House of Commons
Wednesday 11 January 2012
The House met at half-past Eleven o’clock
[Mr Speaker in the Chair]
Oral Answers to Questions
The Secretary of State was asked—
Ministry of Defence Police
We have regular discussions with ministerial colleagues on defence matters relating to Scotland. The Under-Secretary of State for Scotland, my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell), last spoke about the issue to the Under-Secretary of State for Defence, my right hon. Friend the Member for South Leicestershire (Mr Robathan) —who is responsible for defence personnel, welfare and veterans—earlier this week.
As recently as November last year, the Prime Minister said that
“there are no current plans to reduce the number of Ministry of Defence police at the Faslane or Coulport naval bases.”—[Official Report, 23 November 2011; Vol. 536, c. 295.]
Since then, however, the Government have confirmed plans to cut the MOD police budget by 50%. I am curious to know whether the Prime Minister’s assurances hold water. May I ask the Secretary of State what proportion of that cut will fall in Scotland, and whether he believes that the threats to our national security have diminished sufficiently in recent months to justify a 50% cut?
What the Prime Minister said stands. There are no current plans for the MOD to reduce the core police role relating to the security of our national institutions, such as nuclear safety at Coulport or Faslane. National security, including the security of our defence installations, is our highest priority. The reason we have so many MOD police in Scotland in the first place is our huge defence imprint, which would be put at risk immediately if the country were to become independent.
I am delighted by what the Secretary of State says about the importance of security at Faslane and Coulport, and by his assurance that there are no current plans to reduce the number of MOD police. I hope he will also be able to assure the House that the Government will never adopt any plans to reduce security at Faslane and Coulport, given the importance of the nuclear installations there.
Child Tax Credits
The welfare system must remain fair and affordable, while protecting the most vulnerable. Most working-age benefits, benefits for disabled people and the basic state pension will increase by 5.2% in April. In order to remain on course with the debt consolidation plan and meet their fiscal mandate, the Government will increase the child element of child tax credit by the rate of inflation.
According to the House of Commons Library, the Government’s decision not to proceed with the £110 increase in the child element of child tax credit will take £41 million away from nearly 400,000 children in Scotland alone. Worst hit in Scotland will be Glasgow city, where 44,000 children are set to miss out on £4.8 million. When will the Secretary of State stand up for the children of Scotland?
The Government are standing up for the children of Scotland. That is why our priority is sorting out the mess that the Labour Government made of our economy. The hon. Gentleman would do well to heed the words of the former Secretary of State for Scotland, the right hon. Member for East Renfrewshire (Mr Murphy):
“The truth is the Labour party would have to make cuts if we were in power.”
After another week that has been dominated by political debate and headlines relating to Scotland’s constitution, we must not ignore a report by End Child Poverty showing that 50% of local authority areas in Scotland contain wards in which 30% of children are living in poverty, and that in some wards in my constituency the figure is 50%. What action is the Secretary of State taking, along with the Scottish Government, to ensure that every child in Scotland is given the best start and opportunities in life?
The hon. Gentleman raises important issues, such as the fact that many of the levers relating to child poverty rest with the Scottish Government. As a result of the autumn statement, the Scottish Government received more than £500 million in additional revenue. I should have thought it would be better if they focused on how to deploy that revenue to deal with such problems as child poverty than to obsess about the constitution.
My right hon. Friend the Secretary of State and I firmly believe that Scotland is the ideal destination for international inward investment, and we have taken a range of actions to promote such investment. My right hon. Friend recently led the largest ever Scottish trade delegation to Brazil to promote closer business links with a key emerging market for the Scottish economy.
In contrast to the previous intervention, will the Minister acknowledge that international companies investing in Scotland since the re-election of the Scottish National party Scottish Government include INEOS, PetroChina, Dell, Gamesa, Amazon, Hewlett Packard and Mitsubishi Power Systems? Does he acknowledge that and welcome the investment?
That is the usual mantra that we hear from Government Members. Will the Minister respond to Scotland’s leading entrepreneur, Jim McColl, who said on this very subject that business is “not concerned” about the
“independence referendum…What many of us in business are convinced about is that a productive and prosperous future for this country depends on securing real economic powers for the Parliament through constitutional change”?
Will the UK Government drop their foolish conditions, so that we can secure that change in the autumn of 2014?
I am sure the hon. Gentleman will agree that Mr McColl is entitled to his opinion, as is any other citizen of Scotland. I am sure you will encourage them, as your own party’s Scottish Government already have, to contribute to our consultation on the independence referendum.
Does my right hon. Friend believe that were Scotland to become separate from the United Kingdom, and were it to be forced to join the eurozone as a condition of re-entry into the European Union, that would hinder or help inward investment into Scotland?
The annual population survey of 2010 estimates that 36,000 18 to 19-year-olds in Scotland were not in education, employment or training between 2009 and 2010.
I thank the Secretary of State for that response, but it does not really answer the question of what is happening between the ages of 16 and 18, which is as important, if not more important. What is he doing to encourage youngsters to enter industry and to enable them to take up apprenticeships as joiners, electricians and plumbers, because this Government have failed to attract people into those industries? Does he agree that the idea, which I suggested to him at a meeting, of setting up schools-industry liaison committees is worth supporting?
The hon. Gentleman rightly continues to focus on this issue. We are all deeply concerned about youth unemployment. I have visited his constituency, and I have also had other meetings in Ayrshire and elsewhere, and it is right that we should join the Scottish Government, employers and all the agencies to help young people—aged between 16 and 18 and of any age—to find work or support. The youth contract that we announced before Christmas will bring £1 billion of extra investment into supporting the young unemployed, whether through wage incentives, additional work experience and opportunities or money to the Scottish Government. That money could also be used to create the school-industry liaison groups the hon. Gentleman wants.
As the Secretary of State says, youth unemployment is a huge concern for Members of all parties and for people across Scotland. The youth contract will help by providing 40,000 opportunities for young people in Scotland, but this problem will not be solved easily, so what will my right hon. Friend do to bring together people from the UK Government, the jobcentres and the Scottish Government, as well as business employers and education representatives, to offer the opportunities that young people in Scotland need?
Over many months now, I have been bringing together exactly those groups in different parts of Scotland—including Ayrshire, Falkirk and the borders. At the end of March, I, along with the Secretary of State for Work and Pensions and the Scottish Finance Secretary, will bring everybody together so we can focus as two Governments and as all the interested parties on tackling this scourge that we must get rid of.
The problem with the Secretary of State’s complacent answers is that he simply does not grasp the scale of the crisis of slumping demand, employment and confidence that grips Scotland’s economy due to the crushing austerity being imposed by this Government. Does he not share the real fears of young people that, with youth unemployment at over 21% and seven people chasing every vacancy in Scotland, there simply are not enough jobs to go around, and is it not time to change course by boosting demand through a cut in VAT now, before this Government’s failing economic plan plunges Scotland into the misery of another downturn?
I think it is wrong for the Labour party to be complacent about its record on the economy, which landed us in this mess in the first place. The shadow Defence Secretary, one of my predecessors as Scottish Secretary, said this week that Labour has to face up to the realities of the economy and the deficit, and the hon. Gentleman should do that, too. We want to work with everybody so that we can reduce youth unemployment, and I invite him to look at the youth contract in more detail.
5. What assessment he has made of the effect of the autumn statement on levels of poverty in Scotland. (88256)
The Government took action at the autumn statement to build a stronger and more balanced economy. As a result, more than £500 million has been added to the existing Scottish budget by the UK Government, which provides the Scottish Government with additional resources in these uncertain times.
I thank the Minister for that answer. Does he agree that one of the most important ways of tackling poverty is ensuring full employment? Does he therefore share my concern that Mahle Engine Systems in my constituency seems set to remove jobs from an area hit by high unemployment, taking those jobs out of Scotland and out of the UK?
I would be very disappointed if that were the case. I know that the hon. Lady is a doughty campaigner for employment in her constituency. We must continue to stress the benefits of employers remaining in Scotland, which is why the current constitutional uncertainty is so damaging.
On Monday, when 700 of my constituents employed by WJ Harte Construction returned to work, they were told that the company had gone into administration, without any consultation whatsoever. I am told that Scottish Enterprise and the trade unions were not even aware of this. The MSP was not aware of it, and the MP certainly was not. The company was taken over by a venture capitalist more than two years ago, when it had a turnover of £100 million. It has now been run into the ground and the executives have run away with the money. Will the Minister meet me to discuss what we can do to save as many of these 700 jobs as possible? This is a disgraceful situation.
Work Capability Assessment
6. What discussions he has had with the Secretary of State for Work and Pensions on the work capability assessment in Scotland. (88257)
My right hon. Friend the Secretary of State and I are in regular contact with Ministers from the Department for Work and Pensions on a range of issues concerning welfare reform. We also recently met Professor Malcolm Harrington to discuss his second review of the work capability assessment.
I thank the Minister for that answer. I am sure he will be aware of a report published today by Citizens Advice entitled “Right First Time?”, which examines the high level of incorrect and inaccurate decisions made in the work capability assessment. Given the amount of money that Atos Healthcare receives from the public purse for undertaking these assessments, is it not now time for the Government to consider the report’s recommendation that financial penalties be imposed on Atos for a number of those incorrect assessments? [Interruption.]
Now that the move from incapacity benefit to employment and support allowance is well under way, anecdotally, it would appear that Atos is finding it very difficult to carry out the necessary work capability assessments, so there could be extra delays. Will the Minister please engage with his fellow Ministers in the DWP to make sure that Atos can deliver on the contract?
Yesterday, I made a statement announcing a consultation to seek views on how any referendum can be made legal, fair and decisive. I discussed this yesterday with the First Minister, and I hope to have further discussions with the Scottish Government, along with other politicians and people from across Scottish civic society, during the consultation.
The House of Commons Library has given me strong evidence to show that the economies of Quebec and Canada as a whole suffered in the 1990s due to constitutional uncertainty. For the sake of jobs in Scotland and England, does my right hon. Friend agree that the last thing we need is a prolonged period of constitutional uncertainty, and that the First Minister should stop playing politics and get on with it?
My hon. Friend is correct to point to that independent analysis and the experience of Quebec and the rest of Canada. It is vital that the economic uncertainty we now face because of the referendum is resolved, which is why we have brought forward proposals to make the referendum legal, fair and decisive. I want it to happen as soon as possible.
The central issue arising from the consultation that I launched yesterday is that, as things stand, the Scottish Parliament does not have the legal power to hold a referendum, regardless of how that is described, and we need to provide that power by working with it. I am committed to working with the Scottish Government, and with people from across the country, so that we can get the power devolved to Scotland, the Scottish Government can then develop the question and we can get on with the referendum, which will be made in Scotland, for the people of Scotland.
My hon. Friend is focusing on some of the central issues that we need to be able to get on to debate in the decision about whether Scotland should go its own way or continue to be part of the most successful multi-nation state in the history of the world, as I think it is vital it does. So let us get on and devolve the power to make it a legal referendum. Let us have a fair referendum and let us make sure it is decisive.
The Select Committee on Scottish Affairs has already embarked on an inquiry to identify those issues, such as defence, which need to be resolved before a referendum is held. Does the Secretary of State plan to contribute to that debate with the Select Committee?
I certainly do. What is really important is not just our debate now about the future of Scotland, but ensuring that everybody in the country gets the opportunity to participate in the consultation on the shape of the referendum, and I hope that people will respond to that. I hope that everybody across the country—not just politicians—will get involved in debating defence, welfare and the state of our economy, all of which, I believe, are much safer within the United Kingdom. [Interruption.]
We now know that there will be an independence referendum in the autumn of 1914—[Laughter.] That, of course, was the year that the great war started. There will be an independence referendum in 2014, designed and decided by the people of Scotland. If the Secretary of State is so concerned about the legal powers for the referendum, why does he not just devolve the powers, through section 30, without condition? I see that the Prime Minister has walked into this debate. I really hope that the Secretary of State can encourage the Prime Minister to come to Scotland as much as possible in the next two weeks, because the Prime Minister is the best recruiting sergeant for a “yes” to independence vote that we have.
My right hon. Friend the Prime Minister will be a full participant in the debate, as will all people across the United Kingdom. For us, it is important that we have a referendum that is made in Scotland for the people of Scotland about our future in Scotland. The First Minister and now the hon. Gentleman —who gave a slightly different date—have put forward their preference for when that referendum should be, but before we can get anywhere near it we must ensure that it is legal. I hope that the Scottish Government will work with us to ensure that that is the case.
Does the Secretary of State recognise that following this week’s important developments, the referendum campaign on Scotland’s future is now effectively under way and it is time to get on to the substance of the issue? What is more, given that the Scottish Government have said that they have been involved for some time in considering the details of the prospects for Scotland, will the Secretary of State tell the House whether any UK Government officials have been involved in any discussions on the future of the Scottish economy and, in particular, on whether a separate Scotland will keep the pound, join the euro or have a separate currency?
The hon. Lady is right to focus on those key issues about the future of Scotland. I believe that Scotland is best served by continuing to be part of the United Kingdom, where our economy is stronger and our defence more secure, where we have much greater clout internationally and where our welfare system will be more generous and better. I hope that the Scottish Government will publish their plans about what they think should happen in an independent Scotland and in the meantime, as the hon. Lady says, let the debate commence.
I thank the Secretary of State for that answer. Does he agree that one of Britain’s greatest achievements was the creation of the welfare state? Have any discussions taken place about the implications of separation for welfare spend in Scotland, particularly as recent figures reveal that it was three times greater than oil revenues in 2010?
The hon. Lady makes an important point about the contrast between the level of spending to support some of the most vulnerable in our society in Scotland and, indeed, the rest of the country and the volatility of oil revenues. I believe that we can have a more secure and generous welfare system by sharing the risks and resources across the whole of the United Kingdom, which has helped Scotland through difficult times in the past and at present.
Does my right hon. Friend agree that all Scots should be entitled to vote in any referendum on independence, whether or not they live in Scotland, including my dad, who is a proud Scotsman who happens to live in England and thinks of himself first and foremost as British?
I pay tribute to my hon. Friend’s dad’s sense of patriotism and I am sure that he, like many other Scots around the country and around the world, will wish to contribute to our consultation. Like me, they will want to see this referendum on the most historic decision we will ever take in Scotland carried out legally and fairly, on a straightforward and decisive basis. Let us get that sorted and let us get on with the debate.
The Government have committed £1 billion over the next three years to implement the youth contract. Our package of support includes wage incentives for employers to recruit 18 to 24-year-olds from the Work programme and increased work experience opportunities for that age group. Other support is also available.
I thank the Secretary of State for that answer. He is well aware of the rising levels of youth unemployment in North Ayrshire and I know that he has received strong representations about it from all the Ayrshire MPs. What more does he think that this Government can do at Westminster to increase public and private investment in North Ayrshire?
I acknowledge the work that the hon. Lady has done and the fact that we recently met to discuss this very serious issue. It is important that the youth contract, which my right hon. Friend the Deputy Prime Minister visited Scotland to discuss on Friday, is taken advantage of by people across the country. I look forward to coming to the hon. Lady’s constituency in the near future to meet those very people so that we can discuss how to implement it most effectively.
Health and large aspects of transport are devolved areas, and it is for the Parliament in Scotland to decide how to allocate its budget. The Government have provided an annual subsidy to Post Office Ltd of £150 million for the last financial year and £180 million for this financial year. The subsidy is not distributed by country or region.
The Prime Minister was asked—
I am sure that the whole House will wish to join me in paying tribute to the servicemen who have fallen in the service of our country since we last met for Prime Minister’s Question Time—Captain Tom Jennings from the Royal Marines, Squadron Leader Anthony Downing from the Royal Air Force, Private John King from 1st Battalion the Yorkshire Regiment, and Rifleman Sachin Limbu from 1st Battalion the Royal Gurkha Rifles, who died after a long period in hospital where he was much loved by the staff who looked after him in Birmingham. Their outstanding courage and selflessness will never be forgotten. They have given their lives serving our country and making our world more secure, and our thoughts should be with their families and friends.
This morning I had meetings with ministerial colleagues and others, and in addition to my duties in this House I shall have further such meetings later today.
The whole House will wish to associate itself with the Prime Minister’s tribute to the fallen.
May I ask the Prime Minister to join me in congratulating Cranswick Country Foods on its £15 million investment creating a state-of-the-art facility in my constituency, which is licensed for exporting to the US Department of Agriculture, exports throughout the EU and employs more than 1,200 people? Unfortunately, the Food Standards Agency is blocking exports from that excellent plant to the far east. Can my right hon. Friend assure me that job-destroying and unnecessary regulation will not be tolerated by his Government?
I certainly join my hon. Friend in congratulating the company in his constituency on its expansion and on the welcome new jobs it is bringing. It is vital that we rebalance our economy, with greater emphasis on business investment and on exports. Exports to China went up by 20% last year. I shall certainly do everything I can to help to resolve the situation, and I shall be happy to ask a Minister from the Department for Environment, Food and Rural Affairs to meet my hon. Friend to discuss this issue.
May I join the Prime Minister in paying tribute to Captain Tom Jennings from the Royal Marines, Squadron Leader Anthony Downing from the Royal Air Force, Private John King from 1st Battalion the Yorkshire Regiment, and Rifleman Sachin Limbu from 1st Battalion the Royal Gurkha Rifles? All of them showed enormous courage and bravery. They have made sacrifices on our behalf, and our deepest condolences go to their families and friends.
In the autumn statement the Chancellor said that train fares would rise by only 1% above inflation. Can the Prime Minister therefore explain why rail companies this month on some of the busiest commuter routes have increased their fares by up to 11%?
No, Mr Speaker, the Prime Minister is wrong. The last Labour Government stopped them doing that, and this Prime Minister, when he came to office, reversed that policy, which we introduced. That is why the companies are able to rig the fares. That is why someone travelling from Northampton to London will see a rise on the season ticket of more than £300. Will he now stand up to the train companies, get a better deal for commuters and change his policy?
I know that the right hon. Gentleman has had a difficult start to the year, but I am afraid he has made it worse by getting the facts wrong. Labour, in 2009, allowed fare increases of up to 11%, because they introduced the idea of flexibility of 5% over and above the RPI plus 1% that was the case. What was the case in 2009 is the case today, but the key issue is this: there are only two places that money for railways can come from. It can come from the taxpayer or it can come from the traveller. What really matters is whether we are going to put money into rail investment, and this Government are putting that money in. We are building Crossrail, we are electrifying the Great Western main line, we are electrifying the line between Manchester and Liverpool, we are putting £308 billion into Crossrail, and of course, as my right hon. Friend the Secretary of State for Transport announced yesterday, we are building High Speed 2 as well.
I am afraid the Prime Minister is just wrong about the facts. The Labour Government saw that train companies were taking advantage of consumers, ripping them off by increasing fares more on the busiest routes, and we stopped it. We took that power away from them. He came to office and brought the power back. He made the wrong decision. And as for his idea that this is all to help the passenger, only last month the National Audit Office warned that the problem was that the money would probably result in increased train operating company profits. I ask the Prime Minister again: will he now go back and reverse his policy?
We originally set out an RPI plus 3% policy for train fares. We found money in the autumn statement to reduce that to RPI plus 1%, but if the right hon. Gentleman wants to see more money go into our railways—presumably he supports the electrification of the Great Western main line and the railway lines in the north-west—he will be touring the country telling us that he supports these things, but he is never prepared to take difficult decisions in order to support them. It is time—[Interruption.]
It is time for the Leader of the Opposition to listen to his shadow Defence Secretary, who wrote very candidly over Christmas:
“There is a difference between populism and popularity”—
and that difference is called credibility. Time to have some, I think.
Instead of his pre-prepared lines, the right hon. Gentleman should get his facts right about his own policy. He is just wrong. He says that he is continuing the policy of the Labour Government, and he is simply wrong on the facts. The Labour Government saw what the train companies were doing and said that we would put an end to it. The Prime Minister said at the weekend that he wanted to take action against crony capitalism. He has failed at the first hurdle. I ask him for the last time: will he now reverse the policy?
We are now on to the issue of higher pay. On the issue of the rail fares, let me be absolutely clear. Labour introduced the policy of 5% flexibility. They changed it for one year only—for an election year—but with no intention of making that permanent. If the right hon. Gentleman does not know that, he should. [Interruption.] If he wants to get on to the issue of executive pay, he is entirely right to raise it. Unlike a Government who did nothing—[Interruption.]
I understand that my right hon. Friend recommended me for one new present, and I am about to ask him for another. The Leader of the Opposition is talking drivel, I am afraid. My constituents on the Kent coast line had been paying up to 10% increases under the previous Government for the last four years, until they lost office. I congratulate this Government on their courageous decision to pursue High Speed 2. May I ask my right hon. Friend to turn his attention now to a piece of unfinished business left by the previous Government? High Speed 1 at present runs, in effect, only from St. Pancras to Ashford. Could he see it driven through to Thanet, so that we can enjoy the sort of benefits that in the future will be enjoyed by Birmingham?
First, I congratulate my hon. Friend on his well-deserved honour for his many years of service to his constituents. He is entirely right about what happened under the previous Government, when regulated fares went up by over 18% and unregulated fares went up by over 23%. I will certainly look into what he says about High Speed 1, but I think that it is an advertisement for what we can get by linking up our country with high-speed rail, shortening commuter distances and helping to change the economic geography of our country so that we can build a stronger economy.
Q2. Over 80,000 pensioners in Liverpool will lose up to £100 this winter following the Government’s cut in winter fuel allowance. Will the Prime Minister adopt Labour’s policy of ensuring that energy companies automatically put elderly customers on the cheapest tariff for gas and electricity? (88198)
I am afraid that, as with the hon. Lady’s party leader, there seems to have been an outbreak of collective amnesia on the Labour Benches, because we have kept the previous Government’s policy on the winter fuel allowance and are meeting in full all the promises that she and her party made on the winter fuel allowance. We have gone one further, because they introduced higher cold weather payments only for election year, but we have made them permanent.
The Prime Minister will have experienced at first hand the quality of nursing at Treliske. What steps are the Government taking to ensure that patients across the country receive the highest possible standards of nursing care from the NHS?
My hon. Friend is entirely right. I well remember—indeed, I will never forget—the time I spent at the Royal Cornwall hospital and the happy days I had there, and it was a great privilege to go back again last year. We have very high standards of nursing care in our country and the overwhelming majority of nurses do a fantastic job, but I do not think that we would be serving our constituents properly if we did not highlight those few cases where it goes wrong, and we have seen in the Care Quality Commission reports that there are areas where it has gone wrong. I think that it is incumbent on the Government to try to remove the bureaucracy that can get in nurses’ way, but it is also important for us to highlight best practice in the best hospitals in our country—I visited an excellent hospital in Salford last week—and say, “Let’s copy that right across the country,” so that we have high standards of care and look after the nutritional needs, indeed all the needs, of vulnerable people in our hospitals.
I want to ask the Prime Minister about Scotland. We on this side of the House believe that the United Kingdom benefits the people of Scotland and the people of the rest of the United Kingdom in equal measure. We are stronger together and weaker apart. Does he agree that we must make the case for the Union—not simply a case against separatism, but the positive case about the shared benefits to us all of Scotland’s part in the United Kingdom: the shared economic interests, the shared institutions such as the NHS, the defence forces and the BBC, and above all the shared values we hold together?
I am happy to say that this is an area where the right hon. Gentleman and I will be in 100% agreement. I passionately believe in the future of our United Kingdom, and passionately believe that we are stronger together than we would be by breaking apart. Frankly, I am sad that we are even having this debate, because I support the United Kingdom so strongly, but we have to respect the fact that Scotland voted for a separatist party in the Scottish parliamentary elections, so the first thing that it is right to do is make clear the legal position about a referendum, which is what my right hon. Friend the Scottish Secretary has been doing. We have made the offer to devolve the power to hold that referendum so that it can be made in Scotland and held in Scotland. Frankly, I look forward to having the debate, because I think that too many in the Scottish National party have been happy to talk about the process but do not want to talk about the substance. I sometimes feel when I listen to them that it is not a referendum they want, but a “neverendum”. Let us have the debate, and let us keep our country together.
May I agree with the Prime Minister? This is not a fight about process between the Westminster Government and the Scottish Government, or between the British Prime Minister and the Scottish First Minister. The way to tackle this issue is to have immediate cross-party talks in Scotland about the timing of the referendum, the nature of the single-question referendum and the vital involvement of the Electoral Commission. Does the Prime Minister also agree with me that we need as soon as possible, as he said, to get beyond process and have that discussion about the substantive issues? This is a momentous decision that our children and grandchildren will have to live with if we get it wrong, so we need a serious, thoughtful and inclusive debate about the choices and the benefits to Scotland of staying in the United Kingdom. On this important issue, the people of our country deserve nothing less than that serious debate about the benefits of the United Kingdom.
The right hon. Gentleman is right on those three points. On the process of negotiation, which is very important now, particularly given that the SNP has come out and made more clear what it wants to do, I am very happy for the UK Government and the Westminster Parliament to speak directly to the Scottish Government and the Scottish Parliament, and let us come to a conclusion about the best time and the best way to hold the referendum. But it must be clear, it must be legal, it must be decisive and it must be fair. Those are the absolute keys. I absolutely agree with the right hon. Gentleman: as soon as those process questions are settled, we need to get on to the substance. [Interruption.] The only point I would make about the timing—[Interruption.] As SNP Members, who cannot seem to keep quiet, are so keen to leave the United Kingdom, I do not quite understand why they want to put off putting the question for so long.
My hon. Friend is absolutely right to raise that issue. We have taken some steps, as the previous Government did, to try to crack down on the practice of forced marriage, which, tragically, does take place in too many communities and too many places in our country. We are looking specifically at whether we should take further legal powers and make it a criminal offence, and I am taking a personal interest in the issue, as I think we should be taking every available step to say that it is simply unacceptable, in 2012 in a civilised country such as ours, to have such a barbaric practice.
Q3. Nottinghamshire police serve areas of deep deprivation, face some of the highest crime levels in the country and, rightly, have ambitious crime reduction targets, but Her Majesty’s inspectorate of constabulary says that Nottinghamshire is one of five forces facing the most significant challenge to protect their front lines, and senior officers tell me that Government cuts will impact on front-line policing. Is it not time to implement the police funding formula in order to give my local police the resources that they need? (88199)
I shall look carefully at what the hon. Lady says, but all police forces are having to make efficiencies, and I praise chief constables for the steps that they have taken to deliver those efficiencies without affecting front-line policing, while at the same time still delivering a reduction in crime levels.
In Nottinghamshire police there are still 47 officers working in back-office jobs, there are still trained police officers working in human resources, finance and corporate development, and there is still further work to be done to civilianise those parts of the police force and make sure we get all our police officers out on the front line.
Q4. Following the murder of my constituent Jane Clough by her former partner, a rapist, Jonathan Vass, I presented the Bail (Amendment) Bill to the House, and in October the Ministry of Justice team agreed to change the law. Can the Prime Minister confirm to the House, and to Jane’s parents, who are in the Public Gallery today, when that will happen? (88200)
First, on behalf of the House, may I pay tribute to my hon. Friend for his work on the issue and, indeed, on that case? Our sympathies go out to the family, who have suffered so appallingly. I accept, and the Government accept in principle, that there should be a right of appeal against Crown court decisions allowing bail. There is of course that right in magistrates court cases, so there is a strong case for changing the law, and we will table an amendment in the Lords to the Legal Aid, Sentencing and Punishment of Offenders Bill, creating a right of appeal to a High Court judge against the granting of bail by a Crown court. I hope that that will improve the law, be more helpful to victims and give some satisfaction to the family whom my hon. Friend is representing so well.
The Scottish Government were elected with an overwhelming mandate to deliver an independence referendum in the second half of this parliamentary term—[Interruption.] They were. It is a fact. In contrast, the Conservative party has fewer Members of Parliament in Scotland than there are giant pandas in Edinburgh zoo. Why is the Prime Minister trying to emulate Margaret Thatcher by dictating to Scotland?
Quite the opposite: we want to give Scotland the power to hold a legal referendum. Right across this House there is a uniform belief that that needs to happen. Discussions can now be entered into about the timing of the referendum and its precise nature, so that we can ensure that it is fair and decisive. The people of Scotland deserve nothing less.
Q5. Care of our older people is one of the most pressing issues facing this country today. Will the Prime Minister join me in welcoming Age UK’s Care in Crisis campaign, which was launched on Monday? Will he commit to ensuring that the White Paper due in the spring will present a way forward on this vital issue? (88201)
I pay tribute to my hon. Friend for his work on this issue, and to the Age Concern campaign. We have a huge challenge to rise to this agenda and we want to do so through the White Paper. There are three elements: we must do something about the rising costs of domiciliary care, improve the quality of the care that people receive, and address the issue of people having to sell their homes and all their assets to pay for care. We are looking hard at all those issues to work out a way forward that is right for our system, and that the country can afford.
Q6. The Sunday Times showed that in the past two years the 1,000 richest persons in Britain got richer by £137 billion—enough to pay off the entire deficit. Will the Prime Minister therefore tax them to fund the creation of 1 million jobs, which would be a far better way of cutting the deficit than prolonged austerity? (88202)
For a minute, I thought that the right hon. Gentleman was talking about the Prime Minister he served under. It is essential that as we reduce the deficit and take difficult decisions we are fair, and are seen to be fair. What we have done so far has seen the top 10% of the country paying 10 times more than the bottom 10%. Crucially, the top 10% in terms of earnings are paying more not only in cash terms, but as a percentage of their income. As we go ahead with this agenda, I want to ensure that people behave responsibly, and that the Government do too.
Q7. I am sure that you, Mr Speaker, and the Prime Minister will want to congratulate Mr Tony Whatling, who has served as postmaster in Westhall for more than 60 years and has still not retired. However, residents in Wangford and Walberswick are being let down because there is no post office outreach provision. Will the Prime Minister encourage the Post Office to use its generous subsidy to ensure that rural villages are served, not left stranded? (88203)
I certainly join my hon. Friend in paying tribute to Mr Whatling. To run a village store and post office for 60 years is a huge achievement. It is people like him who keep our country going. The Government have committed £1.3 billion to improve the network. As a condition of that funding, the Post Office must maintain at least 11,500 branches, but the point that my hon. Friend makes about mobile post offices is a good one. That is a way to serve many communities and to ensure that elderly and vulnerable people in particular get the services that they need.
The position is very straightforward. We did not sign the treaty because we did not get the safeguards that we wanted to receive. That situation is not going to change. What coalition partners want to put in their manifestos at the next election is entirely up to them.
Q9. Does the Prime Minister agree that people should pay their taxes, keep their businesses onshore and not live as tax exiles in Switzerland, leaving pensioners high and dry? What is he doing to stamp out such predatory business practices? (88205)
My hon. Friend makes an interesting point. For all the lectures about predatory capitalism and taxing different businesses in different ways, the one person the Leader of the Opposition has chosen to advise him on this issue has based all his companies in the British Virgin Islands.
Q10. The funding for the United Kingdom Resource Centre for women in science, engineering and technology has been cut. Given that 1 million women are unemployed and that women make up only 12.3% of people in science, engineering and technology, will the Prime Minister look again at funding for the UKRC, and at thereby restoring Britain’s leading role in science, which nurtured the talents of Dorothy Hodgkin and Rosalind Franklin? (88206)
I will certainly look at the case that the hon. Lady sets out. As she knows, despite having to make difficult decisions across a range of public spending areas we did not cut the science budget. Indeed, in the autumn statement the Chancellor provided a series of enhancements for specific science-based projects. I will look at the specific one that the hon. Lady mentions and get back to her.
Today, unfortunately, is the 10th anniversary of the opening of Guantanamo Bay, a despicable institution that to this day still holds one UK national. Will the Prime Minister commit to doing all he can to see that 2012 is the last year in which that institution operates?
My right hon. Friend the Foreign Secretary is working very hard with the United States to try to secure the issue and bring this chapter to a close. As the hon. Gentleman will know, we have also taken steps as a Government and as a country to try to achieve some closure to what happened in the past, through a settlement with the people who were in Guantanamo Bay and through setting up a proper inquiry to ensure that the British Government were not complicit in any way in the torture of people in Guantanamo Bay or elsewhere.
Q11. A moment ago, the Prime Minister was clear that it is crucial that Government economic policy be fair and be seen to be fair. Can he therefore confirm that the 50% tax rate on incomes above £150,000 will remain in place for the duration of this Parliament? (88207)
We take pretty much the same point of view as the former shadow Chancellor who, when he introduced that rate, said that it should be a temporary measure. I think we should also make a judgment about how much money the tax is actually raising. The purpose of the tax system is to raise money for the funds that we need to put into our public services, and it is very important that we look at how it works in practice.
Will the Prime Minister congratulate the Secretary of State for Transport and the good workers of Bombardier on securing a £188 million contract on 28 December, and on the announcement on the Toronto stock exchange, which was so important to the workers in Derbyshire?
I congratulate everyone at Bombardier on winning that contract. As I have said before from the Dispatch Box, I want the Government to be a good customer of British firms and work with their supply chain, and not to make the mistakes that the last Government made. They drew up the contract for the railway service that Bombardier did not win.
Q12. The Prime Minister will probably be aware that a chief executive of a stock exchange top 100 company is paid 35 times as much as a hospital consultant who keeps people healthy and saves lives. If the Prime Minister is going to act tough on high pay, and if he really does get it, will he give a date—a year from now, or within the lifetime of this Parliament—when we will see that obscene 35 times multiple come tumbling down? (88208)
I do think that we should make progress on the issue of pay ratios, and we can start with the Government setting out their own pay ratios as an act of leadership. I think this Government have shown some leadership, not least by cutting and freezing Ministers’ pay and having total transparency on pay across Government. On the specific case that the hon. Gentleman raises, this year we have seen a 49% increase in pay yet only a 4% increase in the FTSE. I am not against people running great companies being paid lots of money if they are growing and expanding them and succeeding, but we should not have rewards for failure. Frankly, the last Government had 13 years to deal with this, and did sweet nothing.
My hon. Friend makes an important point. The issue of top people’s pay and this issue are, in many ways, linked. We need to get rid of a something-for-nothing culture in this country. We inherited an out-of-control benefit system in which there were families on many tens of thousands of pounds of housing benefit. We had an out-of-control immigration system in which it paid to cheat, and we also had an out-of-control banking system in which reward was not linked to success. Unlike the last Government, we are going to deal with all those things.
The first and most important thing is that we are committed to year on year increases in NHS spending. I am afraid that that position is not backed by the hon. Gentleman’s party. Alongside the extra money, we also need to make sure that there is reform so that we give clinicians a leading role in the health service. We also have to do more on the public health and health promotion agenda, because that is the best way to reduce demands on our NHS. There is also one extra thing that we need to try to achieve: looking at the links between alcohol and crime, and alcohol and hospital admissions, which put massive pressure on our NHS. That is an issue that I want this Government to deal with.
Ethnic cleansing and apartheid are evil. Sadly, successive Governments have supported a country where those vile actions are inflicted on indigenous people. We welcomed the Arab spring, but the long Arab winter continues for Palestinians. Last Tuesday the Israeli Government said that they would proceed with the forced eviction of 30,000 Bedouin Arabs from their historic lands. Is it not time we treated Israel as we did apartheid South Africa?
What I would say to my hon. Friend is that first, we should respect the fact that Israel is a democracy. It is a country that has a right to exist and that has frequently been threatened by its neighbours—but also, we are a country that should stand up for clear human rights and clear rights and wrongs in international relations. This Government have been very clear that we do not agree with the Israeli Government’s practice on settlements. I raised the issue myself with the Israeli Prime Minister in a new year telephone call, and this Government will continue to act and vote on illegal settlements.
Q14. Bethany Mickleburgh, a 14-year-old girl in my constituency, has leukaemia and desperately needs a bone marrow transplant. Despite an incredible campaign by her family to get more people to join the blood stem cell register, Bethany still does not have a match and is having to look overseas. What plans do the Government have to improve public awareness of that vital issue and increase the number of potential bone marrow donors in the UK? (88210)
The hon. Lady is right to speak up for Bethany specifically, but also for all bone marrow cancer sufferers. The need to get more people on to the register, because of the importance of trying to get a match, is not widely enough understood. The Government will spend about £4 million this year to help promote that and make it happen. However, all of us, in our constituencies and in our own ways, can promote the idea and encourage people to do as the hon. Lady says.
May I draw my right hon. Friend’s attention to the excellent paper that ResPublica published this morning, which seeks to build on the Government’s initiatives both to build up cadet forces and to get more former military personnel into schools as teachers? It proposes that we set up in some of most deprived communities military academies and free schools administered by the reserve forces and cadets associations.
I pay tribute to my hon. Friend, who does so much to speak up for our reserve forces and our cadet forces, which are incredibly valuable assets to our country. It is worth noting that this year the cadet forces will do a huge amount to try to save and preserve our war memorials from the appalling crime of metal theft that they have been suffering. I will look very carefully at the ResPublica report that my hon. Friend mentions. We should empower our cadet forces to expand and perhaps to go into parts of the country where they have not always been present. The link that my hon. Friend makes between them and schools is a very good idea, which we should promote and support.
My constituent Miss S, who is 32, has lived alone for eight years and was forced on to housing benefit because of redundancy. That benefit has just been cut by nearly 50%, to the shared accommodation rate. Which does the Prime Minister think is most likely: that her landlord will reduce the rent by 50% or that she will be made homeless?
I congratulate the right hon. Lady on her preferment in the new year’s honours list. Although I profoundly disagree with many of the things that she has tried to do over her political career—mostly to disarm Britain one-sidedly—I praise her for her persistent efforts. No one can accuse—[Interruption.] I am sorry; let me answer the question very directly. As I understand it, all parties are committed to reform housing benefit. That was Labour’s commitment before the election. The housing benefit bill is completely out of control. Labour’s own welfare spokesman said last week that, at £20 billion, it was unacceptable and had to change. What we have seen so far, as housing benefit has been reformed and reduced, is that rent levels have come down, so we have stopped ripping off the taxpayer.
With permission, Mr Speaker, I would like to make a statement about PIP breast implants. The House will be aware that approximately 40,000 women in this country have had implants manufactured by the French company Poly Implant Prothese, and that these implants could have been made of a non-medical grade silicone gel. My concern throughout has been for the safety and well-being of all these women. I wish now to update the House on what happened; how we are looking after the women concerned; and the further actions required.
In 1997, PIP received a European CE mark for its silicone breast implants. The CE mark was overseen by the German notified body, TUV Rheinland. The Medicines and Healthcare products Regulatory Agency adverse incident centre received a number of reports annually about PIP implants. Based on such reports, in 2008, the MHRA raised its concerns with the German regulatory authorities and the manufacturer. The MHRA was reassured by the notified body that the number of adverse reports was adequately explained by changes in the company’s reporting practices and by the increasing number of implants sold.
However, in March 2010, the French regulator discovered that rather than using medical grade silicone gel in the implants, PIP had in fact been using unauthorised silicone gel. This is in clear violation of the CE mark. The mark was promptly withdrawn and all EU member states immediately alerted. The MHRA immediately issued advice to stop using PIP breast implants in the UK. The French authorities are currently investigating this as a criminal matter, and the UK Government will help in any way we can with their investigation.
Initial toxicology tests in both France and the UK found no significant health risk to women with the implants. Also the MHRA could find no evidence of an increased risk of cancer. However, on 23 December 2011, following an increase in the number of reported ruptures, the French Ministry of Health announced that it was advising women, as a non-urgent precautionary measure, to consider having their PIP implants removed. The MHRA’s advice was that there was no scientific basis for recommending routine removal of implants in the absence of symptoms.
The available data, however, were incomplete. For this reason, I asked Sir Bruce Keogh, the NHS medical director, to form an expert group and to review the available data, including information from the French authorities, and to offer more definitive advice. I received the group’s interim report on Friday 6 January and a copy has been placed in the Library. I would like to thank the experts and members of the profession for their hard work and commitment in producing this rapid report.
The main findings of the expert group were, first, that there is no causal link between these implants and breast cancer. Secondly, the evidence on the rate of ruptures for PIP implants compared with other implants is incomplete and so this risk cannot be assessed definitively. Thirdly, although the rupture of implants or leakage of material can result in inflammation, there is no clear evidence that these problems are more serious in relation to PIP implants than other implants, or that they result in increased long-term health risks. Therefore, they have not recommended routine removal of the implants. Fourthly, there are risks inherent in the removal of breast implants, just as with any surgery, and these risks should be taken into account when taking any clinical decisions. However, for this particular group of women the risk is very low. Fifthly, the expert group recognises, as we have throughout, that women with PIP implants will be understandably concerned that they did not have the character of implant that they thought they did. The expert group advises, as we have, that we should give every woman an opportunity to secure advice, investigation and remedy.
The women who received the implants did so on the understanding that the implants met the requirements of the CE mark and were safe. That was not the case, and every provider has a responsibility to put things right. Although the majority of women will have received their implants privately, some—such as those who have had reconstructive surgery following mastectomy—will have received PIP implants through the NHS. All those patients will receive the highest possible standard of care. First, they will be contacted to inform them and give them all the relevant information and advice. Women who wish to will be able to speak to their GP or the surgical team that carried out the original implant to get advice on the best way forward for them. If the woman chooses, that could include an examination by imaging. If, when informed by an assessment of clinical need of the risks involved and the impact of any unresolved concerns, a woman decides with her doctor that it is right to do so, the NHS will remove and replace the implants, if the original operation was done by the NHS. Last week the NHS chief executive wrote to the service, and Dame Sally Davies, the chief medical officer, wrote to GPs and relevant health professionals. Copies of those letters are available in the Library.
It is right that those who received their care privately should also receive a similar level of service and reassurance from their care provider. However, I do not think it fair to the taxpayer for the NHS to foot the bill for patients who had their operation privately. Eight private health care companies, including Nuffield Health, Spire Healthcare and BMI, have confirmed that they will follow the same guidelines as those that I have set out for NHS patients. However, I want to be absolutely clear that the NHS will continue to be there to support any woman. If a clinic that implanted PIP implants no longer exists or refuses to remove the breast implants, where that patient is entitled to NHS services, the NHS will, in consultation with their doctor, support the removal of PIP implants in line with the guidance that I have just outlined. Any NHS service in that instance would cover only the removal of the implant, which would not include the replacement of private cosmetic implants. In such cases the Government would pursue private clinics to seek recovery of our costs.
These events highlight the need to ensure the safety of people having cosmetic interventions. It is clear from the information that we have received from the industry that the safety information that it collects and provides to the regulator is of variable quality. Without good data, we have no way of knowing when problems arise. I believe that there are a number of things that we now need to do. First, lessons need to be learned from this case and incorporated into the ongoing review of the EU medical devices directive. I spoke to Commissioner Dalli yesterday, and can confirm that this European work is under way. We also need to understand what happened in this instance in the United Kingdom. A review for that purpose will be led by the Minister for Quality, Earl Howe, with expert advice, and will shortly put its terms of reference in the Library. That review will investigate and report rapidly. The blame for what happened lies with PIP, but the review will enable us to learn lessons to improve future regulatory effectiveness and will feed into the Commission’s review.
In addition, the Care Quality Commission will conduct a swift review of private clinics. That review will look at evidence of compliance, patient safety and clinical quality, and the information and support given to their patients. Where a provider does not meet those requirements, the CQC has a wide range of enforcement powers that it can use to protect the safety of patients. The findings of that review will be published before the end of March.
Looking to wider issues of clinical safety and regulation, I have also asked Sir Bruce Keogh to reconstitute his expert group to look at how the safety of patients considering cosmetic interventions can be better ensured in the future. That will include treatments such as cosmetic surgery and dermal fillers. I expect his review to consider whether cosmetic products and interventions are appropriately regulated and have strong clinical governance; whether patients and consumers can be confident that the people who carry out procedures have the skills to do so; and whether the settings in which such procedures take place are able to ensure the care and welfare of people who use their services. That review will consider issues of governance, data quality, record keeping and surveillance, as well as ensuring that proper information is provided to secure patients’ informed consent.
I expect the review also to include consideration of an outcomes-based register of frequently implanted devices, covering everything from breast implants to heart valves and replacement joints, in order to provide the United Kingdom with a valuable asset for further innovation and safety improvement. There is already considerable clinical support for such a comprehensive register. The Government’s commitment is to provide effective reassurance and remedy for women with these implants, and also to learn the lessons to deliver safety and quality for the future. I commend this statement to the House.
I thank the Health Secretary for his statement, and for the steps that he is taking to help the thousands of women who have found themselves in this worrying situation. We welcome much of what he has just announced, including the further reviews that he has commissioned. I assure him that we will support him in his efforts to reach a resolution as quickly as possible for all those people who are affected, but I have to tell him that he has a lot of work to do, and a lot of ground to recover, as his response to date has not helped to build those people’s confidence.
Over the Christmas break, the mixed messages coming from the Government did not go unnoticed. They only added uncertainty in what has been an anxious time for many people. The Health Secretary has gone from downplaying the dangers on 23 December to announcing an urgent review on new year’s eve, then giving an inconclusive statement late last Friday evening. This has left the people affected struggling to make sense of what it means. For the vast majority whose implants were fitted privately, there was precious little practical advice or help from the Department of Health as they began approaching their private providers. Many women were unable to access their records or told that long delays would be involved. Others have been asked to pay large fees to access their records. Many have simply hit a brick wall when they have sought medical advice or removal, even where there is evidence of rupture.
What people needed at the earliest stages was a strong statement from the Government of what was expected of all private providers—namely, that records should be provided without delay and without charge; that consultations should be arranged when people were worried; and that removal should be arranged urgently when there was evidence of rupture. The reality is that the Government’s failure to provide that leadership from the outset has left people fending for themselves in the face of a self-serving and unaccountable industry.
The Health Secretary was right, however, to establish an urgent review of the evidence by the NHS medical director, Professor Sir Bruce Keogh. We welcome the speed with which that review was conducted, and we echo the Health Secretary’s thanks to the members of the review panel. We accept the Government’s judgment on the advice to women regarding the removal of implants on the basis of the data that they have seen, but what confidence can we have in the evidence and data on which those decisions were reached?
We note the Secretary of State’s public comments about the industry’s failure to provide quality information in a timely fashion, and the interim report’s finding that the evidence is subject to “considerable uncertainty”. The review concludes that it should reconvene in “about four weeks time” to examine any new evidence, and to consider whether to update its recommendation on removal. I have to tell the Health Secretary, however, that that feels way too vague and ad hoc. May I press him to give a clearer timetable for this further process of review on whether to change the recommendation on removal? People need absolute clarity on when further statements will be made, so that they can make informed decisions. This is of course a separate matter from the long-term reviews that he has announced today.
This is particularly important in the light of the different decisions that other Governments are beginning to make in response to the situation. Yesterday, the Welsh Government announced that all women who received PIP implants, including those treated privately, will be offered replacement implants on the NHS. That is of course different from what the Health Secretary has announced today. What discussions did he have with his counterpart Minister in the Welsh Assembly Government before their announcement was made? Will he assure the House today that all the data that were available to Welsh Ministers and officials were also available to, and considered by, the Keogh review? Governments around Europe have responded sooner, more decisively and with greater clarity than the coalition has done. By contrast, people here have found the Government’s statements in response to be both inconclusive and ambiguous.
We support the decision to help NHS patients to have PIP implants removed and replaced, but does the Secretary of State appreciate how that decision has added to the confusion that many people feel and was interpreted as contradictory to the review’s overall finding? The clear implication of the Keogh review is that the best course of action is, in fact, to have the implants removed, but again no practical help was offered beyond the statements of expectation for private providers to match the support on offer from the NHS and the reference made to “moral duty”.
I, too, commend the private providers, such as Nuffield, Spire and BMI, that have done the right thing by their patients, but in recent days we have heard how some of the leading cosmetic surgery clinics have simply ignored the Health Secretary’s appeal. Transform, which used PIP implants on over 4,000 patients, has said that all women affected will have to pay £2,800 for removal, while the Harley Medical Group, which has 13,900 patients with PIP implants, has offered to pay for the cost of the new implant, but only if the NHS pays the far greater bill for the surgery. I am sure the whole House will agree that this is an appalling response to this situation, and that the failure of these companies to face up to their duty of care for their patients leaves everybody, including the Government, in a difficult position. It is simply unacceptable for any woman in England to be left in a position where she is worrying about her health and thus has no peace of mind, but is unable to afford to do anything about it.
I appreciate what the Health Secretary has said today about helping people out of this predicament. I agree with his decision where private clinics no longer exist, but in accepting that the NHS will provide private treatment where private providers refuse to, is he not in danger of letting those providers off the hook? May I remind him that most people will not accept that the NHS should subsidise the failures of private companies, and will look to him to pursue them to the nth degree to get any costs back? For instance, has he fully explored the insurance position of these private providers as a means of recovering costs? He says he will pursue them, but what assumptions has the Department of Health made about the likelihood of his success, and how much money is expected to be recovered? Has he fully explored the position of the French Government and considered whether there is any residual liability on the device manufacturer in that company?
Let me turn briefly to questions of regulation. Can we support what the Secretary of State said today about the wider review of regulation of the cosmetic surgery industry? If there are any loopholes, we will support him in closing them down.
Finally, the right hon. Gentleman’s Health and Social Care Bill envisages a much expanded role for the private sector in the delivery of health care. I make no comment about that, but has he reflected on the Bill and revisited the assumptions behind it? Will he assure us that issues of quality and safety will be safeguarded in the NHS that he seeks to create? We want to be assured that he is giving careful consideration to all these issues, as he considers his response to this worrying situation.
I am grateful to the shadow Health Secretary for his welcome of my statement and the principles behind what we are setting out to do to look after the women affected by these implants.
I do not share the right hon. Gentleman’s view that there were any mixed messages. I am sure he would have been the first to complain if I had not identified the lack of available and consistent data and not asked an expert group to look into this. As we look at countries across the world, we can be confident that we have set an exemplary standard in looking after women through the NHS and in bringing together an expert panel fully to understand what would be the best advice for women. The advice that no identified specific safety concern justified the “routine removal” of these implants was true on 23 December and it remains true today. As we have recognised from the outset and as I said on 23 December, if women are worried or concerned about the possibility of not having the implant they thought they had, that provides a perfectly reasonable basis on which to seek advice and investigation. It would be right for some women to ask for removal, but we should not assume that women are choosing to have these implants removed on the basis of clinical advice—even in France.
The chief medical officer spoke to a clinical counterpart in the Welsh Assembly Government before the publication of the expert group’s work. I have made sure that they are informed, but I have to say that the Welsh Government made an announcement yesterday without previously informing us.
It may be called devolution. I respect the devolved Administrations and always inform them of what I am doing, where it is relevant to them. We do not recognise the advice that Wales received. Sir Bruce Keogh’s expert group, which included some of the foremost experts in plastic surgery, made clear recommendations last week for patients in England and concluded that there was no significant increased clinical risk in cases where implants are not replaced.
If the shadow Secretary of State commends what the Welsh Government have done—[Interruption.] Perhaps he did not, but if he or anyone were to commend it, they would need to recognise that it runs the risk of letting the private providers off the hook. I am very clear that they should provide an equivalent standard of care. As the right hon. Gentleman made clear, there are limitations on what can be done. I do not have powers and I did not inherit powers to control what the private providers do in the private sector. I have to tell the right hon. Gentleman, however, that I have reflected on the Health and Social Care Bill, which is a positive legislative step forward. Just as it allows Monitor as a health and social care sector regulator, on which we are consulting, to look at the prudential regulation of private providers in social care, so it would allow us to consider the role of Monitor as a health sector regulator in licensing private providers of private health care. It is thus a positive not a negative step forward. There is no comparison, as the right hon. Gentleman will recognise, between the role of the private sector providing private care and the private sector in the NHS, which is subject to the same duties and obligations as an NHS provider. The Bill does not lead to an increase in private sector provision, but in so far as there are private sector providers, they will be properly regulated in the NHS.
On the role of private providers, they may be insured and there may be warranties relating to these implants. We do not have data on this aspect, but I am clear that these providers have legal and, indeed, moral obligations. I particularly commend a letter issued this morning by the leaders of the profession—the two principal professional associations—to their surgical colleagues. Having talked about the standard of care in the NHS, the letter went on to say:
“Those working in the private sector are urged to support in similar fashion. We would hope that implanting surgeons would honour requests for replacement surgery free of surgical charge”.
The private providers that have not made this offer to the women for whom they are responsible can see that their surgical associates are willing to carry this out free of surgical charge, so I see no reason why they should not now step up and deliver the standard of care that women have a right to expect.
May I welcome my right hon. Friend’s statement and the prompt action he has taken over the last few weeks to address this issue? Does he agree that the first priority when these concerns came to light was to ensure that the women who have had these implants had clear, authoritative advice based on the evidence of the right way to treat them, and that the process he established under Sir Bruce Keogh has provided and will continue to provide exactly that authoritative evidence-based advice? Does he further agree that there are some longer-term policy issues around the regulation of this industry that need to be addressed, but in a more considered way and not tied up in the emotions of this immediate concern?
I am grateful to my right hon. Friend and agree with all his points. I would add that when the French Government informed us of their prospective announcement—I spoke to the French Health Minister the day before it—we gave the best advice to date, based on the MHRA’s knowledge of the toxicology tests and its discussions with the French regulator. What we have to do is to establish the extent to which surveillance of these implants over a number of years should have led to any different conclusion. It remains true, however, that there is no evidence of long-term health effects that would give rise—and would have given rise at that time—to a different recommendation from the one that we made.
This is not a new issue, as the Secretary of State must know. Twenty years ago I raised the case of a constituent who had to have a double mastectomy because silicon implants had leaked in her body. As a result, we set up an organisation called SOS—Survivors of Silicon. We worked with Which? magazine and the Department of Health, and we helped to set up the register of implants, which was unfortunately not made compulsory. That is why the data are missing.
This is part of a wider issue, of the proper regulation of the cosmetic surgery industry, 70% of which is virtually unregulated. I hope that the Secretary of State will insert an amendment into the Health and Social Care Bill to ensure that there is proper regulation of the whole industry.
I completely understand the right hon. Lady’s point, but this activity is not unregulated. For example, the Care Quality Commission is responsible for the registration of providers, and for ensuring that they meet essential standards of safety and quality. However, for precisely the reasons cited by the right hon. Lady, I am asking Sir Bruce Keogh’s group to consider wider issues relating to the regulation of cosmetic surgery and cosmetic interventions.
The registry to which the right hon. Lady referred was discontinued in 2004 because a substantial number of women were not consenting to the addition of their names to the register. I believe that, given the positive experience that has followed the establishment of the National Joint Registry, we can reassure women that their data can be entered without prejudicing their patient confidentiality.
I should make it clear that as yet we have no evidence demonstrating any significant difference between the rupture and leakage rates of PIP breast implants and those of other implants. Last June the American Food and Drug Administration published the findings of a study of normal implants, two of which had a 10% to 13% rupture rate over a 10-year period. It is important to appreciate that implants in themselves pose a distinct risk of rupture and leakage.
I welcome the clear commitment to putting women’s health needs first in this context, but is not the heart of the problem the obvious conflict of interests for private clinics when it comes to the provision of long-term safety statistics? Will my right hon. Friend ensure that any future system allows women to self-report to the registry—albeit with a follow-up from specialists for confirmation purposes—so that we can have a complete picture of the long-term complications caused by devices of this kind?
My hon. Friend is right. When Sir Bruce and his colleagues are considering the establishment of a wider registry, they will consider not only the possibility of self-registration but the possibility of making clinical professionals responsible for the publication of such data. The responsibility should not rest solely on providers or manufacturers.
I understand that a number of private clinics will not even scan a patient with PIP implants without charging. However, these goods were counterfeit. They were not of a medical standard, and they could be injurious to health. Should not the NHS be prepared to help women who must be worried sick, and perhaps cannot even afford to have a scan to reassure them? I cannot believe that the NHS would turn its back on a patient who was suffering after drinking counterfeit vodka, so why should it turn its back on these patients?
I am sorry that the hon. Lady framed her question in that way, because I thought I had made it clear that the NHS would always be there to support women. We will seek to recover the cost to the NHS if the original provider was a private provider: that approach has been adopted for years, and I am sure that it would have been adopted by my predecessors. No woman should have to feel that she will not be looked after, but I am making a different point—namely that, in the first instance, women should be looked after by the original providers, who have a continuing duty of care. They also have legal obligations—as well as the moral obligations to which I have referred—but it is not for me to advise on those.
If the Government are paying for something that is needed, it is logical to assume that some private firms must be dodging their responsibilities. If those firms are not indemnified against the risks of surgery or willing to accept responsibility for its consequences, why on earth do we allow them to practise? Does the remedy not lie in our hands?
I entirely understand my hon. Friend’s point. The position we have inherited is that I have no powers in relation to the provision of private health care by private companies. As I said to the right hon. Member for Leigh (Andy Burnham), the Health and Social Care Bill provides for the establishment of Monitor as a health sector regulator that will license such providers. I am not making any judgment at this point on whether it would be appropriate for conditions to be attached to such licences in relation to the continuity of service to patients, but it is one option that we can consider.
May I suggest to the Secretary of State that the problems in the cosmetic intervention industry may be far more extensive than we have known thus far? A few years ago, I had my eyes lasered. I visited five clinics, four of which seemed to be trying to sell me an intervention rather than trying to do anything that would be in my general health interest. Will the Secretary of State add laser surgery clinics to his list, and also private dentists, many of which are encouraging patients to undergo operations that they certainly do not need?
I will reserve my position on dentistry, because there is a very wide range and cosmetic intervention constitutes a substantial proportion of overall dentistry activity, but I will happily consider whether there is an issue to be dealt with. As for laser eye surgery, I will ask Sir Bruce’s group to consider not only the establishment of a registry in relation to implants and devices, but cosmetic interventions more generally. I hope that we shall be able to reassure the hon. Gentleman when we publish the terms of reference.
I commend the Black Country Partnership NHS Foundation Trust on conducting 517 breast implant operations in the decade before 2008 without the use of a single PIP implant.
What this furore has revealed to me is the existence of a growing private sector offering a vast array of cosmetic surgery that extends well beyond breast implants. I fear that the need for tighter regulation of the industry will prove widespread, and I therefore welcome the Government’s commitment to a review. Does my right hon. Friend expect to be able to charge the private sector for the costs of any additional regulation that the review group may deem necessary?
I am grateful to my hon. Friend for what she said about the NHS. I think that before considering whether there is a cost associated with regulation and how it might appropriately be met, we should consider what is necessary to assure patients of safety and quality.
I welcome the statement, but may I caution the Secretary of State against placing additional burdens on the Care Quality Commission without providing it with additional resources? May I also urge him to heed the advice of my right hon. Friend the Member for Leigh (Andy Burnham), and pause to listen and reflect on what lessons can be learned and what safeguards can be provided for the future? I am thinking both of the protection of patients’ safety and of future NHS liabilities when surgical procedures or treatments are carried out by the private sector, which is likely to become more frequent as the privatisation provisions of the Health and Social Care Bill are implemented.
For reasons that I have already explained, the hon. Gentleman is simply wrong about that. It is nonsensical to attempt—as the editor of The Lancet did this morning—to compare the regulation of private providers of private care with that of private providers of NHS care. There is no comparison at all.
The CQC will inspect a sample of providers of cosmetic surgery to check that they are meeting registration requirements, and will undertake a number of unannounced inspections as part of that. We expect the inspections to be completed by the end of the month, and expect the CQC to have published its report by the end of March. It has confirmed that it has enough resources to undertake the inspections within its existing budget.
I add my support and thanks to the Secretary of State for what he is doing on this very important issue which has caused so much distress to so many women. Does he agree that this episode flags up a wider issue in the cosmetic surgery industry, in that some practitioners performing medical procedures do not have any medical qualifications or knowledge of anatomy? Does he also agree that it is a problem that there is no psychological counselling and that a holistic look at patients is not taken, as this is an on-demand industry? Finally, does he agree that there must be a proper paper trail and record system in the industry, so that we can consider what is in the best interests of patients and so that there is proper accountability for all providers?
My hon. Friend makes a number of important and perceptive points. It is, and will continue to be, one aspect of NHS advice that psychological assessment can form an important part in the management of patients referred for low-priority procedures, including cosmetic surgery. However, although we will look at cosmetic interventions and their regulation more widely, we must recognise that the issue in this instance related to what was a criminal act—seeking to adulterate the material in the implants. Many private providers were using what they regarded as properly certified implants for a perfectly proper procedure. To that extent, they were not engaging in any improper behaviour. However, they have legal and moral obligations to their patients, and I am asking them to discharge those obligations.
It saddens me that, despite previous reports recommending more effective regulation of the cosmetic surgery industry, it has taken this crisis, causing so much distress to so many women, for the issue to be taken seriously. I am nevertheless glad that it is being taken seriously. Will the Secretary of State consider ensuring that people seeking cosmetic procedures must have independent counselling and advice from a body that will not make a profit from that procedure, and whose whole concern is the health of the patient?
I welcome the statement. What has the Secretary of State learned from this episode about the quality and take-up of routine insurance products offered by private companies to protect both patients and providers when cosmetic surgery goes wrong?
I am grateful to my hon. Friend for her welcome for the statement. Those seeking cosmetic interventions must ask serious questions about not only the nature of the procedure but the quality and reputation of the provider organisation, and ask it how it would protect their interests if things went wrong.
The Secretary of State referred in his statement to the possibility that an organisation that had carried out operations had gone out of business. As there are long-term implications from such surgical interventions, has the Secretary of State considered instituting some form of levy or fund that would have to be paid into—nor do I want to let the private sector off the hook—so that if organisations go out business there would be a sum of money from which people could claim?
As I hope the hon. Lady will appreciate from what I said to the right hon. Member for Leigh (Andy Burnham), the Health and Social Care Bill introduces for the first time a comprehensive continuity of service regime for the NHS, and it also creates, through the health sector regulator, the potential for us to consider whether such continuity of service needs to be extended beyond the NHS.
If the NHS stands behind private providers in such cases, it is effectively providing free indemnity insurance. Will the Secretary of State look at the insurance position of providers of such services and ensure that the taxpayer does not face open-ended liabilities?
As my hon. Friend points out, to that extent the NHS has always stood behind the private sector provision of health care. If things go wrong, people have the right to access NHS treatment as they must be looked after on the basis of clinical need. Referring back to points I made earlier, the Health and Social Care Bill gives us an opportunity to look more systematically at continuity of care for patients both in the NHS and the private sector and at the responsibilities of providers under their licence.
I thank the Secretary of State for coming to the House and making this statement. How many clinics will the CQC be reviewing, and what will happens in respect of any clinics that are no longer practising? Presumably the CQC will not have access to their records.
I cannot tell the hon. Lady how many clinics the CQC will visit, but it will be a sample of providers, not all of them. As she may know from the material we published last Friday, there were 93 private providers. The operations were heavily concentrated in that a lot of them were carried out by a small proportion of providers, but about 87 other small providers, or even single-handed providers, are involved and accessing data from all of them will be difficult. I also recognise that, as the hon. Member for Edinburgh East (Sheila Gilmore) said, some may not be in business any longer, or there may be surgeons who have retired.
I also thank the Secretary of State for making the statement. Following on from a vein of questioning that has already been explored, will he elaborate on the point about the Government pursuing firms to recover costs and explain what mechanisms are available to the Secretary of State to recover costs?
I will do so to an extent. It depends on the nature of the legal contract between a woman and her private provider. I hope that in many cases the legal obligations derived under that contract or under sale of goods and services legislation will clearly mean that the woman will get redress from her private providers or her insurers. If the NHS becomes involved, there may be compensation through the injury costs recovery scheme, so if the NHS incurs costs, we can go on to seek to recover them.
Given the nature of the work I am asking Sir Bruce Keogh and his group to undertake, it will take them some time to look at the range of cosmetic interventions and make any recommendations. They are coming together as rapidly as they can. Many of them have given up a great deal of time over the past two weeks to help us in this work. We must recognise that there are things we need to do rapidly to ensure that there is support and reassurance for any woman affected by PIP implants, and we are acting rapidly. There are lessons and wider implications to be learned. This particular area of cosmetic surgery was not without regulation. The question is to what extent things were properly regulated with surveillance and enforcement over a number of years.
I welcome the Secretary of State’s statement. As he knows, I co-chair the all-party group on breast cancer and we will want to monitor how women are treated by the NHS and private providers, and we will certainly feed that into the Department. For women who have fought breast cancer and been through the trauma of reconstructive surgery, this will bring it all back and be tremendously upsetting. Does the Secretary of State therefore agree that speed is of the essence in respect of replacement surgery where it is wanted, so that those women can again put this nightmare behind them?
I am grateful to my hon. Friend and I completely recognise the points he makes. As he will know, the overwhelming majority of the approximately 3,000 women who had PIP implants through the NHS will have had them as breast reconstruction surgery following mastectomy. From day one, we were clear that we wanted all those women to be able to get advice, investigation and remedy, and removal and replacement, should they wish. If the NHS was responsible for the original operation, we will be responsible for the replacement with new implants, if that is what is wanted.
The NHS is very clear about this issue in the advice that was presented. I welcome the fact that my professional colleagues in the associations are making it clear that, through the NHS, replacement procedures for these women should be possible rapidly, but it should not prejudice the availability of urgent referral for cancer, which will continue to be an operational requirement in the NHS.
The question arises of access to records in both the private and NHS sectors. Is it not time to look again at who is the keeper of medical records? Should it not be the patient—therefore bringing together the NHS and private provision, where applicable—rather than the institutions?
Of course, as the hon. Lady knows, we have been thinking hard about precisely this issue. The NHS Future Forum made further recommendations to us only yesterday about achieving access for patients to their own records by 2015 across the NHS. The NHS should keep records, but the patients themselves should have access to them. We will pursue that issue in the NHS, although frankly, I am not in a position to mandate that in the private sector. However, any patient would be well advised to say, “Why can’t I hold my own record from a private provider?”
I welcome the Secretary of State’s statement, but PIP is not the sole supplier of breast implants across the industry. What assurances has he received from the industry that no other company has embarked on the practice of using non-medical grade silicon in its breast implants, so that women who have had such implants can feel safe?
I have no evidence of such behaviour on the part of other companies. My hon. Friend is right: PIP is only one of a number of suppliers, and in this country probably only one in seven breast implants were PIP implants. Other countries have looked at this, and across Europe the regulatory process should ensure the scrutiny of these implants, including proper testing. The European review must look at whether that surveillance, including unannounced inspections and appropriate testing, gives us the assurance we are looking for.
Yesterday, I was contacted by a constituent who had PIP implants inserted by the Harley Medical Group in 2006. She said:
“There is so much conflicting information at the moment, I feel as though I’m being pushed from pillar to post. To add absolute insult to injury nobody is keen on helping us, they are saying the NHS should help…or they say they will perform the procedures on us for an extra fee.”
Can the Secretary of State tell me precisely what further representations he will be making to private providers to ensure that all women get access to the advice and treatment they need?
We have been very clear about the advice we have given to women, and I hope that, through the NHS, any woman in those circumstances would go and see their general practitioner, who will have full access, from the chief medical officer, to the expert advice we have disseminated. I know that the Harley Medical Group has not shared with others the view that it can match the NHS’s standard of care; but given that, the professions are suggesting to surgeons that they should honour requests for replacement surgery free of surgical charge. I hope that gives a basis on which more of the private providers will now meet their full obligation of a duty of care.
I am sorry to disappoint my hon. Friend but I cannot offer him such an estimate. We know that some 37,000 women had PIP breast implants. Clearly, not all those will necessarily want removal, and on advice, it might be any proportion of those; I cannot tell him what that figure would be. As we see in France, recommending the removal of implants does not mean that all women will have them removed.
I acknowledge the Secretary of State’s commitment to engaging proactively with the devolved Administrations on this issue. However, in his statement he used somewhat clumsy language regarding the third main finding of the expert group, saying that “there is no clear evidence that these problems are more serious in relation to PIP implants than other implants, or that they result in increased long-term health risks.” Is he not concerned that, put so clumsily, that will not only fail to reassure those with PIP implants but extend concern and alarm to those who have received other implants?
I am afraid that absence of evidence does not mean evidence of absence. We can be very clear, on expert advice, that there are no specific safety concerns that routinely require the removal of these implants, nor identification of any increased long-term health risks, in precisely the way I have described. I cannot go further and provide, on advice, absolute assurance, and the expert group was clear about that. That is why the French Health Minister, whom I was talking to last week, and I were clear that we should undertake additional toxicology tests on implants when they are explanted, in cases where they were implanted over a period of time, to begin to understand the extent to which they had adulterated filler material and what was in it.
I commend my right hon. Friend’s initiative. However, he said the following, which may have been sloppy wording: “those who have had reconstructive surgery following a mastectomy, will have received PIP implants through the NHS.” Of course, the majority will not have done so, and I have confirmed with surgeons in Cornwall that PIP implants have never been used in the NHS in Cornwall. Given that the Medicines and Healthcare products Regulatory Agency issued advice to stop using PIP implants in the UK in March 2010, can the Secretary of State confirm that this advice was acted on, no doubt within the NHS but across private clinics as well?
I hope I did not say what the hon. Gentleman ascribes to me. Some 3,000 women, we think, had PIP implants, and of course, that is only a fraction of the number having breast reconstruction surgery. I think I can offer him reassurance. The MHRA withdrew authorisation in March 2010, and given that there was only one distributor of these implants in this country—Cloverleaf—they will not have been distributed for use after that date.
A constituent in Chesterfield contacted me who is at her wits’ end. She has been in considerable pain since having a PIP implant fitted, and has been told by the private provider that she will have to pay £3,600 to have it replaced. What more can the Secretary of State do to ensure that her private provider follows the example of the other eight providers that are doing this free of charge? Let us put some pressure on these companies to make sure that all of them do the same as the NHS and replace the products they have fitted.
I think I have made it clear that not only the Government but, helpfully, the professional associations are looking to give no reason why private providers should not match that standard of care, especially if the implanting surgeons are willing to offer replacement surgery free of surgical charge themselves. It would be very helpful if the hon. Gentleman and other Members gave us details of such cases on behalf of their constituents. Clearly, his constituent will have had that implant before March 2010. The adverse incident centre has had 478 reports of ruptures over the whole period, which extends back many years. One of the things we want to understand as part of our review is why, if there were ruptures and, more to the point, adverse health effects associated with these implants, they were not disclosed to the adverse incident centre. As yet, we have not seen a range of health effects over a period of time that, in themselves, distinguish these implants from other, normal implants.
I contacted the Harley Medical Group on behalf of a concerned constituent this morning and was told that it would be making a decision on its response to this issue by Friday, although that is somewhat contradicted by the comments made by the shadow Secretary of State. Regardless of that, does my right hon. Friend not agree that the Harley Medical Group, or any other company, should step up to the plate, take full responsibility and work to make sure that it gives the people involved complete satisfaction, without any cost to the individual concerned?
My hon. Friend will understand that I cannot speak about the precise details of the situation with the Harley Medical Group. All I can say is that the group has told the media that it does not feel it can offer that standard of care completely, but that will have been before the professional associations wrote to their members asking them to support replacement surgery free of surgical charge. I know that the group has told members of the media that it is willing to offer to the Government that if we are responsible for the removal of implants, it will pay for implants to be available for replacement purposes. Frankly, if surgeons are willing to waive the surgical charge and the group is willing to pay for the implants, it is not too much to ask for it to be responsible for removal and replacement, where it is in the woman’s best interests to do that.
Does the Secretary of State not regret failing to react to the call made last May for British patients to have the same protection against failures of all medical devices as that enjoyed in the United States? Is not the real scandal here, again, the chronic under-reporting by the industry and the MHRA of failures of devices and drugs? Is not the answer for this probe to look into the possibility of having a genuinely independent regulatory authority, instead of one that is entirely funded by the industry, because self-regulation is often no regulation?
The hon. Gentleman says that this body is entirely funded by the industry. It is true that in relation to pharmaceuticals the MHRA is funded by levies on the pharmaceutical industry, but much of the cost of the regulation of medical devices is actually met by the taxpayer. I regard the MHRA as operating in an independent fashion and its expert and scientific advice as independent from Ministers. None the less, as he says, the review that Earl Howe will lead will examine the lessons to be learned, including those about the effectiveness of regulatory surveillance and enforcement in this country, albeit that the regulatory failure occurred, in essence, in Germany, in the first instance, and in France.
The uncertainty that many women face relates to not only the level of risk associated with PIP implants, but whether the implants they had fitted were PIP implants. I accept what other hon. Members have said about problems with record keeping in the private sector, and that needs to be taken up. The Secretary of State said that the estimated 3,000 NHS patients will be written to. If they are to receive such a letter, will he reassure them about when that will be?
Will the Secretary of State send officials to investigate the Birkdale clinic in Rotherham and its executive, Mr Promod Bhatnagar? Scores of women have had PIP implants at the clinic and are now being told that they have to pay £2,900, in cash, to be screened and looked at again. Mr Bhatnagar has threatened groups in south Yorkshire with “unimaginable consequences” if they raise this issue. After his very unclear statement, will the Secretary of State finish by saying that as in every other European country, and standing with the women of Britain, taxpayers do not mind paying for a few hundred women to be properly investigated? My constituents have contacted me saying that the women of south Yorkshire should be able to go to their general practitioner, go straight into hospital and be seen to, and we should clear up all the fuss about bills afterwards.
I think I have been absolutely clear about what I expect to happen, in relation both to women treated through the NHS and what I expect of private providers. I have also made it clear that if private providers will not or are unable to meet that standard of care, the NHS is available to support women. It is absolutely wrong to say that we are somehow responding to women differently from other European countries, because across Europe countries affected by this are taking exactly the same view that we take.
I thank the Secretary of State for his statement and I again highlight the concerns that a great many ladies have. Just today, I have been made aware that constituents of mine, as well as those from other regions of the United Kingdom, have had PIP breast implants carried out privately in the Republic of Ireland. When they contacted the firm, they found that it had gone bust, so what help can he give ladies, both financially and physically, who were NHS patients in the United Kingdom but had operations carried out outside the United Kingdom, specifically in the Republic of Ireland?
The Secretary of State has demonstrated his obvious concern for the women affected by this situation. Does he accept that they are gravely concerned about the difference of opinion that is emerging between Governments in the countries where these implants have been used, in particular, the difference between our Government’s advice and that of the country where the implants were manufactured, France? Will he also reflect on whether companies in the private sector that are giving either cosmetic or other treatments of this nature to women are properly insured, so that even if they go out of business the insurer will cover women for future treatments should something go wrong?
On the hon. Gentleman’s final point, I refer him to what I said earlier about how we might deal with that in the future. On the point about other countries, I have spoken to Commissioner Dalli and I have spoken to my French counterpart twice. What I want to be clear about is that the French authorities did recommend routine removal of implants, but from any individual woman’s point of view we are, in effect, recommending that the same thing should happen: any individual woman should see the clinician responsible, should be examined—by imaging, if necessary—and should consider, in the light of that and in a clinical decision with her adviser, what is right for her. That will be true in France and in Britain. I wish to emphasise that we have not seen, on advice, scientific evidence that justifies the recommendation of the routine removal of these implants. We are not saying to women that we think they should have them removed; we are saying that women should have access to imaging. Clearly, women with symptoms, or women for whom evidence of rupture or leakage has been provided through imaging, may well choose to have the implants removed, and we would support that.
Trade Union Officials (Refund of Pay to Employers)
Motion for leave to bring in a Bill (Standing Order No. 23)
I beg to move,
That leave be given to bring in a Bill to provide that pay for hours worked on behalf of trade unions by trade union officials during hours when they are paid by an employer should be refunded to the employer by the trade union; and for connected purposes.
The Bill addresses an issue that has recently attracted great public attention: the funding by the taxpayer of public sector employees who in fact work not as nurses, teachers, social workers, local government officers or civil servants but as trade union representatives. It was raised in an Adjournment debate last year by my hon. Friend the Member for Cannock Chase (Mr Burley) and I pay tribute to him for that, to my hon. Friend the Member for Witham (Priti Patel) for her work in the area and to other colleagues for their support today. The number of my colleagues in the Chamber attests to the importance of this issue.
This is not an area where definitive information is available, because adequate records have not been kept. The facts so far, taken from freedom of information requests to some 1,300 public sector organisations, are as follows. In 2010-11, trade unions received £113 million from public sector organisations. If extended over the lifetime of a Parliament, that would amount to the extraordinary sum of more than half a billion pounds in payments. An estimated 2,840 full-time equivalent public sector employees worked for the trade unions in 2010-11, paid for by taxpayers. That is equivalent to 2,840 public servants whose work has to be done by others: teachers who are not teaching, nurses who are not nursing and social workers who are not assisting their clients. The Department for Work and Pensions alone has 308 full-time equivalent staff working on trade union activities paid for by taxpayers, while Her Majesty’s Revenue and Customs has 181, to give just two examples. These facts are quite unknown to most people in this country and they deserve much wider publicity. It will be a source of huge anger to my constituents in Herefordshire, who must fill in their tax forms this month in very difficult economic times, to learn that they are subsidising nearly 200 tax officials who do no tax work at all—all the more so as under the previous Government the Revenue drastically cut back its office in Hereford.
It is important to be clear about one thing, however. The Bill is not about attacking the unions. The trade union movement in this country has an often distinguished history of supporting and protecting working men and women and their families. Many unions do very good work for their members today. I recognise these things and I welcome them. In a similar spirit, the House will know that I am a great supporter of co-ops, mutuals, credit unions and other organisations whose purpose is to empower and support people who are often on very modest incomes. The issue here is one of basic principle: is it appropriate for the taxpayer to subsidise any such large-scale activity by private organisations? If it is, should it be allowed without proper processes of competitive tender and public accountability? My own answer to these questions would be, in general, a resounding no.
Taxpayers’ money should be spent, as far as possible, on the front line of public services. In general, private organisations should not be subsidised by the state. Moreover, the fundamental principle of no payment without accountability is already observed throughout the public sector in other areas. Public procurement is supposed to be competitive and transparent, and so is commissioning of services in the NHS and across local government. In exactly the same way, there should be proper transparency and accountability in public funding for trade unions.
I myself have just waged a long campaign to recover some £1.5 billion for the taxpayer on the private finance initiative—only a small portion, so far, of the money overspent by the previous government on PFI. In effect, PFI included a massive subsidy to the financial and construction sectors. The principle is exactly the same here: taxpayers’ money should not be used to subsidise private organisations without proper transparency and accountability. Why should the unions be any different?
There is an important further argument. Subsidising the unions with taxpayers’ money is not ultimately in the interests even of their own members. Indeed, it will tend to undermine the services those unions provide. All subsidies distort incentives. This subsidy encourages union leaders to lobby politicians for hand-outs, rather than focus on doing the jobs their members pay them to do.
Finally, taxpayer funding creates huge conflicts of interest. Inevitably, some union reps will be tempted to engage in political activity during time funded by the taxpayer. That was the problem with Ms Jane Pilgrim, the former nurse turned union rep at St George’s hospital, Tooting, who denounced the Secretary of State for Health on the basis of a meeting she had never attended. That was politicking pure and simple, but the conflict between political activity and taxpayer funding would be removed if unions were required to refund public money received, as this Bill would demand.
Various defences have been made of such payments. It has been suggested that they actually save money, that union reps are needed for pay negotiations and that union reps must be employees, but those arguments entirely miss the point. The issue is not whether the unions provide valuable services, whether they should be paid for doing so or whether public servants may not also be union reps; the issue is why they should be paid in that role by the taxpayer.
There is a wider point as well, which is that of transparency itself. Last week, my office called seven of the biggest unions, asking for their latest financial reports and accounts as background research. The response was extraordinary. Some unions, such as the National Union of Rail, Maritime and Transport Workers and the Union of Shop, Distributive and Allied Workers, do not put this information online at all—USDAW kindly invited me to write to its treasurer with a request. Others, such as the NASUWT, make it available only to members. Unison had its 2009 statements online, and the National Union of Teachers had a summary. Only the Public and Commercial Services Union had a full recent report and accounts online.
Matters only become murkier on further investigation. The unions are regulated by the relatively little-known certification officer, who requires them to file an annual return. In the case of Unite, that reveals that the union had income in 2010 of £141 million and made a pay-off of more than half a million pounds to its outgoing joint general secretary, Derek Simpson—