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Commons Chamber

Volume 533: debated on Tuesday 18 October 2011

House of Commons

Tuesday 18 October 2011

The House met at half-past Two o’clock


[Mr Speaker in the Chair]

Business Before Questions

London Local Authorities and Transport for London (No. 2) Bill [Lords] (By Order)

Transport for London (Supplemental Toll Provisions) Bill [Lords] (By Order)

Second Readings opposed and deferred until Tuesday 25 October (Standing Order No. 20).

Oral Answers to Questions


The Secretary of State was asked—

Organ Donation

Sustained work at national, regional and local level has seen an increase in donor rates by some 28% since 2008. We continue to work with a large number of organisations, such as the Give and Let Live initiative in schools, which is run by NHS Blood and Transplant. Other initiatives include requiring people to answer a question about organ donation when applying for a driving licence and to sign on the organ donor register when applying for a European health insurance card or for a Boots advantage card. We also have specific initiatives within the black and minority ethnic populations, such as working with faith groups and local radio stations.

I recently met young campaigners from Sign Up, Speak Up, Save Lives whose organ donation campaign features on Channel 4’s “Battlefront” programme. Will the Minister please meet Hope, Abby and me, together with the Minister responsible for constitutional reform, so that we may discuss with them both our idea of inviting people to join the organ donor register at the same time as they will soon be asked to join the electoral register?

I congratulate Sign Up, Speak Up, Save Lives. I am happy to meet Hope, Abby and the hon. Gentleman, along with the Parliamentary Secretary, Cabinet Office, my hon. Friend the Member for Forest of Dean (Mr Harper). The electoral registration form has been used as an opportunity. In 2000 there was a campaign called Vote for Life, which was stopped after about 15 months because of problems with the Representation of the People Act. I would be happy to revisit it and would enjoy an opportunity to discuss the matter further. Anything we can do to get those rates up matters.

The reorganisation of NHS procurement has been described in a National Audit Office report as fragmented and poor value for money. The report shows—

What discussion has the Minister had with Welsh Ministers who are bringing forward legislation for an opt-out system of organ donation? If she has had such discussions, what conclusions has she drawn?

The Government will examine thoroughly the detail of any Assembly Bill when it is laid before the Assembly, but I urge Wales to look at the evidence. We can look back to what happened in Spain, where there was presumed consent for 10 years without any shift in organ donation rates. The issue is more complex than that. It is about organ donor transplant co-ordinators and increasing donations from emergency medicine. A number of measures need to be put in place to increase those rates.

Will my hon. Friend be kind enough to meet Mr Adam Crizzle, who was the original inspiration behind the Give and Let Live organ donation programme in schools, to see how the promotion of this excellent scheme might be further improved?

I would be very happy to meet that gentleman. There is no doubt that promoting this in schools has a profound impact and is an opportunity to change people’s attitudes to organ donation and, more importantly, makes families discuss it, which is critical. It is not just about signing on to the register.

Last week I had the opportunity to meet members of the Ticker club, an organisation of former heart patients who continue to provide support to patients at Wythenshawe hospital, a specialist centre for cardiac and thoracic surgery, including heart and lung transplants. They have strong opinions on organ donation, so will the Minister agree to involve such groups in ongoing campaigns to raise awareness of the benefits?

I thank the hon. Gentleman for raising that issue. My right hon. Friend the Secretary of State has visited that hospital, and I am happy to work with any group. I reiterate the fact that we particularly need to work with black and minority ethnic groups, in which the rates of donation are truly dreadful: 23% of people on waiting lists are from black and minority ethnic communities, but only 1.2% of those on the register are from that same group. We need to do everything we can to improve those rates.

NHS Hospital Indebtedness

The national health service is forecasting a surplus for 2011-12, but the previous Government left a legacy of up to six hospital trusts whose private finance initiative payments are a risk to their financial sustainability and up to 24 trusts with such high levels of debt, following years of bail-outs, that they might not meet tests of their future financial sustainability. We are working with all of those to identify their individual needs so that we can help trusts to achieve consistent standards of quality and financial sustainability, and I will make an announcement on that later this year.

I thank my right hon. Friend for spelling out the appalling debt that some parts of the NHS inherited from the previous Government. Can he assure me and the House that this Government will deal with the root causes of hospital debt, rather than with the continuing bungs and bail-outs that the previous Government left?

My hon. Friend is absolutely right. We are determined to root out poor performance, by which I mean not only that we should deal with waste, inefficiencies and poor value for money in the NHS, but that we must identify where standards and quality of care are being met. Both are equally important, and one depends on the other. He will know from the Royal Berkshire NHS Foundation Trust how important it is to sustain finances and quality through foundation trust status. We are seeking to ensure that many NHS trusts reach foundation trust status, something that the previous Government failed to achieve and we aim to achieve.

The Secretary of State will be aware of the indebtedness of the Royal Cornwall Hospitals NHS Trust, and that Cornwall as a whole has suffered a disadvantage for many years as a result of the previous Government’s funding formula, having actually received less than the Department’s target budget for many years. Does he agree that such factors should be taken into account when deciding how to reschedule the debts of such trusts?

My hon. Friend will know, from our conversations and from my visit to Cornwall and the Royal Cornwall Hospitals NHS Trust, the steps that we are taking alongside other NHS trusts to bring them up to high standards of care and financial sustainability. In that regard, the 3.1% increase in revenue allocations for the Cornwall and Isles of Scilly primary care trust between last year and this year will help Cornwall as a whole towards greater financial sustainability.

I am grateful, Mr Speaker. On indebtedness, the National Audit Office has produced a report on NHS procurement in England, which it describes as “fragmented” and “poor value for money”. The report shows that £500 million could be saved each year if trusts came together to buy products more collaboratively. Is this further evidence that the Government are wrong to pursue an agenda of competition, rather than co-operation?

I am afraid that the hon. Gentleman is completely wrong about that. In procurement throughout the NHS, what we have had is fragmentation, and what we need is better co-ordination. That is precisely why, since the election, for example, we have instituted a consistent bar-coding system, allowing procurement throughout the NHS to be undertaken more effectively; and why under the quality, innovation, prevention and productivity programme, the improvement in procurement —reducing the costs of procurement—is intended to achieve those savings and more.

Labour is proud of its legacy, with more than 100 new hospitals built to replace the crumbling Victorian buildings that we inherited in 1997, and it is not just the National Audit Office that has blown a hole in the Secretary of State’s assertion that 22 hospital trusts are on the brink of financial collapse due to PFI. John Appleby of the King’s Fund said:

“The…pressures on hospitals are not to do with PFI but…the need to generate £20bn worth of productivity improvements.”

Is not the real issue that the Secretary of State has tied up the NHS in a distracting and wasteful reorganisation that will cost more money than it will save, and take money away from patient care?

I welcome the hon. Gentleman to the Opposition Front-Bench position. We are looking forward to the exchanges with him and his colleagues, including during questions today.

Twenty-two trusts have told us, in the course of our looking at where the impediments are to their financial sustainability for the future, that the nature of the PFI contracts entered into by the previous Government is a significant problem in this respect. It is absolutely right for the NHS to build hospitals, which is why we are, for example, building a new hospital at Whitehaven in the hon. Gentleman’s constituency. [Interruption.] I beg his pardon—in the constituency of the hon. Member for Copeland (Mr Reed); we are building so many new hospitals. The nature of the PFI projects we enter into must be to provide value for money and be sustainable in the future. That is something that the previous Government failed to achieve.

Urgent Care

3. What representations he has received on the reorganisation of urgent care in the past six months. (74849)

A search of the Department of Health’s database revealed that 131 items of correspondence, and five parliamentary questions relating to the reorganisation of urgent care were received in the past six months. In addition, I have received three requests to meet MPs on this subject.

Wycombe hospital is currently going through a consultation on a change to urgent care services, and it is doing so in the context of the betrayal felt after “Shaping Health Services” in 2004, which removed our accident and emergency department. I would like to escape this cycle through mutuality. What is the Government’s position on mutuality? Will the Minister join my call for directly owned community health services?

The Government have supported the right to request, which has enabled 45 staff-led social enterprises to be established. This policy has supported approximately 25,000 staff into social enterprises, with contracts of roughly £900 million. NHS staff have been assisted by a wide-ranging programme of support from the Department.

Has not the Government’s so-called moratorium on the reconfiguration of services put back improvements to urgent care by several years? The Minister inherited perfectly coherent plans for every region in England under the auspices of Lord Darzi’s next-stage review. How many lives have been lost and how much money has been wasted by the tearing up of those plans?

I am afraid that the right hon. Gentleman is wrong. It is not holding back the national health service; it is moving it forward with things such as the establishment of the 111 service and the reconfiguration proposals, which are based on the four tests that my right hon. Friend the Secretary of State introduced in May last year. That not only links reconfiguration to the needs of the local health economy but takes into account the wishes and needs of the local community and medical staff.

Does my right hon. Friend agree that the improved delivery of urgent care right across the health service is one of the great challenges facing the new commissioning structure and one of the great opportunities to deliver more integrated services that deliver better value and better quality to patients?

I am extremely grateful to my right hon. Friend; speaking with the authority of the Chair of the Health Committee, he is absolutely right. It is the way forward to drive improvements in service, raise standards and ensure that there is high-class, quality care at an urgent care level and across the acute sector.

Public Health

4. What assessment he has made of the potential effects of NHS reorganisation on the protection and improvement of public health. (74850)

Our reforms put public health at the heart of the new system. The creation of Public Health England, alongside significant new functions and, for the first time, ring-fenced budgets for local authorities, will give public health an unprecedented level of priority. The new local authority role integrates public health with other local authority functions that impact on people’s health.

Under the previous Government, NHS Hull saw excellent results in improving public health. Under the current Government, Kingston upon Hull’s teaching primary care trust has seen a 2.6% cut this year compared with Kingston upon Thames PCT getting a 2% increase—and Hull city council has a 9% cut in its funding as well. What does the Minister think will happen to public health in areas such as Hull with those kinds of cuts?

I think that public health in areas such as Hull will do exceptionally well. I point out to the hon. Lady that under the previous Government, what happened in practice was that public health budgets were raided constantly and we did not get improvements. If she looks at the figures, she will see that inequalities in health widened.

Does my hon. Friend agree that despite the previous Government’s good intentions on public health, health inequalities have widened, as she has rightly said, obesity rates are going up, smoking among young girls is going up, and alcohol abuse is a serious problem? Does she agree that it is right to deliver services with local authorities and to get into local communities and schools if we want to address these big public health challenges?

My hon. Friend is absolutely right. Local authorities have a long and proud tradition of improving the public’s health. Public Health England will bring together a fragmented system and strengthen our national response on emergencies and health protection. It will help public health delivery at a local level with proper evidence and leadership.

Contrary to the Minister’s statement that the Health and Social Care Bill will put public health at the heart of the health service, 40 directors of public health and 400 public health academics, including Michael Marmot, wrote to The Daily Telegraph to say that the Health and Social Care Bill will

“widen health inequalities; waste much money on attempts to regulate and manage competition; and undermine the ability of the health system to respond…to communicable disease outbreaks”,

and that it will

“disrupt, fragment and weaken the country’s public health capabilities.”

How can the Minister put her judgment against that of those doctors and experts? Is not the proposal that more than 40 specialist neonatal units may lose staff in the coming year an example of the weakening of public health that is involved in the Bill and the Government’s proposals?

I draw the hon. Lady’s attention to the fact that the Health and Social Care Bill proposes for the first time a duty on the Secretary of State to have regard to health inequalities, which, I repeat, widened under the previous Government. I also point out to her that the letter to peers signed by Professor Marmot and others welcomed the emphasis on establishing a closer working relationship between public health and local government. I suggest that the hon. Lady gets out more, because she would hear from public health doctors and local authorities on the ground who welcome these changes.

NHS Hospital Finance

5. What steps he is taking to reduce the burden on NHS hospitals of (a) PFI repayments and (b) debt. (74851)

A study conducted by the Treasury has identified savings opportunities of up to 5% on annual payments in NHS PFI schemes. The Cabinet’s Efficiency and Reform Group is rolling out a programme of work to secure savings of up to £1.5 billion across the 495 PFI contracts in the public sector in England.

Contrary to the earlier complacent comments of the Opposition spokesman, some national health trusts are paying up to 20% of their revenue to PFI contracts. What steps can we take to ensure that the payments are reduced and that the same terrible financial situation never happens again?

I am grateful to the hon. Lady. I, too, recognise the small number of organisations that are reporting financial challenges. The Department is continuing to work with strategic health authorities to ensure that those organisations have robust plans in place for financial recovery, while ensuring the quality of services for patients.

On the subject of financial pressures on hospitals, does the Minister recall the circular to hospitals from Monitor that was smuggled out on the eve of the royal wedding, which raised the requirement for efficiency cutbacks on hospitals from 4% to 6.5%, which is more than £1 billion in this year alone? Will he admit that the service cutbacks that we are seeing in many hospitals around the country are deeper, as that circular confirms, directly because of the Government’s policies?

No, I do not recognise that, because the figure that the right hon. Gentleman has used is an upper calculation, not an actual figure. I say to him that we are making efficiency savings, and that trusts should be cutting not front-line services but inefficiency, waste and excessive management, and reinvesting every single penny in front-line services.

Treatment Options

6. What steps he is taking to ensure that patients receive accurate and unbiased information on treatment options. (74852)

The NHS constitution gives people a right to information about their treatment options. I want everyone to get timely, trustworthy information such as patient decision aids, so that they are involved in their care decisions. The Health and Social Care Bill will ensure that the commissioning board and clinical commissioning groups secure that.

In the light of that answer, will the Minister condemn the decision by GPs in Haxby to use NHS data to tout the services of their own private company and give wrong information to patients? Or is that simply a foretaste of what will happen under the Health and Social Care Bill when clinical commissioning groups decide what services are necessary, leaving private companies in which they may have an interest to pick up the slack in a privatised, marketised NHS in which patients come last?

The hon. Lady is spreading yet more myths and misconceptions about the reforms that this Government are making. If she had researched the matter more thoroughly, she would know that there is a code of conduct for the promotion of NHS-funded services, which makes it clear that providers of primary medical services cannot directly or indirectly seek or accept from any of their patients payment or other remuneration for any treatment. As a result, the PCT is questioning that clinic about how it has used patient information and will continue to pursue the matter.

Does my hon. Friend agree that many patients look to NHS Choices for accurate and unbiased information? Is he aware that its site on homeopathy is both biased and inaccurate? As the Department has had a long-standing review that has not reported, will he—

If the hon. Gentleman would care to write to me setting out where he believes there are inaccuracies, we will examine them.

It is good to be back. I see that in my absence, the Secretary of State has at last made some progress with his plans for a US-style health care system.

I have a letter sent by the practice that my hon. Friend the Member for Warrington North (Helen Jones) mentioned a moment ago, in which it wrote that

“we can no longer offer your procedure as one of our NHS services…I am writing to make you aware of some of the options that you have to have the procedure completed as a private patient.”

Helpfully, it enclosed a leaflet announcing the practice’s new private minor operations service. Can the Minister point me to any part of the Health and Social Care Bill that will prevent that practice in future?

I wonder whether the right hon. Gentleman could have pointed me to any such arrangements in current legislation. There is none. However, Dr David Geddes, the medical director of NHS North Yorkshire and York, has stated:

“We have some concerns about the activities of the Haxby and Wigginton health centre in York and we will be discussing these issues with them directly as a matter of urgency. These concerns are around possible breaches of the Data Protection Act and the accuracy of the information sent to patients. For example, of the eight procedures they list, three are routinely funded by NHS North Yorkshire and York”.

Let us be clear that when he was Secretary of State, that PCT was in a worse financial state.

That is total bluster, because that vision is precisely what the Government want to do to our NHS. As my hon. Friend the Member for Warrington North said, it is a terrifying glimpse of a Tory NHS in future—not a national health service but a postcode lottery writ large, in which, as we read today, random rationing is taking place around the country. The NHS is in chaos because the Secretary of State made the mistake of combining a £2.5 billion reorganisation, at a time when every ounce of energy should be focused on the NHS front line. This Secretary of State has placed our national health service in the danger zone, and he has lost the confidence of GPs, nurses and midwives. Is it not time that he stopped digging in, listened to NHS staff and dropped this damaging Bill?

That was a good example of bluster—perhaps that is what we will see from the Opposition under the right hon. Gentleman’s stewardship.

The right hon. Gentleman ought to be aware, because it happened on his watch, that primary care trusts and strategic health authorities have seen their management costs increase by more than £1 billion. There was a 120% increase from 2002 to when this Government took office. That is why we are determined to cut overhead costs in the NHS, so that we can reinvest every penny in the front line.

Heatherwood Hospital, Ascot

7. What recent representations he has received from Berkshire East primary care trust on the future of Heatherwood hospital in Ascot. (74853)

My constituents are shocked to discover that yet again, the future of Heatherwood is under threat. I have had sight of a major petition, and I am actively campaigning with hard-working local councillors, activists and residents to uncover why Heatherwood’s future is under threat when the funding from the Government to the region has increased. Does my right hon. Friend agree that the Berkshire East PCT must cut its bureaucracy costs and introduce efficiencies before threatening the money to Heatherwood hospital and other local services?

I am grateful to my hon. Friend and completely understand what he is saying. In this financial year compared to the previous one, revenue available to Berkshire East PCT increased by £16.3 million. That is just one part of the £3.8 billion increase in revenue resources available to the NHS this year compared with last year.

Although I very much welcome the shadow Secretary of State to his new position, we will miss his predecessor. We welcome the new shadow Secretary of State not least because he might begin to explain to the NHS why he thought it was irresponsible to increase resources to the NHS in real terms by about £3.8 billion—

Order. I am grateful to the Secretary of State, but we have a lot to get through. He will resume his seat—and I know he will do so happily.

One reason for those increases in resources is the growing birth rate in that part of Berkshire. Slough mums who want to use the Ascot birthing centre at Heatherwood have been locked out since the end of September because of a lack of midwives. If the Government had provided the 3,000 midwives they promised, that centre would not be shut. What does the Secretary of State say to that?

As the hon. Lady knows, I am very familiar with Heatherwood, because I have two daughters who were born there in the days when it had an obstetrics service, which disappeared under the previous Government. She also knows that I visited Wexham Park in September last year to announce support to the trust in the form of loans, based on commercial principles, totalling £18 million. There is no shortage of midwives under this Government compared with the previous one. Since the election, 522 additional midwives have been recruited, and we are maintaining a record level of midwifery training places.

Decisions made locally are a matter for local commissioners. If they seek to change services, they must meet the four tests that I set out shortly after the election.

The hon. Member for Windsor (Adam Afriyie) is absolutely right to raise concerns about the future of Heatherwood hospital, as are Members on both sides of the House who raise such concerns about their hospitals, such as Chase Farm.

The Health Service Journal reports that the Department of Health is discussing a hospital closure programme, and yet the Prime Minister has promised to fight bare knuckled against any hospital closures. Will the Secretary of State tell us today categorically—yes or no—whether it is still his policy to have a moratorium on hospital closures? If so, for how long will the moratorium last?

I welcome the hon. Gentleman to his position. The Government are rebuilding his hospital, so it is slightly ironic that he attacks us on that point.

The answer to the hon. Gentleman’s question is that the Government are pursuing no plan for hospital closures. We are doing precisely what I said we are doing: we are working with hospital trusts across the country to ensure that before they reconfigure their services, they must meet key tests on patient access and choice, local authority support, commissioners’ views, and the clinical safety and evidence base. We are working with many of the NHS trusts that the previous Government left in a serious position to ensure that they reach quality and financial sustainability.

Children’s Heart Surgery

8. When he expects to make a final decision on the safe and sustainable review into children’s heart surgery units in England. (74854)

This is a clinically led, independent review, within the NHS. The joint committee of primary care trusts, on behalf of NHS commissioners, will make decisions on the future pattern of children’s heart surgery services in England. The review is expected to report before the end of the year.

I am sure that the Secretary of State recognises the huge and spirited campaign by local people to retain the children’s heart unit at Leeds general infirmary. Will he confirm that option E, which would retain the Leeds unit, will receive full and equal consideration by the joint committee of primary care trusts?

The review will develop the recommendations to ensure that children’s heart surgery services deliver the very highest standard of care for children and their families. The joint committee of primary care trusts will consider all the relevant evidence before making a decision on the future configuration of children’s heart surgery services, and I hope that that will reassure my hon. Friend.

I should emphasise that no aspect of this review is driven by money: it is entirely about how to ensure sustainable high-quality surgery. The issue is in how many and which centres surgical teams should be based in order to maintain that high-quality care.

There is a deep-rooted belief that this review is biased against the survival of the Leeds unit. Will the Minister therefore please assure the House that the decision will be made purely on the evidence, and not on the basis of any preconceived idea of which units should survive and which should not?

It is an independent review and I can assure the hon. Lady that that is indeed the case. It will be based on the evidence. I am sure that she will have heard the response to a debate earlier in the year by the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), who said that while the review has put forward options for consideration, it should not be constrained to consider only those options.

Will my right hon. Friend confirm that the criteria for the review remain the same; that the rather strange remarks—about more people having voted for one option but more organisations having voted for another—have not affected them; and that those criteria will be used to judge the decision?

This review came about as a result of the tragic Bristol heart babies scandal in the 1990s, and it is a measure of the quality of services at Bristol children’s hospital that it is now being considered for all four options under the consultation. A few weeks ago, I abseiled down the children’s hospital for Wallace & Gromit’s Grand Appeal, which is an excellent charity. However, will the Secretary of State assure me that, with the move to fewer and larger specialised units, they will be properly funded and will not rely on MPs throwing themselves off tall buildings?

I am grateful to the hon. Lady. All the representations that we have received in the debates in this House are ample evidence of the high regard and support that Members have for their children’s heart surgery services. None of this is about saving money or resources. It is entirely about what delivers the best quality surgical services for children with cardiac problems. To that extent, the intention is that those services—once the decision has been made—are fully funded.

Foreign Nationals (NHS Services)

9. What progress he has made on reducing the number of foreign nationals using NHS services without payment. (74855)

We have updated and simplified regulations and guidance on identifying and charging visitors who must pay. Immigration rules now before Parliament will allow the UK Borders Agency to refuse entry to visitors with an unpaid debt to the NHS, and we are now reviewing this area more fundamentally to identify further improvements.

I thank the Minister for that answer. On 19 July, I spoke in the House about foreign nationals using the NHS without payment and, having entered a freedom of information request to each foundation trust and PCT, I now have a more accurate picture of the sums involved. It suggests that some £15 million has been completely written off. Will the Minister meet me to discuss the findings and what possible solutions might be found to tackle this important issue?

I share my hon. Friend’s concerns about this important issue and challenge for the NHS. I would be more than happy to see the results of his FOI request, and I or a colleague would also be happy to meet him to discuss the matter further.

There is a relatively painless way to deal with this. At the time that the visa is applied for, the person should sign an undertaking that they will pay the costs of NHS treatment. Will the Minister talk to the Minister for Immigration to see whether it is possible to introduce such a requirement?

I am grateful to the right hon. Gentleman. We are looking at a range of options and I am more than happy to pass on his suggestions to my hon. Friend for them to be considered.

Care Sector (Uniforms)

10. What representations he has received on the need for effective and clear distinction in uniforms worn by fully trained nurses and other workers in the care sector. (74856)

The Department receives occasional representations from individuals and groups about uniforms, including the need to distinguish between staff groups. Guidance is available to help employers set sensible policies and, in line with Government policy to reduce central control, we expect decisions on uniforms to be made locally.

There is real concern about the lack of distinction between the uniforms worn by qualified nurses and care workers. The latter are free to wear whatever uniform they like and often give the impression that they are medically qualified. This presents a risk to patients, especially because more and more vulnerable elderly patients are being treated in their homes. Will the Minister look again at this to see what action could be taken to clarify the situation?

My hon. Friend has written to me about this matter on behalf of a constituent. The responsibility sits in three places: first, providers have a responsibility to provide clear information to people receiving services from them about who is providing that service; secondly, commissioners have a responsibility for how they contract for those services; and thirdly the Care Quality Commission has a responsibility to regulate those services. Undoubtedly, however, I would be more than happy to look further at the points he makes.

Neuromuscular Services

11. What assessment he has of the provision of ventilation machines and related equipment for patients with muscle-wasting diseases who experience respiratory difficulties; and if he will make a statement. (74857)

Local health bodies have responsibility for ensuring that adequate provision of health services is made available to those living with neuromuscular conditions. All specialised commissioning groups have now completed their reviews of neuromuscular services, which are a priority in the annual work plans of each of the specialised commissioning groups in 2011-12.

I thank the Minister for that answer, but will he also outline the steps being taken to ensure that there is adequate knowledge about neuromuscular conditions among general practitioners and health professionals in Lincoln, so that referrals to the specialist respiratory service in Nottingham can be provided as appropriate?

My hon. Friend is right to raise the issue of ensuring sufficient awareness of the pathways that exist for people to gain access to those services. I understand that the east midlands specialised commissioning group has recently carried out a review of non-invasive ventilation services. I shall ask the group to write to him in more detail.

NHS Service Access

The NHS constitution gives patients the right to make choices about their care. The Government are committed to empowering patients. Our goal is for patients to have more choice of treatment.

What steps is my hon. Friend taking to ensure that my constituents requiring cardiac services will have access to the care that they need in Leeds?

My hon. Friend raises an important and controversial issue, as he will have heard when listening to my right hon. Friend the Secretary of State earlier and the debates that he has attended in the House on this subject. We are determined that proper facilities will be made available, based not on money but on the high quality of care, particularly for children. An independent review is being carried out by the joint committee of primary care trusts, which is expected to announce its recommendations later this year.

Has the Minister considered exchanging expertise with the regions of Scotland, Northern Ireland and Wales? That exchange could take place without any charge.

The hon. Gentleman raises a valid point. The NHS in England has regular contact and discussions with the NHS in other parts of the United Kingdom, and will continue to do so because both the UK and the devolved authorities can learn a considerable amount from sharing views and practice.


The Minister might know that the midwife-led unit at Salford Royal hospital is due to open in the next few weeks, and I want to put on the record my thanks to the midwives there who carry the heaviest work load in the north-west and are doing a brilliant job. She will not know, however, that last year there were 2,500 extra births in Greater Manchester that were neither expected nor planned for, that there are current vacancies for midwives at St Mary’s hospital and that mothers are being pressured to leave hospital sometimes within two or three hours of giving birth. What assurances can she give me that the same standards of safety and quality applying at Salford Royal will be available to Salford families in the future?

We need to ensure that they are, which is one of the reasons we have asked the Centre for Workforce Intelligence to undertake a pretty in-depth study of the nursing maternity work force during 2011-12. I can reassure the right hon. Lady that the current number of midwifery students entering training is at a record level—more than 2,500—and I join her in paying tribute to our midwives.

After the recent inquiry into the Furness General hospital maternity unit, will the Minister confirm that she will give full support to midwives across the Morecambe Bay trust area and that the excellent midwife-led unit at Westmorland General hospital in Kendal will be protected?

I always give my full support to midwives, but we must not forget that this is about teamwork as well. There has been an increase in the number of maternity support workers, who also play a critical role, as do the obstetricians and gynaecologists, all of whom have increased in numbers as well.

Hospital-Acquired Infections

The NHS is making significant process toward the zero-tolerance approach that we have made it clear it should adopt in respect of all avoidable health care-associated infections. Over the past 12 months MRSA bloodstream infections have fallen by 29% and C. difficile infections have fallen by 17%.

I thank the Secretary of State for his reply. Will he confirm that the Government will continue with the zero-tolerance approach to hospital-acquired infections as the only sure way to resolve and eradicate this problem?

Yes, my hon. Friend is absolutely right; indeed, we are extending the range and frequency of the publication of data relating to infections to support the NHS in that work. With his commendable consistency, my hon. Friend asked a question on exactly this subject on 8 March, when he raised the issue of the Barking, Havering and Redbridge trust. I am pleased to be able to report that in the past five months C. difficile infections in the trust have fallen by 57% in comparison with the same five months of 2010, while MRSA bloodstream infections have been reduced by 25%. I expect the trust to continue to bear down on those and other infections in future.

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.

In the wake of the former Defence Secretary’s resignation and the fact that 40 peers who voted on the Health and Social Care Bill have private sector health interests, and given the Secretary of State’s known connections with private health care companies, can he assure the House that he has been as transparent as possible about the influence of private health care companies on the passage of the Bill?

I am sorry, but I think the hon. Lady should withdraw that. I have no connection with private health care companies, and if I did, I would have entered it in the register of Members’ interests.

I am grateful to the Secretary of State, who has put the position very explicitly on the record.

T2. The coalition agreement states:“Doctors and nurses need to be able to use their professional judgement about what is right for patients and we will support this by giving front-line staff more control of their working environment.” That being the case, can my right hon. Friend explain why, despite national clinical guidelines, GPs in my constituency face financial penalties if they do not meet targets for reducing the cost of the drugs that they prescribe? (74873)

I am grateful to my hon. Friend, and I understand that Kent and Medway primary care trust is working to incentivise the optimisation of medicines usage. We provide advice through the National Prescribing Centre and in other ways, and we support that work with GPs through the structure of the quality and outcomes framework. However, this is about incentivisation for best prescribing practice, not about financial penalties.

Many families will be deeply concerned about standards of care for older people in hospitals following the Care Quality Commission’s recent report. Patients and the public must be confident that all the necessary steps are being taken immediately to tackle this issue. Months after its initial inspections, will the Minister confirm that the CQC has revisited only six of the 17 hospitals that were failing to ensure that older people had enough food and drink, and if so, can he explain why?

Let me make it clear to the hon. Lady, whom I welcome to her new responsibilities, that the reason the Care Quality Commission undertook unannounced nurse-led inspections in hospitals to look at issues of dignity and nutrition was that I asked it to. As an independent regulator, it must make its own decisions about what it does, but I have been clear in my conversations with the Care Quality Commission that it is moving from the tick-box regulatory approach inherited from Labour to one focused on going out there and finding out where there is poor performance. The CQC is shining a light—not least at our request—on poor performance and poor care in the NHS, and it will continue to do so.

Order. I remind the House that there is intense interest, and therefore there is a premium on brevity from Back and Front Benchers alike.

T4. Several of my constituents, including members of the Cure the NHS group, have raised concerns over the way in which “Do not attempt resuscitation” notices are used in hospitals. Will the Secretary of State tell the House what the NHS is doing to ensure that the national guidance is followed? (74876)

This is an area in which the medical director of the NHS, the General Medical Council and others issue guidance to the NHS. I will gladly write to my hon. Friend setting out the details.

T3. I know that I am not alone in being an MP who represents pharmacists who are struggling on a daily basis to access life-saving drugs to treat asthma, diabetes and cancer, even to the point at which some of them are running out of those products. What more can the Secretary of State do to ensure that manufacturers and wholesalers have those life-saving drugs that people’s lives depend on? This is not good enough. What more can the Government do? (74875)

The hon. Gentleman will know that we inherited significant supply problems to pharmacies from the previous Government, not least because of the exchange rate and the possibility of countertrade. We have worked with the industry to resolve those issues. The hon. Gentleman would be well advised to talk to the Welsh Assembly Government about the fact that patients in Wales cannot access the latest cancer medicines, as patients in England can do under the cancer drugs fund.

T6. Today is anti-slavery day, and our excellent Prime Minister will be hosting a reception at Downing street tomorrow to promote the new Government anti-trafficking strategy. That strategy includes a requirement for the health service to be proactive in identifying victims of trafficking. What progress has been made on that? (74878)

I am sure that we all share my hon. Friend’s view of the great importance of this matter. The Department of Health leads on ensuring that health care is available to people who have been rescued by the police from human trafficking. We also lead on promoting an awareness that local government has multi-agency safeguarding processes to assist in supporting people who have been abused and harmed. There is more to say, but I will write to my hon. Friend on the subject.

T5. In the evidence session on the Health and Social Care Bill, the Secretary of State told me that he was committed to reducing health inequalities. We also heard from the Under-Secretary of State for Health, the hon. Member for Guildford (Anne Milton) on that subject a few moments ago. Will the right hon. Gentleman therefore explain why he made a political decision last December, against the advice of the Advisory Committee on Resource Allocation, to reduce the health inequalities component of primary care trusts’ target funding from 15% to 20%, in effect shifting funding from poor health areas such as my constituency to richer health areas such as his own? The Government are saying one thing— (74877)

I made no decision contrary to the advice of the Advisory Committee on Resource Allocation. If the hon. Lady cares to look at the increase in revenue allocations to primary care trusts across the country, she will see that many of the lowest allocations are in richer areas and the highest are in the most needy areas.

T8. Last week, a survey found that 80% of people want more choice in how and where they are treated. Does that not show that the Government are absolutely right to press on with modernising the NHS? (74880)

Yes, it was absolutely clear that the public wanted choice of treatment. That is one of the reasons that we have published some of the patient decision aids for the first time, and we will continue to do more. People want a choice in the consultant-led team that will provide their treatment, and in the hospital where that will happen. In the past few weeks, we have set out the details of how we are going to give patients the choice that they seek.

T7. I have noticed a growing creeping privatisation of cleaning contracts in the NHS this year. Does this signify a return to the old Tory days of longer waiting lists and dirty hospitals? (74879)

The hon. Gentleman seems to be somewhat confused. This is not about privatisation in a derogatory sense, as he is trying to suggest. For many years, including the 13 years of the Labour Government, hospital cleaning services in NHS hospitals were put out to tender, and many private companies provided the service. That is simply continuing.

T9. I am a long-standing supporter of independent sector treatment centres and of the need for commissioners to be able to bring in private and voluntary sector providers, as well as alternative NHS provision where existing services fail to improve—[Interruption.] I see that some Labour Members, including the hon. Member for Leicester West (Liz Kendall), disagree, but does at least the Secretary of State agree— (74881)

I will not interrupt the hon. Member for Leicester West (Liz Kendall) who is replying from a sedentary position. I agree with my hon. Friend. What we heard under the Labour Government appears to be very much at odds and not at all in keeping with what we hear from the Labour Opposition now. Let me remind my hon. Friend that the South Gloucestershire primary care trust has received a cash increase of £10 million, or 3%, this year. Like every other part of England, it is receiving increases in resources this year that the shadow Health Secretary opposed.

May I ask the Secretary of State to look back at issues of public health? What is he doing to provide leadership in this sector, especially when we talk to people at the top of the health service who say that there are real problems with obesity in nurses and smoking among doctors? Where is the leadership coming on those issues?

Let me just give the hon. Gentleman one or two examples. In the last few days, we have published an obesity call to action, which sets out national ambitions to reduce calorie consumption to a point where people can maintain a healthy weight or reduce their weight. We have set out a tobacco control plan, which is regarded as a leader across the world. About three weeks ago, I attended the United Nations General Assembly in order to join in debates with colleagues on reducing the tide of non-communicable diseases across the world. There is also the work of Sir Michael Marmot, which we share with him; he knows that we are taking it forward nationally and internationally to tackle the wider social determinants of health. That is why we have put local government leadership on health improvement at the heart of the Health and Social Care Bill.

Mr Paul Eccles is a constituent of mine. He is a qualified care assistant who wants to go freelance and set up his own business, helping people in their own homes. However, the annual up-front £1,000 charge of the Care Quality Commission is preventing him from starting this new venture. Will the Secretary of State meet me so we can find a way to help my constituent get his business off the ground?

My hon. Friend is absolutely right to highlight how well-intended regulation can sometimes be a way of blocking effective growth and the opportunities available for new people to set up businesses in the care sector. I would be very happy to meet my hon. Friend to discuss that matter.

Stockport is one of only five PCTs in the country that does not provide any in vitro fertilisation treatment—in spite of recommendations from the National Institute for Health and Clinical Excellence. Does the Secretary of State think it fair that my constituents, who pay the same taxes as everybody else, do not get the same access to this treatment as people living elsewhere?

The hon. Lady will know, I hope, that the deputy chief executive wrote to primary care trusts a few weeks ago further to remind them of the need to respond to NICE clinical guidelines. It was the hon. Lady’s Secretary of State, John Reid who, when NICE published its guidelines, told PCTs in 2004 that they should not follow them.

The news that the Woodhaven hospital in my constituency is threatened with closure only eight years after it was opened as a state-of-the-art mental health facility is causing great concern. Will my right hon. Friend endeavour to look into what is proposed for the closure of acute in-patient beds because the “hospital at home” alternative is simply not good enough?

I am grateful for the hon. Gentleman’s question and I would certainly be happy to look further into the matter and write to him accordingly.

When the Minister responsible for care services wrote to me about the closure of the Edale unit in Manchester, why did he not address the issue that the closure would cost more money than it saved or the fact that the police had expressed concerns about their access in emergency times, particularly during the weekend?

I am sorry if the hon. Gentleman feels that all the issues have not been dealt with following our telephone conversation and subsequent correspondence. I will check the correspondence again, and if I find that something is missing, I will certainly provide an answer.

I welcome the policy review of the entitlement of foreign nationals to free NHS care, but will my right hon. Friend assure the House that it will examine the options relating to charges for GP as well as hospital services?

My hon. Friend has asked an extremely reasonable question, and I can give him the assurance that he seeks.

PCTs in Staffordshire are pre-empting legislation by merging and reorganising now, which has led to plans to close the high street practice in Newcastle-under-Lyme simply because it is run by salaried GPs. Is that really NHS policy? If not, what will the Secretary of State do to help 5,000 patients rescue a much-needed surgery?

Nothing that is being done pre-empts legislation. What is being done in relation to primary care trust clusters is being done under existing legislation, and was necessary not least to enable us to achieve a reduction of £329 million in management costs in the first year following the election. In contrast, there was a £350 million increase in the year before the election under the hon. Gentleman’s right hon. Friend the Member for Leigh (Andy Burnham).

I do not know the circumstances of the centre to which the hon. Gentleman referred because the decision will have been made locally and will not have involved me, but I will gladly write to him about it.

The full roll-out of 111 services is now proceeding. Is the Secretary of State satisfied that imploding PCTs can get the procurement right in the time allowed?

I am confident that we will make the progress that we seek. If we are not ready in any location, we will not be able to proceed with that procurement, but the PCTs will act on the basis of an evaluation of four pilots. To that extent, the character of what they are procuring through the 111 system will be well defined through piloting.

What progress has been made since the launch of the Secretary of State’s tobacco control plan last March in changing the behaviour of people who smoke in cars in the presence of children?

The right hon. Gentleman has a long-standing interest in this subject. We are working on a number of areas, but I think that the extension of public health duties to local authorities will open up many opportunities to persuade parents to think carefully about where they smoke, whether it is in cars or in their own homes.

There is real concern throughout the country about the health inequalities left by the last Government. Will the Minister confirm that funding for areas with relatively large health inequalities will not be raided, as it has been in the past under Labour?

As my right hon. Friend the Secretary of State said earlier, the Health and Social Care Bill proposes the introduction of the first ever legal duty for the Secretary of State to have regard to the reduction of health inequalities. That covers both NHS and public health functions. We are also addressing the health needs of some of the most vulnerable people through the “Inclusion Health” programme.

My right hon. Friend the Leader of the Opposition and the officers of 12 all-party groups associated with care have urged the Government to commit themselves to the urgent reform recommended by Dilnot. Will the Minister update the House on the Government’s response to the Dilnot recommendations, and tell us when the cross-party talks will begin?

I know that the hon. Lady follows these issues closely. In September we published a plan for consultation on the proposals, which includes looking beyond the Dilnot commission’s recommendations at issues of quality, regulation, and many other aspects of how we can secure a comprehensive reform of social care. Today my right hon. Friend the Secretary of State wrote to Opposition Front Benchers with the aim of resuming the discussions across parties to ensure that we get the conversation going with the new Opposition Front-Bench team as soon as possible.

In a recent ministerial response, I was informed that public health services were a matter for the local NHS and that it would not be appropriate for Ministers to become involved or intervene. The transfer of staff from PCTs to local authorities excludes staff delivering services relating to weight management, smoking cessation, physical activity promotion, sexual health, community development and diabetes awareness-raising. How on earth can local authorities pick up the responsibilities without being given the staff who would enable them to do it?

The transition period is critical, and there is no suggestion that local authorities will not have all the tools in the box to enable them not only reduce to health inequalities, but to improve the public’s health. As we have stated many times, it is absolutely dreadful that under the last Government health inequalities increased rather than decreased.


With permission, Mr Speaker, I should like to make a statement on Afghanistan.

Let me begin by paying tribute to Rifleman Vijay Rai of the 2nd Battalion The Royal Gurkha Rifles, who died in Afghanistan on Saturday. His commanding officer described him as tough, loyal, utterly professional and immensely proud to have been serving in the British Army. I am sure I speak for the whole House in saying that our thoughts are with his family at this difficult time.

The House will appreciate that I have not yet had an opportunity to visit our troops in Afghanistan. I intend to do so as soon as is practical. The purpose of this statement is to provide information on progress in Afghanistan since the Prime Minister’s statement to the House on 6 July. Our mission is to ensure that Afghanistan does not again become a safe haven for international terrorism, and the presence of our armed forces in Afghanistan to achieve this aim is supported on all sides of the House.

This mission has a cost: 383 members of our armed forces have lost their lives since operations began—eight since the Prime Minister’s statement of 6 July. I know the whole House will want to join me in paying tribute both to their sacrifice and to all those who have returned with serious injuries, and to the families who support them. I would also like to take this opportunity to pay tribute to the troops from Estonia, Denmark and Tonga who are operating under British command in central Helmand. Since 6 July, two Danish soldiers and one Estonian soldier have also lost their lives, and I am sure the House will want to join me in expressing condolences to their families.

I am clear that this is an operation to protect our national security and national interests. That view is shared by the 49-nation, UN-mandated coalition. We share a common purpose: to enhance security and build the capacity of the Afghan national security forces and the Afghan Government, so that Afghans themselves can be responsible for their own territory, their own security and their own affairs. We ensure our national security and the security of the NATO alliance by helping the Afghans to take control of theirs.

Our strategy is comprehensive, drawing security, governance and development objectives together. In 10 years, with international support and assistance, Afghanistan has come a long way. Governance and the rule of law are improving across the country. The Afghan Government are providing increasing levels of basic services, with Afghans enjoying much greater access to health facilities, and more education opportunities—including for girls—than in 2001. We welcome the Afghan Parliament’s decision on Saturday to approve the supplementary budget to recapitalise the central bank, paving the way towards agreement on a new International Monetary Fund programme of support in the coming weeks. My right hon. Friend the Secretary of State for International Development has been actively engaged with the Afghan Ministry of Finance and the IMF in support of this objective. Agreeing the new programme will reinvigorate the Kabul process, allowing donors to align themselves behind Afghan Government priorities and systems as we move through transition and beyond.

Let us not understate the tangible improvements that have taken place, but let us also not underestimate the scale of the remaining challenge. We are working from a very low base. If progress is to be sustained, the commitment of the international community, including the UK, will have to endure for many years to come, long after international troops have withdrawn from combat operations.

On the security front, progress has been real and meaningful, but it has been hard won and is not irreversible. In many areas, Afghanistan remains a dangerous place. Levels of violence vary dramatically from region to region, but the insurgency continues to be a nationwide threat. The insurgency is under considerable pressure, but its leaders remain committed to conducting a violent campaign. Over recent months we have seen them increasingly focus on high-profile attacks, such as that on the British Council in August and on the US embassy and the international security assistance force headquarters in September. The murder of former President Rabbani is a particular setback. It is important that his death does not derail efforts to engage with those willing to renounce violence and work towards peace. We will continue to support President Karzai’s efforts to promote peace and reconciliation, and are encouraging engagement to support this from all those in the region, including Pakistan.

Despite that difficult background, there is also cause for optimism. In the UK area of operations in central Helmand, there is clear evidence that the ISAF troop surge has brought security gains, limiting the insurgents’ ability to prosecute their campaign. UK troops, partnered with Afghan security forces, are having a tangible impact on insurgent activity in our area of operations. On 9 October, 20 Armoured Brigade assumed authority for Task Force Helmand from 3 Commando Brigade, who can be proud of the progress made during their tour.

The central achievement this summer has been the commencement of the formal security transition process. July saw the first group of three provinces and four urban areas across Afghanistan, covering almost a quarter of the population, begin that process. This included Lashkar Gah, the capital of Helmand province, where the Afghan national police now lead on security in this bustling community of 120,000 people. ISAF remains ready to provide support if needed, but the ANSF have been able to respond effectively to insurgent attacks and to pre-empt many. That has been a source of considerable pride, both to the Afghan security forces and to the civilian population. Here in the UK, we should remember that the ANSF have suffered very considerable losses themselves.

The process of transition is on track and will continue. The Afghan Government, with ISAF support, are continuing the preparatory work needed to begin the transition process in the next set of provinces and districts. October also saw Task Force Helmand resume responsibility for the upper Gereshk valley. That follows the temporary deployment of US marine corps to the area, during which time UK forces provided security on the strategically significant Highway 1, outside the UK area of operations. UK forces will now work with the ANSF to prepare the district to enter the transition process in the future. We look forward to the second tranche of transition and an announcement later in the autumn by President Karzai outlining which areas are to be included.

Strong Afghan national security forces are key to achieving our objectives. The ANA now stands at 169,000 men and the ANP stands at 134,000, and both are on track to meet their target levels by October 2012. But progress cannot be measured in quantity alone—it must be measured in quality too—in respect of the effectiveness of the Afghan forces and the strength of their organisation. The Afghan-led response to the attacks on the US embassy and ISAF headquarters saw the ANSF successfully complete an exceptionally difficult night-time building clearance and, for the first time, Afghan air force helicopters were deployed in direct support of troops on the ground. Operational effectiveness rates are improving, allowing the ANSF to take the lead in many operations. Literacy rates among the ANSF are also improving. All 12 of the Afghan army’s planned specialist branches are now functioning, which will, in time, improve self-sufficiency and professionalism. Measures to improve retention rates in the ANSF have also been introduced. Such measures include a pension scheme and a work cycle consisting of periods of operations, training and leave. So the ANSF are improving but, as the recent report by UNAMA, the United Nations Assistance Mission in Afghanistan, shows, there remain important areas where further improvement is crucial.

President Karzai has stated his commitment to his Government assuming lead security responsibility across the country as a whole by the end of 2014, which is a goal that we share and support. That means that British troops will not be in a combat role by 2015, nor will they be deployed in the numbers they are now. The ANSF will, however, still need support from the international community even after the conclusion of the transition process. We will continue to support their development: for instance, through our lead involvement in a new officers academy announced by the Prime Minister in the summer.

On 5 December, the Afghan Government will chair an international conference in Bonn. This is a key opportunity to advance the political track. The Istanbul conference in November and the Chicago summit next May are further opportunities for the international community to reiterate its long-term commitment to Afghanistan. That commitment is crucial if we are to deliver on our key objective of ensuring that Afghanistan does not again become a safe haven for international terrorism. Our armed forces will continue to protect our national interests with the selfless devotion to duty we have come to expect. I am sure that we in this House will reciprocate by maintaining the staunch cross-party support that has underpinned the operation from the outset, and I commend the statement to the House.

I echo the tribute paid to Rifleman Vijay Rai of 2nd Battalion The Royal Gurkha Rifles, who died in action on Saturday. On all such occasions it is right that we should recognise the sacrifice and dedication of our service personnel here at home and overseas. They fight for others’ security and peace in order to protect our own. They carry our pride and our patriotism and they, and their families, must be the constant in our minds. It is also right that we should pay tribute to our allies, many of them nations that have also been scarred by terrorism.

I welcome the new Secretary of State and thank him in advance for his statement. I want to put on record my personal view that, whatever other disagreements I had with the right hon. Member for North Somerset (Dr Fox), I never doubted his passion about doing the right thing in Afghanistan, his personal commitment to supporting our forces, and the skill that he showed in trying to build consensus on the operations in Libya. As I made clear to him, when the Government do the right thing we will strongly support them, while carefully scrutinising their decisions. Will the Secretary of State take this early opportunity to reiterate his predecessor’s welcome commitment that nothing in the strategic defence and security review will adversely impact on the Afghan front line, and will he say whether anyone currently serving in Afghanistan is in line for compulsory redundancy?

Media attention has understandably been on Libya in recent months, but it has been another difficult summer in Afghanistan. Despite the painful losses, British casualties have mercifully been significantly lower than in the last two years, and casualties among all international forces lower than last year. There are, however, worrying security trends, with high-profile terrorist attacks including that against the British Council, which reminded us again of the danger in which many of our people, including civilians, put themselves for the sake of stability in Afghanistan and security at home. There have also been increased targeted assassinations across the country, and signs of insurgency spreading to previously calmer areas, and mixed messages on the political track. Despite that, our forces are doing brilliant work in central Helmand, jointly with the Afghan army and police force. This remains an intense and challenging campaign and one that is in our national interest. I hope the new Secretary of State will consistently make the case for why our forces are engaged in Afghanistan.

Let me turn now to my specific questions. We continue to support the intention to end the British combat role in Afghanistan by 2014. Will the Secretary of State share his assessment of the security situation and how it has changed in the districts and provinces involved in the first phase of transition? Will he assure the House that detailed plans for troop withdrawal will always be based on military advice and conditions on the ground?

On security, last week I spent time at NATO HQ and met the Secretary-General of NATO, who was full of praise for our forces. We discussed the security situation in Afghanistan. Will the Secretary of State comment on reports that Pakistani militants are exploiting a security vacuum left by the departure of US troops from parts of eastern Afghanistan, notably Kunar and Nuristan?

This is an issue for the whole of NATO, so how does the Secretary of State think we can persuade other nations with forces in Afghanistan to bear more of the burden? Pakistan is, of course, central to the future of Afghanistan and the wider region, so could he reflect on the worrying assessment by Admiral Mike Mullen that Pakistani intelligence is currently supporting extremists in Afghanistan? The campaign of targeted assassinations has also suggested a pattern of infiltration by the Taliban into Afghan forces. Could he say what changes are being made to Afghan national army and Afghan national police recruitment procedures and effective background checks to protect against this in future?

On the political process, we all know that for progress to be made in Afghanistan, there must be inclusive politics inside and beyond the country’s borders. Within its borders, could the Secretary of State reinforce the importance of protecting the gains made in development in Afghanistan in reducing child mortality and improving education? There are more than 7 million students in schools across the country, one third of whom are now girls. Beyond Afghanistan’s borders, India has recently signed a strategic partnership with Afghanistan. What does he see its significance as being, and what does he read into Pakistan’s response? The forthcoming Bonn conference, as he suggested, can be a real moment of strategic progress. Will he share his assessment of the credible likely outcomes coming from the Bonn conference?

In conclusion, we need Afghan security forces that are strong enough to defend and sustain the political and economic progress, and a constitution that reflects a changed Afghanistan, but to do so we need genuine and deeper achievements on economic development, political reconciliation, and better involvement with neighbours. Britain fought three wars in 80 years in Afghanistan; this is our fourth, and we have no intention of there being a fifth. That is why it is essential that real progress be made at the forthcoming Bonn conference.

I am grateful to the right hon. Gentleman for his welcome, and indeed for his continuing endorsement of the cross-party approach to this issue. He asked about the impact of the SDSR on the Afghan front line and I can tell him that in the very short time that I have had at the MOD, one of the first things I have done is to ask for an assessment of the equipment and personal protection available to our troops in Afghanistan. I am satisfied that they have the best level of protection they have had since this campaign began and appropriate equipment to carry out the task that they are being asked to carry out, and I will ensure that that remains my No. 1 priority. He asked about compulsory redundancies. No troops serving in Afghanistan will be subject to compulsory procedures either while they are serving in Afghanistan or during their recovery period upon return.

The right hon. Gentleman talked about the importance of the political track, and I absolutely agree with him. If Afghanistan is to have a stable and sustainable future, there has to be an inclusive solution to the political challenges that the country faces. I recognise that there are huge issues in achieving that but it must remain our focus. He was also right to draw attention to the success of our forces. A military solution alone will not be sufficient, but without a climate of security we will not be able to achieve the nation-building and reconciliation process that is so important for the future. I confirm that I will consistently make the case for the presence of our troops in Afghanistan.

The right hon. Gentleman asked about the current security situation. In the districts and provinces that have transitioned, the experience is good and the Afghan national security forces are showing good capability. Indeed, ISAF in Lashkar Gah has had to intervene only once since the transition took place.

The right hon. Gentleman asked about Pakistani militants, and I think he was referring to Haqqani network activity in the more easterly provinces to the east of where Task Force Helmand is operational. There has certainly been an increase in activity and the pattern clearly is that there has been a reduction in military activity in Regional Command South West but a corresponding increase in some other areas, including the area subject to Haqqani network influence.

The right hon. Gentleman is absolutely right to talk about the centrality—the crucial involvement—of Pakistan in the long-term solution to the problem. We should never forget that Pakistan has borne a burden as great as that of any other country in the fight against terrorism, taking more civilian casualties than any other nation. We will continue to work with the Pakistanis to ensure that they engage in the interests of Afghan security, and indeed of their own long-term security, by ensuring that the insurgency is defeated.

The right hon. Gentleman asked me about the infiltration of the ANSF through recruits. I absolutely accept that this is a critical issue. I have been assured that progress is being made, but I do not have the details that I can give to him across the Dispatch Box. I am very happy to write to him later today.

Finally, the right hon. Gentleman asked about protecting development gains. We are clear that a long-term lasting solution must involve the securing of those development gains and building on them—enhancing them. Afghanistan has to become a viable nation capable of offering its citizens basic services that they require, and capable, in a sense, of competing in its offer with what Taliban and other insurgents have been offering at local level. We have to build on those processes. We have to secure the gains that have been made, and I hope that at the Bonn conference the international community will take the opportunity to send a very clear signal of its long-term commitment to this process, beyond the draw-down of forces at the end of 2014.

I welcome my right hon. Friend to his vitally important post and wish him every success in it, but may I commiserate with him, as I have with his six predecessors, on bearing responsibility for what, despite the tremendous bravery of our troops, I have always predicted since 2002, future historians will regard as a fiasco as great as the first two Anglo-Afghan wars? The wisest thing the Secretary of State for Defence can now do is to bring our troops home as soon as possible.

I am grateful to my right hon. Friend for his views. I am sure other Members of the House are familiar with them. That is not the view that the Government take. The Government take the view that we are embarked on a process. The Afghanisation of security is progressing. We have set out a timetable for the draw-down of forces, and we will continue to engage actively with the processes of nation-building, reconciliation and Afghanisation of security over that timetable.

I welcome the Secretary of State to his position. Is he yet able to say anything to the House about the Government’s policy on the need for co-ordination across the whole of ISAF of the draw-down of troops between now and 2014 towards the end of the combat mission? I am concerned. We are already backfilling in the upper Gereshk valley and we are operating out of area, as he said, on Highway 1. If we take that too far, we will damage the troop density that has given our troops the ability to make the operational progress that they have made. The Secretary of State needs to watch this. Our troops are enthusiastic to help. They see a job that needs to be done and they want to go and do it. If he allows that to go too far, it will damage their ability to operate.

I am grateful to the right hon. Gentleman and thank him for his welcome. Some points of information: the operation on Highway 1 has concluded, so we are no longer operating out of area on Highway 1. We are not backfilling in the upper Gereshk valley. The upper Gereshk valley is part of the UK area of operations. The US marine corps moved into the area in order to protect contractors carrying out a blacktopping of the strategically important Highway 611. That is now complete, and we have retaken control of it.

On the crucial issue of draw-down, the right hon. Gentleman is absolutely right. We cannot talk about the profile of UK draw-down to the end of 2014 and beyond in isolation. We have to look at what the United States is doing, and we will obviously have careful regard to the announcements of US intentions and take the advice of the military in responding to those.

May I, too, offer my congratulations to my right hon. Friend? Is he aware of some suggestions that there has been an adverse impact on the availability of certain equipment in Afghanistan because of deployments over Libya? That may have been necessary and even acceptable in the short term, but may we take it that at the earliest date any such equipment—I particularly have in mind Apache helicopters—will be made available for deployment in Afghanistan?

I am grateful to my right hon. and learned Friend, who will know that the news from Libya appears to be progressing, and that progress is being made towards liberation. I hope that we will very quickly be at the point where equipment tied up in the Libya campaign can be released.

I welcome the Secretary of State to his position, thank him for advance sight of his statement, and join in his message of condolence. Earlier today a survey of Afghan opinion was published by the Konrad Adenauer Foundation, and it found that 56% of Afghans now see the foreign troop contingent as an occupying force, and only 39% see ISAF as a guarantee of security—down from the 45% who did so only last year. Does the Secretary of State have any reason to disbelieve those pessimistic findings?

The important thing is that the ANSF are growing in size and capability, so, with 25% of the population already living in areas that have been transitioned and another tranche of transition to be announced later this autumn, Afghan civilians will increasingly find that their day-to-day security contacts are with the Afghan national security forces. As we move towards 2014, allowing foreign forces to be seen as formations that can be withdrawn without compromising the security that Afghan civilians enjoy is a positive step, so I should like to see something positive in the figures that the hon. Gentleman cites.

I, too, welcome my right hon. Friend to his position. He has a hard act to follow, but I am sure that he will do a very fine job—and if he does not, the Defence Committee will hold him to account. Does my right hon. Friend agree that one of our key strategic aims in Afghanistan must be to bolster the stability of Pakistan? How does he think that we can manage the draw-down of our combat troops so as to bolster that stability, rather than undermine it?

I thank my right hon. Friend, and absolutely agree with his analysis that the greatest strategic challenge is security in the wider region, including security in the vulnerable cross-border area. If he does not mind, with only 48 hours under my belt, I will not give the House a lecture on how that is to be delivered, but I will confirm that I recognise it as a very important priority.

I, too, welcome the Secretary of State to the formidable challenges that lie ahead of him. Can he assure the House that if the security situation in Afghanistan were to deteriorate after 2014, there would be sufficient flexibility to deploy British military assets in support of the Afghan security services?

The Prime Minister has made it very clear that we will have withdrawn from a combat role by the end of 2014, and that the number of UK troops remaining after that point will be very considerably fewer than are there now. The detail of the role of those few remaining troops has yet to be determined.

May I welcome the Secretary of State to his office? He rightly says that our mission is to ensure that Afghanistan does not again become a safe haven for international terrorism. When he does get out to Afghanistan, will he reflect on the possibility that, with the death of Osama bin Laden and other leading terrorists, that mission might already have been achieved? If he reaches that conclusion, will he agree that it gives him some flexibility over the rate of the draw-down?

I am sorry to say to my hon. Friend that I think that that is a slightly optimistic assessment. I do not need to get to Afghanistan to make that assessment. We know from history that areas that are subject to divided—weak—Government and poor security are likely to become safe havens for international terrorism. It is very much in our own national interests that we support the Afghan national Government to be a strong, unifying and inclusive force and secure the development gains that have been made, as well as the Afghanisation of the security process. That will be the Government’s agenda.

2014 also happens to be the end of the second term of President Karzai, who has led us to believe that he will not seek reappointment—which would also be unconstitutional. That means that at the very time when we are withdrawing troops, we require political stability. Can the Secretary of State give us some indication of his thinking on how that political stability in Afghanistan can be provided?

The draw-down of troops will take place between 2012 and 2014, and the profile of that draw-down has not yet been decided or confirmed. At the same time, the Afghan national security forces will be taking an ever greater role in maintaining security in the country. I would like to think that by that stage the political process will be able to go on in a constitutional fashion, while the Afghan national security forces protect the security of the country and the population and create the stable baseline that will allow for that political process.

I thank the shadow Secretary of State for his kind and sincere words about my right hon. Friend the Member for North Somerset (Dr Fox). I also express my faith in my right hon. Friend the Secretary of State; I am sure that he will fulfil our expectations that he will do a good job in his new role. Is he concerned that President Karzai has, once again, ruled out any dialogue with the Taliban when it is quite obvious that any stable political settlement in Kabul is essential if security is to be maintained as we withdraw from Afghanistan?

It is clear that politicians in Kabul will have to respond to the assault on the peace process that the assassination of former President Rabbani represents. However, it is also clear that in the long run there is no alternative to an inclusive peace process that will bring all elements of the Afghan population into a durable and sustainable settlement.

One thing that we are all united on is the sheer bravery of the British troops in Afghanistan; there is no division on that. Is it not important, however, for the new Defence Minister to realise that there is not unanimous support for a 10-year-old war that many of us consider to be absolutely unwinnable, and that it is certainly the strong feeling in the country—there is no doubt about it—that the sooner that British troops come home, the better it will be?

If I have got it wrong I will correct myself, but I am pretty sure that I said “cross-party” support, and resisted the temptation to say that there was support in all parts of the House.

Public recognition of service and sacrifice in Afghanistan is terribly important. The good people of Royal Wootton Bassett were delighted to welcome the new Secretary of State and the Prime Minister there on Sunday. Will my right hon. Friend similarly try to find time in his diary to be at the north door of Westminster Hall on 31 October at 3.30 in the afternoon to welcome in 3 Commando Brigade as they return from Afghanistan?

Instead of detonating improvised explosive devices safely at a distance, we still instruct our soldiers to dismantle them by hand in order to identify—to find the fingerprints of—the bomb makers, and then imprison them. After the escape of 500 Taliban prisoners from Kandahar, including many bombers, is it reasonable to ask our troops to continue to dismantle those bombs in such a dangerous way when we cannot keep the prisoners safely behind bars?

There are two parts to the hon. Gentleman’s question. First, we clearly have to work with the Afghans to improve detention arrangements in Afghanistan in terms of ensuring that human rights issues are properly respected and that prisons are secure. On the first part of his question regarding the technical process used for dealing with IEDs, I am afraid that I have not got to that part of my briefing pack yet, but now that he has drawn my attention to it I will ask the relevant questions this afternoon, and will be happy to write to him.

It is highly probable that when our troops withdraw in 2014, the insurgency will still be active. Among its top targets will be any civilians whom we leave behind to engage in nation building, and any Afghan interpreters who have helped our forces. When he has the time and opportunity, will the Secretary of State give serious thought to how those two groups are to be protected?

My hon. Friend is, of course, right. The plan for post-2014 has to include a credible way of protecting UK civilians involved in reconstruction and development, and a solution for those who have served the British forces and who might be at risk as a result.

I hope that the Secretary of State will find time in the near future to read the Defence Committee’s report, “Operations in Afghanistan”. Will he say more about what assessment the Government have made of the role of women in the future of Afghanistan?

The Select Committee’s report is in my box and I was hoping to have read it before today, but alas! I will certainly put it high on my reading list. It is clear that a sustainable future for Afghanistan has to include all parts of the population. We have to build on the enormous gains that have been made, particularly in the education of girls. That is already beginning to flow through into changing the nature of Afghan society. We must build on those gains, and we are clear that they are part of the sustainable future that we crave.

May I join other colleagues in welcoming my right hon. Friend to his post? May I press him on the implications of the Indian-Afghan strategic partnership? He rightly talks about the need for an inclusive political process internally. Externally from Afghanistan, that must include China, Pakistan, Iran and Turkey, as well as India.

I completely agree with my hon. Friend. It is important that all Afghanistan’s neighbours are engaged in the process and that none of them should feel threatened by it.

To follow on from the excellent question asked by the Chairman of the Select Committee on Defence, if the Government are to meet their deadline of coming out by 2014—in other words, if we assume that the insurgency will be well under control and that the Afghan national army and police can deal with it—it will be crucial for the Pakistani security services to be in a much better position in terms of the co-operation that they give than they are now. I know that the Secretary of State has been in the job only a short time and that he may want to write to me, but can he give an assessment of whether the situation of the Pakistani security services helping the Taliban and other extremists has got better or worse in the past six months?

The hon. Gentleman will, I hope, forgive me if I say that from what I have seen so far, this is an incredibly complex and sensitive area. I would rather study it a little further before writing to him, if he does not mind.

I welcome the Secretary of State to his position. He inherits a well-intentioned campaign, but if we are honest, there has been a drift in mission and a lack of clarity and conviction from the international community. If we are honest, there is not the required sense of governance at a regional or a national level, which means that a lot of the good work that we are doing in Helmand may well be reversible. I ask him to examine the provinces of Kunar and Nuristan, which were handed over to the Afghan forces but are, sadly, now in the hands of the Taliban.

I will certainly look at those provinces and draw the attention of my right hon. Friend the Foreign Secretary to what my hon. Friend has said. Of course, my focus will be on the area of central Helmand, for which the British forces have direct responsibility.

On behalf of my right hon. and hon. Friends, I welcome the Secretary of State to his new position and pay tribute to the professionalism of his colleague who served before him. Will the Secretary of State assure me, and the House, that soldiers who have returned home from Afghanistan with serious physical and mental injuries will continue to receive the best possible medical attention for as long as they need it?

The Government have put a huge investment of time, management effort and money into that exercise, and I can assure the hon. Gentleman that those who need medical help as a result of injuries that they received while fighting on behalf of their country will receive it.

The battalion that I commanded, 1st Mercians, will shortly return to Afghanistan, within two years. When it was there last it lost 12 men and more than 100 were wounded. May I ask the Secretary of State to write to me, when he can, to explain how battle casualty replacements will work in the future? Commanding officers find it very difficult if they lose 100 men out of 500, and it will be especially difficult as we will be withdrawing and drawing down in the next couple of years.

I am happy to write to my hon. Friend, who of course has direct experience of handling such issues. The good news, of course, is that casualty figures are substantially down. UK forces are taking far fewer casualties than they were at the time to which he refers. However, I will write to him.

The right hon. Gentleman is the seventh Secretary of State since the conflict started, and we all wish him well. The statements, though, have not changed, even if Secretaries of State have come and gone. We hear about cautious optimism, determinism, determination and some interesting development statistics, then the next Secretary of State comes along and repeats the same statements. May I urge him to be the first one to grab hold of strategy and tactics from our 250-odd generals and ensure that whatever presence we maintain in Afghanistan, there are no more funeral cavalcades through Royal Wootton Bassett? Our men should stop being Taliban target practice.

I thank the right hon. Gentleman for his question. He may detect a similarity in the statements, and I may detect a similarity in his questions. I can tell him that there has been very significant military progress in the taskforce Helmand area. Violent incidents and casualties are down dramatically this summer fighting season compared with last.

The right hon. Gentleman may shake his head, but the fact is that the number of enemy-initiated violent incidents this summer fighting season is 40% down on the number last summer fighting season. In parallel with that, governance is improving. Governor Mangal, in Helmand province, is behind an effective programme of poppy eradication that has reduced the poppy crop year on year. [Interruption.] The right hon. Gentleman says something unrepeatable, but I say to him that tackling the root causes of the problem at the level of the Afghan economy, basic public services and security is the way to create a stable situation in the future, and we will persist with it.

I congratulate my right hon. Friend on his assumption of his extremely challenging post. Despite the title of the statement, the questions asked today have revealed that the problem lies as much in Pakistan as in Afghanistan. Will the Secretary of State tell the House when he is likely to engage in talks with his Pakistani counterpart?

Of course the Foreign Secretary leads on our relationships with Pakistan, but I am absolutely ready and willing to engage with my military counterparts in Pakistan if he wishes me to do so.

The Secretary of State has emphasised military transition, political inclusion and stabilisation. Is he sensitive to the concerns in Afghan civil society that the imperatives for the international community, and the interests of Afghan political powers in the context of those imperatives, may not extend to sustaining the advances that there have been in the status of women? As well as insisting that Afghanistan must never again be a safe haven for terrorists, will he outline the Government’s determination that it will never again be a theme park for atavistic prejudice against women?

I think that some of the gains already made, such as the education of girls, will be irreversible changes in Afghan society. We have made it very clear that we want to ensure that those gains are consolidated. However, it is not for us to dictate to the Afghan people their agenda for the future. It is for us to ensure that there is a climate of security and stability in which they can exercise their constitutional right to determine the future of their country in a way that does not threaten the security of ours.

With all due respect to the right hon. Member for Rotherham (Mr MacShane), may I urge my right hon. Friend to stick to the strategy, and leave the tactics to the soldiers on the ground? Much work has been done in increasing the capacity of the Afghan national Government, but given the need for economic development, which has been highlighted, much more work needs to be done in provincial government, where capacity remains poor, if we are to leave Afghanistan in a stable state in the long term. Will the Secretary of State say a few words on how we will address that problem?

I am sure that the soldiers would thank my hon. Friend for his intervention, and I will consider it carefully. The Government are very much aware of the need to reinforce governance at local and provincial level. My right hon. Friend the Secretary of State for International Development is focused on ensuring that the UK and the broader international package deals at all levels. I would say to my hon. Friend that the initiative to recruit Afghan local police, which is already bearing fruit in a number of provinces, will continue to help to stabilise the situation at local level.

I thank the Secretary of State for his statement, and wish him well in his new post. A large percentage of the soldiers who have been killed or injured in Afghanistan have been killed or injured as a result of improvised explosive devices. Some progress has been made on the equipment that the soldiers are issued with, but the US army, along with private companies, has developed modern technology to combat the threat of IEDs. Will the Secretary of State confirm that that technology advancement in the US will be exchanged with, and made known to, the UK and allied armies, so that the horror of IEDs can be reduced?

We have made considerable progress in providing better equipment to reduce the risk of IEDs to the forces. However, developments are ongoing, particularly in relation to vehicles, and we will keep on top of them.

The last quarterly statement discussed the challenging supply route from Karachi. Can my right hon. Friend update the House on that route, and on measures to improve the supply of Helmand province from the north?

My understanding is that the US is exploring other possible routes of supply into Regional Command South West. However, for the moment the UK remains dependent on the supply route through Pakistan. As my hon. Friend says, that is a difficult, vulnerable and expensive route. The route is fragile, but it remains a vital lifeline to our operation in Helmand.

I welcome my right hon. Friend’s observations on the importance to nation building of the progress of women and girls. Two weeks ago I met Fawzia Koofi, an MP and presidential candidate in Afghanistan, who expressed great concern about the role of women in the upcoming Bonn conference. What can his Department do to ensure, or at least to encourage, the participation of women in that conference?

I am not aware of the exact composition of the Afghan delegation to that conference, but I shall certainly take up the issue and discuss it with my right hon. Friend the Secretary of State for International Development to see whether he needs to intervene to ensure that the interests of women are effectively represented.

May I welcome the Secretary of State to his extremely important position and wish him well? May I also welcome his reassurance in response to the Opposition spokesman’s question on equipment? Will he reassure the House that, unlike the previous Government, this Government will never deploy troops with inadequate equipment?

I have been saying for many years, long before I came anywhere near having a responsibility at the Dispatch Box for this issue, that it is not moral to ask troops to go into mortal danger without the best equipment that we can provide them for personal protection, and that remains my view.

May I congratulate my right hon. Friend both on his appointment and on the remarkable speed with which he is mastering the brief? He mentioned the importance of developing the local police force. One of the key factors for success in Helmand province and elsewhere in southern Afghanistan will be recruiting southern Pashtuns into the Afghan national army, so that it is no longer seen as an army of northern foreigners.

My hon. Friend is absolutely right. At the moment the ethnic balance in the ANA does not reflect the ethnic mix of the population, as it is heavily Tajik dominated. In the longer run, it will be necessary to achieve a better representation of the ethnic mix of Afghanistan in the forces, but that process will take time and inevitably will be a consequence of the reconciliation and reintegration process that will take place over the coming years.