House of Commons
Wednesday 22 February 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—
1. What recent discussions he has had with the First Minister of Scotland on a referendum on independence for Scotland. (95262)
8. What discussions he has had with the Scottish Government on a referendum on independence for Scotland. (95269)
10. What recent discussions he has had with the First Minister of Scotland on a referendum on independence for Scotland. (95271)
The First Minister and I met on Monday 13 February to discuss a referendum on independence. The Prime Minister, the First Minister and I had a further meeting on Thursday 16 February, when we discussed the need for any referendum to be legal, fair and decisive. It is in everyone’s interests that both of Scotland’s Governments work together and I look forward to meeting the First Minister again in due course.
The Scottish Government are the most resolute defenders of the Barnett formula, arguably against the interests of the other nations of the United Kingdom. Does the Secretary of State therefore think that if the people of Scotland vote yes in a referendum on independence, the Barnett formula should apply to the nation’s debt?
I do not envisage that Scotland will become independent from the United Kingdom. I think we are stronger together and weaker apart. The hon. Gentleman touches on the fundamental issue of sorting out what the basis of that independence might look like, and the Scottish National party has so far singularly failed to answer questions on that.
Will the Secretary of State again confirm his and the Government’s commitment to a single, non-leading question in the referendum on Scottish separation, and will he further commit to a simple yes or no reply?
The fundamental issue is about independence, and that is what we must resolve. We must have a legal, fair and decisive independence referendum.
Will my right hon. Friend clarify whether he has had conversations about Antarctica and whether it is true that the previous Government simply forgot to deal with Antarctica and the British territory there? What is his position on making sure that we retain control of it?
The hon. Lady highlights an important part of the world in which it is important that the UK Government have a role to play. May I point out that through the Scotland Bill, which is passing through their lordships House, we are delivering the biggest transfer of powers to Edinburgh since the Act of Union and tidying up some of the inconsistencies of the devolution settlement?
When the Scottish Secretary and the Prime Minister met the First Minister, the Prime Minister offered a proposal for enhanced devolution but failed to spell out what that might be. What does the Scottish Secretary envisage a package of devolved financial powers might look like? Would it include corporation tax, all of income tax and the aggregates levy?
It is incredible that the SNP wants to ask a question about further devolution when it has not set out what the fundamentals of independence would be. One would think that after decades of having that as its main reason for existing, it might have some clear ideas on the issue.
That was a very instructive answer because it failed entirely to answer the question. There was no detail about what the Prime Minister proposes. Is that because there is no detail, is it because the announcement was made simply to capture one day’s news headlines, or is it meant to cover the embarrassment of this Government, who voted against the devolution of any further powers in the Commons debates on the Scotland Bill last year?
Honestly, the hon. Gentleman has a bit of a cheek talking about a lack of detail when his party cannot spell out what the currency situation would be in an independent Scotland, what the national debt might look like and how it might deal with pensions and financial regulation. It is absolutely clear that we must make the most fundamental decision on Scotland’s future in a clear-cut and decisive way. The debate about devolution will be ongoing and I very much look forward to being part of it.
My right hon. Friend has spelt out the absence of detail given by members of the Scottish National party in this House. Has he impressed on the First Minister, in the opportunities he has had to do so, the First Minister’s unequivocal obligation to explain to the people of Scotland not just the process of independence but the consequences and costs of it and the length of time it would take to implement?
My right hon. and learned Friend highlights some very important central issues in the debate about independence. I believe Scotland is stronger as part of the United Kingdom, and the United Kingdom is stronger because Scotland is part of it. On financial issues, our place in the world and the strength of our defences, there are huge numbers of unanswered questions for the SNP that it must now get on and address.
2. How many young people aged between 16 and 24 are not in employment, education or training in Scotland; and if he will make a statement. (95263)
According to the latest figures published in the annual population survey, the number of 16 to 19-year-olds estimated to be not in education, employment or training in Scotland in 2010 was 36,000.
There is another important element to the question that I asked, which refers to young people up to 24 years old. They are the hardest-hit young people and we do not want to see that generation lost. In rural localities such as the right hon. Gentleman’s and mine, policies to get young people back into work will depend, as far as the private sector is concerned, on small and medium-sized enterprises. These businesses are suffering severely and the pressure on them is not enabling them to create jobs. Does the Secretary of State understand that we need a taskforce mentality to deal with young people’s unemployment?
My officials are working on the statistics for up to 24-year-olds. They are not currently published but I look forward to getting the data for the hon. Gentleman and other hon. Members.
On the fundamentals of the economy, I absolutely agree that we need small and medium-sized businesses to be given the ability to grow. That is why we are putting pressure on the banks to lend to them and ensuring that we support the young people we are dealing with. The youth contract is fundamental—£1 billion to help people get more places on work experience and to help employers to take people on. It is that kind of action that will help people get into the jobs market.
My right hon. Friend rightly mentions the youth contract, which comes into effect in April. Does he agree that it is imperative that the Scottish Government, the British Government and employers in Scotland work together positively to ensure that young people get the opportunities, and that they are not distracted by scoring points against each other, but rather work together for young people?
I quite agree with my right hon. Friend. Working with Members across the House over the past six to eight months, I have held meetings and seminars around Scotland that have been focused on youth unemployment and on bringing together employers, young people, Scottish Government agencies and United Kingdom Government agencies. In March in Dundee we will have a national convention which John Swinney and my right hon. Friend the Secretary of State for Work and Pensions will attend, so that we can take the agenda forward together.
No one in the House is complacent about youth unemployment and the plight of young people trying to find work in very trying economic circumstances. I welcome the joint initiative of the national convention taking place next month, but may I press the Secretary of State on what outcomes he expects from that convention, and whether he will welcome the initiatives that the Scottish Government have taken to ensure a place for every young person aged 16 to 19 in Scotland in work, training or education?
It is vital that Scotland’s two Governments work together on this terrible problem that existed under the previous Government and continues. We need to address that using everything we can to help young people get experience, training or jobs. We will work hard on all those, and if others wish to work with us, we will welcome that.
Will the Secretary of State tell the House how many young Scots have lost their jobs since he was appointed to his job in May 2010?
If I may say so, the hon. Lady should remember the economic mess that we inherited from the Labour Government, since when we have been fixing the deficit and seeking to rebalance the economy and ensure that we have sustainable growth. The youth contract, work experience and all the support we are giving are vital to ensuring that we get young people back into the workplace.
I notice that the Secretary of State struggled somewhat with that answer. There is one statistic that he should be familiar with. Since his Government scrapped the future jobs fund, 23,000 jobs have been lost in Scotland. That is more than 400 jobs every week for young people, while he has become the Tories’ man in Scotland. We are in the midst of a youth unemployment crisis, and the Secretary of State for Scotland has been posted missing. In contrast, Labour took direct action through the future jobs fund, delivering more than 10,000 real jobs for young people in Scotland. So can the Secretary of State share with the House what plans he has—any ideas at all—to take direct, effective action to tackle youth unemployment in Scotland?
As ever, the hon. Lady wishes to leave behind the horrible mess that the Government she supported left for us to fix. She cannot escape that reality or the fact that youth unemployment rose under Labour. We are investing £1 billion in the youth contract, which will enhance the number of work experience places and provide additional support for employers taking on young people, and has provided the Scottish Government with additional resources. I have been working with her colleagues and others to ensure that we do everything we can to tackle this terrible problem.
3. What steps he is taking to ensure that the findings of the Equality and Human Rights Commission’s inquiry into human trafficking in Scotland are discussed by the relevant officials in England and Wales. (95264)
The Government are considering the findings of the Equality and Human Rights Commission’s inquiry into human trafficking in Scotland, in line with the ongoing implementation of the human trafficking strategy we launched in July 2011.
If the Minister had read the inquiry report, he would have seen that its main recommendation is that there should be a new human trafficking Bill for Scotland. I suggest to him that that would solve the problem of implementing the EU human trafficking directive, which we have signed up to, across the UK. I invite him and other interested parties to attend the all-party group on human trafficking next Monday in Room 7 to hear the inquiry being reported on in the House and perhaps take some advice.
If I am available, I will certainly be delighted to attend.
Does my right hon. Friend agree that the field of human trafficking, where co-ordination between involved agencies is critical if we are to find real solutions, is yet another practical example of a policy area that is best tackled at UK level?
I absolutely agree with my hon. Friend that the UK can bring great weight to this issue on behalf of Scotland. It is also an issue where we have been able to work with the Scottish Government, demonstrating that the two Governments can work together on matters of great importance on a day-to-day basis.
4. What recent discussions he has had with the Chancellor of the Exchequer on a credit rating for Scotland. (95265)
Thanks to the decisive action that this Government have taken, the whole of the United Kingdom benefits from record low interest rates and a confirmed triple A credit rating status.
What estimate has the Secretary of State made of the extra debt interest that an independent Scotland would have to pay were it not to benefit from a triple A rating?
My hon. Friend makes an important point about how an independent Scotland would fare. The rating agencies have been quite clear that there are issues relating to the track record of Government, the pension arrangements, national debt and so much more that they need to take into account. Of course, it is in the gift of the Scottish Government, should they so wish, to ask for a draft opinion on what that status might look like, but so far they have not done so.
What analysis have the Government undertaken on the impact of a low credit rating on my constituency, and more widely on Lanarkshire, in the event of Scotland separating from the rest of the United Kingdom?
I recognise the challenges that face the right hon. Gentleman’s constituents and many others in Lanarkshire and elsewhere. I stick to the basic belief that Lanarkshire and Scotland are better off being part of the United Kingdom and much stronger that way than they would be if we went our separate ways.
Crucial to a good credit rating for Scotland will be its attractiveness to private investment to come into the country to invest in jobs and the economy. To that end, will the Secretary of State emphasise to the Scottish First Minister that the uncertainty caused by the referendum is causing a growing number of companies to pause their investment decisions until they get clarity on Scotland’s direction of travel?
My hon. Friend goes to the central issue, which is when this debate will take place. We should get on and make this fundamental decision about Scotland’s place in the United Kingdom sooner rather than later. I cannot for the life of me understand why we should have to wait the best part of three years, with all the economic uncertainly that will generate, until reaching that decision.
Does the Secretary of State not understand that it is not the credit rating score that matters, but the cost of servicing Government debt? Japan, which has a much higher net debt and a double A minus credit rating, pays less interest on Government bonds than the UK. The truth is that it is the yield that counts, not the triple A rating or lack thereof. Will he now stop this ridiculous scaremongering about ratings?
Is the hon. Gentleman seriously suggesting that the triple A status has no bearing on the interest rates we pay? He really needs to wake up and, with his colleagues, answer some of the fundamental questions at the heart of the debate, which so far they have ducked.
5. What meetings Ministers in his Department have had with Ministers in the Department for Works and Pensions to discuss the effect on Scotland of the proposed benefits cap. (95266)
12. What meetings Ministers in his Department have had with Ministers in the Department for Work and Pensions to discuss the effect on Scotland of the proposed benefits cap. (95273)
Mr Speaker, you will be aware that the Chairman of the Work and Pensions Committee, the hon. Member for Aberdeen South (Dame Anne Begg), who is a regular attendee at Scotland questions, has suffered a fall. I am sure that we all wish her well in her recovery.
My right hon. Friend the Secretary of State for Scotland and I are in contact with Ministers in the Department for Work and Pensions on a range of issues concerning welfare reform.
Is it not clear that if the nationalist Government in Scotland had control of welfare policy, there would be no benefits cap in Scotland, despite widespread public support for it?
What is clear is that the Scottish National party is making a proposition for independence without explaining to people how benefits at current levels would be paid in future, or where the money would come from.
With the average income in Scotland being £419 a week, does the Minister not agree that a benefit cap of £500 a week is a reasonable and sensible level?
I do agree that that is a reasonable and fair measure, and constituents in constituencies such as mine cannot understand how the Labour party and the nationalists can promote the idea that the benefit cap should be higher than £35,000.
Is not the truth about the benefit cap, however, that if such a household on £419 a week, as cited by the previous questioner, had six children—like some of my constituents do—who had to be cared for, they would also receive child benefit, and that therefore the comparison that has been made is not fair? What is going to happen when the discretionary housing payments to a council—that is the only answer from the Government—run out?
The hon. Lady should listen to her hon. Friend the Member for Leeds West (Rachel Reeves), when she says that if Labour is to be taken seriously on any issue it has to
“pass the test of fiscal credibility.”
On this issue, that is a very relevant point.
The right hon. Gentleman will not be aware that I have the highest percentage of single women in any constituency in the country. What is he doing to help those women—[Interruption.] This is not a joke. This is a serious point, and Government Members can laugh all they like, but there are single women in this country who are struggling. What is his party going to do to help them?
What this Government are doing is tidying up the mess that the hon. Gentleman’s Government left, which has placed single women and many other people in a perilous financial position.
6. What recent estimate he has made of the level of public expenditure per person in Scotland. (95267)
The most recent estimate of the level of public expenditure in Scotland, published in October 2011, shows that the level of public expenditure in Scotland was £10,165 per head for 2010-11.
Last week at the breakfast table, Mrs Bone and I were talking about public expenditure in Scotland and the First Minister, as one does, when suddenly our 11-year-old son, Thomas, asked, “Is Alex Salmond a goodie or a baddie?” What does the Secretary of State think?
With reference to public expenditure per person in Scotland.
As ever, the goings on at the Bone household breakfast table are a thing of national interest, and we look forward to further updates in due course. I think that when the hon. Gentleman’s son gets a chance to meet the First Minister, he will be delighted by the conversation that he has, but the important point that we should know is that the First Minister wants to make England separate from Scotland; we do not.
On public expenditure, the Secretary of State will know that not one ounce of UK steel is being used to build the new Forth road bridge. Is it not shameful that 29,000 of tonnes of steel can be shipped 12,500 miles from Shanghai but not 33 miles from Lanarkshire?
The hon. Gentleman’s commitment to Lanarkshire and to the steel industry is absolutely understood and well known, and his anger is understood, too. It is a matter that was of course devolved to the Scottish Government, and it is for them to answer his very difficult question.
In welcoming the additional per capita expenditure represented by the £100 million investment in sleeper services, I wonder whether the Secretary of State agrees that it is a good example of the Westminster and Holyrood Governments working more effectively together than separately, and will he seize the opportunity now to call on the likes of Richard Branson, Pete Waterman and others with innovation and entrepreneurial skills to see whether we can re-establish motor-rail services now that the sleeper services are secure?
My right hon. Friend is right to highlight the important investment that we have committed to the sleeper services, for which he has been an undoubted champion over a very long period. He is right to stress that we need to look at innovative ways to develop those services, and I look forward to discussing his idea further.
Severe Disability Premium
7. How many disabled children receive the severe disability premium in Scotland. (95268)
As at 3 April 2011 in Scotland, there were 4,800 in-work families benefiting from the severely disabled child element and with child tax credit above the family limit. There are 5,000 severely disabled children in these families.
I thank the Minister for that answer. The Prime Minister told this House on 14 December and again on 23 January that his Government will not be cutting benefits for disabled children. Given that almost 8,000 children in Scotland will lose £1,400 a year through the child tax credit changes, does the Minister agree that the Prime Minister was plain wrong and clearly does not understand his own policy?
What I agree with is the fact that the Government are not making any savings at all from these changes. Savings from abolishing the adult disability premiums and changes to the child rate will not return to the Exchequer; those savings will be recycled into higher payments for more severely disabled people. [Interruption.]
Order. There are far too many noisy private conversations taking place in the Chamber. I know that the House will want to hear Mrs Eleanor Laing.
Thank you, Mr Speaker.
Does the Minister agree with me and my constituents that in matters of disability payments for severely disabled children, and of all other payments from taxpayers’ money for the people who are most in need throughout our entire country, we are better off raising money together and working together as one United Kingdom?
The Minister should answer with reference to the disability premium.
The severe disability premium and all other benefits are clearly set out by the United Kingdom Government. The Scottish National party has failed to set out how a single benefit in Scotland would be paid for post independence, if it were ever achieved.
Defence Munitions Beith
9. What discussions he has had with the Secretary of State for Defence on the future of DM Beith. (95270)
I spoke to the Under-Secretary of State for Defence, my hon. Friend the Member for Mid Worcestershire (Peter Luff), last week on this issue. As he confirmed on Monday, there are no current plans to change the status of DM Beith. There is a need to maintain Beith until the Spearfish torpedo has been converted to a single-fuel system, when the need for specialist facilities may lapse. The conversion programme is expected to be completed around 2018.
Defence Munitions Beith is one of the largest employers in North Ayrshire and is wholly dependent on Ministry of Defence contracts. Will the Minister ensure that there is a ministerial visit to the facility from the Scotland Office to find out what more can be done with a view to ongoing representations for future contracts with the Ministry of Defence?
I am pleased to be able to confirm to the hon. Lady that the Secretary of State for Scotland will be pleased to visit that facility in her constituency.
Independence (Financial Effects)
11. What assessment his Department has made of the financial effect on Scotland of independence. (95272)
15. What preparations his Department has made for dealing with issues that would arise in the event of Scottish independence. (95276)
The Scottish Government are proposing independence, but they have failed to set out what independence would mean for Scotland. This Government are clear that Scotland is stronger for being part of the United Kingdom and that the United Kingdom is stronger for having Scotland within it.
Does my right hon. Friend agree that Scottish politicians, instead of focusing on independence, should, in these difficult economic times, stop depending on one industry in the North sea and look to create a broader industry sector that will provide economic support for the rest of Scotland?
My hon. Friend is right that our primary concern is to ensure that we get the economy on the right track. By fixing the deficit, rebalancing the economy and ensuring that there is sustainable growth, we will do just that. In the meantime, we should get on with resolving the issue of independence to remove the uncertainty that it causes. [Interruption.]
Order. There is still far too much noise. I want to hear Mr John Stevenson.
Does the Secretary of State agree that in the event of independence, there would be many unnecessary financial and regulatory costs to both Scotland and England in the areas along the border between the two countries? In an extreme case, there is the absurd possibility of border controls.
First, I am not contemplating Scotland actually becoming independent, because I am confident that Scotland will vote to stay in the United Kingdom. However, my hon. Friend highlights a central issue. The SNP cannot dodge some of the issues that there would be in relation to Europe if we were to become separate, including those to do with the borders. As a borders MP, I think that those issues are as absurd as he does.
Has the Secretary of State considered the recent study by the National Institute of Economic and Social Research, which shows that even if it formed a sterling zone with the UK, a separate Scotland would experience volatile public finances, inherit debts at either 70% or 80% of GDP, and face tougher constraints on levels of tax and borrowing than it does as an equal participant in fiscal union with the UK?
Of course I have studied that report. The hon. Gentleman puts its conclusions succinctly. Those are points that the SNP has failed to answer.
The Prime Minister was asked—
Q1. If he will list his official engagements for Wednesday 22 February. (95247)
I am sure that the whole House will wish to join me in sending our deepest condolences to the families and friends of Senior Aircraftman Ryan Tomlin from 2 Squadron, Royal Air Force Regiment. It is clear from the tributes paid by his RAF colleagues that he was a determined young man with immense potential. His service and his sacrifice to our nation will never be forgotten.
Members of the House will also have seen the reports that the talented and respected foreign correspondent of The Sunday Times, Marie Colvin, has been killed in the bombing in Syria. It is a desperately sad reminder of the risks that journalists take to inform the world of what is happening, and of the dreadful events in Syria. Our thoughts should be with her family and friends.
This morning I had meetings with ministerial colleagues and others. In addition to my duties in this House, I shall have further such meetings later today.
May I associate myself with the Prime Minister’s comments about our brave troops and the brave journalists who report their activities?
The Prime Minister has said that one of his main priorities is to fight crime. Will he explain, therefore, why since the election there has been a cut of more than 4,000 in the number of front-line police officers? The South Yorkshire police helicopter, which last year was responsible for apprehending more than 700 criminals, will be scrapped by the Policing Minister against the advice of the chief constable. How can the Prime Minister explain these matters? They clearly indicate to the public that crime will rise. This is simply another broken promise from this Prime Minister.
On the issue of the helicopter, talks are under way between South Yorkshire police and the Association of Chief Police Officers. I am confident that helicopter coverage will be maintained. On the wider issue, I would make the point that recorded crime is down under this Government. The figures from Her Majesty’s inspectorate of constabulary show that it believes that there will be more police in visible policing roles this March than there were a year ago.
This Monday was meant to be a happy reunion for pupils at Alvechurch Church of England middle school following the half-term break. Instead, it has turned out to be a day of mourning for the school and the entire community because of the news of a coach crash in France, which claimed the life of a much-loved local teacher, Mr Peter Rippington, and left many school children seriously injured. Will the Prime Minister join me in expressing sympathy for all those who have been affected and in wishing all those who are still being treated in France a swift recovery and a speedy return home?
I am grateful to my hon. Friend for raising this desperately sad case. I know that Peter Rippington was much respected in the local community and at the school. He will be hugely missed. I am sure that the thoughts and sincere condolences of everyone in the House will be with my hon. Friend’s constituents and everyone who has been affected. Our consular staff in France continue to provide support to all those who are still in France. Our ambassador, Sir Peter Ricketts, has visited passengers in hospital and is liaising with the local authorities. We will do everything we can, with the French authorities, to get people home safely.
I join the Prime Minister in paying tribute to Senior Aircraftman Ryan Tomlin from 2 Squadron, RAF Regiment. He died bravely and courageously serving our country, and our thoughts are with his family and friends.
We are also thinking today about the tragic death of Marie Colvin. She was a brave and tireless reporter across many continents and in many difficult situations. She was also an inspiration to women in her profession. Her reports in the hours before her death showed her work at its finest, and our thoughts today are with her family and friends.
On Monday, the Prime Minister held his emergency NHS summit and managed to exclude the main organisations representing the following professions: the GPs, the nurses, the midwives, the pathologists, the psychiatrists, the physiotherapists and, just for good measure, the radiologists. How can he possibly think it is a good idea to hold a health summit that excludes the vast majority of people who work in the NHS?
What I want to do is safeguard our NHS. We are putting more money into the NHS—money that Labour is specifically committed to taking out. But let us be frank: money alone will not be enough. We have to meet the challenge of an ageing population, more expensive treatments and more people with long-term conditions, and that is why we have to reform the NHS. My summit was about those organisations, including clinical commissioning groups up and down the country—8,200 GP practices—that want to put the reforms in place.
So the Prime Minister has got no answer about his ridiculous summit that excluded the vast majority of people who work in the medical professions. Let us remind ourselves of what he said just a few short months ago during his so-called listening exercise. He said that
“change—if it is to…really work—should have the support of people who work in our NHS. We have to take our nurses and doctors with us.”
Now he cannot even be in the same room as the doctors and nurses. Does that not tell him that he has lost the confidence of those who work in our national health service?
What I want to know is, when is the right hon. Gentleman going to ask a question about the substance of the reforms? He does not want to ask about choice, because the Opposition used to be in favour of choice but will not back it in the Bill. He does not want to ask a question about competition, because they used to favour competition but now will not support it in the Bill. They used to support GPs being put in charge of health budgets. They backed that, but they will not support it now it is in the Bill. Why not ask a serious question? Incidentally, as we are being kept here to vote at 7 o’clock on the publication of the risk register, why does he not ask a question about that?
Does the Prime Minister not think it was a serious question about his exclusion of the vast majority of people who work in our NHS? He should not worry—[Interruption.]
Order. The House must calm down. Tranquil and statesmanlike is the mode for which Members should strive.
We will come to the substance of the Prime Minister’s Bill, but let me ask him this very important question. There were people who attended the summit and expressed deep concerns about his Bill. Even those who were invited to his summit did so. Following his health summit, can he tell us what changes, if any, he is planning to make to his Bill?
Why does the right hon. Gentleman not stop worrying about my diary and start worrying about his complete lack of substance? We are going ahead with these reforms because we think it is good for patients to have choice, good to have the involvement of the independent and voluntary sectors in the NHS and good to have more emphasis on public health. That is why we are doing these reforms.
Let me remind the right hon. Gentleman of one thing that he used to believe. He used to believe—this was what his Health Secretary said—that
“the private sector puts its capacity into the NHS for the benefit of NHS patients, which I think most people in this country would celebrate.”—[Official Report, 15 May 2007; Vol. 460, c. 250WH.]
The Opposition are now committed to a 5% cap on the private sector, which would mean hospitals such as the Marsden hospital sacking doctors, sacking nurses and closing wards. Let me ask the right hon. Gentleman again: we are here at 7 o’clock to vote on the risk register. Are you going to ask a question about it, or are you frightened of your own motion?
Order. I think it would be good if we could preserve some parliamentary manners in this place, and the Prime Minister will know that I am not frightened of anything.
Nobody believes the Prime Minister and nobody trusts him on the health service. At the Homerton hospital on Monday, I met senior staff working in HIV services, who explained to me how the Bill will fragment and disrupt services—[Interruption.] The Health Secretary should be quiet and listen to the people who work in the health service. If he had done some listening before—[Interruption.] He should calm down.
The senior staff working in HIV services explained that HIV treatment is currently commissioned by one organisation: the primary care trust. Under the Prime Minister’s plans, treatment will be commissioned by three organisations: the national commissioning board, the clinical commissioning group and the health and wellbeing board. The staff said that that will damage the world-class service they provide for patients. Why will he not listen to the people who actually know what they are talking about in the NHS?
If the right hon. Gentleman is opposing other organisations that have expertise in AIDS and AIDS treatment taking part in the NHS, he is opposing the Terence Higgins Trust, which does an enormous amount to support HIV. The fact is that we are seeing complete opportunism from the Labour party, which used to back choice, the independent sector and reform. I say to you, Mr Speaker, you don’t save the NHS by opposing reform; you save the NHS by delivering reform.
The Prime Minister does not even understand his own Bill. Let me explain to him. The question was about the fragmentation of commissioning. The experts at the Homerton—[Interruption.]
Order. Opposition Members are becoming over-excited. There is a long time to go and I want to get to the bottom of the Order Paper.
Let me say to the Health Secretary that I do not think the Prime Minister wants advice from him.
Let me explain to the Prime Minister that the question was about the fragmentation of commissioning—[Interruption.] Good: I am glad you have got it. Maybe when you get up you can answer the question.
Order. I say to the Leader of the Opposition: keep me out of it. I said that to the Prime Minister and I am saying it to him.
The reason why the Prime Minister has lost the—[Interruption.]
Order. [Interruption.] Order—I say that to the shadow Chancellor as well—[Interruption.] Order. Members might be enjoying themselves, but I ask them to think of what the country thinks—[Interruption] Order. I ask Members to think of what the country thinks of how we conduct ourselves.
The Prime Minister has lost the confidence of the NHS professions because of the promises he made before the election. Will he now give people a straight answer to the question I asked him two weeks ago and admit that he has broken his promise of no top-down reorganisation?
If the right hon. Gentleman took any longer, we would have to put him on a waiting list for care, his question took so long. He asks about integration. Let me explain to him, because I do not suppose he has read the Bill, that clauses 22 and 25 place a specific duty on key organisations to integrate health and social care. The Bill is all about integration, but here we are, on his fifth question, and he still will not mention his vote on the risk register. I think I know why. I have here Labour’s brief for this afternoon’s debate. There is an excellent section explaining why we do not publish risk registers. The second argument is particularly strong. It goes like this:
“Andy Burnham blocked the publication of the Department of Health’s risk register in September 2009.”
There we are. The Opposition are absolutely revealed as a bunch of rank opportunists, not fit to run opposition, not fit for government.
I will tell the Prime Minister what happened under the previous Labour Government: the lowest waiting times in history; more doctors and nurses than ever before; and the highest patient satisfaction with the NHS. I will match our record on the NHS with his any day of the week. The problem with this Prime Minister is that he asks people to trust him but he has betrayed that trust. The problem with this Prime Minister is that on the NHS he thinks that he is right and everyone else is wrong. It has become a symbol not of how his party has changed but of his arrogance. I tell him this: this will become his poll tax. He should listen to the public and drop the Bill.
Six questions and not one mention of the motion that the Opposition are putting before the House tonight! To put it forward and then not back it up shows an absence of leadership. [Interruption.]
Order. Members on both sides of the House are yelling at each other. It is rude, it is unfair on the Prime Minister and the Leader of the Opposition and it should stop.
I will tell the right hon. Gentleman what is actually happening in the health service under this Government: waiting times for outpatients, down; waiting times for inpatients, down; the number of people waiting in total, down; the number of people waiting for more than a year, halved; hospital infections, down to their lowest level; and mixed-sex wards, down by 94%. That is our record. There are 4,000 more doctors, almost 1,000 more midwives and fewer managers. He talks about what people think about this Government, so let me remind him what his two-time candidate said about him this week:
“You are not articulating a vision or a destination, you’re not clearly identifying a course and no-one’s following you…My problem is that you are not a leader.”
I could not have put it better myself.
Q13. In 2009, when the Conservatives took control of Lancashire county council, fostering services were rated unsatisfactory. Since then, its budget has reduced by £120,000 and it is now rated outstanding. Will my right hon. Friend join me in congratulating county councillor Tony Winder and his Conservative colleagues not only on doing more for less but on doing it better? (95259)
I certainly join my hon. Friend in that, and he makes an important point: across the country we have different councils coping with the issues of fostering and adoption, and producing very different results. We need to publish all these figures so that we can see which councils are doing well and getting value for money, as they clearly are in Lancashire, and, above all, which councils are doing the best to get children out of care and into a warm and loving home.
Q2. The national minimum wage has lifted millions of workers out of poverty pay, so will the Prime Minister support hard-working people and give a commitment today to drop unjust plans to freeze it? (95248)
We support the minimum wage, we have supported its uprating and we have already uprated it. It has an important role to play.
Q3. The children of Somalia should be able to expect a life before death. Does not tomorrow’s London conference provide an opportunity to signal to the terrorists, pirates and corrupt of Somalia that we are all determined to do whatever we can to ensure stability and good governance in Somalia? Will the Prime Minister welcome the participation in the conference of the President of Somaliland, given its experience of peace-building in the region? (95249)
I am grateful to my hon. Friend for raising this issue. We will be welcoming the President of Somaliland to the conference. Somaliland has taken an important step forward in showing that better governance and better economic progress are possible. In many ways, it is an example that others can follow. But the conference is not about recognising Somaliland; it is about trying to put in place the building blocks, among the international community but above all among the Somalis themselves, for a stronger and safer Somalia. That means taking action on piracy and hostages, supporting the African Union Mission in Somalia and increasing its funding and role in Mogadishu, and working with all the parts of Somalia to try to give that country, which has been more blighted by famine, disease, terrorism and violence than almost any other in the world, a second chance.
Given what the Prime Minister said last week in Scotland, will he devote as much time to facing up to the grievances that the English feel from the current proposals of devolution as he will to considering new proposals of devolution to Scotland? Will he open a major debate here in the House on the English question, so that Members from all parts of the House can advise him on what measures of devolution England needs if we are to gain equity with other countries of the United Kingdom?
We have, obviously, set up the West Lothian group to look at this issue, and obviously we want to make sure that devolution works for everyone in the United Kingdom, but I would part company slightly with the right hon. Gentleman for this reason: I believe the United Kingdom has been an incredibly successful partnership of all its members. Far from wanting to appeal to English people in any way to nurture a grievance they feel, I want to appeal to my fellow Englishmen and say, “This has been a great partnership”—a great partnership for Scotland, but a great partnership for England too. Of course Scotland must make its choice, but we hope that Scotland will choose to remain in this partnership that has done so well for the last 300 years.
Q4. Does the Prime Minister agree that an elected mayor and more power for cities, including over local railway infrastructure, present a great opportunity for those of us in Bristol who have long campaigned for the resurrection of local rail, including the Henbury loop line around the north of the city? (95250)
I support having elected mayors in our great cities. Obviously it will be for those cities themselves to choose. I am hugely encouraged by what has happened in Liverpool recently. We will be having referendums, and people in Bristol will have their chance to make that choice. At the same time, what people have not entirely noticed is that the Government are going through a huge act of devolution to cities, in terms of the powers and the money that we are prepared to offer them, so that they can build their own futures. If we think of how Bristol, Leeds, Manchester, Liverpool and Birmingham—these great cities—built themselves up in the first place, we see that it was not on order and instruction from London; it was the great city figures who did that for them. We want that to happen again.
Q5. On Tuesday the Education Secretary said that the Prime Minister’s decision to set up the Leveson inquiry was having a “chilling” effect upon freedom of expression. Does the Education Secretary speak for the Government? (95251)
The point I would make is this. It was right to set up the Leveson inquiry, and that is a decision fully supported by the entire Government, but I think my right hon. Friend is making an important point, which is this: even as this inquiry goes on, we want to have a vibrant press that feels it can call the powerful to account, and we do not want to see it chilled—and although sometimes one may feel some advantage in having it chilled, that is not what we want.
Many of my constituents will be fully supportive of the Chancellor’s refusal yesterday to sign off on the EU accounts. Does the Prime Minister agree with me and my constituents that it is totally unacceptable that for 17 years now the EU has failed to get auditors to sign off on its accounts?
My hon. Friend raises an important point, and it was not just Britain that took this stand; it was also the Dutch and the Swedes. For too long the accounts have not been properly dealt with, and corruption and fraud have not been properly dealt with, and it is entirely right to make this stand.
Q6. Last week in Edinburgh the Prime Minister said there were more powers on the table for Scotland, but could not name any. A few months ago he mocked the idea of Scotland controlling its own oil wealth, and in the Scotland Bill even the Crown Estate was too big. Can the Prime Minister now name one power that he has in his mind from this latest U-turn? (95252)
I did not think that the Scottish National party favoured devolution; I thought it favoured separation. Yet as soon as you are offered a referendum that gives you the chance to put that in front of the Scottish people, you start running away.
Q7. Tomorrow, Members of this House will have the chance to debate the importance of cycling, following The Times cities fit for cycling campaign. The Minister for cycling, the Under-Secretary of State for Transport, my hon. Friend the hon. Member for Lewes (Norman Baker), has made some welcome announcements and investment, but there is still much more to do. Will the Prime Minister commit the Government to support The Times campaign, increase investment in cycling and take much greater steps to promote cycling across the country? (95253)
The Times campaign is excellent, and I strongly support what it is trying to do. Anyone who has got on a bicycle, particularly in one of our busier cities, knows that they are taking their life into their hands every time they do so, so we need to do more to try to make cycling safer. The Government are making it easier for councils to install mirrors at junctions. We are putting £11 million into training for children and £15 million into better cycle routes and facilities across the country. If we want to encourage the growth in cycling that we have seen in recent years, we need to get behind campaigns such as this.
Since he has been Prime Minister, the company A4e has won contracts worth £224 million from the Department for Work and Pensions alone. In view of the fact that there are record numbers of unemployed people and that employees of this company have been arrested, what action is he taking to make sure that neither vulnerable unemployed people nor the taxpayer are victims of fraud by A4e?
The hon. Lady raises an important issue, which I understand dates back two years to schemes run by the previous Government. As I understand it, it was the company itself that raised the issue with the relevant authorities. There is an ongoing police investigation, so it would be inappropriate for me to comment much further. All I would say is that the investigation needs to be thorough and needs to get to the truth, and then we can take its findings into account.
Q8. Generations of young people have benefited from work experience schemes through getting experience of the working world. Will the Prime Minister praise those companies that are doing everything they possibly can to encourage work experience schemes—unlike the militant hard left, who have not only shut down these schemes, but would rather see people get a handout as opposed to a hand-up in life? (95254)
I think my hon. Friend speaks for many in this House and the overwhelming majority in this country who think that companies offering work experience schemes to those on unemployment benefit is a thoroughly good thing. Let us be clear: this is not a compulsory scheme, but one that young people ask to go on. The findings are that around half of them are actually getting work at the end of these schemes. That is a far better outcome than the future jobs fund had—and at about a 20th of the cost. I think we should encourage companies and young people to expand work experience because it gives people the chance to see work and all it involves, and gives them a better chance to get a job.
Prime Minister, thousands of BAE workers in every constituency right across Lancashire are concerned and angry about the Eurofighter Indian contract. Earlier this week, you held a meeting with Lancashire’s Tory MPs. When will you be arranging a meeting at 10 Downing street for all Lancashire MPs—or do you have something to hide?
Order. I am not arranging any meetings at 10 Downing street, although it is possible that the Prime Minister might. We will hear.
I have met a number of Members of Parliament for whom BAE is in their constituencies—including the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson),who came to see me with my right hon. Friend the Member for Haltemprice and Howden (Mr Davis). I have had many MPs coming to see me. This Government are absolutely committed to helping with Eurofighter and Typhoon in every way we can. That is why I have undertaken trips right across the middle east. Let me say that when I do, I often get criticised by Labour MPs for taking BAE or Rolls-Royce on the aeroplane. I think it is right to fly the flag for great British businesses, and I will continue to do so.
Q9. Last week at the breakfast table, Mrs Bone was saying how she knew the Prime Minister wanted to deport the terrorist Abu Qatada straight away and put the national interest first—[Interruption.] (95255)
Order. I want to hear about the views of Mrs Bone.
Mrs Bone knew, however, that this action was being blocked by the Deputy Prime Minister and the Liberal Democrats. Suddenly, our 11-year-old son Thomas asked, “Is Nick Clegg a goodie or a baddie?” What does the Prime Minister think?
There is only so much detail I can take from the Bone household. In believing that I am very keen that Abu Qatada be deported, Mrs Bone is indeed psychic, as that is exactly what I believe. That is why the Home Secretary and Home Office Ministers are working so hard with the Jordanians to get the assurances that we need so that this can indeed take place. The Deputy Prime Minister thoroughly backs that approach.
Both the Prime Minister and the Housing Minister have told the House that rents are falling in the private rented sector, when the evidence—including from the most recent survey by Inside Housing—is that rents are rising. Will the Prime Minister take the opportunity to put the record straight, or will he continue to blame the tenant when the real responsibility lies with landlords charging ever-higher rents and the failure of his Government’s house building programme?
Given that that question has come from a member of a party that saw house building fall to its lowest level since the 1920s, I think I will take it with a lorryload of salt.
Q10. We have put great effort into stamping out and kicking out racism in football in this country. Will my right hon. Friend assure the House that when he brings together representatives of the sport later today, he will do everything he can to ensure that prejudice does not creep back into the game and that racism stays out of football? (95256)
My hon. Friend is entirely right to raise this issue. It was a huge achievement when Britain, and its football authorities and clubs, led the world in kicking racism out of football, something that has not happened in all other countries. However, we have seen some worrying signs recently.
The reason I think that this matters so much, not just to football but to Government and to everyone in our country, is that football and footballers are role models for young people. What people see on the football pitch they copy when they go and learn to play football themselves. That is why I think it important to bring people together and ensure that we kick racism out of football for good.
Q11. Let me first associate myself with the Prime Minister’s condolences to the family and friends of the member of the armed forces who lost his life last week. I am sure that the Prime Minister will join me in thanking the thousands of people who serve in the reserve armed forces. My constituents who serve in the Royal Marine reserve forces in Dundee have expressed concern about the possible closure of the Royal Marine reserve detachment, but when I write to Ministers at the Ministry of Defence about it, they refuse to give me a definitive answer. Does the Prime Minister agree that that is inappropriate, unsatisfactory, and perhaps even arrogant? (95257)
I thank the hon. Gentleman for raising again the case of the brave man from the RAF regiment who gave his life, and all those who serve in Afghanistan. He is absolutely right: the reserve forces in our country are a huge national asset. We want to expand them, and we are putting in more than £1 billion between now and 2015 to ensure that we can do that.
No decision has been made about the future of the Dundee Royal Marine reserve headquarters, but there is no intention to cut the number of Royal Marine reservists in Scotland. Indeed, those who look at the whole issue of our armed forces and reservists throughout Scotland will see that we actually need more people to join the reserves. I hope that everyone in the House who likes our Territorial Army and the other reserve forces will back the recruitment campaigns, because if we are to have an Army with 80,000 regulars and 40,000 reservists, we need a cultural step change in our country so that we really respect what our TA and other reserve forces are doing.
Q12. On Friday, United States marshals will escort my 65-year-old constituent Chris Tappin from Heathrow to a jail in Texas, where he will face pressure to plea bargain in order to avoid lengthy incarceration pending a financially ruinous trial for a crime that he insists he did not commit. What steps is the Prime Minister considering to reform the US-UK extradition treaty, which has been so unfair to the likes of Gary McKinnon and, now, my constituent Mr Tappin? (95258)
I quite understand why my hon. Friend has raised the case of his constituent. Obviously Chris Tappin has been through a number of processes, including those of the magistrates court and the High Court, and the Home Secretary has thoroughly considered his case.
My hon. Friend has also raised the more general issue of Sir Scott Baker’s report on the extradition arrangements, which he has completed and which we are now considering. He did not call for fundamental reform, but my right hon. Friend the Home Secretary will examine his findings carefully, and will also take into account the views of Parliament that have been expressed in recent debates. Of course, balancing the arguments is vital, but I think it important for us to remember at the same time why we enter into these extradition treaties: to show respect for each other’s judicial processes, and to make sure that people who are accused of crimes can be tried for those crimes—and Britain can benefit from that as well. A proper, sober, thoughtful review needs to take place, and this case shows why.
Q14. So far, the Government’s response to the unfair relationship between pub companies and their licensees has been self-regulation, not statutory regulation. On 12 January this year the House voted unanimously to set up a review panel, to be agreed by the Business, Innovation and Skills Committee, to review the implementation of self-regulation, but to date there has been absolutely no response from the Government. Can the Prime Minister tell me whether he is backing the will of Parliament or the will of pub companies? (95260)
I am a keen supporter of Britain’s pubs, so I will write to the hon. Gentleman and get him a good answer.
In his speech in Edinburgh last week, the Prime Minister rightly described Scotland as
“a pioneering country all its life”
“the turbine hall of the Industrial Revolution”.
The next pioneering revolution in this country will be in green technology, and the green investment bank will be key in its promotion. As he has now visited Edinburgh, does he agree with me that it is the perfect location for that institution?
It is certainly one of the locations that are being considered, but the hon. Gentleman will know that a number of bids have been made by different towns, cities and, indeed, regions of the country, which all want to host this excellent innovation, the green investment bank.
Q15. Returning to the issue of the NHS and the pertinent question posed by the Leader of the Opposition, why has the Prime Minister broken his promise not to engage in another top-down reorganisation of the national health service? (95261)
What we are doing is abolishing the bureaucracy that has been holding the NHS back. We are going to cut, in this Parliament, £4.5 billion of bureaucracy—by getting rid of the primary care trusts and the strategic health authorities—all of which will be invested in patient care. The policy of the hon. Gentleman’s party is to say that real increases in NHS spending are “irresponsible”. That is his party’s view. We do not think that it is irresponsible—we think that it is responsible—which is why we are putting the money in, and he would take the money out.
There have been lots of interruptions today, but I am concerned about the interests of Back Benchers.
Last week in Ethiopia with Save the Children, I saw at first hand how malnutrition is stunting the growth of the world’s poorest children. Does the Prime Minister agree that the UK has a real opportunity to lead the international debate in tackling malnutrition, which will help the growth of the world’s children, and economic growth as well?
My hon. Friend is entirely right about this, not only because we work with excellent organisations and non-governmental organisations such as Save the Children that are doing excellent work, but because the UK is the second largest bilateral donor in the horn of Africa, where we have seen that appalling famine with many people starving and dying. Not only are we doing our bit in money, investment and time, but that gives us an opportunity to lead the debate on where we need to take the development and aid agenda next.
Annual Statements of Healthcare Costs
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 require the Secretary of State to instruct general practices to issue annually to each person eligible for care provided by the National Health Service an itemised account of the cost of his or her healthcare in the preceding 12 months, and for connected purposes.
It would appear that, by chance, I am the warm-up act for the Opposition day debate on the NHS risk register. That is purely coincidental, but it is timely and fortunate for me, because I am going to propose a serious policy suggestion that should be considered by Members from all parts of the House.
For decades, so-called informed political opinion has argued that significantly changing health care provision in Britain is not possible. “Don’t touch the NHS,” they have said, “It will be political suicide.” My political contemporaries and I do not have the luxury of that option. Health care costs, driven upwards by an inexorable increase in patient demand, have reached a tipping point. Any politicians who think that the current NHS model can be sustained in the medium to longer term under that onslaught are deluding themselves. Indeed, to think so betrays a remarkable ignorance of the realities of health-care demand in Britain today. For sure, changing the public’s mindset on the issue will be an extremely painful political process, with no short-term reward, but we have no choice, particularly those of us who want to protect the fundamental principle of access to all.
No doubt advocates of change, like me, will face professional and personal vilification: observe the recent treatment of health care reforms by vested interests—and those reforms are just about modifying the system of supply. However, I am not interested in a party political spat. First and foremost, I care about my country and its people, and I am determined to communicate the fact that there are other ways to provide and pay for health care, that there is life after the current NHS and that it could be better. For I want people to be free to choose any lifestyle, while understanding that the consequent health care costs are their responsibility. I want to give more to the truly deserving because we have spent less on those who were perfectly able to provide for themselves. Where is the implicit incentive to look after oneself in the current system? It is not there. In its place is a clever ruse to breed dependence on the state—an ingenious construct to support a command and control, tax and spend bureaucracy, headed by a wealthy elite who, ironically, often opt for private health care themselves.
Where is the long queue of nations lining up to replicate the national health service? If imitation is the sincerest form of flattery, the NHS is flattered not at all. For example, patients in Denmark, with very few exceptions, pay for their drugs at cost, and in Norway patients pay to see their GP. Those rich countries, and others, could see that the current NHS system was unsustainable in the longer term and implicitly based on rationing. We should remember that the NHS is predicated on the Bentham principle of the greatest good for the greatest number, so if we need expensive new cancer drugs in the future, we should not hold our breath, because the system will not be willing or able to pay for them.
Clearly, securing public support for fundamental change is always imperative, and in order to do that, the true costs of health care must be known by all. That is why I am presenting this Bill to Parliament, calling for the introduction of an annual personalised statement of health care costs to be issued to everyone. Irrespective of age, the costs of GP and hospital appointments, drugs, surgery, vaccinations, diagnostics and treatment would be itemised. That would make the British public more receptive to NHS changes in the future, because the knowledge would be empowering.
I wish to move on to address the obvious questions and concerns that colleagues might have, particularly those who fear additional Government paperwork. My approach would not be bureaucratic for the patient, as I am talking about a simple itemised statement, with the attached NHS number, based on the health care provided, and most of the data exist. Indeed, they all should exist, and are generally in a form that can be easily extracted. Furthermore, the GPs I have spoken to would relish the opportunity to clarify the true costs of hospital interventions, so forcing that knowledge to the surface would attract widespread support in the primary care sector, particularly in the new age of commissioning. Believe me, GP support always matters when introducing something new to the NHS.
I shall now deal with the cost. On postage, GP practices issue correspondence to patients every day. They send letters to remind patients of flu jabs, cholesterol checks, medication reviews and chronic disease annual reviews, to name but a few things. Numerous interactions with patients take place already, so why not add a printed statement in the envelope? After initial modest start-up expenditure, the running costs should be minimal. On the basis of a simple internet search of data extraction software management charges, a pro rata administrative salary of £25,000 per surgery—[Interruption.]
Order. I apologise for interrupting the hon. Gentleman, but quite a lot of noisy conversations are taking place in the Chamber and that is unfair on him. He must be allowed to introduce his motion and get a hearing.
I might say, in response to some of the heckling coming from Labour Members, that this idea is to be shared with parties. Indeed, if there is a future Labour Government—God forbid—they may benefit from public understanding of the true costs of health care. I say that particularly given that Labour Members have in the past suggested co-payments as a solution to the current NHS difficulties.
As I was saying, after initial modest start-up expenditure, the running costs should be minimal. On the basis of a pro rata administrative salary of £25,000 per surgery, data extraction software management charges, additional printing costs and so on, my office has estimated a cost of approximately 50p per patient per year—a total annual expenditure for England and Wales of about £30 million, or 0.03% of annual NHS spend. Indeed, that figure could be lower, as part of the details of my Bill would make it in the financial interest of each GP practice to keep overheads to a minimum. Indeed, even if it were more, the impact of the statements would be that fewer patients would attend out-patient appointments and fewer people would store drugs in their larder at home, thus saving the NHS money.
A further concern that has been expressed to me is that the statements could upset patients. It has been suggested that those who receive most of the care—the frail and the elderly—might not appreciate receiving such a statement, and that it might be distressing and lead to an avoidance of health care. All I can say to that is that we cannot all be young all the time, so when would be the right time to introduce this policy? Those who are young now need to know how much they are going to cost when they are old. Why should the elderly benefit from a system that is unlikely to be there for the young when they need it? To be blunt, it is time to tell it as it is, not as we would wish it to be. Tough politics? Yes. Morally and politically right? Yes to both.
In presenting this Bill, I am not advocating any particular policy solution. Indeed, I encourage those on both sides of the House to come forward with different policies in response to it. I am merely suggesting that, having introduced the statements, an informed public debate about health care provision could begin. Such a debate is long overdue in this country. The challenge facing the NHS is not one of supply; the demands being placed on it because of ageing, obesity and changes in health-seeking behaviour mean that Governments of all political colours urgently need to bring forward plans that are truly sustainable in the longer term. For that reason, and for the other reasons that I have given, I respectfully submit that this Bill is timely, and I commend it to the House accordingly.
It is with some regret that I rise to raise concerns about this proposal—
Order. For the avoidance of doubt, procedure requires that the hon. Lady should not only raise concerns about the Bill but also oppose it.
And to oppose it. I have no doubts about the intentions of my hon. Friend the Member for Bracknell (Dr Lee), for whom I have great respect, as someone who works in the health service. I have serious doubts, however, about the impact of the Bill and the message that it will give to people who are extremely concerned about the future role of health services.
Not so long ago, certain things were routinely prescribed on the NHS that we would now find it ludicrous to prescribe. My mother used to work in an old-fashioned system called the pricing bureau, and people would routinely bring in “scripts” for zinc and castor oil cream or cotton wool. Now, we would find it amazing to see such things on an NHS prescription. We have moved on, and accepted that the NHS cannot provide for everything in our lives. I would welcome a debate on some of the services that people expect the NHS to provide, such as cosmetic surgery, tattoo removal, or even in vitro fertilisation cycles for people of certain ages. That would be a valuable debate, because, as my hon. Friend so wisely says, we have to think about the future and adopt a sustainable, affordable model for the NHS.
However, I believe that giving a person and their family an annual statement of their cost to the NHS could be profoundly divisive. I am concerned, for example, about the effect that it could have on people who have served in our armed forces and come back with life-shattering injuries. They might have had to make difficult decisions about their lives, having been made limbless in the service of their country. What mental effect could it have on them to be told every year what their treatment is costing their country?
Similarly, what mental effect could it have on people who feel that their lives are not worth living, and that they are being burdensome, to be told that there is a tariff associated with their ongoing care? What effect could it have on a family who have fought long and hard for a child with cystic fibrosis or another life-limiting condition, to be sent a bill or tariff, after the child had died, setting out what their child’s life had cost? I believe that such experiences would be unsettling and distasteful for some people.
I am also concerned—I am sure this is a leap that goes way beyond any of my hon. Friend’s intentions—about the Kafkaesque situation that might result, whereby we would start to look at people in the context of how costly they were to keep going, and whether their life was worth that expenditure. If people are made to feel that they are responsible for their own health, whether that is because of obesity, smoking or drinking, so be it, but I am not sure that presenting people with a breakdown of what it has cost to treat them will necessarily make them change their ways.
Having nursed somebody who died from cancer, I can tell hon. Members that people feel like a burden when their life is in a difficult place. They will often say, “I wish I wasn’t doing this to you, to the family, or to others. If I wasn’t around, perhaps you could collect on the insurance, or your life could move on in a different and happier way.” I feel that adding an extra burden for families in such a position, through sending them a breakdown of the annual cost to the NHS, would be unacceptable. That is not a voice that I wish to see coming from the Government, and I do not believe that this suggestion should ever become a Bill. I am comforted by the fact that most ten-minute rule Bills never get anywhere.
If I thought that this ten-minute rule Bill would get somewhere, I would go around soliciting support and testing the waters in Parliament to see whether anybody else shared my concerns. I accept that my hon. Friend simply wishes to ensure that people get the best treatment according to an affordable model, and that people who are being feckless with their own health should be made to face up to and be aware of that fact, but I do not think that having an individual statement of their health care costs that year will make those people change their ways. It might—this is why I oppose the Bill, although I do not intend to press it to a Division—[Hon. Members: “Oh!”] If other hon. Members wish to divide the House, that is up to them, but I have not made arrangements to do so.
I was concerned that the Bill might go unchallenged, because ten-minute rule Bills often are, and I thought through some of the possibilities that, although they are not necessarily implied in my hon. Friend’s plans for his Bill, could creep through if what he has been describing took effect. I was concerned enough to raise my worries today, and to think that if the information locked in the NHS about individuals’ costs were made public, it could be used by the people who argue that we should not save seriously sick people, or treat people with complex needs, or value people with disabilities, because the tariff associated with them is higher than the cost for a healthy person. That is not a society that I wish to endorse, and that is why I wanted to raise my concerns.
Question put (Standing Order No. 23).
On a point of order, Mr Speaker. Would it be possible for you to arrange the urgent deposition of the report by Her Majesty’s inspectorate of constabulary on police numbers in the Library? In answer to Question Q1 today, asked by my hon. Friend the Member for Sheffield South East (Mr Betts), the Prime Minister said that there were more police officers on the beat in the past year, when in fact there are 4,000 fewer. I would not wish the House to be inadvertently misled by the Prime Minister’s comments today.
What I would say to the right hon. Gentleman is that if the report in question is not available in the Library, I am confident that the Library will make good and ensure that it is. I am sure that is really all he was seeking from me.
NHS Risk Register
In view of the extensive interest in this debate, I have imposed a seven-minute limit on Back-Bench contributions. That limit is based on the premise of reasonable self-discipline being shown in terms of the length of the opening Front-Bench speeches.
I beg to move,
That this House calls on the Government to respect the ruling by the Information Commissioner and to publish the risk register associated with the Health and Social Care Bill in order to ensure that it informs public and parliamentary debate.
These are extraordinary times for the national health service and, indeed, for our democracy. A top-down reorganisation that nobody voted for, which was ruled out by the coalition agreement and which Parliament has yet to approve, is happening anyway. From the moment the White Paper was published 20 months ago, the NHS began to change in every constituency represented in the House. From that very moment, the Opposition consistently argued that the Prime Minister was making a catastrophic error of judgment in allowing that to happen.
Will the right hon. Gentleman give way?
Not at the moment.
When the Government chose to combine the biggest ever financial challenge in the NHS with the biggest ever top-down reorganisation, they gave the NHS mission impossible. The £20 billion so-called Nicholson challenge was always going to be a mountain to climb—it is an all-consuming challenge on its own—but with this reorganisation the Government have effectively tied not one but two hands behind the NHS’s back and taken away the maps and safety equipment. The Health Secretary began to dismantle the existing structures of the national health service across England before he had permission from Parliament to put new ones in their place. The result has been a loss of grip and focus at local level in the NHS just when it was most needed.
Let me make this point, and I will give way in my own time.
People talk of confusion and drift, of a huge loss of experienced staff and established relationships and of an NHS in which no one knows who is making the decisions. That leads to concerns about the risks being run with our NHS—risks to patient safety, service standards and in relation to the efficiency challenge. The chief executive of the NHS confirmed that to the Public Accounts Committee when he said:
“I’ll not sit here and tell you that the risks have not gone up. They have.”
So, that is a fact. The Prime Minister who promised to protect the NHS has put it at risk. That much is clear, but what are the precise risks that the Health Secretary and the Prime Minister are taking with the NHS, and how serious are the risks? Does not the public have a right to know what they are? You would think so, would you not, Mr Speaker, given how much the NHS matters to people and how utterly so many people with long-term illnesses and disabilities depend on it.
When the right hon. Gentleman was Secretary of State he refused a freedom of information request to publish risk registers in September 2009. Why was that? Was he aware of the request, and why did he not publish?
I will come to that in a moment. If the hon. Gentleman is patient, I will answer his point directly.
Given the risks that are being taken, and given how much the NHS matters to people and how utterly they depend upon it, particularly those with long-term illnesses and disabilities, one would think they had a right to know about the risks that the Secretary of State is running with their health service. Well, one would be wrong. Instead, Members of this House and of another place have been asked to approve the most far-reaching reorganisation of this country’s best-loved institution by a Government who have not had the courtesy to give them the fullest possible assessment of its potential impact on the NHS.
The right hon. Gentleman is clearly arguing for transparency on risk registers. Will he outline how many risk registers he used when he was the Secretary of State, and how many of them were published?
I did not launch the biggest ever reorganisation of the national health service, but I will come to the hon. Gentleman’s point in a moment, if he is patient.
The Government have not given the House the courtesy of their own assessment of the risks that they are running with the NHS before they ask us to approve the biggest ever reorganisation at a time of financial challenge. It is quite simply disgraceful.
I thank my right hon. Friend for giving way and for his excellent opening remarks. He knows that every year 37,000 people die earlier in the north of England because of health inequalities. Does he agree that as a result of the Government concentrating on a top-down reorganisation and making primary care trusts put aside billions for this reorganisation, risks to health inequalities can only grow?
Those on the Government Front Bench are laughing. They will not be laughing when I have finished my speech.
More than 150 experts in child health wrote to a newspaper last week to say that health inequalities among children will widen as a result of the Bill. Are Ministers listening? No. It is disgraceful that they behave as they do.
Will the Secretary of State confirm—sorry, the shadow Secretary of State—that in clause 3 of the Health and Social Care Bill for the first time in the history of the NHS reductions in inequalities in health have been put on the face of a Bill as a duty to achieve?
I confirm to the Minister that I am the shadow of my former self, but it sounds as though he would like to have me back. Expert opinion says that health inequalities will widen. Is he listening to that opinion? That is the question he should answer today.
I will give way later.
We called this debate today to give the House a chance to vote for the openness and transparency that the Government once promised. More specifically, in opening the debate, I have three clear purposes. First, I want to test the Government’s argument for withholding the transition risk register and clear up the confusion about current Government policy on risk management and freedom of information. Secondly, I want the debate today to give people watching in the country the real picture of what is happening on the ground in the NHS across England. I know that Labour Members’ contributions will bring that out.
Faced with a conspiracy of silence on the Government Benches to keep the risk register secret, it falls to the Opposition to tell patients and the public what this Government do not want them to know. Today I will reveal new information from locally held NHS risk registers about the real risks that the Government are running with patient care, public safety and the quality of NHS services in communities across England. Based on the information that I will reveal, my third purpose today is to counter what seems to be the Government’s main remaining argument in favour of their reorganisation—namely, that things have already gone so far that it is now better to carry on than to stop.
That argument will be demolished by the new information that the House will hear. It explains why so many professional organisations and royal colleges have already made the judgment that even now it is safer to drop the Bill and work back through the existing structures of the NHS than to proceed with the turbulent and risky experiment of introducing an entirely new legal structure for the NHS based on markets and competition. Indeed, the new information is so troubling that it raises a simple question for the Prime Minister and the Health Secretary: if they were aware of the risks on such a scale arising from their reorganisation, how could they possibly have allowed it to carry on so long?
Let me deal with the first point, testing the Government’s reasons for their action and their policy on FOI and risk management. Let us recap the events leading up to today. We on the Labour Benches always said that it was dangerous to reorganise the NHS at a time of intense financial pressure.
Has the right hon. Gentleman read the article in The Times today by Stephen Bubb, which says:
“When in government . . . Labour’s Shadow Health Secretary spoke of his vision for a preventive, people-centred NHS that would allow the maximum freedom for local innovation… And yet, to judge by the reaction that”
the Secretary of State’s
“Bill has provoked, one would think that a centralised, bureaucratic and too often inefficient NHS is politically sacred and permanently untouchable”?
[Interruption.] Is that the impression that the shadow Secretary of State is trying to create?
Order. I remind the House that there is a lot to get through, many Members wish to contribute, and interventions in any event should be brief.
I have never believed in a free market in the NHS. I did not believe it then and I do not believe it now. That is why I oppose the Bill that the hon. Lady supports.
I was saying, before I was rudely interrupted, that we say it is dangerous to reorganise the NHS at this time. On the day the White Paper was published, I stood opposite the Secretary of State and described his plans as
“a huge gamble with a national health service that is working well for patients.”—[Official Report, 12 July 2010; Vol. 513, c. 663.]
He never has explained why this successful NHS needs to be turned upside down. From day one we have asked the Government to be up front about the precise nature and scale of the risks that they are taking. Their failure to provide a full assessment of those risks to inform the House’s consideration of their Bill led my predecessor, my right hon. Friend the Member for Wentworth and Dearne (John Healey), to initiate a freedom of information request for the transition risk register. I wish to point out that my right hon. Friend did not request the full departmental risk register, which was subject to a similar request in August 2009 at the height of the swine flu pandemic.
Let me now directly answer the question that the hon. Member for Weaver Vale (Graham Evans) asked. There are three crucial differences between that situation and the subject of today’s debate. The first important difference—[Interruption.] The hon. Gentleman would do well to listen, as the Prime Minister got his facts wrong at Prime Minister’s Question Time.
The first important difference is that the debate relates to a different document. This debate is about the transition risk register, not the strategic risk register held by the Department. They are different things. The transition risk register relates solely to the reorganisation and the effects that the reorganisation could have. That brings me to my second reason why the situation is different. I did not initiate the biggest ever top-down reorganisation of the NHS. It is the policy of the hon. Gentleman’s Government to do that. We on the Labour Benches who care about the NHS have a right to know what damage that reorganisation might cause. The Government are not just launching the biggest ever reorganisation; they are doing it at a time of the biggest ever financial challenge in the history of the NHS.
The third reason—
Conservative Members should listen. The hon. Member for Weaver Vale asked for the reasons. The third reason the situation is different is that the request submitted in August 2009 was from a member of the public, not from a Front-Bench politician—
Order. May I make it clear to Back Benchers that the shadow Secretary of State is clearly not giving way at present, and that in the circumstances they should exercise some self-restraint?
They do not want to listen because it does not suit their argument. This was meant to be their whole reason today, and we heard it from the Prime Minister earlier, but now they do not want to hear the reasons.
The third reason this situation is different from the one in August 2009 is that at that time there was not a precise ruling from the Information Commissioner, but there is a clear ruling from the commissioner in this case. Those are three important differences. Let me remind the House of that ruling. It stated:
“The Commissioner finds that there is very strong public interest in disclosure of the information, given the significant change to the structure of the health service the government’s policies on the modernisation will bring.”
That is where one of the Government’s key arguments for withholding the register falls apart. The Minister in another place has repeatedly defended the Government’s action by saying that they had published a full impact assessment for the Bill—[Interruption.] “It’s true”, says the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns). Let me answer that point. Having had sight of the impact assessment and the transition risk register, the commissioner said that
“disclosure would go somewhat further in helping the public to better understand the risks associated with the modernisation of the NHS than any information that has previously been published.”
In other words, the impact assessment that the Secretary of State has published is not good enough and the public deserve to know the full truth about his reorganisation.
I am pleased that the right hon. Gentleman has been converted to the cause of freedom of information but hope that it is not for a fourth reason: he was then in government but is now in opposition. Will he give a commitment that, should he ever again become Secretary of State for Health, he will grant every FOI request for a risk register?
They should be judged on their merits, but let me say that it was the Labour party that introduced the Freedom of Information Act, so we will take no lectures from the hon. Gentleman. As I will explain in a moment, we did publish risk registers under freedom of information rules, so let us keep the high horse out of today’s debate, if he does not mind. We were used to hearing pious lectures from Liberal Democrat Front Benchers on openness, transparency and how the supremacy of freedom of information trumped everything else, and we heard from Conservative Front Benchers that sunlight was the best disinfectant, but that all seems a long time ago. We now have the sorry spectacle of Government Members on both Front Benches defying a clear ruling by the Information Commissioner and taking it to a tribunal hearing early next month. This action raises serious questions on what precisely is the Government’s policy on these matters, as there is a real danger that it will look confused and contradictory. A search of the Treasury website brings up a clear statement of policy on the Government’s principles for risk management. It states:
“Government will be open and transparent about its understanding of the nature of risks to the public and about the process it is following in handling them. Government will make available its assessments of risks that affect the public, how it has reached its decisions, and how it will handle the risk. It will also do so where the development of new policies poses a potential risk to the public.”
That is the statement of the Government’s policy as it stands today. Why on earth are they not following it?
I declare my interest. I remind my right hon. Friend that yesterday statistics were published showing that 1.3 million diabetics had not had their annual checks. It is important that we have this information on the risks posed to diabetics by the new commissioning arrangements. Does he not think that that is an argument for full transparency?
My right hon. Friend eloquently makes the point I made at the beginning of the debate: people with long-term conditions, such as diabetes, who depend utterly on the NHS have a right to know whether there is any risk to the continuity or integration of the care they receive. I understand that representatives of patient groups, who perhaps have not been heard enough in this debate, made that point directly to the Prime Minister on Monday. It is absolutely essential that their voice is heard. They say that the Bill represents a danger to the integrated care that they receive and depend upon. It seems pretty clear to me that the Government are not following their own policy—[Interruption.]
I quoted from the policy, but the Secretary of State is not publishing the risk register—
Order. I am sorry to have to interrupt, but I must say to the hon. Member for Broxtowe (Anna Soubry), who no doubt is an immensely brilliant individual, that in her capacity as Parliamentary Private Secretary to the Minister of State, at this stage in her career her role is to fetch and carry notes and nod in the right places, not to conduct a running commentary on the debate. I trust that she will now exercise a self-denying ordinance for the remainder of the debate.
As I was saying, the Government clearly are not following the statement of policy set out on the Treasury website, but the strange thing, as the House will hear shortly, is that NHS bodies across the country at local and regional level are following the policy closely. As I understand it, the Treasury’s theory is that the more widely the risks are understood and shared, the greater the ability to mitigate them. Indeed, I recall the Minister stating in a press release as recently as last October, the month before the commissioner’s ruling, that an open and transparent NHS would be a safer NHS. Two simple questions follow: why is the Department for Health not following stated Government policy and what it said in October was its own policy; and is the Department in breach of Government policy, or has it secured an exemption from it? I hope that the Health Secretary will shed light on this point today, because at present it does not look too good.
Let me turn to the Government’s other reasons for fighting publication. First, it is claimed that disclosure would
“jeopardise the success of the policy”
That is a moot point. The Information Commissioner said that it is a strange defence, given the Government’s other statements on openness and scrutiny building more robust plans. Secondly, it is claimed that it could have a chilling effect and that officials would be less frank in future. Given that risk assessment is a core part of all public servants’ responsibilities, not an optional activity, that claim was not accepted by the commissioner. Thirdly, it is claimed that the names of junior officials could be disclosed, but the commissioner has said that he was satisfied that the register would identify only senior civil service or senior NHS officials.
Fourthly, it is claimed that disclosure would set a difficult precedent and could lead to the publication in future of information relating to national security. The weakness of this argument, as the commissioner pointed out, is that a precedent has already been set, and it was set by the Labour party when we were last in government. A comparable risk register linked to the specific implications of a particular policy—the Heathrow third runway—was released by the previous Government in March 2009 following a ruling by the Information Commissioner on a request from the current Transport Secretary. Why are this Government not following the clear precedent set by the previous Government? That is the answer to the hon. Member for Weaver Vale. In truth, these four reasons seem to me to be the desperate defences of a desperate Government who have something to hide and a desperate Secretary of State.
Let me offer the shadow Secretary of State a view that has been put to the House previously:
“Putting the risk register in the public domain would be likely to reduce the detail and utility of its contents. This would inhibit the free and frank exchange of views about significant risks and their management, and inhibit the provision of advice to Ministers.”—[Official Report, 23 March 2007; Vol. 458, c. 1192W.]
Does he recognise that view?
The Secretary of State clearly was not listening. It is not a comparable situation. We are talking about a different document. Does he understand that? It is a different document. How more simply does he want me to say it? He was just talking about the strategic risk register. Today the House is debating the transition risk register, and I would be grateful if he did not continue to muddy those waters.
Why are the Government not following the precedent we set? I do not know whether they will try to produce any more desperate reasons today, but it looks to me as though they have no real defence, as the hon. Member for Cities of London and Westminster (Mark Field) has pointed out. People will be expected later to troop through the Lobby for the Government, without so much as a fig leaf of a principled argument to support their call. Liberal Democrats, who used to lecture us on the supremacy of freedom of information, will be exposed once again: spineless, co-conspirators against the NHS, acting out of nothing but gut loyalty to the suicide pact that is this coalition.
That brings me to my second point. What exactly are Government Members all so desperate to hide, and what precise risks are they running with the NHS? When the Prime Minister made his disastrous decision to allow the Health Secretary to break the promises that he had personally made to NHS staff—indeed, those promises were then enshrined in the coalition agreement—and to proceed with his top-down reorganisation, we warned that the hard-won improvements in waiting times over the Labour years would be placed at risk. That is exactly what has happened.
The Government inherited a strong, self-confident NHS, independently judged one of the best health services in the world, if not the best, and in just 20 months they have reduced it to a service that is demoralised, destabilised and fearful of the future. Throughout the country there are growing signs of an NHS in distress. A and E departments are under increasing pressure, with figures published last week showing that the Government missed their own lowered A and E target for the seventh week in a row.
Between December 2010 and December 2011, there was a 13% increase in the number of people waiting longer than 18 weeks and a 105% increase in people waiting longer than a year. The number of patients waiting more than six weeks for their diagnostic tests has more than doubled, and the number waiting more than 13 weeks has more than trebled.
We have a habit in this House of reeling off such statistics, but every single one represents a family living with worry, a life on hold. On Monday the Health Secretary said that
“pressure on hospitals is reducing.”
If ever I heard it, there speaks a voice from the bunker: a sure sign of what happens when you surround yourself with people who say only what you want to hear.
We must proceed from facts and be accurate. The number of patients waiting more than a year for treatment in May 2010—the time of the most recent election—was 18,458. In the latest figures, published for December 2011, that figure had more than halved, to 9,190.
I will trade figures with the right hon. Gentleman. He quotes a different time frame from the one that I quoted. If he is going to resort—
No, I have given way to the right hon. Gentleman. He resorts to those tactics and gives us the view that the pressure on hospitals is reducing, when all over the country hospitals are under intense pressure and A and E departments and wards are being closed, but, if he expects us to take those statements from him, he should know that we are not going to do so. This is not a man living in the real world, and he is not listening to the warnings that are coming from the NHS. It can be no surprise to people that the NHS is slipping backwards, because that is precisely what local and regional NHS bodies have been warning him. The fact is—[Interruption.] I will not give way. The fact is—
On a point of order, Mr Deputy Speaker. For the purposes of accuracy, I understand the right hon. Gentleman to have said that 105% more patients waited longer than a year for their treatment in December 2011 compared with December 2010, when he should know that the figure—[Interruption.]
Order. I wish to listen to this point of order.
It is not a point of order.
Order. I will decide whether it is a point of order, Mr Campbell.
Thank you, Mr Deputy Speaker. For the purposes of accuracy, the figures published by my Department for December 2010 were 14,671, and for December 2011 were 9,190, a reduction of almost 5,000.
That is not a point of order for the Chair, Mr Lansley. As—[Interruption.] Order. As you well know, that is a point of debate.
Even though it was not a point of order, Mr Deputy Speaker, let me just answer it. I was comparing December 2010 with December 2011. That is a different time frame from the one that the Secretary of State quoted, which involved a time frame since the election. The Government inherited an NHS in which those waiting times were going down, and that is why he quoted those figures. On his watch, they are going back up, and it is a disgrace that he does not have the courage to admit it.
The fact is, as I said a moment ago, that warnings have been coming from the NHS, and I want the House to listen carefully to this information. The right hon. Gentleman has not been listening. The Government will not publish the transition risk register, but we have a pretty good understanding of what is in it from the local and regional risk registers that have been made public in line with Government policy as expressed on the Treasury website. So what do they say about waiting times?
Let us take the risk register from NHS Bradford and Airedale. Its assessment warns of
“a risk of poor patient access and assessment within four hours at Leeds Teaching Hospital due to significant staffing pressures resulting in potential patient safety issues and delay”.
The likelihood of that happening is considered 4, likely to happen, and the consequences are rated 4, major, giving an overall risk register rating of 16, which is extreme.
It’s not actually going to happen.
The Secretary of State says that it is not actually going to happen, but that assessment was made after mitigation. The assessment states that it is likely, that it is major and that mitigating effects have not taken the risk away. He should probably learn to understand the risk register before he refuses to publish it.
NHS Surrey warns of
“performance measures as set out in vital signs for 18 weeks are not met due to a loss of capacity or focus or availability of funding”.
The rating is 16: extreme, likely to happen, with major consequences. The risk has not been mitigated.
What do the local risk registers say about care for cancer patients? Worryingly, some predict—[Interruption.] The Secretary of State would do well to listen; he is not good at listening. He would do well just to listen to what I am saying. Worryingly, some predict poorer treatment for cancer patients.
NHS Lincolnshire’s corporate risk register states:
“New risk in December—the continuation of the Cancer Service improvement, cancer network and the achievement of cancer waiting time targets”.
The risk rating is 16: extreme, likely to happen, with major consequences.
At NHS Bradford and Airedale again, there is a similar risk, with
“poor patient access to cancer waiting times 62 days urgent referral to first treatment, resulting in poor patient care.”
Its rating was 16: extreme, likely to happen, with major consequences.
Will the right hon. Gentleman give way?
No, the House will listen to this information.
What do the risk registers say about patient and public safety and about staffing levels? South Central strategic health authority’s risk register warns—