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Commons Chamber

Volume 551: debated on Tuesday 23 October 2012

House of Commons

Tuesday 23 October 2012

The House met at half-past Eleven o’clock


[Mr Speaker in the Chair]

Business before questions

New Writs


That the Speaker do issue his Warrant to the Clerk of the Crown to make out a new Writ for the electing of a Member to serve in this present Parliament for the County Constituency of Corby in the room of Mrs Louise Daphne Mensch, who since her election for the said County Constituency has been appointed to the Office of Steward or Bailiff of Her Majesty’s Manor of Northstead in the County of York.—(Sir George Young.)


That the Speaker do issue his Warrant to the Clerk of the Crown to make out a new Writ for the electing of a Member to serve in this present Parliament for the Borough Constituency of Cardiff South and Penarth in the room of Alun Edward Michael, who since his election for the said Borough Constituency has been appointed to the Office of Steward or Bailiff of Her Majesty’s Three Chiltern Hundreds of Stoke, Desborough and Burnham in the County of Buckingham.—(Ms Winterton.)


That the Speaker do issue his Warrant to the Clerk of the Crown to make out a new Writ for the electing of a Member to serve in this present Parliament for the Borough Constituency of Manchester Central in the room of Mr Anthony Joseph Lloyd, who since his election for the said Borough Constituency has been appointed to the Office of Steward or Bailiff of Her Majesty’s Manor of Northstead in the County of York.—(Ms Winterton.)

City of London (Various Powers) Bill [Lords] (By Order)

Second Reading opposed and deferred until Tuesday 30 October (Standing Order No. 20).

Oral Answers to Questions


The Secretary of State was asked—

NHS Cost

The latest estimates of NHS spending are those published in the 2012 Budget. The planned NHS spending for 2012-13 is £108.8 billion.

The Conservative-led coalition Government are increasing spending on the NHS, unlike what Labour would do. In my constituency, we will get an urgent care centre in a few months as a result of Tory health reforms. People in Corby already have an urgent care centre as a result of Tory reforms. Does the Secretary of State agree that, while Labour talks about the NHS, Conservatives deliver on the NHS?

I absolutely agree with my hon. Friend. Indeed, last week we announced that waiting times are at near-record lows. The number of hospital-acquired infections continues to go down and mixed-sex wards have been virtually eliminated. I am very pleased that my hon. Friend has an urgent care centre, and am sure that Mrs Bone will appreciate it even more than he does.

Does the Secretary of State recognise that the Office for National Statistics survey shows that the mortality rate in north-east England is 12% higher than that in the rest of the UK? Does he recognise the need to invest in more advanced radiotherapy equipment, bearing in mind that 70 of the 212 systems will need to be replaced by 2015?

I would not necessarily expect the hon. Gentleman to follow announcements that are made at the Conservative party conference, but we did make the big announcement that access to radiotherapy will be transformed, making it available to everyone for whom it is clinically necessary and cost-effective. Improving mortality rates is extremely important. As I have set out, one of my key priorities is to transform the NHS so that we have the best mortality rates in Europe. I hope that that is welcome news for his constituents.

Does my right hon. Friend agree that there will be less budget pressure on the NHS if we do better with long-term conditions, get better at integrated care and use data better to predict ill health? To that end, will he come and see the work of the Kent Health Commission on those issues?

I would be delighted to see the innovative things that are happening at the Kent Health Commission. Looking at how we deal with people with long-term conditions—that is 30% of the population, and the proportion is growing with the ageing population—will be a vital priority for the NHS over the coming years.

May I welcome the Secretary of State and his new team to their positions? As the only other person to have made the jump from Culture to Health, I am sure that he will find me a constant source of useful advice.

The Secretary of State has not said much since his appointment, but he did set out his mission in The Spectator:

“I would like to be the person who safeguards Andrew Lansley’s legacy”.

Let us talk about that legacy. Just last week, the Secretary of State slipped out figures on the latest costs of NHS reorganisation. Would he care to update the House on the current estimates?

Order. The Secretary of State has been in the House for seven and a half years. I think he knows that we refer to Members by constituency, not by Christian name. It is not difficult.

First, may I say how delighted I am that the right hon. Gentleman and I once again have the same brief? I look forward to having a constructive relationship with him, not with total optimism, but I will try my best.

The right hon. Gentleman talked about my predecessor’s reforms and legacy. One of the finest things about my predecessor’s legacy is that he safeguarded the NHS budget—indeed, he increased it during this Parliament by £12 billion—when the right hon. Gentleman said that it would be irresponsible to increase it.

Look at the figures: the previous Secretary of State gave the budget a real-terms cut for two years running. Let me give the exact figures, which the Secretary of State did not give the House. The costs of the reorganisation are up by 33% or £400 million, making the total £1.6 billion and rising. And what is that money being spent on? A full £1 billion is being spent on redundancy packages for managers: 1,300 have got six-figure pay-offs and there are 173 pay-offs of more than £200,000. Scandalously, that news comes as we learn today that the number of nurse redundancies has risen to more than 6,100. Six-figure pay-outs for managers, P45s for nurses and the NHS in chaos—is that the legacy that the Secretary of State is so proud of?

Let us look at some of the facts. The number of clinical staff in the NHS has gone up since the coalition came to power. The right hon. Gentleman talked about the cost of the reforms, which is about £1.6 billion. Thanks to those reforms, we will save £1.5 billion every single year from 2014 and the total savings in this Parliament will be £5.5 billion. Let me remind him that he left the NHS with £73 billion of private finance initiative debt, which costs the NHS £1.6 billion every single year. That money cannot be spent on patient care. He should be ashamed of that.

Will the Secretary of State confirm that NHS spending will increase in real terms during the lifetime of this Government, and that there are no plans from anyone to close the accident and emergency department and the maternity unit at Kettering general hospital? Will he condemn those who say that the Government want to close the hospital, when nobody is going to do that at all?

My hon. Friend is absolutely right: that is a mendacious scare story that is being put out on the ground. Real-terms spending on the NHS has increased across the country, which has not been possible across all Government Departments. Because of that, we are able to invest more in patient care, cancer drugs, doctors and facilities across the country, and indeed in Kettering.

Ambulance Waiting Times

2. How many patients waited longer than half an hour in an ambulance to be transferred to accident and emergency in each year since 2009-10. (124135)

The Department’s records date back to 2010-11. The number of ambulance handovers delayed by longer than half an hour was 63,892 between 1 November 2010 and 24 February 2011 and 77,543 between 1 November 2011 and l March 2012.

On 27 September, patients and paramedics were left waiting outside James Cook university hospital in Middlesbrough for two and a half hours before being handed over. Dr Clifford of the college of emergency medicine described such delays as being due to an unacceptable mismatch in demand and supply. Does the Secretary of State agree with Dr Clifford, and what steps will he take to ensure that those problems do not recur for my constituents?

I am extremely concerned about what happened on 27 September. I can confirm to the hon. Gentleman that all the red 1 calls on that day were met within the target time of eight minutes, but the delays were completely unacceptable. I know that the trust is taking measures to ensure that the problems are not repeated, particularly looking forward to the winter time when there is likely to be extra pressure on ambulance services. I will follow the matter very closely, and I expect the trust to come up with measures to ensure that his constituents are properly safeguarded.

In the summer, I spent an interesting and thought-provoking day observing the work of a crew of the East Midlands ambulance service. Can my right hon. Friend confirm that ambulance trusts across the country, including the East Midlands ambulance service, are performing well in meeting their response time targets?

I can absolutely confirm that. In fact, I was extremely pleased to see last week that all the standards are being met for both eight-minute category A calls— red 1 and red 2 calls—and 19-minute calls. That is as it should be, but it is no grounds for complacency. Although that is a country-wide picture, there are parts of the country where those standards are not being met in the way that we would like. We will continue to monitor the situation closely.

I will be charitable to the Secretary of State, but he brushed over the figures in his answer to my hon. Friend the Member for Middlesbrough South and East Cleveland (Tom Blenkinsop). I have got the actual figures through a freedom of information request. They show that under this Government, 100,000 additional patients are being left waiting in ambulances outside accident and emergency departments for more than half an hour when they need urgent treatment—a totally unacceptable situation. What more evidence does the Secretary of State need of the chaos engulfing the national health service under his Government? It shows that the focus has slipped off patient care and that our accident and emergency units are struggling to cope.

The hon. Gentleman speaks as though the problem of ambulance waits never happened for 13 years under Labour, but he knows that we actually had some appalling problems, with ambulances circling hospitals because hospitals did not want to breach their four-hour A and E wait targets. We are tackling the problem, and as I mentioned, if he looks at the figures published last week he will see that we are meeting the standards for ambulance waits that his party’s Government put in place. However, we are not complacent, and we are monitoring the figures closely. Particularly with the winter coming up, we want to ensure that the ambulance service performs exactly as the British public would want.

Many ambulance trusts are indeed doing extremely well, as the Secretary of State indicated. Does he agree that that is at least partly due to localism in the ambulance service, which may be undermined if, for example, the Great Western ambulance service becomes an amalgamated regional service? Now it has been announced that the call centre in Devizes will be closed in favour of one in Bristol. Does he agree that there is at least a risk that the local service for people in Wiltshire will be reduced if such regionalisation is allowed?

I agree with my hon. Friend that the purpose of the changes that the coalition Government have brought to the NHS is to tap into local innovation, ideas and ambitions to transform services, and it is important that no changes undermine that. He should take comfort from the fact that my predecessor introduced clear tests for any major reconfigurations, including that they should be strongly supported by local doctors, that the public should be involved in any consultation, that the changes should improve patient choice and that there should be clear evidence of benefits to patients. I hope that that gives him and his constituents some reassurance.

National Pay Arrangements

NHS trusts and foundation trusts have the freedom to determine the terms and conditions of the staff they employ. As the hon. Lady will be aware, the “Agenda for Change” was negotiated and brought in during 2004 by the then Secretary of State, John Reid, to agree a national framework for pay in the NHS. In general, most trusts support the agreed pay framework and the “Agenda for Change”, and they are likely to continue to use national terms, provided they remain affordable and fit for purpose.

In fairness, a truly national health service demands a national pay scheme, and the British Medical Association has warned that the move to regional pay undermines the ethos of “national” in our national health service. How does the Minister intend to act on that warning?

I remind the hon. Lady that it was the previous Government who set up the current national pay framework in 2004, and that framework has been amended 20 times to support employers over that period. The previous Government gave foundation trusts the freedom to amend those pay terms and conditions. Regional pay does exist in the NHS. On the basis of what she has said, does the hon. Lady wish to remove the London weighting for those workers who live in London? I am sure she would not want to do that because we recognise that it is more expensive to live in certain parts of the country, and workers should be rewarded for that.

The Lib Dem conference rejected regional pay entirely, but not the London weighting, and 25 honourable colleagues endorsed a submission to the pay review body. With that in mind, is it not odd that the south-west consortium remains part of national pay bargaining?

My hon. Friend makes a good point and it is important that we support national pay bargaining where we can. There is an agreement in principle, endorsed by NHS employers, that national pay bargaining is supported throughout the NHS. It was supported throughout the NHS under the previous Government, who set up the “Agenda for Change”, and during their tenure, that agenda remained fit for purpose. Twenty changes during the previous Government’s tenure benefited employees in the NHS, and rightly so. The current Government believe that we must continue to ensure that the system is fit for purpose.

It is most unusual to find the ghost of Christmas past sitting next to the invisible man. The truth is that in May this year, the Deputy Prime Minister stated:

“There is going to be no regional pay system. That is not going to happen.”

Regional pay will strip millions from local NHS services; it will hit the poorest areas of the country hardest, damage front-line NHS care, and there can be no justification for it. Will the Minister categorically rule out continuing with these ruinous proposals—yes or no?

The arguments presented by the hon. Gentleman are fatuous, and the previous Government endorsed regional bandings for London workers. If today he is saying that he does not agree—[Interruption.] You might learn something if you listen. If he is saying that he does not agree with London weighting for London workers, which is a form of regional pay—[Interruption.]

If the hon. Gentleman listens, he may well learn something about what his Government did when they were in power. They endorsed the fact that in the NHS it is important to recognise that we need inducements in some parts of the country to encourage workers to work there. That is why we have central London and outer London weighting. If it was good enough under the previous Government, it should be good enough now.

Order. We are immensely grateful to the Minister, but we have a lot to get through and we really must press on with rather greater dispatch from now on.

Clinical Trials

4. What his policy is on making available all information about the results of clinical trials to patients, doctors and medicine approval bodies. (124137)

The Government support transparency in publishing results of clinical trials, and they recognise that more can, and should, be done. In future, greater transparency and the disclosure of trial results will be achieved via the development of the European Union clinical trials register, which will make the summary results of trials conducted in the EU publicly available. Greater transparency can only serve to further public confidence in the safety of medicines, which is already robustly assured in the UK by the Medicines and Healthcare products Regulatory Agency. By law, the outcomes of clinical trials undertaken by companies must be reported to that regulator, including negative results.

Order. We are grateful to the Minister but some of these answers are simply too long. If they are drafted by officials, Ministers are responsible—[Interruption.] Order. I require no assistance at all from the Under-Secretary of State for Health (Anna Soubry). She should stick to her own duties, which I am sure she will discharge with great effect.

I thank the Minister for his answer and for recognising that missing data from clinical trials distorts the evidence and prevents patients and their doctors from making informed decisions about treatment. Will the Minister meet a delegation of leading academics and doctors who remain concerned that not enough is being done to see how we can ensure that all historic and future data are released into the public domain?

My hon. Friend raises absolutely legitimate concerns, which have been raised by others, including Ben Goldacre. I am happy for my noble Friend Lord Howe or me to meet her and experts to discuss this important issue further.

Diabetes and Asthma

5. What steps the Government are taking to help people cope with conditions such as diabetes and asthma. (124138)

We are working on an outcomes strategy for long-term conditions such as diabetes and asthma structured around six shared goals, early diagnosis, integrated care, promoting independence, and steps to support those with long-term conditions to live as well as possible.

Given that type 1 diabetes in under-fives is growing at 5% each year, what can my right hon. Friend do with the innovative Secretary of State for Education to ensure that nursery and primary school staff have the right skills and knowledge to ensure that they can help young children to cope with type 1?

The answer is that we are doing quite a lot—a good booklet, “Managing Medicines in Schools and Early Years Settings”, goes around schools, and there are other resources for schools—but we need to do more. We will be announcing a diabetes action plan, a long-term conditions outcomes strategy and a cardiovascular disease outcomes strategy, which will go further to address the issues that my hon. Friend raises.

I declare my interest as someone who has type 2 diabetes and welcome what the Secretary of State says. However, according to the latest report, another 700,000 people will contract the disease by 2020, and 80% of amputations are avoidable. Could he ensure that this very important subject is on the agenda of local clinical commissioning groups?

I certainly can. The number of diabetes sufferers overall will go up from about 3.7 million, which is already 5% of the population, to 4.4 million. We need to do a lot better in how we look after people with long-term conditions if the NHS is to be sustainable. We can also do a lot to transfer the individual care of people who have diabetes through things such as technology, which I will look into carefully.

Does my right hon. Friend agree that the effective delivery of care to people with long-term conditions relies on breaking down the silos within the health service, and between the health service, social care and social housing? Will he encourage the new health and wellbeing boards to follow through that agenda with a serious purpose?

My right hon. Friend is absolutely right. By 2018, nearly 3 million people will have not one but three long-term conditions. All too often, the system treats them on a disease or condition basis, and not as a human being who needs an integrated care plan. That is the route to lower costs, but it is also the route to transformed care.

The Public Accounts Committee has heard that, of 20 trusts that needed to improve their diabetes care, only three took the accepted help. How will the Secretary of State ensure that care through health providers meets the grand targets he has set for himself?

The hon. Lady is absolutely right to point out that the consistency of provision is not good, but we will be publishing a diabetes action plan that will try to ensure more consistent provision throughout the NHS. We also need to raise our sights as to what is possible, because as I have mentioned, a third of the population have long-term conditions, and we can do much better at helping people to live with those conditions in a way that promotes their independence.

Community Hospitals

6. What assessment he has made of the role of community hospitals in the range of local health care and hospital provision. (124139)

My hon. Friend is right to highlight the importance of community hospitals in his constituency and elsewhere. They can provide high-quality care close to home, particularly for people with long-term conditions and the frail and elderly.

I am grateful to my hon. Friend for that answer. If there is a conflict between local health officials and local people as to the desirability of a community hospital, as there is in Littlehampton in relation to the Littlehampton community hospital, which most people in the town want to see rebuilt, whose views should prevail—the NHS employees or the local residents of Littlehampton?

I thank my hon. Friend for his question. As he is well aware, it is down to local commissioners—local doctors—in Littlehampton to decide, in consultation with local communities, what is good health care. Of course, we must not get fixated on buildings in the NHS. I know there is a local campaign to support the re-establishment of Littlehampton district hospital, and although that may be a very desirable end, there may be many other ways in which high-quality health care can be provided for his constituents closer to home.

From April, my local health centre will be transferred to a national property company, a quango, in Whitehall. How can local people in Hyndburn regain some influence over this health centre and its use after April?

Part of reorganising services and delivering good health care is about clinical leadership—I hope that is supported across the House—and local doctors, nurses and health care professionals saying what is important for their patients and what local health care priorities are. Obviously, local communities need to be engaged in that process, but what really matters is what is good for patients and delivers high-quality care for them. We need to deliver more care in the community, and in doing so we have to recognise that some of the ways we have delivered care in the past—picking up the pieces in hospitals when people are broken—need to change. We have to do more to keep people well at home and in their own communities.

Given that the maternity unit at Berwick infirmary has been suspended since the beginning of August for safety reasons, with births being referred to a hospital 50 miles away, will the Minister take into account the urgent need to provide the necessary clinical support for community hospitals in remote areas so that they can provide local essential services to the highest standards?

I thank my right hon. Friend for that question. We discussed this issue in the Adjournment debate before the autumn recess. He is a strong advocate for his local maternity services. The concern was that only 13 births take place at his local maternity unit every year, and whether staff can continue to deliver high-quality care with such a low number of births. Of course, his local providers will want to consider the rurality of the area and the potential, as outlined in the Birthplace study, of rotating staff in and out of the hospital to support his local unit.

Domiciliary Care

7. What steps he plans to take to ensure that providers of domiciliary care employ staff who are properly qualified and security checked. (124140)

Providers of services are responsible for the safety and quality of the care they provide. All staff must be properly qualified and vetted, and the Care Quality Commission can and must take action against providers who fail in that regard. Action can range from a warning notice to, ultimately, cancelling a provider’s registration. The commission must be willing to take that action if necessary.

But the Minister knows that a recent BBC programme showed that 217 providers of care at home use staff who are not properly qualified, and that dozens of people with criminal records have not been vetted and are working unsupervised in people’s homes. The Care Quality Commission has reached only just over one in four of its target inspections, with 40% of care at home providers never having been inspected by it. What will the Minister do to ensure that we can have more confidence in care provided at home to vulnerable people and that it is up to a better and safer standard?

I absolutely share the hon. Lady’s concern about this. It is intolerable that people receiving domiciliary care do not get high-quality care and that in some cases people are inappropriately employed. The Care Quality Commission must take action where there is evidence of employers not taking sufficient action to guarantee the quality of their staff. It is essential that the people who run those services are held to account if they fail in that regard.

Will the Minister also consider the matter of the uniforms worn by staff in this sector? I understand that on occasions there has been confusion in members of the general public between such staff and qualified nurses.

It is absolutely essential that users of services know exactly who the staff are who are caring for them, and the issue of uniform is something that I would be happy to discuss further with the hon. Gentleman.

Health Allocation Formula

We will soon publish the final recommendations of the independent advisory committee on resource allocation. That committee reviews the approach and the formula under which money is allocated to clinical commissioning groups and local authorities so that they can fulfil their public health duties.

There have been two problems with how the formula has worked over the past few years. First, it has not placed enough emphasis on ageing as a criterion, and secondly the Department of Health has not implemented it properly, in so far as flat-rate increases have been given to primary care trusts, meaning that there has been no impact from changes. Both these things have worked to the detriment of Warrington. Will the Minister resolve these issues?

I am glad to assist my hon. Friend and assure him that fairness is imperative when it comes to distributing money and deciding where it goes. One reason the Government are keen to make the formula fair is our determination to reduce health inequalities, especially given the last Administration’s legacy of increased inequalities.

The former Secretary of State wanted to make age the only factor in the formula, which would have totally ignored poverty and the local cost of care—[Interruption.] He said it. It would have taken £295 per head away from the north-east. Will the Minister confirm that the local cost of care and poverty will be included in the formula allocation?

That was not my understanding of the former Secretary of State’s comments, but I can say that we are absolutely determined to ensure that fairness is achieved, and all the factors she mentions are important in ensuring that fairness.


Tackling dementia—particularly the shockingly low diagnosis rates—is a key priority for me and the Prime Minister.

I welcome the Government’s steps to support carers and the work they have done, especially on the £400 million to give carers’ breaks from their important responsibilities. Will my right hon. Friend explain what is being done to increase awareness and understanding of carers’ health care needs?

My hon. Friend is right to highlight this point. In the draft Care and Support Bill, local authorities will be required to meet the eligible needs of carers. That is a particular concern with dementia, because, all too often, someone looking after a partner with dementia gets to a tipping point where there is no alternative to residential care, but, if we can give them better support, they will have a better chance of remaining at home, which, in the vast majority of cases, is where they want to be.

Many elderly people with dementia remain trapped in hospital, because there is not adequate provision in the community for them to be looked after at home. How does the Secretary of State intend funds to be extracted from hospitals to be spent in the community, particularly at a time when local authority funding cuts mean that many of the voluntary agencies providing that support are actually losing posts in my borough?

The hon. Lady is right to highlight this growing issue. One million people will have dementia by 2020, so we have to take it very seriously. It is not an either/or situation, though, because about 25% of patients in hospitals have dementia, and hospitals would like them placed in the community or at home, where they can be better looked after. This is one of those examples where, under the new reforms, we need much greater integration of services to ensure that those people are treated in the way they need to be.

Pancreatic Cancer

We are providing more than £450 million during this spending review period to help diagnose cancer earlier. In January, we are planning to pilot a general symptom awareness campaign that will be relevant to a range of cancers, including pancreatic cancer. Unfortunately, however, pancreatic cancer is often very difficult to detect in the early stages.

Has the Minister considered the early diagnosis summit report from Pancreatic Cancer UK highlighting that currently half of diagnoses are emergency diagnoses? It also makes strong cases for new referral pathways, risk assessment tools, direct access for GPs to investigative and diagnostic tools and the development of a National Institute for Health and Clinical Excellence quality standard for pancreatic cancer. Can we expect progress on any of these before the 2013 cancer awareness campaign?

I thank the hon. Gentleman for his work. I am aware of the campaign that he has been running effectively in his constituency, based on the experiences of one of his constituents. As I say, however, and as he will know, pancreatic cancer is, by its nature, a particularly difficult cancer to diagnose early. We will all, of course, remember the untimely death of Sir Stuart Bell. Unfortunately, he was diagnosed only very shortly before his death. I wish that were not as common as it is, but we are doing everything we can to improve screening. I thank the hon. Gentleman again for his campaign, and I would be happy to meet him to discuss it further.

Cancer networks have played a crucial role in improving patient care, including by earlier diagnosis. The former Health Secretary promised this House that their funding would be guaranteed in 2011, but the South East London Cancer Network now says its budget was cut by 40% between 2009 and 2011. This year, it has been slashed by a further 55% and its staff have been cut from 15 to eight. Will the Minister now admit that her Government have cut funding for vital front-line cancer experts and have broken their explicit promises on cancer care?

My information is that any 40% reduction is a result of cuts in administration—and that, if I may say so, seems the right way to go about things. This Government are determined to make sure that when we make cuts of that nature, they are not actually cuts—[Interruption.] It is about moving money around so that it goes to front-line services. This Government are determined to reduce bureaucracy in the NHS and to make sure that patients get the benefit of our spending—unlike under the last Administration, who had it round the other way.

Mental Health Services

The children and young people’s improving access to psychological therapies project, which we introduced in 2011, is about transforming mental health services for children and young people with mental health conditions. The Government’s mental health strategy implementation framework, published in July, suggests actions that schools, colleges and children’s services can take to provide better support.

The Government should be congratulated on tackling the stigma of mental health by their “No health without mental health” policy, but the growing problem of mental illness among school-age children is a concern and with the demise of the early intervention grant, which included the targeted mental health in schools funding, there is a worry that too many schoolchildren will be neglected. Will the Minister liaise with the Department for Education and with school nurses to make sure that appropriate and timely access to talking therapies and others are available for school age children rather than having to rely on the belated chemical cosh of powerful drugs?

May I first pay tribute to my hon. Friend’s work in this area? He has been really impressive and dedicated in his work. I absolutely agree with him about the importance of ensuring access to mental health services for children and adolescents. In fact, the Government are investing over £50 million over a four-year period through the children and young people’s improving access to psychological therapies programme and, critically, involving schools and colleges in that work. I would be very happy to work with my hon. Friend to improve access for children and young people.

I repeat the point that we are actually investing more in a transformation of children’s and adolescents’ mental health services—and it is making a real difference. People within the service can see the benefits that it is bringing.

Regional Pay

Has the Minister had an opportunity to study the research done by the New Economics Foundation a few months ago, which reveals that fully regionalised public sector pay could strip up to £9.7 billion a year from local economies, put 110,000 jobs at risk and hit women twice as hard as men? Given that, what possible justification could this Government have for such a crazy policy?

Let me bring the hon. Gentleman back to planet earth for a while—[Interruption.] He should have listened to the answer I gave a little earlier about allowing for flexibility in pay frameworks. Some degree of regional pay was introduced by the previous Government in “Agenda for Change”. On principle, then, the previous Government, the hon. Gentleman and his colleagues, including the former Secretary of State, were supportive of regional pay. However, on the current negotiations and discussions, we would like to see a collaborative relationship between employers, unions and employees in the NHS at the NHS Staff Council to make sure that we maintain national pay frameworks as long as they remain fit for purpose.

Why should there be an assumption that local pay will lead to lower pay in the public sector? In a constituency such as mine, where the unemployment rate is below 2%, local pay could quite possibly lead to higher pay in the public sector so that people are attracted to it.

My hon. Friend makes an excellent point. It was the previous Government who, through the “Agenda for Change”, gave flexibility to NHS trusts to allow some employers to pay a 30% premium in areas with workplace shortages.

17. At a time when NHS budgets are under exceptional pressure, my constituents simply do not understand why the Government are so intent on pushing trusts to divert money away from patient care and into wasteful local pay bargaining. Is there not a risk that Nottingham’s excellent NHS hospitals and community services will be unable to recruit and retain the best staff if regional pay results in cuts to their salary scales? The Government are supportive of the idea, endorsed by the previous Government, that local pay flexibility allows additional rewards to be paid to staff in areas with workplace shortages, as my hon. Friend the Member for Banbury (Sir Tony Baldry) just made clear. The Government are supporting the unions, employers and employees, as the NHS Staff Council, in coming together to try to agree how we need to modify the “Agenda for Change” and other agreements to ensure that they remain fit for their purpose of protecting employees. (124152)

Intensity-modulated Radiotherapy

13. What assessment his Department has made of the extent to which the cancer radiotherapy innovation fund will increase access to intensity-modulated radiotherapy. (124146)

The £15 million radiotherapy innovation fund is designed to ensure that from April 2013 radiotherapy centres will be ready to deliver intensity-modulated radiotherapy to all patients who need it. We are working with professional bodies and Cancer Research UK to develop a programme, including support visits, training and criteria for allocating the fund.

I thank the Minister for that answer and she will know that the UK’s first clinical trials of IMRT were carried out at Addenbrooke’s hospital in Cambridge, funded by the Breast Cancer Campaign, and showed reduced side effects and improved cosmetic outcomes. How many breast cancer patients a year does she think could benefit from IMRT and how will she ensure that they all manage to do so?

We know that 9% of all radical radiotherapy treatment should be delivered using forward-planned IMRT and that that should be used for and will benefit breast cancer patients. A survey of radiotherapy centres was carried out in preparation for the launch of the new fund that showed that 26% of radical activity was being delivered using forward-planned IMRT. The hon. Gentleman might say that that does not exactly answer his question and I am more than happy to make further inquiries and, if necessary, to write to him in full detail.

That is important. I have recognised in the short time in which I have been in my post that there is often disparity across the country and in certain areas, frankly, the service is not as good as that in others. One of our aims is to ensure that regardless of where someone lives they will get good treatment from the NHS.

Multiple Learning Difficulties (School Provision)

14. What steps he has taken to ensure that children with profound multiple learning difficulties have their health care needs met while at school. (124148)

We are working with the Department for Education to introduce integrated commissioning of education, health and social care for children and young people with special educational needs and disabilities. This will ensure that children with profound multiple learning difficulties can get the care they need while at school.

I recently visited Hadrian school in my constituency, which caters for children with severe learning difficulties and profound and multiple learning difficulties. I saw fantastic teachers and carers doing fantastic work with fantastic children, but I also saw in the reception classes that more children with more severe health needs were entering the school. What guarantees can the Minister offer that funding will be in place for those children in five or 10 years so that Hadrian school can plan now for their needs?

The hon. Lady makes a good point. We know that the Government are putting more money into the NHS. However, this not just about putting in more money, but about how we deliver care in a more joined-up way. At the moment, education works too much in its own silo and the NHS works in another. The Government’s new commissioning arrangements will follow the more joined-up approach that we need to take properly to meet the needs of children with learning disabilities in the round. That must be a good way forward in properly joining up education and health care.

Topical Questions

It is my privilege to serve as Health Secretary responsible for the national health service. I have identified four priority areas where I hope over the next two years to make the most progress. They are improving mortality rates for the major killer diseases so that we are among the best in Europe, which we are not at the moment; improving the way we look after people with long-term conditions such as diabetes and asthma; improving the way we deal with dementia, both as a national health service and as a society; and, perhaps most important of all, transforming the attitude to care throughout the NHS and social care systems so that the quality of care is seen to be as important as the quality of treatment.

What assistance can the Secretary of State give to the newly appointed chairman of the Sherwood Forest Hospitals Trust as he begins to wrestle with the private finance initiative signed under the previous Government and attempts to find repayments in excess of £40 million a year?

The first thing I would say to my hon. Friend about Sherwood Forest is that I know everyone in the House will join me in saying that our hearts go out to the families of the women who were misdiagnosed for breast cancer. We expect the local NHS to come up with a serious package of measures to make sure that that kind of thing cannot happen again.

My hon. Friend is right to talk about PFI. We inherited an appalling scandal. In order to tackle the PFI debts of just seven institutions, we are having to put aside £1.5 billion over the next 25 years, but we are working with all institutions to deal with this appalling debt overhang.

We know that the Secretary of State’s views on abortion do not have a religious basis, so does he care to share with the House the scientific evidence to support his view that abortion time limits should come all the way down to 12 weeks?

Four years ago I voted with my conscience, as I am sure she voted with hers, but I did so as a Back-Bench Member of Parliament and we have made it clear that it is not the policy of the Government to change the abortion law. My job as Health Secretary is to implement the elected will of the House, which voted in 2008 not to reduce the abortion time limits.

T2. What steps is the Department taking to tackle the growing incidence of drug-resistant cases of TB, which increased by more than a quarter in the past year? (124160)

We are funding TB Alert to raise public and professional awareness of TB. We also expect the NHS organisations and their partners to ensure early detection, treatment completion and co-ordinated action to prevent and control TB. The Health Protection Agency maintains diligent monitoring of all types of TB and the National Institute for Health and Clinical Excellence also includes specific guidance on treatment and rapid contact tracing of people in contact with any type of drug-resistant TB.

T5. Before the last election, the Prime Minister promised a “bare knuckle fight” to save district general hospitals and promised that they would be enhanced. Now that we know that the board of St Helens and Knowsley hospitals is looking at a merger with Warrington and Halton to solve its problems, can the Minister give the House an unconditional assurance that no services at Warrington will be downgraded or removed, whether that merger goes ahead or not? (124164)

There was an option to discuss this issue at the board meeting on 29 August—not of the hon. Lady’s hospital trust but of the Halton hospital trust—because the Halton trust is looking to achieve foundation status. So I can reassure her that the services at Warrington hospital are safe.

T3. What is the administration overhead cost to the NHS and the Department this year and how does it compare with 2009-10? (124161)

I will get back to my right hon. Friend with the exact details, but the impact of the reforms that the Government have introduced will cut administration costs by a third across the whole NHS, leading to net savings of £4 billion during this Parliament.

T7. Last Wednesday, the Prime Minister told the House that Kettering hospital was safe. The following day—Thursday—evidence in a document leaked to the Corby Telegraph said that 515 of the 658 beds in the hospital could be lost. Will the Secretary of State ask the Prime Minister to come before the House to put right the statement he made to the House, but will the people of Corby not conclude that whatever the Prime Minister says, the national health service will never be safe in Tory hands? (124166)

What a disgraceful comment. We do not need the Prime Minister to come before the House because I can tell the hon. Gentleman that Kettering hospital is safe, and that it is totally irresponsible scaremongering by the Labour party in the run-up to a by-election to suggest anything else.

T4. Will the Secretary of State join me in welcoming the progress that has been made to reduce mixed-sex wards and improve patient privacy at Medway Maritime hospital in my constituency? (124163)

My hon. Friend is absolutely right to highlight the Government’s success in reducing mixed-sex wards not just in his hospital but throughout the NHS—we inherited a very different situation from the previous Government. Medway has been a pioneer in that area and my hon. Friend is right to commend the hospital and I put on record my thanks for all that it is doing.

T8. Will the Secretary of State take a close personal interest in the proposed changes to the NHS in Trafford? Given the uncertainty about alternative accident and emergency provision, and indeed the delays in commissioning community services, will he ensure that any final decisions are deferred so that they can be considered as part of the wider review planned for NHS services across Greater Manchester? (124167)

I should like to reassure the right hon. Gentleman that I take a close personal interest in all reconfigurations because they tend to end up on my desk. In this case, I encourage him to take part in the consultation for Trafford general, which will go on until the end of the month, but I remind him that the Government have put in place four important tests for any major reconfiguration. We must be satisfied that those tests are passed before we approve any reconfiguration, and those include the support of local doctors.

T6. As breast cancer action month comes to an end, recent research by Breast Cancer Campaign has shown that 76% of women would like more information about breast cancer signs and symptoms. What steps are the Government taking to encourage early diagnosis of breast cancer? (124165)

Achieving early diagnosis of symptomatic cancer is key to our ambition to save an additional 5,000 lives a year by 2014-15. As I explained in an earlier answer, we are providing more than £450 million in funding over the spending review period to support early diagnosis. From January to mid March 2013, we will be running a regional pilot of our previously tested local campaign on breast cancer symptoms in women over 70. We are targeting those women because that is an area where, unfortunately, survival rates are particularly poor.

Since his promotion, the Secretary of State has said little and, I assume, read a lot. Did his starter pack include details of the Prime Minister’s promise:

“This year, and the year after, and the year after that, the money going into the NHS will actually increase in real terms.”?

Did it include Treasury figures that show there has been a real terms cut each year since the election? What is he saying to NHS staff and patients who see the cuts and see the Prime Minister’s big NHS promise being broken?

May I just remind the right hon. Gentleman that there has been a real terms increase in NHS spending? That contrasts rather starkly with what was said by the Health Secretary under the previous Government. He said it would be irresponsible to increase health spending in this Parliament. We ignored that advice and NHS patients are benefiting.

T9. The food labelling consultation closed in August. Could the Minister indicate when the Government response is likely to be issued and confirm that the Government will not bring in unnecessary burdens on the food industry over and above those set out in European regulation? (124168)

This is an area that is important to the Government’s work. At this stage it is important to make sure that we do not over-regulate but that we work with industry and manufacturers. The four Governments across the United Kingdom will shortly issue a statement about front-of-pack nutrition labelling, and we expect to publish the formal response to this year’s consultation within the next few weeks.

The excellent children’s heart surgery unit at the Royal Brompton hospital will be pleased that a full review has been announced. Why does it have to report within four months, including the Christmas period, and why were previous referrals by both Brompton and Leeds refused? Will the review be full and impartial or not?

It will be a totally impartial and very thorough review. This is an extremely important decision, and that is why I asked the Independent Reconfiguration Panel to take the time that it needs to do the review properly; that is the least that the hon. Gentleman’s constituents would want.

In order to get the Health and Social Care Act 2012 through this House, the Government gave explicit assurances that private companies could not cherry-pick the easiest procedures and patients, yet a recent letter from David Flory, the deputy chief executive of the NHS, back-pedals on the Government’s position, and shows that the Government are dependent purely on guidance. What can the Government do to put a bit of backbone back into that important policy?

May I reassure my hon. Friend that we are absolutely committed to the “no cherry-picking” provisions of the Act? We think that we have found the right way to achieve that in the NHS, and I will write to him to explain exactly how we will do that.

Given the apparent increase in spending in the NHS and the £4 billion surplus, will the Secretary of State look at lifting the pay restraint for lower-paid workers, to increase morale and boost productivity?

The £12 billion increase in spending on the NHS under this Government, which the right hon. Member for Leigh (Andy Burnham) thought was irresponsible, means that we will be able to do a lot more for patients, but there is also rising demand. If we do not have that pay restraint, we will not be able to meet the needs of an ageing population.

What specific consideration is being given to matching the annual growth funding uplift to actual changes in population? That is essential to my constituency, which has high population growth.

It is my understanding that that is already part of the formula, but my hon. Friend makes a good point, and I am sure that he joins me in wanting to make sure that the formulas are fair, so that we reduce health inequalities. I am happy to discuss the issue with him further.

The Public Accounts Committee says that 11 of the 144 foundation trusts across England are now in serious financial difficulty. What contingency funding is in place for those trusts, to protect patients?

We have a clearly set out programme for all those trusts, to make sure that they get back to the proper financial controls and proper governance structures that they need. We do not want to get into the business of bailing them out; we want them to stand on their own two feet. That is the vision of the Health and Social Care (Community Health and Standards) Act 2003, passed by the hon. Gentleman’s party when it was in government.

Will my right hon. Friend extend the scope of personal budgets? They help not only patients, giving them wider choice, but carers, allowing them to leave their post.

My hon. Friend makes an extremely good point. This is all about giving power to patients. Personal budgets have already been very successful in social care, and there are pilots under way in health care; the indications are that they are proving very successful.

The NHS has a responsibility for all patients in ill health, especially those who are elderly. Is the Minister aware of the information released last week that 3,000 general practitioners have drawn up a list of 7,000 patients who have less than a year to live—in other words, whose level of care is in question? Will the Minister condemn that list and take every possible step to ensure that every patient gets NHS care, irrespective of age?

The whole purpose of that approach is to ensure that patients get appropriate care at the end of their life. There is very strong consensus supporting that approach, including on the part of Marie Curie Cancer Care and Age UK. It is really important that all GPs and others involved in the care of people at the end of their life engage fully with the patient and the patient’s loved ones. That is the right approach.

My right hon. Friend will know that in this country, over 1,000 people a year die as a consequence of asthma. We have one of the highest prevalences of asthma in the world. Will he outline to the House what action we will take to get those mortality rates down?

We are doing a lot of work on the outcomes strategy that will directly impact on asthma sufferers. As part of that work—we are as concerned as my hon. Friend is about this—we are looking at every single asthma death in a 12-month period, starting from this February, to try to understand better the causes of mortality, because we need to make very rapid progress.

Further to the answer that the Minister of State gave to my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), why do the Government not make it a criminal offence for those who recruit staff on the cheap not to bother checking employees’ employment records, qualifications or criminal records? Surely they are putting people’s lives at risk.

I absolutely share the hon. Gentleman’s concern. I am looking at the whole issue very closely. It seems to me that the fundamental point is to ensure that the people in charge at the corporate level are held to account for failures of care. We are very serious about ensuring that that happens.

The hon. Gentleman has been in the House since 1987; he knows perfectly well that points of order come after statements, not before them. I feel certain that he was just teasing the House and me.

Bovine TB and Badger Control

I am delighted that my presence has received such a welcome.

Bovine TB is the most pressing animal health problem in the UK. The importance of the epidemic for our cattle farmers, their families and their communities cannot be overemphasised. This was once a disease isolated to small pockets of the country; it has now spread extensively through the west of England and Wales. The number of new cases has doubled every nine years. Last year, TB led to the slaughter of 26,000 cattle in England at a cost of nearly £100 million. In the past 10 years, bovine TB has cost the taxpayer £500 million. It is estimated that this will rise to £1 billion over the next decade if the disease is left unchecked.

The task of managing bovine TB and bringing it under control is difficult and complex. The Government are committed to using all the tools at their disposal and to continuing to develop new ones as a package of measures to tackle the disease. In high-risk areas, herds are tested annually and any cattle that test positive are slaughtered. Restrictions on cattle movements have been further strengthened to reduce the chance of disease spreading from cattle to cattle. Only last week, we announced plans for a new surveillance testing regime and stricter cattle movement controls. We also continue to look at ways to improve the testing of cattle for TB.

Research in this country over the past 15 years has demonstrated that cattle and badgers can transmit the disease to each other; culling badgers can lead to a reduction of the disease in cattle if it is carried out over a large enough area and for a sufficient length of time. That is why we believe that, based on the best available evidence, culling badgers to control TB can make a significant contribution.

It is crucial that we get this right. The National Farmers Union has taken the lead on behalf of the farming industry to plan and organise the pilot culls. It has been working tirelessly over the past few months, signing up farmers and landowners in the pilot areas and ensuring that contractors are property trained. I have been immensely impressed by the effort, commitment and determination that have been demonstrated by farmers in the two pilot areas. I am also most grateful to the police in the two areas for their support.

The exceptionally bad weather this summer has put a number of pressures on our farmers and caused significant problems. Protracted legal proceedings and the request of the police to delay the start until after the Olympics and Paralympics have meant that we have moved beyond the optimal time for delivering an effective cull. We should have begun in the summer. In addition to these problems, the most recent fieldwork has revealed that badger numbers in the two areas are significantly higher than previously thought, which only highlights the scale of the problem we are dealing with.

Evidence suggests that at least 70% of the badgers in the areas must be removed. This is based on the results of the randomised badger culling trial so that we can be confident that culling will reduce TB in cattle. Despite a greatly increased effort over the past few days and weeks, the farmers delivering this policy have concluded that they cannot be confident that it will be possible to remove enough badgers based on these higher numbers and considering the lateness of the season. It would be wrong to go ahead if those on the ground cannot be confident of removing at least 70% of the populations.

Today I have received a letter from the president of the NFU, on behalf of the companies co-ordinating the culls, explaining why they do not feel that the culls can go ahead this year and requesting that they be postponed until next summer. In these circumstances, it is the right thing to do, and as they are the people who have to deliver this policy on the ground and work within the science, I respect their decision. I have placed a copy of the letter in the Library of both Houses.

By starting the pilots next summer, we can build on the work that has already been done and ensure that the cull will conform to the scientific criteria and evidence base. I know that this will be very disappointing for many, particularly those farmers in the two pilot areas, but I fully support the decision of the NFU to delay the start of culling operations.

I must emphasise that there is no change to the Government’s policy We remain absolutely committed to it, but we must ensure that we work with the NFU to get the delivery right. We also remain committed to our wider TB eradication programme and to continuing to strengthen it, so that we can move towards our goal of a TB-free England. Vaccination is another tool and one that we would all like to be able to deploy more widely. Unfortunately, we are not there yet in terms of its development or practicality. If we had a viable and legal cattle vaccine, we would be using it. It will, however, be some years before this is the case and neither we nor the industry can afford to wait that long. It is for this reason that we must look at all the options.

The Government are determined to tackle bovine TB by all the means available to us. Now, in the next few months, we will ensure that the pilot culls can be implemented effectively, in the best possible conditions, with the right resources. Having looked at all the evidence over many years, I am utterly convinced that badger control is the right thing to do, and indeed the higher than expected badger numbers only serve to underline the need for urgent action. I remain fully committed to working with the farming industry to ensure that the pilot culls can be delivered effectively, safely and humanely next summer. I commend this statement to the House.

I begin by welcoming the Secretary of State to his post and thank him for advance sight of his statement.

Another day, another U-turn, announced first to the “Today” programme and now to Parliament. Labour has warned the Government for two years that the badger cull was bad for farmers, bad for taxpayers and bad for wildlife. In addition, the Government’s handling of the cull has been incompetent and shambolic. It is right that it has been delayed, but we were not alone. Lord Professor John Krebs, the eminent scientist who first suggested that the culling of badgers be tried to tackle bovine TB, described it as a “crazy scheme”. The Government’s own chief scientist, Professor Sir John Beddington, declined to endorse the policy. The free shooting of badgers in some big society badger cull was always a terrible idea. It had never been tried, never measured.Professor John Bourne, who led Labour’s badger cull trials, called it an “untested and risky approach”.

The cull would cost farmers more than it saved them, put huge strain on the police and spread bovine TB in the short term as badgers move out of cull areas. It would cost half a million pounds a year to police per area, and all for a 16% reduction in bovine TB over nine years. Bovine TB is a terrible disease for farmers, their families and their communities, which is why we, when in government—[Interruption.] That is why we ran the cull trials to see whether culling made a difference—

Order. There is too much noise coming from both sides of the House. Mr Kawczynski, I have had reason to indicate this to you before, but you must calm down. I think that you need to go on an anger management course, man. [Interruption.] Order. Get a grip.

Bovine TB is a terrible disease, but the Secretary of State’s cull was never going to be a silver bullet. Then, last Thursday, we saw the first signs that the badger cull was shaping up to be another Government disaster. As Ministers went to ground, the Secretary of State’s own press office told “Channel 4 News” that the policy was being scrapped, but an hour later they rang back—it was unscrapped. To have to announce one U-turn may be regarded as misfortune, but two U-turns in one afternoon looks like carelessness, even for a Government as weak and incompetent as this one.

What was the reason for the wobble? I had asked some parliamentary questions, and Ministers’ answers revealed some awkward facts. My first basic question was how many badgers there were in each cull area. The answer was that the Government

“have yet to issue definitive target figures for the two areas”.—[Official Report, 17 October 2012; Vol. 551, c. 296W.]

The cull is predicated on killing at least 70% of badgers in an area. How could it proceed when Ministers did not know how many animals there were? We had said all along that the cull was a shot in the dark, and here was the proof. It was that admission, two days before the cull was due to start, that meant DEFRA was wide open to a judicial review for being in breach of the law. The Government’s own best estimate of badger numbers was far higher than previously estimated, making both culls more expensive than forecast. That would mean more expense for farmers and increasing the contingency fund, the bond that farmers are required to lodge with Natural England. Why did Ministers not ask how many badgers farmers needed to kill before this whole fiasco started?

What sort of announcement is the Minister making today? Is it like the forests U-turn, when they pulled the plug and then set up an independent panel to kick it into the long grass forever, leaving just enough cover to save the Prime Minister face; or is it like the infamous Health and Social Care Bill, when the Prime Minister pressed the stop button, waited for things to calm down and then carried on regardless? Is this delay a proper U-turn or a pretend U-turn? I think that the country deserves to be told.

We welcome the tougher measures on biosecurity that the Secretary of State announced last Friday. He says the cull will start again next summer. He has blamed the weather and the police, yet his own colleague the Home Secretary said that the cull must not go ahead during the Olympics and Paralympics. What happens if the weather is bad next year? What estimate has he made of the impact on the tourism industry of a cull next June? Does he expect MPs and the public to believe him when he says that the cull will happen next summer? If it does not take place, is there not a risk that his Department will be pursued for costs by farmers left out of pocket as a result of his incompetence? Is not the truth that the Prime Minister yanked him back from his festival of fromage and fizz in Paris last night and told him it was game over? Who exactly is in charge?

After months of agonising, with hundreds of thousands of pounds of taxpayers’ money having been spent on consultations, counting badgers, training marksmen and issuing licences, and after thousands have been spent by farmers setting up companies, we have had another U-turn from this incompetent Government. They have spent two years puffing life into a policy that should never have left the ministerial red box. After just six weeks in his post, the Secretary of State has discovered that DEFRA is filled with elephant traps for the unwary. With forests, circus animals and now the badger cull, he has completed a hat trick unmatched by any other Department.

Labour has always said that the badger cull was bad for taxpayers, bad for farmers, and bad for wildlife. This Government are out of touch with the nation. This cull should have been stopped months ago. Today we have the right decision for all the wrong reasons. The cull has been stopped because of the Government’s endemic incompetence. They should have listened to the scientists, the charities and Labour Members, and made policy based on the evidence instead of twisting the evidence to fit their policy. Once again, Ministers present the House with a disaster entirely of their own making. Once again, it is farmers and taxpayers who are left counting the cost.

I thank the hon. Lady for her kind words in welcoming me to my place, but it was pretty thin stuff, wasn’t it, Mr Speaker?

Let us start with Professor Lord Krebs, whom the hon. Lady quoted. He confirmed the policy when he said in April last year at a meeting of independent scientific experts:

“The science base generated from the…Randomised Badger Culling Trial shows that proactive badger culling as conducted in the trial resulted in an overall beneficial effect compared with ‘survey only’ (no cull) areas on reducing new confirmed cattle herd breakdowns which is still in evidence 5½ years after the final annual proactive cull.”

The hon. Lady then touched on the comments of the chief scientist, Sir John Beddington, but failed to say that his recent quote in full is this:

“The proposed pilot culls differ from the RBCT in a number of ways. Additional biosecurity aimed at reducing perturbation effects, any predictions as to the efficacy of the culls will be accompanied by uncertainties. However, if the results were similar to those of the RBCT we might expect a 12 to 16% reduction in bovine TB over an area of 150 km sq after nine years relative to a similar unculled area. It will be important to monitor the results and to subject them to rigorous statistical analysis to assess humaneness, safety and efficacy.”

That is exactly what the pilots were for: they were the logical conclusion—[Interruption.]

Order. I told Mr Kawczynski that he was making too much noise and he accepted his fate with good grace. Members on the Opposition Front Bench must not yell at the Secretary of State as he is answering questions. The right hon. Gentleman must be heard. Let us hear it from Mr Secretary Paterson.

Thank you, Mr Speaker.

The previous Government took forward the RBCT in a whole series of trials and then stopped and decided to do nothing. They presided over a horrendous increase in this disgusting disease. We have taken the logic of the RBCT and extended it, which means conducting it over a larger area with hard boundaries and a more efficient system of culling. We are wholly conforming to the science and to the advice that we have taken. However, as I explained in my statement, at this late stage of the season, because of the various delays and because of the larger numbers than had previously been planned for, the NFU has come to me requesting a delay. I should like to reassure the hon. Lady that this policy is absolutely intact. We will work with the NFU over the coming months and from next summer we will deliver pilot culls that will show the efficacy of what we are intending to do.

I call Mr Jim Paice. [Interruption.] Sir James Paice—I apologise profusely to the right hon. Gentleman.

Apology accepted, Mr Speaker, with good grace.

This is clearly very disappointing news for everybody, including the farmers, who had planned for and expected our getting to grips with this disease as quickly as possible. May I endorse my right hon. Friend’s comments about these being pilots? We have always recognised that in some areas they differed from the original RBCT measures, and that was the reason for having the two pilots—to see whether those differentiations still produced the same results. The increase in numbers to which he refers is surprising—or the fact that it is a problem is surprising—given that most people who live in these areas should have been well aware, as most country people are, of the massive increase in badgers.

Finally, does my right hon. Friend agree that science shows that if the population of any species significantly increases in density, disease spreads more quickly as it is more likely to sustain itself? This increase in the badger population therefore increases the need to carry out the control.

I thank my right hon. Friend and commend him for the tremendous work that he did in his job as Minister of State. Wherever I have been in recent weeks, many, many people across the industry have paid him great tribute for the sterling work that he did. I commend him for taking this policy on; it was not easy.

My right hon. Friend is absolutely right. The two pilots were the logical extension of the trials conducted under the previous Government, which stopped dead once they had finished. The next logical step is to go on to a larger geographical area and use a more efficient method of culling. He is absolutely right to say that the real lesson from these very significantly higher numbers is that the disease will be prevalent among the badger population and spreads more quickly in a dense population. This is a problem that we have to grip. It is no good criticising from the outside without coming up with a policy.

Order. A very large number of hon. and right hon. Members are seeking to catch my eye. I am keen to accommodate them, as this is a hugely significant matter, but if I am to do so, economy from Back Benchers and Front Benchers alike would greatly assist.

In July 2011, Natural England estimated that there would be 3,300 badgers in each 350 sq km cull area, using data from the randomised badger cull trial, yet DEFRA used the figure of only 1,300 badgers for each 350 sq km area. Why did DEFRA get the figures so badly wrong?

I am grateful to the hon. Lady for that question. It will be helpful if I explain the chronology. In September this year Natural England first determined that there were deficiencies in the sett data. Shortly after I took up my post, it set about a detailed sett survey and came up with these very significantly large numbers. We have to respect the science. It is most important that everyone understands this. The simple facts are that with these increased numbers the NFU did not believe that in the later weeks of this year, as it gets more difficult to get out on the ground, it could deliver the 70% figure. The responsible thing to do is to postpone; the easy thing to do would have been to thunder on and not deliver. We have to respect the science; we are being very clear about that. Over the past few days we have discussed this in great depth with the NFU and it is quite clear that despite a big effort in recruiting and a big increase in resources it cannot deliver the 70% figure. It is therefore right not to go ahead for the time being, and we will go ahead next year.

Will the Secretary of State give an assurance that farmers in the hotspots will be given all the available legal protection over the coming months, given the uncertainty before the cull can proceed? I welcome the fact that he has confirmed that the science is that of the independent scientific group in 2008. Will he use this pause to make the strongest possible argument within the European Union that the produce of any vaccinated animal, whether vaccinated with the badger bovine TB vaccine or the foot and mouth vaccine, will be legal trade with our European partners?

I am grateful to the Chair of the Environment, Food and Rural Affairs Committee for her question, which touches on security. I want publicly to thank the chief constables and all their staff in the two main areas, who have co-operated a tremendous amount. This has been an extra burden on them in recent weeks. We have worked with them closely and I thank them. They have reassured me at all times that they will ensure that legal protest can go on, but law and order will prevail.

On vaccination—I am glad that we are getting into this so early in our discussion—the fact is that the current vaccine is only about 50% to 60% effective, while that for smallpox, for example, is well over 95%, so we do not have a very effective vaccine. On my hon. Friend’s point, we have developed a DIVA—differentiation of infected from vaccinated animals—test recently, which differentiates between a vaccinated and a diseased animal, but it is still in the early stages. We would all agree—every single person in this House and those outside—that we would like to press a vaccine button today but, sadly, we do not have one.

The European authorities are absolutely clear that if we went about a vaccination programme now, before we have an absolutely scientifically clear and evidence-based system of differentiating between diseased and vaccinated, we would not be able to export any cattle products. We are talking about a trade of billions of pounds. That would be suicide. I am in total agreement with hon. Members who want to see vaccines but, sadly, we are just not there. It is incredibly important that everyone understands that we do not have a button-pressed vaccine today. We are working extremely hard on it. I take on my hon. Friend’s encouragement. I will discuss the issue at the Commission, but at the moment I cannot go to the Commission with a clear, evidence-based programme to use a vaccine.

Order. I always listen to the Secretary of State with the closest possible interest, but I am afraid that we do not have time on this occasion for a treatise in response to each question. We need pithy replies, if possible.

The Secretary of State is right to say that we must address the problem of bovine TB. Will he, therefore, this year, while this delay is in place, use the funding that would have been made available for the cull to improve biosecurity in the cowsheds and byres of farmers, and set minimum standards for biosecurity, which the Krebs report said was a very important element in controlling the disease?

I am in agreement with the hon. Gentleman that biosecurity can help, but the problem is that we are dealing with an animal that can get into sheds. When I was in opposition, I went to Michigan and they had clear evidence where they had separated white-tailed deer from cattle herds and invested significantly in fencing off the cattle herds indoors. It is not possible to do that with badgers, because our cattle system has cattle out on the fields, and 1 ml of badger urine yields 300,000 colony-forming units of disease and it takes only 0.001% to infect an animal. That is the problem. We have animals out on grass, mixing freely with wild badgers, and that is where the disease is being picked up.

I draw the attention of hon. Members to my entry in the Register of Members’ Financial Interests. The right hon. Member for South East Cambridgeshire (Sir James Paice), who was until recently a Minister in the Department, is right. People living in the countryside are not surprised, because they report seeing more badgers more frequently. Does the Secretary of State agree that work should be undertaken on the correlation between the increase in badgers and the increase of bovine TB in the cattle herd?

I thank my hon. Friend for his question. The evidence is extremely obvious. We can see from 1972 onwards that when there is a big increase in the badger population there is an increase in TB. It is very simple. I do not know of a single country in the western world that does not bear down on disease in wildlife and in cattle.

The Secretary of State said that vaccination is only 60% or 70% effective, but is that not an awful lot more than 16% effective for the cull? Secondly, he said that a cattle vaccination and the DIVA test are years off, but that is not the case—that is not what scientists are telling us. Will he use the money that has so far been earmarked for the cull to bring those vaccines to market as soon as possible? Will he start negotiating now with his EU colleagues to make sure that the DIVA test will mean that we can distinguish between infected and vaccinated cattle and that we can, therefore, continue to export beef?

I am grateful to the hon. Lady for her question. We are not yet there with a vaccination programme. If this vaccine is only 50% to 60% effective, a significant number of cattle will be either diseased or, perhaps, vaccinated. Until we can differentiate between them, we cannot go to the Commission and no neighbouring country would want to buy stock from us. This is a real, practical problem. I reassure the hon. Lady that I am as keen as her to get to the position of having a vaccine, and I promise that we will work on this over the next year. We are spending £15.5 million over the next four years on top of the £40-odd million that we spent recently. This is a real priority, but we are not in that position yet.

When I was lucky enough to serve on the agriculture committee nearly 20 years ago, I remember the then Chairman saying that we had to have a badger cull in selected areas to deal with this disease. Since then, Governments have been hopelessly indecisive and weak and, as a result, our farming community has undergone untold misery. Will the Secretary of State assure us that he will now get a grip and that he will be swayed only by science and not by emotions, and save our farmers from this terrible disease?

I am happy to reassure my hon. Friend emphatically that we will stand by this policy. As I have said, there is no country in the western world where such policies do not apply. We should consider the situation in New Zealand with possums and that in Australia with buffalo, and look at what every other western European country is doing. A cull is taking place in Ireland as we speak. On Monday I talked to a farmer in Burgundy, where badgers are not protected. There is no other country where they are not bearing down on disease in wildlife and in cattle. We have to do both.

This is probably not the auspicious start that the Secretary of State wanted on the DEFRA Front Bench. No one takes the cull of badgers lightly, but what is the Department’s plan B? The Secretary of State has said, in effect, that over the next 12 months, until next summer, 30,000 cattle will be slaughtered and his Department will have to pick up the bill of £100 million. In Northern Ireland it will be £20 million and a vast amount of cattle will be slaughtered as a result of bovine TB. I hope that we are not witnessing the eradication of the Department’s courage to follow through with a policy that could change things.

The hon. Gentleman is absolutely right to say that, until we get a grip on this, these horrendous slaughter figures will continue at an horrendous cost and cause horrendous damage to famers’ livelihoods and their families. That is clear, but we have to respect the science. The NFU told me this morning that it cannot achieve the 70% and, if we agree with the science, which states that if we cull less than 70% we provoke perturbation, I have to respect that advice. The hon. Gentleman is from Northern Ireland, so he knows perfectly well the value of a cull. The four counties trial showed a 96% reduction in Donegal. There is no question but that bearing down on wildlife and cattle will eradicate the disease eventually.

Farmers across North Wiltshire will be disappointed about the delay—although they will understand it—but so will true wildlife lovers. Will the Secretary of State confirm that even if a workable badger vaccine was available—there probably is not—it would have no effect whatsoever on badgers that are ill? In other words the hundreds of badgers that are ill, underground and dying in agony would not be affected even if a vaccine was available.

My hon. Friend’s constituents will be as disappointed as mine about this delay and postponement. There is actually an injectable badger vaccine, which was licensed in March last year, but everybody needs to consider the practicality. We have an enormously increased badger population. It is certainly 250,000 to 300,000. An injectable vaccine requires injecting every badger every year and, as I have said on cattle vaccine, it is not possible to cure an animal that is already diseased so, with the deepest respect to the Welsh Government, I am doubtful of the value of that process.

Will police forces that have had to commit resources to prepare for the pilots be compensated for the work that they have had to do?

Yes. We have made it clear that we will help the police forces that have had to put in extra resources. I talked to all the chief constables of the forces this morning, thanked them personally for their significant effort and the skilful and tactful manner in which they have deployed their teams recently, and I have agreed that we will help them.

The Secretary of State has made an entirely supportable and practical decision this morning in guaranteeing that this is not a change in policy, but simply a delayed policy. Does he agree that the reaction of Labour Members to his statement will have sent a shiver down the spine of farmers who are watching and will have made them realise that for the Opposition, this is a political issue, not a practical one? So much for one nation!

I entirely agree with my hon. Friend. I did not want to get into a party political argument, but the Labour party’s record in office is shameful. The disease has gone on and on, but after the trials, the Labour Government stopped dead. We are following the logical conclusion of what they set in place. They stopped; we are going on. We are determined that this is the right thing to do.

It will be the marginal costs. We will have to discuss that with the relevant forces and come up with a number.

The Secretary of State has rightly said that the Government will continue to tackle all sources of the disease and to look at biosecurity, as well as dealing with the cull. If there are further problems over the next few months with the designated cull areas, will he look at other areas where landowners and farmers might be keen to be part of the cull trial?

That is an interesting question. Yes, I will look at that in detail. At the moment, the NFU is probably thinking of carrying on in the two areas where it has put in such a lot of work and preparation, but I am open to looking at other areas. We want to pull off two pilots that show that this system, in a bigger area and with a more efficient system of culling, does work and does reduce TB.

Ministers constantly lecture us about the need for their counter-productive austerity measures, so how can the Secretary of State justify earmarking £250,000 for post-mortems on dead badgers following the cull? Is that not a colossal waste of money and an example of an omnivore-shambles?

What a ludicrous question. The attitude of some Opposition Members is absolutely tearful. We are heading towards a bill of £1 billion.

I commend the Secretary of State for acting so decisively today, following the change of heart by the NFU. Although dairy farmers in south Devon will, of course, be disappointed, they will understand it, provided that he continues to say, day after day, that this is just a delay, not a change of policy, and that the cull will take place in 2013.

I am most grateful for my hon. Friend’s support. As he knows, when I was the shadow spokesman, I went down to his part of the world and I asked 600 parliamentary questions. That made me determined that this was the right thing to do. I wholly commend the last Minister of State, my right hon. Friend the Member for South East Cambridgeshire (Sir James Paice), who did great work on putting this policy into practice. We are determined to push it through, because it is the only way in which we will save our cattle industry.

Will the Secretary of State say how many firearms licences have been issued by the police for the culls, and at what cost?

I can give the hon. Lady an accurate reply after the statement. The team in each pilot area is made up of roughly 60 people and the firearms licences had to be amended. I am happy to get back to her with the exact number.

Cattle owners like me will respect the Secretary of State for taking the advice of the NFU. However, will he take this opportunity to look at the compensation tables, which are causing so much misery to cattle owners who are receiving less than it costs to replace their cattle?

My hon. Friend touches on a fraught area. I have cattle breeders in my patch who are producing the most wonderful pedigree cattle of the highest standard and getting adequate compensation is a constant problem. At the moment, we are paying the market rate, but I am happy to discuss the matter with him.

Will the Secretary of State take the opportunity that this postponement allows to meet the 30 leading scientists, including vets and animal disease scientists, who think that their science is correct and that the NFU’s science, on which the Secretary of State is relying, is not correct?

I am most grateful for the hon. Gentleman’s question, but he is just wrong. This is not the NFU’s science. The science that the policy is based on comes from the main trials that his Government put into practice. It is the logical conclusion of those trials. I quoted Lord Krebs and I have a meeting with him this week or next week, so I am very happy to meet scientists. We are following on from the logic of the science-based evidence that has been produced.

Roughly how many people have been threatened in the two areas, because there have been a variety of reports about that? If he can confirm a number, that would be useful to the House. In his view, have such people been properly protected by the police?

I am happy to reassure my hon. Friend that the number is tiny. I strongly commend, once again, the skill and tact of the police forces, which have maintained law and order in a dignified manner, under difficult conditions.

As the Secretary of State knows, I represent a rural constituency in Northern Ireland. What discussions did he have with Ministers in the devolved Administrations yesterday in the margins of the EU Council of Ministers on agriculture matters? Will he confirm what tools are at the Government’s disposal to ensure that our farming industry is protected?

I am sorry to inform the hon. Lady that I did not get to Luxembourg yesterday because my flight was cancelled.

By the fog. If Members want a technical update, the flight was delayed and then cancelled. There was only one, so sadly I did not get to the Agriculture Council and I did not have a chance to put the very pertinent points that the hon. Lady mentioned. If she looks over the border, she will see that in the Republic of Ireland there is a reactive cull. As I said, the four counties trial showed a 96% reduction in Donegal.

As a neighbouring Shropshire MP, the Secretary of State will know what devastation bovine TB has caused in Shropshire, with more than 2,000 cattle slaughtered last year alone. Will he give an assurance that if the trials are successful next summer, other parts of the United Kingdom, such as Shropshire, will be able to move forward quickly to a cull?

I commend my neighbour from Shrewsbury and Atcham for his stalwart support on this matter and for the very public stance that he has taken. The answer is emphatically yes. I want the two pilots to go ahead and to conform to the science. I am confident that they will prove to be safe and efficacious, and that we will see a reduction in TB. That is what we want to see rolled out across the country.

On 8 May, I wrote to the then farming Minister, the right hon. Member for South East Cambridgeshire (Sir James Paice), to highlight how complex it was to assess the number of badgers in the pilot areas and received very glib reassurances in response. Why is the Secretary of State now telling us that it was only in late September that concerns about those numbers came to light?

I am grateful to the hon. Lady for that question, but I did answer it earlier. It appeared in September that Natural England was not happy with the figures that had been provided locally. That is why it asked FERA to do a full survey, which took some time. That shows how deadly serious we are in respecting the science. It would not have been right to go ahead on the basis of numbers that Natural England believed to be inaccurate, so it was right to take more time and to do a thorough survey, and that came up with dramatically larger numbers.

Dairy and beef farmers in my constituency are desperate because of TB. They have been cleaning their cattle for years. There now needs to be clean wildlife to stop the disease spreading. Can I have the absolute assurance of the Secretary of State that the cull will go ahead next year?

I am entirely in agreement with my hon. Friend. We want to see healthy wildlife—healthy badgers in this case—living alongside healthy cattle. We will achieve that only if we drive through the two pilots and extend them across the country, as I have just assured my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski).

Will the Secretary of State explain why there was a delay to avoid a clash with the Olympics and Paralympics, and what are the ideal weather conditions for killing badgers?

My predecessor was very responsible, because the Government had a request from the police and discussed it with the Home Secretary. There was obviously a huge amount of discussion about security before the Olympics and Paralympics. The whole nation wanted the games to be a success, and of course they were the most outstanding success. It was quite right not to burden the police with an extra task, so I think my colleagues were completely responsible.

The hon. Gentleman makes a good point about the weather. We have obviously had the most extraordinarily wet year, which has made it difficult to get out on the land and difficult to get vehicles out. There is also a technical problem, which mainly applies to Gloucestershire. The maize is still standing, and part of what needs to be done is the cutting of maize, because otherwise badgers come and take the cobs. That is rather more a Gloucestershire problem than a Somerset one, but all in all, he must understand the practical difficulties of getting on the land in a very wet year.

It is to the NFU’s credit that it has decided not to conduct a cull this year in circumstances in which it could not be confident that it would be effective in reducing the incidence of bovine TB. What are the next steps in developing the DIVA test to the point where it is widely acknowledged to be conclusive?

I entirely endorse my hon. Friend’s commendation of the NFU. It would have been quite wrong to go ahead when it was not confident of reaching the 70% target and could have made the position worse.

I was discussing the DIVA test with my senior scientists this morning, and we are determined to go full bore on it. There is agreement throughout the House that in an ideal world we would have a vaccine and a DIVA test, and we could then go to the Commission. I am keen that we look at the new technological developments as soon as we can.

How many discussions has the Secretary of State already had with European colleagues and the Commission to lobby for the DIVA test and cattle vaccination to be rolled out in the UK?