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Commons Chamber

Volume 524: debated on Tuesday 8 March 2011

House of Commons

Tuesday 8 March 2011

The House met at half-past Two o’clock


[Mr Speaker in the Chair]

Oral Answers to Questions


The Secretary of State was asked—

Public Health Duties

1. How much funding he plans to allocate to local authorities to perform new public health duties in each of the next four years. (44476)

6. How much funding he plans to allocate to local authorities to perform new public health duties in each of the next four years. (44481)

9. How much funding he plans to allocate to local authorities to perform new public health duties in each of the next four years. (44485)

Through the Health and Social Care Bill, we will give local authorities the powers and resources they need to improve the health and well-being of their local populations and to improve the health of the poorest fastest. To support planning by local authorities, I will later this year announce shadow allocations for 2012-13 for the local ring-fenced public health budget.

Will the Secretary of State explain whether reforms outlined in the public health White Paper “Healthy lives, Healthy people” allow for a new formula for public health spending that sufficiently compensates deprived areas that have higher health needs, such as Liverpool?

Yes, it is certainly our intention that that should happen. The consultation on the structure of the health premium, which does not close until 31 March, is specifically designed to secure responses so that we can design the health premium to support local authorities in delivering the greatest increment in health improvement among those populations that currently have the poorest health. We will also continue to get advice from the Advisory Committee on Resource Allocation so that that is technically supported by the best advice.

Will the Secretary of State give us more detail on how local authorities will be incentivised to innovate in public health, given that hospitals rather than councils will benefit financially from better public health?

In the first instance, local authorities have the direct incentive that they represent the people who elect them and so will want to use the public health resources available to them to deliver the best possible public health services to their local population. The intention of our proposals, which has been very strongly supported, not least by the British Medical Association, the Faculty of Public Health, the Local Government Association and others, is to put public health resources alongside the range of responsibilities of local authorities which will have the greatest impact on the overall determinants of health: education, employment, housing, environment, transport and the like.

Will the Secretary of State assure us that the forthcoming tobacco plan will be both comprehensive and targeted to ensure that smoking rates are reduced? Will he promote what works, such as the use of smokers group help sessions, which the Public Accounts Committee found to be very effective, and will he limit the recruitment of new smokers by banning tobacco displays in shops?

In the public health White Paper, which was just mentioned, the Government committed to publish a tobacco control plan, and we will present that to the House shortly.

A public health function which is funded by the Department of Health is carried out by the charity Marie Stopes. The last accounts available for this registered charity are from 2009 and, upon inquiry, it appears that no further accounts will be available for scrutiny until October 2011. Does the Secretary of State think that that is transparent? Is it good enough?

I am grateful to my hon. Friend for her question. As a registered charity, Marie Stopes is of course under an obligation to follow the rules and guidelines established by the Charity Commission on such matters. To that extent, these are not directly matters for me.

On international women’s day, what assurances can the Secretary of State give about the protection of reproductive and sexual services within the new framework?

My hon. Friend will know that through the plans set out in the Health and Social Care Bill the commissioning of those services will be the responsibility respectively of the NHS commissioning board and local authorities. Through local authorities, and as part of our public health responsibilities, we will be looking to promote good sexual health and high-quality support for people who need assistance with reproduction.

My right hon. Friend has referred to the ring-fencing of the money that is going to be given to local authorities. Will he advise the House how long he expects that ring-fencing to last? Is it until such time as local authorities can be trusted to spend the money on public health?

The purpose of the ring-fencing is not to force local authorities to spend money on public health that they would not otherwise spend, but to be very clear that that NHS money is in the hands of local authorities to deliver health gain. We want that transparency, and we want to link those resources directly to the achievement of the public health outcomes that we set out in draft in our consultation on the public health outcomes framework. As there is that separate intention to deliver overall public health outcomes, linked to the local health improvement plans, we wanted to be clear that those resources would be deployed for that purpose. But local authorities will have very wide discretion about how they deliver those services locally to secure that health gain.

Does the Secretary of State accept that the public could be forgiven for worrying that things will get worse, rather than better, in relation to public health? That is true of his health reforms across the piece, partly because, as we know, some local authorities are already cutting public expenditure given the budget cuts that they have to make, but also because of the difficulty in effectively ring-fencing the new funds that will be given to local authorities in due course.

In the first instance, I am not sure how the hon. Lady can argue that there is a difficulty with ring-fencing public health budgets, as they are not and will not be formally in the hands of local authorities until 2013-14. Clearly, there are no such practical issues at the moment. Further, she should have reflected the simple fact that we are already working between the NHS and local authorities to deliver much greater co-ordination in health, public health and social care. For example, this financial year, because we made savings in the Department of Health’s budget, we were able to provide, through primary care trusts, £162 million extra for the purpose of delivering improvements in social care in local authorities. Local authorities are having to deal with substantial reductions in their formula grant and some reductions in their spending power, but the NHS and social care are getting a substantial increase in support, both from the formula grant of my right hon. Friend the Secretary of State for Communities and Local Government and specifically through the NHS.

Cancer Mortality Rates

“Improving Outcomes: A Strategy for Cancer” sets out our plans to reduce mortality rates by tackling preventable incidence and improving survival rates for those diagnosed with cancer. As we make it clear in the strategy, we cannot deliver the reductions without a focus on poorer socio-economic groups.

I wonder whether the Minister has seen the statistic that 70% of people with cancer can lose half their income during the course of their disease. Obviously, those who are least well-off will be hit the most. Would it not be best therefore for the Government to heed the warning from Macmillan Cancer Support and others that the Welfare Reform Bill proposal to end abruptly the eligibility for employment support allowance after 12 months is both unfair and arbitrary, particularly for those who have the fewest resources, as they try to recover from cancer?

That sounds more like a Second Reading speech on the Welfare Reform Bill than a Health oral question; but of course, we listen carefully to what Macmillan says. We work closely with it on many aspects of our cancer strategy, but it is also important to bear in mind that we need to ensure that people who are suffering from cancer receive the benefits to which they are entitled in a timely fashion, and we are working on that with colleagues from the Department for Work and Pensions.

Mr Speaker, you might remember in the last Parliament that a young constituent of mine—a five-year-old boy—had neuroblastoma and that his likelihood of surviving that rare cancer was very small, but thanks to the intervention of Ann Keen in the last Parliament and working together, I am pleased to say that it has just been announced that that little boy is clear of cancer. Will the Minister comment on whether, as I hope, it will not be so difficult in this Parliament to get treatment for such cases?

I thank the hon. Gentleman for his question, and I share his satisfaction and pleasure at the successful treatment that his constituent’s son received. Certainly, on cancer survival rates and cancer outcomes, we need to make sure not just that we are delivering for the most typical cancers, but that we have good processes that ensure early diagnosis of all cancers.

NHS Reform

The Government received more than 6,000 responses to the White Paper consultations. As a result, we have significantly strengthened both our approach to implementation and our proposals in the Health and Social Care Bill. We continue to engage widely across the health sector on our modernisation plans.

Is not it only a Tory Government who can bring a system into the NHS whereby doctors get paid more for giving less treatment to their patients? What does the Minister have to say to the chairman of the BMA’s GP committee, who described the plans for the quality premium as “appallingly unethical”?

I have to admire the hon. Gentleman’s sheer gall, because, of course, it was his own Government’s 2004 contract with GPs that enabled them to do less work for far more money.

The Minister will know that a concern about the Government’s health policies is the increased role for the private sector. He will also be aware that at the Christie hospital in Manchester 150 jobs have been transferred from the NHS to the private contractor on that site. Will he give the people of the north-west an absolute guarantee that we will not have twin-track cancer treatment at Christie’s and that there will not be a fast track for the private patient and a slow track for those on the national health?

I can categorically give that assurance to the hon. Gentleman, because there is no two-track system. Where the private sector may provide care, it is to help to raise standards. I imagine he would agree with that, because he fought the general election on this manifesto commitment:

“Patients requiring elective care will have the right…to choose from any provider who meets NHS standards of quality at”

the NHS level.

Will my right hon. Friend tell the House how many representations the Government have received arguing the case in favour of the PCTs in the structure that we inherited at last year’s general election? If, as I suspect, the answer to that question is not very many, is that not because there was a shared commitment between this Government and the previous Government to introduce genuine clinical engagement to the commissioning process?

I am grateful to my right hon. Friend for that question. I can go a little further and say that, to the best of my knowledge, we received no representations to keep the PCTs. He is right when he talks about what the previous Government were seeking to do, and we want commissioning to go to the local level—to GP commissioners, who have the best knowledge of the needs of their patients. The fact that we have so many pathfinders shows that GPs are signing up voluntarily, with enthusiasm, to take part in the scheme.

A consultation is under way on the reconfiguration of children’s heart surgery units. Last week, a number of colleagues from both sides of the House met a number of parents who are campaigning to keep the unit at Leeds general infirmary. Will my right hon. Friend confirm when he will announce his preferred option and what processes will be gone through to reach that decision?

I am grateful to my hon. Friend, who was present at last Thursday’s Adjournment debate. He will know that the proposals, the options put together and the consultation, which we have just begun, have been organised at arm’s length from Ministers by the joint committee of PCTs. As I said on Thursday, I trust that he will forgive me if I say that it would be totally inappropriate for me to comment, because that might be seen as trying to influence or prejudge the ultimate outcome.

Before the election, the Secretary of State went up and down the country promising that his NHS reforms would save local A and E and maternity services, but on 1 March, during consideration in Committee of the Health and Social Care Bill, when I asked the Minister whether London’s A and E departments would be on the safe list of designated services that will not close, he said that

“I suspect the answer is that no…it will not be a designated service…there is a significant number of A and E services in London. There would not be a need to designate them”.––[Official Report, Health and Social Care Public Bill Committee, 1 March 2011; c. 349.]

Will the Minister now give the House a clear and simple answer to a simple question: will every London A and E remain open under this Government—yes or no?

Mr Speaker, if you had had the opportunity to read the exchange in Committee, you would understand that the hon. Lady’s question is not factually correct. She asked me figuratively what would happen in an urban area as compared with a rural area, and as I explained three times during further interventions from her, my answer was illustrative, not definitive, because that would have been premature. She is trying to scaremonger—causing fear with something that she knows is inherently not true.

MRSA and Clostridium Difficile

4. What recent steps his Department has taken to reduce the incidence of MRSA and clostridium difficile in hospitals. (44479)

This Government have made it clear that the NHS must adopt a zero-tolerance approach to health care-associated infections. We reinforced this in the “NHS Operating Framework 2011-12”, requiring the NHS to prioritise delivery of the MRSA and the new C. difficile objectives. In 2009-10 C. difficile infections decreased by 29% and MRSA decreased by 35% on the previous year.

I thank the Minister for his reply, but will he tell me specifically what action the Government are taking to deal with MRSA and C. diff, particularly in the Queen’s hospital in Romford and throughout the Barking, Havering and Redbridge NHS Trust? Will he assure the House that any such case will be made public by the hospital trust and not kept quiet?

I can assure my hon. Friend that the performance at his trust on health care-associated infections is unacceptable. We have set demanding objectives for reducing both those infections. In 2011-12, his trust’s MRSA objective requires a reduction of 58%, one of the highest reductions in the country. Its C. difficile objective requires it to deliver a 24% reduction. The consequence of non-achievement is an option to withhold part of the contract payments, and I can categorically assure my hon. Friend that there is no question of keeping this information or developments secret. We require weekly publication of figures.

As the Secretary of State knows, the north Cumbrian health economy is in crisis. GP commissioning is providing £30 million less for acute hospital services in north Cumbria this year than it did last year. This has resulted in the trust being unable to seek foundation trust status, and it is seeking a merger which minutes leaked to me by consultants say could lead to the closure of the West Cumberland hospital. Will the Secretary of State meet me as a matter of urgency so that we can collectively find how we can get the hospital out of that hole? Will he also consider a delay to foundation trust status to give the hospital trust more time to get back on its feet?

I am a bit confused, Mr Speaker, as the question is about MRSA and C. difficile, and I did not hear any specific question from the hon. Gentleman on that subject.

I am grateful to the Minister of State. My sense is that the hon. Member for Copeland (Mr Reed) is seeking a meeting. The Minister is perfectly at liberty to say more if he wishes, or if he does not think it is worth it, he does not have to do so.

Mr Speaker, you are a wise owl to be able to interpret what Opposition Members are thinking but may not be saying. If the hon. Gentleman has concerns along the lines that he mentioned, I or one of my ministerial colleagues would be more than happy to meet him.

Wise owl is the kindest description that the hon. Gentleman has ever offered of me. I shall take it that he means it. It’s the best I’ll get.

GP Commissioning Consortia

Last week I announced the third wave of general practice-led pathfinder consortia. I am sure my hon. Friend will be delighted that the Nuneaton and Bedworth pathfinder was announced as part of that. There are now 177 groups of GP practices covering in total 35 million people across England, piloting the future general practice-led commissioning arrangements. I expect further coverage in the coming months. Pathfinders are playing an increasing role in commissioning care for patients, so more and more people will benefit from clinical leadership in planning their care.

In giving GP consortia such powers, will my right hon. Friend confirm that if consortia prove to be good housekeepers in terms of both commissioning and budgets, there will be some form of reward incentive that they can invest back into local patient care?

Yes, I can. Consortia will be able to reinvest any savings they make from their commissioning budgets for patients into improving patient care and health outcomes for patients for whom they are responsible. We have also proposed that consortia should receive a quality premium based on the outcomes achieved for patients, similar at a consortium level to the quality and outcomes framework for individual practices. That will incentivise the consortium as a whole to deliver improving outcomes for patients.

Some Government Members have supported the Government’s proposals for GP consortia because they believe that hospitals in their constituencies will be protected from closure, but yesterday’s leaked letter from the Foundation Trust Network to the Department of Health proves them wrong. It warns that financial stress is threatening the organisational survival of some foundation trusts. Now that they know that their hospitals are in danger, will the Secretary of State tell us all which faceless bureaucrats will be closing our hospitals and what extra powers, if any, local communities will have to stop them?

That will be the leak that took place when the head of the Foundation Trust Network gave it to the BBC.

The hon. Lady might not be very experienced in these matters, but she will know that at this time of year, in anticipation of the new financial year, hospitals tell their local primary care trusts how much money they would like to have, but that is not the same as the amount of money available in the whole system. That is part of the contract negotiations. She should also know that the necessity to deliver efficiency savings and redesign clinical services will mean that hospitals need to deliver 4% efficiency gains year on year, right across the NHS.

It will not be 6.5%, because things need to change so that efficiencies can be achieved within hospitals. That much is absolutely clear, and we have been clear about that. It does not threaten the future of hospitals, but incentivises to improve the design of clinical services and improve care for patients, providing more accessible care in the right place and at the right time.

Cancer Services

We published our cancer strategy in January, which set out a range of actions to improve cancer outcomes and cancer services. We set out our plans to improve earlier diagnosis, access to screening, treatment and patient experience of care.

I am grateful to my hon. Friend for that answer. He and my right hon. Friend the Secretary of State will be aware of the concerns expressed by a number of GPs across the country, including in my constituency of Sleaford and North Hykeham, about the pace of reform in the NHS. What assurances can he give the House that GP consortia will continue to have access to the expertise they need to commission effective cancer services?

I am grateful to my hon. and learned Friend for that question, because part of that pace is, of course, due to the fact that a substantial part of the country is now covered by pathfinder GP consortia, many of which are actively engaging with their colleagues in cancer networks and developing the expertise and experience that will be essential in taking forward their commissioning responsibilities. We have already made it clear that funding will be available in the coming year for the commissioning networks for cancer and that after that it will be a matter for the NHS commissioning board.

Cancer specialists at Peterborough City hospital tell me that they are prevented from prescribing drugs to needy patients, even after accreditation by the National Institute for Health and Clinical Excellence, as a result of the necessity for further approval by their local primary care trusts. Will the Minister undertake to tackle that bureaucratic delay, as it is having a significant impact on clinical outcomes in my constituency?

There are several aspects to my hon. Friend’s question. One is that we need to see much more commissioning for outcomes in cancer services. We must also ensure that full advantage is taken of the cancer drugs fund. I would be happy to look at any specific details of the case he has mentioned if he cares to write to me.

Does my hon. Friend agree that an important part of improving cancer care in this country is supporting the excellent palliative and respite care wards, such as Oakwell ward in Ilkeston community hospital in my constituency? It would be remiss of me, as the daughter of a nurse, not also to ask him to pay tribute to the nursing staff who work in that important area.

First, I will take the opportunity to pay that tribute to the excellent and hard work of clinicians in providing invaluable support to people affected by cancer. My hon. Friend is also right to refer to the importance of respite care for families. As part of the end-of-life strategy that the Government are taking forward, we are looking to improve palliative care services and inquiring into the possibility of a per-patient funding mechanism to cover the costs of these services.

Given the Minister’s commitment to improving patient experience, and the significant learnings from the national cancer patient survey, will he ensure that from now on the survey will be conducted annually?

My hon. Friend is right to draw attention to that survey, which has produced invaluable data. More than 65,000 patients took part in the 2010 survey, and it is proving to be an invaluable tool in enabling trusts and commissioners to identify areas where there is scope for improvement locally. The cancer strategy that we published in January commits us to repeating such a patient experience survey, and we are exploring the options at the moment.

What is the Government’s policy in relation to those charities that provide indispensable services to cancer patients and their families? I have in mind, in particular, Macmillan and Marie Curie.

My hon. Friend is absolutely right to describe the contribution of Macmillan, other cancer charities and, indeed, charities in the health sector more generally as indispensable. I recently had the pleasure of visiting Macmillan’s headquarters, where I did an online chat with a number of cancer sufferers and their families and saw the helplines and other support services that it provides. In our cancer strategy, we are very clear that such charities have an invaluable role to play.

Plymouth and neighbouring Cornwall, a former objective 1 area, suffer from enormous deprivation. Will the Minister therefore do all he can to ensure that those communities benefit from Plymouth Hospitals NHS Trust’s much hoped-for CyberKnife technology, and that its benefits for cancer patients are felt not just in London, but more widely in other regions?

I am very grateful to the hon. Lady for her question, and she is absolutely right: that technology is invaluable. We want to ensure that it is available to the patients, and the tariff structures need to ensure that it is properly supported. She is right also that issues of equality in the service are key, and that is why we have maintained this Government’s commitment to supporting the NHS constitution and its commitment to promote equality in the system.

What assessments has the Minister made of the work of academics, such as Robert Putnam, who claim that one of the biggest influences on health outcomes and recovery is social cohesion within a neighbourhood, friendship groups and families? If the Minister has made an assessment, is he putting forward any policies that will help to expand that area?

I thank the hon. Gentleman for that question. Indeed, the importance of family and social networks is a key component of the vision for social care, which we set out in November. Importantly, social care can support those networks through support for family carers.

Queen Elizabeth hospital in my constituency provides excellent cancer care for the people not just of Birmingham, but of the west midlands. Following a freedom of information request by Unison, it has become clear that the hospital faces a 17%—or £22.5 million—cut in its funding from primary care trusts. How can the Minister say that cancer care will not be compromised if we have cuts on that scale?

First, there has been a 3% average increase in the funding that is available to PCTs, and, as my right hon. Friend the Secretary of State said in answer to an earlier question, we are currently in that process of negotiation between hospital trusts and PCTs. It remains to be seen where the final figures will settle, but the money is in the system: the Government are committed to putting £10.7 billion extra in the system—something that the Labour party actually opposed.

As someone whose mother died of cancer, no one needs to tell me how important cancer is within the NHS, but it is noticeable that nine out of 13 questions asked by Conservative Members are about cancer; it seems to be the only part of the NHS which the Government are happy to talk about. But cancer cannot be taken in isolation from the rest of the NHS, when there is a massive reorganisation costing billions of pounds which only one in four GPs thinks will actually improve the service. How can that possibly involve doing the best for cancer patients?

Again, I suspect that the hon. Gentleman is trying to re-run the Second Reading of, in this case, the Health and Social Care Bill, but in fact this Government are committed to seeing improvements across the board. That is why in the NHS outcomes framework we do not just talk about cancer, we identify other areas as well. If hon. Members table the questions, I am certainly happy to answer them.

The Secretary of State is fond of making unfavourable comparisons between European and UK health outcomes, but recent research shows that we are doing much better than the picture he portrays. Independent research has borne that out. Concerns have also been raised about the impact of his NHS reorganisation on cancer networks. Sarah Woolnough of Cancer Research UK says:

“One of our concerns is to ensure that we do not lose the expertise that we have been developing.”––[Official Report, Health and Social Care Public Bill Committee, 10 February 2011; c. 116, Q227.]

Under this Government, however, patients are already waiting longer than six weeks for diagnostic tests, many of which are for cancer. In fact, the numbers have doubled, and that is according to the Department’s own figures. Can I ask the Minister why?

On the hon. Gentleman’s last point, the first thing to say is that average waiting times have gone down, but beyond that, he is right to identify the need to achieve earlier diagnosis. That is one of the reasons performance in this country on cancer survival has not been as good in comparison with other European countries. That is why, in the outcomes strategy that we published in January, we made it clear that we would put in an extra £450 million over the next four years to fund the additional diagnostic procedures directly available to GPs so that they can make those tests available to their patients.

Care Home Beds (North-east)

8. What assessment he has made of the adequacy of the number of care home beds available in the north-east over the comprehensive spending review period. (44484)

Local councils are responsible for ensuring that there is sufficient residential care provision to meet the needs of their populations. I understand from the Care Quality Commission that the number of care home places in the north-east has risen substantially and steadily in recent years.

A recent report from Bupa predicts a shortfall of 100,000 in the provision of care home beds nationally because of the cuts and because of our ageing population. That will obviously impact on hospital beds. How will the Minister prevent that from impacting on health care in the north-east if he is not going to ring-fence the social care budget?

First, let me re-emphasise that we know, on the basis of independent assessments that have been carried out, that across England there is a surplus of 50,000 care home places. As regards the provision of care home places and the funding of social care, we have committed to an extra £2 billion going into the system by 2014, half through local government and half directly via the NHS, to ensure that social care services receive support; and just this year, an extra £162 million will go to local authorities to support them in their social care activities.

Mixed-sex Accommodation

Mixed-sex accommodation breaches patients’ privacy and decency. The number of breaches is now coming down, but there are still far too many. That is why, from April, hospitals will be fined £250 for every breach of mixed-sex accommodation. That money will be reinvested back into patient care.

I welcome the Government’s move to increase accountability to patients by publishing all occurrences of a patient being placed in mixed-sex accommodation. Does my hon. Friend agree that this move, with the prospect of hospitals being fined £250 per patient placed in mixed-sex accommodation, shows that this Government are tackling a problem that the previous Government claimed was impossible to solve?

We are taking this extremely seriously. I should point out to my hon. Friend that there should be no exceptions to providing high-quality care, which includes high standards of respect for people’s privacy and dignity. We need robust information and the monthly publication of the breach figures, which will tell the public what is going on and allow the NHS to make progress. The previous Government dragged their feet on this issue with a complex system that was neither transparent nor effective.


We expect NHS organisations and their partners to ensure early detection, treatment completion and co-ordinated action to prevent and control TB. The Department and the National Institute for Health and Clinical Excellence have published supporting guidance. We are also continuing to support the charity TB Alert to raise public and professional awareness of TB.

I think the House should be concerned that in an excellent presentation back in September, it was explained that only 61% of people in London complete treatment for tuberculosis, that the incidence of tuberculosis in the UK is behind only the levels in Spain and Portugal, and that there were over 400,000 cases in the European Union in 2009. The London report that came out said that we had to invest in the service to provide a TB board for London and probably spread that to other big cities, where most of the people who have TB were not born in the UK.

The hon. Gentleman is absolutely right. The World Health Organisation threshold for high instance is defined as 40 cases per 100,000. Of the 19 relevant primary care trusts in this country, 16 are in London. There is no doubt that this is a complex problem. In the past two decades, the increase in instances has come from people who were not born in this country. We are doing a number of things. The Home Office is reviewing the effectiveness of screening, and is running a pilot of pre-entry TB screening in areas of countries where there is a high instance. The problem is that it is not always detectable when people enter this country.

Tuberculosis is a key health issue for those in the London borough of Hounslow. What more does my hon. Friend feel we can do to build public awareness and to ensure early diagnosis?

My hon. Friend is right. NHS London will continue to fund the TB find-and-treat outreach programme for the homeless and other vulnerable groups, which includes the use of mobile X-ray units. The Department will continue to provide money to support TB Alert, which builds capacity in the voluntary sector and raises awareness.

GP Commissioning Consortia

16. What estimate he has made of the average amount of time per week GPs will allocate to the administration of commissioning consortia under his proposals for NHS reform. (44494)

We anticipate that GPs will focus on the aspects of commissioning that will benefit most from their clinical expertise and understanding of patients’ needs. Only a minority of clinicians will play a hands-on, executive role in consortia. Moreover, they will be able to secure support services to assist with their administrative and commissioning duties.

At present, GPs are able to spend only about eight or nine minutes on average with each patient. How can the Secretary of State expect GPs to be meaningfully engaged in commissioning when, unlike him, they are putting patients first?

Unlike the hon. Gentleman, my right hon. Friend the Secretary of State actually understands the situation. It is not true that doctors see patients for only eight minutes; GPs see their patients for the length of time that they feel they should see them. The concept that GPs will have their time taken away from looking after patients to do commissioning is not right, because GPs will employ commissioners with expertise to work with them and do the commissioning for them, so that they can get on with looking after their patients.

With regard to the admin load of GPs, the Government correctly want to have better integration of health and social care. Why, therefore, are they creating GP consortia that are less coterminous with local authority boundaries than the existing primary care trusts? How will that help to deliver a better integrated health and social care system?

I hope that I can reassure my hon. Friend in so far as that is not automatically or necessarily the case. The geographical area of a consortium will be determined by what is most appropriate in the local area.

When, oh when, will the Minister listen to the country, get his sticky mitts off the health service and stop meddling with our hospitals and doctors?

We are not meddling; we are modernising the NHS to put quality at the heart of care, and to enhance and improve outcomes, which is the most important thing for patients.

Cancer Strategy

18. What assessment he has made of the effect on survival rates of his Department’s cancer strategy. (44496)

We published “Improving Outcomes: A Strategy for Cancer” on 12 January. It sets out a range of actions to improve cancer outcomes, including diagnosing cancer earlier, helping people to live healthier lives to reduce preventable cancers, screening more people, introducing new screening programmes, and ensuring that all patients have access to the best possible treatment, care and support. Through those approaches, we aim to save at least an additional 5,000 lives every year by 2014-15. We will publish annual reports to measure progress on implementation of the strategy.

Does my hon. Friend agree that the establishment of the cancer drugs fund will help the UK to raise its cancer survival rate from among the worst in Europe to potentially one of the very best? [Interruption.]

My hon. Friend is absolutely right to draw attention to that, and it is interesting that a number of Opposition Members are saying that they do not see it as making any contribution whatever to the quality and extension of life. Yes, the funds that the Government provided very early on will be available to ensure that people get access to drugs that have hitherto not been available to them.

The Minister has indicated several times that diagnosing cancer earlier is the solution to the difficulties that we face. What is he going to do to bring that about?

Just a few weeks ago we started a pilot of a national advertising campaign on bowel cancer, with the key message being that people should never feel embarrassed about talking about their poos, so that they get the diagnosis that they need at the earliest opportunity. We are ensuring that such messages get across, even in the Chamber today. We are taking steps to raise awareness so that people get earlier diagnoses.

Topical Questions

My responsibility is to lead the NHS in delivering improved health outcomes in England, to lead a public health service that improves the health of the nation and reduces health inequalities and to lead the reform of adult social care, which supports and protects vulnerable people.

Prostate cancer is the most common form of cancer in men, with a quarter of a million men currently affected and one man dying every hour. This month is prostate cancer awareness month. What action is my right hon. Friend taking to help raise awareness of prostate cancer?

As the Minister of State, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), has set out in previous answers, our cancer outcome strategy commits more than £450 million a year over the spending review period to achieving earlier diagnosis of cancer, including access for GPs in the community to diagnostic tests such as non-obstetric ultrasound. At the heart of the strategy is the need to improve awareness and early diagnosis of all cancers, and we are working with the prostate cancer advisory group to help men who do not have symptoms to make decisions about whether to have a prostate-specific antigen test.

The Prime Minister promised to protect the NHS. What does the Health Secretary say to the people who are not getting the hip, knee and cataract operations that they need, and to the patients who are now having to wait longer for tests and treatment?

I will say three things. First, we did protect the NHS, contrary to the recommendations of the Opposition, who said that we should cut the NHS budget. Next year, primary care trusts across England will receive an average increase of 3% in cash. I went to Wales at the weekend, to Cardiff. The people of Wales are seeing a Labour-led Assembly Government cutting their NHS budget in real terms. That was what the Opposition recommended we should do, and we are not doing it.

Secondly, the number of hip and knee replacement operations went up in 2010 compared with 2009—the Patients Association figures were wrong about that. Thirdly, waiting times are stable, as we have set out, and the latest figures show that the average waiting time for diagnostic tests has gone down.

The Secretary of State is a man in denial. What does he say to the chief executive of the Patients Association, who has said:

“It is a disgrace that patients are being denied access to surgical procedures that they would have had if they had needed them a year ago”?

What the Government are doing on the NHS is making things worse, not better. The Secretary of State is axing Labour’s patient guarantee on waiting times, he is breaking the promise of a real rise in NHS funding, he is wasting £2 billion on the Government’s top-down reorganisation and he is forcing market competition into all parts of the NHS. Does he not see that the NHS is rapidly becoming the Prime Minister’s biggest broken promise?

I can tell the right hon. Gentleman and the House exactly what we are doing. We are increasing the budget for the NHS by £10.7 billion over the next four years, contrary to what the Opposition told us they would do and what a Labour-led Assembly Government in Wales are doing. They are cutting the NHS budget in real terms.

Let me take one example. The number of hip operations in the first half of this financial year was 41,863, whereas in the previous period it was 39,114, and waiting times are stable, so the right hon. Gentleman’s assertion simply is not true. We are delivering an improving quality of care.

Let me give the right hon. Gentleman another example. As the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), said, not only are waiting times stable but infections are going down, with a reduction of 29% in C. diff rates and 35% in MRSA rates in our hospitals. Safer, higher-quality care—

Order. I am very grateful, but from now on we do need briefer answers—[Interruption.] No, we need briefer answers, because I want to accommodate Back-Bench Members. It is about them that I am concerned.

T2. I believe that the introduction of plain packaging for cigarettes would be gesture politics of the worst kind, that it would have no basis in evidence and that it would simply be a triumph for the nanny state—and an absurd one at that. Given that, does the Secretary of State believe that I am still a Conservative, and if so, is he? (44502)

I am happy to believe that we are both Conservatives. The coalition Government made a commitment in our public health White Paper to publishing a tobacco control plan. We will do so shortly, and the purpose will be very clear: to secure a further reduction in the number of people smoking, and as a consequence, a reduction in avoidable deaths and disease.

T4. What assessment has the Secretary of State made of epilepsy helplines in helping to save NHS costs? I have constituents who are able to live happy and fulfilled lives by talking with epilepsy specialist nurses on the phone rather than going into hospital, but unfortunately, it seems as if that service is under threat from the University hospital of North Staffordshire. What is Government policy, and will he look at the situation in north Staffordshire? (44504)

The hon. Gentleman is absolutely right to say that telephone services of the sort he describes play an invaluable role in giving people support. Again, we are at that point in the year when there are budget arguments between PCTs and hospitals, to which he refers. If he supplies me with further details on this case, I will happily write to him.

T3. The Secretary of State has visited Milton Keynes, so he will be well aware of the historical problems at the maternity unit there and, following the intervention of his Department, of the positive outcomes that have been achieved with one-to-one supervision for all mothers. I am convinced that the increased training of midwives has contributed to those outcomes, but may I press him to reassure the House that that level of training will continue? (44503)

Yes, I am very grateful to my hon. Friend and I share his wish for continuing improvement in the maternity services at Milton Keynes hospital. I can tell him and the House that we are delivering on our commitment to improve maternity services, which is at the heart of that wish. The number of midwifery training places commissioned for next year—2011-12—will be no less than this year, sustaining a record number of midwives in training. That will be on top of an increase between May and November 2010—after the coalition Government came in—of 296 additional midwives employed in the NHS.

T6. Following on from the question asked by my right hon. Friend the Member for Wentworth and Dearne (John Healey) on the £2 billion that the Secretary of State is using for his top-down reorganisation, does the Minister feel that that kind of money, which was not mentioned in the Conservative manifesto, would be better spent on health care and on building new hospitals? (44506)

May I tell the hon. Gentleman that his figures are wrong? The cost of the modernisation of the NHS is £1.4 billion by 2012-13. That will be recouped in savings that by the end of this Parliament will be £1.7 billion a year, every year till the end of the decade, of which every single penny will be reinvested in front-line services and for patients.

T5. A new primary care hospital opened in Redcar at the end of 2009. So far, the endoscopy unit and the two operating theatres are completely unused, and a state-of-the-art hydrotherapy pool has hardly been used. Will the Minister meet me to discuss that commissioning failure and to see how we can bring those facilities into use for the local community? (44505)

I understand that the PCT will continue to work with health care providers to develop existing and future services at Redcar primary care hospital, and to promote the availability of services, but I would be more than delighted to meet the hon. Gentleman to discuss that issue.

T7. Every 23 minutes, someone in the UK is diagnosed with a blood cancer disorder—that is 23,600 people per year, including many children. Survival often depends on a donor match. Today until 6 pm, the Anthony Nolan trust has a stand in Portcullis House, where people can get more information, and where those under 40 can register. Will the Minister join me in promoting the donor register and in encouraging MPs and staff to visit the stand? (44507)

I think that more than one of us wanted to do just that, because the Anthony Nolan trust does a fantastic job. The hon. Gentleman is right to raise awareness of it, and all hon. Members should take the opportunity to visit its stand today.

T8. Witham town council and my constituents are deeply concerned about the lack of local medical facilities serving our town. Will the Secretary of State reassure my constituents that under the new commissioning arrangements medical provision in our town will be able to expand? (44508)

I can give my hon. Friend the reassurance that in future her local general practices—together in a commissioning consortium—and their other health care professionals, meeting with the health and wellbeing board in the local authority, will be able to bring democratic accountability in order to ensure that they have in her town and surrounding area the necessary services, based on a strategic assessment of need in their area.

T9. The NHS in north-west London is facing a £1 billion shortfall in funding over the spending period. Is the Secretary of State surprised, therefore, that yesterday’s NHS Confederation survey of managers found that just 13% of managers thought that supporting GP commissioning was the highest priority, compared with 63% who thought that the cash crisis was the highest priority? Is it not the case that financial pressures are dictating the NHS reform agenda, rather than the other way around? (44509)

I remind the hon. Lady again that next year we are increasing NHS resources in real terms. There will be a 3% increase across England in resources for primary care trusts, and as she will know, PCT managers in London are being brought together into PCT groupings. I do not understand the survey. They have a responsibility both to improve clinical commissioning by supporting their GP groups, which are coming together across London to do this, and to ensure strong financial control.

How can the Secretary of State ensure that HIV and sexual health services receive sufficient local political attention?

Local attention, through the public health responsibilities that currently lie with PCTs, but which in future will lie with local authorities, is a means by which we can improve health and the health of some of the groups most at risk of HIV. We have a number of pilot schemes that my hon. Friend might know about and that we are currently assessing, which have looked at opportunistic HIV screening for the many people who are currently undiagnosed with HIV. That is encouraging, and we might well be able to follow up on it.

T10. Given that the chief medical officer does not have a background in public health, and despite the existence of Public Health England, should the Secretary of State not ensure that there is a public health expert on the national commissioning board, because that is where all the power lies? (44510)

I am surprised, because the hon. Lady is on the Select Committee on Health and should know that responsibility for public health will lie both with Public Health England, inside the Department of Health, and with local authorities. The NHS commissioning board will have a responsibility for prevention, but the population health responsibility will lie with Public Health England, and I have absolute confidence that Dame Sally Davies, the newly appointed chief medical officer, will be a leader in public health delivery, through Public Health England.

I represent a constituency with a young and highly mobile population. Younger women are very much over-represented among those who do not respond to routine invitations to screenings. Will Ministers promote the increasing use of mobile communications in inviting women to routine screening services?

That is certainly one way in which we can improve access, and it is one of many that we outlined in the improving cancer outcomes strategy that we published in January.

Given that the Prime Minister has ordered his new communications director to order a shake-up of the health team because he is worried that they are losing the argument on the Government’s health upheaval, would it not save us all a lot of trouble if the Secretary of State admitted, not least to the Prime Minister, that it is not the public relations that is the problem, but the policy?

The cancer drugs fund is available only for pharmaceutical drugs, but can it be used for wider support services, such as healers, aromatherapists, those using therapeutic touch and other such practitioners?

We are finalising the design of the future cancer drugs fund from April, and we will publish shortly. The interim cancer drugs fund is designed to support new effective medicines, based on clinical panels’ assessments of the needs of individual patients.

Today is international women’s day, so let me pass on the good wishes of the women of Darlington to the Secretary of State.

Indeed. However, what does the Secretary of State have to say to those women when they are angry and concerned at the proposal from the County Durham and Darlington foundation trust to move their maternity services from Darlington to Durham, 20 miles away?

I would be grateful if the hon. Lady conveyed my very best wishes to the women of Darlington on international women’s day and said to them that I know from my visits to the north-east that a general practice-led commissioning pathfinder consortium has come together in their area. It is with that consortium and their local authority that they should look at which services they think should be provided in their area, and they will have the power to make that happen.

What plans does my right hon. Friend have to increase the number of single rooms in the NHS? Increasing their number will help to tackle mixed-sex accommodation, and increase privacy and dignity in end-of-life care.

I thank my hon. Friend for that question. As was said earlier, privacy and dignity are central to all the care that we provide in the health service. Mixed-sex accommodation was not tackled by the previous Government; we are determined to tackle it now, and providing single rooms is part of that. Privacy and dignity must be maintained at all times.

New Member

The following Member made and subscribed the Affirmation required by law:

Daniel Owen Woolgar Jarvis, for Barnsley Central.

Points of Order

On a point of order, Mr Speaker. Today the Government have published their draft carbon plan, which we all welcome. There is a commitment in the plan to reviewing feed-in tariffs for microgeneration in 2012-13, as originally set out by the previous Government. However, in just the past few weeks the Government have announced that a fast-track review of those solar feed-in tariffs is to take place by this July. Thousands of jobs in this country are dependent on the certainty and clarity of knowing what will happen with the feed-in tariff review and when it will happen. Today’s document is co-signed not only by the Secretary of State for Energy and Climate Change, but by the deputy leader of the coalition and the Prime Minister himself. Have you had a request, Mr Speaker, for any Government spokesman or the Prime Minister to come and clarify whether the review will take place now or in 2012-13, so that we can end the uncertainty that is jeopardising thousands upon thousands of jobs?

The short answer to the question is that sadly I have not. I am grateful to the hon. Gentleman for giving me notice of his intention to raise this matter; however, it does not constitute a point of order on which I can rule. There will be—and I think he knows there will be—other opportunities to pursue the matter in other ways, and I have a suspicion that he will use them.

On a point of order, Mr Speaker. Yesterday, I asked the Foreign Secretary to investigate the circumstances in which my constituent, Jennifer Currie, and her children had left Libya, and the fact that my caseworker had had to make many of the arrangements for them to do so. The Foreign Secretary stated that the Government did not accept my description of the lack of support received from the Foreign Office. The family has confirmed to me today that the Foreign Office initially declined to help Jennifer and her children, and then told the family to book and pay for their flights. Mr Speaker, what advice can you give to my constituent and me to enable us to ensure that the Foreign Secretary justifies his claim about what happened in Libya, given the different versions of events and the real danger that she and her children faced?

I am grateful to the hon. Gentleman for giving me notice of his intention to raise this matter. Naturally, I recall the exchange that took place in the Chamber between him and the Minister yesterday. What he has said today will have been heard, or will be heard, by those on the Treasury Bench and by the Ministers directly responsible for this matter, but it is not a matter upon which I can rule. There is an argument here, and the hon. Gentleman has put his view of the events, and his verdict on the sequence of events, very clearly on the record. He can approach the Table Office and pursue the matter through questioning, if he wishes, or he can write to the Minister further to pursue the matter on behalf of his constituents, if he chooses.

On a point of order, Mr Speaker. I would like to apologise for misleading the House yesterday, make a correction and clarify a position. During our debate on the Scotland Bill yesterday, I outlined the importance of having overnight counting, as many of us were exceedingly excited as we watched the result of the Barnsley by-election come in on Friday morning and found that the Liberals had not retained second place. We learned that they had not come third or fourth, and that they had in fact come sixth. My error was to say that the only reason the Liberals had come sixth was that the Scottish nationalists had not stood, and that, had they done so, the Liberals would have come seventh. In fact, my error was in not correctly pointing out that, had the Welsh nationalists or indeed the Democratic Unionist party stood, the Liberals might very well have come ninth. I was going to make the same point about the Social Democratic and Labour party, but that would be taking it too far.

I am grateful to the hon. Gentleman, to whom I always listen with interest and respect. However, I have to say that that effort, though a nice try, was some hundreds of miles away from being a point of order. I think that we will leave it there.

Charitable Healthcare Providers (Value Added Tax Relief)

Motion for leave to introduce a Bill (Standing Order No. 23)

I beg to move,

That leave be given to bring in a Bill to provide for charitable healthcare providers taking on new responsibilities from the National Health Service to be able to recover value added tax on the same non-business supplies as the NHS in respect of those responsibilities; and for connected purposes.

I am delighted to have secured strong cross-party support for this Bill. This demonstrates how important the issue is, and how serious the House is about the crucial role that charities play, alongside the public and private sectors, in our society. Estimates suggest that the total spend by primary care trusts on outsourcing to third-party service providers is approximately £80 billion per annum. A significant proportion of those services will be delivered by the charity sector, and that proportion will increase in the coming years as the big society and public service reform agendas increase.

Health care charities such as hospices have a strong history of building relations with local communities and the Government in order to provide care for people who are nearing the end of their lives. This applies to independent hospices and larger hospice providers such as Marie Curie Cancer Care and Sue Ryder Care.

At this point, I must commend the work of Lindsey Lodge, the independent hospice that serves local people in the Scunthorpe constituency, which I am proud to represent. It provides a wide range of services for people living with life-limiting conditions such as cancer, multiple sclerosis and motor neurone disease. More than 300 volunteers from the local community donate their time and skills to support the work of the hospice and many more make voluntary financial contributions.

It will cost Lindsey Lodge hospice almost £2 million to provide its services this year. Two thirds will come directly from the local community through fundraising, legacies and donations. This funding picture is typical of the majority of hospices, with varying proportions of voluntary funds required. Charities such as the Lindsey Lodge hospice do not operate within a vacuum, but within their community context in partnership with local government, health and other agencies. Those partnerships are what create the climate for success. On average, adult charitable hospices receive 32% in statutory funding and they provide 80% of palliative in-patient beds in the UK. The passage of this Bill would show that the Government are serious about recognising the importance of such charitable services.

In a recent written question, the hon. Member for Keighley (Kris Hopkins) drew attention to the fact that, unlike the NHS or his local council, Manorlands, the Sue Ryder hospice in his constituency, cannot reclaim the VAT it has paid on non-business supplies. He rightly called on the Prime Minister to create a level playing field for health care charities. Under current legislation, the NHS is able to recover value added tax on non-business supplies, yet the charity sector is not.

In the rhetoric of the big society, the Government appear optimistic, encouraging the voluntary and community sector to take a larger role in society through the delivery of public services. This offers opportunity for new types of service delivery, building on the best that already exists, but we must not expect charitable agencies to do this for free or effectively to subsidise the Government from charitable donations. Figures produced by Sue Ryder Care suggest that for every £10 million spent by the NHS on outsourcing to the third sector, the additional cost burden will be in the region of £400,000. That burden will need to be absorbed by the charity.

I am sure all hon. Members will join me in applauding the contribution charities make to their communities. Under current rules, if services are transferred from the NHS to charities, their VAT bills will increase. This provides a VAT dividend to the Treasury from charities at the point of transfer, which is surely not fair.

Currently, when services are transferred from the NHS into the charitable sector, allowances for irrecoverable VAT are not made in the contract. This finds the charity in the perverse situation of having to cover VAT costs with charitable donations. Any efficiency savings finance the VAT gap first before benefiting patients and their local community. A recent example can be seen in the transfer of services from an NHS hospice to the charity, Sue Ryder, in West Berkshire. Services are due to begin transferring to the charity on 1 April.

The transfer will result in streamlined palliative and end-of-life care services for all those living in the area. The hospice will work alongside Sue Ryder’s existing hospice to provide integrated services. Figures produced for Sue Ryder show that the transfer will add 4% to the cost of delivering the services as a result of the different VAT recovery for the NHS and charities.

Sue Ryder projects efficiency savings of £0.3 million in the first year, yet these efficiencies will not all be invested in improvements in service delivery. Half the savings will be swallowed up by the Treasury as a result of the new VAT burden placed on the charity, which did not apply to the NHS as a provider. If efficiency savings are not realised, charitable funds will need to be used to plug the gap.

As the economy stagnates or contracts and consumer confidence falls, there is a very real danger that charities will be hit by decreasing donations and cuts in local government and national Government grants. Now is not the time to punish those forward-thinking charities that are willing to expand their services into new, innovative areas, formerly delivered by the NHS.

It is, of course, unrealistic to ask the Treasury to write a blank cheque and allow all charities providing NHS services to recover VAT, but it is realistic to look forward and level the future playing field. The proposals in the Bill will not cost the Government any more than the costs that are currently in the system. If the Government are serious about this aspect of big society thinking, they should welcome these proposals, supported as they are by Members in all parts of the House. Transfers of services to the charitable sector should not bring a tax dividend to the Treasury, but should bring an innovation and investment dividend to patients and their local communities.

The Government should stop the problem from worsening by allowing charities to which services are transferred in future to recover the same VAT on non-business supplies as the NHS. The proposals in the Bill are fiscally neutral. On Shrove Tuesday of all days, they represent an opportunity for the Government to give something up for the wider good and not just for Lent. In his Daily Telegraph article on 20 February, the Prime Minister said that the Government

“will still have a crucial role to play”


“ensuring fair funding”.

I am therefore sure that he will want to examine this funding anomaly.

The way in which the Government should address the anomaly is to amend section 41 of the Value Added Tax Act 1994 to put charities and the NHS on a level playing field, or to consider a form of compensation scheme for those taking on NHS services. That would create a level playing field in VAT between charities and the NHS. As things stand, the Treasury is set to make money from charities that choose to take on public services. Sue Ryder has called that

“an unintended consequence of the ‘big society’ and public service reform agendas”.

At present, I am inclined to agree. It is effectively a tax on the transfer of services from the NHS to the charitable sector. I urge the Government to address this inconsistency and thereby avoid the risk that charities and the public will start to view it more cynically.

Question put and agreed to.


That Nic Dakin, Stuart Andrew, Mr Kevin Barron, Chris Evans, Julie Hilling, Kris Hopkins, Martin Horwood, Greg Mulholland, Paul Murphy, Andrew Percy, Bob Russell and Jim Shannon present the Bill.

Nick Dakin accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 17 June and to be printed (Bill 159).

European Union Bill

[Relevant documents: Tenth Report from the European Scrutiny Committee, The EU Bill and Parliamentary sovereignty, HC 633, and the Government response, First Special Report, HC 723; Fifteenth Report from the European Scrutiny Committee, The EU Bill: Restrictions on Treaties and Decisions relating to the EU, HC 682, and the Government response, Second Special Report, HC 852.]

Consideration of Bill, as amended in the Committee

I had intended to call the hon. Member for Birmingham, Edgbaston (Ms Stuart) to move the new clause, but it can be moved by another of its supporters. I call Mr James Clappison.

New Clause 1

Provision of documentation under Part 1

‘(1) A statement laid before Parliament under section 5 of this Act shall be accompanied with all relevant documentation on the treaty or decision concerned, including all amendments sponsored by Ministers and other member states during negotiation of the treaty or decision.

(2) All decisions which as a result of any of sections 6 to 10 of this Act require approval by referendum or Act or resolution shall be accompanied with all relevant documentation on the decision concerned, including all amendments sponsored by Ministers and other member states during negotiation of the decision.’.—(Mr Clappison.)

Brought up, and read the First time.

I beg to move, That the clause be read a Second time. As another Member who willingly put his name to the new clause, I am delighted to do so.

Members who are familiar with the Second Reading debate and the proceedings in Committee will know that clause 5 is about a statement that must be laid before the House within two months of the conclusion of any of the treaty changes covered by the Bill, as part of the process whereby a referendum takes place. It covers treaty changes in both the ordinary revision procedure—the one with which we are all familiar, involving a convention followed by the full panoply of treaty change and agreement between the nations—and the simplified revision procedure that was introduced by article 48(6) of the treaty of Lisbon, which makes it much easier for the parties to the European Union to bring about treaty change. Under that article, all they need to do is reach an agreement within the Council and then put it to the member states, and unanimity is required for that. It is generally regarded as a measure that speeds up treaty change.

New clause 1 would require much more information to be included in the statement, or to be provided with it. When my friend the hon. Member for Birmingham, Edgbaston (Ms Stuart) drafted the new clause, she may well have had in mind what took place during this House’s proceedings on the treaty of Lisbon, and I certainly had that in mind when I signed it. The then Government advocated all the measures in the treaty of Lisbon to the House—and to the country—but it was revealed during the debate that at the Convention that led to the drafting of the constitutional treaty which later became the Lisbon treaty, they had opposed a number of key proposals.

Is my hon. Friend also conscious of the fact that the Conservative party was, for the first time since 1972, united on that issue, and that it voted consistently against every provision that was worth voting against in the Lisbon treaty, yet subsequently accepted it?

Yes—and not only that, because my hon. Friend is being characteristically modest, as some of the warnings about the consequences that would flow from the treaty of Lisbon have proved right in the short time that has elapsed since its introduction. I am thinking in particular of the warnings that were given about what I regard as the unfortunate influence of the European External Action Service and the EU’s new Foreign Minister, Baroness Ashton, which has not entirely served the interests of this country.

The new clause is excellent. I like the idea that Ministers would have to report that they tried to get an improvement but they lost. Is it also proposed that some of the arguments should be made available, because it would be much more interesting if we knew how badly they had lost?

My right hon. Friend makes an excellent point. Too often decisions are made behind closed doors, certainly in the Council. They are made in a remote and unaccountable way, and members of the public in this country simply do not have the information that they should have to be able to evaluate the decisions taken in their name.

During our debates on the Lisbon treaty, it was striking that time after time we had to remind members of the then Government of what they had said in the Convention about the measures that they were now putting before the House. I cannot remember whether they had opposed the establishment of the EU External Action Service and the EU Foreign Minister—I would not have blamed them if they had—but it emerged on a number of occasions in the debates in the House that Ministers had previously opposed what they were now proposing. That came to light only through the assiduous work of the then Conservative Front-Bench Members, and I pay tribute to them, as well as to colleagues such as my hon. Friend the Member for Stone (Mr Cash) and my right hon. Friend the Member for Wokingham (Mr Redwood).

The new clause would remedy this problem, as the fullest possible information would be placed before the House, with the statement, so we would know exactly what had taken place, and whether the Government really agreed with what was being proposed or whether they had lost the arguments and been outvoted. In short, we would know whether we were being called upon to do something with which our democratically elected Government did not agree.

I give way to the Liberal Democrat Member who, of course, supported the Lisbon treaty on many occasions during its passage through this House.

Absolutely—and a referendum on it.

The hon. Gentleman is speaking as if the new clause related to the situation after the negotiations have been completed, but what it actually says is

“during negotiation of the treaty or decision.”

I attended a negotiating skills course some years ago, and I was always advised not to give away my negotiating position during the course of the negotiation. Would not the new clause destroy the British Government’s negotiating position? Is that its intention?

No, because the British Government are representing the British people and the British people should know what is being negotiated on their behalf. This is not a private company trying to make a profit; it is democratically elected Ministers acting on behalf of the people. May I slightly correct the hon. Gentleman? I do not know whether he was in the House at the time, but I certainly recall this, because I was sitting directly behind the Liberal Democrats. That party supported an in/out referendum on the European Union, but it did not support a referendum on the Lisbon treaty itself. I remember that debate taking place. He will correct me if I am wrong, but I recall that although the Liberal Democrats got very agitated about having an in/out referendum, they were not exactly full-hearted in supporting a referendum on the Lisbon treaty.

I will give way again to the hon. Gentleman, who has a very honourable record of supporting further European integration.

I will correct the hon. Gentleman, as he is wrong. I voted for both an in/out referendum and a referendum on the Lisbon treaty.

I stand corrected. I do not know whether the hon. Gentleman’s colleagues voted both for and against an in/out referendum, or whether they voted both for and against having a referendum on the Lisbon treaty. I do remember, because it would be hard to forget this, that one of his colleagues was excluded from the Chamber because he got into such a terrible temper about not being able to have an in/out referendum. I am not sure how many of his colleagues supported the amendment that we dealt with several evenings ago proposing an in/out referendum; the Hansard record will doubtless show the number.

The fullest possible information should be available to this House and to the British people so that we know what is really going on. One of the fundamental problems of the European Union is the feeling of disillusionment that people have about its lack of accountability. We do not know what is taking place and being done in our name. The EU is remote and decisions are taken behind closed doors. Some arrangements are entered into beforehand in an entirely private way, with decisions not even being taken at the meetings themselves, but often being taken behind closed doors. We need more information about such matters.

Even as we speak, a gigantic deal is being done in Europe. It is called the “competitiveness package”. It took me an urgent question—thanks to you, Mr Speaker—to elicit the truth about what was going on in European economic governance. What my hon. Friend says is absolutely right: a tradition of deceit lies behind all this, and it goes right across the whole of Europe.

I am grateful to my hon. Friend, because he has done the House a service. It was entirely due to him that the contents of the Van Rompuy report, as they affected this country, which they clearly did, were revealed to this House. We look forward to having a fuller debate on those in due course. We want a fuller debate on many other issues, but when a treaty change comes before this House and is the subject of a statement under clause 5 we need to have all the information. We need to have everything out in the open so that we can have a full and well-informed debate.

By way of explanation, Mr Speaker, I think I have fallen victim to my usual habit of reading newspapers from back to front. I apologise for not having been here at the start of the debate, and I thank the hon. Member for Hertsmere (Mr Clappison) for introducing the new clause.

I need to explain the antecedents of the thinking behind the new clause. When I was a Minister I attended meetings of the Council of Ministers, and I knew that it was perfectly impossible for any national Parliament to find out even whether their Minister was there to vote, let alone whether they had made any particular representations. I am sure that I am not the only Minister—people on both sides of the House must have done this—who performed the most amazing U-turns on policy when doing a Council of Ministers stint. I am talking about little notes along the lines of, “The United Kingdom no longer supports amendment 58”—and that was all that was ever said about the matter. There is nothing wrong with that; we do that in politics. But in this House, if the Government perform a U-turn, someone at some stage has to stand at that Dispatch Box and say, “We’ve changed our minds.” They have to give reasons for doing so, and on occasions those are perfectly acceptable. This is the one thing that is completely missing in our dealings with the European Union.

Post-Lisbon, we have made some advances in the information provided for the European Parliament. Although I welcome those provisions, I would challenge even hon. Members to close their eyes and tell me, hand on heart, that they can name all the MEPs who represent their region. I bet that they could not do that; I could not name them all myself. [Interruption.] My right hon. Friend the Member for Rotherham (Mr MacShane) says that he does not even know all the MPs for Birmingham. Fortunately, I could tell him all their names, even in alphabetical order.

Greater accountability comes from information being available. If a national Parliament, for whatever reason, chooses not to follow that up, it is perfectly entitled to make that decision. In the limited confines of the Bill, new clause 1 is an attempt to ensure that all the documentation made available to Ministers is also made available to the House.

The hon. Lady is absolutely right. I can remember visiting EU Councils as a Minister and discovering that the Council of Ministers often met as a legislature. It was about to enact extremely important laws affecting all our countries, and all that the others and I said was entirely secret and did not have to be shared with the public. That is an absolute disgrace: we need much more transparency.

The right hon. Gentleman is absolutely right. I negotiated the opt-out for the junior doctors working time directive back in 1999, and in a sense we knew on the negotiating basis all the problems that would happen in the NHS that the UK Government saw coming. We also knew that the directive would not actually hit us until about 2008-09. Now it is here, and everyone here is entitled to say, “We didn’t see it coming.” In fact, on one level we did see it coming.

It is also important for the House to consider the fact that, during the discussions on the Convention on the Future of Europe, I was in the very unusual position of being a negotiating partner at Government level, and also representing the House. Therefore, provided that I used a legal adviser from the House, I could be given the legal advice that was given to the previous Administration.

We should consider the nature and length of debates in the European Union. I deliberately chose the working time directive for junior doctors as an example, because it started in 1992 and started to have legislative impact on this country 10 years later, and only now are we beginning to find out its full effect.

We have now moved from Conservative to Labour to Conservative, and within our Government machinery—[Hon. Members: “Coalition.”] It is okay—the Liberal Democrats came sixth in Barnsley, so there is a ray of hope. Given the veil that falls between one Administration and the next, which hides the accumulated knowledge that could allow parliamentary scrutiny, there must be a mechanism that transcends individual Administrations, which would give the House access to the information that has been given to Ministers. Although new clause 1 is limited, it is nevertheless an important wedge representing that principle.

I understand that the hon. Lady is suggesting not necessarily publishing everything for everyone on this country’s negotiating position, but perhaps listening to Parliament. Am I right in thinking that a similar system exists in Denmark?

Yes and no. I would caution against using the Danish principle, because it mandates Ministers bindingly. No one needs to talk to them when they are sitting round the negotiating table in Brussels, because they know what they will say. They do a head count and say, “The Danes say x.” The hon. Gentleman is right to refer to not publishing all the information, because too much information is also a weapon: people can be drowned in information, and they cannot see the wood for the trees.

The advice given to Ministers should be made public to Parliament, so that Parliament can decide whether it wishes to pursue something. More importantly, that would allow information to move from one Administration to the next, and Parliament could develop the collective memory of responsibility and decision making that is essential in our dealings with the European Union.

We are having an important debate, and the first thing to do is find our national interest in the context of that debate. Otherwise, we will head into treacherous waters. For me, the national interest is to ensure that the Government are able to promote our interests in the best possible way in dealings with our EU partners. Anything less would risk undermining our prospects of promoting the best solutions for Britain in the EU.

I understand some of the reasons why the new clause has been introduced. For example, I see why Members of the European Parliament might be interested in hearing more about the position of the British Government—under the co-determination procedure, they have an interest in knowing more—but we are not Members of the European Parliament; we are Members of this Parliament, and we should be concerned about the accountability of the Government to this Parliament. We have no real interest in giving information to a Parliament that happens to have representation from all the nation states that we would be negotiating with. That is a bad reason for promoting the new clause, and if it was to be further advanced in the House, I would repeat that argument.

There might well be another reason, and I have thought about this myself. The previous speaker, the hon. Member for—

Excellent, a beautiful place. The hon. Lady might well think that the transparency of the Commission is important—indeed, the transparency of the Council of Ministers—and I have certainly thought about this long and hard. I understand why people would wish there to be more transparency in both those organisations. After all, they make decisions that are important to us, but the new clause tackles the issue in the wrong way because it would undermine the Government’s capacity to negotiate. That is what we have to underline.

When the Government enter negotiations with other nation states about the future of Europe, they must do so with the knowledge that they may or may not enter into alliances with various Governments, and that those alliances may change during the negotiations.

I think my hon. Friend is misreading the new clause. It would mean that, when all the negotiation was done and we knew the final outcome, we would also know whether our Ministers had won or lost. What is wrong with that? How dare he be so undemocratic?

Because it is important to bear in mind the next negotiation and not think only about the one we have just had. That is obvious, because alliances can fluctuate and relationships are important. I do not think my right hon. Friend would say the same thing about any negotiation on a treaty outside Europe, and certainly not, for example, about NATO.

The hon. Gentleman is fundamentally misunderstanding the nature of the negotiations. One thing that British Ministers are famous for is the fact that, by the time they go into negotiations, they have reached agreement across Whitehall. Quite often that does not allow us to play a poker game. There is a formed body of opinion that represents the British view, and, after the negotiations, we, as a House, have the right to know.

I would prefer to take the line that it is much more important to consider the outcome. Certainly, the House should be testing the Minister on that outcome and should be able to hold that Minister fully to account for it, but explaining how we got there would be a dangerous route to take.

Order. I have not given way at all. I just want to help the hon. Gentleman to get it right, and I am sure that he will use the correct parliamentary language.

I am most grateful for your help and advice again, Mr Speaker. The House is also about the people we represent. If it is right and proper that they should have full knowledge of what their Government are doing, does the argument that my hon. Friend is making not deny them that right too?

I certainly think it is important for people to know how decisions are made, but it is equally important to ensure that we have the quality of decisions that are best for Britain and that we do not box ourselves in for the future. Many of the decisions made in Departments are not necessarily things that the public need to know before those decisions are implemented and discussed in the House.

My hon. Friend is being exceptionally generous in giving way. The idea of keeping those decisions secret is the reverse of what the Prime Minister wants. In his speech of 26 May 2009, the Prime Minister argued strongly for transparency so that people would know how the Government negotiated. Is my hon. Friend opposing the Prime Minister?

Certainly not. The Prime Minister is right to seek transparency wherever it is appropriate and possible. That is a good characteristic of the coalition Government and I welcome it. I can see huge opportunities for more transparency, wherever appropriate. I think the Prime Minister also wants to be sure that his position representing this country or the position of his Ministers representing this country in the Council of Ministers enables them to negotiate, form the appropriate alliances with necessary nation states and deal with matters properly, with the guarantee that trust and understanding are possible. Otherwise we will find that we as a nation state are not respected by our partners. We must be respected on our terms—that is, for promoting our national interest and making sure that what we want to do is achievable.

I understand where my hon. Friend is coming from, and equally, I understand the new clause. The reality is that after any Council meeting, 26 other countries run to their national press to say exactly what the British negotiating position was and what we might have given away. Within about 24 hours, anybody out there can see most of the negotiations that have taken place. I am sure the hon. Member for Birmingham, Edgbaston (Ms Stuart) will understand this point. If we are going for transparency—if the detail of the negotiations is going to be out there anyway—surely it would be easier for the British Government to come back, lay their cards on the table and say how they played their hand.

The role of Ministers in interpreting each other’s decisions and talking to the press later is different from formally disclosing key positions. I do not spend a huge amount of time reading the newspapers, certainly not those produced by Mr Murdoch. I would much prefer the House to test Ministers on the outcomes and make sure that the integrity of the decisions was protected and that the capacity of our Ministers to act independently in the interests of this nation state was upheld. That is why the clause is not helpful.

I understand the motives, as I said at the beginning of my remarks. I can see why people want to have more information about the European Parliament and more transparency in relation to the Commission. It is not a clear structure at the best of times. I can see why more transparency should be required of the Council of Ministers, but the clause is not the right mechanism. The critical issue, as we discussed last time, is to make sure that this House can test Ministers thoroughly and properly at each and every opportunity.

I am grateful to my hon. Friend for giving way; he has done so with charm and good grace and been very generous indeed. He has said a number of times how important it is for the House to hold Ministers to account. How can the House hold Ministers to account if Members do not understand precisely what has been discussed, which then comes before the House? He undermines his own argument, does he not?

No, I do not. The real way of holding Ministers to account is to examine the quality of the decision that has been made and the impact that that decision will have on this country. It would be far better to look at the decision and its implications and understand the reasons for it than to worry too much about why it was made and by whom. That is the key. Too often in this country, we tend to examine the entrails rather than the direction of travel and the implications of the decision that we are supposed to be implementing.

I have one concrete example for the hon. Gentleman: the way we deal with the art market and the extra tax on it. Britain currently has an opt-out, but it is coming up for renewal, which could completely undermine Christie’s and the art market in this country. At what level in this House does he think he will debate the ministerial decision on that?

You make a very good point. I am sure that the Minister, if he is involved in that negotiation, has taken heed of what you have said.

Order. I am always delighted to be told that I have made a good point when I have done so, and even when I have not, but in this case I have not. The hon. Lady might have done.

Many apologies, Mr Speaker—it is a long time since I have had quite so many interventions. The key thing here is the quality of the decision. If a Minister came along and tried to defend a decision that this House was unhappy about, this House should say so. That is the right approach.

May I suggest a much simpler piece of logic to explain why the new clause would probably not be helpful? If the hon. Gentleman has ever attended a European Committee, whose members are supplied with a large volume of documentation that they are supposed to read before debating the issue and taking a position when voting, he will realise that most do not read it. The more information that is supplied on European matters, the more paper that is provided, which will not be read.

Right. [Laughter.] That is longer than Stroud.

That is an important point to end on, because I do not think that everyone does read everything they should, and we have come across that in the past. The European Scrutiny Committee is under the excellent chairmanship of my hon. Friend the Member for— [Hon Members: “Stone.”]—for Stone (Mr Cash), but one of the things I noted before becoming a Member was that scrutiny of European measures, if carried out at all, was not thorough. I have done some research and found that decisions have literally been nodded through, which is characteristic of these kinds of issues. It is far better for this House to consider the outcomes seriously, because it is the outcomes that matter. That has always been the case in decision making. Sometimes the process that we use needs to be scrutinised because the outcome is not so good, and clearly we might want to test that.

We should never undermine the capacity of a British Minister to represent our interests and make adjustments to his or her position while in negotiations with other nation states. I repeat that if we were having this discussion about the United Nations or NATO, for example, I do not think we would be talking in these terms, because we understand the value of empowering Ministers to make decisions on our behalf and report back with outcomes that are to our liking.

I follow very much in the footsteps of the hon. Member for Stroud (Neil Carmichael) by highlighting two very worrying developments in our discussions in this House on Europe that have taken place since the coalition was formed: the abolition of the twice-yearly debates on Europe and the decision of the Foreign Affairs Committee no longer to go to the country holding the EU presidency to examine its plans.

I am such a fan of the hon. Gentleman’s work on human trafficking that I feel I must give way, but I will try not to take many interventions, for obvious reasons.

The Backbench Business Committee received a powerful bid today for a debate about the European Union and fish discards, and we are taking it forward, so I think that there will be a debate in the House soon about Europe.

I am grateful that the poor fish thrown into the sea will now have their flippers flipped in the House of Commons.

I want our Government and our House regularly to debate Europe, but the plain fact is that it is the decision of this Government—this coalition—not so to do. The Foreign Affairs Committee, with its coalition majority, is also abolishing its regular trip to the European Union nation that holds the presidency.

Has the right hon. Gentleman noticed that we are debating Europe all day today, and that we have had quite a lot of days on this Bill?

Yes, and I well remember the right hon. Gentleman in the even longer debates—going through the night—on the treaty of Amsterdam saying that signing it would mean the abolition of Britain. When there is a new Bill, we have debates, and we have had many debates and some good discussions on this one.

Can I make just a wee bit of progress? [Interruption.] Well, I will give way to one of my favourite ex-MEPs. How can I resist?

I am not sure whether I should take that as a compliment. Has the right hon. Gentleman had a chance to read the written ministerial statement about this subject that was issued during our previous five days of debate? It included what, in coalition terms, would probably be deemed a full and comprehensive offer to the House about how we might scrutinise justice and home affairs matters. We should examine that offer in much closer detail today, and perhaps we will later on.

I am very grateful to the hon. Gentleman, because he brings to the House considerable knowledge of how the European Parliament does its business. That is exactly the way in which the European Parliament carries out its scrutiny. Perhaps we should learn from him; perhaps he and I should set up a small committee to go to Strasbourg —for him to return there—to see what we might learn.

In essence, the hon. Member for Stroud is quite right: this is the WikiLeaks amendment. It would abolish the need for WikiLeaks, because the process of Government decision-making would be published. I would love to see that for something infinitely more important to my constituents—the thinking, advice and documents that have led to the promulgation of the NHS Bill or, in two or three weeks’ time, that lead to the Budget. I expect, however, that I would find very little support on the Government side of the House and absolutely none from the Opposition Front Bencher waiting for his turn to speak for the idea that we do government better if we allow Mr Julian Assange to publish every document and every communication that goes into a Minister’s box.

I can confirm exactly the point that my hon. Friend the Member for Birmingham, Edgbaston (Ms Stuart) made about how negotiations can and do take place. I recall once trying to protect the steelworkers of Britain from a proposal, which the then Labour Government supported, to allow the import of steel—a derogation of the then EU trade rules—from a dodgy supplier in Egypt which I knew to be linked to the army and was, in my view, a wholly corrupt organisation. I could not quite work out why we were so keen to allow the deal to go through, which would have damaged steelworkers’ jobs and production in this country and, if the steel were re-exported, those in the rest of Europe, too.

I could not, however, convince any civil servants. At one stage, I had 27 of them, including two knights of the realm, grouped around me, telling me, “Minister, you have to give way.” I put down my little foot and said, “No, I am elected. That is what I am paid to do.” Then, they went out and got the Secretary of State for Business and Industry to phone me, and at that stage either I resigned on the spot or accepted a superior order.

No, I did not resign, simply because I work in a team. When the hon. Gentleman graces the Front Bench, as I hope and I am sure he soon will, he will have to learn that there is something called teamwork, and that until he becomes Prime Minister he will take rather than give orders.

I am not sure that it would have been any particular help to have published all my animadversions immediately afterwards, although I told my steelworker community friends privately what had happened. Frankly, one cannot do business in that way. I am not even sure whether, constitutionally or legally, suggestions made before a decision is taken can then go fully into the public domain if they belong to other people. I think we may find, legally, that there are certain rules on what is the property of other states. We do not publish every communication with the United States, France, or any country, for good and sensible international legal reasons.

The process in Europe is legislative. When this House legislates, the debates are published, regardless of the ultimate decision, so that the British people know how the debate has been formed in the legislature. As the Commission, Council and Parliament of Europe are legislatures, the information should likewise be public.

We can enter into a political science or constitutional debate on the nature of decision making in the EU—which, I remind right hon. and hon. Members, spends only 1% of Europe’s gross national income—but the plain fact is that the Commissioners are appointed and it is the Council of Ministers that takes decisions, as mandated by its member countries. It is no more a legislature than it is a legislative process when one goes to negotiate a treaty on the law of the sea or on new environmental rules.