House of Commons
Tuesday 15 January 2013
The House met at half-past Eleven o’clock
[Mr Speaker in the Chair]
Business Before Questions
Canterbury City Council Bill (By Order)
Motion made, That the Lords amendments be now considered.
Lords amendments to be considered on Tuesday 22 January.
Leeds City Council Bill (By Order)
Motion made, That the Lords amendments be now considered.
Lords amendments to be considered on Tuesday 22 January.
Nottingham City Council Bill (By Order)
Motion made, That the Lords amendments be now considered.
Lords amendments to be considered on Tuesday 22 January.
Reading Borough Council Bill (By Order)
Motion made, That the Lords amendments be now considered.
Lords amendments to be considered on Tuesday 22 January.
City of London (Various Powers) Bill [Lords] (By Order)
Second Reading opposed and deferred until Tuesday 22 January (Standing Order No. 20).
Oral Answers to Questions
The Secretary of State was asked—
Vascular Disease (England)
Despite the huge improvements that have been made over the last decade in the outcomes for people with cardiovascular disease, it is still one of the biggest killers in England and the largest cause of disability. That is why we are developing a CVD outcomes strategy, which will set out where there is scope to make further improvements in patient outcomes in this area.
I am chairman of the all-party parliamentary group on vascular disease, which recently produced a report highlighting the need for early diagnosis and intervention, and the additional risks associated with obesity and diabetes. Is the Secretary of State willing to meet me and some of my colleagues to consider how we can improve outcomes for sufferers of vascular disease?
I thank my hon. Friend for his excellent work with the all-party group and for the group’s constructive response to our consultation on the outcomes strategy. I am more than happy to meet him and other representatives of the all-party group. With an ageing population and rising levels of obesity, we cannot be complacent about cardiovascular disease and have much to do.
The Prime Minister promised before the election that there would be no reconfigurations or closures unless there was clinical and local support. Why then has the Secretary of State decided to break up the existing vascular network centred on Warrington hospital, meaning that emergency patients face a trip to Chester by ambulance, when this has neither clinical support nor support in the local community? When did that policy change, or was it just an election promise that the Conservatives never intended to keep?
We believe in the clinical networks, including the network for cardiovascular disease. We have increased the funding for those networks by 27%. However, we want them to include mental health and maternity services. We think that it would be wrong to do what the Labour party wants, which is to concentrate that funding on cardiovascular disease and cancer, and deprive of the clear benefits of such networks the 700,000 women who give birth on the NHS every year and the nearly 1 million people who will be diagnosed with dementia.
Given that the majority of vascular interventions are acute in nature, following trauma or cardiac episodes, is it not reckless for NHS Lancashire and NHS Cumbria to be talking about moving vascular services away from the Morecambe bay area, meaning that people from the south lakes and north Cumbria will have to travel as far as Preston, Blackburn or Carlisle to receive treatment? Will the Secretary of State meet me, other local MPs and local consultants to discuss how we can put the matter right for local people?
We are very keen to ensure that all reconfigurations of services have strong local, clinical support. We are making good progress in this area. There is always a trade-off between access, which I recognise is extremely important in a rural constituency such as the hon. Gentleman’s, and the centralisation of services, which sometimes leads to better clinical outcomes. I am happy to arrange for him to meet me or one of my colleagues to discuss his concerns in more detail.
Those with diabetes, such as myself, are five times more likely to get cardiovascular diseases. Last year’s National Audit Office report indicated that 1 million diabetics did not get their nine checks. What steps will the Secretary of State take to ensure that those checks are made available to all diabetic patients?
I congratulate the right hon. Gentleman on his campaigning work for people with diabetes, and I am aware that there are 24,000 premature deaths every year because we are not as good as we need to be at tackling the disease. It is shocking that only half those with diabetes are getting the full set of nine checks that everyone with diabetes should be getting every year, and when we publish the cardiovascular disease outcomes strategy—which I hope will be in spring—I hope we will address some of his concerns about how we can do a better job for diabetes sufferers.
Deep vein thrombosis is the leading direct cause of maternal deaths across the United Kingdom. Will the Minister consider interaction with the regional assemblies, including the Northern Ireland Assembly, to agree a UK strategy to address that issue?
Hospital Waiting Times (England)
Latest figures for October 2012 show that 70,000 fewer patients are waiting longer than 18 weeks than at the last election. The Government’s mandate to the NHS Commissioning Board makes timely access to services a priority.
Those figures compare extremely well with those in Wales, where most patients are waiting for 26 weeks, and many for 36 weeks. Would the Minister be willing to share some advice on how to get waiting lists down with his counterparts in Wales, and perhaps discuss with them why patients wait so much less time in the Conservative NHS in England than in the socialist NHS in Wales?
My hon. Friend is right to highlight key differences between the NHS in England and in Wales. The Labour-run Assembly in Wales is cutting funding by around 8%, which will—of course—impact on the quality of care available to patients and other front-line services. At the same time, in England we are ensuring that we continue to invest, with £12.5 billion in the NHS during the lifetime of this Parliament. I would be happy to point that out to colleagues in Wales and the Welsh Assembly, and to make the point that it is the Conservatives and the coalition Government who deliver better patient care through investing in the NHS.
I am happy to inform the hon. Lady that we are meeting the 95% target nationally for the A and E wait. On the most recent figures available, 96% of patients were seen within that period—96 out of every 100 patients are seen within four hours in A and E. The key difference between this Government and the last Labour Government is that we trust clinicians to ensure that they prioritise those patients in greatest need ahead of purely meeting targets and ticking boxes.
As winter bites, the NHS faces its toughest time of year, but there is mounting evidence that the Secretary of State has left it unprepared. For 105 of his 133 days in office, the Government have missed their own A and E target for major A and Es. Last week, for the first time, the figure fell below 90%. Right now in A and Es up and down England, ambulances are stuck in queues outside, patients are on trolleys in corridors, and people are waiting to be seen for hours on end. Does the Minister accept that there is a growing crisis in our A and Es, and if he does, what is he doing about it?
The right hon. Gentleman is good at putting across figures based on brief snapshots in the year. We know that on an annual basis we are meeting the target, and that 96% of patients are being seen on time in A and Es. We have made allowances for winter pressures, which we know are always difficult during the flu season every year, and we have put aside £330 million to ensure that we support the NHS during those winter pressures. Let me make it clear to the right hon. Gentleman that it is wrong to try and distort figures based on outcomes from a snapshot of just a few days or a week. It is important to put across the clear picture, which is that the Government are meeting targets in the NHS and patients are being treated in a much more timely manner than under the previous Government.
I suggest to the Minister that he needs to get out on the ground in the NHS a bit more. The figures I gave him were for major A and Es. If he got out more, he would realise that his complacency, which we have just seen at the Dispatch Box, is not justified. Let us look at Milton Keynes, which was identified by the Care Quality Commission as one of the 17 understaffed hospitals, and where last week just 72% of patients were seen within four hours. Milton Keynes is one of 15 trusts in England where A and E performance plummeted below 80%. These are the kind of figures that we have not seen in the NHS since the bad old days of the mid-1990s. Ministers like to blame nurses, but it is time they started accepting some responsibility. Will the Minister today ensure that all A and Es in England have enough staff to get safely through the winter?
I reassure hon. Members that, unlike any Member on the Opposition Front Bench, I still work in the NHS every week and I ensure that I see what happens on the ground. That cannot be said of any Front-Bench Opposition Member. The coalition has Ministers who are in touch with what is happening in the NHS on the ground. On A and E waits, we are trusting clinicians to exercise their judgment, which is why we now have a 95% target. We are ensuring—and the statistics show—that we are meeting that target on an annual basis. Patients are being treated in a timely manner. Furthermore, we have put in £330 million to deal with winter pressures. It is wrong of the right hon. Gentleman to try and mislead the House in this way—[Hon. Members: “Oh!”]—and use figures from a snapshot in time, rather than in a generality, which would indicate—
Leeds Children’s Hospital (Heart Surgery Unit)
I know that some are disappointed at the decision by the Joint Committee of Primary Care Trusts and want to see children’s congenital heart surgery continue at their local hospitals. However, the Safe and Sustainable review was an NHS review, independent of Government. Under the circumstances, and given that legal proceedings and a review by the independent reconfiguration panel are under way, my hon. Friend will understand that it is not appropriate for me to comment further.
One hundred and seventy clinicians from across Yorkshire and northern Lincolnshire have written to express their dismay at the decision, stating that for time-critical transfers it
“exposes a number of children to the risk of death,”
largely because it will require transfers to Newcastle, where services are not co-located. Does that not prove that the decision does not enjoy clinical support in Yorkshire and north Lincolnshire and that it is simply not true that this has been a clinically led review?
I have seen the letter to which my hon. Friend refers and I understand that these are extremely complex issues. Let me reassure him that when I take my final decision, it will be on a clinically led basis. I will do that when I have received the IRP’s report, which I am due to receive by 28 March.
I will make my decision when I have the IRP’s final recommendation. Obviously I cannot speculate on what the final decision will be, but let me reassure the right hon. Gentleman, as I did with my hon. Friend the Member for Brigg and Goole (Andrew Percy), that my decision will be taken on the basis of clinical need—in other words, what will save the most lives.
I note my right hon. Friend’s comments about his final decision being based on clinical advice, but will he also give consideration to patients and families in areas that are more remote from the centre, such as my constituency? This decision causes extra strain and cost to families and will also mean that they will not go to Newcastle, and therefore Newcastle will not achieve its target number of operations.
I understand the Secretary of State’s reluctance—quite rightly—to comment on the processes he is going through, but will he confirm that he expects full transparency in the review process? That means all the minutes of the JCPCT being given to the review process and none of them being redacted.
The Government are committed to ensuring that the number of midwives in training matches the needs of the birth rate. There are now over 800 more midwives working in the NHS than there were in May 2010, and a record 5,000 currently in training.
The Oliver Fisher neonatal intensive care unit at Medway Maritime hospital in my constituency is an excellent charity that looks after approximately 900 premature and sick new-borns each year. What further midwife support will the Government give to such care units?
My hon. Friend is absolutely right to point out the excellent work done at his local unit, which receives funding from the NHS and from charitable sources. We are investing more money into training midwives, and there are now more midwives working in the NHS. It is for local commissioners to capitalise on that, and to invest in support for neonatal units.
With births per midwife rising, maternity services being cut and newly qualified midwives unable to find a job, what on earth happened to the famous boast of the Prime Minister that he would recruit 3,000 more midwives and make their lives a lot easier?
With respect, perhaps the hon. Gentleman should listen to my answers before he pre-prepares a statement. I just outlined clearly that in the past two years there have already been 800 more midwives working in the NHS, and there are record numbers in training thanks to the investment being made by the Government. We are delivering on making sure that we are investing in maternity and investing in high-quality care for women. We are proud to be doing that—something the previous Government failed to do.
NHS Funding Formula (Rural Areas/Elderly People)
Age is the main driver of an individual’s need for health care, as reflected in recent funding formulae. This is for the NHS Commissioning Board, but the independent advisory committee recommends continuing to review the case for additional resources in rural areas, particularly as more information on community provision becomes available.
It is disappointing to hear that the NHS Commissioning Board has decided not to implement a fairer funding formula. What does the Minister suggest I say to my constituents who potentially face having services withdrawn, when, in the same region, areas such as Barnsley receive almost 30% per head more in funding?
As a Member of Parliament for a rural area with an elderly community I understand the hon. Gentleman’s concerns, but allocations have to be based on solid evidence. The area where we do not have the evidence is on community services. The data will start to be collected on that and we will therefore be able to demonstrate whether community services cost more in rural areas, as I suspect they do. If that is the case, the allocation formula will be able to reflect that.
The north-east suffers some of the worst health outcomes in the country, despite having excellent care services. On many occasions, the Government have said that they are committed to reducing health inequality, specifically in the north-east. Why then did Ian Dalton say that using the new advisory committee on resource allocation formula
“on its own would have…moved resources from areas where people…have worse health outcomes to those where people have much better outcomes”.
Does that not show that the Government have no commitment to reducing health inequalities?
I think the news on the allocations for public health budgets is actually a remarkably positive story. Every part of the country will see real-terms increases in funding for public health. This is an historic moment where we shift the emphasis away from repair to prevention of ill health. The hon. Lady’s own area will see real-terms increases. Across the country as a whole, there will be an average of 10.8% over two years real-terms increases in public health funding. I am very proud that the Government are doing that.
Improving the quality of care throughout the NHS is a key priority for the Government, and one of the things we are doing to make that happen is, for the first time, asking all NHS in-patients whether they would recommend the care they received to a friend or member of their family.
My constituents have consistently been let down by the failure of the last Government and a debt-ridden PCT to invest in local community health services. Will my right hon. Friend join me in encouraging the new clinical commissioning groups to respond to Witham’s growing population and health needs by investing in localised community health care?
I am happy to do so, and I commend my hon. Friend for her campaigning, because if we invest properly in community health services, we can allow the frail elderly, who are among the biggest users of the NHS, to stay at home happily, healthily and for much longer. That must be a key priority for us all.
At the last Health questions, the Secretary of State told me:
“Every NHS bed is getting an extra two hours of care per week compared with the situation two years ago.”—[Official Report, 27 November 2012; Vol. 554, c. 122.]
Quoting national average nurse-patient ratios does not help to improve the patient experience, but cutting 7,000 nurses sure does affect it. We have unsafe levels of care in 17 hospitals. Will he treat this issue a bit more seriously and do something about those unsafe levels?
With respect to the hon. Lady, she cannot talk about alleged cuts in the NHS while her Front-Bench team support a policy of real cuts in the NHS budget. In the last Opposition day debate, the right hon. Member for Leigh (Andy Burnham) said that he thought it was irresponsible of the Government to increase the NHS budget in real terms. That means he wants a real cut in the NHS budget, which would make the staffing issues to which she referred much, much worse.
Does my right hon. Friend agree that one of the most effective things we can do to improve the patient experience of health and care is to improve the co-ordination, not just between the hospital service and community-based health services, but between the NHS and social care, and to put in place the infrastructure, including the IT infrastructure, to make that real?
My right hon. Friend makes an extremely important point—in fact, I will be giving a speech on this tomorrow—because, in the end, if it is not possible to see a full medical record of some of these frail elderly or heaviest users of the NHS going in and out of the system throughout the year, it is not possible to give them the integrated, joined-up care that they desperately need. This will be a very big priority for us.
One of the biggest drivers of patient experience on hospital wards is the dedication and care of the nursing staff, but, as my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) said, the Care Quality Commission has identified 17 NHS hospitals that are operating with unsafe staffing levels, putting vulnerable patients and especially older people at risk. Frankly, it is the Secretary of State’s job to ensure that every NHS hospital operates with safe staffing levels, so does he now think it was a mistake to strip out almost 7,000 nursing posts from our NHS?
It is my job, and that is why the Government have protected the NHS budget. The hon. Gentleman’s Front-Bench team, on the other hand, want to cut it in real terms. He has to think carefully before he starts talking about all these so-called cuts, given that his shadow Health spokesman wants to cut the NHS budget in real terms. [Interruption.] That is what he said last December. I agree with the Care Quality Commission that it is totally unacceptable for hospitals to have unsafe staffing levels. The commission also said, however, that budgets and financial issues were not an excuse, because those budget pressures existed throughout the NHS and many hospitals were able to deliver excellent care despite them.
Cancer, Stroke and Heart Disease (Survival Rates)
Our cancer strategy set out the ambition to save 5,000 lives by 2014-15 through earlier diagnosis, cancer screening and improved access to treatment. We are working on an outcomes strategy for cardiovascular disease.
I am happy to inform my hon. Friend that 25,000 people have benefited to date from the cancer drugs fund, which the previous Government failed to introduce. On top of that, 53,000 more people every year are being admitted for chemotherapy and 219,000 more cancer treatments are happening every year than happened in any year under the last Labour Government.
21. I have previously raised with the Secretary of State the opportunity cost—in terms of cost and effectiveness —of the proton beam therapy system. Given that expert opinion—in the form of the national radiotherapy advisory group—is divided, and given that the cost of the proton beam therapy system is 100 times more than other advanced radiotherapy systems that my region and others lack, why is he proposing to spend £125 million on it? (136853)
I recognise that the hon. Gentleman has a long-standing view on this matter. I am guided by clinical advice. Over the next two years, we will publish the cancer survival rates by multidisciplinary team across the country in all the major cancers for the very first time. That will give us a much better objective base from which we can work out what the most effective treatments are.
20. Despite the fact that the incidence of breast cancer peaks in the 85-plus age group, the peak age for breast surgery is for women in their mid-50s and 60s. Does that not confirm the findings of the Royal College of Surgeons-Age UK report that, despite trends towards older people leading healthier lives, many older women are missing out on curative surgery, from which they are perfectly fit enough to benefit? (136852)
My hon. Friend will know that last October we outlawed age discrimination, and if that is the reason for this happening, it is totally unacceptable. We have to recognise that cancer is one of our biggest killers and that the over-85s are a key group if we are going to tackle it. He will welcome today’s news about making available drugs to tackle breast cancer, which may mean that surgery will no longer be necessary.
Sexual Health Policy
We plan to publish our policy document on sexual health and HIV shortly. Improving sexual health is very important for individuals and communities.
From April, local authorities will be responsible for commissioning services. Because we have seen this really impressive increase in funding for public health, local authorities will have the ability to maintain and indeed improve sexual health services for their local communities. That is something of which we should be proud.
On the sexual health strategy, the Minister will be aware that nearly half of the national incidence of HIV is in London, so what steps will be taken from April to co-ordinate the prevention of HIV London-wide?
I am very much aware of the situation in London, and I acknowledge that some good work has already been undertaken there. Local authorities are very much aware of their responsibility that will apply from April and are already working with clinical commissioning groups in London to ensure that comprehensive services are in place for the London community.
Pan-London preventive health care is important, but with the devolution of funding to local authorities, there is a great risk of them refusing to pool funds and of preventive health programmes in London collapsing. Can the Minister reassure Londoners that pan-London programmes will continue?
Yes, I can absolutely reassure the hon. Gentleman that there will be comprehensive services, which will cut across local authorities. We have to remember that local authorities will be under a legal responsibility to provide confidential open access to sexual health services and contraception services. Local authorities in London are aware of the need to ensure that comprehensive services are available from April this year.
Health Care Appointments/Operations (Postponements)
My Department collects data on the number of cancelled elective and urgent operations, which show that these remain very low compared to total activity. We do not collect information on postponed appointments or operations. The NHS must make arrangements locally to minimise postponements and cancellations to avoid the inconvenience to patients.
I thank the Secretary of State for that answer. This is an issue in my area, with the chief executive of South Tees hospital saying that one factor is excessive use of A and E for non-urgent cases, resulting in pressure on hospital resources. What can the Secretary of State do to make sure that A and E units are used only for genuine accidents and emergencies?
My hon. Friend makes a very important point. I am concerned that 114 non-urgent operations were cancelled in the South Tees area between November and January, which is significantly higher than this time last year. He is right that we need to think about the model for an A and E service. Nearly 1 million more people go through A and E every year than they did two years ago. We have to recognise that for A and E services to be sustainable, we need to think about people who would better off seeing their GP or going to an urgent care centre.
Is the Minister aware that health care appointments are still bedevilled by the number of people who do not show up, even for appointments with consultants and senior hospital staff? Is it not about time that we looked at a simple system, in which people could pay up front a small amount of money that they get back when they turn up? I am sure that my constituents, as good Yorkshire people, would take their appointments much more seriously if they got their money back when they turned up?
I am interested to hear that suggestion from the Labour Benches, which is not necessarily where I would have expected it to come from. The hon. Gentleman might be surprised at my response, which is that I would be very concerned about such a system. I understand the issue and I think we need to modernise the process of GP and hospital appointments. Technology can play a good role in that, for example by giving people text reminders of appointments that they have booked. My concern is that the system suggested by the hon. Gentleman would put people off going to see their doctor if they needed to. I would not want to do anything that deterred people from using the NHS who most need to do so.
Accident and Emergency Departments (Waiting Times)
In 2012, the NHS saw nearly 22 million people in A and E across the country, with 96% seen within four hours, which I am sure the hon. Lady will agree is a great achievement. That means that the A and E clinical quality indicators for high-quality patient care are being met in the NHS.
Last week, the Manchester Evening News reported that more than 1,000 patients had waited more than four hours at A and Es across Greater Manchester in December. I am sure the Minister is well aware of the planned downgrading of services at Trafford general hospital, and I understand that last night the joint health scrutiny committees of Trafford and Manchester agreed that the proposals should be referred to the Secretary of State for decision. Given last month’s alarming figures, will Ministers assure me that in reaching a decision about the future of Trafford general hospital, full account will be taken of capacity across Greater Manchester?
I thank the hon. Lady for her question. I recognise her concerns for her constituents. As has been outlined, there are seasonal variations, and I am sure that local commissioners will want to take such issues into account when they make decisions, and they must meet the reconfiguration tests set out by the previous Secretary of State for Health, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley).
The Better Services Better Value review of NHS services in south-west London identified that Croydon university hospital does not have sufficient senior doctors in its A and E, and nor did it under the previous Government. The review has been put on hold because Surrey has asked to be included. Will the Minister reassure my constituents that there will be a rapid solution to ensure that we have the A and E care that we deserve?
My hon. Friend is right to highlight a long-standing problem—it has not happened just recently —of a lack of particularly middle-grade doctors in A and Es. Although the number of consultants has increased by about 50%, as A and Es move rightly towards becoming a 24/7 consultant-led service, attracting middle grades to the specialty has been a problem. We set up a task force to consider that, as well as making better use of a multidisciplinary work force and emergency nurse practitioners to meet some of the staff shortages.
The performance of A and E services has an obvious and acute effect on the performance of ambulance services. In London, freedom of information requests show that the number of ambulances waiting more than 30 minutes from arriving at hospital to handing over their patients has gone up by two thirds over the last year, that ambulances are missing their targets in responding to the most serious life-threatening callouts, and that the average length of time that patients wait in ambulances before accessing A and E is going up, and in some cases patients are waiting almost three hours. The Care Quality Commission says that London Ambulance Service NHS Trust does
“not have sufficient staff to keep people safe”.
The question for the Secretary of State is simple: what is he going to do about it?
The hon. Gentleman is right to highlight the unacceptable variations in the quality of triage and handover between ambulance services and hospitals, not just in London but in other parts of the country. Many hospitals, however, do that well, and it is important that local MPs highlight the issue, champion good practice on handovers and ensure that that good practice is carried out at other A and Es. It is unacceptable that patients should wait for handover.
As my hon. Friend knows, we are developing the 111 service further to improve triage and take pressure off accident and emergency services when that is appropriate. I am sure all Members agree that when patients do not need to go to A and E, it is best for them to be treated in the community or properly triaged.
Specialist Accident and Emergency Doctors
That is a long-standing problem. Recognising that emergency medicine is moving towards becoming a 24-hours-a-day, seven-days-a-week service, the Government have set up an emergency medicine task force to tackle the problem and encourage more recruitment of middle-grade doctors to A and E specialties.
Might it be time for us to take a leaf out of the Department for Education’s book, and consider offering scholarships or bursaries tied to doing the job for a certain number of years in order to improve recruitment and retention in this difficult area?
Bursaries are already available to medical students to encourage recruitment to the medical profession. As for the specific question of A and E recruitment, at the end of last year I published—alongside the report from the Doctors and Dentists Review Body on the consultant contracts and clinical excellence awards—a report on junior doctors in training. That has given us an excellent opportunity to consider what rewards and inducements may be available to encourage junior doctors to move into A and E and other specialties in which the work is particularly intensive and the meeting of staffing requirements has posed a long-standing challenge.
We know that it takes five or sometimes six years for doctors to complete their medical training. The key difference is that under the plans left by the last Government not all doctors were guaranteed places of work in the NHS after completing their training, whereas the present Government are ensuring that they find NHS jobs. That is why we have 5,000 more doctors in the NHS. The same applies to midwives: under the last Government they were not finding places after completing their training, but under this Government they are, and there are 800 more of them.
Alcohol Consumption (Damage to Health)
We published the Government’s alcohol strategy on 23 March 2012, and we are taking a comprehensive approach to reducing the incidence of alcohol-related disease and crime. Our strategy includes the introduction of a minimum unit price for alcohol, actions at local level, and pledges from industry under the responsibility deal.
The number of UK deaths from liver cirrhosis has increased by five times since 1970, while in France, Italy and Spain it has halved, and is now lower than the number in Britain. Even more disturbing is the fact that thousands of babies are still being born every year in Britain permanently damaged by alcohol. When will the Government take urgent, effective action to deal with this crisis?
I entirely share the hon. Gentleman’s concern. The Government have already taken action: we set out a strategy in March last year, and we are now consulting on the introduction of a minimum alcohol price. That could save up to 700 lives a year in 10 years’ time, which would make a dramatic difference. I am sure that the hon. Gentleman supports what the Government are doing.
Damage to health as a result of alcohol consumption often leads to wider social damage. I have seen that at first hand when visiting shelters for the homeless in Rotherham. Many homeless people cannot gain access to rehabilitation services because they do not have GPs to refer them. What steps is the Minister taking to ensure that those services are available to everyone, especially those who need them most?
The hon. Lady has raised a really important point. One of the consequences of the responsibility deal is that by 2015, 1 billion units of alcohol—about 2%—will be taken out of the market, and that will help some problem drinkers significantly. Moreover, the money that the Government are investing in public health gives local authorities an opportunity to invest in prevention services in order to deal specifically with the core group of people to whom the hon. Lady has referred.
Urgent Care Services
The configuration of urgent care services is a matter for the local NHS, and commissioners should ensure that there is provision of appropriate urgent care services locally to provide safe and effective care for patients.
A review of urgent care services by the new GP-led clinical commissioning group for Solihull is causing consternation as it is throwing the future of our highly regarded walk-in centre into doubt. Does the Minister agree that users must be properly consulted, as services must be designed around patients, and that allocation to cost centres must come second to delivering services?
I agree with my hon. Friend. Where there are well-functioning local services that have local support, commissioners should recognise that in their decisions, but it is also important to highlight that any reconfiguration of local services has to meet the four tests laid down by the previous Secretary of State: support from GP commissioners; strengthened public and patient engagement; clarity on the clinical evidence base; and support for patient choice. I hope that reassures my hon. Friend.
One of the ways in which the Government are trying to prevent urgent care and A and E admissions is by holding down the funding for unplanned admissions to 30% above 2009 levels. That is proving very hard in places where many people who arrive for A and E or urgent care are not registered with a GP. What can the Minister do to help with the funding of services in communities where it has proved impossible to reduce A and E admissions?
The hon. Lady rightly highlights that there are challenges ensuring registration with GPs, particularly in areas with large migrant population groups. In some parts of London, each year as many as one third of patients move and change GP surgeries. This is a big challenge and we are encouraging local hospitals to make sure that people who turn up at A and Es inappropriately subsequently register with a GP.
The Government are committed to supporting the NHS to work better by extending best practice on improving discharge from acute hospitals and increasing access to care and treatment in the community. Community hospitals play a valuable role in this process.
My hon. Friend makes an excellent point. Community hospitals can provide a good focus for palliative care, respite care, intermediate care and step-up and step-down care close to home, particularly for people in rural communities who may otherwise have to travel very long distances to attend hospitals. I hope the community hospitals in my hon. Friend’s constituency will have a long and vibrant future.
We want to make 2013 the year we break down the stigma associated with dementia and transform the care and treatment received by the one in three over-65s who will get the condition at some stage. Today, the Alzheimer’s Society published a map showing the totally unacceptable variations in dementia diagnosis across the country, with some areas diagnosing fewer than a third of people who have the condition, thereby denying them the medicine and support that would help them live happily at home for much longer. We are determined to put this right.
Given that next week is designated as cervical cancer prevention week and we know that many women ignore, or do not recognise, the early symptoms of cervical cancer, what action will the Secretary of State take to raise awareness of cervical cancer symptoms?
That is a very important point. Every year we screen about 3.5 million women for cervical cancer and we think we save about 4,500 lives, but we could save many more. Our “Be Clear on Cancer” campaign is highlighting the four clear symptoms people need to watch out for: unexplained bleeding, weight loss, pain, and lumps.
T3. The Minister of State earlier failed to answer the key question on midwife numbers, so I wonder whether the Secretary of State could take it on. Before the last election, the Prime Minister made a firm pledge to increase the number of midwives by 3,000. Will the Secretary of State tell the House whether that pledge will be honoured or discarded along with all the other promises on the NHS? (136859)
The number is up by 800 already, but as the Labour Front-Bench team knows, it takes some time to train midwives. I say to the hon. Gentleman that none of the investment in additional midwives would be possible if we had a real-terms cut in the NHS budget, which is what his Front-Bench team wants.
T2. Many of my constituents in Jaywick have complained about local GP services, saying that there are too many locums and inadequate provision. In order to attract and retain good GPs in an area with a challenging work load, the local commissioning body needs to be able to offer them more favourable terms. Will the Minister ensure that there is sufficient local flexibility so that the commissioning body can do that? (136858)
My hon. Friend makes a very important point, putting his finger on a key issue: the 24-hour availability of GP services. That is going to be crucial as the NHS goes forward. The NHS medical director, Bruce Keogh, is looking at the whole issue of seven-day working in the NHS and will certainly be examining what flexibility needs to be given to local areas to make that possible.
T4. On 30 December, ambulances in north-east London were diverted from the Whipps Cross, Queen’s and Homerton hospitals, with only the accident and emergency units at the Royal London hospital and the King George hospital in Ilford being open. Last week, on 8 January, Queen’s hospital in Romford was again diverting ambulances. Will the new Secretary of State look at the decision of his predecessor, whom I see on the Bench near him, and cancel the insane decision to close the accident and emergency unit at King George hospital? (136860)
The decision has been taken, but we have made it absolutely clear that we will not proceed with implementing it until there is sufficient capacity in the area, particularly at Queen’s hospital in Romford, to cope with any additional pressures caused by it, and that undertaking remains.
T5. The NHS has confirmed that North Yorkshire is the only part of the country that will inherit a £19 million debt, which has to be carried by the new clinical commissioning groups. That was the situation we were promised we would never be in. What is the Secretary of State going to do to urgently address the chronic underfunding of rural areas for the NHS in North Yorkshire? (136861)
My hon. Friend and I have previously discussed this matter, and she is right to highlight that there are particular challenges to address in rural areas, in terms of both distances to travel and an ageing population requiring considerable health care resources. That will of course be a matter for the NHS Commissioning Board to examine when it considers future funding allocations.
T9. Many of my constituents are concerned by the Care Quality Commission’s recent findings at Milton Keynes hospital, which came despite an increase in nursing staff since 2010. What reassurances can my right hon. Friend give my constituents that the problems are being rectified and that they will be able to enjoy high-quality care? (136865)
First, let me say that substandard care simply will not be tolerated and it has to be taken extremely seriously. I understand that the trust involved is reviewing its staffing levels so that the necessary improvements can be made. It has also started two-hourly checks, during which nursing staff check that patients have everything they need to be both safe and comfortable. There is clearly a big challenge and the trust has to meet it.
T7. The implications of HIV go well beyond health issues alone, yet the Government have so far refused to implement a new, cross-departmental HIV strategy. The Scottish and Welsh Governments have implemented their own such strategies, but 95% of people in the UK living with HIV reside in England. Will the Secretary of State commit to discussing this issue with his Cabinet colleagues, particularly those in the Department for Work and Pensions and the Department for Education? (136863)
I take extremely seriously the point that the hon. Lady makes. It seems to make more sense to be part of a comprehensive, integrated sexual health strategy, which the Government are planning and which will be published very soon. Services tend to be delivered together in the same units, so it makes sense to have a single strategy to deal with all those issues.
T10. In the light of widespread representations from constituents about the proposals for the centralisation of pathology services, will my right hon. Friend the Secretary of State consider the clinical concerns very carefully before any such changes are sanctioned? (136866)
T8. Last week, the Secretary of State refused my request to meet a small group of local GPs, hospital doctors and residents who are opposed to the closure of accident and emergency and maternity at Lewisham hospital, yet in his former role he seemed very happy to trade hundreds of texts with Rupert Murdoch’s lobbyists about the purchase of BSkyB by News Corp. Why is it one rule for Rupert Murdoch’s lobbyists and another for doctors in Lewisham? (136864)
I think that the hon. Lady might perhaps read Lord Leveson’s conclusions before she starts hurling about allegations, many of which came from her side of the House, that were later shown to be totally false. With respect to the decision on Lewisham hospital, I thought that we had a very useful meeting last night with the south London MPs who are directly affected. She understands that the process put into law by her party and her Government means that I cannot reopen the entire consultation and start seeing some groups without seeing all groups that are affected. That is why I am limiting the discussions I have with colleagues, but I think that that is the right thing to do.
The evidence is compelling that improved access to talking therapies for children and adults makes a huge difference to their mental health. Will the Minister therefore assure me and the House that the NHS Commissioning Board will have the necessary dedicated teams to ensure that the adult improving access to psychological therapies—IAPT—programme is delivered and that the new children’s programme is, too?
I thank my hon. Friend for that question. The Government take the development of talking therapies extremely seriously and I can confirm that I met Lord Layard yesterday, together with representatives of the NHS Commissioning Board. There will be a central team and we are absolutely determined to keep driving this approach forward, as there is real evidence of results.
Today’s edition of The Daily Telegraph carries an article on dementia, including a quote from a GP who says that it is not useful to give an early diagnosis when there are no drug or care needs. Does the Minister agree that that GP, like many others, fails to realise that for pre-senile dementias in particular, early diagnosis allows planning and allows families to understand the confusion created by altered personalities, behaviour, emotional responses and language skills?
I know that the hon. Lady spoke very movingly in the debate on dementia last week and I wholeheartedly agree with her. The medicines available for people with dementia do not help everyone, but we do not know that until we try them. By diagnosing only 42% of people with dementia, as is currently the case, we are denying nearly two thirds of dementia sufferers the chance to see whether they could benefit from those medicines and, as she rightly says, the chance to plan their care, which could mean that they could live at home for much longer.
The all-party group on cancer is delighted that the one and five-year cancer survival indicators have been included in the CCG outcome indicator set. We have campaigned for that in the belief that it will drive forward earlier diagnosis, as the Secretary of State knows. Can he clarify how CCGs will be held to account through that indicator set? For example, what action will be taken on underperforming CCGs?
I congratulate my hon. Friend on his campaigning on cancer issues through the all-party group. The NHS Commissioning Board is held to account through the mandate, which clearly states that we must make tangible progress towards having the lowest mortality rates in Europe for cancer and a number of other major diseases. I will expect the board to clamp down hard on CCGs who fail to deliver on what needs to happen for them to deliver on that promise.
Cancer Research UK has expressed deep concern about the fragmentation of cancer services and the climate of uncertainty that makes it harder to improve them due to the Government’s NHS reorganisation. I appreciate that that is not the fault of the Secretary of State, but he has the power to do something about it. Will he listen to Cancer Research UK and stop the fragmentation of cancer services?
Of course, I understand the concerns of Cancer Research, and I know that the hon. Gentleman understands the personal tragedy that cancer can cause. The change in the clinical networks is happening because we want them to cover dementia, which we were talking about earlier, mental health services and maternity and paediatric services. It is right that they should do so, but I want to make absolutely sure that as we go through the restructuring the benefits of the cancer clinical networks remain as strong as ever.
Will my right hon. Friend look at the east midlands cancer drugs fund? While I welcome the cancer drugs fund enormously, the east midlands will yet again underspend, leaving some of my constituents paying for their own treatment because they have been refused funding. Will my right hon. Friend please get his Department to investigate why?
Kettering has the sixth fastest household growth rate in England, and accident and emergency admissions to Kettering general hospital are now at 12% year on year. Will the Secretary of State ensure that the NHS funding formula reflects the very latest population estimates?
Penalties on readmission rates were introduced to improve clinical practice, but patients suffering from sickle cell and thalassaemia in my constituency and elsewhere cause hospitals to be fined for readmission, even though it is often in the patient’s best clinical interest. Will the Minister once again reconsider exempting sickle cell and thalassaemia from the penalty?
The hon. Lady is right to raise concerns about specific groups. The direction of travel in reducing readmission rates has to be the right thing; far too many patients were bouncing back to hospital when they would have been better looked after in the community. The longer term answer for some conditions, such as heart disease and possibly sickle cell and thalassaemia, may be year-of-care tariffs, which we are looking at very closely, as is the NHS Commissioning Board.
The Secretary of State just referred to the new strategic clinical networks. As the cancer networks are merged with them, what safeguards are there to stem the loss of expertise in cancer and what specialist support will be available to CCGs trying to achieve the targets we have heard about?
The biggest safeguard is the fact that the Government have made it one of our key priorities to improve mortality rates for cancer to the best in Europe. That means we are putting in a huge amount; for example, we are investing £450 million in early diagnosis. There are many other measures, which shows how seriously we take it.
My 92-year-old constituent, Ron Lewin, was referred for minor oral surgery. He was eventually written to by the specialist, who said that waiting lists were very long and that assessment appointments were available in 18 weeks, but that they did offer an independent service if he wished to be seen earlier. Independent obviously means paying to jump the queue. Is that how the Government propose to cut waiting lists?
It is a decision for front-line medical professionals to outline when treatment should or should not be given. Treatment must always be given on the basis of clinical need, so I am sure the hon. Lady will be feeding that message back to local commissioners. There is an opportunity for people to appeal against decisions when they are not made on the basis of clinical need, as that is clearly not the right thing and not in the interests of patients.
Will my right hon. Friend’s Department make an assessment of the effects on local air quality and public health of a potential third runway at Heathrow, and will he submit those findings to the Davies commission on airport capacity?
My constituent, Elaine Catterick, has had a serious operation at the James Cook hospital on Teesside cancelled twice in three months—once with just a few hours’ notice. She has also learned that there are twice-daily meetings at the hospital to decide whose operation should be cancelled next, as staff struggle to cope with spending cuts. I hope that is not what the Secretary of State wanted from his reforms, so what is he going to do about it?
All cancelled operations are a concern. The number of cancelled operations was about 50% higher as a proportion of all operations under the previous Government, but no operation should be cancelled, and we will continue to do what we can to bring down the numbers.
Supermarket Pricing Information
Motion for leave to bring in a Bill (Standing Order No. 23)
I beg to move,
That leave be given to bring in a Bill to require supermarkets to publish pricing data on all the goods they sell in a standardised, accessible, online format suitable to enable comprehensive comparison of the price of supermarket goods by retailer, store and product, and to enable independent analysis of pricing; and for connected purposes.
My aim is simple: to enable supermarket shoppers, which is most people in the country, to compare the prices of goods, product by product, store by store, company by company through an app on their smartphone, laptop or personal computer. None of the information that I want shoppers to have is secret. It is all publicly available. The problem is that, to get our hands on it, we would need an army of volunteers to go into every store, every day, to check the prices of every product. That is possible in theory, but it is quite impossible in practice.
The spread of smart devices, public familiarity with apps, and the development of a community of innovative app designers capable of handling data analysis in sophisticated ways has made things possible that could not be done a few years ago. I think that this is the time to harness that technology in the interests of consumers. If we do, we can even things up just a bit between the supermarket giants and the consumer.
Barely a day goes by without someone in the House saying that times are tough for hard-working families. Real wages have fallen for many. Family budgets have been squeezed. For many, the weekly supermarket bill—about 16% of family spending on average, but much bigger for many low-income families—is one of the largest single parts of family spending. No one has money to waste. Shoppers want to know that they are getting the best value for money for their hard-won pounds.
We want to know which supermarket genuinely has the best prices. We want to know how much extra we will pay if we go to the small branch—the local, the express—rather than a superstore of the same company. We do not want to be lured in by attractive headline promotions, only to be ripped off once we are inside the store. We want an easy way to work out the difference in cost between vegetables, some of which are bagged, some of which are loose and some of which are sold confusingly in different quantities. The truth is that no one can be sure that they are getting the best deal or the best information on any of those things today.
The major supermarkets are quick to say how competitive the grocery market is. It is true that there are 10 major companies competing on the high street, but that does not mean that the market always works for consumers. The supermarkets have a huge advantage over the rest of us. They amass data about our shopping habits—I am not talking about the data they have on each of us individually, but about the information they have on our collective shopping habits. They know what shoppers buy, how much and how often. They know what sort of price promotions attract us. They know when and what sort of pricing does not put us off because it looks good, because it is an essential, or because we just cannot work it out while pushing a trolley with kids in tow.
While the supermarkets have a huge amount of information on us, most shoppers are still left shopping around in a way that we would recognise from 20 years ago. Use of price comparison websites is growing fast, but those sites do not cover all supermarkets, all products or all stores. It is not an equal battle. As a GCSE economics student would tell us, markets only work well when everyone has the same level of information about what they are buying. It is not surprising that numerous studies have highlighted what is going on, and I have tried to summarise some of them on my website. Briefly, last year, The Grocer magazine found that in Tesco’s Big Price Drop campaign, for every two items that dropped in price, three went up. On 7 January, mySupermarket.co.uk highlighted current problems, and I shall give the House two examples. Sainsbury’s Goodfellas pizza—two for £4.50. Not only was that product cheaper in two other retailers where the customer would have had to buy only one, but the offer price was 16% higher than the price in Sainsbury’s most of last year. Innocent Smoothie—two for £5 in Asda and Waitrose, but cheaper in two other retailers and an offer price 20p higher than the average in those shops over the past 12 months, a price which had fluctuated between £2.79 and £2.30.
On Friday my office looked at a basket of 12 items in a Sainsbury Local in Bethnal Green and the Sainsbury superstore in Whitechapel. Across the basket of groceries the local store was 10% more expensive, with bananas 42%, carrots 59% and broccoli 49% more expensive. I accept that most people must know that local stores are more expensive, but do they know how much, and is it not worrying that the mark-up is so great on fresh fruit and vegetables?
The picture is clear. It is almost impossible to get comparable and reliable information about prices across all supermarkets and all products. It is hard to be sure when a price promotion is a bargain and when it is a rip-off. It is difficult to get the facts we need to question why prices vary so much from store to store or week by week. All these data are held on central supermarket IT systems. If the data were made available, online and in real time, innovative entrepreneurs would quickly produce apps that would not only compare prices but would, automatically and online, police such misleading deals and shed a light on store-by-store pricing policies.
I think those same entrepreneurs would focus on areas that currently see little competition but which are expensive, such as gluten-free foods. They may link pricing data to other data on organic food, farming practices, sustainability and local sourcing, for shoppers who want to combine value for money and their other values. I stress to the House again that I am talking only about data that are, in principle, a matter of public record. I am not asking supermarkets to reveal any commercially confidential data. But making public and really available real information about real prices would be enough to throw the spotlight on value for money and misleading discounts.
In November the Office of Fair Trading published a report on discount pricing policies and promoted a voluntary code of practice. In my view, the previous Government, of whom I was part, often found themselves between the rock of statutory regulation, burdensome and heavy handed, and the hard place of voluntary guidance, usually shot full of holes. The current Government are often in the same place. The simple beauty of my proposal is that a minor regulation could make the whole panoply of statutory regulation and investigation by the OFT largely redundant. Price transparency, backed by efficient data analysis, would simply drive sharp practice and misleading pricing out of the marketplace.
So far the supermarkets have been reluctant to say this is a bad idea. How could they? In principle, the data are public already. The issues they raise are mainly financial and technical. So I challenge the supermarkets today: you put up your technical experts and your systems managers, and I will assemble an independent team of experts, put them together, and let us see how hard it would be.
I have limited my proposal to the 10 supermarkets that would be covered by the current Groceries Code Adjudicator Bill, but many independent convenience stores may wish to join. Most use propriety software for their pricing and tills, and once an industry standard is established, it would be simple for that software to be upgraded and to give those stores the chance to join.
My proposal has gained the support of the consumer organisation Which?, comparison websites, and the chief executive of the Open Data Institute. Open data is an unstoppable movement. As a Cabinet member I made Ordnance Survey mapping data freely available, to the benefit of the public and innovative businesses alike. This Government have supported the Open Data Institute for public data. Over time, what is good enough for the public sector will become a demand on the private sector. As smartphones and consumer apps grow in availability and popularity, the supermarkets will not be able to ask, “Why should we do this?” They will have to explain why they have not done it.
Unless I am very lucky, this Bill may not become law, but I predict that this is only the start of a movement for transparent pricing and online information that will grow and grow. I commend the Bill to the House.
Question put and agreed to.
That Mr John Denham, Dr Alan Whitehead, Mr Nick Raynsford, Paul Blomfield, Lorely Burt, Jonathan Edwards, Justin Tomlinson and Caroline Lucas present the Bill.
Mr John Denham accordingly presented the Bill.
Bill read the First time; to be read a Second time on Friday 1 February, and to be printed (Bill 119).
[Relevant document: the Sixth Report of the Scottish Affairs Committee, on The Referendum on Separation for Scotland: The proposed Section 30 Order—Can a player also be the referee?, HC 863.]
I beg to move,
That the draft Scotland Act 1998 (Modification of Schedule 5) Order 2013, which was laid before this House on 22 October 2012, be approved.
I am grateful that we have longer to debate the order than would usually be the case. This reflects the interest that hon. and right hon. Members have shown in the issue and the time they have spent scrutinising it, not least in the Scottish Affairs Committee, whose report is a very important contribution to the parliamentary process.
On 15 October 2012, the Prime Minister, the First Minister, the Deputy First Minister and I signed an agreement on behalf of our respective Governments that will, if the order is approved by this House and the other place, allow a legal, fair and decisive referendum to take place on Scottish independence. We will face the most important political choice that people have taken in Scotland in more than 300 years.
I applaud the hon. Gentleman’s early intervention. He will not be surprised to know that he has anticipated slightly an issue that I will turn to at reasonable length, with the House’s permission, later in my speech. Put simply, we expect the same standards to apply to the Scottish Parliament as apply here—no greater, no less.
This process began with the Scottish National party’s victory in the May 2011 Scottish parliamentary elections and its manifesto pledge to hold an independence referendum. From the very beginning, we recognised the political mandate that the SNP had secured for a referendum. However, as I set out in the House just over a year ago, the Scotland Act 1998 is very clear that the Scottish Parliament cannot legislate on matters reserved to this Parliament. That includes the constitution and, specifically, the Union of the kingdoms of Scotland and England.
That is why we published a consultation paper on 10 January 2012, which set out the different ways to deliver a legal referendum. Shortly afterwards, the Scottish Government set out their own consultation.
Our paper sought views on how to facilitate a legal, fair and decisive referendum. We set out the available legislative options and stated that our preferred option was to provide the Scottish Parliament with the legal competence to legislate itself. This received the overwhelming support of those responding to our consultation. More than 70% of respondents agreed that the Scottish Parliament should be given that power. Throughout the discussions with the Scottish Government, we stressed that there should also be a single question to deal decisively with the issue of independence. Three quarters of respondents to our consultation agreed. In our consultation paper, we set out our view that the Electoral Commission, the independent body responsible for overseeing referendums in the UK, should be responsible for this referendum. That is the same position as for any other referendum.
The UK Government’s position was supported by 86% of respondents. Indeed, that was a point that the Scottish Government accepted fairly quickly. They moved from their initial proposal to establish a separate Scottish body to oversee the poll to a position of accepting that the Electoral Commission was the right body to oversee the referendum.
We also sought views on timing and on the franchise. On timing, we sought views on when the referendum should be held. Many people supported our view that it should be held sooner rather than later. Indeed, the order before us today provides an end date for the referendum, but it does not prevent it from being held sooner. It will be for the Scottish Government and the Scottish Parliament to set the referendum date.
On the franchise, we asked for views on who should be entitled to vote in the referendum.
Will the right hon. Gentleman tell us whether there are any provisions in the Bill to take account of the views of the many Scottish people who live in other countries—especially the Scottish population in Corby, who are absolutely convinced that we are stronger and better together? Will he take account of their views?
It is important that people in all parts of the United Kingdom make it clear to all of us living in Scotland that they value the Union and the United Kingdom. I respect the fact that there is a strong and rich diaspora of Scots all over the United Kingdom and, indeed, all over the world. Having looked carefully at the options for the franchise, we took a straightforward decision—we agreed wholeheartedly with the Scottish Government’s view on this—that the same franchise should apply to the referendum as applied to the Scottish Parliament elections that gave the Scottish National party its mandate in that Parliament. That keeps it simple, straightforward and fair, and that is the basis on which we will proceed.
I think that that is a reasonably easily understood anomaly. The French person, the EU national, who has made a commitment to living in Scotland is entitled to vote in a referendum there, just as they would be in the Scottish parliamentary elections. It is important that we show consistency on that front. I accept, however, that there is a range of opinion on this matter, and my hon. Friend has made his own point clearly.
On the issue of 16 and 17-year-olds participating in the referendum, respondents to our consultation were divided. I will return to that issue later.
Will the Secretary of State confirm that, if this order goes to the Scottish Parliament and if that Parliament agrees to allow 16 and 17-year-olds to vote in the referendum, the matter will no longer need to come back to this House or to the other place?
The hon. Gentleman highlights an important point. He is right to suggest that, if this House and the other place agree this order and it is passed, that will transfer responsibility for the referendum totally to the Scottish Parliament.
Following the respective consultations, a period of discussions between Scotland’s two Governments led to the signing of the Edinburgh agreement on 15 October. I will return to the other important elements of that agreement shortly, but first I want to deal with the order itself.
The order is made under section 30(2) and (4) of the Scotland Act 1998. It inserts a new paragraph 5A into part 1 of schedule 5 to the Act. Part 1 provides, among other things, that the Union of the kingdoms of Scotland and England is reserved to the UK Parliament. New paragraph 5A will ensure that the reservation does not apply to a referendum on independence, provided that the referendum meets the requirements set out. Those requirements are for a single-question referendum, on the subject of independence, to be held before the end of 2014, and without any other referendum provided for by an Act of the Scottish Parliament being held on the same day.
The order also makes provision in respect of public referendum broadcasts and free mailshots, which would otherwise be outside the legislative competence of the Scottish Parliament. Under the Political Parties, Elections and Referendums Act 2000—PPERA, as we know it —referendum campaign broadcasts can be made only by or on behalf of a designated campaign organisation. The order applies that provision of PPERA to an independence referendum. That means that the restriction in PPERA on who can make referendum campaign broadcasts can apply to the independence referendum.
The agreement in 2006 between the Secretary of State for Culture, Media and Sport and the BBC requires the BBC to broadcast referendum campaign broadcasts, as defined by PPERA. The provisions of the order mean that the BBC will have the same obligations and responsibilities in respect of independence referendum campaign broadcasts as it would have in respect of any PPERA referendum broadcasts. Under PPERA, each designated campaign organisation can send a mailshot to every elector or household without being required to pay the postage costs. That service is provided by Royal Mail and the costs are recovered from the Consolidated Fund. The order applies those provisions in PPERA to an independence referendum. It specifically provides that the cost to the Royal Mail of providing the service will be recovered from Scottish Ministers.
The section 30 order that we are debating today will enable the Scottish Parliament to legislate for a legal referendum. The Scottish Parliament has already considered the order and approved it unanimously. If the order is approved by both Houses of this Parliament, it will enable the Scottish Government to introduce a referendum Bill setting out the wording of the question, the date of the referendum and the rules of the campaign for the Scottish Parliament to consider. This devolution of power will ensure that the details of the referendum process itself are made in Scotland, in the Scottish Parliament. That is a principle of great importance to the devolution settlement. Furthermore, the approach here respects another key feature of devolution—namely, that once a matter is passed to the Scottish Parliament, it is for that Parliament to determine the details of the legislation that follows.
However, our agreement does not just make the referendum legal and respect the devolution settlement. It also sets out the conditions that are necessary and that have been agreed between the UK and Scottish Governments for the referendum to be fair and decisive. In this context, it is important to consider the memorandum of agreement alongside the order. The agreement is a statement of political intent by Scotland’s two Governments. It commits us jointly to an approach to, and the delivery of, the independence referendum which will ensure that the proceedings are fair and that the outcome is decisive. With permission, Mr Speaker, I will therefore briefly describe that broader agreement.
At the heart of any fair referendum must lie a set of rules and processes that have the support of both sets of protagonists. For the outcome to be legitimate, both sides of the argument must have faith in all aspects of the referendum. That is particularly true when we are considering the future of our nation. The agreement therefore sets out the commitment of both Governments to the normal rules and procedures that govern referendums in the UK, as contained in PPERA. A core part of the PPERA process is the central role of the Electoral Commission. The two Governments have agreed that the Electoral Commission must review the proposed referendum question, and that its report will be laid before the Scottish Parliament. That process is under way. Since PPERA came into force, there have been three referendums held under that legislation.
I think that there would be a price to pay for that. If the hon. Gentleman will be patient, I shall return to that issue shortly.
The three referendums held under the auspices of the Electoral Commission have been: the north-east regional assembly referendum in 2004; the referendum in Wales in 2011 on further devolution; and the referendum on the voting system for the UK Parliament, also held in 2011. In all three cases, the Electoral Commission reviewed the Government’s proposed question and provided its advice. The Government responded by revising the questions in line with that advice. Of course, in the past, some Members on the SNP Benches have referred to the wording of the proposed question for referendums on local council tax.
The Government made it clear when they brought forward the regulations to provide for those referendums that discussions were ongoing with the Electoral Commission on the wording of the question. Revised regulations were tabled on 8 January and the Electoral Commission has confirmed that it is content with the revised wording.
Under the terms of the Edinburgh agreement, it will be for the Scottish Government to respond to the advice of the Electoral Commission. The Scottish Government have committed to putting before the Scottish Parliament their response to the Electoral Commission’s recommendations. That means that the Scottish Government will be held to account by the public and Parliament alike for how they respond to that advice. All Opposition leaders in the Scottish Parliament have stated their intention to abide by the Electoral Commission’s judgment in this case. To do otherwise would be a significant step, for which there would be a political price.
As I have set out, both Governments recognise that the referendum process must be seen to be fair by both sides of the campaign. That applies across the process, but particularly to the financing of the campaign. As part of the Edinburgh agreement, the Scottish Government committed to consulting the two campaign organisations for their views before proposing spending limits for the referendum campaign to the Scottish Parliament.
The agreement ensures that the independent Electoral Commission will provide the Scottish Government with advice on the appropriate spending limits for the two campaigns and the parties. That is what has happened in previous referendums, such as the 2011 referendum in Wales on further powers for the Welsh Assembly. In that referendum, the Electoral Commission recommended that the spending limit for designated campaign organisations should be set by reference to the expenditure limits that apply to elections to the relevant legislature. In its response to both Governments’ consultation documents, the Electoral Commission provided its view that the model remains appropriate for the Scottish independence referendum. The Electoral Commission has met the parties represented in the Scottish Parliament to seek their views on the finance arrangements.
When the Scottish Government set out their final proposals for financing the referendum campaign in the referendum Bill, they must set themselves aside from their own campaigning interests and recognise that their approach is being watched by all of Scotland, and indeed by the international community. That is a point that the Deputy First Minister recognised when she rightly said that the poll must satisfy the highest international standards. All people must believe that there is a fair process and, therefore, a fair result.
Both Governments agree that the basis for the franchise will be that for the Scottish Parliament elections—that is, those UK or EU citizens who are resident in Scotland. That is set out in the Edinburgh agreement. In addition, the Scottish Government propose to give 16 and 17-year-olds the right to vote. I recognise and respect that there are differing views on that issue in the House. My party, the Liberal Democrat party, supports the principle of 16 and 17-year-olds participating in all elections. Our coalition partners do not, however. Views on both sides of the argument can be found on both sides of the Chamber.
In devolving the power to hold the referendum, however, we respect that this is a matter that should be debated and determined by the Scottish Parliament. Indeed, where the Scottish Government and Parliament have the power to hold referendums and elections already, they have chosen to allow some 16 and 17-year-olds to vote. However, the Scottish Parliament’s decision with respect to health board and crofting commission elections in Scotland has set no precedent for any elections for which the UK Government are responsible. I fully expect that the Scottish Government’s proposals will be debated robustly in the Scottish Parliament. However, let me be clear that it will be for the Scottish Government to make the case for this proposal in the Scottish Parliament and to deal with the issues that arise. Let me be equally clear that any decision taken by the Scottish Parliament for the referendum will not affect the voting age for parliamentary and local government elections in the United Kingdom. That remains the responsibility of this Parliament alone to determine.
Have there been any practical discussions between the UK Government and the Scottish Government about the ability to implement this measure ahead of the referendum, given that there has been much talk of the inability to do so because of the state of the electoral register?
That issue was discussed during the negotiations leading up to the Edinburgh agreement. However, as we made plain in the agreement and as I have repeated this afternoon, as we are devolving that power, it is for the Scottish Government to bring forward their proposals. That will require legislation and that legislation will be properly scrutinised by all of us and, in particular, by MSPs. That process is yet to get under way.
I thank the Secretary of State for giving way; he is being very generous. We, as campaigners, will be contacting minors to seek their views and discuss the issues. Has he had any discussions with the Scottish Government about the rules and regulations that will apply to parties engaging with people who are not yet adults?
The hon. Lady hits on an important, sensitive and practical point that must be considered carefully in any legislation on this issue that is introduced in the Scottish Parliament. Until the legislation is published and people can consider its detail, her point cannot be properly examined. I am confident that the Scottish Government are alert to that issue and it is incumbent on them to bring forward appropriate proposals with the necessary safeguards.
Does my right hon. Friend agree that although the whole House agrees that the Scottish Parliament should make the decisions about the conduct of the referendum, matters such as the franchise ought also to be discussed fully in this House, as we are doing now and will do for some considerable time today, because the outcome of the referendum affects not only Scotland, but the whole United Kingdom?
My hon. Friend has made two important and linked points. On the first issue, nobody is suggesting for a minute that people in this House cannot offer an opinion about whether it is right or wrong for 16 and 17-year-olds to vote. She is right that this afternoon is a good opportunity for people to make the case one way or the other. On the second point, she is also right that what happens in Scotland affects the whole United Kingdom. A huge amount is at stake in this big debate. Although people south of the border will not vote in the referendum, it is important that their views are included in the public debate. I am sure that they will be.
Before I took the interventions, I made the point that when 16 and 17-year-olds have been allowed to vote in admittedly smaller elections in Scotland, it has had no ramifications for the decisions that are made in this place, and neither will this decision. However, the debate on the rights and wrongs of 16 and 17-year-olds voting will remain live in politics and I see no worry about that.
I thank the Secretary of State for giving way yet again. Before we move on from the franchise, will he advise the House whether there has been any progress in the talks on allowing members of the Scottish armed forces who are, through no fault of their own, serving elsewhere in the UK or around the world to vote in the referendum?
I pay tribute to the hon. Lady, who has made that point strongly not only on the Scottish Affairs Committee, but in other debates. I recognise that it is a sensitive issue. We must ensure that, as would be the case in any other referendum or election, those in the armed forces who have a connection to Scotland are aware of what it will take for them to vote in the referendum. There is a range of complexities in that, but the Scottish Government are aware of the issue and understand it. When they publish the legislation, there will be plenty of time for people in the Scottish Parliament, and those of us here who take an interest in the matter, to offer their views on the details.
The hon. Gentleman makes a valid point that reinforces the views of his colleagues, and I recognise that this matter is important to Members on all sides of the House. It will now be an issue for the Scottish Parliament to consider, and I am confident that in the political debate across Scotland the role of the armed forces and voting will be properly considered.
The exchanges of the last moment or two have raised a broader question. Once responsibilities are handed to the Scottish Parliament, what will be the role of this place in monitoring the issue and ensuring—so far as we can—that the objectives of fairness and decisiveness are properly maintained?
My right hon. and learned Friend highlights an important issue and principle. In the order and the political agreement that sits alongside it, we set out what we believe should happen when the referendum process is resolved in the Scottish Parliament. As I said earlier, we are observing and honouring the principles of devolution so that when a matter is devolved from this place to the Scottish Parliament, it becomes that Parliament’s responsibility, including all the details and everything that goes with it. We are not, however, disfranchised from the political debate. Plenty of MSPs offered views on this process long before it went anywhere near the Scottish Parliament, and I am confident that lots of MPs will contribute to the debate long after it has left this place, and, if it is passed, the other place as well.
Will the Secretary of State confirm whether, as well as actively encouraging members of the armed forces from Scotland to register to vote, people will be encouraged to register their sons and daughters who are 16 and 17 years old? This issue will affect their lives as well.
The hon. Lady adds to the points made by her hon. Friends. I am confident that all these issues will be debated in the Scottish Parliament, and I encourage her, and others, to make such representations directly. We are not stymied in this debate simply because we have passed the legal process—assuming that we do; I do not wish to take the House for granted in that respect.
May I probe the Secretary of State on the timing of the referendum? He may recall the separatist slogan, “Scotland free by 2003”, yet when it gets the chance in 2012, the SNP says that it is not ready until 2014. Has he picked up any rationale for why that is the case, or is it just the general public view that they are just big fearties?
I am sure we can offer Hansard the appropriate assistance should it be sought. This is a point on which I agree with the hon. Gentleman. It is slightly curious that after 80 years of existence—give or take—the Scottish National party is not rushing to get this over and done with straightaway. One would have thought it would want to do it as quickly as possible, and it would certainly be in Scotland’s best interest to resolve the issue as quickly as possible. However, it will be a matter for the Scottish Government and then the Scottish Parliament to consider.
I understand there is some suggestion that the Committees in the Scottish Parliament that will deal with the Bills on both the franchise and the referendum will be subject to a truncated timetable programme. Has the Secretary of State had any discussions with the Scottish Government about that? Given the importance of the referendum for our whole country, does he agree it is important that the Scottish Parliament’s Committees have appropriate time to consider the issues in great detail and ensure they are satisfactorily answered?
The hon. Lady makes an important point. I do not believe it is appropriate for us to discuss that directly with the Scottish Government; it is for the Scottish Parliament to decide how it determines its own business. Former Members of that Parliament who are in this House today may wish to pick up on the hon. Lady’s point. I absolutely agree, however, with her central point that we should consider the issue properly and seriously. Symbolically, we are taking longer than we would normally to consider a statutory instrument because of the significance of the order. People would look askance if parliamentary processes elsewhere were cut short in the course of the debate, but the issue is for the Scottish Parliament to determine. We all have colleagues in that Parliament who, I am sure, will make the hon. Lady’s point very vigorously.
Let me turn to one issue that has attracted some comment, particularly from the Scottish Government. The concluding paragraph of the Edinburgh agreement contains a commitment by both Governments to hold a referendum that is legal, fair and decisive. There have been some creative interpretations of this paragraph in recent times, and I want to take the opportunity to restate its clear and obvious meaning.
Paragraph 30 reads:
“The United Kingdom and Scottish Governments are committed, through the Memorandum of Understanding between them and others, to working together on matters of mutual interest and to the principles of good communication and mutual respect. The two Governments have reached this agreement in that spirit. They look forward to a referendum that is legal and fair producing a decisive and respected outcome. The two Governments are committed to continue to work together constructively in the light of the outcome, whatever it is, in the best interests of the people of Scotland and of the rest of the United Kingdom.”
That means that the two Governments will conduct the referendum on the same constructive terms as they work today, and that if the referendum follows the path set out in the order and agreement, its outcome will be decisive. Regardless of the result, that constructive relationship should continue as we move forward. That is good practice and common sense. It does not mean, however, that in the event of a yes vote, the remaining UK would facilitate Scotland’s every wish—no more than an independent Scotland would unquestioningly facilitate the wishes of the remaining UK. Inevitably, when there are two separate countries, there are two sets of interests—sometimes mutual, sometimes at odds. That is the case in the UK’s relationships with its closest allies today, and we honour that principle, and so it always will be between separate, sovereign states.
The Edinburgh agreement, particularly paragraph 30, is a statement of our determination to hold a referendum that is legal, fair and decisive. It does not—and cannot—pre-empt the implications of that vote, and it is important that everyone is clear about that.
The Secretary of State talks about what might happen if the result of the referendum is yes. Whose interests will he be representing post the yes vote?
I am absolutely confident that Scotland will vote to stay in the United Kingdom. I am committed to doing what is in the best interests of Scotland, regardless of the outcome, as I said on the radio yesterday morning.
Scotland’s future within the UK will be the most important decision that we as Scots take in our lifetime. Facilitating a legal, fair and decisive referendum is critical. That is why we consulted on this issue, why both Governments have spent many hours discussing and negotiating the process, and why we seek the support of the House today to approve this order.
Debating this order in the House today marks an important step as we move from discussions on process to the substance of the great debate. It is now essential that the referendum decision is focused on determining whether Scotland chooses to remain an integral part of the most successful partnership of nations the world has ever seen; to remain part of a family of nations that works in the interests of all; or whether it wishes to leave and go it alone. That decision should not be taken lightly; it should be taken after examining all the facts.
The hon. Gentleman and his fellow Committee members have written important reports on this subject and highlighted the dangers in the process. As I made clear in my earlier remarks—and this, I think, is the tenor of the contributions we may anticipate this afternoon—the Scottish Government will act in setting the rules and pushing them through Parliament on behalf of all Scots and both sides of the argument. It is important that they do so in a way that is not fair to one side and unfair to the other.
I strongly believe that, with the support of colleagues across the House, across Scotland and across the whole of the United Kingdom, fellow Scots will join me in the autumn of 2014 in choosing to remain part of the United Kingdom. We are indeed better together. In the meantime, I commend the order to the House.
This is indeed an important day in the life of our nation and this Parliament. Rarely do we have an opportunity to debate an issue as fundamental as the future of our country.
Let me be clear at the outset that we welcome the order that is before the House today. This House has witnessed significant discussions on the future of nations, most recently the future of Scotland and Wales in the Union and the constitutional status of Northern Ireland. Today’s discussion is no less significant, for two reasons. First, it contemplates the possibility of an end to the 300-year-old Union with Scotland. That is important to emphasise, not just for those of us in the Chamber who are from Scotland, but for people who live in the rest of the United Kingdom but believe in a United Kingdom with Scotland as a crucial part of it—I give due recognition to the good people of Corby for their enthusiasm for that commitment. Secondly, today’s discussion is significant because it is a novel way of settling the issue. Parliament is being invited not to legislate or to make a decision, but to delegate the power, under certain strict conditions, to the Scottish Parliament, ultimately—we should never forget this—to allow the Scottish people to make that decision.
The agreement puts it beyond doubt that, in the words of the First Minister and the Secretary of State, the referendum will be “made in Scotland”. It can be argued that this is not just an example of the success of the United Kingdom’s democracy, but evidence of the strength of the Scottish Parliament—a devolved institution argued for and established by, of course, a Labour Government. The principle that the referendum should be controlled by the Scottish Parliament is important in commanding respect from all sides. However, it is particularly significant in ensuring that after the referendum the Scottish Government cannot suggest that there is any ambiguity about the process or the result. The choice before the people of Scotland is straightforward: whether to leave the United Kingdom or to continue in a partnership of equals in a Union with England, Wales and Northern Ireland.
As I said at the outset, Labour Members support the order. We support it because, if followed, the principles contained in it, as well as in the memorandum of agreement, would provide for a referendum that met the test that we set at the start—namely that, as the Secretary of State said, it should be fair, legal and decisive. Together, the agreement and the order provide that all three conditions can be met if all parties in the referendum hold to their spirit and their letter. It is clear that we now have the opportunity to put before the people of Scotland the question of separation, and that decision will bind us all. As the agreement says, the referendum will deliver a decisive expression of the views of the people of Scotland, along with a result that everyone will respect and must respect.
This debate is important, because endless constitutional uncertainty is bad for all interests in Scotland, not least those of us who would rather spend our time, energy and efforts dealing with the reality of life for hundreds of thousands of Scots, if not millions, who need us to focus on defending and pursuing their interests. Labour spent a generation arguing for devolution, against the protests of the parties opposite—or one of them, I should say; I am in a generous mood towards the Secretary of State today.
Indeed. Other parties opposed devolution, as my right hon. Friend points out. We argued for devolution because it was the best way to deliver social justice and economic progress and because it commanded the support of the vast majority of the Scottish people.
I wonder if the hon. Lady can tell us whether the ends of social justice were advanced last week in the Commons when the majority of Scottish MPs voted against welfare reforms that are being foisted on Scotland by MPs from the rest of the UK. How does that further the ends of social justice and why does she support the right of a Tory Government to govern Scotland and do exactly that? Why is she not an independence supporter?
For many years I have argued with the SNP, which wants to say that the problem facing Scotland is the English. I say that the problem facing Scotland at the moment is the Tories and the SNP. The SNP is imposing college cuts, and making Scotland one of the nations of the United Kingdom with the highest increases in unemployment. The hon. Gentleman would be well fit to look to his own party to see the damage it is inflicting in Scotland, instead of always trying to hide behind the blanket of independence—[Interruption]—although I thank him for that encouragement to energise this debate.
The order we are debating today demonstrates that devolution has been a success. It has empowered Scots and given our nation a new sense of confidence. With it, we have modernised and changed Britain and the way we govern ourselves. Labour Members will take the opportunity that the referendum presents us with to make the argument for a prosperous Scotland within a United Kingdom, backed up by a strong devolution settlement. We will be arguing against the nationalists, who would stop devolution in its tracks just 15 years after we set out on this journey and after it has been so successful. At the end of this process, that means that perhaps we can finally heed the advice of Scotland’s first First Minister.
I thank the right hon. Gentleman for his intervention, which affords me the opportunity to draw attention to the fact that those who opposed devolution—perhaps most strongly at some points—were those in the Scottish National party, which never participated on any multi-party basis to give Scotland the constitutional agreement that we now have. In fact, many of us who were prepared to work with others—and who demonstrated that we could do so—did, in fact, work in the best interests of Scotland.
The right hon. Gentleman also allows me to make the point—which I was just about to make—that we should heed the advice of Scotland’s first First Minister, Donald Dewar, who said in 1998:
“The…decade must not be one long embittering fight over further constitutional change. For me, the question now is what we do with our Parliament, not what we do to it.”
In these challenging economic times, perhaps we should focus our minds on the powers of the Scottish Parliament and question how they are being exercised at the moment. That, too, should occupy our energies.
My hon. Friend has just mentioned the late, great Donald Dewar, who said that the decade from 1998 should not be a decade of stifling the Scottish Parliament, but since the SNP got a majority in that Parliament, has not its whole ethos indeed been stifled?
I thank my hon. Friend for that point. As a number of hon. Members present know, I served in the Scottish Parliament for 12 years. I was part of many of the exciting developments and changes it inaugurated, but it is with deep disappointment that I now see a Parliament that does not seem to have the proper opportunity to scrutinise the Executive who are part of that arrangement and who also seem to be significantly failing the Scottish people. Although I see constitutional change as a means to an end, I have never seen it as an end in itself. It would serve the Scottish people well if the Scottish Government focused on the work of serving the Scottish people and their interests, rather than just for ever furthering the goal of constitutional change.
This is something I raised in a previous speech on Scotland, but today we have once again heard the chuntering from the SNP, whose Members are sat on the Benches beside me—the bullying tactics that have been used in the Scottish Parliament to stop proper legislation going through. Can we trust these people?