With permission, Mr. Speaker, I will make a statement about the reform of welfare and skills.

Since 1997, the Government have transformed work: 29.2 million people are in work—2.8 million more than in 1997—1 million fewer people are on out-of-work benefits, and increased prosperity has been felt in every region and every nation in the UK. But the world continues to change, and we must change, too. In an increasingly globalised and competitive world, we must use to the full the skills, talents and aspirations of all our people. As my right hon. Friend the Prime Minister said this morning, Britain’s economy of the future will have 5 million fewer unskilled jobs than today, so to succeed as a country, we must raise our skill levels as never before.

The global changes threaten those who are least well equipped to respond. Those with low skills will find it harder to find work. Even today, it is estimated that 15 per cent. of claimants have basic skills needs and 50 per cent. have qualification levels below level 2. They and their families struggle to share in the increasing prosperity of Britain.

That is why, today, together with my right hon. Friend the Secretary of State for Work and Pensions, I have published “Opportunity, Employment and Progression: making skills work”. It sets out how we are transforming welfare by putting skills at the heart of the system. As my right hon. Friend the Prime Minister said this morning:

“If in the old days lack of jobs demanded priority action, in the new world it is lack of skills.”

We will change the benefits, skills and employment system. When people sign on for benefits, they should sign up for skills. We will make it easier for those on benefits to gain new skills. We will provide the tailored support that people need in order to get into work, and we will provide new opportunities for people to train. We intend to introduce legislation to give legal rights to train, but with those rights come responsibilities—responsibilities to upskill and to work.

Obtaining work, however, is just the start. We will also help people to get on in work by helping them to progress. We will create an advancement and careers service to help people overcome the barriers to moving from welfare to work and beyond. As my right hon. Friend the Secretary of State for Work and Pensions has announced, all new jobseeker’s allowance claimants will be given a more rigorous skills check to identify those who need basic numeracy, literacy and English language training or support. All new claimants will be able to use the new advancement and careers service to undertake a comprehensive skills health check. For those who are out of work for six months, we will make skills health checks mandatory, at the discretion of Jobcentre Plus advisers.

Where the need for raised skills is firmly identified, we will pilot giving Jobcentre Plus personal advisers enhanced powers to mandate training, and to offer training allowances of up to eight weeks’ full-time study when it is clearly designed to meet employers’ needs. For lone parents on income support we will extend the employment retention and advancement pilot nationally, providing in-work advisory support and discretionary emergency hardship grants of up to £300. We are also rolling out a weekly work credit of £40, or £60 in London. All lone parents will receive a skills screening at the start of their claims, and we aim to ensure that all of them can undertake a skills health check. We will offer such a check to lone parents two years before they are due to return to work, and will consider making it mandatory.

For those on incapacity benefit, the housing benefit rules will be changed to abolish the 16-hour rule which limits the hours of study for those on the short-term rate. Long-term benefit claimants moving into work will see an increase in income of at least £25 per week, allowing for reasonable transport costs.

As we change the welfare system, we will also improve opportunities to train. In setting the Learning and Skills Council budget for the next three years, I recently announced improved opportunities for training at every level. We will invest £1.5 billion a year in basic skills for life and pre-level 2 training. We will increase the number of training places at level 2 to 800,000 by the end of the next three years, and will increase the number of level 3 places by 148 per cent. by three years from now. We have set aside enough funds—subject to the availability of high-quality employer places—to increase the number of apprenticeships in England from 250,000 to 400,000.

However, we need to do more to ensure that the training opportunities are available to those who need them most. My right hon. Friend and I will ensure that Jobcentre Plus, colleges and training providers work more closely together. Tomorrow my right hon. Friend will give more details of how Jobcentre Plus services are to be commissioned in future, but I can say today that there is a joint commitment to greater convergence with LSC funding, and that we will jointly explore the scope for progressively joining up processes to underpin the integration of employment and skills services.

For many people, the transition from a low-paid to a better-paid job can be as hard as moving from benefit to work. We will ensure that the advancement and careers service works closely with Jobcentre Plus, training providers and other voluntary and statutory agencies to provide skills screening, skills health checks and access to advice on overcoming all the obstacles to progression, including child care, housing, transport and in-work benefits. I can announce today that I have allocated £2 million to test 10 prototypes in 10 areas next year.

The advancement and careers service will provide full skills health checks for half a million work seekers and half a million people in work per year by 2010-11. I can also confirm that we will pilot skills accounts from next year. We want learners with skills accounts to have access to £500 million of funding by 2010-11, and to nearly £1.5 billion by 2015.

Through local employer partnerships, more than 200 companies have committed to offer jobs to people who are out of work, helping towards meeting our target of 250,000. The Learning and Skills Council, colleges and training providers will work closely with Jobcentre Plus and employers to ensure that individuals receive both pre-employment and in-work training. High-quality in-house training is provided by many companies involved in the LEPs, and I have asked for the accreditation of in-house employer schemes to be fast-tracked, and expect the first schemes to be accredited by Christmas.

This country can deliver the opportunities to work and to gain better skills only through the closest possible partnership with employers. That is why we are making the training system more responsive and flexible to meet the needs of employers. Fifty-two thousand employers have taken advantage of “train to gain” with more than 100,000 learners gaining new qualifications. Today I can confirm that the budget for “train to gain” will rise to more than £1 billion by 2010-11—about one third of the adult training budget. Colleges that are successful in meeting employers’ needs will be able to expand the volume of training they provide, and the bureaucracy of taking part in “train to gain” will be reduced.

We will allocate £90 million to enable 60,000 small and medium-sized businesses to identify how skills training would grow their business and profitability. We will extend “train to gain” to cover volunteers, the self-employed and offenders who have secured employment prior to their release. We will ensure that there is a further education system that provides specialist vocational excellence in key areas of teaching and learning, both at national level—through national skills academies—and at regional and local levels. “Train to gain” brokerage will be extended to larger companies.

Our reforms to put skills at the heart of welfare will help to drive Britain’s economy forward to compete in an increasingly competitive world. By giving people new rights and responsibilities, we will unlock the talent and aspirations of all our people to ensure that no one gets left behind. These reforms are fundamental to creating a stronger, fairer and more prosperous society. I commend the paper to the House.

Nobody on the Opposition side of the House would quarrel with the Government’s objective of having a more skilled work force, or the importance of tackling the barriers that stop unemployed people getting into work, but in order to make real progress in tackling those problems the Secretary of State would have had to confront uncomfortable evidence that would have explained that after 10 years of initiatives many of the Government’s policies are still not working. In particular, why is it that after 10 years the number of young people aged 16 to 24 who are not in education, employment or training—the so-called NEETs—has increased from 1,082,000 to 1,260,000? The Secretary of State should have confronted that uncomfortable evidence, so as to do better in the future.

The Opposition agree on the importance of linking jobcentres and skills. That link desperately needs to be made, and we want it to work. Again however, for it to work the Government need to learn lessons from what has not worked so far. In particular, if the only skills training that is going to be available at jobcentres is accredited training leading to LSC-approved qualifications —which is how so much of the funding is currently disbursed—is there not a real danger that some of the most worthwhile programmes will suffer from not being accessible to unemployed people? This morning, I visited City Lit—probably the country’s largest adult education college, and an excellent institution which I know that the Secretary of State has visited—where I was told that many of its most worthwhile courses that help people out of unemployment and into work were suffering from cuts in LSC funding, because they did not provide accredited qualifications of which the LSC approved. If the Secretary of State is going to use this joint working simply to push people into accredited qualifications, is there not a danger that he will miss out many of the courses that people really need?

I also have some questions about the programmes that the Secretary of State has announced. He has announced that £1.5 billion a year will be invested in basic “skills for life” and pre-level 2 training. He has announced that we will increase the number of training places at level 2 to 800,000. However, are these not courses that plug the gaps that should have been filled at school? They are teaching people the basics of reading, writing and arithmetic—giving people the basic equivalents of GCSEs. The Secretary of State began by saying that this was part of his new vision of a highly skilled work force competing in a competitive global economy. Now, what he is really announcing is extra places to plug the gaps in a school system that should be doing better.

I accept that not all those people left school under Mr. Blair. Some will have left school under Margaret Thatcher and John Major, and quite a few probably left under Harold Wilson and Jim Callaghan. However, the Secretary of State cannot pretend that such a programme is in any way rising to the challenge of providing skills for the 21st-century economy.

The Secretary of State also talked about apprenticeships, but let us be clear about what he is pledging. He is now talking of a target of 400,000 apprenticeships, up from 250,000 today. Will he confirm that back in 2002, the then Chancellor—now the Prime Minister—promised 300,000 apprenticeships by 2004? Will he confirm that then, in April 2003, the then Chancellor promised 320,000 apprenticeships by 2006? Will he confirm that as recently as this year’s Budget, in March, the then Chancellor promised to double apprenticeship numbers to 500,000? So what we have here is a record of successive retreats from ambitious commitments and pledges because of a failure to deliver them. Will the Secretary of State also confirm that the number of apprenticeships that we recognise as apprenticeships—genuine technical qualifications sponsored by employers, which are now called advanced apprenticeships—have been in steady decline under this Government, and have now fallen below 200,000?

Finally, I congratulate the Secretary of State on something that is enormously to his credit—on not using at any point in his statement today that British National party slogan, “British jobs for British workers”. The Opposition congratulate him on his self-restraint. Long may it continue.

I am grateful for the warm welcome that the hon. Gentleman has given the statement—but unfortunately I have to point out to him that he is in error on almost everything that he said. Let us take for a start the claim that the figure for young people not in education, employment or training shows a fundamental failure in the system. The first thing that we must understand is that there has been a massive fall in the long-term youth unemployment that characterised the experience of so many young people under the Conservative Government. Secondly, there has not been a significant change in the proportion of that cohort who are not in education, employment or training compared with the period when the Tories were in power; however, there have been very significant shifts in what it represents. It represents not only far less long-term youth unemployment but the massive increase in the number of students taking gap years from university, who are not distinguished in the figures.

There is a real issue here. There has been some increase in the number of under-25s claiming incapacity benefit, which is one reason why my right hon. Friend the Secretary of State for Work and Pensions, as part of his statement earlier today, indicated that pathways to work—the very successful programme that has begun to reduce the number of people on incapacity benefit—will not only be extended nationally to new claimants but will for the first time be targeted at existing claimants, starting with the under-25s. So where there is a problem, we are determined to address it.

On training, the hon. Gentleman and I are simply going to have to disagree. There are a range of measures, budgeted for, for the Learning and Skills Council and Jobcentre Plus that are intended to ensure that individuals gain the early skills that they require to get into work, and that they can continue to get recognised qualifications when in work. Those courses—whether they are delivered by the employability skills programme that started in August, which focuses on getting people into work, or by the pre-level 2 programmes—are designed to achieve the two things that individuals want: sufficient capacity to get a job in the first place, and the qualifications and skills that mean that they remain in work and do not go back on to benefit. Our programmes are chosen with those aims consistently in mind. We have stripped out the programmes that have proved not to be effective for the individuals concerned.

As for the £1.5 billion to plug the gap, the hon. Gentleman had enough intellectual honesty to abandon his argument halfway through. We could spend all afternoon agreeing that Mrs. Thatcher’s Government were a terrible Government. A moment’s thought will tell us that the vast majority of those in the work force did not leave school under this Government—and certainly did not complete the greater part of their schooling under this Government. That does not really matter, though, because some of them did, and the point about these policies is that we cannot write people off. There must be a second or even a third chance for people who missed out first time round—and I would extend that to the diminishing number of young people for whom that would be true under this Government. This is the right thing to do.

On apprenticeships, the hon. Gentleman’s research is simply wrong. He has—inadvertently, I am sure—confused figures that my right hon. Friend the Prime Minister used when talking about the UK as a whole with the figures that I have been using for England. The significance of my announcement is that the target for 2020 was for 500,000 apprenticeships for the UK as a whole and 400,000 for England. With the funding that we have set aside, and if we can secure the proper, quality employer places, we can achieve the 2020 target about eight years early. That would be good for the economy and enormously good for young people who are seeking work in this country.

I congratulate my right hon. Friend the Secretary of State on his visionary statement. Although I agree that many people need help because they did not have the advantage that young people have today of having literacy and numeracy skills set before them, some who did have such chances now need to gain new skills because they have ill health and have to change to a different job. Will my right hon. Friend explain to the House more fully how people whose old skills are no use to them any more, and who need a new chance, can, with the help of their employer and perhaps their trade union, train for something else?

My hon. Friend raises an important issue, and I shall just mention two things. First, I pay tribute to the work of the 18,000 union learning representatives. We estimate that they have encouraged about 250,000 fellow employees back into work over the past couple of years since the scheme has been running. Someone’s best friend at work will often be the most likely person to convince them that they should have another go at training, and the union learning representatives have been a success.

Secondly, and importantly, I come to something that was part of our review of “train to gain”. In the first year of the programme, it was not possible to use “train to gain” to provide a subsidised place for someone who already had a level 2 qualification. We are now saying that where an employer is using “train to gain” we will not discriminate in that way between those of their employees who have a first level 2 qualification and those who do not. That will free up the system enormously for precisely the sort of person that my hon. Friend has in mind.

I thank the Secretary of State for providing an advance copy of the statement, and there is much to be welcomed in it. The joined-up approach is common sense, and I welcome the change in respect of the 16-hour rule for benefit and study. We have requested that for a long time. We might question why the long-term unemployed and those who are workless were not receiving a skills audit as a matter of course, because most people would have expected that to have been happening anyway. It is worth reminding everyone that the number of people who are long-term sick is more or less the same as it was when this Government came to power in 1997.

I have some questions about the Secretary of State’s statement. Does he envisage the advancement and careers service to be the same as the universal adult careers service that he announced in the summer? If it is not the same, how were they linked together? If it is the same, has he learned the lessons from the Connexions service? Although Connexions improved the service for many young people from socially excluded groups, we found that a decline in access occurred for people who wanted simpler and more straightforward advice.

There are three obvious elements that a careers service needs to work. The first is personalisation, the second quality and the third independence. Personalisation is obviously key, and I wonder whether the Secretary of State has learnt the lessons from the new deal, in which many young people were pushed on to generic programmes, rather than on to specific courses that addressed their personal issues. Does he envisage some sort of triage system, which could provide signposted advice to people who may require advice on medical issues or child care? How would that link with the careers service?

Often, the issues with access to training and work are about confidence, and many people do not have the self-confidence to go on a full accredited course. It would be a shame if the Government ruled out the option of unaccredited courses, in areas such as leisure, which they often pooh-pooh. For many people, those are the only route back into learning.

On quality, how will the proposals be linked with the closure of Jobcentre Plus offices, especially in rural areas? Does the Secretary of State really think that Jobcentre Plus is the ideal vehicle for providing an expert careers service, and will he invest sufficient money to bring it up to standard? The Connexions service provides services to 2 million young people and costs £500 million. If we extend that to all the workless, it would cost some £2 billion. Does he envisage that level of investment to provide a high-quality service?

On independence, what involvement does the Secretary of State envisage for the voluntary sector, and what role will local authorities play? The Lyons review, for example, foresaw a role in place shaping, and that would appear to be a good example of how local authorities could play a role in training.

For many people, it is a big jump to a full accredited course. The people who are finding it difficult to stay in the job market are the very ones who will find it difficult to stay on a full course. When will the Government make proposals for a credit-based or unitised approach to level 2 and level 3 accredited learning? That is vital to ensure that people who begin training can reap the benefits of what they have already undertaken.

The Secretary of State has announced £1 billion for the “train to gain” programme—but what proportion of that money will go to the broker system, rather than to training?

I congratulate the hon. Lady on a considered and intelligent response to the issues I raised this afternoon. The figures that I have for incapacity benefit suggest that the numbers claiming it have fallen since 2003 by 120,000, which is due in no small measure to the success of the pathways to work programme, which is why it is now being extended across the country and targeted at young people under 25. It is worth remembering that had the trends continued as they had become well established in 1997 under the previous Government, some 4 million people would be on incapacity benefit by now. This Government had to turn round the supertanker and get it going in the right direction.

The hon. Lady asked about the advancement and careers service, and it does refer to the same concept. My view was that the idea of a careers service sounded much narrower than the practical support that many people want, which will also address child care support, disability access issues and housing issues, all of which may be as significant an obstacle for an individual as the obtaining of a qualification.

The hon. Lady raised some good questions about the design. As I said in the statement, I want to see about 10 prototypes across the country, because I do not want to prescribe the approach from the centre. We will need to link up Jobcentre Plus with colleges—but different areas have different patterns of local voluntary sector advice services, for example. I hope that local authorities will make various proposals for the best way to achieve an integrated service, and I am sure that they will involve the voluntary sector.

On the issue of accreditation, vocational qualifications are moving towards a system of unitised credits, so it will be possible for someone to put together a vocational qualification having done part of a course here and part there.

That is attractive and sensible. However, it is not sensible for us to start putting a lot of money into completely unaccredited courses that cannot contribute to an overall training or qualification record for the individual. Despite what is often said by advocates of unaccredited courses, there is little evidence that they are helpful in enabling people to get into work or stay in work.

During the Queen’s Speech debate on training, Cabinet Ministers said that every young person would have a legal right to an apprenticeship. Today, my right hon. Friend said that increasing the number of apprenticeships in England from 250,000 to 400,000 would be subject to high quality employer places being available. Will he assure me that if not enough apprenticeships are available in the private sector the numbers will be made up in the public sector?

I can certainly tell my hon. Friend that we want significant expansion of public sector apprenticeships. Some parts of the public sector, including the Ministry of Defence, have a tremendous record in providing high quality apprenticeships; others, including some but not all local authorities, the health service and so on, provide relatively few. We shall want to encourage such provision in any case. We hope to achieve the legal right for young people by 2013. However, I do not want to mislead the House; we could achieve the 400,000 England total without actually reaching the full number we would need to meet the young person’s guarantee—that will take longer on any trajectory. I do not want to achieve the numbers of apprenticeships at the cost of quality, so it is right that we always caveat the target. We have put aside the money, a major review of apprenticeships is going on and a draft Bill on apprenticeships will be published later this year setting out our plans. All that will be aimed at ensuring we get the number of apprenticeships we want as well as high quality. There is no point in giving young people a guarantee if it is not a guarantee of something they actually want.

Earlier, in seeking to dismiss the figures given by my hon. Friend the Member for Havant (Mr. Willetts), the Secretary of State significantly did not mention the number of advanced apprenticeships. Can he inform the House of the number of advanced apprenticeships over the last few years and tell us what plans he has for those schemes? A lot more people will reach level 2 qualifications, but if we are really serious about building skills for the future we need a lot more people to do an awful lot better than they do at present.

We need to remember that this is all relative; there were only 75,000 apprenticeships when the Government came to power, but there are 250,000 now. The completion rate for level 3 apprenticeships was not good and we have massively increased and improved the completion rate for level 2 apprenticeships. One of the issues the apprenticeship review will examine is options for an increase in apprenticeships at higher level. As a step in the right direction, in our recent guidance to the Learning and Skills Council we asked for 30,000 new apprenticeships—10,000 a year—aimed specifically at over-25s who want to retrain or up their skills to a higher level. I think that will be the first time provision has ever been made for a dedicated apprenticeship service for over-25s.

May I ask the Secretary of State about one of the most excluded groups in Britain—teenage mums? As he knows, we have the second highest level of teenage pregnancy in the world and the highest in Europe. All the evidence suggests that girls who underachieve at school are the most likely to get pregnant under the age of 16 or 18 and that those who become teenage mums are the least likely to complete their education. Will my right hon. Friend consider launching a particular effort to try to cut teenage pregnancies by increasing educational opportunities?

I am sure my hon. Friend is right. It is an issue that the Secretary of State for Children, Schools and Families, my right hon. Friend the Member for Normanton (Ed Balls), is pursuing with the Department of Health. It is enormously important. It is also important that there is the possibility of a second chance for teenage mothers so that, having started a family much earlier than they had planned, or possibly wanted, they can still get back into the world of work. One of the reasons why we want the new advancement and careers service to reach into places such as Sure Start children’s centres is to make it clear that there are options to go back and train and to have a second chance to gain the skills and qualifications that were missed at school. We must make sure that such advice is available in the places that young teenage mothers are likely to go and where they are likely to be with other people who can support them to take up a training option even if they missed out at school.

Does the Secretary of State not accept that his Prime Minister actually appreciates the achievements of the Thatcher Government despite what is said by those on the Government Benches? It is important to understand that.

Does the Secretary of State not also accept the point made by my hon. Friend the Member for Havant (Mr. Willetts) that secondary schools underplay and underestimate the importance of vocational training, which is now provided in the main by colleges? What extra money is therefore being given to the colleges of further education, such as Macclesfield college, that do so much to provide the skills that are required by the industrialists and the commercial companies of this country?

Vocational training should obviously be properly recognised in every part of the education system. That is one of the reasons why my right hon. Friend the Secretary of State for Children, Schools and Families has brought forward proposals not only to introduce but to extend the range of diplomas, which for many young people will be able to bring together academic and vocational studies. It is also one of the reasons why the machinery of government was reorganised to give the Department for Children, Schools and Families a clear focus on 0 to 19-year-olds and particularly on 14-to-19 policy. It is very important that there is a coherent plan in each area for the different routes available to young people at 14 and that must include the option of a good vocational education, including the option of a pre-apprenticeship in school and going on to an apprenticeship at 16. I hope that the effects of these reforms overall will be to ensure that all children receive guidance that a vocational course is a very good course to take if it is right for their skills, aptitudes and ambitions.

My constituents in Blackpool will very warmly welcome what the Secretary of State has said about the abolition of the 16-hour rule, about the extra help for small and medium-sized businesses and particularly about the support for lone parents, of whom there are high numbers in this country. However, does he agree that the reskilling of older workers in particular is as vital as upskilling? To that extent, will he confirm that, as part of the overall approach, the Government are looking to have an all-age strategy for advice and guidance and, in so far as they are able to do so, they will make it clear to local authorities with budgetary considerations that they should do likewise?

First, I pay tribute to the work that my hon. Friend has done on the issue of skills, particularly as part of his leadership of the all-party skills group.

Of course, this is not purely a strategy for younger members of the work force. Everybody will recognise why a priority is given to lone parents and to under-25s because of the long-term costs to them of being locked out of the world of work and becoming totally dependent on the benefits system. However, the overall approach has to apply right across the work force. That is one of the reasons for creating apprenticeships aimed directly at the over-25s, and it is another reason for changing the “train to gain” system so that it can include those people who already have a level 2 qualification if their employer is taking part in “train to gain”. The advancement service is clearly there for them as well.

The challenge of getting the work force that we need in this country by 2020 means raising skills right across the work force. Some 70 per cent. of that work force have already left school and the grim truth for our economy is that we cannot achieve the skills levels that we want by focusing solely on those who are currently in school or have left school in the past few years.

Are the Government going to withdraw benefit if someone refuses a training place or a job on offer?

We have said today—my right hon. Friend the Secretary of State for Work and Pensions has said it—that it has been agreed that there will be pilots for mandatory training. That will come in after six months if a personal adviser is, first, convinced that somebody should undertake a skills health check and, secondly, that it would be directly relevant to them to get training. Although the details have to be worked on, I suspect that it will also take place after somebody has refused to take up the offer of extended support, such as up to eight weeks of full-time training with a training allowance. Most people in the House would take the view that the system should operate to provide people with every possible bit of advice, encouragement and support to go back into training, but there is a point at which somebody has to say, “If you haven’t taken the opportunities, you can’t expect not to do anything about it.”

I welcome the thrust of my right hon. Friend’s statement, but I take exception to one point. There is absolutely no evidence that moving lone parents to a JSA regime will produce the effect that has been mentioned. His last words, about encouraging people to participate, reflect the right approach—not being punitive. Is he aware that the big four supermarkets employ 600,000 people and 200,000 a year leave—most of them are women and a large percentage are lone parents—because they are given no skills, no encouragement, no training and no prospect of advancement? What does that say for the skills pledge that all those companies have signed?

The detail of the proposals to lower the age—the children’s age—at which lone parents can continue to claim income support, and other changes to the JSA regime, were consulted on in the summer. The Department for Work and Pensions has just come to the end of the consultation period and will deal with the detailed issues that my hon. Friend raises when the results of that consultation are announced in due course. However, there are things that most people will welcome in today’s announcement—particularly the roll-out of the employment retention allowance, part of which is aimed at dealing with the sort of short-term problem that can force a lone parent out of the labour force, when otherwise they would keep their job. It is sensible to get lone parents to focus on their skills needs well before the time when they might potentially lose their entitlement to income support. So there is a period of two years during which, by definition, the children will be at school—there will be extended schools to cover the hours—and the lone parent will have time to gain qualifications. Those changes to the regime are sensible and will have a positive effect on the lives of many lone parents.

Plaid Cymru and the Scottish National party welcome, in particular, the changes to the 16-hour rule. Any further investment in skills is very much welcome too. The Secretary of State said that claimants will be helped to gain core skills, including English language skills where needed. Welsh language skills are occupational qualifications for many jobs in Wales. Will the Government make extra, consequential help available to the National Assembly to take on this extra burden?

This is one of those moments when my gratitude for the fact that this is a dissolved responsibility—[Interruption.] Not dissolved, devolved. This is one of those moments when my gratitude for that fact knows no bounds. However, I will draw the matter to the attention of the relevant colleagues.

The statement contains a number of useful initiatives, but will my right hon. Friend say a little more about the 16-hour rule? That rule has been a barrier not only to young people, who have not been able to fulfil their potential by getting back into education, but to people who have lost their jobs. Up until now, we have sent out a ludicrous message by telling them to retrain and then cutting their benefit if they do. How are the changes intended to work, not just for those on incapacity benefit, but more broadly?

First, on incapacity benefit—an issue on which many Labour colleagues have campaigned for a long time—we have said that we will remove the 16-hour rule in relation to housing benefit completely for short-term recipients of incapacity benefit so that they, like long-term IB claimants, will always be able to take up the training they need to return to work. We will consider whether it might be practical to define limited exemptions from the 16-hour rule for specific groups such as young people living in supported accommodation—an issue that has been pushed strongly by the Foyer movement. In addition, under the JSA regime, there will be the possibility that after the six-month point has been reached, the DWP or the Jobcentre Plus advisers will have greater discretion to offer a training allowance for up to eight weeks of full-time training, where that is judged clearly to be what an employer needs to get an individual back into work.

Will the Secretary of State clarify whether it is still the case that people who have enormous difficulty in reading, writing and counting can still be in receipt of JSA for six months without any requirement that they receive help in upgrading those skills? Is that not a real worry, given that two thirds of all JSA claimants each year—around 1.6 million people—are making repeat claims, so many claimants are going in and out of work before the six-month period, with very low skills?

One of the reasons for ensuring that the initial skills check is more rigorous than the current check is to ensure that those whose basic numeracy and literacy problems have not been tackled in the past are correctly identified and directed towards the areas where they can receive assistance. We have also said, and I said this afternoon, that further down the process, we will pilot mandatory training for those whose personal adviser judges that that is the major obstacle to getting somebody into work. In doing that, we will look at the experience that we have gained from a prior attempt to pilot the scheme, which did not produce a big return to work. We believe, though, that particularly with the development of the employability skills programme that was introduced jointly between my Department and the DWP just this August, we are clearer about the type of work-related training that can successfully deliver the very skills to which the hon. Gentleman refers, and therefore make the piloting of mandatory training more plausible than it may have been in the past.

In the Westbourne ward in my constituency, 83 per cent. of all children are growing up in workless households only a mile from the west end, not because those people lack ability or because they lack motivation, but because of the multiple challenges of high housing costs, high child care costs and a mismatch between skills and the labour market. Will my right hon. Friend consider areas such as that being used as a prototype to test various measures, and in particular to examine the issue of job sustainability? It is not entry into the labour market, but keeping work that is the problem. Will he undertake to examine why some areas and some groups of people face particular problems maintaining themselves in work?

I pay tribute to the high level of work and sustained commitment that my hon. Friend has given to this area of interest. I cannot say this afternoon where the prototype areas for the advancement service will be, but I am sure that if the right group of people could be put together locally, we would certainly be interested in proposals coming from her area. She rightly identifies the complex set of issues that individuals often have to face in moving successfully into work. Rightly, I have emphasised to the House this afternoon the importance of skills, but I have also emphasised that often it is not skills alone that will make the difference to somebody’s ability to progress.

It is worth my reinforcing what I said in my statement about our overall aim—that is, we will ensure that long-term unemployed lone parents and those on incapacity benefit are better off in work, even after reasonable transport costs. That will be done by ensuring that long-term benefit claimants moving into work will see an increase in their income of at least £25 per week for, I think, a six-month period. That commitment and the changes that will be made to implement it will be significant in my hon. Friend’s area.

I understood the Secretary of State to say that there would be up to 500,000 improved and more rigorous skills health checks a year. Can he, in conjunction with his Secretary of State colleague, assure us that there will be sufficient people with the ability and skills to carry out those skills health checks, that the checks will be rigorous, appropriate and not peremptory, and that they will be supported by people and advisers who know not just about job placement, but about careers development and the educational attainments that are appropriate to the scheme? If there is to be a single skills result, there must be a multi-skills offer for those people.

The hon. Gentleman has made a constructive point, which relates to one of the reasons for having a number of pilot or prototype areas. There will be different ways of bringing together in local areas people with the various skills that he has described. We need to invite people to suggest the best ways of achieving the aim that I have set out this afternoon.

To be clear, two types of skills checks are being talked about. One is the original, simple—although hopefully more rigorous than it is today—skills check for the new claimant to identify their basic skills needs. The 500,000 skills checks or health checks for those in work and the other 500,000 for those out of work are the more comprehensive assessment, which would look at everything—existing vocational qualifications and skills needs other than basic numeracy and literacy. Rather more will be taking place than the hon. Gentleman took from my earlier statement.

The Secretary of State’s announcement this afternoon, with all its meaty proposals, stands in stark contrast to the lightweight proposals on the skills agenda that have come from the new Scottish National party Government in Scotland. Like many others, I welcome the abolition of the 16-hour rule in housing benefit; that was acting as a real barrier against people with disabilities getting back into the workplace and into training.

Has the Secretary of State looked at the physical barriers against disabled people going into training? There is an excellent access to work scheme that helps disabled people going into work to get adaptations or equipment that they need to access the workplace. Is it time for an equivalent access to training scheme, which would help disabled people to get into college or university for whatever training they need, so that they can upskill and get into the workplace?

My hon. Friend has made a good point. With others, my Department has to publish a single equality strategy, and I assure her that as part of that we shall look again to ensure that we have identified the issues that she has raised and to see whether further things should be done. My hon. Friend has made a valuable point and she is certainly right to pay tribute to the access to work programme, which has helped many people.

Does the Secretary of State agree that there is a great deal of difference between an inability and a disability, and that British citizens who do not speak the English language have an inability, not a disability? If he agrees, what progress does he think he will make on the issue in the next 12 months? What target has he set himself for getting people who do not speak English, and who are unable to work as a result, into the workplace?

The hon. Gentleman will know that we have recently made a couple of important changes to the English for speakers of other languages arrangements. First, we want to ensure that the budget, which is three times as big as it was just four or five years ago, is better targeted and that those who can afford to pay, and should reasonably be asked to, make a contribution towards the cost of their training. We want to do that to make sure that we target those in greatest need.

Secondly, we have introduced an ESOL for work programme for more recent migrants. That is paid for, but we think that it will meet the immediate workplace needs. I think—and I suspect that the hon. Gentleman does—that the challenge comes from those long-term residents, often British citizens, who do not have the English language and are therefore excluded from many activities of wider society. I assure him that we shall continue to look closely at the ESOL system and how it operates to see what we can do further to target resources on those people.

Does the Secretary of State agree that transport costs can be an obstacle to those who want to take full advantage of the opportunities available to them? Will he support the north east regional youth assembly in its campaign for concessionary travel for those between the ages of 16 and 19 who want to pursue further education and training across the region?

I pay tribute to my hon. Friend’s imaginative initiative in raising an issue that is beyond my departmental responsibilities, in respect of funding for 16 to 18-year-olds and transport policy. I cannot answer directly about any proposals on that particular age group. However, I draw attention to the commitment to which I have already referred a couple of times today: we intend to ensure that long-term unemployed lone parents and those on incapacity benefit are better off in work, even after reasonable transport costs. That will be done by ensuring that long-term benefit claimants moving into work will, for a period, see an increase in their income of at least £25 a week. That applies to workers older than the group to which my hon. Friend referred; we clearly have plans to raise the participation age and so on. I shall draw his question to the attention of my right hon. Friends.

Hertford regional college in my constituency is undertaking a major new build programme to create a campus in Turnford fit for the 21st century. However, it will have to pay a VAT bill of more than £3 million for that building work. When secondary schools do new build work, they are not subject to VAT. Will the Secretary of State make representations to the Chancellor on behalf of the further education sector to see whether we can end that inequality?

Bearing in mind that 10 years ago there was no capital budget for further education colleges at all, I am fortunate to be presiding over a budget of £2.3 billion for FE colleges over the next three years. It is a bit of a cheek to complain about the VAT rules that applied under the previous Conservative Government.

It is a genuine question that deserves an answer.

But it is worth making the point that the difference between schools and colleges is that colleges are incorporated as independent institutions, which gives them a different tax treatment. I have not yet met a principal of an FE college who wished to return to local authority control, even if they would be able to reduce their VAT bill as a result.

I welcome the statement, particularly the great expansion in the number of apprenticeships. Does my right hon. Friend agree that the people at the bottom of the pile in respect of access to jobs and skills are ex-offenders? Although his statement makes reference to offenders who have secured a job before their release being able to benefit from “train to gain”, the majority of offenders are not in that position. Does he agree that providing more advice, guidance, support and assistance for offenders after they leave custody is important both in its own right and as an incentive to reduce reoffending?

My hon. Friend is absolutely right to talk about the importance of offender education. I understand that the number of learner hours has increased by 35 per cent. in the past year alone. However, I would not like to lose sight of the significance of today’s announcement. We know that one of the things that most reduces reoffending is an offender’s knowing that they are working towards a guaranteed job when they leave prison. Including such offender learning within “train to gain” means that it will now be possible for an employer who is prepared to take on an offender to get their training paid for once they have left the prison estate. That could make a big difference to future reoffending rates, and it should more than justify the investment involved.

Does my right hon. Friend agree that unlike the Opposition, who wrote off huge chunks of my constituency with the closure of the mining industry, these proposals will continue to extend people’s opportunities not only to get into work but to undertake vocational training and to upskill, and that that is important not only for individuals and their communities but for the economy as a whole if it is to prosper?

My hon. Friend is absolutely right, both about the historical attitude of the Conservatives and in recognising that the statement says that the world has changed and moved on. When we came into power, we had to deal with the backlog of people who had previously been written off and the backlog of a party that had said that mass unemployment was a price worth paying. Today, the issue has changed. Unless we raise skill levels not only for people who are still workless but for millions of people in work, we will not be able to be a prosperous country in the future, nor will we be able to ensure that nobody is left out. The challenges have changed; today’s announcement is about how we will meet those challenges.

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

This is an important Bill introducing improved and integrated regulation of the health and social care system as well as enhancing the regulation of health professionals who work within it. It will help to assure safety and quality of care for all patients and service users. The Bill will also set new regulatory measures where they are necessary, and enhanced regulation where it is appropriate. It will expunge provisions that are out of date and that no longer meet the needs of patients and service users.

Those measures are essential to meet the challenges of 21st century health and social care provision. What was once the single biggest worry for patients—long waiting times—is now far less of a concern. Before we came to power it was common for patients to have to wait 18 months for operations. By the end of next year, patients can expect to wait a maximum of just 18 weeks between being referred by their GP and beginning their treatment. I stress that that will be the maximum waiting time. We expect that most patients will be treated within eight or nine weeks of referral. However, as the spectre of long waiting lists evaporates, patients’ expectations change with the times. Regulation of health and social care must keep pace with new demands, demographic change and medical advances.

This Bill will create a new integrated regulator for health and adult social care in England, the care quality commission, with tough new powers to inspect, investigate and intervene where providers fail to meet safety and quality requirements. Crucially, where infection control and hygiene are poor, the new commission will be able to act quickly and decisively. It will bring together functions from three existing statutory bodies—the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission—and will build on the expertise of those organisations.

I thank the Secretary of State for giving way at an early point in his speech. He will be aware that there is some concern in the social care sector that social care should have exactly the same status as health care under the new commission. Sadly, in the past, that partnership has been unequal. Will he assure me that the new commission will treat social care with the same importance as it does health care?

My hon. Friend raises the crucial issue with regard to the plan to merge the three current regulators. Social care must have parity in the new commission. That must be reflected on the board of the new commission and in everything that the commission does. I am pleased that she has given me the opportunity to reassert that that is the case, and that it needs to be the case. That point will be emphasised throughout the passage of the Bill.

I emphasise again that the Bill brings the vital role carried out by the Mental Health Act Commission into the heart of the care quality commission. That will strengthen the monitoring of the Mental Health Act 1983, and offer increased oversight of the treatment of patients subject to compulsory detention. I know that the MHAC places great emphasis on its visiting programme, covering each hospital and each ward that accepts detained patients. I expect the new commission to continue that approach.

The Government recently published their response to the consultation on the future regulation of health and adult social care in England. The consultation highlighted clear support for an independent, integrated regulator with a stronger focus on assuring safety and quality. For the first time, the regulation of the national health service, social care and independent sector providers will be carried out by the same organisation. As services become jointly commissioned and the boundaries between health and adult social care are broken down, it makes sense for our new integrated regulatory framework to work across those boundaries as well.

On the issue of joint commissioning, does the Secretary of State recognise that, as is so often the case, there is perhaps inadvertent confusion about whether the local authority or the primary care trust pays for a particular package of care? Within that confusion, it is often the patient—the consumer or end user; the person who needs services—who is subject to extra stress and burden, because they are being written to day after day by someone saying, “It is not our partnership; it is not our problem.” Such people are falling between two stools. Will the Secretary of State give a commitment to the House that the Bill will address those key issues?

I accept that things are not perfect. Practice-based commissioning, which is quite new, has still to attract genuine buy-in. Lots of people say that they operate practice-based commissioning, but it is not operating as we would like. The question is not just about the Bill, but about other measures, too. World-class commissioning, which we are working on and will launch shortly, is aimed at ensuring that people do not merely talk the talk on commissioning, but walk the walk.

The Secretary of State talked about the independence of the new care quality commission. If a chairman of the Healthcare Commission were required now, the appointment would be made by the Appointments Commission under the Health Act 2006. In the Bill, the Secretary of State proposes that the chairman and members of the care quality commission should be appointed by the Secretary of State. Why is he reducing the independence in the appointments process?

We will need to discuss that point as the Bill goes through the House. With a joint integrated commission, it is the Secretary of State’s role to make that appointment. It is a far more fundamental position, and such an approach is a necessary part of accountability to Parliament.

The new registration system for providers of health care and adult social care, which will cover both public and independent provision, will set the requirements that every registered organisation will need to meet. They will include requirements relating to infection control. With the creation of a new registration system for all registered activity, patients can rest assured that the care or treatment that they choose will be from providers who have demonstrated compliance with the same key safety and quality requirements, no matter where that treatment is provided.

I think that this is the appropriate point to mention that psychotherapists in the United Kingdom sometimes have a qualification, and sometimes do not. Sometimes that qualification is bogus; sometimes it is not. Sometimes they also have a medical qualification; sometimes they do not. The situation is a mess. Inexpert psychotherapy can be harmful to patients, who may think that they are receiving psychotherapy from someone who is properly trained. Indeed, the patient may think that the individual is a psychiatrist, which is entirely different—although some psychiatrists are psychotherapists, too. Will my right hon. Friend consider introducing regulation for psychotherapy under the auspices of the Bill?

Not as part of the Bill, but as a separate exercise, we are seeking to clarify precisely those areas that my hon. Friend has rightly mentioned.

My right hon. Friend is very accommodating.

I do my best.

We expect that the vast majority of providers will continue to demonstrate that they deliver quality services in a safe, clean environment. However, the Bill will introduce a wide range of enforcement powers that the commission will be able to use when registered providers fail to deliver safe, high quality care.

In the run-up to the Bill, the Government have talked about lightening the burden of regulation for health and social care providers. Is that not worrying? Providers such as one or two that provide elderly persons’ care in my constituency have closed down for failing to meet standards. We should be putting to the fore the safety and welfare of residents, not the burden on providers.

My hon. Friend makes a fair point. Of course, the new regime will involve a risk-based assessment, whereas previously providers received the same amount of treatment irrespective of whether they had a good record or even a record that was exemplary year after year. Usually the visits were determined by Government, not the regulators. The point of risk-based assessment is to ensure that organisations that have an excellent track record can experience either light-touch regulation or even no regulation, unless there is a problem. Meanwhile, the regulator can concentrate its attention on providers who have not met those standards. The two things go together. The essential point is that many organisations found themselves being visited by different regulators, and one regulator could carry out that function. I believe that that is an important step forward, without in any way compromising the important points raised by my hon. Friend.

Once any activity is registered, the commission can apply specific conditions to respond to specific risks, such as requiring a ward or service to be closed until safety or infection control requirements revert to the expected standard. The current Healthcare Commission can issue infection control improvement notices to NHS trusts only when it considers that the improvement will not be achieved in any other way. The new commission will not be restricted in that way. It will be able to visit trusts more frequently, close down wards and insist on their being thoroughly disinfected before they can be reopened. It could follow that up with more unannounced spot checks. It can also carry out annual infection control inspections of all acute trusts, using teams of specialist inspectors.

More generally, the commission will have the power to issue warning notices and penalty notices or instigate court proceedings to levy fines on any provider breaching registration requirements. When NHS bodies incur fines, the money will be returned to the local commissioners and reinvested to improve services, so that the local population does not lose out. The Bill also provides for the commission to undertake periodic assessments and reviews of care. The new commission will help reduce the burden of regulation on providers from itself and other public inspectorates through gate-keeping powers, which mirror those for other inspectorates, and through targeting activity where it is most needed.

The public expect value for money from their public services. In bringing together the regulation of health and adult social care in one regime, we will streamline regulatory activity and ensure that the commission manages its budget effectively, adopts a more independent and intelligent approach to regulation and provides a sharper focus on safety, quality and cleanliness.

I thought that I would ask this question before the Opposition asked it, because the streamlining to which my right hon. Friend refers means bringing together the Commission for Healthcare Audit and Inspection and the Commission for Social Care Inspection, which are two bodies—I appreciate that a third body is also included—that the Government statutorily established only four years ago. Why the change after only four years?

As usual, my hon. Friend asks a pertinent question. If we consider the history, we see that there was no regulation before 1999 apart from that under the Mental Health Act 1983, which was an important development that the previous Government introduced. When the two new regulators were introduced, there was a debate in Government about whether they should be merged immediately—whether we should have one regulator for the health service and for social care, while recognising that a separate regulator already existed for mental health. At the time, it was decided that that would be too much in one go, so the two separate organisations were set up but a process of evolution meant that, almost as soon as the Healthcare Commission was established in 2004, a proposal was made in 2005 to merge the two bodies. We are therefore considering a natural evolution. There will be no great change in the organisations’ functions, apart from the important change for which the Bill provides, which is all about integration. Taken together, the provisions will make regulation of providers more efficient and more responsive to people’s concerns. With social care and mental health as vital components, we will have a regulator that reflects the reality of integrated care delivered effectively to all patients, whatever their needs.

The Bill will also improve the regulation of the health professions and social care workers. Let me be clear from the outset that the overwhelming majority of health care professionals show remarkable expertise and exceptional commitment in their dealings with patients. They are as disturbed as we are about the rare occasions when a practitioner falls short of the high standards that they set themselves. That is why, as a society, we hold the professions in such high esteem and place so much trust in individual practitioners.

Earlier this year, the Government published the White Paper “Trust, Assurance and Safety”, which set out wide-ranging reforms to the way in which health professionals are regulated. Those reforms build on the far-reaching recommendations in Lady Janet Smith’s inquiry into Shipman and the report “Good doctors, safer patients” from the chief medical officer. Although the bulk of the legislation to implement the reforms will be effected through secondary legislation, the Bill will enact four key provisions.

I am grateful to the Secretary of State for giving way again. He will know how frequently the hope has been expressed in the House that when we legislate to follow up Dame Janet Smith’s recommendations we will do so not only in respect of health professional regulation, but in respect of coroners and death certification. It was clear in a debate in Westminster Hall back in July that it was the Government’s intention and hope to do that, but there is no coroners Bill in this Session to accompany the Health and Social Care Bill. Why not?

That is a matter for the usual channels. I do believe that we listed that Bill, but whether we shall find time for it in this Session is as much to do with the Opposition as it is to do with us. If we get the Health and Social Care Bill through speedily, we shall have more time available.

The Bill will enact four key measures. The first is to ensure that all the professional regulatory bodies use the civil standard of proof, so that the General Medical Council, the General Optical Council and the Nursing and Midwifery Council operate to a method consistent with the other eight health profession regulators. The second measure is to create an independent adjudicator, initially to adjudicate on fitness to practise cases for doctors, to enhance public and professional confidence in the impartiality of the GMC’s judgments. The third measure is to ensure that health care organisations employing or contracting with doctors appoint a responsible officer to identify and handle cases of poor professional performance by doctors, and to make recommendations to the GMC for revalidation. The fourth and final key measure is to pave the way for the creation of a new general pharmaceutical council.

The Bill will also make a number of other changes to arrangements relating to the composition of councils of the regulatory bodies, to the Council for Healthcare Regulatory Excellence and to the legislation currently governing the regulation of the social care work force.

Clearly the Committee, on which I do not expect to serve, would be the place to go into this point in great detail, but has the Secretary of State consulted the judges, who have laid down that if someone’s job was at risk, the civil standard of proof would not be high enough? They have laid down that in some serious cases the criminal standard ought to be used.

I cannot say whether we have consulted the judges; all I can say is that eight of the current regulatory bodies operate in accordance with the procedure that I have set out. Our consultation suggested that there was wide-ranging support, including, incidentally, from the GMC—the recommendation stemmed from Dame Janet Smith’s inquiry into Shipman—which believes that there should be a change from the criminal standard. The other argument, which is probably the clincher, is that if a case against an individual doctor was that serious, the criminal benchmark would apply. For all those reasons, the proposal has a widespread consensus behind it. I cannot say whether that consensus stretches right through the legal profession, but we have a strong enough argument to proceed on that basis.

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Before I give way, I should like to record my appreciation of the thoughtful and constructive approach that the professional regulatory bodies have taken to the proposals.

My right hon. Friend mentioned ensuring that we have a sufficiently skilled and qualified work force. However, there are fears that work force registration will not be sufficiently enforced and that some people might slip through the net, possibly creating two-tier provision. Will he assure us that everyone in the work force will be properly registered and properly qualified?

Up to a point, Lord Copper. Given the procedures that we have set out in the Bill and the arrangements that apply quite separately, it is difficult to envisage anything further that we could do to ensure that. However, we are always willing to accept ideas and suggestions as we take the Bill through Committee. The Bill will also introduce a number of public health measures.

I am grateful to my right hon. Friend for giving way, Mr. Deputy Speaker, and I shall seek to catch your eye later in the debate. Just moments ago, I tabled early-day motion 386, which calls for citizens councils—as recommended in the NHS plan 2000—to be involved with the regulation of health care professionals. Does my right hon. Friend believe that the public, as patients, are sufficiently involved in the process of setting and reviewing the criteria for admission to the various professions and for continuing to practise in them? The evidence is that the public feel cut off from that process.

There are separate arrangements to ensure that the patient has a clear involvement. The other provision that arises from Dame Janet Smith’s inquiry into Shipman is that there will no longer be a majority of professionals on these bodies; there will be equality for lay people. That offers an important reassurance.

I thank my right hon. Friend for giving way with his usual smiling generosity. He referred a few moments ago to what might alliteratively be described as poor professional performance under this regulatory regime. Would that cover the surprising approach being taken by some GP practices, including some in my own constituency, and I believe by NHS Direct, of using 0845 numbers, which are a rip-off for the consumer—in this case, the patient? If this regulatory regime will not cover that practice, will he assure me that he will look into the matter? GPs are getting paid handsomely and properly by the state, yet some of them seem to wish to make extra money out of their patients’ phone bills.

My hon. Friend has raised an important point, but this is not a matter for the Bill. I am already well aware of the practice that he mentions, however, and we issued guidance earlier this year to say that patients should pay no more than the cost of a local call. Indeed, we believe that to charge in the way that he has described breaches the terms of the GP contract. The matter does not need the weight of this legislation, or the time that it would take to pass the measures, to deal with it.

The Secretary of State will be aware that many parts of the Bill will be subject to a legislative consent motion in the Scottish Parliament. Will he confirm my understanding that there has been excellent input by the Scottish Government and excellent consultation in Scotland on these measures? Is he content, as I am, that the provisions in the Bill are exactly what is needed?

I can confirm that there has been excellent co-operation, both before and after May 2007. That has really helped us to arrive at the provisions—particularly those on public health, which I shall come to in a second—that will ensure that the whole of the UK is well equipped.

The Bill introduces measures to help to prevent and control the spread of diseases that could present significant harm to human health caused by infection and contamination. The measures in the Bill will update the existing powers and provisions in the Public Health (Control of Diseases) Act 1984 relating to preventing and controlling disease. That legislation is clearly out of date. For instance, it allows us to regulate the risks from rag and bone men while remaining silent on the dangers of chemical and radioactive contamination.

The Bill seeks to bring our health protection into the 21st century by taking an all-hazards approach to health protection rather than by focusing only on specified diseases. That will allow a quick response to new or unknown diseases. I emphasise that the new legislation will be proportionate. We are updating the legislation to ensure that, while we have the powers needed to respond effectively to a public health threat, safeguards are written into the new legislation to ensure that the powers are used only when appropriate, and only to the extent necessary to secure the protection of public health.

The Bill will also support the health of pregnant women by introducing a new health in pregnancy grant. The grant will be a universal, one-off payment of £190, available to all expectant mothers ordinarily resident in the UK from the 25th week of their pregnancy. It will provide pregnant women with additional financial support towards meeting the costs of a healthy lifestyle, including diet, and other costs in the run-up to the birth.

There are also a number of small amendments in the Bill relating to the financial arrangements for pharmaceutical services; indemnity schemes in connection with the provision of health services; direct payments in lieu of provision of care services; repeal of the liable relatives rule; definition of ordinary residence as applied to the National Assistance Act 1948; payments to social enterprises; the creation of a national information governance board, ensuring that parents get automatic feedback about their child’s health through the national weighing and measuring programmes; and the functions of the Health Protection Agency in relation to biological substances.

May I ask about the Bill’s implications for the health service ombudsman and whether an increase in the number of complaints is expected? If so, will the ombudsman be adequately resourced to handle them?

There may be an increase in the number of complaints, but the new commission will not deal with them; they will go through the usual channels. We will stay in touch with the ombudsman to see whether staffing is sufficient to ensure that they can cope with any increase in work. I am sure that all the miscellaneous items that I have mentioned will receive due attention during the Bill’s passage through the House.

The Health and Social Care Bill will deliver a range of measures to assure the levels of quality and safe care that all patients and care service users have a right to expect. It will also introduce legislation that updates our current health protection powers to make them fit for purpose in the modern age and contribute to a healthier lifestyle for both expectant mothers and young children. I commend the Bill to the House.

I am grateful for the opportunity to speak on Second Reading. The Secretary of State says that the Bill is important. I do not dispute that it has important implications, but it seems that its importance was not such that the Prime Minister thought fit to refer to it at all at the start of the Gracious Speech debate. It is customary each year for at least one health Bills to be a flagship Bill, as it were. Unfortunately, this year the health Bill is not so much a flagship as a fleet auxiliary—useful measures grouped together in much less visible form that never acquire the status of a flagship.

I am afraid that this Bill in no way represents the changes in overall regulation that are required. After the 2005 election, the Government believed that there should be a wider review of regulation. They commissioned a review by Lord Currie of Marylebone and others, but they then more or less ignored it. They proceeded to publish consultation documents—frankly, inadequate ones—about the regulatory review, which culminated much later than originally intended in the document to which the Secretary of State referred.

This Bill implements only one aspect of all that—the part that relates to the Healthcare Commission—but it is perfectly clear that it will not achieve the regulatory changes necessary to provide assurance in the longer term to those providing services to the NHS. If one believed in the long-term role of the independent sector, for example, in supporting the NHS, one would need not only powers of inspection for the commission, but an independent regulator to undertake economic regulation in respect of market entry or market exit. Since 2003, the Government have failed to introduce legislation for the failure regime or for the exercise of powers relating to competition and pricing. None of that is in the Bill: it is not the legislation that we really need to provide either autonomy or proper accountability.

We have made it clear that we will introduce the necessary legislation in this Session and we will endeavour to ensure that it complements the aspects of the Bill that we support. In the course of the Bill’s passage, we can do certain things to make it more consistent with our long-term structure and vision for health care.

Before exploring some of the Government’s proposals in more detail, let me isolate one point. What is lacking in the Bill—for example, in respect of the structure of the care quality commission—is any formal structure to give a voice to patients and the users of services. Members—particularly those who are present—will recall that when legislation was introduced during the last parliamentary Session to abolish patients forums and set up local involvement networks, we thought it important for patients to have the national voice that was missing from that legislation. The same applies to social care for care users and, indeed, carers. This Bill provides no such national voice. Although clause 2 enjoins the care quality commission to have regard to the views of patients, no structure is built into the Bill to make that happen.

The Secretary of State intends the care quality commission to bear comparison with other regulators, but such structures are explicitly incorporated in many other regulating bodies. The Office of Communications, for instance, has a consumer panel, set up under the statute that inaugurated it, whose purpose is to acquire patients’ views. That is one of the reasons why, in the measures that we propose, we will make specific provision for HealthWatch—working alongside the Healthcare Commission, or the care quality commission, as it will become—to represent patients and express their views on the health service to the whole regulatory structure and the Secretary of State. The same could, of course, apply to those using social care.

Conservative Members will seek to amend this Bill to bring those principles into effect. Back in 2005, when Lord Currie of Marylebone presented his report to the then Secretary of State, he made it clear that such a national voice for patients was an essential part of a future structure.

The hon. Member for Wolverhampton, South-West (Rob Marris) kindly asked part of the question that I had intended to ask the Secretary of State. However, I recall from my membership of the Standing Committee considering what became the Health and Social Care (Community Health and Standards) Act 2003 that at that time we abolished the Commission for Health Improvement, which I think had been around for only about three years, in order to establish the Commission for Healthcare Audit and Inspection, now colloquially known as the Healthcare Commission. It does not seem as though any of those bodies had been entrenched for any length of time before being abolished, and the same is true of the Commission for Social Care Inspection. The National Care Standards Commission was abolished in the 2003 Act, CSCI was established, and no sooner is it up and running than we are to abolish it.

I would not wish the House to be in any sense misled. We believe that there has always been a strong case for those bodies to work side by side. We have always supported the proposition that we must try to break down the barriers between health and social care, and institutional divisions in the regulatory structure do not help that to happen. If we are to encourage, for example, the use of individual budgets and personalised care stretching across health and social care, it clearly makes sense for the regulatory bodies to work side by side.

On the commissioning side, the current position in Herefordshire, where the primary care trusts and the local authority have effectively merged their activities at executive level, suggests that a single organisation could be helpful. The relationship between Ofsted and CSCI in respect of children’s services is a good example.

While I am happy with the principle that the two bodies should be merged, the central issue—as the hon. Member for Blackpool, North and Fleetwood (Mrs. Humble) rightly said and as the Secretary of State rightly accepted—is that when social care and health care are brought together there is a natural, or perhaps unnatural, tendency constantly to prioritise health care to the exclusion of social care, and to make mental health a Cinderella within health care. There is an inherent danger that bringing everything together under one regulator will cause both the functions currently performed by the Mental Health Act Commission and those performed by CSCI to attract less priority than the current functions of the Healthcare Commission. I have no doubt that the more often we say that during the passage of this Bill, and the more persistent we are in Committee about the nature of the duties—we shall have to spell that out clearly, as the duties are expressed only in the vaguest terms in current legislation—the more likely we will be to ensure that this body delivers what is intended. In my experience, the more independent a regulator needs to be, the more important it is that their duties, including the factors to which they must have regard, are spelled out in legislation; otherwise, that independence will be undermined—or if there is independence, the more likely it will be that the regulator behaves in ways that do not attract the support of the House.

Will the hon. Gentleman also reflect, however, on the fact that too often this House has added so many details to regulatory legislation that instead of regulators being able independently to work out the most effective form of regulation, processes have become bureaucratic and tedious and there has been a failure to achieve the overall objective? The House must give the powers to regulators so that they are able to use them effectively, rather than try to tie them down so much that they spend their time ticking boxes instead of understanding what is happening on the ground and ensuring that people can get hold of the information they need to know whether things are working or not.

I am interested in what the right hon. Lady says because under other legislation enacted by this Government the view has been that it is rather important to set out those duties—in relation to an energy regulator, for example, that it is important to set out the duty on security of supply, the duty on promoting competition and the interests of consumers and the duty on the achievement of environmental objectives. I do not think it would have helped to have said, “We are setting up a regulator who has a duty for the improvement of energy services,” which is more or less what is happening in the current context: a regulator is being set up with the duty to improve health and social care.

How is the regulator to define that? The answer, which is built into clause 2, is that it is to be defined by reference to the Secretary of State and Government policies. Clause 2(4) re-incorporates into legislation what is currently section 130 of the National Health Service Act 2006 in respect of the Healthcare Commission. [Interruption.] Yes, I am showing off now. That pretty much says that both the Healthcare Commission and CSCI have statutory provisions under which they must have regard to the policies of the Secretary of State. Therefore, when the Secretary of State says, “This body will be independent,” we will take a very close look at what that means. Strictly speaking, “independence” should mean independently appointed, with independent duties established by Parliament, and with an ability to pursue the duties of, for example, safety, quality, efficiency and effectiveness to whatever conclusion. It should not mean having that compromised by the way in which the Secretary of State sets out his policies.

It is evident that much of the burdensome regulation that the Healthcare Commission has to undertake in relation to health care providers is the direct consequence of the way in which successive Secretaries of State have set out the targets that they want health care providers to meet. Therefore, the target culture is a direct precursor of the burden of regulation. It is more important for us to be focused on the delivery of the duties of quality, safety and efficiency instead of having that overridden by the Secretary of State. I am sorry that that has been such a long digression, but it has been a helpful one from my point of view, so I am grateful to the right hon. Lady.

It is important to pursue the question of risk-based regulation. Although the Secretary of State says that it will be risk based, I am unclear whether the Bill delivers that. It is certainly intended to be proportionate to the risk that is to be safeguarded, but it could easily be said that all health care providers—depending on what they do—have more or less the same kind of risks attached to what they do. We must look hard at this Bill to incorporate into it the principles of risk-based assessment and regulation, because they are not in it yet. I hope that as the Bill progresses we can ensure that the care quality commission has not only a specific role as a national voice for patients, but specific ways in which it takes into account the interests of patients, care service users and carers.

The Secretary of State talked about health care-associated infections. This feels a little like the groundhog day of health legislation, because it is almost exactly two years ago that I was standing here responding to the Secretary of State’s predecessor, who was telling us that the 2006 legislation was the last word in regulation, and that the Healthcare Commission was to have these new powers. In fact, the commission can carry out unannounced inspections. At the time, the Government looked at and we discussed the question of fines. They concluded that the best thing to do was not to introduce them, and that it was better to have a process of improvement notices.

I do not know what evaluation has taken place. The code of practice set up under the 2006 legislation came into force on 1 October 2006. We are less than a year down the line of the introduction of that code of practice, and although I am not aware of how many inspections there have been, there were an initial 15 inspections for compliance with the code of practice. I do not know to what extent the Secretary of State regards this as a successful or a failed regime. One improvement notice has been served, against Chase Farm hospital, and we have yet to have others.

I simply do not know what the evidence base is for the Government’s concluding that their policy failed and that they must have a new one. The cynics among us might suspect that in fact, from the Secretary of State’s point of view, a new Secretary of State must equal a new policy, and a new policy must equal new activity. Perhaps when he asked the Department, “What is it that we have not done that we could do in respect of health care-associated infections?”, he was simply served up something that his predecessor had rejected. That is often how these things happen, and I am afraid that this looks a lot like that.

I should be very disappointed if it were felt that this Bill or the role of the care quality commission itself was a sufficient response to the demands of tackling infection control. We debated this issue last week, so I will not travel down all the paths associated with it, but it is clear that on the Maidstone and Tunbridge Wells NHS Trust, for example, the Secretary of State is hiding behind the Healthcare Commission as though it were not an inspectorate coming in to establish to what extent a body is failing in its duty to provide care; instead, he seems to be regarding it as a performance management organisation. However, it is not; as things stand, it is the strategic health authority’s responsibility to manage the performance of the Maidstone and Tunbridge Wells trust, and the Department of Health has line management responsibility for the performance of the SHA. However, given the events surrounding the trust, it looks to me as though performance management was ignored.

The Secretary of State talked about world-class commissioning. However, the primary care trust clearly subcontracted its responsibility for infection control and quality to the health protection unit. Effectively, the PCT played no role in determining the quality of the services being provided to patients at Maidstone and Tunbridge Wells. Likewise, the SHA subcontracted its responsibility to the health protection unit, which did not get involved until an outbreak had been notified. Even then, it did not have the necessary powers. So the Secretary of State needs to think hard, and we should think hard, not only about how we strengthen the role of an inspectorate in assessing from the outside where things are going wrong, but about ensuring that performance management works more effectively inside the national health service, because at the moment, it clearly does not.

I take the hon. Gentleman’s point, but may I also suggest that he think hard, as many of us do, about trying to strike the right balance between decentralisation and local control, and national priorities for a national health service? Both our parties struggle with that.

An example of that balance can be seen with hospital-acquired infections. If asked, people say that they want local control of their health facilities. They say that until something goes wrong or until they perceive a disparity of provision, which is sometimes called a postcode lottery. They then say, “We are worse off than the people next door” and they ask why somebody, usually Whitehall or the Government, does not sort it out. Hard thinking is required to strike that balance, and the Conservative party needs to do some of that.

We have done quite a lot of hard thinking about this matter. I do not know whether the hon. Gentleman has had occasion to read the autonomy and accountability white paper that we published in May, but it expressly addresses these issues. For example, it makes it clear that the independent allocation of resources to try to achieve greater equivalence in access to health care across the country relative to the burden of disease is important. Figures that I published yesterday demonstrating the wide disparities across the country in expenditure per cancer patient are largely associated with that. Even if one were to equalise the allocation of resources relative to the burden of disease, it would not mean that the same amount would be spent, because different parts of the country would have different priorities. I do not believe that we could ever reach the point where the centre could mandate how much is spent, but a nationally funded national health service should have a national allocation system that is at least geared towards providing equivalent access to health care services for people in the same circumstances.

We can also be clear that commissioning guidelines and standards can be established nationally, which is why the Bill reproduces existing legislation. Standards should be set nationally, and the care quality commission, whose task is to assess performance against those standards and provide information on that, should be in place. I do not know what the Government’s view is for the future, but I think that the role of patient choice and decentralised commissioning then becomes all the more effective, because performance against those national standards can be taken into account and can help to drive the local response in terms of what is being delivered. That is our view, but heaven only knows where the Government stand on patient choice.

I thank the hon. Gentleman for that thoughtful response. I have not read every word of that shadow white paper, and he will correct me if I am wrong about this next point. I recall that after its publication in May the Conservative party proposed a policy of increased localism—I use that term in a broad sense—and at the same time called for a national moratorium on any proposals to close an accident and emergency hospital unit in England. That gets the balance a bit wrong; I am not saying that the Government necessarily have that balance right, but that is why I was politely suggesting that he should think a little harder about this balance between localism and centralism.

The hon. Gentleman is, in a sense, misdirecting himself, because a moratorium is just that—it stops a process that is under way.

It is a local process.

No, it is not a local process. This is why the hon. Gentleman is misdirecting himself. Our proposal to impose a moratorium on what is happening is us saying that we will not countenance—or would not have countenanced had we taken office following an election—a process whereby national clinical directors and Ministers in the Department of Health wander around telling people what they should be doing. They should be going to places such as the constituency of my hon. Friend the Member for Worthing, West (Peter Bottomley), where the national clinical director is saying to people that there has to be a drainage population of 400,000 plus in order to provide an accident and emergency service. That is clearly not justified by the evidence. Subsequent material, such as the report published by the Academy of Medical Royal Colleges, makes it perfectly clear that accident and emergency departments serving smaller populations are entirely viable.

What I am saying is entirely consistent, because I believe that the clinical evidence and the decision making should combine locally. The clinical evidence will not all be derived locally, and indeed much of it will be prepared by the professions nationally, but it has to be interpreted into local circumstances and be the product of local decisions. Under this Government, it is not the product of local decisions but of national influence and determinations from the centre.

I am grateful for my hon. Friend’s reference to the situation at Worthing and Southlands hospital. I think that the primary care trust will now have another serious look at the issue, and I am grateful to the Secretary of State if he was quietly involved in that, as I suspect he was. I put it to my hon. Friend that it is wrong for national standards to come from papers written by tsars that are not peer-reviewed, contain no evidence and are, in effect, a series of anecdotes.

I agree, and that is at the heart of the issue that we have presented. It is unacceptable for local managers to receive documents from the Department of Health that are not evidence-based or peer-reviewed, and are inconsistent with the professions’ collective view. Such documents are presented as though they are clinically driven and have to be translated locally, just because they are written by someone who happens to work in the Department. That is not acceptable.

I would be interested to know exactly which part of Roger Boyle’s document the hon. Gentleman disagrees with.

I was talking about accident and emergency departments, so I meant George Alberti’s document. However, the same point can be made about Roger Boyle’s document. He presented an argument about the need to centralise stroke services, but—as the Secretary of State knows—there is no model for doing so. There is no basis for knowing what the necessary catchment population should be, for either acute care of stroke or the concentration of services for primary angioplasty. The pilot studies on primary angioplasty have not reported, been peer reviewed or provided evidence. But Roger Boyle produces his document, and the Prime Minister and others stand at the Dispatch Box and say that services must be centralised on that basis. That is why we propose a moratorium: so that such issues—the design of stroke services or cardiac interventions based on evidence—can be structured locally on the basis of evidence, rather than assertions from the Department of Health.

I shall now return to the subject of the Bill, Mr. Deputy Speaker. The House will recall the passage of the Mental Health Act 2007, and it is extraordinarily important that the introduction of community treatment orders—and the extent of compulsion under them—is the subject of independent scrutiny. That will be the role of the Mental Health Act Commission, and I hope that it will be made clear during the passage of this Bill that that should happen.

When the Minister of State winds up, I hope that he will tell us when we may expect the proposed section 60 order on the governance of the General Medical Council, because it would be helpful to consider that alongside the broader proposals to shift towards parity in lay and professional participation. The Secretary of State will know that we have accepted some of the principles. We accept the principle of parity, but we do so in the context of helping to support confidence in professional self-regulation, not helping to undermine it. I hope that during the passage of the Bill we will explore carefully the proper role of the office of the health professions adjudicator and why it has to be operated independently from the GMC. If we believe in professional self-regulation, we should be able to structure the regulation in a way that keeps the functions of investigation and adjudication within one body, even if they are functionally separate.

The Department appears to assume that responsible officers will be in place in April 2009, but that is a heroic assumption. For a start, I am not sure that it is right to assume that in most cases the medical directors of primary care trusts should be the responsible officers.

Eighteen months?

I believe so. I understand that the date is April 2009, but if I am wrong the Minister will let us know. I think the time scale is too rapid—it is a heroic assumption.

Should a responsible officer combine clinical governance responsibility with the assumption of part of the management responsibility? Let us consider that point in the context of primary care. If GPs as contracting providers have a developing relationship with the primary care trust, is it necessarily right that the responsible officer as a member of the PCT board should also have responsibility for their clinical governance arrangements? I have no doubt that clinical governance should be improved and strengthened, even more so in primary care than in secondary care, but we must do that in a way that commands the greatest possible confidence among the professions. It is important that clinical governance be conducted by somebody who has only that responsibility, with no risk of conflict of interest with other responsibilities.

I repeat my question about the scrutiny process of the professional practice of doctors. On the one hand a revalidation structure is being set up; on the other, where there is the possibility of serious failings there are fitness to practise investigations and, in the middle, there is the question of what happens when someone has difficulties in their professional practice that are not such as would give rise to an investigation by the GMC. Such cases are pursued by the National Clinical Assessment Authority, alongside the National Patient Safety Agency. I have never understood why. If there is a spectrum of issues relating to professional practice, from making sure that people are up to date to the correction of serious problems, one body should be responsible for all of them.

On standard of proof, the Opposition Front-Bench team have made it clear that we accept in principle that we should move from a criminal to a civil standard. The medical profession is concerned that the loss of livelihood of its members would be accomplished on the basis of a more-likely-than-not calculation and, it would argue, on evidence that might not substantiate the loss of livelihood and its resulting impact on the individual. I do not think the profession is right about that; it is important to recognise that in practice a graduated scale is applied by tribunals, and courts, even with a civil standard of proof, which relates the nature of the evidential test—the quality of the evidence provided—to the penalty that would eventuate from the conclusion that somebody was guilty of an offence.

We need to make it clear in the legislation that that is the case, to try to set minds at rest, and that it is true, as my hon. Friend the Member for Worthing, West in effect said in his intervention on the Secretary of State, that when a court is presented with the proposition that somebody will lose their livelihood—which is very significant for doctors, as they may not easily be able to pursue another career—there must be almost a criminal standard of proof before that result is achieved. I think that that is pretty much what the court was saying—so there is a precedent for saying that the civil standard of proof must be applied in a way that is sensitive to the nature of both the allegations and the evidence. As we incorporate that provision in the statute, we must attempt to give the medical profession that assurance.

The hon. Gentleman is making a balanced argument, but if we use the civil standard of proof how will he ensure that we word legislation that allows us to slide up the scale towards the criminal standard for some offences and not for others? How can we make that clear without it leading to more and more legislation as people take tribunals or the GMC to court because they did not get the answer they wanted?

The hon. Gentleman’s expertise is medical, not legal, but those who write the legislation will have to try to ensure that the guidelines are at least very clear. We will have to see to what extent they can be incorporated directly into the primary legislation and in the schedules to it, but I am sure that the House will have noted his declaration of interest in these matters—or not.

I will not delay the House on the part of the Bill dealing with public health. On the face of it, the updating is pretty straightforward. The powers requiring people to be quarantined or to submit to medical examination if they are infectious have been extended quite a long way, so we need to ensure that the safeguards exist. I have no doubt that there should be such powers but, taking the wider view, I just wish that we also had public health legislation that helped to achieve the things that we have proposed to create a much stronger separately funded public health service that works with local authorities to deliver better on our public health objectives.

The Secretary of State will know that only a third of the dedicated public budget of £300 million that the Government have allocated since the White Paper “Choosing Health: Making healthy choices easier” has been spent on public health objectives. He will also recall that Ara Darzi’s document on “A Framework for Action” in London expressly sets out the fact that primary care trusts spend on public health in inverse relation to their deprivation. For example, Tower Hamlets, which is one of the most deprived areas in London, spends £6 a year on preventive health spending.

Per capita.

I beg the hon. Gentleman’s pardon. Tower Hamlets spends £6 per head, whereas the Bromley primary care trust, which is not among the most deprived, spends £33 per head per year on its preventive spend. Frankly, that is an outrage.

The Secretary of State did not dwell at length on the issue of health in pregnancy. My hon. Friend the Member for Eddisbury (Mr. O'Brien) has reminded me that I am taking up some time, but I will talk about more things than the Secretary of State mentioned; we need to mention some things that he did not. The health in pregnancy grant was announced in the 2006 pre-Budget report as something that would merely bring forward child benefit payments to pregnancy, but it now has a slightly different character. It is not designed in precisely the same way.

I have two questions about the grant. Is it to be administered entirely by Her Majesty’s Revenue and Customs and will it be paid for by the Treasury directly? I will not dwell on HMRC’s administrative potential and the nature of the data that will have to be supplied, when they will be supplied, by whom they will be supplied and to whom HMRC may supply them. The House needs an answer because there is no impact assessment to tell us not only what the overall costs will be but who will pay the cost of implementation of £8.4 million in the next financial year.

The Secretary of State seems to think that the health in pregnancy grant is the best way of spending the relatively large sum of £175 million a year to support nutrition in pregnancy. May I direct him to the draft guidance from the National Institute for Health and Clinical Excellence that was published just a couple of months ago? Paragraph 3.5 says:

“Interventions which ensure that a woman is nutritionally equipped for pregnancy are likely to have the greatest effect if delivered before conception and during the first 12 weeks”.

Later the guidance considers the gaps in the evidence and says:

“There is a lack of well-designed interventions on how to…improve the nutritional status of women before and during pregnancy”.

It adds:

“There is a lack of well-designed studies that have evaluated the use of food vouchers to encourage health eating.”

Let us leave aside the simple fact that the grant may be spent by pregnant women on things other than what is necessary for their diet. The guidance also gives rise to the question as to whether this is a well-calculated and evidence-based intervention even in terms of improving diet.

That brings us to question of weighing and measuring children. It has always been our argument that not only should children be weighed and measured, but there should be an effective follow-up. I see nothing yet in the Bill—perhaps the Secretary of State will add more in terms of policy—about an adequate follow-up. The report from the National Institute for Health and Clinical Excellence clearly shows that universal interventions by midwives, health visitors and school nurses are critical. However, what is the actual situation? Let us consider health visitors. In 2004 there were 10,137 full-time equivalent health visitors. By 2006, that figure had reduced to 9,376. It is clearly not possible for us to deliver the kind of improvements in childhood obesity that we want to see, when the number of health visitors is declining.

Let us consider what the Government have said about school nurses. The then Minister of State said in March 2006:

“Because we know school nurses make such a difference, we want at least one, full-time qualified nurse working with every cluster of primary schools and their related secondary school by 2010.”

There are 3,343 secondary schools in England. According to the Minister of State, Department of Health, the hon. Member for Exeter (Mr. Bradshaw) on 23 October this year, there were 815 full-time equivalent nurses with the appropriate nursing qualification working in England. So we are nearly 2,500 short of what is required by— [Interruption.] The hon. Member for Wolverhampton, South-West says from a sedentary position, “Cluster.” There are 3,343 secondary schools. The policy is for one full-time qualified school nurse per secondary school and its cluster of primary schools. I am using the number of secondary schools, so the comparison is entirely valid.

On the social enterprise investment fund, I welcome what the Government are proposing, and the benefit of that. We already know the potential impact of social enterprise in the health care sphere, if only by reference to what hospices do for palliative and end-of-life care. In that context, it is astonishing that the Government are going down this path without at least ensuring that they have provided, through the publication of the end-of-life care strategy and the development of the tariff for palliative care, a full cost-recovery structure for hospices, if they wish to take it up, for the delivery of end-of-life and palliative services. Hospices are social enterprises that do a remarkable amount, and they should at least have the option—even if they are not required to do this—of providing services to the NHS in a fully supported way.

The Government propose, under clause 134, to extend direct payments. We have always welcomed that. Some Members will recall that when the “Our health, our care, our say” White Paper was published on 30 January 2006—excuse me, Mr. Deputy Speaker, but I am going to quote myself—I said:

“Will the Government legislate to allow direct payments to extend across health and social care, so that patients with long-term conditions can control the management of their care?”

The then Secretary of State replied:

“The hon. Gentleman…mentioned the extension of direct payments, not only to social care but to health. That sounds like the revival of the patient’s passport.”—[Official Report, 30 January 2006; Vol. 442, c. 26-29.]

In the White Paper, the Government said:

“It has been suggested that we should extend the principle of individual budgets and direct payments to the NHS. We do not propose to do so, since we believe this would compromise the founding principle of the NHS that care should be free at the point of need.”

I did not agree with them then and I do not agree with them now. Interestingly, Lord Darzi said in his interim report:

“we need to learn how to support and allow eligible service users increasingly to design their own tailored care and support packages. This could include personal budgets that include NHS resources.”

The Government have done a complete U-turn. Will they say today that they will incorporate in the Bill the necessary provisions to allow individual budgets and direct payments to extend across health and social care, in the way that Lord Darzi has made clear he now supports?

Finally, on the pharmacy contract, there is a proposal to transfer the global sum into the hands of primary care trusts. Will the Secretary of State—or the Minister of State, when he replies to the debate—acknowledge that thus far there has been a pitiful take-up of most of the advance services that would have delivered precisely what the Prime Minister, when he became Prime Minister, said that he wanted— pharmacies that offer more screening, more lifestyle support and more opportunities for people to access sources of advice and information about their health?

That is not happening under the current pharmacy contract. It needs to be transferred from the Government to the primary care trusts, and the Government should make sure that there are sufficient incentives for the pharmacy contract to do what was intended, as distinct from pharmacies getting a global sum as a consequence of the manipulation of category M list prices.

This is a portmanteau Bill. The Secretary of State has arrived with his bag full of lots of tricks, most of which have been in gestation in the Department since long before he arrived there. None the less, some of them will be useful. Many of them will require scrutiny during the passage of the Bill, but none of them, as put forward by the Government, constitute the long-term sustainable vision of how health and social care can be regulated in a way that will deliver the improvements in standards that we all so long for.

I declare an interest. In 1999 I was appointed, along with two other Members of the House, to the doctors’ regulatory body, the General Medical Council, and in 2003 I was reappointed to the new council by the National Health Service Appointments Commission, and I still sit on that body.

I am pleased that the Bill is before the House and that we are considering the introduction of a care quality commission, which will have tough powers to deal with the safety and quality of care. We have just heard the hon. Member for South Cambridgeshire (Mr. Lansley) speaking from the Opposition Front Bench about how important performance management is in the national health service. I agree with him about that. It is difficult to grasp who is responsible for what. Over time, a regulator that deals with the quality of care could answer many questions about the differences in treatment that patients—our constituents—sometimes experience between one establishment and another.

Also, bringing together the regulation of health, adult social care and mental health care should ensure a more consistent approach to regulation. The regulation of social care will represent a large part of the work of the new regulatory body. Hopefully, it will implement our manifesto commitment to strengthen clinical governance and the regulation of health care professionals.

During the last general election when I was a candidate and not a Member of the House, I spent an evening in Tameside talking to a group of people who were relatives of the victims of Dr. Harold Shipman. After talking to them for two or three hours, the need for a change in regulation was all too apparent. Because of the dreadful consequences that their families had faced, those people knew more about regulation than many health professionals or Members of the House. Health and social care professionals should be more accountable to the public as well. I hope that that is implicit in the aims of the Bill.

The merger of relatively new regulatory bodies will have to be handled carefully. There is always a danger of losing effectiveness when change takes place, as people are left wondering whether their position will exist in a few months. The Select Committee on Health, on which I sit, has often found that change tends to take people’s mind off what they should be doing. Care must be taken that that does not happen when the merger proposals in the Bill are implemented.

Having been on the General Medical Council for many years, I have more than an outside interest in these matters. I am interested in the doctors’ approach to the Bill. The British Medical Association is moving a little clos