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Commons Chamber

Volume 467: debated on Tuesday 13 November 2007

House of Commons

Tuesday 13 November 2007

The House met at half-past Two o’clock

Prayers

[Mr. Speaker in the Chair]

WAYS AND MEANS

Sessional Returns

Ordered,

That Returns be laid before the House for Session 2006-07 of information and statistics relating to—

(1) Business of the House;

(2) Closure of Debate, Proposal of Question and Allocation of Time (including Programme Motions);

(3) Sittings of the House;

(4) Private Bills and Private Business;

(5) Public Bills;

(6) Delegated Legislation and Regulatory Reform Orders;

(7) European Legislation, etc;

(8) Grand Committees;

(9) Chairmen’s Panel; and

(10) Select Committees.—[The Second Deputy Chairman of Ways and Means.]

Oral Answers to Questions

Health

The Secretary of State was asked—

Doctors

1. What estimate he has made of the number of British-trained doctors looking for permanent placements; and if he will make a statement. (162930)

The estimated number of junior doctors who will complete their specialist training in England in 2007, and who are therefore likely to be looking for permanent posts, is 5,400. That number also includes those doctors who may choose to take a voluntary break before applying for posts.

The Department of Health made a complete hash of negotiating the GP contract, giving doctors a great deal of extra money for doing what they were in many cases doing already. Does the Secretary of State agree that the contract has now attracted a great many doctors from overseas with the result that home-trained doctors are now unemployed in their thousands? When is the Department going to acquire some commercial sense and look after taxpayers’ money properly and have better regard for doctors trained at taxpayers’ expense who now have no prospect of a permanent placement?

The right hon. Gentleman is confusing several different issues.

On the GP contract, I do not accept that it was a bad deal. The contract reversed the trend whereby we were losing GPs because, by and large, medical graduates did not want to be GPs. The latest statistics show that 100 per cent. of GP training posts have been filled. The contract also incentivised GPs to look at preventive health issues for the first time—taking patients’ blood pressure, for example—so prevention as well as cure is now their concern.

That contract has in no way led to the situation that I think that the right hon. Gentleman is getting it confused with. I accept that there is an issue about the fact that there are 10,000 international medical graduates trained as undergraduates abroad who are seeking positions in postgraduate training in this country, but we are seeking to resolve it.

We are in the position of having several thousand UK graduates who after seven years of training—and, in many cases, with substantial debts—are without work. They now face all the associated costs—both economic and human—that go with it. One of the worst indictments in the MTAS report related to the lack of centralised work force planning. Will the Secretary of State therefore reassure the House that he will ensure that such planning is introduced so that we never again face the scale of loss and injustice that we have seen in recent months?

Also apropos the previous question, no one will be unemployed when our employment guarantee ends on 31 December. The question from the right hon. Member for Wells (Mr. Heathcoat-Amory) was about British-trained doctors. There are 3,600 UK undergraduates who have not accepted a training post for 2007 and about 1,650 posts are still to be filled, though our undergraduates will be competing with international medical graduates. However, the sum total of all that is that, at most, we expect 100 people to be unemployed, because the vast majority of those applicants are already working in a job in the NHS. That is not to undermine the important points that my hon. Friend raised about MTAS and the distress caused to junior doctors this year.

The interim report on MTAS by Sir John Tooke—an excellent piece of work—set out a number of recommendations, which we are examining. They relate to the system in 2009 rather than in 2008, so we need to ensure that the lessons are learned for next year as well. It is a valuable piece of work and when we receive Sir John’s final report, I know that it will ensure that the problems that we faced this year are not repeated in future years.

There will be opportunities—perhaps for the Select Committee—to discover who was responsible for how the modernising medical careers initiative and the medical training application system developed. However, looking forward from now, will the Secretary of State make it plain who should be gathering evidence of where there are too few applicants in some specialties—as with applications for anaesthetics in London, for example?

Strategic health authorities should be doing that. The hon. Gentleman is absolutely right. In trauma and orthopaedics, there is only a 95 per cent. fill rate; in paediatrics, 95 per cent.; and in psychiatry, 94 per cent. Jobs are there if some trainees are prepared to pursue a career other than their originally intended one, but the information should be gathered by the SHA. As my hon. Friend the Member for North-West Leicestershire (David Taylor) said, we need to be much better at work force planning. If we follow Sir John Tooke’s advice, we will get to a satisfactory end. One final point to note is that John Tooke himself said:

“Modernising Medical Careers (MMC) was an honest attempt to accelerate training and assure the fundamental abilities of the next generation of doctors”.

It was not the concept of MMC that was at fault—we are now in a far better place than under the old opaque and unfair system—it is just that we need to ensure that the problems of this year are not repeated in the future.

Until the mess that Ministers made of modernising medical careers, junior doctors were rightly accommodated free of charge in hospitals. Now we discover, after Ministers slipped it through on the sly—unannounced to MPs or to the doctors themselves—that doctors in their first year, who do not have the option of renting privately as they are required to move every few months from hospital to hospital around the country, are to be forced to pay rent to each hospital. Is there no depth to which Ministers will not sink in hammering our junior doctors?

There are many depths to which we will not sink—[Interruption.] I guarantee that they are diminishing all the time. I was unaware of the particular issue that the hon. Gentleman raises, and I will look into it. Sir John Tooke points out that the profession was also in favour of the basic principle of modernising medical careers. There was a real consensus on the need to move to a much more open system. Before that system was introduced, we had no national data telling us about shortages in differential specialties. It is the right road to pursue, but I shall look into the question of doctors being charged rent.

I was shocked to hear that the Secretary of State did not think that the new doctors’ contract was a bad deal. We have now learned that salaries have increased by 25 per cent. and productivity has decreased by 15 per cent. If that is not a bad deal, could the Minister tell us what is? I cannot imagine a worse situation for my constituents in Northampton.

I think that the hon. Gentleman is talking about the GPs’ contract, not MMC. Before 2004, GPs were retiring and not being replaced; medical graduates did not, by and large, want to be GPs; GPs were not incentivised in any way to look after their patients’ well-being, and the profession was not paid decent money and deserved a new contract. I completely disagree with the hon. Gentleman and his Front-Bench colleagues who believe that we should return to a situation in which GPs are called out at 5 o’clock in the morning out of hours, and are then expected to treat people properly at 9 o’clock in the morning. I disagree that the GP contract was a mistake, and we intend to build on it to ensure that GPs are much better incentivised to increase access to health care, which is another public priority.

Abortion

It is accepted parliamentary practice that proposals for changes in the law on abortion come from Back Benchers and that decisions are made on the basis of a free vote. The Government’s view is that the Abortion Act works as Parliament intended.

Bearing in mind the recent majority Select Committee report on the draft human tissue and embryos Bill recommending changes to the current law for abortion on demand, with the signature of only one doctor merely relating to the length of gestation, as well as allowing nurses to undertake the procedure, how will the Government ensure that the health of women is protected from subsequent well-documented and researched psychological damage, including higher suicide rates? Will all post-abortion sequelae be taken fully into account?

The requirement for two doctors signatures was believed necessary when the Abortion Act 1967 was passed, to ensure that its provisions were observed and that they safeguarded women. I note the Science and Technology Committee’s report that the British Medical Association and Royal College of Obstetricians and Gynaecologists believe that there is no need for two doctors’ signatures in the first trimester, and I am sure that Members of Parliament will want to take that into account when and if they vote on the issue in the House.

My Bridgend constituency had a significantly higher-than-average number of abortions in 2005 among 18 to 25-year-olds. That was dealt with through improving the availability of local pregnancy advisory services and contraception and sexual health clinics to young people. Is not the need to improve the availability of advice and contraceptive services to young people rather than to amend the law?

I agree with my hon. Friend on the two important points that she makes. First, where access to abortion is required, it is important that that is undertaken as speedily as possible within the requirements of the Act. Some 89 per cent. of abortions are conducted under 13 weeks. She is also right that, alongside ensuring that the provisions in the Act are working as Parliament intended, it is also necessary to ensure that advice on sexual health is made available to young people and to others to ensure that they have every opportunity to control the point at which they become pregnant.

I put it to the Minister that reducing the 24-week upper limit and insisting on directional counselling—in other words, trying to tell women what to do, lest they otherwise would not do it—would be a thoroughly retrograde step for this House to take and that a far better reform of the abortion law would be to ensure much more equitable access to first-trimester abortion across the country and a proper and prudent extension of the range of professionals who can undertake that necessary procedure.

I understand that feelings on this issue are held strongly by Members of Parliament, and that they have differing views. But the point that the hon. Gentleman makes is right—where access to abortion is required, it is vital that it is as speedy as possible to ensure the health of the woman. Under the present arrangements, proper counselling and advice is given to women, and any attempt to delay access to abortion further increases the pressure on the woman and her health. If the matter is debated in the House, I am sure that those matters will be given careful consideration and the Committee’s report will be looked at carefully by all Members.

Does my hon. Friend agree that, as less than 1 per cent. of abortions take place at more than 20 weeks and that those cases are usually women in difficult and vulnerable positions, lowering the limit would not be the right way forward and would not help to reduce the number of abortions? Does she also agree—

The studies that have been conducted on the operation of the Abortion Act, as amended in 1990, focusing specifically on the question of survival have demonstrated clearly that at 21 weeks none survive, at 22 weeks 1 per cent. survive and that at 23 weeks 11 per cent. survive. When abortion is allowed under the circumstances provided in the 1967 Act, as amended in 1990, the issue is how to ensure that the process is conducted speedily and in a way that safeguards the woman and the decisions that she has taken. I am sure that the House will give that careful consideration if and when it debates the issue.

Would the Minister accept that the best way to reduce the number of abortions in this country would be to reduce the number of unwanted pregnancies by improving access to contraception and sex education, rather than seeking to deny access to a very small number of extremely vulnerable women who present late for abortion within the current law?

I agree entirely. What is crucial is that information on sexual health and sex education are provided in a comprehensive fashion to ensure that every person understands the responsibilities that they will undertake in parenthood. There is also a requirement to ensure that the services that the Government provide on contraception are appropriate and widely available.

Maternity Services

3. If he will make a statement on the level and quality of provision of maternity services in Sussex. (162932)

7. If he will make a statement on the downgrading of maternity services in (a) Eastbourne and (b) England. (162936)

Proposals for the reconfiguration of services and the responsibility to provide the appropriate level of very high-quality maternity services are a matter for the NHS locally, working in conjunction with clinicians, patients and other stakeholders. The safety of mothers and babies is our top priority. In April, we published “Maternity Matters”, which sets out how we will deliver local provision of safe, high-quality maternity care for all women and their babies.

Is the Minister aware that, under proposals tabled by two separate and unconnected primary care trusts, two of the three hospitals that supply maternity services to my constituents—the Eastbourne district general hospital and the Princess Royal in Haywards Heath—will see those services disappear? The third hospital, the Royal Sussex in Brighton, is already at capacity and regularly turns mothers away because it cannot handle the extra casework. Is she going to take action to intervene, or will she provide mobile facilities for mothers who cannot make it to the nearest hospital?

Yesterday, I met Nick Yeo, the chief executive of both the East Sussex Downs and Weald PCT and the Hastings and Rother PCT, so I am well aware of the hon. Gentleman’s concerns. The local health overview and scrutiny committee has referred the consultation process to the Secretary of State for Health, and the Independent Reconfiguration Panel is currently considering the referral.

But is the Minister aware that when asked about maternity services on 6 November this year on BBC Radio 2, the Secretary of State said that

“you shouldn’t be going 20 miles, 20 miles is a bit far”?

Will she therefore abandon today the absurd and dangerous proposals that, in my area, will involve pregnant mothers travelling 21 miles over the extremely poor roads between Eastbourne and Hastings?

I am sure that the hon. Gentleman has experience himself of remarks sometimes being taken out of context. The consultation in his constituency ended on 27 July and the PCT is evaluating the responses to that consultation. Therefore, we have to wait, but I am happy to see him at any time he wishes.

My hon. Friend will know that the reorganisation of maternity services in Greater Manchester is one of the largest, if not the largest, in the whole country. She will also know that the report of the Independent Reconfiguration Panel gave an absolute assurance that no change should take place to local services until community midwifery and community paediatric services were fully in place. Can she repeat the importance of that guarantee now in view of the fact that, last week, the health authority published a timetable that would appear to make it extremely difficult to fulfil the promise of the IRP?

I can say to my hon. Friend today that the safety of mothers and their babies is our priority at all times and the views of clinicians and midwives are always taken into account.

Is the Minister aware of the magnificent work done by the Support the Princess Royal campaign in Haywards Heath to save the maternity services mentioned by the hon. Member for Lewes (Norman Baker)? Is she also aware that because of the Government’s outlandish housing targets for the north of Sussex, the population is growing at such a pace that to have the idea that it would be sensible to downgrade maternity services at the Princess Royal is really an act of folly? Will she receive a delegation from the Support the Princess Royal campaign to discuss this matter with them?

The hon. Gentleman raised this issue in an Adjournment debate of which I took serious note. As I have said to the House, the views of clinicians and the safety of mothers are paramount at all times. If he wants to bring new evidence to me, he should by all means do so.

If the Minister is serious that clinicians’ views and the interests and safety of mothers and babies are paramount, why is a proposal being made to downgrade maternity services at Chase Farm hospital without the clinical evidence? Why is it that that unit, along with the others mentioned in the House today, are close to the level that the Royal College of Obstetricians and Gynaecologists recommends should be kept open?

There is no evidence at all that the clinicians’ views in any of the reconfigurations are not being taken seriously. Safety for mothers is paramount, and that is why we have the safest record in Europe and one that is even safer than that of the United States. That point is on the record. We have to say that reconfiguration sometimes causes distress through the consultation, but the consultation will proceed at all times by taking into account the safety of mothers and babies.

Is the Minister aware that on the first Sunday in June, the maternity units at Brighton, Eastbourne, Worthing, Hastings and Haywards Heath were all full and stopped admitting pregnant mothers? With a rapidly growing population in Sussex, and with units already at capacity, is it not madness to be suggesting that there should be fewer units, rather than maintaining those that are there now?

I am sorry to keep repeating this, but there is no other answer. We have to look at the safest practice for mothers and babies, and clinicians are asking us to do so. I am sure that the local health economy has taken these points into account.

Would the Minister accept that the quality and safety of maternity services very much depends on the midwifery profession? I declare an interest as an honorary vice-president of the Royal College of Midwives. I know that the Minister is aware that there is a shortage of midwives in both the community and hospitals. Will she seek to do something to increase the number of midwifes to benefit maternity services throughout England, including in Sussex?

I am sure that the Royal College of Midwives is very pleased to have the hon. Gentleman as an honorary vice-president. Being a friend to midwives is always a popular thing to do. I assure him that 1,000 extra midwives are being recruited. We are looking seriously at return-to-practice courses for midwives who have left for a variety of family reasons. I agree with the hon. Gentleman that more needs to be done, but that is what we are doing, and I look forward to working with him to achieve that.

Is the Minister aware that my hon. Friend the Member for Eastbourne (Mr. Waterson) is leading a march through the streets regarding maternity services in his area? Is she also aware that according to a recent survey by the Royal College of Midwives, two thirds of midwives say that they have considered leaving the profession, while almost half those people state that increased work load and having to compromise care are the main reasons why? How does the Minister expect to fulfil the Government’s aspirations of choice when people in the maternity services are demoralised, when more midwives are leaving than joining, when the birth rate is up 12.5 per cent.—

Order. I have got to say to the hon. Lady that she must not make a speech from the Dispatch Box. She is asking a supplementary question.

Perhaps I could give some general tips on marching because I marched throughout the ’80s and ’90s when the Conservative Government were in power. We were constantly marching and raising money for services. Many members of the profession were leaving then, but members of the profession today are pleased to be involved in the review in which the NHS is participating, and they will be celebrating 60 years of the NHS with us next year.

Connecting for Health System

4. What recent assessment he has made of the effectiveness of connecting for health; and if he will make a statement. (162933)

Progress with NHS computer systems is measurable in hospitals, general practices and pharmacies across the NHS in England. Despite the challenges associated with all large IT programmes, the connecting for health system is bringing benefits to doctors, nurses and, most importantly, patients.

I thank the Minister for that answer, but hospital patient administrations from the supplier, iSOFT, are still not in place. After an £80 million bung from the NHS, financial meltdown, an investigation of the company and a takeover by the Australians, can the Minister guarantee that hospital software ordered from iSOFT is written, workable and ready for roll-out by 2008, or are we being a tad optimistic?

Progress is good, as the Health Committee accepted in its recent report. There have been delays, but any cost overruns are being borne by not the taxpayer, but the private suppliers. When the private suppliers have been unable to deliver the goods, they have been replaced by other private suppliers.

Is any further training taking place in the national health service—in both the primary and acute sectors—so that people are able to use the connecting for health system?

Yes. One of the criticisms in the Health Committee’s report—we responded to it in full yesterday and almost entirely accepted it—was about the need for better clinician engagement. That is certainly going on across the health service. It is worth the House acknowledging the enormous benefits for not only patients, but health service staff, from having proper IT systems that are integrated and can deliver better patient care.

My hon. Friend will know that to maximise the usefulness of all our health service professionals, especially in primary care, it is essential that we make maximum use of the expertise of pharmacists. What plans has he to ensure that pharmacists will soon have read and write access to patient records, so that we can maximise everyone’s skills in primary care?

Pharmacies’ use of IT for e-prescribing is increasing all the time. My hon. Friend will have to wait a little while, until we publish our pharmacy White Paper, for us to say more about that, but he is right to say that there is enormous potential for pharmacists to deliver better services to patients if they have full access to IT and their access is interoperable with the rest of the health service.

Gastro-intestinal Cancer Treatment

5. What discussions he has had on the centralisation of upper gastro-intestinal cancer services in Devon; and if he will make a statement. (162934)

My hon. Friend the Member for Exeter (Mr. Bradshaw), in his capacity as a local constituency MP, has passed on concerns raised by his constituents. The organisation of services is best decided locally, and the Devon overview and scrutiny committee has recommended formal consultation on the proposals.

The Minister will be well aware of the well regarded provision of keyhole surgery in the treatment of gastro-intestinal cancer, as performed by the Royal Devon and Exeter hospital. He will also be aware that in his NHS next stage review interim report, Lord Darzi states:

“Localise where possible, centralise where necessary.”

Does the Minister not agree that it is quite unnecessary to move the provision of that treatment from Exeter to Plymouth, and will he hold urgent discussions with the Devon primary care trust to point out the error of its ways?

No final decision has been made. The local authority has said that, even before it decides whether to refer the matter to the Independent Reconfiguration Panel, it wants to consult locally. I urge the hon. Gentleman to engage fully in that consultation, which will take place before any final decision is made. I should also point out that there is a contradiction in saying that it is inappropriate for the Government to issue central diktats and directions from Westminster and Whitehall while demanding central Government intervention in local decision making.

I will, Mr. Speaker.

When considering the reconfiguration of gastro-intestinal cancer services in Devon and, indeed, elsewhere, will the Minister bear in mind the innovative straight-to-test GI cancer assessment service pioneered by Dr. Madhotra at Milton Keynes, which has drastically cut the time taken to get patients through diagnostic services? That is clearly relevant to the examination of GI cancer services everywhere.

That was ingenious and innovative, like the doctor my hon. Friend mentions. Her point is incredibly important, because it underlines the fact that developments in medicine and technology and the genius of clinicians are changing the health service all the time, so to maintain services as they were before those changes occurred would be a complete nonsense. That is why calling for a moratorium on any change in the NHS is irresponsible.

Hearing Aid Assessments

6. What the average waiting time was for hearing aid assessments in (a) Gravesham and (b) England in the last period for which figures are available; and if he will make a statement. (162935)

The median waiting time for a diagnostic audiology assessment, including hearing assessment, is 52 weeks at the Medway NHS Trust, which includes the area of Gravesham. The average for England is 16 weeks.

Does the Minister think that the Government will hit their own target of six weeks to initial assessment by 2008, given that now some of my constituents are waiting up to 12 months? Has he thought about the distressing effect of such waits, especially on the elderly?

The length of waiting times in the hon. Gentleman’s local trust and in some others is entirely unacceptable. That is why we have a target of a maximum wait for assessment of six weeks to be achieved everywhere by March 2008. It is also the reason why, in March, I issued the new audiology framework, which is essentially a strong message to every trust in the country that they must reduce waiting times to the level achieved by the best PCTs, which is already happening in many parts of the country.

Is my hon. Friend aware of North Staffordshire primary care trust’s use of mobile facilities, particularly in Leek? It massively reduces waiting times, both for assessment and for fitting devices.

That is exactly the kind of innovative and imaginative process that was suggested in the framework that we issued in March. In every locality, the most effective way of reducing waiting times for assessment and the fitting of hearing aids should be deployed. Where that imagination and innovation is to be found, we need to learn about it, and we need to ensure that it is mainstream throughout the system. As the hon. Member for Gravesham (Mr. Holloway) said, not having access to appropriate hearing services is distressing for people, and it affects their quality of life; that is why the issue is so important.

The Royal National Institute for Deaf People estimates that over 500,000 people are waiting to have hearing aids fitted. In many parts of the country, people are waiting far more than a year to have one fitted. Will not those who are waiting feel badly let down by last week’s announcement that the 18-week target will not be quite as watertight as we were all led to believe? Is not that yet another instance of manipulation of Government targets, as the Government knew full well that they had no chance of meeting the target?

It seems eminently sensible that when we set targets, we take account of practical issues such as the fact that patients sometimes fail to turn up and fail to co-operate with the clinicians and the health service. It would be nonsense to tell hard-working NHS professionals that they had failed to meet a target due to circumstances outside the control of either the trust or the professionals and clinicians involved. Think of the damage to morale that that would cause. The announcement made last week is entirely sensible, and it will not affect the fact that we will get waiting times down for audiology services in every part of the country.

Hospital Cleanliness

8. If he will make a statement on the training given to staff conducting the deep clean of hospitals. (162937)

Deep cleaning will occur in all hospitals starting this winter, and it will be completed as soon as possible thereafter. Resources will be allocated through the strategic health authorities. Trusts’ deep clean plans will vary according to local need, and trusts will be able to identify what additional training is needed to ensure that their local programme is delivered to the appropriate standards. All trusts will submit costed deep clean plans to their lead primary care trust, which will monitor performance against the plan, according to normal performance management arrangements. Strategic health authorities will take an overview of progress across their area and will report to the Department. We will assess the progress and impact of the programme.

Given the importance of tackling hospital-acquired infections, perhaps the Secretary of State will explain why it has taken the Government 10 years to come up with a rigorous cleaning programme, say how many fewer cases of MRSA we can expect in our hospitals as a result of the initiative, so that we can test whether it has been successful, and say how deep cleaning compares with using environmental cleansing equipment, such as Steris’s vaporised hydrogen peroxide equipment, to tackle the disease.

The deep clean is one of a series of initiatives. The issue is the subject of huge public concern. We are the only country in the world that has mandatory comprehensive surveillance, and the only country in the world that knows exactly what the situation is with our health care-acquired infections. As a result, we are able to tackle the issue through a series of measures—not just through the deep clean, but through the “bare below the elbows” policy, which has been used at the Royal Marsden hospital for many years, just as deep cleans have been used in many hospitals for many years. It is a case of ensuring that every hospital follows best practice.

There are other initiatives, of course, such as the new powers that we are giving the care quality commission—an issue that we will discuss in the debate on the Gracious Speech. There is pre-screening for MRSA for all people coming into hospital, whether for elective or emergency surgery. There is a whole series of other measures, which means that we have a comprehensive programme to address the problem, which affects all countries around the world.

Does the Secretary of State accept that what is needed for clean hospitals is not just deep cleaning but an assurance that we will continue to clean them, and thus a motivated, well-funded work force? Will he learn the lessons of the 1980s, when the Conservatives reduced the number of ancillary workers in England from 177,000 to 60,000?

I agree with my hon. Friend about the need to ensure that there are proper cleaning facilities. He may wish to know that spending on hospital cleaning has increased from £403 million in 2000 to £662 million in 2006-07, which is an increase of almost 65 per cent., so it is essential to ensure that there is investment in cleaning services as part of a range of measures to tackle those problems.

My constituent and friend, Doug Gregory—a wartime Mosquito pilot who was awarded the distinguished flying cross—has just survived his latest brush with death in Southampton general hospital, where he contracted C. difficile after a routine operation. Is it not a disgrace that people go into our hospitals and find themselves fighting for their lives under such circumstances in the 21st century?

I express my commiserations to the hon. Gentleman’s constituent, but let us get this into context: there have always been health care-acquired and associated infections.

We do not know what the scale was, as the simple fact is that it was never measured and no figures were produced. Indeed, people who have worked in the health service for many years suspect that it was far greater in the past than it is now. Turning to the serious point made by the hon. Member for New Forest, East (Dr. Lewis) about clostridium difficile, there is a question about hand cleanliness, and it is soap and water that work rather than an alcohol rub. The big problem, however, is a certain complacency about prescribing antibiotics. We can engage in political cut and thrust, but the message that we must all give our constituencies is that this issue is about washing hands and ensuring that they are clean; it is about ensuring that there is responsible prescription of antibiotics; and it is about ensuring that patients who unfortunately acquire those infections are isolated as soon as possible and given cohort nursing. Those are the three major rules, and it would be good if we all ensured that that is the message that we give the public.

While questions remain about the scientific evidence and the Government’s analysis and monitoring of the Prime Minister’s deep-cleaning policy, Ministers cannot escape the fact that the Government are responsible for infection control. Centrally controlled process-driven targets, high bed occupancy, lack of focus management and financial deficits all exacerbate the prevalence of hospital-acquired infections. Given that 111 trusts have not complied with hygiene standards, it is clear that Government policies have not worked. When will the Government implement a search and destroy policy, and ensure that the Healthcare Commission specifically analyses, measures and reports on C. difficile rates?

I disagree completely with the hon. Gentleman about the reasons for the problem, particularly, as once again, the lame excuse that targets have something to do with the failures at Maidstone and Tunbridge Wells has been trotted out. [Interruption.] The hon. Member for Guildford (Anne Milton) says, “Read the report”, but the exact words of the chairman of the Healthcare Commission were:

“Targets or their equivalent are an inevitable feature of a modern 21st-century healthcare system, in the sense that some standard or measure to be achieved must be part of the management of any organisation providing healthcare. The obligation to meet targets cannot be used as an excuse for failing to meet other management objectives.”

Indeed, he made exactly that point in the text of the report on Stoke Mandeville a year ago, so to suggest that patients have a choice—they must wait on long waiting lists, or take eight hours to get to accident and emergency, and if they are not prepared to do so, they must put up with hospital-acquired infections—is nonsense. The second point I would make—

Order. That would not be fair to those who took part in the ballot and whose names appear on the Order Paper.

Skin Cancer

9. What recent discussions he has had with charities concerned with teenage cancer on skin cancer prevention. (162938)

SunSmart, the national skin cancer prevention and sun protection campaign, is run by the charity Cancer Research UK on behalf of the UK Health Departments. The Department’s officials are in regular contact with the charity, which has a dedicated SunSmart website and produces resources and information that include advice relevant to teenagers.

I appreciate the Minister’s answer. I recently met representatives of the Teenage Cancer Trust, who have been supportive of my campaign to restrict or stop the use of sunbeds by underage children. Will my right hon. Friend meet other child cancer charities to raise awareness of skin cancer in young people and to highlight the dangers of overexposure to the sun and of sunbed use?

I congratulate my hon. Friend, who has been tenacious in pursuing that important campaign. As she knows, organisations such as the Teenage Cancer Trust are doing excellent work in this area. I have already arranged to meet my hon. Friend, and I am happy to leave it to her discretion whether she brings representatives of the children’s cancer charities to that meeting or suggests an attendance list for a subsequent meeting when I can discuss the issues that she raises.

Topical Questions

The responsibilities of my Department embrace the whole range of NHS, social care, mental health and public health service delivery, all of which are equally important. I am delighted that in the Gracious Speech there are two Bills for which my Department has responsibility—the Health and Social Care Bill and the Human Fertilisation and Embryology Bill. I am also pleased that my Department is leading on the Green Paper on the long-term reform of the funding of the social care system, as announced in the pre-Budget report.

I congratulate the Secretary of State on taking urgent action on the obscene payout to the chief executive of the Maidstone hospital. That is only the tip of a rotten iceberg in the health service, with a considerable number of officials getting outrageous payouts and then often sliding into other jobs in the NHS or consultancy contracts. That is damaging to the NHS across the country and to staff morale. What is he going to do about it?

My right hon. Friend is right to be concerned. Three things—first, in relation to other trusts, I have asked the chief executive of the NHS to write to all trusts pointing out that any payments to be made above and beyond contractual obligations must be cleared through the strategic health authority and cleared by Her Majesty’s Treasury. Secondly, on redundancy payments, all staff ought to receive the same deal on redundancy. If the redundancy agreement is for x times annual salary, that applies to people at the highest level as well as at other levels in the health service. The third point on which I have asked for action is that the period of notice should not exceed six months for someone in a senior position. It could well be less than that, but it should not be more than that. A combination of those three steps can address an issue for Members in all parts of the House—that public money should not be squandered on large and unjustified payouts for senior executives. It rankles with staff in the NHS and it brings the vast majority of very good managers in the NHS into disrepute quite unfairly.

The NHS dental practice in Ambleside in my constituency serves 3,000 NHS dental patients across a geographical area of more than 90 square miles. The PCT in Cumbria is planning to close down the Ambleside practice in March next year, when the current dentist retires. Given that already 50 per cent. of my constituents do not have access to an NHS dentist, does the Secretary of State agree that the PCT in Cumbria should ensure that the NHS dental practice in Ambleside remains open?

The PCTs have an obligation to ensure that there is proper dental provision in their areas. We are spending another £450 million on dental care. We have discussed new contracts, but under the old contract if a dentist decided to pack up and leave or go to the private sector, the local community lost that dental service. Under the new procedure and contract, the PCT is obliged to ensure that proper NHS dental provision is available. If the hon. Gentleman would like to write to me about the issue that he raised, I shall look into it.

T2. My right hon. Friend will be aware that, according to the Royal National Institute of Blind People, the leading cause of blindness in the UK right now is age-related wet macular degeneration. The new drug Lucentis is costly but effective in treating the condition. Four of my constituents have been summarily refused the drug by North Staffordshire PCT until the National Institute for Health and Clinical Excellence finally pronounces. Meanwhile, other PCTs around the country are providing funding for the drug. Will my right hon. Friend urge NICE to get a move on in its review and will he work with midlands MPs to ensure that precious resources go to patients who are going blind and not to multi-million-pound eye-care contracts, such as that with an independent treatment centre in Burton, which is simply not working well? (162921)

I understand the important point raised by my hon. Friend about Lucentis; it has been raised with me directly by a number of Members from both sides of the House.

On the deliberations of NICE, the final appraisal determination has not yet been made available. It is important that the consultation and procedures for appeal are properly followed; it is an independent organisation and must take the proper steps. My hon. Friend’s second point was about the particular experiences in his own area. I shall be more than happy to meet him to discuss the issues and see what action I can take.

Given the urgency of tackling the more than 6,000 deaths a year from hospital-acquired infections in our hospitals, why does not the Secretary of State take urgent action on the issue, rather than waiting 18 months so that a new quango can be set up? Whatever that quango might be able to do should be done now, because the problem exists now and people should not live in fear of dying from going to hospital.

If the right hon. Gentleman is referring to the care and quality commission, I should say that legislation needs to go through for the regulator to be given those extra powers. However, that does not mean that we should freeze everything in aspic. As was mentioned earlier, there are a whole series of initiatives. I did not mention the doubling of the number of improvement teams, nor the fund of money available to nurses at the front line so that they can access things, such as curtains and fittings, that they know very well need to be replaced. I did not mention that we are going to move from 2,000 to 5,000 matrons and that they will be given power over the cleaning contract and given whistleblower protection to report on such issues to the trust and beyond. The right hon. Gentleman is right to be concerned about the issue; it is a matter of concern to the public. However, there are a whole series of measures, none of which we need wait 18 months for.

T4. My right hon. Friend will be well aware of the outcry that followed the decision on the YL case in the other place. It was decided that elderly people living in private-sector care homes were excluded from the protections of the Human Rights Act 1998. That is a serious issue that requires urgent attention. Will my right hon. Friend say when and how it will be tackled so that the elderly in private care homes have the same protections as everybody else? (162923)

My hon. Friend is right to raise that issue of concern. Publicly funded residents of private residential and nursing homes should be covered by the 1998 Act and I believe that that was Parliament’s original intention. The Department of Health is engaged at ministerial level in discussions with the Ministry of Justice; we shall look for an appropriate legislative slot to put that anomaly right. In the meantime, I shall consider what instructions we can give to the regulator to ensure that homes, including independent-sector homes, are regulated on the basis of their meeting the requirements of the 1998 Act.

I am not aware of that quote, but I agree in the sense that the amount of time that people spend in hospital should be reduced. That is happening in health care services around the world. As the hon. Gentleman knows very well, it is now perfectly acceptable, with a whole range of new technology, to treat people closer to their home and to provide that if they do have to go to hospital, they spend less time there. A good example is that of cataracts. Ten years ago, the number of people waiting for long periods—more than a year—for treatment for cataracts was huge; that number has been reduced dramatically. Today, 5 per cent. of patients spend more than one night in hospital for a cataract operation; 10 years ago, it was 50 per cent. All those factors combine to say that the number of beds in a hospital, which was traditionally the way in which one judged that one had a decent health service, is increasingly becoming irrelevant.

I am surprised that the Secretary of State does not read the Daily Mirror—the quote was from 8 February this year—but I advise him not to agree with his predecessor, as that is probably a bad idea.

On 8 November, the Secretary of State’s Department published a study into infection control which said that high bed occupancy rates were considered to be a key factor that affected infection control decisions in about 70 per cent. of responding trusts. Will he tell the House when the Government intend to meet the commitment that he gave to the Public Accounts Committee in 2000 that by 2003-04 bed occupancy rates would average 82 per cent.? They are still more than 2.5 per cent. above that and, as we saw in Maidstone and Tunbridge Wells, that is directly contributing to deaths of patients.

We want to get bed occupancy rates down to that level, and we are not there yet, although the averages around the country are reducing. I do not draw that parallel between bed occupancy rates and rates of health care-acquired infections—[Interruption.] Well, there are hospitals around the country that have a fairly high level of bed occupancy and a very low level of health care-acquired infections, so I do not think that there is an absolute parallel between the two.

Tens of thousands of Welsh patients are treated in English hospitals each year. Does my right hon. Friend believe that Welsh MPs, of all political parties, should be able to lobby and write to him and his team and to speak and vote in this House on English NHS issues?

I certainly agree that they should be free to lobby. Indeed, one of my hon. Friend’s colleagues recently came to see me with a group of fellow MPs from England about an issue regarding services at the Countess of Chester hospital. He is absolutely right to draw attention to the issue, which I have taken up with my Welsh colleague. If he wants to come to talk to me about a similar problem, he is welcome to do so.

T3. On 16 May, in a Westminster Hall debate on Kettering general hospital, the then Health Minister accepted an invitation to visit the hospital to see the work being undertaken to meet foundation trust status and the efforts being made to counter the hospital’s misfortune at being top of the national league tables in terms of hospital-acquired infections. Sadly, that visit never took place, so will the Secretary of State or a new Health Minister accept a fresh invitation to come to visit the hospital to see for themselves, first hand, the work being done there? (162922)

T5. I wonder whether Ministers have seen today’s report on public health ethical issues by the Nuffield Council on Bioethics. In the press coverage, Oxford was unfairly singled out as having particular problems of binge drinking. Does the Minister accept that binge drinking, particularly among the young, is a real problem, especially in the era of 24-hour drinking? Perhaps the Government could spend more time concentrating on that issue instead of seeking for political reasons to criminalise cannabis more. (162924)

I have had the opportunity to look at the report to which the hon. Gentleman refers. I entirely agree that under-age drinking is a crucial issue that we need to address as a Government because of the harm caused to those young people. I am sure that he agrees that we have made important progress in reducing access to alcohol for the 11 to 15 age group. None the less, harm is being caused to young people who are still drinking excessively, and we need to consider that and take proposals forward.

I would like to raise an issue with my right hon. Friend the Secretary of State. He has made it clear that when the National Institute for Health and Clinical Excellence is considering whether a drug should be made available on the NHS, primary care trusts should consider any application to use that drug on the basis of medicine rather than finance. However, concerns were raised with me about a recent case. An applicant who needs a drug went to the panel in the PCT, then went to appeal and lost. There is a sense that that person has no further right of appeal and no possibility of getting an independent judgment, separate from the PCT, as to whether a life-saving drug should be made available.

My hon. Friend is correct about the advice on what PCTs should do when considering whether to prescribe a drug. I am not familiar with the precise details that he raises, but if he sends me details, I shall be happy to meet him to consider appeals to the local PCT panels in order to determine whether there is an issue that needs to be addressed.

T6. Is the Minister aware that one of the factors contributing to bed overcrowding at the Maidstone and Tunbridge Wells trust was the continuing closure of beds at the excellent Sevenoaks community hospital due to financial pressures on the primary care trust? When are those beds likely to be reopened? (162925)

As the hon. Gentleman will know, the local health authority has undertaken a review of future requirements for beds in the community hospital and has announced that over the next year to 18 months it will open beds in those facilities to address the future need that it believes will exist in the local community.

Security Industry Authority

With permission, Mr. Speaker, I would like to make a statement on Security Industry Authority licensing checks and the issue of entitlement to work in the United Kingdom.

The Security Industry Authority was established in 2003 under the terms of the Private Security Industry Act 2001. Before its establishment, the private security industry was largely unregulated, with no national licensing system. The legislation sets out that the SIA must establish that applicants are fit and proper before granting them a licence; the detailed criteria are set out in the SIA publication “Get licensed”. The fit and proper person requirement primarily involves establishing that the applicant has undergone training and that identity and criminality checks have been completed. To date, more than 250,000 licences have been issued.

I must make it clear from the outset that it is the legal duty of all employers to ensure that those they employ are entitled to work in the United Kingdom. The SIA has not failed to do anything that it was obliged to do in law. As my hon. Friend the Minister for Borders and Immigration stated on 11 September 2006, in response to a question from the hon. Member for Monmouth (David T.C. Davies):

“Employers have clear legal responsibilities under the Asylum and Immigration Act 1996 which makes it a criminal offence to employ a person who is subject to immigration control unless that person has permission to work in the UK. The possession of a Security Industry Authority licence does not give a person a right to work in the UK, and employers are still expected to assure themselves that their employees have the necessary permission.”—[Official Report, 11 September 2006; Vol. 449, c. 2234W.]

That is a matter of record in this House.

While under no legal obligation, the SIA has the discretion to seek information that applicants have the right to work in the UK. As a responsible organisation, the SIA decided in April 2005 to initiate a limited right-to-work check on 10 per cent. of non-European economic area applicants. I am informed by the SIA that between April 2005 and December 2006, more than 3,000 checks were conducted and 41 individuals were identified who were not entitled to work in the United Kingdom. Licences for those individuals were refused.

Ministers were informed in April 2007 that a Border and Immigration Agency enforcement operation had identified that 44 people employed by a security company did not have the right to work in the UK. Of those, 12 had been subcontracted to a further company that provided staff to guard locations under Metropolitan police contracts. One of the individuals was involved in guarding an MPS facility where modified cars would be taken for any repair work. Those identified at that stage were immediately removed from their posts. The Metropolitan police have assured me that there was no security threat to any of the vehicles that had to visit that facility.

In June this year, the BIA and the SIA agreed that the BIA would carry out a more intensive check of the 10 per cent. sample of non-EEA applicants. That analysis showed that a higher proportion of non-EEA applicants might not have a right to work than the earlier work had suggested. Ministers were informed and immediate action was taken.

From 2 July this year, every applicant identified as a non-EEA national by the SIA also has their right to work in the United Kingdom checked. I am informed by the SIA that of the 32,500 licence decisions made since 2 July 2007, 740 were refused because the SIA was not satisfied that the applicant had a right to work in the UK. I have been advised by the BIA that all those cases are in the process of being investigated with a view to enforcement action. In addition, from 1 October the SIA has required new and tighter identity checks for all applications and renewals.

Although action could be and was immediately taken on new applicants, it remained unclear how many people who had been granted licences before 2 July did not have the right to work. The SIA undertook further work to assess the potential volume of licences that might have been given to people who did not have the right to work in the UK to consider what remedial action should be taken. On 9 August, I set out my approach to the advice I had received. My approach was that the responsible thing to do was to establish the full nature and scale of the problem and to take appropriate action to deal with it, rather than immediately to put incomplete and potentially misleading information into the public domain. Much has been made of the fact that I said the lines to take were not good enough for the press office or Ministers to explain the situation. The fact is that they were not good enough because the analysis of the issue had not been completed.

I took immediate action by asking for work to estimate the numbers involved to be speeded up. I was not content to wait 10 weeks to get these numbers and asked for that time to be halved, and to have preliminary advice on my return to the office on 20 August. I approved a letter from the SIA to senior managers of all 2,000 private security companies on its records reminding them of their obligation as employers to check entitlement under section 8 of the Asylum and Immigration Act 1996. I made it clear that I did not want to delay the schedule for its release.

I also approved with modifications a second letter from the Cabinet Office to Government HR directors and departmental security officers reminding them that all staff with access to Government assets should be subject to the requirements of the baseline personnel security standard, which includes the verification of an individual’s right to work in the UK. I will place copies of the two letters in the Library of the House.

I requested an update by 2 pm the following day, and received a further update from officials on 10 August. In that update, officials believed that it should be possible to provide revised estimates of the numbers involved by the end of August. In the advice that I received on 30 August, I was informed that the SIA and the BIA could build the capacity to check the estimated 40,000 non-EEA nationals who had previously been granted licences at the rate of 4,000 a month from October 2007.

On 5 September, I asked for further details on why that process should take so long and also asked the Under-Secretary of State for the Home Department, my hon. Friend the Member for Gedling (Mr. Coaker), who is responsible for crime reduction, to chair a taskforce to resolve and, if possible, to increase the figure of 4,000 a month. The taskforce met on 8 October. As a result of that, the current estimate is that those checks will now be completed in December—much more quickly than originally planned—and I will report again to Parliament when that work is complete. Preliminary work by the BIA has categorised the 6,000 cases checked so far into three groups, although those figures are not finally verified. Provisional assessment from the BIA reports that 77 per cent. of those checked have been shown to have a right to work, with 10.5 per cent. shown not to have a right to work. Checks are ongoing on the remaining 12.5 per cent. I repeat that those are early estimates.

I believe that that is a clear example of the Government’s determination to put in place effective systems and procedures further to protect the public and to keep those systems under review. As has been made clear, possession of an SIA licence does not give a person a right to work in the UK. Employers are expected to assure themselves that their employees have permission to work. That is what the law requires of them. We have nevertheless taken action to tackle illegal working in the security industry sector. As I have demonstrated today, Ministers and officials are taking robust action to satisfy ourselves of the scale of the problem and to ensure that the SIA and the BIA work together to address it.

I thank the Home Secretary for advance sight of her statement.

When the current Prime Minister became leader of the Labour party he heralded, in his words,

“a different type of politics—a more open and honest dialogue: frank about problems, candid about dilemmas, never losing touch with the concerns of people.”

Faced with one of her first tests, why was the Home Secretary not frank and candid about the 5,000 illegal workers licensed to work in sensitive security posts in this country? She has now admitted to the House that she was first told on 12 July, but she instructed officials that the matter was—I quote from her e-mails—

“not ready for public announcement”.

There are two key issues. Has the Home Secretary dealt effectively with the original crisis and has she been open and honest with the public?

The response of the Home Office so far has been blunder, panic and cover-up: blunder when it set up the Security Industry Authority and did not ask it automatically to check when granting security licences to potentially illegal workers; panic when it was first told about that in April; and cover-up when it decided not to tell the public because, according to one of the Home Secretary’s leaked e-mails, she did not think

“the lines to take that we currently have are good enough for Press Office or Ministers”.

She says that that was because the analysis of the issue was not complete. Let us be clear about this. The Government have known about the problem since April. She says that they had not completed the analysis by August. It is now November. The House has been sitting since early October. Is this really the first opportunity that she has had to tell the House about the issue? Is she telling the House that it had nothing to do with the advice that she was given that if the media became aware of the issue, they would be likely to focus on the various “negative stories” associated with SIA licences?

I have a number of specific questions for the Home Secretary; I hope that she will answer each of them. Can she confirm that 11 illegal workers were guarding Metropolitan police buildings? In the case to which she referred of the illegal worker guarding the site where the Prime Minister’s car was parked, how can she, or indeed the Met, be sure that there was no actual or potential security threat? How many more illegal workers were guarding Government buildings or other critical national infrastructure? Can she guarantee that no illegal worker is still guarding any Government, police or military building, or any other part of our critical national infrastructure today? Of the 5,000 illegal workers identified, how many have been caught? How many have been removed from the country?

Given the Home Secretary’s stance on employers, how many employers have been prosecuted because of these discoveries? Does the Border and Immigration Agency now notify the SIA immediately when an SIA licence holder’s work permit expires? If not, why not? And why has the Home Secretary not made proposals to place a statutory duty on the SIA to check immigration status before awarding a licence, given the Home Office position that

“an SIA licence is seen as a demonstration that the holder is a fit and proper person to work in a position of trust within the security industry”?

The Home Secretary no doubt regrets not making this statement some time ago. The Prime Minister spoke of frank and candid government yet, in one of her first actions as Home Secretary, the right hon. Lady put avoiding political embarrassment ahead of solving the problem and informing the public. That is neither frank nor candid.

The right hon. Gentleman says that there are two tests for the Government: whether effective action is taken and whether accurate information is given. I agree that those are the two tests for the Government. I have spelled out the effective action that has been taken already, and the action that we are taking, to tighten the system and to clarify the full extent of those granted licences before 2 July, when the full checks were put in place. I also agree it is important for the Government to give accurate information, which is why I have made it clear that I will return to the House when the speeded-up process of clarifying precisely what the situation is has been completed. I will report the results to the House then.

On the specific points that the right hon. Gentleman has raised, I made clear in my statement the position with respect to the 12 employed on Metropolitan police contracts. I have received assurances from the Metropolitan police that there was no danger to cars from the activities of those guards. It is also clear that the Metropolitan police, and other employers, will review and take seriously their responsibilities to check the right to work of those who are securing their facilities. It is also clear that in writing as I did, not only to 2,000 private security companies but to Government Departments to identify the need to carry out these checks, and in referring the Departments to the specific requirements relating to the employment of security guards in Government areas, I quite rightly undertook to communicate with those who were able to make a difference.

I have a responsibility to act and to explain. I do not make any apologies to the House for being the sort of Minister whose first reaction to an issue is not “What should I say about it?” but “What should I do about it?” That is what I have done. I have taken action and, when I am clear about the situation, I will return to the House and report to it.

I want to make one further point to the right hon. Gentleman. He rightly challenged the original legislation. The Opposition’s approach at the time of our introducing the Private Security Industry Bill, according to the then Member for Surrey Heath, was:

“The Opposition’s approach to the Bill is that it should not place unnecessary, overly complex, bureaucratic or burdensome regulations on the legitimate sector of the industry.”—[Official Report, 28 March 2001; Vol. 365, c. 980.]

To speak now with the hindsight displayed by the right hon. Gentleman is disingenuous, to say the least.

Finally, I share the right hon. Gentleman’s concern that all those who work in this country should have the right to be here, which is why this Government will introduce identity cards for foreign residents from next year. We are yet to learn whether Opposition Members will support that.

I welcome the Home Secretary’s statement, the actions that she has taken and her undertaking to return to the House in December, presumably, to tell us about the outcome of all the inquiries. Is she satisfied that the form that is currently used for an application for a licence allows for full disclosure concerning the right to work? Has she seen the form, and is she satisfied that it does that? Will she undertake to give the appropriate department in the Border and Immigration Agency the resources to complete the task by December 2007?

My right hon. Friend has made an important point. First, the SIA has expected much tighter documentation of identity since 1 October. Secondly, the SIA’s ability to carry out, as it has done since 2 July, the 100 per cent. checks on the right to work of everybody applying for a licence is supported by the ability directly to fax applications to the BIA and by the ability of the BIA to check that information and return it to the SIA. I am content that appropriate new arrangements have been implemented. I am also content that we have speeded up the process for the verification of those granted licences before 2 July, but as my right hon. Friend will have heard, I have constantly argued for faster progress in order to be able to report on licences granted before 2 July.

May I start by apologising on behalf of my hon. Friend the Member for Sheffield, Hallam (Mr. Clegg) for his absence from this statement?

The previous Home Secretary, the right hon. Member for Airdrie and Shotts (John Reid), famously said that the Department was “not fit for purpose”. Following his review, we should remember that the structures and staff in the Home Office are the sole responsibility of this Government. After 10 years in power, and with a slimmed-down Home Office stripped of many of its functions, how can the Secretary of State explain the continued incompetence in her Department? Is it not the case that the Government talk tough on crime and immigration, whereas the reality is weakness and failure? The Government need to spend less time legislating to create party political divides and more time concentrating on running their core functions effectively.

Will the Home Secretary publish the findings of her internal inquiries? Will she also tackle the entire culture of spin and obfuscation in her Department? The legions of media officers working in the Home Office are paid by us, the taxpayers, to inform the public and not to conceal the deficiencies of her Department. The Home Office would benefit from a fresh approach based on frankness, openness and transparency.

Why did the Home Secretary not report the information to Parliament when MPs returned on 8 October, the same day that the taskforce met? What confidence can the public have that the Home Office is capable of running the vast ID cards database, when it is unable to administer much smaller projects properly? Is not the truth that even with a new Prime Minister, a new Home Secretary and all the restructuring, the Home Office under Labour is still not fit for purpose?

We are all sorry that the hon. Member for Sheffield, Hallam (Mr. Clegg) decided to campaign today rather than attending the Chamber.

The hon. Member for Taunton (Mr. Browne) is wrong: there has not been a blunder in operational terms. In fact, the issues were identified because of improved joint working between the SIA and the BIA going beyond the requirements of the SIA licensing regime in order to make sure that there was a belt-and-braces approach to ensuring the right to work of those applying for a SIA licence.

In operational terms, there has been no blunder; there has been an improvement in processes. I have already reiterated to the hon. Gentleman that I believe that the job of any responsible Minister and certainly the Home Secretary is to provide this House and the public with accurate and clear information. That has been my priority throughout.

Does my right hon. Friend accept that most sensible people would expect any Home Secretary, particularly a new Home Secretary, to want to know the full facts before disclosing them? Following the point made by the right hon. Member for Haltemprice and Howden (David Davis), is my right hon. Friend going to ensure that all these private sector employers are prosecuted for their criminal offence in employing people who should not have been employed? Where they are holders of Government contracts for security, will she ensure that they lose them, even if in some cases it makes it more difficult for them to give funds to the Tory party?

We take seriously the responsibility of employers to carry out right-to-work checks for their employees, which is why the BIA and my hon. Friend the Minister for Borders and Immigration have already undertaken a consultation on what more we can do to ensure that employers who negligently employ people without a right to work face appropriate civil penalties and that those who knowingly employ workers without a right to work actually face much stiffer penalties. That will help to ensure that all employers live up to their responsibilities. Alongside that, we will continue to ensure that the BIA provides support and assistance to help employers to carry out that activity.

Has the Home Secretary asked herself why all the failures of her Department are in the same direction—the direction of lax application of the rules, failure to apply checks and failure to deport people? Is it not because, within the discretion granted by law, officials do what they believe their masters want them to do? Have they not reached the conclusion that this Government want to increase and allow the maximum amount of work and settlement in this country, while minimising the problems and minimising the numbers?

The right hon. Gentleman is just plain wrong. As I spelled out to the hon. Member for Taunton a few moments ago, there has not been any failure of the processes during the course of this activity. There has been a tightening of the requirement to put alongside an application for an SIA licence a check for a right to work. That is not a statutory obligation: it is an additional operational safeguard put in by the Government and jointly adopted by the SIA and the BIA. It is an improvement of the position, not a blunder or a failure.

I congratulate my right hon. Friend on her very clear statement. Will she confirm that, during the passage of the Bill that established the Security Industry Authority, no Opposition Member—then or since—raised the issue of transferring clear legal responsibility from employers to the SIA? Will she also confirm that in dealing with this issue in July, she took cognisance, first, of the fact that we need a robust and reliable biometric database to be able to identify those who should not be claiming and able to work in this country and, secondly, of the critical importance of not equivocating or agonising about the analysis, but actually to act? My right hon. Friend did exactly that and we should congratulate her today on the steps that she has taken.

I did not have the pleasure of serving on the Committee that considered the Private Security Industry Act 2001. As my right hon. Friend says, however, I understand that the Opposition at no point argued for the things that they now argue should be in that legislation. In fact, as I have pointed out, they specifically argued for a proportional and light-touch approach.

My right hon. Friend is right: the changes made have been the result of improved operational activity between the Security Industry Authority and the Border and Immigration Agency, and of our not being satisfied solely with the statutory obligations on the Security Industry Authority—we have increased the obligations over and above those originally required in law. Our action has toughened the system.

When the fiasco first came to light, did the Home Secretary tell the Prime Minister? If not, why not? If she did, did the Prime Minister remind her of his promise to abandon spin and embrace candour?

I did not tell the Prime Minister because there was not a fiasco; action was taken to strengthen the system, and there was an investigation to provide the evidence to allow an explanation to be given to the public. There was no fiasco or blunder; there was strengthened and improved action.

Will my right hon. Friend expand on how the introduction of ID cards for foreign nationals will help employers have certainty at the point at which they take people on? Does not the Opposition’s resistance to that proposal suggest that their concerns expressed today are more crocodile tears than real ones?

My hon. Friend makes an important point. I am genuinely interested in how we can ensure that only those people who have a right to be and work in this country can do so. It is the responsibility of employers to check that, but it will be manifestly easier to do so if the people who have a right to stay and work in this country have ID cards. Frankly, arguing for tougher controls and attempting to criticise the Government, while being unwilling to support the things that will make the system stronger and better able to ensure that only those who should be here can work, is, to say the least, hypocritical. As my hon. Friend suggests, it has much more to do with political soundbites than serious politics and policy.

The Home Secretary stated:

“The fit and proper person requirement primarily involves establishing”

among other things,

“that identity . . . checks have been completed”.

Will the Home Secretary explain how an identity check does not show immigration status and whether the person identified has a work permit? Surely we identify somebody so that we know what they are about, yet at least one in 10—possibly one in five—security personnel work illegally.

As of 1 October, one of the things that we have tightened is the documents that must be provided to the Security Industry Authority to identify somebody correctly. The hon. Gentleman, however, identifies a problem: clever criminals can forge documents. That is why a Government-managed identity scheme for foreign residents will provide more certainty of identity. Given his question, perhaps he will support that.

When a full analysis of the situation is made, does the Home Secretary believe that it would be appropriate to publicise a list of all employers who appear to be either ignoring or understating their responsibilities?

I would not want to make a commitment to the House that I was not clear that we could deliver. My hon. Friend, however, makes an important point: it is the employer’s responsibility to check the right to work of somebody employed in the security industry. To help them to do that, we have introduced 100 per cent. right-to-work checks, using records of the Border and Immigration Agency, from July this year. We have given the industry’s employers every assistance, which I hope they will take up, and I hope that they will live up to their responsibilities, which are clearly spelt out in law.

The questions referred to in the statement were tabled in September 2006 in response to industry insiders who were telling anyone who would listen that that was what was happening. Why did it take the Home Office an extra seven months to discover something that a Back Bench Member of Parliament and anyone in the security industry knew about in September?

As we made clear in response to the hon. Gentleman’s question, it is the responsibility of security industry employers to check the right to work of those people whom they employ. I have made that case clearly already.

I congratulate the Home Secretary on using the SIA, set up by this Government, to tackle this particularly difficult problem. What assessment has she made of the effect that the light-touch approach advocated by the Opposition would have on her ability to deal with this problem?

My hon. Friend makes an important point. Up to 2003, it was of course the case that there was no regulation for people working in the security industry. It was this Government’s willingness to take through the Private Security Industry Act 2001 and set up the SIA that enabled us to identify and solve the problem and to strengthen the restrictions on those working in the security industry.

How many of the people identified so far have held high-security jobs in Scotland? What discussions has the Home Secretary had with Scottish Ministers? Can she confirm that even though she has known about this issue since April she has made no attempt to consult or inform Scottish Ministers, even though this is a serious and significant issue north of the border?

No, I obviously cannot give the hon. Gentleman details about those people working in Scotland. Scottish Ministers will understand their responsibility, as do UK Ministers, for ensuring that employment law is appropriately applied.

Is not this the industry that, under the Conservative Government, was allowed to get away with paying wages of, on occasion, less than £1 an hour? Was it not our Government’s minimum wage policy that put a stop to that? Is it not now clear that certain elements of the industry are continuing to try to get away with paying derisory wages, and should not my right hon. Friend be congratulated on trying to put a stop to that again?

I certainly think that it is important that we support high-quality employers in the security industry. That is why one of the improvements that the SIA has been able to make is an assured employers scheme, which acts as a kitemark of high-quality employment practices, including as from 1 August the ability of employers to verify the right to work of those whom they employ. That is regulation that, as my hon. Friend points out, supports responsible employment in the security industry and has improved the industry as a whole.

Following the question by my right hon. and learned Friend the Member for Folkestone and Hythe (Mr. Howard), can the Home Secretary tell the House on which date the Prime Minister was informed about this issue?

The hon. Gentleman should listen. I said that I did not inform the Prime Minister because there was no blunder—[Interruption.] Action was being taken to strengthen—[Interruption.]

Order. Let the Home Secretary speak. It is out of order for hon. Members to shout across the Chamber.

Action was being taken to strengthen the system. Every day of the week, Ministers in the Home Office take action to strengthen and improve the system and we do not go running to tell the Prime Minister about it every time.

Perhaps I, along with Members from other parties who were on the Committee that passed the legislation, should apologise to my right hon. Friend for failing to spot a weakness in it. However, having taken out of the security industry crooks, vagabonds and other people with outrageous ambitions in their field, has not the SIA improved the security of places of work, including Government institutions?

My hon. Friend is absolutely right. Before the SIA, the security industry in this country was unregulated. Although many in the industry carried out good work, there was certainly an opportunity for those who were not interested in either the security of the people and places they guarded or the employment of their staff to get away with it. That is no longer the case thanks to the work of my hon. Friend and others who took through the legislation.

Were the workers in question in possession of national insurance numbers, and should not their legal status have been verified before they were issued with such numbers? Does the Home Secretary share my curiosity that, since 2004, her Department has issued work permits for 270,000 non-EU nationals, whereas in the same period 896,000 national insurance numbers have been issued for non-EU nationals?

This is another area where sharing intelligence across government—in this case between the Border and Immigration Agency and the Department for Work and Pensions—will be important for doing what the hon. Gentleman and I have as a shared objective: making sure that those people who are here and who are working have a right to be here and a right to work. Perhaps he will therefore also support our plans for ID cards for foreign nationals.

I congratulate my right hon. Friend on resisting the naive siren calls of Opposition Members who seem to think that the records of 250,000 licence holders working in 2,000 companies can be checked overnight. That is not possible. Will she assure me that she will continue to ensure that she takes enough time to act to address the issues her Department faces and to publish accurate information—to make speed and not make haste?

I can give my hon. Friend that assurance. Although I have consistently pushed for work to analyse those non-EU residents who have applied for SIA licences and consistently pushed to speed up the work to find out which of them had the right to work, it has been fundamentally important to me that that work is done with accuracy and that I am able to report it fully when I am confident about its accuracy.

Since the Home Secretary reminded all public sector employers of their duties under the legislation, how many illegal immigrants have been found to be working in the public sector, and what action is she proposing to take about that?

Never mind whether it is the public or the private sector, there is rightly continued enforcement activity, including, for example, the 3,700 successful Border and Immigration Agency enforcement operations against illegal workers last year. All that work would have been decimated by the Conservative party’s proposals in its manifesto at the last election to halve the money made available to the agency. It is a bit rich for Conservative Members to demand enforcement activity when they would have halved the agency’s ability to carry it out.

Avian Influenza

With your permission, Mr. Speaker, I would like to make a statement on an outbreak of avian influenza.

Last Sunday, Animal Health received a report of a large number of deaths in turkeys on premises near Diss on the Suffolk-Norfolk border. The premises house approximately 5,000 turkeys as well as around 400 geese and more than 1,000 ducks. The location was immediately placed under restriction, a veterinary investigation was carried out and samples were sent to the Veterinary Laboratories Agency in Weybridge, Surrey. Preliminary results received yesterday afternoon were positive for H5 avian influenza. Our contingency plan was immediately put into operation. A 3 km protection zone and a 10 km surveillance zone were established around the infected premises. No movements of poultry are currently permitted in those zones, although we are considering licensing necessary low-risk moves. Having acted on the suspicion that this was H5N1, I can tell the House that laboratory results earlier today confirmed that the virus strain was indeed the highly pathogenic H5N1.

The culling of all birds on the premises and the following up of any dangerous contacts will now take place—indeed, the culling has already begun. The health and safety of those involved in the operations are the priority and a strict approach is being taken. All workers on the premises already potentially exposed to infection have been given Tamiflu. All those who will be going to the infected premises will be given Tamiflu prior to commencing operations. Due to the nature of the premises, the work might take some time to complete.

The culled birds will be transported to a plant in Staffordshire in sealed, leak-proof containers that will be escorted at all times. That is the nearest suitable plant for rendering in these circumstances. It is the same plant that we used during the outbreak in February, which was also in Suffolk, and it is geared up to deal quickly with large numbers of carcases under biosecure conditions.

We have established both a national and local disease control centre, based in Bury St. Edmunds. We have also sent text messages to all birdkeepers nationwide, particularly to those in the zones who are on the poultry register. We will continue to work closely with Animal Health, local authorities and the industry on local and national communications.

In addition, following consultation with ornithologists and other experts, a wider restricted zone was established last night. The zone covers much of Norfolk and the whole of Suffolk, based on administrative boundaries. The housing of poultry, or their isolation from wild birds, is required in the zone. Movements in the zone can take place, but are not permitted out of the zone at present. We expect to make available general licences for low-risk movements out of the zone shortly.

The European Commission has been informed. The export of poultry to the EU remains permitted under EU law from areas outside the restricted zone. With third countries, we have notified all posts around the world. We are withdrawing export health certificates for those third countries that already require complete avian influenza freedom.

In addition, the national general licences permitting bird gatherings in England, Scotland and Wales have been revoked. No bird shows or pigeon racing will be permitted for the time being. We have taken this measure nationwide as bird gatherings pose an especially high risk for the onward spread of the disease.

The measures that we have taken are precautionary and reflect the uncertainty of the situation. A full epidemiological investigation has started into the source of the outbreak and the risks of further spread. Tracings and surveillance work are under way. As a result of the investigation, we expect the culling of any dangerous contacts to take place. We will confirm details as soon as possible as more information becomes available.

It is too early to speculate about the source of the virus and all possibilities are being investigated. The chance remains that there might be further undisclosed disease in the area, which, as hon. Members will know, has a high density of poultry. As further information becomes available, and in consultation with ornithological and other experts, the restrictions already in place may be adjusted. It is for that reason that the acting chief veterinary officer, Fred Landeg, has been urging all poultry keepers to practise the highest standards of biosecurity and to be vigilant for signs of disease. It is very important that they act quickly and contact their local Animal Health office if they suspect anything.

I wish to reassure the House that avian influenza is primarily a disease of birds. It is an animal, rather than a human, health problem. The Department of Health and the Health Protection Agency have been fully involved in the action taken so far and their advice is clear. Avian influenza has so far been shown to spread between birds and humans only through close and prolonged contact with infected birds. In other words, it is a difficult disease to catch. Therefore, the only current known possible human health consequences are for those working closely with live or dead infected poultry. We have taken a precautionary approach to protect the health of the workers involved. The Department of Health has made seasonal flu vaccine available to all poultry workers to guard against the risk of the disease mutating by spreading to a person with seasonal flu. The Food Standards Agency advises that there is no risk in eating any sort of properly cooked poultry and eggs.

Finally, I would like to record my thanks to all those who are working so hard on this task, including Animal Health, local authorities, the police, stakeholders and many others, especially given the important work that is continuing on foot and mouth disease and bluetongue.

I thank the Secretary of State for his statement and for the brief advance notice I had of it. Like him, I look forward to the day when he comes to the House with something good to say.

Coming after foot and mouth disease and bluetongue, an outbreak of avian influenza at a turkey farm in the run-up to Christmas is a nightmare for the farming industry. Matters are tough enough in the poultry sector because of recent large increases in the price of feed. Farmers could be forgiven for asking what on earth they have done wrong to deserve the blows that they have had to endure this year. It is clearly especially bad news that the strain involved in the present case is the highly pathogenic virus H5N1. Although that means that even greater than usual vigilance will be required, it is important to recognise that, as the Secretary of State said, this is a disease of birds and it remains completely safe to eat cooked poultry meat.

As in the case of bluetongue, although—infamously—not in the case of foot and mouth disease, the latest outbreak of avian influenza arises from circumstances beyond the Government’s control. I congratulate those who are involved in dealing with the situation on the ground in Suffolk, including local authorities. They have our good wishes.

Is the Secretary of State aware, however, that recently the Minister with responsibility for animal health, Lord Rooker, received a letter from Councillor Geoffrey Theobald, chairman of the Local Authorities Co-ordinators of Regulatory Services—LACORS—protesting at cuts being imposed by his Department in the funds available to local councils for dealing with outbreaks of animal disease? Councillor Theobald pointed out that originally £9.7 million was promised for those purposes this year, but that because of DEFRA’s financial mismanagement only £8.5 million was allocated to councils. They have now been told to cut their animal health budgets by 12 per cent. within the last five months of this year. As Councillor Theobald put it to Lord Rooker,

“This is very difficult to understand in the current environment where all local councils are working hard to control FMD and now bluetongue disease. To cut back on funding of disease control measures and other animal health work, by this amount and at this time, seems particularly inappropriate.”

It seems even less appropriate now, following the latest outbreak of avian influenza.

The public simply will not understand why, with their local councils in the front line of the battle against such animal diseases and with resources already stretched to breaking point, DEFRA has pulled the rug on the budget for controlling animal disease. Can the Secretary of State explain why he is cutting the animal health budget for local authorities, and what he now proposes to do about it in the light of these events?

Obviously, it will be essential to take no risks with biosecurity, but can the right hon. Gentleman assure the House that he will take full account not only of the economic impact on the farming sector, but of the collateral impact on other rural businesses of any restrictions imposed? For example, this is a key time of year for shooting—an activity that contributes £1.6 billion to the UK economy. I understand that during the last outbreak of avian influenza, restrictions were placed on shooting without any consultation. Will the Secretary of State ensure that, notwithstanding the need to act quickly, there will be proper discussion with those whose livelihoods are likely to be affected by measures to control the disease?

After the avian influenza outbreak in February, the Government launched a lessons-learned inquiry. The report made 34 operational recommendations on the management of an outbreak of AI. The Government accepted all of them, but how many have actually been implemented? What steps has the Secretary of State taken since the outbreak in Holton in February to increase awareness of the Great Britain poultry register? On that subject, can he confirm that some 3 million birds are registered within the surveillance zone? Has he any information on how many there are within the overall restricted zone?

What assessment has the Secretary of State made of the feasibility of housing a huge number of birds across the area, many of which are kept out of doors, with no housing available? What assessment has he made of the practicality of keeping commercial flocks away from the wild bird population? On transporting carcases for disposal, he will be aware that concerns were expressed during the Holton outbreak that lorries carrying carcases were not properly sealed, despite the Government’s assertions to the contrary. What measures has he put in place to ensure complete biosecurity during transport?

We very much hope that the outbreak will be contained, but we must of course be prepared to deal with the consequences if it is not. Is the Secretary of State satisfied that he has the resources, facilities and slaughter capacity to deal with the culling and disposal of a much larger number of birds in a more widespread outbreak? Has he ensured that divisional veterinary officers have established arrangements for responding to an outbreak of disease at all large commercial poultry premises in their area, as recommended by the lessons-learned inquiry?

Finally, what assessment has he been able to make so far of the adequacy of the biosecurity arrangements at the farm at the centre of the outbreak, and when was that farm last inspected?

I am grateful to the hon. Gentleman for his kind words for those who have been working extremely hard in the past 24 hours and beyond to deal with the situation. I am aware of the letter that Councillor Theobald wrote. There is a discussion every year about the estimates of what local authorities will need to expend, and about the amount of money available. Given the length of time that the hon. Gentleman dedicated to that bit of his response to the statement, I was not entirely clear whether he was advancing the argument that the issue in any way affects our capacity, or local authorities’ capacity, to respond to the outbreak. If he has any information to that effect, I would be grateful if he gave it to me.

We will assess the economic impact. The countryside remains open. On shooting, restrictions were previously put in place, but I can tell the House that I currently have no plans for such a restriction, because, on reflection, what was done last time seemed disproportionate to its potential impact. I promise that there will be consultation if that position changes. I will happily respond to the hon. Gentleman to let him know exactly where we have got to on the implementation of the lessons learned from the incident in February this year. I am sure that he will understand that those who might draw up that letter are now working hard, dealing with the current outbreak, so I will be extremely grateful if he will bear with me.

As the hon. Gentleman knows, the Great Britain poultry register was established in December 2005. As of 1 October, the register held details of 24,161 premises, and a very large number of birds have been registered in that time. Keepers of poultry premises with 50 or more birds are required by law to register their holding. Those with fewer birds are not required to do so, but it is possible for those with smaller flocks to do so on a voluntary basis. One of the difficulties is that there will be smaller poultry keepers who are not registered, so it is important that all of us give them the message that they, too, must be vigilant and must report any concerns that they have.

The hon. Gentleman raises an important point about the practicalities. Where there is housing, poultry can be taken inside, and netting can be used, but there are real difficulties. We must recognise the circumstances, particularly in view of the proximity of the premises in question to a nature reserve, where a large number of wild birds are to be found. I can assure him that every step will be taken to ensure that containers and lorries are properly sealed. I say again that if anyone has any concerns, it is important that they raise them with me or my officials.

Animal Health has the resources that it needs to deal with the current outbreak, but it is stretched because of the other two diseases with which it is dealing. I will not speculate in the House on whether the outbreak will get larger; we are doing our darnedest to make sure that it stays where it is.

On the hon. Gentleman’s final point, investigations are taking place on the arrangements that applied at the farm concerned. The most important thing, having locked things down, is to trace the contacts and movements, so that we can take the appropriate action.

The Secretary of State has made it clear that if poultry is properly prepared and cooked there is no danger to human health from eating it—but this is a vital time for the poultry sector. Will he talk to colleagues and the wider industry to promote the case for poultry at a critical time for the industry?

I will gladly do that. We all have a responsibility, particularly at times like this, both to take the right action to deal with disease outbreaks and to reinforce the point that those industries are extremely important to the country, to exports and to the livelihood of the people who work in them. It is important that we promote their products, given the advice that I have received, and which my hon. Friend confirmed, that it is safe to eat properly cooked poultry.

I, too, thank the Secretary of State for an advance copy of the statement. I pay tribute to those who identified the outbreak and worked to contain it in those premises. This is the third major blow to the UK meat industry: first foot and mouth affected the beef, sheep and pig industries, then bluetongue—and now, avian flu could not have come at a worse time for poultry farmers. What assessment have the Government made at this early stage about the likely origin of the outbreak, and the involvement of migratory birds? Could other poultry units be at similar risk? How quickly can licensing arrangements be up and running for the movement of live poultry in and out of the restriction zone? I understand that there is a hatchery within that zone, and I should like to know whether the Minister has made any assessment of the welfare of chicks delayed in the hatchery because of movement restrictions. On the basis of welfare, what will happen to poultry owners who do not have enough housing to house all their poultry as required under the regulations? What assessment has the Minister made of the need to balance the restriction zones to ensure that we provide biosecurity and a proportionate response for the industry? Is he confident that Animal Health has sufficient capacity in its mobile gassing units to cull poultry on the affected site, and possibly other affected sites, to the agreed welfare standards? Finally, what assessment has he made of vaccination as a response to the outbreak?

I am grateful to the hon. Gentleman for his kind words for those who are working so hard at the moment. On the origin of the outbreak, the honest truth is that we do not currently know. We can speculate, but it is not terribly helpful to do so. Obviously, the epidemiological team will work very hard to try to find out the origin. We do not yet know whether this is the first and only case, or whether there are others; we will just have to see what transpires while working hard to contain the outbreak. Licensing officials will work to provide those licences as soon as possible. I have not looked at the question of the hatchery, but I will make inquiries and come back to the hon. Gentleman, if that is all right. Similarly, on cases where there is not sufficient housing, guidance is available on the website, but I will make inquiries about whether it is possible to net animals as an alternative. We absolutely will balance the restrictions that have been put in place, and have regard both to the overriding need to contain the outbreak, and to trade implications. That is why we moved swiftly last night to put the bigger restriction zone in place, so that bigger intra-Community trade can take place outside the zone.

The location of the outbreak makes it a difficult site for Animal Health, but having spoken to Glenys Stacey this morning about the equipment and material that has been brought in, I am confident that it is doing all that is required. As I reported to the House, the culling has already begun. The House will know that vaccination is permitted in zoos, because they house rare breeds, and biosecurity can be of the tightest standard, but apart from that, vaccination is not the policy and is not permitted, because it can mask animals carrying the disease, thus making the control of an outbreak more difficult. If that position changed, I would obviously inform the House, but the policy is not to vaccinate in these circumstances.

I understand that the Department operates a dedicated helpline to deal with calls related to this serious problem. Will my right hon. Friend give the House a little more detail about the operation of the helpline?

Yes, I can. For those who want to make a note, the number is 08459 335577. The helpline operates from 6 am to 10 pm and it can provide information to those who have queries. Information is also available on the DEFRA website.

I thank the Secretary of State for contacting me promptly as soon as the outbreak was discovered in my constituency. I trust that he will give all the support in his power to those in the East Anglian farming industry as a whole, who have had a very tough year indeed. The local veterinary office in Bury St. Edmunds is already dealing with bluetongue controls. What additional resources will the right hon. Gentleman make available to that office so that staff, already busy, are not stretched to breaking point or deflected from important bluetongue surveillance?

I thank the hon. Gentleman for his kind words. That gives me the opportunity to thank the Under-Secretary of State for Environment, Food and Rural Affairs, my hon. Friend the Member for Chatham and Aylesford (Jonathan Shaw) and the Minister for Sustainable Food and Farming and Animal Health, my noble Friend Lord Rooker, who have been notifying other right hon. and hon. Members whose constituents are affected by the bigger restriction zone. I can assure the hon. Gentleman that additional staff are coming into the disease control centre that has been established locally in Bury St. Edmunds, so that people can continue the work in relation to bluetongue. Sadly, as a result of the events of the past few months Animal Health is well used to gearing up and getting going pretty quickly, and that is exactly what staff are doing.

As the Secretary of State knows, I represent a large number of poultry and duck producers in west Norfolk. Can he tell me how many of those producers will be in the restricted zone? Also, at a time when the poultry industry is suffering huge pressure because of large increases in feed prices, what compensation will be available to farmers whose flocks have to be culled?

I have not yet done a count of the number of premises or producers who will be affected by the restriction zone that we put in place yesterday evening, but I am sure that information can be gleaned from the poultry register. If the hon. Gentleman will bear with me, I will get that to him as quickly as I can. The position on compensation is this: if healthy poultry are culled, compensation will be paid. If the poultry were already diseased or had died as a result of avian influenza, compensation is not provided. A calculation is done at the time when the culling takes place. Those are the well-established arrangements in place.

What estimate, if any, has the Secretary of State made of the number of birds not covered by the poultry register? Although one can understand the reluctance to take steps that are disproportionate, it remains the case that the smaller flocks are more likely to be out of doors and more likely to be at risk. In a world where avian flu is apparently becoming more commonplace, is it time to consider extending the poultry register to cover most, if not all, birds?

The hon. Gentleman raises an important question. By definition, we do not know how many birds are not covered, because they are not on the register. The arrangements are those that I set out a moment ago. As I understand it, when the poultry register was first established, consideration was given to how low down, in terms of numbers, we should go in making it a requirement to register. A view was taken that at a certain point the regulatory burden—a subject with which many hon. Members are familiar—is greater than the case for making that a requirement. One of the things going on now is an attempt to identify those premises, particularly immediately around the premises at the centre of the outbreak. As I have said to the House on all such occasions, when the incident is over there will be further lessons to reflect upon, and the hon. Gentleman has raised one.

The Secretary of State is aware that I represent Mid-Norfolk. Sadly, over the past 10 years we have had, directly or indirectly, the impact of foot and mouth, swine fever, avian flu once, and now avian flu again and bluetongue. One of the things that I have learned from that—and I know how difficult this is for the Secretary of State—is that farmers and others need to be able to get up-to-date information easily. Sadly, in the past the system has frequently been overwhelmed. I understand that there is an element of resources and getting the process on flow, but I urge the Secretary of State to look into that matter. It is one of the issues that undermines confidence, particularly among farmers, in the first crucial week.

That, too, is an important point. We have done a range of things, some of which I have already described, to inform Members of Parliament, who are an important source of information down the line to constituents. We have introduced the helpline, the website and the news releases and notified local vets. The issues are widely reported in the media. As I have described, for all the registered keepers on the poultry register, information packs are ready to be delivered in the particular zones. The local media do a really important job, and the acting chief veterinary officer has given a press briefing this afternoon.

If it would be helpful to right hon. and hon. Members, I was going to suggest that we do a briefing. Would that be useful? [Hon. Members: “Yes.”] We could get some of the team along and Members could raise more detailed questions. If that would be of assistance, I shall organise it.

As it is essential that there should be public confidence in how the disease is tackled, and as we all know that there is no situation that is not made worse by panic, will the Secretary of State assure the House that the lorries taking the carcases to Staffordshire will not only be sealed but will be escorted by police?

I am happy to give the hon. Gentleman those assurances—in that the lorries will be escorted: there will be vehicles behind them to make sure that they are not leaking, and they will be checked before they go. The carcasses that went to Frome during the foot and mouth outbreak were dealt with in exactly the same way.

I welcome the precautionary approach taken by the Secretary of State. I support the call for vigilance and agree that the disease is difficult to catch other than through close and prolonged contact with infected birds. The problem is on the Suffolk-Norfolk border, but the movement of wild birds cannot be controlled, and there are risks for elsewhere, particularly as the H5N1 strain is involved. Will the Secretary of State give an assurance that proper discussions are taking place with the agriculture and public health Ministers in the devolved Administrations, and that proper contact has been made with the chief scientific officers—particularly the chief veterinary officers—in the devolved Administrations as well?

The hon. Gentleman makes an important point. If it transpired that wild birds were responsible—that is an “if”, because we do not yet know—that would be a difficult source of transmission to deal with. I am extremely grateful for the support of the devolved Administrations in agreeing, in respect of those parts of the United Kingdom, to the measures that I have announced this afternoon. Yes, we are in close contact; I cannot comment on the relationships between the different Ministers in the devolved Administrations, but the Cobra meeting that I chaired at lunchtime today included representatives from the Scottish Executive and the Welsh Assembly.

The Secretary of State said that the vaccination programme was applicable to zoos. Will he consider whether farms with rare breeds breeding stock could also be included in that programme? I have a number of such farms in my constituency. Should the dreadful disease spread, it would pose a considerable threat to the future of rare breeds in this country.

I gladly undertake to consider that—but there are good and sound reasons, which I have explained, why the policy is as it is. Zoos are an exception because of biosecurity and the containment arrangements that they can put in place. I am sure that the hon. Gentleman would want nothing to be done that might put the control of avian influenza at risk. However, I shall consider the issue that he has raised and come back to him.

Point of Order

On a point of order, Madam Deputy Speaker. I apologise for delaying the important debate that is to follow. On 30 April this year, I asked the then Solicitor-General two questions: first, about my concerns about the leniency of sentencing, and secondly, about how many times he had referred matters to the Court of Appeal on that subject. Sadly, according to the Library today—some seven months on—there is still no reply. May I seek your advice, Madam Deputy Speaker, on how I can get an answer to those simple questions?

Orders of the Day

Debate on the Address

[Fifth Day]

Order read for resuming adjourned debate on Question [6 November],

That an Humble Address be presented to Her Majesty, as follows:

Most Gracious Sovereign,

We, Your Majesty’s most dutiful and loyal subjects, the Commons of the United Kingdom and Great Britain and Northern Ireland in Parliament assembled, beg leave to offer our humble thanks to Your Majesty for the Gracious Speech which Your Majesty has addressed to both Houses of Parliament.—[Mr. Caborn.]

Question again proposed.

Health and Education

I beg to move, as an amendment to the Address, at the end of the Question to add:

‘but regret the absence of measures in the Gracious Speech to empower professionals responsible for the delivery of health and education services and of measures which would make those services more accountable to patients and parents; deplore the absence of measures to improve public health and reduce health inequalities; regret the lack of a reformed legislative structure for the National Health Service which would reduce central targets and devolve decision-making closer to patients and enable health services to respond to the need for high quality and accessible care; further regret the lack of measures to deal with school discipline, raise standards in literacy, numeracy, science and languages, address under-performance in the primary sector, tackle disadvantage at its roots and provide effective support in the earliest years; and further regret the absence of measures which would deliver the real improvements needed in these and related public services.’.

Last Tuesday, I sat here and listened to the Prime Minister’s speech, but I waited in vain for him to talk about health or the national health service. Back in July he described the national health service as his priority, but in November that turns out to have come to nothing: an empty vessel—from hero to zero. I suppose that we should not have been surprised, given that last year, as Chancellor of the Exchequer, he completely ignored in his Budget speech the financial crisis that was afflicting the national health service. At the same time, he said that education was his passion. So it may be, but the passion must be for high standards in education, not just for high spending. In last week’s speech, he did not even commend doctors, nurses, social care workers or teachers—all those in our public services on whom we depend—so let me start by doing so.

Public services are vital to our well-being and to our quality of life. We value and support the NHS and its staff, teachers and support staff in schools and colleges, and social workers and care workers. We know that while we can make promises here, it is they who deliver. However, we cannot expect the delivery that we want when morale and motivation in public services is not high. Earlier this year, a hospital doctor carried out a substantial survey. Two thirds of the doctors who took part said that morale had fallen in the past year, while 54 per cent. said that morale in their hospital was poor or terrible. I am afraid that we need higher morale right across our public services. I therefore make no apology for repeating that one of our central intentions as a party must be to re-empower professionals working in public services so that they can deliver the service that they wish to deliver, whether to parents or to patients.

In the Gracious Speech, Her Majesty, on behalf of the Government, announced that there would be an education and skills Bill. There is something of a theme to this Gracious Speech. For all that the Prime Minister might like it to be thought that there is a change in this Government, in fact there is no change. When I listened to the speech, I thought, “Surely I’ve heard these intentions before”—and so I had. In July 1999 the Government published a document called “Bridging the Gap”—I am sure that the Secretary of State for Children, Schools and Families recalls it—in which Tony Blair said:

“staying at school or in training until 18 is no longer a luxury. It is becoming a necessity.”

Indeed, but that was in 1999. The trouble, as with all these things, is how well the Government have delivered on their intentions.

Eight years on from the intentions expressed then, the number of those not in education, employment or training has risen from 160,000 to 220,000. Connexions, which we were promised in 1999 would be one of the solutions, has come and is about to go. The Learning and Skills Council has gone through an endless succession of reorganisations without ever delivering on its intentions. However, there has not been a recognition of the fact that, as stated in “Bridging the Gap”, non-participation beyond 16 is strongly linked to the relative achievement of young people prior to 16. That is the central issue. That is why what the Government are saying feels like such a failure on their part. Extending the education leaving age is an insufficient response to earlier and continuing failings in educational achievement, particularly among those in low-income households.

Participation depends on motivation, the relevance of the education offered and the reward that young people expect from it. Young people have to think it worth while; there have to be results. If they fail to see results from a decade of schooling, why should they respond positively to more compulsory education and training? My hon. Friend the Member for Surrey Heath (Michael Gove) will explain this in more detail later, but we must tackle the roots of disadvantage, and ensure that young people in schools, including those from the poorest households, have a platform for their participation in learning through life, and see that they can secure their future position through the acquisition of standards, including basic standards in literacy and numeracy, in a disciplined environment.

Is the hon. Gentleman disputing the facts that have been produced by Stockton borough council stating that in low-income areas, the improvement in English and maths has been between 30 and 47 per cent. during the past five years? That is an incredible improvement in primary schools, which should be celebrated. Is the hon. Gentleman really disputing that that is taking place?

I am sure that my hon. Friend the Member for Surrey Heath will be able to elaborate on that later. All I do know is that the Government’s acknowledged statistics show that they have not met their targets for key stage 2, and we have seen some of the standards in basic literacy and numeracy pretty much flatlining in recent years.

There was nothing in the Prime Minister’s speech, or in the Gracious Speech, on the subject of public health. The Secretary of State for Health said that his priority was to tackle health inequalities, so where was that in the Gracious Speech? Where was it in the Prime Minister’s speech? It was not there at all. Just as we want to tackle inequalities in educational outcomes, we have to tackle them in health outcomes, too, because they have been widening. The Secretary of State must know, because it was in Lord Darzi’s framework for action in London—the right hon. Gentleman has of course subcontracted responsibility for policy in the Department of Health to Lord Darzi, so perhaps he does not bother to read his documents—that the spend per head on public health in primary care trusts in London is inversely related to the relative deprivation of those trusts. Frankly, that is a scandal.

The Government have been distributing ever larger amounts of money in the direction of primary care trusts that have statistics of relative deprivation, and yet what do we find in London? They spend less on tackling that problem. Why do they do that? It is not a wilful desire on their part to ignore their responsibilities. It is because, of course, in the national health service everything is focused, through the target culture, on the delivery of a small number of Government targets. Too little is focused on the necessity of understanding that we must prevent disease and improve health outcomes. That is one of the reasons why my party has made it clear during previous Queen’s Speech debates, and in our own proposals, that we should have separate funding to tackle specific public health needs.

I urge the Government and the Secretary of State, if they are serious about tackling health inequalities, to amend the structure of public health care. In the health and social care Bill, they will do a little to reform public health legislation on the control of infectious diseases, but they could do so much more to ensure that we have a strong public health infrastructure that can use dedicated resources to back up local authorities in the NHS, which are tackling those issues through local area agreements. The Secretary of State came to the Dispatch Box only a couple of weeks ago and described obesity as akin to climate change. He probably does not seriously believe that—try telling it to people in sub-Saharan African or Bangladesh. It is, however, an important issue. His response seemed to be that there should be a national debate—but that debate did not even get as far as the Queen’s Speech.

During the Gracious Speech we were promised a children and young persons Bill. Again, I am afraid that we have been here before. For a very long time, the Government have not taken those responsibilities seriously. I was a member of the Select Committee on Health, with David Hinchliffe, in 1997-98, and we produced a report on the care of looked-after children. Why has it taken so many years to address this issue? We have waited 10 years to see legislation to avoid circumstances in which lots of young people are looked after at a considerable distance from where they live and where their friends and families may be. The gap between looked-after children’s educational achievement and that of other children has widened. It is still true that 30 per cent. of looked-after children still do not have full access to immunisation programmes. The duties of local authorities to young people and the responsibility that we take on when children are looked after must be clear.

We Conservatives understand that none of that will be possible without not only clear duties but the staff to make to it happen. That is why my hon. Friends established our commission on social workers. Lady Butler-Sloss and Lord Laming were the patrons and brought together a team without party affiliation to make it clear how we can support social workers who work with children, value their profession and help them in the process of delivering better services.

Clearly, if there had been a plethora of NHS legislation, the hon. Gentleman would have criticised the Government for taking panic measures and for thinking that legislation was the answer to everything. In fact, many of the issues that he talked about are being addressed through means other than legislation, not least investment. Is he trying to suggest that there were halcyon days in the health service prior to 1997? Does he not recall that at that time a quarter of a million people had waited more than six months for their operations? Now, virtually no one waits that long. Does he expect people to believe that what he has to offer is any different from what the Tories offered before?

I am not pretending that before 1997 the national health service did not have problems. Equally, however, if the hon. Gentleman thinks that the public think that reducing waiting times to the exclusion of their safety, through the clear increase in infection rates, is an advantage, he is absolutely wrong. In the same way—[Interruption.] Labour Members should do as we have done, and understand from experience what will make the best policy for the future. I see no evidence from those on the Government Front Bench that they are learning at all.

The hon. Member for High Peak (Tom Levitt) is still peddling the idea that the pursuit of waiting time targets has been an unalloyed good. It has not. During the course of questions, the Secretary of State has seemed to dispute that fact, but the report on Maidstone and Tunbridge Wells NHS Trust states:

“Many staff told us about the consequences of targets, in particular the target that no patient should be in A&E for more than four hours. Some staff told us senior managers had given the A&E target much greater priority than the control of infection, including at the time of the outbreaks…One senior manager said that because of the other pressures and ‘over-heating’ in the trust, the A&E target was delivered at the price of chaos elsewhere in the system.”

I emphasise the “price of chaos”. We have had a report like that on Maidstone and Tunbridge Wells and another on Stoke Mandeville, and across the NHS people have made it clear that it was also targets—the waiting time target in particular—that led the NHS into the financial disaster that was 2004 to 2006.

No, I will not give way again. If, in the change that has occurred since 1997, the Government had understood better what they were setting out to do, they would have learned at an early stage that moving from central top-down targets to a culture of continuous improvement and performance measurement and management inside the national health service was the point. The Secretary of State gets up and says, “Sir Ian Kennedy is in favour of targets.” Well, no one in their right mind does not have the idea that a service should have performance measurement and management, but the idea that it should be done through a single set of targets dictated from the centre in a one-size-fits-all fashion is completely absurd.

The Government are now moving to the point where they want to run the whole health service on the basis of the 18-week referral to treatment target. What they do not tell anybody is that the 18-week referral to treatment target actually applies to only 30 per cent. of hospital activity, let alone whether it has any impact on people living at home with chronic conditions or on primary care services.

The hon. Member for High Peak asked what we would have said if there had been a series of health service Acts. But there has been a series of health service Acts— I am afraid that this is a constant theme of this Queen’s Speech. There was the Commission for Health Improvement, established in the 1999 legislation, which we were told would be the answer to the problem of standards in the national health service. Then the 2003 legislation abolished the Commission for Health Improvement and created the Commission for Healthcare Audit and Inspection, which we were told would solve all the difficulties with standards and problems such as infection control. Then we had the Health Act 2006, when the Government said, “Ah, well, the Healthcare Commission’s trying to do this thing, but it must have the code of practice”, but no, it turned out that that was not good enough, either.

I was here two years ago arguing that the code of practice needed to be strengthened, but that was not done; and then suddenly, in 2007, we are told, “Oh no, the Commission for Healthcare Audit and Inspection’s now going to be abolished and a new care and quality commission created in its place.” So in eight years we shall have gone through three inspectorates, all with exactly the same intentions.

Before my hon. Friend allows the hon. Member for High Peak to get away with his comment, does he agree that before 1997 people in my constituency could at least get a national health service dentist? Those over the age of 80 were not sent back from the hospital several times in order to get the waiting list time started again, people could access a proper health service, because local hospitals such as the Bartlet hospital had not been closed, and, although I have some of the oldest constituents in the country, we did not receive one of the lowest payments per head. The Government have given a second-rate health service to areas such as mine that they do not think are worth supporting.

Another thing that people did not find before 1997 was their local hospital’s maternity services disappearing and being transferred 15 miles up the road, as has happened in Welwyn, which I visited on Saturday. People in Banbury, where I also visited, did not find their maternity services being transferred to the John Radcliffe hospital 10 years ago. Likewise with A and E services. Right across London, people might well wonder what kind of NHS they have when, after 10 years and three times the amount of money, they cannot visit their local hospital safely, because although it advertises that it has an A and E department, it does not have the necessary back-up to make it one.

Lord Darzi, who is on—[Interruption.] The Minister of State, the right hon. Member for Bristol, South (Dawn Primarolo), mentions Tomlinson from a sedentary position—I have a quotation from when she opposed the Tomlinson report—yet she and her colleagues propose a reconfiguration in London that seems to be based on the proposition that A and E departments will be available in local hospitals that have high dependency level 2 care, not intensive care. However, the Academy of Medical Royal Colleges has said in terms that for an A and E service to be provided, it is essential that it should be backed up by level 3 intensive care. And these Ministers have the temerity to come to the House and tell us that the reconfigurations are locally determined and based on clinical criteria. They are not; they are being dictated by the Government.

The latest evidence came out only last week, in the Health Service Journal, that the Government are proposing to try to fix the NHS tariff, so that they can force specialist services into centralised, larger hospitals by undermining the viability of specialists in district general hospitals.

Frankly it is an outrage, and the right hon. Lady, having been a Minister for four months, could at least have visited the hospital concerned before she starts to lecture the House about what is going on, because she has not done so yet.

I am concerned that my hon. Friend might have forgotten the fact that people throughout the country are too frightened to go into hospital now because of the MRSA problems.

I am grateful to my hon. Friend. I have not forgotten about that—far from it. Indeed, the Government’s central argument for their promised health and social care Bill is that it will strengthen infection control, but the code of practice should have been stronger and it should have been enforced. Indeed, we were here legislating for that more than 18 months ago and arguing about what needed to be done even before that. The Secretary of State can talk about the importance of screening now, but we were arguing that screening before admission was necessary four years ago. The chief medical officer said, in “Winning Ways” in December 2003, that screening before admission was a necessary part of the process of infection control, but Ministers did not implement that proposal. They talk about accountability, but there is no accountability on the part of Ministers for their failure to deliver infection control.

Years ago, the National Audit Office demonstrated that there were insufficient isolation facilities in the NHS. Now, Ministers talk about isolation but cannot provide it. We have known for years that bed occupancy rates are too high. For nearly two years, the Department of Health has been in possession of a report quantifying the increases in MRSA as a result of bed occupancy rates rising to above 90 per cent., but what have Ministers done? They actually reduced the number of beds in the NHS by 6,000 in the last year for which figures were available, so that we are now way below the figure that obtained in 2000, when the NHS plan—which, according to Ministers, is the basis on which they are working—said that there was to be an increase of 2,100 in the number of general and acute beds.

The health and social care Bill will simply bring together the Healthcare Commission, the Commission for Social Care Inspection—CSCI—and the Mental Health Act Commission. In principle, that is fine. Indeed, Opposition colleagues argued for that arrangement way back in 2003 when those bodies were first established. In implementing it now, however, it is important that we do not lose sight of the role of CSCI in respect of social care, which must be protected. It is also important not to lose sight of the responsibility of the Mental Health Act Commission, which must be carried into the new body in order to follow up on the Mental Health Act 2007, which we passed earlier this year.

Where in the Government’s legislative programme is the wider regulatory review that was always promised? Frankly, we have done the work over the past two years to determine what is needed to give the NHS a sustainable, long-term structure that will give professionals in the service greater autonomy while ensuring that that devolved power is subject to enhanced accountability. We have put those measures into a Bill, which we have published ourselves and which we will introduce in this Session. It sets out for the first time a constitution for the national health service which will incorporate the principles of the NHS, devolve responsibility through the NHS board closer to patients, make services increasingly accountable to patients through patient choice, empower providers to come into the system by creating an independent regulator in Monitor to work right across the health care sector, ensure genuine competition in health care matters, give the national institute its own statutory responsibilities for the first time, and for the first time create a national patient voice. A review undertaken by the Department of Health in late 2005 said that it was necessary to create that voice, but Ministers have signally failed to do so.

Let me make exactly the same offer to the Secretary of State now that I have already made to him privately. In the past, we supported the Government when they were doing the right thing on education and schools, giving greater freedom, through legislation, to those running schools. If the Secretary of State will work with us now, we will use our legislation to give far greater freedom and accountability to patients through the national health service, but the Government will have to be prepared to get away from their ideological fixations and to get into thinking about how this can be achieved more effectively.

We hear the Government’s promises time and again, but those promises seem to turn to nothing in their hands. We see one incompetent failure after another. We have just been listening to a further failure of the Home Office. Unfortunately, we know from the capability reviews that the Department of Health is second only to the Home Office in that regard, thanks to its failings in supporting the national health service. We need that incompetence to end, but I am afraid that that will happen only when we have an election.

Let us look at what we have ahead of us. The Government’s handling of the training scheme for junior doctors was described by the Royal College of Physicians as the worst event to impact on the medical profession for decades. We are not out of the woods. [Interruption.] Ministers think that it is funny, but they are responsible, and it has left a demoralised generation of junior doctors, thousands of whom cannot pursue their training.

Thousands of junior doctors are thinking about next year, and when the Secretary of State speaks, he can tell us what he is going to do. The consequence of thousands of junior doctors not having run-through training posts, in addition to those coming out of the foundation programme, and of the Department of Health losing its court case last week, which means that it will not be able to discriminate against those on the highly skilled migrant programme who are already here, is that the Department believes that there will be a 3:1 competition ratio for applications for training posts in the coming year. By any measure, the impact on junior doctors looking for training posts in the coming year will be worse than it was in the year just gone. What is the Secretary of State going to do about that?

The disasters in the DOH have led to a loss of confidence. Government Members like to talk about how much has been spent in the national health service over the past year, but consider the DOH’s evidence to the doctors and dentists pay review body, which states the real-terms increase in 2006-07 in NHS expenditure: on revenue, the increase was 2.8 per cent. in real terms, which is lower than the long-run average and lower than the average under the last Conservative Government. That is simply a consequence of gross financial mismanagement in the preceding two years, which led directly to the reduction in provision in the national health service last year. When the Prime Minister gets up and says, “Look what a big increase there has been this year in comparison with last,” it is in part because last year’s expenditure was artificially depressed by the impact of previous deficits.

The Government have wasted money time and again, and we cannot be sure that they have finished. The capital building programme went £4 billion over cost; the Paddington health basin scheme was abandoned after £15 million had been spent; and necessary changes to St. Mary’s Paddington simply did not happen. The NHS IT scheme is more than two years off, but the Minister came to the House and told us that that was fine because we do not have to pay most of the bills. If I were a director of a public company and said to the board of directors, “The IT and computerisation scheme that is integral to the improvement of services in our company is not going to be delivered, but that is okay because we are not going to pay the bills just yet,” I would be shot or sacked. The NHS was promised the delivery of benefits, be it electronic patient records or the electronic transfer of prescriptions, but once again there has been a failure.

I love the Department’s evidence this month to the doctors and dentists pay review body, which includes this epic understatement:

“We intended GPs to have benefited from the new contract but we expected more in return”.

The Department did not get it, and that is true of GP contracts and its management across the NHS. This Government’s epitaph will be: “We intended to get more from our taxes, and we expected to get more in return.” They did not get it. [Laughter.] I was never a copywriter; I do policy and management, and it would be better if more Ministers did, too.

The Government say that they want to respond to rising aspirations. Ten years ago, they raised expectations, but they did not deliver, which is also true today. They have tested to destruction the idea that the Government can spend and legislate their way out of trouble. What is needed is a vision of patients who are empowered to demand high standards through choice and competition to secure the service that they have the right to expect. We need empowered professionals in public services who can provide the education, health care and other care that is their professional purpose and passion—if there is passion in all this, then it involves the people who work in our public services and what they want to be able to achieve. We want empowered families and communities who take control of their local services and take responsibility for bringing up young people, including young people’s education and health.

The Conservative party has indeed set out such a vision—not least at our party conference—and we have presented the policies to back it up. We have even done the necessary work to put the framework in place. What we want is more autonomy for professionals delivering our public services; professionals more responsive to the people they serve and more accountable for the outcomes they achieve; and services more focused on high standards. We will meet the aspirations of the electorate after the next election. I commend the amendment to the House.

Last week’s Queen’s Speech set out our programme to respond to the rising aspirations of the British people and to build a Britain in which everyone can rise as fast as their talents and hard work will take them. In the areas of health and education—the twin subjects of today’s debate—we will legislate to make the NHS more focused around the needs of individual patients, as we back British science. We will help all children—including the most vulnerable in our society—to get the best possible start in life and we will extend educational opportunity to all young people in order to ensure that they get the qualifications and skills that they need to succeed. My right hon. Friend the Secretary of State for Health will now legislate to bring the regulation of assisted reproduction and embryo research up to date and he will ensure the safety and quality of health services by introducing a new integrated regulator, the care quality commission, with new enforcement powers. A health pregnancy grant will also be introduced for every expectant mother.

As my right hon. Friend the Secretary of State has said, we have made real progress since 1997 through unprecedented NHS investment and reform. We have had 1 million more operations each year, built 100 new hospitals and reduced mortality rates, particularly for cancer and heart disease. But we still face new challenges—to take advantage of new technologies, to tackle rising obesity, particularly among children and young people, and to meet the rightly rising expectations of patients about what a 21st century health service should provide.

I do not accept that there is such an epidemic, but it is important to do all we can to ensure that young people get the advice and support they need both in schools and outside them. My right hon. Friend the Health Secretary will respond to that later, as I am sure he will to those issues raised by the hon. Member for South Cambridgeshire (Mr. Lansley) that he understood.

May I take the Secretary of State back to his home turf and ask him what deficiencies in the academies programme caused him to ask the Downing street Policy Unit to review this whole area?

I am happy to answer that question. There are no deficiencies in the academies programme that led to any review. As the hon. Gentleman will know, the Prime Minister’s delivery unit conducts regular reviews across all Government programmes. In my September meeting with that unit, I asked it to look at the academies programme to ensure that it was delivering our objectives. It has delivered a faster rise in standards in academies where the catchment areas and pupil intakes have more free school meal pupils than the average school. Because of the scale of the resources that we are spending on this programme, it is right to ensure that we deliver value for money. That is what the review will do. I made it clear yesterday, as I did in my July statement, that we are taking forward, indeed accelerating, the academies programme. That is what we will do; I make no apology at all for looking into it in detail.

Is the Secretary of State really telling us that he asked the Downing street Policy Unit to look into the programme without having any concerns at all about it and without believing that it has any deficiencies? If he expects us to believe that, it would seem to be a quite extraordinary waste of time.

The hon. Gentleman is quite wrong because I have not asked the Prime Minister’s Policy Unit to look into it at all—

The delivery unit looks across all Government spending, Department by Department. I have a six-monthly meeting with the delivery unit and I asked it to look into all aspects of my programmes. If it can make proposals to help us strengthen the academies programme even further, that is all well and good. In July, I announced reforms, including the abolition of the £2 million entry fee to get more universities into the academies programme. We are taking forward and accelerating that programme, as I said yesterday in topical questions. The continual charge that we are slowing down or trying to undermine the academies programme is quite wrong—I said that yesterday and say it again today.

Last Friday, my right hon. Friend the Secretary of State for Innovation, Universities and Skills published the Sale of Students Loans Bill. This week, my right hon. Friend the Minister for Children, Young People and Families will publish the children and young persons Bill to improve the life chances and provide greater stability, more support and a bigger voice for all children in care. In this debate, I want to set out more details of our education and skills Bill, which I will introduce with my right hon. Friend the Secretary of State for Innovation, Universities and Skills. That Bill will deliver world-class skills for all and raise the education leaving age to 17 by 2013 and to 18 by 2015.

Let me pay tribute to my right hon. Friend the Secretary of State for Health for his work and leadership on this issue in his previous job. He published the Green Paper on children in care and highlighted the fact that while the achievement of children in care has risen in the past 10 years, they are still five times less likely to get five or more good GCSEs than the average, and are nine times more likely to be excluded from school. That was not all that I inherited from him: he also published a Green Paper on raising the education leaving age. He set out how, despite rising participation rates, UK staying-on rates at 16 still lag behind those of international competitors, and how a young person’s background is still a key factor in whether they progress into post-16 education and training.

That is why the Queen’s Speech introduces the biggest reform in educational participation for more than 50 years. Let me tell the hon. Member for South Cambridgeshire that it was not introduced first in 1999; in fact, the first proposal in the House to raise the education participation age to 18 was in the Fisher Act of 1918. That Act introduced compulsory education to 14, but it also contained a provision to raise the education leaving age to 18, which was dropped in the years after the first world war because of the Geddes axe.

What was visionary 90 years ago, however, is essential today, both economically and morally. As the Leitch report demonstrated, the demand for higher-level skills is increasing, and the supply of jobs for lower-skilled workers is decreasing. Other countries are making fast progress in developing their own skilled work force, and we need to do more to avoid lagging behind.

Can I take the Secretary of State back not to 1918 but to 1997, when the Labour party pledged that fair funding would mean equal funding per pupil, regardless of local education authority? Perhaps it might be better to live up to that pledge, rather than moving forward to his great vision. Currently, Leicestershire languishes at the bottom of the education funding league. Apparently, across the Braunstone lane, my constituency boundary, a child will get £600 more in 2010 than a child in Leicestershire. How can that be fair, especially given that pledge that I suspect he was involved in, in view of the job he was doing in 1997?

If the hon. Gentleman looks at the detail of the figures that we published yesterday, he will see that Leicestershire is 34th out of 149 local authorities over the next three years. It is in the top quarter of all local authorities—

Leicestershire, over the next three years, will have a 13.4 per cent. increase in spending, which makes it 34th out of 149. Rather than having a go at me for my pronunciation, the hon. Gentleman should congratulate me on delivering for Leicestershire in education funding. If he is still confused, I will explain it to him later.

Those who leave school early without good skills and qualifications are less likely to get a good job or gain further qualifications. Because those young people who leave education and training come disproportionately from poor families, raising the education participation age is also about social justice.

My right hon. Friend is stating clearly one of the central points of the Government’s case, which is that we need more skills and more vocational qualifications in the work force. Does he agree that, at a time when that ambition is being lauded across the sector, it is extraordinary that Opposition spokesmen should appear to be doing their utmost to undermine the focus on vocational skills by what they are saying?

I would not be so pessimistic. I was disappointed to discover that Opposition Members oppose the reforms in the Queen’s Speech on raising the education-leaving age to 18 and the proposals for diplomas, but it is not too late. Later in my speech, I will urge them to change their m