an arrangement is important. Will my right hon. Friend set up measures to encourage parents to do that before the CMEC gets involved?

Yes. One of the provisions of the measure and of the new non-departmental public body will be a strong information and advice service that reaches out and works with other stakeholders, including One Parent Families, to ensure that those matters are explained and that the process is encouraged. However, the commission will stand ready to step in vigorously, with the purpose of ensuring that the children are protected and get the entitlements that they deserve.

The Secretary of State has been generous in giving way. Let me clarify the point that he just made. Will the CMEC take responsibility for providing advice and information? Clearly, such provision is important, and several independent advice organisations, such as Citizens Advice, have expressed concerns that the plans are not clear and that, if the CMEC is to take the lead responsibility for advice provision, there could be a conflict of interest.

There will be no conflict of interest. We want to maximise the opportunities of, for example, Citizens Advice, One Parent Families and the Child Poverty Action Group. All were involved in the extensive, cross-party consultation that took place before the Bill was drafted and following the Henshaw report. While I am about it, I welcome the hon. Gentleman to his new position; I look forward to working and sparring with him.

The arrangements in the Bill provide for a simpler, less bureaucratic assessment process, with new powers to obtain data from Her Majesty’s Revenue and Customs. Never again will the system be frustrated by relying on non-resident parents to provide information on their earnings. The measure legislates for the creation of a new, non-departmental public body, with radically strengthened powers to recover maintenance from those who repeatedly fail to pay.

The new Child Maintenance and Enforcement Commission will replace the existing Child Support Agency and mark a clean break with the past. The new commission will have primary responsibility for all aspects of operational and policy delivery. The CSA was set up in 1993 to replace an inadequate system of court-administered child maintenance. Despite the best efforts of its staff, it has never fulfilled the purpose for which it was established. We all, including me, know that as constituency Members of Parliament. Its problems are well documented.

When we came to office in 1997, the agency cost more to run than it collected in maintenance. It took longer to process claims than the courts. We introduced the Child Support, Pensions and Social Security Act 2000, which made important changes, simplifying maintenance calculations and strengthening enforcement measures. The agency’s performance has improved. Since 1997, it has doubled the number of children who receive maintenance payments—that is a credit to its hard-working staff, who do a good job in difficult circumstances.

The operational improvement plan is helping us to go still further in ensuring that the agency delivers for the parents and children who currently depend on it. That means that 200,000 more children will benefit from maintenance payments, with an additional 40,000 children lifted out of poverty. However, the operational improvement plan for the CSA was designed only to stabilise it and improve its performance in the short term. It cannot address the underlying structural weaknesses of the system.

For that reason, Sir David Henshaw was asked early last year to advise on a fundamental redesign of the whole system. The Bill builds on his recommendations and embeds three principled objectives in the heart of our reforms. They are to enforce children’s rights and parents’ responsibilities by maximising the number of cases; to provide a cost-effective and professional service, which gives the taxpayer the best value for money; and—most important—to make the greatest possible contribution to lifting families and children out of poverty. The Bill will deliver those objectives.

Together with the operational improvement plan, we expect the Bill to increase the number of parents who receive maintenance payments by 90 per cent., cut administration costs by approximately £200 million and lift a further 100,000 children out of poverty.

Has my right hon. Friend had time to talk to my right hon. Friend the Secretary of State for Justice about the Law Commission’s review of reforming the law for couples who live together? It is due to be published shortly and will examine more closely what happens when cohabiting couples split. It considers not only the revenue allocation for children and child support, but—critically—the capital allocation, especially the house where the child is resident. Has my right hon. Friend has a chance to discuss that yet?

I must confess that I have not. I will ensure that I inquire into the matter and I am grateful to my hon. Friend for drawing it to my attention because it is important and we must not overlook it. The Under-Secretary of State for Work and Pensions, my hon. Friend the Member for Warwick and Leamington (Mr. Plaskitt), our colleague in the other place Lord McKenzie and I will consider the matter.

The Secretary of State mentioned the importance of cost effectiveness. Will he clarify whether couples who have a voluntary agreement that breaks down can obtain enforcement of the agreement via the CMEC or will they have to get a CMEC agreement first? If the answer is the latter, it will be much harder to be as cost effective as I believe that he would like it to be.

As I shall explain shortly, an escape route back to the CMEC is important in the event of a voluntary agreement breaking down. We need to examine the precise way in which that will happen. It is important to ensure that the necessary safeguards are in place for the commission to play a statutory role in ensuring that the parent with care and the child or children are protected in such circumstances.

I thank the Secretary of State for that response, but I am trying to make the point that if one cannot enforce a voluntary agreement that breaks down other than by creating a new CMEC case, that will reduce the effectiveness of and public trust in voluntary agreements, and he will fundamentally undermine the basic principle of trying to give people an alternative to having to go to the CMEC.

I thought, at first, that I was agreeing with the hon. Gentleman, but I must flatly disagree with him—I do not say that antagonistically. The new commission will have enforcement powers and provide the necessary protection. I do not understand how it can reincarnate a voluntary agreement. Its role is to provide encouragement for voluntary agreements—that is the new feature of the system, which I know that the hon. Gentleman supports. However, its back-stop role is to ensure protection and statutory backing when necessary.

The Secretary of States mentions the welcome news that 40,000 more children will be raised out of poverty—a matter linked with the raising of the disregard and making it cost-effective for the taxpayer. Is it not the case that if there were an absolute disregard of child maintenance income—in respect of jobseeker’s allowance and income support, for example—the number of children lifted out of poverty could be doubled, at a cost of about £200 million, which, though substantial, is less than it would cost if the same effect were achieved through the tax credit system? Is that not worthy of further consideration?

We obviously have to be very careful about the impact on work incentives. However, the principle behind lifting the disregard in the way the Government and I want is ensuring that those parents who are not currently paying as they should—because they believe that the money is going to the taxpayer rather than to the children—are encouraged to pay. That problem amounts to a very significant blockage in the existing system, so it is important to get the balance right, as my right hon. Friend the Member for Birkenhead quite properly said earlier, but at the same time we must not lose sight of the main objective—to lift children out of poverty. As I will explain in more detail later, that contrasts considerably with the aims and circumstances that led the original agency to be established by Margaret Thatcher’s Government.

The Secretary of State is providing an estimate of the number of children who will be lifted out of poverty as a result of the Bill. Such lifting will occur in two ways. First, maintenance payments that are not currently paid will flow to the relevant families; or secondly, the disregarded income will be changed. I would suggest to my right hon. Friend that his civil servants must have made a calculation that assumes a change in the level of disregard in order to allow him to provide the estimate that he has put before the House today. Will he place in the Library at some later stage a note providing a breakdown of the extent to which the disregard is being changed and of the extent to which increased maintenance payments are envisaged in order to justify the target of lifting so many children out of poverty?

For a Secretary of State doing this particular job, there is always a certain wariness about accepting a question from my right hon. Friend, who knows more about it than I do and who certainly knows a lot more about it than the hon. Member for Epsom and Ewell (Chris Grayling)—and, indeed, more than most of the officials who are sitting over there. I will certainly look further into my right hon. Friend’s point, but the question of the level of disregard has not been decided yet. A number of issues are involved, not least a discussion with the Treasury.

May I ask the Secretary of State to approach the issue in another way? Will he set out for the House—either in the form of a note placed in the Library or more directly on the Floor of the House or in Committee—the different assumptions that his officials are making about the impact of the different levels of the disregard? That would help us to understand the impact on levels of child poverty of the different levels of disregard—whether it be £10, £20, £30, £40 or £50. We need to know about officials’ assumptions in order to understand the differential impact of different levels of disregard.

Speaking as a former Leader of the House, I am always anxious to assist the House, and the Prime Minister made it clear yesterday that he wants proper accountability of the Executive. When I am ready to do so, I will make available whatever information I can. I am not in a position to do so now and I will not promise to do something that I believe to be inappropriate at this stage. When I can make further progress and am clearer about the level of disregard that we think is feasible and appropriate to meet all the different balancing points that my right hon. Friend the Member for Birkenhead and others have suggested, I will try to assist the House.

I would like to clarify the Secretary of State’s answer to the hon. Member for Epsom and Ewell (Chris Grayling) on the issue of minutes of agreement. I was slightly alarmed when he said that in starting CMEC we need to go back to the beginning. I remind the right hon. Gentleman that, in Scotland, a registered minute of agreement can be used in the same way as a summary decree of court, and I urge him not to overlook that point. That often provides a quicker way of implementing a minute of agreement—usually directly by the person involved, but we could perhaps allow CMEC to do it. When a voluntary agreement breaks down, it is important that it be enforced quickly so that we do not go back to square one by making an application to CMEC and having to start all over again.