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Commons Chamber

Volume 559: debated on Tuesday 26 February 2013

House of Commons

Tuesday 26 February 2013

The House met at half-past Eleven o’clock


[Mr Speaker in the Chair]

Business before Questions

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

Consideration of Bill, as amended, opposed and deferred until Tuesday 5 March (Standing Order No. 20).

Oral Answers to Questions


The Secretary of State was asked—

Comparative Performance Data

1. What assessment he has made of the benefits of comparative performance data in raising standards in the NHS. (144336)

Comparative performance data are essential to raise standards in the NHS. I have therefore commissioned a review from the Nuffield Trust to consider whether aggregate ratings of provider performance should be used in health and social care, and if so, how best this should be done.

My right hon. Friend will be aware that NHS North West London has made considerable use of comparative performance data to justify closing four A and E departments in one concentrated part of its area. Charing Cross, Ealing, Hammersmith and Central Middlesex are the four A and E departments closest to my constituents, who will be wondering how their closure will raise standards of health care provision locally. Does my right hon. Friend appreciate that there will be strong support among my constituents for any calls to review the decision and the use of comparative performance data?

I first congratulate my hon. Friend on campaigning extremely hard on behalf of the views and concerns of her constituents throughout the process of the decision that was finally made by NHS North West London last Tuesday. Comparative performance data have a very important role to play, particularly with regard to excess mortality of people who use A and E on weekends. I am, however, aware of my hon. Friend’s concerns and will consider them carefully if, as is likely, the decision is reviewed by Ealing council.

I thank the Secretary of State for his previous answer. Comparative data are essential in compiling an evidence base on which to plan effective health interventions. Will he use the radiotherapy data sets that his Department publishes as a basis to inform planned investments in advanced radiotherapy systems, particularly in regions like mine which lack such equipment?

I know that the hon. Gentleman asks a lot of questions about radiotherapy. We use a strict evidence base before we make any investments. We also want to embrace innovation, but our absolute priority is to save as many lives as possible from cancer. He will know that we are in the lower half of the European league tables when it comes to cancer survival rates, and that is something that we are determined to put right.

On collecting performance data, has the Secretary of State seen the NHS Confederation publication “Information overload: tackling bureaucracy in the NHS”, which points to a great deal of duplication in information? What is his reaction to it?

There is far too much bureaucracy in the NHS, which is why I have asked the chief executive of the NHS Confederation to report to me on how we could reduce the bureaucratic burden on hospitals by a third. If there is a lesson from the Francis report on the tragedy at Mid Staffs, it is that we need to free up the time of people on the front line to care, which is what they went into the NHS to do.

The hon. Member for Ealing Central and Acton (Angie Bray) asked a key question. Under the secondary legislation being introduced by the Secretary of State under section 75 of the Health and Social Care Act 2012, local commissioning groups will be forced to allow private providers into the NHS. These private providers will be exempt from the Freedom of Information Act, which will make it harder for patients to compare data between providers. It cannot benefit NHS patients for core clinical services to be given to private providers that do not have to conform to the same standards of transparency as those in the NHS. Will the Secretary of State see reason, ensure a level playing field for the NHS and withdraw the section 75 regulations without delay?

Who exactly are the section-75 bogeymen that the hon. Gentleman hates: Whizz-Kidz who are supplying services to disabled children in Tower Hamlets, or Mind, which is supplying psychological therapy to people in Middlesbrough? The reality is that those regulations are completely consistent with the procurement guidelines that his Government sent to primary care trusts. He needs to stop trying to pretend that we are doing something different from what his Government were doing when in fact we are doing exactly the same.

Local Authority Public Health Responsibilities

2. What support his Department has given to local authorities in respect of their new public health responsibilities. (144337)

The Department has continued to work with all its partners to ensure that there is a swift and effective transition of public health responsibilities to where they should be—back with local authorities. We have made available £15 million to ensure that the transition is successful and complies with all the requirements that we have laid down.

I thank the Minister for that answer. I invited the Silver Star charity to my constituency on Friday, where it offered free diabetes tests to all residents. Will local authorities be encouraged to work with such charities to improve public health?

The Silver Star bus is making many journeys because as well as going to my hon. Friend’s constituency, it is coming to mine on Saturday. It is an outstanding charity that provides diagnosis at a local level. I pay tribute in particular to the right hon. Member for Leicester East (Keith Vaz) because the charity goes to communities that are often hard to reach, such as the Asian community, where we need to do good work to reduce the level of diabetes, both type 1 and type 2. I look forward to local authorities working with outstanding charities such as Silver Star.

Why is the public health grant for next year £58 per person in Barnsley and £53 per person in Rotherham, but £130 per person in Westminster and in Kensington and Chelsea, especially given that deprivation is less and life expectancy at least seven years longer in those wealthy, Tory London boroughs?

I do not accept that for one moment. I am exceptionally proud of this Government’s commitment to public health which, in the difficult times that we have inherited, has ensured that local authorities are in some cases receiving an increase of some 10% in spending on public health. That is a record that I am proud of and that the Labour Government could not have matched.

My hon. Friend will be aware that the local authorities and the Food Standards Agency have a public health responsibility to ensure that food entering schools and hospitals is appropriately labelled and is safe and healthy to eat. Does she have absolute confidence in the procedures that have been followed in that regard or might she be prepared to review them?

I am grateful for that question. I pay tribute to all my hon. Friend’s work on this matter, especially as Chair of the Environment, Food and Rural Affairs Committee. This has been a difficult time for all concerned. We need to ensure that all food is what it says on the label. Important work needs to be done to ensure that that is the case and to restore confidence to all consumers. We are very mindful of that in the Department.

I thank the Minister for her very kind comments. I know that the charity Silver Star is looking forward to visiting her constituency on Saturday and testing her for diabetes. I am sure that we will find her in perfect health. I remind her that, according to the national health service, it will take five years before all diabetics have access to the full nine checks. Will she consider issuing guidelines to local health and wellbeing boards to ensure that they raise awareness of diabetes?

I am concerned, as we all are, about diabetes and about the recent report. We have accepted all but one of its recommendations and a lot more work needs to be done. I pay tribute to Silver Star and to the work of Diabetes UK, for example in Boots. I was happy to go to the launch of a new system whereby people can go to clinics at Boots and get the sort of checks that Silver Star is doing. We recognise that there is a lot more work to be done and are making every effort to ensure that there is a huge improvement in the diagnosis and outcomes of everybody who is affected by diabetes.

A and E and Maternity Provision (South-east London)

3. What recent assessment he has made of the future demand for accident and emergency and maternity services at (a) Guy’s and St Thomas’ NHS Foundation Trust and (b) King’s College Hospital NHS Foundation Trust. (144338)

I have accepted the trust special administrator’s broad recommendations on the future of A and E and maternity services in south-east London. Appendix E of the administrator’s final report outlines the forecast A and E activity and births in south-east London, and the methodology used to determine that information. That includes activity at Guy’s and St Thomas’ NHS Foundation Trust and King’s College Hospital NHS Foundation Trust.

I am grateful for the Secretary of State’s answer. Following his statement and decision, does he recognise that there are still two significant concerns? The first is that any downgrade of A and E and maternity services in Lewisham will put pressure on the other trusts which they cannot cope with. The second is that there is not yet support among all GPs and clinicians, including in Lewisham, for the current plan. Will he assure me that he will seek their support before anything is implemented, and that he will give us the assurances that we need?

I recognise the concerns that the right hon. Gentleman outlines. As he knows, we have allocated £37 million to help the other four A and E departments that will take the 25% of cases that will no longer go to Lewisham to deal with that extra capacity. He is right to say that the way in which the plan is implemented will be critical. We need to do it properly and extremely carefully to ensure that we meet the concerns that he talks about.

When the Secretary of State announced his decision to downgrade Lewisham’s A and E services and transfer the patients to St Thomas’ and King’s, he said that Sir Bruce Keogh, the medical director of the NHS, had reviewed those proposals and that:

“He believes that…these proposals…could save up to 100 lives every year”. —[Official Report, 31 January 2013; Vol. 557, c. 1075.]

Having read Sir Bruce Keogh’s review, I can tell the House that he makes no mention whatsoever of saving 100 lives each year. Will the Secretary of State now apologise for misleading the House?

Order. Just before the Secretary of State replies, I ought to say to the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) that she is perhaps suggesting that the Secretary of State may have inadvertently, rather than deliberately, misled the House. Could she just confirm that? A nod of the head would suffice.

That is the right hon. Lady’s suggestion, and it is for the Secretary of State to respond as he thinks fit.

Thank you, Mr Speaker.

Sir Bruce Keogh accepts the calculations that were made in the proposals put forward by the trust special administrator that the plans would be likely to save about 100 lives a year, because they would allow the hospitals in south-east London to move towards the London quality standard, which would mean reducing excess mortality at weekends. Sir Bruce Keogh accepted that, and I accepted his view of it.

Order. Many London hospitals and the representatives thereof have an interest in the question. Newark is some distance away, but I feel sure that the hon. Gentleman’s supplementary question will be not about Newark but purely about these London hospitals. On that basis, I am delighted to hear from him.

I am disappointed, but never mind. We will hear from the hon. Gentleman ere long on another matter, I feel sure.

Demand for A and E services at Guy’s and St Thomas’ and at King’s will go through the roof if Lewisham’s full A and E closes. The Secretary of State may claim that he is keeping a smaller A and E at Lewisham, but that is nothing more than dangerous spin. No blue-light ambulances will call at Lewisham under his plans, and even the College of Emergency Medicine says that they do not meet its definition of an emergency department. How on earth can the Secretary of State be so confident that other hospitals in south-east London will be able to cope once he has taken the axe to Lewisham?

I recognise that the hon. Lady has been campaigning hard for her constituents, but she massively overstates her case. The reality of the proposals is that 25% of the people who go to Lewisham A and E will no longer go there—the most complex cases among her constituents, who will get better treatment as a result. Those 25% will be spread among four other A and E departments, and we are allocating £37 million to help them upgrade their capacity. That is a sensible proposal that will save the lives of her constituents.

Local Members of Parliament are right to raise concerns about future capacity at Guy’s and St Thomas’ and at King’s. The recent King’s Fund report showed that between October and December 2012, many A and E departments in England faced their worst winter in almost a decade. Standards of care are deteriorating, with too many people waiting too long to be seen and many being left on trolleys in corridors or waiting in ambulances stuck outside A and E. Does the Secretary of State now accept that the NHS is struggling to cope with the toxic mix of cuts and reorganisation, and that patients in south-east London and elsewhere are paying the price for this Government’s mismanagement of the NHS?

Really, from a party that closed or downgraded 12 A and E departments when in office, I would expect a slightly more mature attitude to an extremely difficult and complex problem. We will not take any lessons in meeting A and E targets from that lot. The reality is that we met our A and E targets last year, but in Wales, where Labour cut the NHS budget by 8%, they have not met their A and E targets since 2009.

Sexual Health Policy

4. What the reason is for the time taken to produce the Government’s sexual health policy document; and when he now expects it to be published. (144339)

Will the sexual health policy document contain a strategic plan, effectively resourced by Government, to address and reduce HIV stigma, especially among health care professionals, the police, media, teachers and social services? Perhaps a good starting point could be to draw on the lessons and the success of the Government’s anti-stigma work on mental health.

I certainly support the sentiment behind the hon. Gentleman’s question, and make it clear that I wanted to ensure that the document included the need for everybody to eradicate prejudice in all sexual health work. I was very keen to put that in the document, and I am sure he will join me in welcoming its publication, which will, we hope, be next month.

The under-18 pregnancy rate has fallen by 25% in the past 10 years. Will the Minister confirm that the strategy document will make it clear that it is important to protect specialist, dedicated sexual health services for young people, such as the Brook service at the Talkshop in Trafford in my constituency?

Does my hon. Friend recognise the excellent progress that has been made in vaccination against the human papillomavirus to prevent cervical cancer in young girls? Will she find the time to meet me to discuss the benefits of vaccinating boys against that virus?

Yes, it is always a great pleasure to meet my hon. Friend, and he raises an important issue. I have met a number of other colleagues to talk about their concerns about screening—or rather the lack of screening—for young women under the age of 25 in relation to cervical cancer. That is a concern and we look forward to working on that. I am very happy to meet my hon. Friend.

The Government have been woefully complacent about producing their sexual health strategy. The Minister constantly says that responsibility for decisions lies locally, but will she admit that the Government’s reorganisation has created huge confusion, splitting the commissioning of sexual health services between GPs, councils and the national board, and that the Government’s lack of interest has delayed the sexual health strategy by 21 months? Will she explain the reasons for the delay, and when the strategy finally comes out, will she commit to it addressing seriously the rationing of access to contraceptive services for women aged over 25?

Is it not remarkable to have criticism of a reorganisation from someone who supported a Government who had nine reorganisations in nine years? The sexual health strategy document is very important, which is why we are working hard to ensure that it is absolutely right. I re-wrote a large section to ensure that it will deliver—[Interruption.] I do not know why the hon. Member for Hackney North and Stoke Newington (Ms Abbott), from a sedentary position, says “Ah.” It is an important document and we want to get it right, and I am sure she will welcome it when it is published. However, let me make it clear: any delay in the document is not preventing rightful commissioning at a local level. I saw that yesterday when I went to Bedford and met the Brook organisation and the Terrence Higgins Trust, which have long been engaged, certainly in that county, in a tendering process from the local authority to continue to deliver excellent services.

Whittington Hospital

5. What recent discussions he has had with the Whittington hospital on the proposed disposal of its assets and reductions in medical and non-medical staff. (144340)

This is a matter for the local NHS, in particular the Whittington Hospital NHS Trust. Neither the Secretary of State nor the ministerial team have met with the trust recently on this subject.

That is a disappointing reply from the Minister. Is he aware that the Whittington is a successful, popular, local district general hospital, yet, as part of its application to become a foundation trust, it is proposing to: sell off a quarter of its land; make 500 of its staff, including many nurses, redundant; and reduce the number of beds to 177, roughly half the current figure? This is, apparently, to provide a better service to the community, a point totally lost on the thousands of local people who are angry at the reduction in their hospital services. They see it as a prelude to its ultimate closure as a district general hospital with an A and E department. Will the Minister take an interest and perhaps intervene to protect a very good local hospital from this not very sensible plan?

The hon. Gentleman is right to highlight the fact that the trust has handled this issue badly at a local level, but, as he will know, decisions about local health care reside with local trusts. The point is this: if we look at the plans, the trust is talking about selling off land that is mostly not used for clinical purposes and reinvesting that money in front-line patient care: investing £10 million in improving the maternity department, which has already benefited from £750,000 from the Government only this year; £2.9 million in the same-day treatment centre to support A and E and treat patients faster; and £1.9 million for a new undergraduate education centre and library. Those assets are being sold off to directly influence and improve patient care, which has to be a good thing.

Is the Minister aware of how angry and concerned Londoners are about the threats to their health service—not just about the £17 million property sales at the Whittington and the drop in bed numbers, but about the threat to four A and Es in north-west London and, of course, the A and E in Lewisham? Ministers have accused campaigners of overstating the case. Is that not a complacent attitude? Surely doctors and residents on the ground know the value of these services better than Ministers in Whitehall. Is he aware that Londoners came out in unprecedented numbers to fight for Lewisham hospital and will continue to fight for the best possible NHS services in our region?

The hon. Lady is absolutely right to highlight the fact that service changes have to be clinically led, meet the tests we have outlined and engage with communities effectively, but the point is that the previous Government also redesigned and changed services, very often for the benefit of patients. When the redesign of services is clinically led and services are better delivered for patients, that has to be a good thing so let us look at these proposals. If they are clinically led, let us see whether they deliver improved care for patients, and if they do, it is the right thing to do.

Alcohol Consumption (Pregnancy)

6. What assessment his Department has made of harm caused to babies by alcohol consumed during pregnancy; and if he will make a statement. (144341)

Foetal alcohol syndrome is a severe, lifelong condition caused by heavy alcohol consumption during pregnancy, and foetal alcohol spectrum disorder is usually less severe. There is a consensus, however, that FASD is more widespread.

I thank the hon. Lady for her answer and for her recent letter to me on this subject. She will be aware of the Medical Research Council’s research suggesting that 7,000 babies are born every year suffering from serious genetic and permanent damage. Just as worrying, however, is that even moderate consumption can have an impact on IQ. In America, all drinks containers must have the following written on them:

“According to the surgeon general, women should not drink alcohol beverages during pregnancy because of the risk of birth defects.”

When will the Government insist that all drinks containers in Britain carry the same slogan?

The hon. Gentleman makes a very good point. Our advice is clear and the chief medical officer continues to give this advice: women who are pregnant or trying to become pregnant should not drink alcohol. If they feel that they must drink it, they should drink one or two units once or twice a week, at the very most. Our advice is clear, but he makes a good point, and I am happy to discuss it with him further.

Recent NHS figures show that £2.7 billion was spent on alcohol-related illnesses. Will the Minister consider a campaign across the whole of the United Kingdom, including the Northern Ireland Assembly and Northern Ireland as a region, to combat the issue of drinking during pregnancy?

That is a very good point. The overconsumption of alcohol, whether by a pregnant woman or not, greatly concerns the Government, and that is one reason we want to introduce a minimum unit price of 45p. It was a good point well made, and I am always happy to meet the hon. Gentleman to discuss the matter further.


The National Institute for Health Research supports a wide range of research, including a number of studies of pre-senile dementias, more commonly known as early-onset dementias. This includes 85 studies recruiting patients with dementia and a further 17 in the set-up phase.

I declare an interest.

Dementia in the ageing population is beginning to be better understood and recognised—I appreciate the Government’s efforts on this—but there are also the frontotemporal dementias, such as Pick’s, corticobasal degeneration, Lewy body, progressive supranuclear palsy, Parkinson’s and stroke-related dementias, which are early onset. There is less understanding and awareness of these dementias. I welcome the Government’s commitment to research in this area, but we also need to extend understanding among nurses, general practitioners and care providers. Will the Government ensure that this wider understanding is available and extended?

I thank the hon. Lady for her interest in early-onset dementia. She is absolutely right: there is a widespread lack of understanding of dementia in general, and of early-onset dementia in particular. In addition to the research that I mentioned in my earlier answer, we are also looking at a major programme to engage GPs. Sadly, some GPs still think that it is not worth diagnosing someone with dementia, and there is a lack of understanding that we absolutely have to put right.

Government and charitable spending on dementia research is 12 times lower than spending on cancer research, with £590 million a year being spent on cancer research and only £50 million being invested in dementia research. What steps can we all, including the Government, take to increase the amount of investment in dementia research?

My hon. Friend makes an important point, and he will be pleased to learn that the Government are more than doubling the amount of money that we put into dementia research. We need to catalyse the private sector companies because although they know that the size of their potential market of people with dementia is huge, they have been frustrated in their attempts to find the breakthrough medicine that we urgently need. We need to use the research to excite their interest and keep them focused on this truly tragic disease.

8. What steps his Department plans to take to improve dementia diagnosis rates and to reduce regional variations in such diagnoses. (144343)

There are unacceptable variations in the level of dementia diagnosis across the country, and we are committed to driving significant improvements. We have asked local areas, through the NHS mandate, to make measurable progress in improving dementia diagnosis over the next two years.

In North Yorkshire and York, only 43% of those suffering from dementia receive a diagnosis. Given the ageing population in the county, that means that about 7,000 people with dementia remain undiagnosed. Does my right hon. Friend agree that the clinical commissioning groups have a large role to play in the delivery of dementia services, and will he tell us what support those groups will get?

My hon. Friend is absolutely right. It is a tragedy for those 7,000 people and their families that they are not getting a diagnosis. With a diagnosis, medicines and drugs could have a big impact and stave off the condition for between one in three and one in four people, and support services could also be put in place for carers. We need a massive transformation, and we need to make it much easier for people to get a diagnosis. We need much better understanding among GPs, as I mentioned earlier, and among hospitals as well, given that 25% of all in-patients have dementia.

Mortality Indicators

9. What recent discussions he has had with officials in his Department on the forthcoming NHS investigation into mortality indicators. (144345)

Ministers have discussed the terms of reference for the review of hospitals that have been highlighted as outliers for the last two consecutive years using nationally published mortality indicators. The terms of reference were published by Professor Sir Bruce Keogh on Friday 15 February.

Just over a year ago, I asked the previous Secretary of State a question about gagging orders and the specific case of Mr Gary Walker, the former chief executive of United Lincolnshire Hospitals NHS Trust. In the light of the recent news that our local health trust is now being investigated amid concerns over patient safety, what assurances can the Minister give the House that such Stalinist gagging orders, which have cost the taxpayer £15 million in the past few years, will be outlawed as soon as possible, to ensure that, under this Government, it will not take 81 requests to ensure that patient safety is paramount?

My hon. Friend is absolutely right to highlight the fact that all staff in the NHS should feel able to speak up and raise concerns about patient safety, so that the organisations for which they work can take up their concerns and investigate them. He will be aware that the people who raise such concerns are protected under the Public Interest Disclosure Act 1998.

Last week I visited Salford Royal hospital, which has the lowest death and weekend mortality rates in the north-west, and the seventh lowest in the country. It is interesting to note that Salford also has higher ratios of nurses per in-patient bed, and that individual wards in the hospital publish data on their rates of MRSA, ulcers and falls. Does the Minister accept that good practice at hospitals such as Salford Royal should be investigated alongside the poor practice and high mortality rates in other hospitals?

The hon. Lady is absolutely right. That is exactly what the review is about. It is going into the 14 hospitals in which concern has arisen over mortality data, looking at the practices there and commissioning a peer review of them from leading clinicians and patient groups. That will help to raise standards of practice where required.

In supporting the points that have just been made by my hon. Friend the Member for Lincoln (Karl MᶜCartney), may I tell the Minister that, as he might expect, there is considerable anxiety among my Lincolnshire constituents over the fact that the United Lincolnshire Hospitals NHS Trust has a higher than average mortality rate? Will he tell us when the promised review of the situation will begin, and who will be conducting it?

To reassure my right hon. Friend, the review is being carried out and led by Sir Bruce Keogh, the NHS medical director. We are already well under way in implementing the review. It should be in place by the very early summer to inform Members of this House and to make improvements to patient care at the local trust level.

People in Dudley were concerned to discover that higher than average mortality rates have led to Russells Hall hospital in my constituency being investigated. I have written to Sir Bruce Keogh to ask whether he or a member of his team will meet me to discuss the inquiry, so that we can find out exactly what has been going on and local people can provide information to it. How does the Minister think that things at the hospital will be improved when nurse numbers in the NHS are being reduced, waiting lists at the hospital have gone up by 177% and the NHS in Dudley has had to spend £20 million on a costly and bureaucratic reorganisation instead of on improving front-line care?

I had thought that the hon. Gentleman had risen on a consensual note, raising his constituents’ concerns—and he was right to do that. The review is about making sure that any failings in care in local trusts are picked up and improved. The fact of the matter is that waiting times are down under this Government in comparison with the previous Government and many more additional clinical staff are working in the NHS—about 2,000 more than under the previous Government. At the same time, we have cut 18,000 administrative and management posts, and the money from that is being reinvested in front-line patient care.

If the hon. Member for Crawley (Henry Smith) wishes to come in on this question, he may, but he is not obliged to do so.

Private Finance Initiative Hospitals

10. What assessment his Department has made of the effect of hospitals built under the private finance initiative on the work of neighbouring hospitals. (144346)

This Government recognise that no hospital operates in isolation. We are providing seven NHS trusts that are facing difficulties as a result of PFI agreements with access to a £1.5 billion support fund to pay for extra costs accrued as a result of those damaging PFI schemes.

I apologise for my voice—perhaps I shall soon be interacting more directly with the NHS.

The Warrington and Halton hospital has independent trust status. It is busy and getting busier. The previous Government built a huge PFI hospital about 10 miles away at Whiston, which does not have the patient volumes to sustain the demands of the botched PFI deal. It is heavily loss-making. Will the Minister provide assurance that there will be no forced merger and that my constituents will not pay for a bad decision made a decade ago?

I thank my hon. Friend for his question. He is right to highlight the very damaging PFI scheme signed by the previous Government for the St Helens and Knowsley NHS Trust. The percentage of annual turnover going on PFI payments at the moment is 14.2%. That is unsustainable, which is why this Government are trying to sort out the mess created by the previous Government’s signing up to too many PFI agreements.

The Minister will be aware that support for excess PFI costs was an important element in the report of the trust special administrator in south-east London, to which the Secretary of State referred in an earlier exchange. That recommendation was widely welcomed. However, as I highlighted in questions a month ago, the Government have not accepted the financial recommendations of the trust special administrator for the capital costs and the transitional costs inherent in his recommendations. If the Government wish to proceed with these changes, will the Government agree to meet those costs as well?

The right hon. Gentleman is in dangerous territory talking about PFI schemes to which the previous Government signed up. No hospital operates in isolation. The South London Healthcare NHS Trust was paying out 13.9% of its turnover on the PFI. That was unsustainable. It has caused huge difficulties in the local health care economy and affected patient care, which was a very bad thing to do. The right hon. Gentleman needs to recognise that this Government are providing £1.5 billion-worth of support to many trusts that have struggled under these PFI agreements—

Order. I am grateful to the Minister, but we have many questions to get through and the answers are sometimes just too long.

GP and Specialist Health Services

12. What steps his Department is taking to increase the availability to patients of GPs and specialist health services. (144348)

The Department of Health is currently working with key partners to support the increase of training numbers in general practice. From 1 April, the NHS Commissioning Board will be responsible for commissioning primary care medical services and specialised services. It will have a duty to commission those services in ways that improve quality and promote integrated care. Clinical commissioning groups will be responsible for commissioning most other services.

The Minister is aware of the need to increase health care provision in Witham town. Can he reassure me that the appalling financial legacy of Mid Essex primary care trust will not hold back proposals to provide much-needed health care in the town?

I applaud my hon. Friend for repeatedly raising her constituents’ concerns about this subject. We have made it absolutely clear that primary care trusts must work closely with clinical commissioning groups to ensure that they meet the challenges of the current financial year. As for the future, the joint strategic needs assessment and the health and wellbeing boards will provide real accountability locally, and I think that my hon. Friend will be able to feed into that to ensure that her constituents are given the health services that they need.

The Limbless Association wrote to Members of Parliament this month expressing concerns about proposals for the commissioning of extremely specialist prosthetic services, which would reduce patient choice and oblige the patient to follow the money rather than vice versa, and would damage some highly skilled professionals in the field. When did the Minister last meet representatives of the Limbless Association, and will he agree to meet them with me?

I should be happy to meet the hon. Lady and members of the association to discuss those concerns further.

There is currently much talk about the importance of integrated services. Can my hon. Friend assure us that when commissioning primary care, the NHS Commissioning Board will emphasise the importance of integrating it with the other community health services supplied by the NHS, and that social care will be included in that fully integrated service?

I am happy to give my right hon. Friend an absolute assurance to that effect. The Department and I are working closely and collaboratively with both the Commissioning Board and the Local Government Association to ensure that we deliver integrated care, which is much the best way of keeping patients out of hospital and maintaining their condition.

There are plans to increase the number of training places for GPs, with the aim of providing more than 3,000 extra places by 2015. That will fully meet the needs to which the hon. Lady has referred.

Premature Mortality

13. What steps he has taken to support research on the most common causes of premature mortality. (144349)

We are still far too low in the European league tables for premature mortality, particularly in respect of cancer, liver disease and respiratory diseases. I have therefore made improving our performance a key priority.

Can the Minister say a little more about what is being done to prevent early mortality as a result of heart disease?

We are investing £34 million in cardiovascular research. Much excellent work is being done at, in particular, the Oxford Biomedical Research Centre, which will help us to make great strides.

19. It is widely accepted that late diagnosis of cancer makes for premature mortality. Will the Government recommend the inclusion of proxy measures such as staging and accident and emergency admissions in the outcomes indicator set, as a way of complementing the one and five-year survival measures? That would give us a more complete picture of how CCGs are performing in encouraging earlier diagnosis. (144355)

I congratulate my hon. Friend on his campaigning. No sooner do we agree to the inclusion of one indicator in relation to early cancer diagnosis than he finds another that should also be included.

I will certainly consider the issue that my hon. Friend has raised, but I think that there is a broader question about the role of GPs. They should see themselves as being in the front line when it comes to early diagnosis of not just people who walk through the doors of their surgeries, but people in their communities who are at high risk. That is a much more fundamental change that we need to think about.

Adult Mental Health Services

14. What was the change in the level of spending in real terms on adult mental health services in 2011-12. (144350)

It is the responsibility of local commissioners to ensure that resources are used effectively to meet the needs of their local populations. According to the national survey of investment in adult mental health services for 2011-12, cash investment rose between 2010-11, but real-terms investment fell by 1%.

I will meet Sheffield Mind on Friday, and one of the issues we will be talking about is the impact of that fall in spending on crisis care. Mind’s research shows that crisis care teams are often under-resourced and overstretched, with four in 10 trusts having staffing levels below the Department’s own guidelines of 14 staff to 25 service users. Does the Minister think that is acceptable, and if not, what is he going to do about it?

The Government inherited an institutional bias against mental health in the NHS. [Interruption.] It is absolutely true; when the 18-week target was introduced, nothing was available for those suffering with mental health problems. Mental health patients did not benefit from choice that was introduced elsewhere in the NHS. I completely agree with the hon. Gentleman about the importance of crisis services, and the first NHS mandate has required the Commissioning Board to do work on the availability of mental health services and to ensure that we can introduce access standards so that mental health service users and patients benefit from the same rights as those with physical health problems.

First, may I thank you for your earlier guidance, Mr Speaker?

May I thank the Department for its approach to the ravages to which Newark health care has been subjected, principally by the last Government, and thank the Minister for his forthcoming visit to Newark and assure him that mental health care services, which have been diminished in Newark, will certainly be top of the agenda?

The Minister who will visit Newark is, in fact, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), but I am grateful to my hon. Friend the Member for Newark (Patrick Mercer) for raising this issue and for highlighting the importance of mental health care. The mandate makes it very clear that the Commissioning Board and the NHS must make measurable progress towards achieving parity of esteem by 2015.

Technology (Savings)

15. What recent estimate he has made of the potential savings to the NHS of making better use of technology. (144351)

PricewaterhouseCoopers estimates that the NHS could save £4.4 billion every year through proper investment in IT, which is one of the reasons I set the NHS the challenge of becoming fully paperless by 2018.

I am grateful to the Secretary of State for his answer, but can he assure me that investment in new technology will release resources for patient care, rather than follow the pattern over the past 15 years, when investment in new technology has detracted from the available resources?

My hon. Friend makes an important point. In encouraging such investment, we are thinking about the nurse who recently reported that in order to admit someone to trauma she had to fill out a 22-page admission form and another 10 forms after that. The whole point of this move is to free up the time of professionals on the front line so that they can spend more time with patients.

The Secretary of State will be aware that the general practice extraction service contract has recently been awarded to French IT firm Atos Healthcare. Given the concerns expressed by the Public Accounts Committee and the National Audit Office about the way in which Atos has performed in respect of other contracts let by the Government, what has the Secretary of State got in mind to ensure that there are safeguards for patient data under the general practice extraction service contract?

With respect to all IT contracts, all I will say is that we have learned a great deal from the mistakes made by the previous Government.

Topical Questions

The last month has seen the Government take two radical steps that will fundamentally improve the quality of health care in this country. First, in our response to the Francis report on the appalling tragedy at Mid Staffs, we announced the setting up of a chief inspectorate of hospitals based at the Care Quality Commission. That will introduce compassionate care, patient feedback and expert peer review into a system that has been too long dominated by targets and box-ticking. Secondly, in response to the Dilnot report, the Government announced a long-term solution to the funding of social care, which will both help thousands of low-income pensioners avoid having to sell their homes and make us one of the first countries in the world where it is as normal to save for social care costs as it is to save for a pension.

This week I will meet my constituents Neal and Rita Denvir, whose son, Fionn, made a miraculous recovery from meningitis. Many are not so fortunate, however, so will the Secretary of State pledge his support to the Meningitis UK “Beat it now” campaign, and include the newly licensed vaccine for meningitis B in the NHS childhood immunisation programme, so that no family has to live with the terror of that terrifying disease?

As the father of two young children, I completely share the hon. Lady’s passion for this issue and I am happy to give my support to Meningitis UK. The decision on whether to include a meningitis jab in the immunisation campaign is made by an independent expert panel, and I will always follow its advice.

T2. We used to believe that tuberculosis was beaten in this country, but the number of instances of it is increasing, and there were more than 9,000 new cases last year. Does that not suggest, particularly when the incidence of drug-resistant TB is a concern, that a comprehensive public health strategy is needed to tackle the disease? What steps is the Department taking to lead that strategy? (144362)

I am grateful for that question, because my right hon. Friend has identified the fact that TB is a growing problem. We are exploring the effectiveness of an approach across health sectors for a national strategy on TB, while ensuring that we recognise the local variances. We need to improve in that area.

I am sure that, like me, the Secretary of State has spent recent weeks absorbing the Francis report and its recommendations; there are lessons for everyone at every level, particularly on staffing. New analysis to be published later today will show that the NHS is set to lose 12,000 nurses over the course of this Parliament, raising doubts about its ability to respond to Robert Francis’s recommendations on staffing. Will the Government say today whether they accept those recommendations and the principle of a minimum staff-to-patient ratio?

If the right hon. Gentleman had read the Francis report carefully he would have, first, observed that the appalling tragedies covered in that report happened between 2005 and 2009, when nursing numbers were going up. So to say that this is an issue about nursing numbers is to miss the point completely. This is not an issue where there is a quick fix; it is an issue about the NHS having become dominated for far too long by a culture of targets at any cost. Unpicking that culture is the biggest challenge we face if we are to return a culture of compassionate care to the NHS.

I have read both Francis reports, and I think it is essential that everybody learns the lessons—that is what I said—including Labour Members. It is also important that we do not repeat the mistakes, and the first Francis report said that the problems were caused because the trust cut staff to dangerously low levels. The most worrying thing from the analysis that will be published today is that four in 10 of the jobs being lost come directly from services linked to the care of older people. Does the Secretary of State therefore agree that there is a danger that the NHS is already failing to learn the lessons of the recent past? Will he join me in sending a message to the NHS that care of older people should be a priority for improvement, not an easy target for cuts?

If we are to learn the lessons of the Francis report and admit to our mistakes, perhaps the right hon. Gentleman will reflect on the fact that, because we decided to protect the NHS budget, there are 8,000 more clinical staff in the NHS today, yet he still wants to cut the NHS budget from its current levels, as he confirmed only last December.

T3. In today’s edition of the Daily Express, the Prime Minister promises to prevent immigrants freeloading on our NHS. Words are one thing, but can the Secretary of State spell out exactly what actions will be taken to deliver on the Prime Minister’s pledge? (144363)

I am happy to confirm to my hon. Friend that we intend to take some profound steps in this area, because we have a national health service, not an international health service. We have to ask whether it is appropriate for us to be giving free health care to short-term visitors, to students, to people on temporary visas. We will be saying more about that issue shortly.

T6. On 13 March 2012, the former Secretary of State said of the Health and Social Care Bill:“There is absolutely nothing in the Bill that promotes or permits the transfer of NHS activities to the private sector.”—[Official Report, 13 March 2012; Vol. 542, c. 169.]However, the new NHS competition regulations break those promises by creating a requirement for almost all commissioning to be carried out through competitive markets, forcing privatisation through the back door, regardless of local will. Will the Secretary of State agree to make the regulations subject to a full debate and vote of both Houses? (144366)

If the hon. Gentleman had listened to my previous answer, he would have heard that the regulations are consistent with the procurement guidelines that his own Government sent out to PCTs. It is not our job to be a champion for the private sector or the NHS sector; we want to be there to do the best job for patients. That is the purpose of the regulations.

T4. Two years ago, the Prime Minister welcomed the installation of CyberKnife, the latest in cancer radio surgery equipment at the world-leading Royal Marsden cancer centre, as an example of how the NHS has progressed. Since then, the Royal Marsden has invited successive Health Ministers to visit the cancer centre but no one has accepted the invitation, and I am aware that Ministers have been to see other cancer treatment systems. Will the Secretary of State follow the Prime Minister’s lead and visit the Royal Marsden to see for himself the great progress that has been made there? (144364)

I understand that the Secretary of State has been to the Royal Marsden, but I am more than happy to accept the invitation and look forward to going along and seeing it for myself.

T10. What steps is the Secretary of State taking to prevent the fragmenting of the national health service through a massive reorganisation that is costing £3 billion, diverting much-needed resources from the front line? (144370)

The truth is that the Government inherited a completely fragmented NHS; we had managed institutionally to separate health care from social care, mental health from physical health and primary care from secondary care. At the heart of the legislation we have already passed and the proposed social care legislation, which we hope to introduce very soon, is the principle of integrated care. I am determined that that should be central in every area of the country so that we deliver proper care and avoid crises, keeping people out of hospital.

T5. The South Devon and Torbay clinical commissioning group is building on the integrated health and social care system for which many have praised the area. Will the Minister help complete the integration by assisting with the inclusion of mental health care services within the regime? (144365)

I thank my hon. Friend for that question and applaud the brilliant work that has been done in Torbay. There has been a reduction in hospital admissions because they care for people better. As I said in my last answer, it is essential that we integrate mental health in the system as well as physical health so that we give people proper care.

On performance data, what plans does the Minister have to expand the friends and family test so that it provides the reasons for patients’ views and real-time feedback on their experience of services?

I thank the hon. Gentleman for his question. The friends and family test will give real-time feedback about patient services, but we need to ensure that the data from the test are used effectively by local trusts and scrutinised by the Care Quality Commission and other organisations so that they can go in if there are problems to ensure that they stand up for the rights of patients.

T7. Kevin Davies, a constituent from Cowbridge, visited my surgery yesterday. He is a prostate cancer patient and robotic surgery was deemed to be the most appropriate form of care. Unfortunately, robotic surgery for prostate cancer is not available in Wales and he was forced to travel to Bristol and pay £15,000 for the treatment. Will my hon. Friend agree to work with the Welsh NHS either to come up with a formal agreement whereby facilities are available to Welsh NHS patients or to press it to invest in its own facilities? (144367)

My hon. Friend makes a good point: in England, the NHS is benefiting from not suffering a cut in funding such as that imposed by the Labour Administration in Wales.

The Prime Minister promised a fight to save district general hospitals, yet the Secretary of State’s recent decision on Lewisham suggests something completely different. Will the Secretary of State therefore give the House an assurance that the north Cheshire hospitals trust will not be forced into a merger or to downgrade its services because of financial problems elsewhere?

I know that the hon. Lady had tabled a question on this matter. The point is that a foundation trust has autonomy and cannot be coerced or forced into a merger. It is for the board of that trust to make decisions for the benefit of patients.

T8. Patients in Suffolk are very worried about the performance of the ambulance service. In the past two months, less than 60% of ambulances have hit the target for reaching emergency cases. The strategic health authority and others, including all the MPs in the region, are not happy about that. Will the Government intervene, too? (144368)

With two Ministers in the Department from the east of England, I can assure my hon. Friend that all of us are aware of the concerns that she and other Members have about their ambulance trust and, if I may say so as an east midlands MP, about the East Midlands ambulance trust. I know that Earl Howe, who has responsibility overall, has offered a meeting with Members from the east of England, and I am sure that that meeting will produce the sort of benefits that everyone hopes for.

Last week’s decision to close four north-west London A and Es, including Charing Cross and Hammersmith in my constituency, will shortly be on the Secretary of State’s desk, as he predicts. It was referred by Labour Ealing council because Tory Hammersmith and Fulham council supports the closures. Will the Secretary of State refer the matter for independent review? This is the biggest hospital closure programme in the history of the NHS. It will see a world-class hospital downgraded to 3% of its size.

I am aware how concerned people are throughout north-west London about the proposals. If the matter is referred to me by Ealing council, I will indeed ask the independent reconfiguration panel for its independent view on the proposals.

T9. The cancer drugs fund has been a huge success and has helped up to 25,000 patients, but the negotiations between the Government and the pharmaceutical companies on its replacement—value-based pricing—is causing real uncertainty for cancer patients and clinicians alike. For example, will new medicines be available to new patients under the new system and what guidance is being given to local cancer drugs funds as they wind down? Can we please have clarity urgently? (144369)

I think the hon. Gentleman was seeking an Adjournment debate and is disguising his request as a question, for which we are grateful.

I thank my hon. Friend for that question. I am happy to discuss it further with him. Value-based pricing will be primarily for new drugs, but obviously I understand his concern. It is the concern of the Government to ensure good access to cancer drugs for patients in the future.

Recent comprehensive research by the international study of asthma and allergies in childhood found strong evidence of a link between fast food and asthma, but when I asked the Minister which public health responsibility deal partners he had discussed that with, he said that evaluating science was not within their remit. Does he agree that if the fast food companies have the kudos of being classed as public health responsibility deal partners, they ought to look into such research and actually take some responsibility?

Those are good points well made, if I may say so. I am more than happy to discuss that further with the hon. Lady, because I take the firm view that everyone involved in making, manufacturing, supplying and selling food has a responsibility to make sure that all of us have longer, healthier, happier lives. I am all for ratcheting up the responsibility deal.

May I alert my right hon. and hon. Friends to the recently published road map for complementary and alternative medicine in Europe, which cost the European Commission £1.5 million? Will they look at it carefully to see where services can be extended in our own national health service?

I assure my hon. Friend that we will look carefully at anything that he wants to put forward, but any treatment on the NHS needs, of course, to be evidence-based.

Every year 18,000 epileptic fits are triggered by video games and screen-based activity. Can the ministerial team tell us what research is being done on that and what discussions they have had with the industry to make video games safer and improve the labelling?

I would be happy to look into that further. I recognise the significant concern that the hon. Lady raises. Often the diagnosis of epilepsy is not good enough and there needs to be much better co-ordinated care. The issue that she raises is important and I am happy to look into it further.

In spite of my right hon. Friend’s earlier comments, I am afraid that the regulation that implements section 75 of the Health and Social Care Act 2012 does not maintain the assurances previously given and risks creating an NHS that is driven more by private pocket than concern for patient care. Will the Secretary of State please withdraw that regulation and take it back to the drawing board?

We are looking at this extremely seriously. Clear assurances were given in the other place during the passage of the legislation, and it is important that they are complied with in the regulations.

Regulation of the Private Rented Sector

Motion for leave to bring in a Bill (Standing Order No. 23)

I beg to move,

That leave be given to bring in a Bill to provide for the regulation of letting agents; to protect tenants’ deposits; to require the enforcement of environmental and energy-efficiency standards in private-sector rented accommodation; to amend the law on secure tenancies; to provide for fair rent to be applicable to all rented accommodation; to require landlords not to discriminate against people in receipt of state benefits; to require local authorities to establish a private rented sector office; and for connected purposes.

Parliament has a responsibility to look seriously at the issues facing people who live in the private rented sector. For a long time, the sector has been ignored. Tenant protection was removed in the 1980s by the Housing Act 1988 and, at that time, the private rented sector was quite small. Indeed, in 2001, only 7% of people lived in the private rented sector. By 2011, this had risen to 17%, and by 2025 it will be 22 % of the population. In inner-city areas such as the one I represent, a third of people now live in private rented accommodation.

Private rented accommodation is very expensive, but when I questioned the Prime Minister on this subject he told me that the problem was that housing benefit costs in London had risen to £6 billion. The reason they have risen is because of the number of people placed in private rented accommodation by local authorities, which are fulfilling their statutory housing duties and have no control over rent levels. In return, the Government have now capped housing benefits at a very low level—given the effective rents charged—and the universal cap will cause even greater problems when it is introduced. Members who represent central London constituencies are already witnessing a massive depopulation of our communities as private sector tenants placed there by the local authority are having their benefit limited and they cannot afford to pay the difference between their benefits and the rent charged. Constituents come to me who have a difference of £100 and more between their benefit level and the rent level, which can be stupendous.

It is high time that Parliament looked at the situation facing people in the private rented sector and introduced thorough and comprehensive regulation. That is why I have introduced the Bill. To prepare for the Bill I have organised two public meetings in my constituency and invited private sector tenants to come along and tell me of their experiences. To put it mildly, those experiences are difficult to comprehend at times because of the sheer nastiness of some landlords towards some tenants. I am not saying that every private sector landlord is a bad person, or that they all go into the business with evil intent, but the lack of regulation means that many people suffer appalling treatment at the hands of this market. That is why we have to look at it.

Letting agencies are unregulated. They charge a search fee, which in some cases can run into several hundred pounds, but the search consists of no more than checking through a computer database to see whether they have any properties for that person. It is an unregulated area and it needs to be thoroughly regulated so that all those purporting to operate in the private rented sector can be registered and we know who they are. Deposits are often not returned, and if the landlord or letting agency is legally challenged they say that it was in fact rent in advance and therefore not liable to be returned. Excessively difficult questions are put concerning very minor changes that may have been made to a flat by someone living there.

If someone living in private rented accommodation complains to the local authority about the poor standards, the lack of repair, the lack of insulation or the sheer refusal of the landlord to engage with the tenant, they may be rapidly evicted. They then have no real redress in law to prevent that eviction, because the majority of private rented sector tenants are on assured shorthold tenancies lasting only six months. There is a real problem.

A group of tenants currently based in Hackney, although I expect similar groups to spread across London, have made an excellent submission to the Communities and Local Government Committee inquiry into the private rented sector. Their proposals include secure five-year tenancies, a requirement for landlords to provide a valid reason for ending a tenancy, a public register of all landlords paid for from the Land Registry, a requirement for decent homes standards to apply to all rented accommodation—not just council and housing association homes, but the private rented sector as well—and full vetting of private landlords before they let homes, including criminal record checks, tax records and previous warning letters from councils. It is time we went ahead with these proposals.

My Bill envisages tenant protection and five-year tenancies with a break clause for the tenant so that they can leave ahead of that time if they need to move away, have a job somewhere else or no longer wish to live in that area. Also, the Bill provides for the enforcement of all environmental standards, crucially including energy efficiency standards because the private rented sector tends to cost more and not just in rent levels, which are often horrendous—roughly three to four times what the local authority charges for similar properties in the same area. In addition, the Bill would protect tenants by ensuring that repairs are done and that if the landlord refuses to do them, that does not become a basis for eviction.

My Bill provides for non-discrimination. If someone walked along any high street anywhere in London, and probably anywhere in the country, and looked into a letting agency, they would see a sign saying, “No benefits here.” In other words, anyone in receipt of a state benefit is not allowed to apply for a private rented flat from that agent. That seems blatant discrimination against a very large number of people and ought to be outlawed. The crucial point for me is that we should return to rent regulation by a process of fair rents set by local rent tribunals. That would bring about a sense of fairness in the system, not the excessive and ludicrous profit-taking by a number of often very small landlords.

In order to implement the Bill, I would require the Secretary of State to consult within six months of the Bill becoming law on a formula for fair rents. Every local authority would be required to set up a local authority office to monitor all law that relates to the private rented sector, to ensure the return of deposits and to ensure that repairs are carried out in a decent and timely manner and that people can live in security and decency.

There are some good landlords in this country who have nothing to fear from this regulation. Indeed, some groups of landlords have been in touch with me to say that they would welcome such legislation because it would provide a sense of fairness. But there are many very bad landlords and many people who make ludicrously excessive profits from private sector rentals. I have come across a case in my constituency where someone who was able to buy a council flat under right to buy some years ago at a very heavy discount is now letting the flat at £600 per week. That is enough for that person to live on, from a flat that they were able to buy. This could be replicated all over the country in different situations.

The previous Housing Minister once told me that he thought rent regulation was a very bad idea because it would damage the property market and that was the fundamental driver of economic success in this country, but other countries manage to regulate the private rented sector. Germany, for example, has full regulation, with virtually permanent tenancies and a very good standard of accommodation to go with it. New York, which last time I looked was pretty much a free market capitalist economy in every other way, has a degree of rent regulation.

We need to provide security, decency and reliable landlords for those people who are unable to buy and unable to access local authority or housing association accommodation. The time is well past for us to legislate to look after a quarter of our population who are living in the private rented sector. I hope the House will support the Bill and give me leave to introduce it.

Question put and agreed to.


That Jeremy Corbyn, Mark Durkan, Sir Bob Russell, Mr Elfyn Llwyd, Caroline Lucas, John Healey, John McDonnell, Katy Clark, Grahame M. Morris, Paul Goggins, Mr David Lammy and Mr David Ward present the Bill.

Jeremy Corbyn accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 26 April and to be printed (Bill 140).

Groceries Code Adjudicator Bill [Lords] (Programme) (No. 3)

I beg to move,

That the Order of 19 November 2012 (Groceries Code Adjudicator Bill [Lords] (Programme)), be varied as follows:

1. Paragraphs 4 and 5 shall be omitted.

2. Proceedings on Consideration shall (so far as not previously concluded) be brought to a conclusion three hours after the commencement of proceedings on the Motion for this Order.

3. Proceedings on Third Reading shall (so far as not previously concluded) be brought to a conclusion four hours after the commencement of proceedings on the Motion for this Order.

I hope that this will be the second day in a row when I can speak to a Bill on which there is broad agreement across the House. The programme motion allocates three hours for debate before we move on to Third Reading, which we think will allow us plenty of time to consider any issues that might be raised on what is—let us remember—quite a narrow and tightly focused piece of legislation, and one that enjoys considerable cross-party support.

I am always worried when a Minister starts by saying that Front Benchers and the usual channels have agreed on a Bill, because that means the legislation is almost certainly wrong. My specific point is that we had a programme motion that we agreed after Second Reading, so why is it being overruled? Why are we shortening scrutiny when the House and Parliament thought that we would have a whole day for it?

I gently point out to my hon. Friend that I did not say that this was something the usual channels were all okay with; I said that there has been a great deal of positivity across the House for the content of the Bill itself. It follows on from previous private Members’ Bills, and on Second Reading and in Committee it was generally welcomed by a large number of Members.

We believe that the programme motion allows sufficient time for scrutiny, because we rigorously tested the Bill on Second Reading and in Committee. Indeed, what we did not know when we passed the original programme motion was that consideration in Committee would finish early, so it was well scrutinised and the time that had been allocated was significantly more than ample.

I concur with the Minister that all members of the Committee were fine members. Perhaps I can help to answer question asked by the hon. Member for Wellingborough (Mr Bone). One reason the Committee got through the Bill faster than anticipated, which we hope we might do again today, was the Government’s fantastic decision to change their mind and include in the Bill the power to impose financial penalties, which saved a lot of time and might also help us today.

The hon. Gentleman makes a very good point. Of course, the House is delighted that he, too, has received adequate recognition for his role in bringing that about. I believe that he was the Total Politics MP of the month because of his campaigning, which is obviously a great accolade—I understand that he collects those, as he was once given an award for being the sexiest MP of the year in Wales. He makes the important point that the Government have been in listening mode, and one of the main issues that various Members expressed concern about on Second Reading was that of fines. We have listened to that, and it was obviously discussed further in Committee.

In that context, I think that three hours will be sufficient to debate the amendments. I hope that I can provide my hon. Friend the Member for Wellingborough (Mr Bone) and others with that reassurance. On that basis, I commend the programme motion to the House.

I do not have much to add to the Minister’s opening speech. Labour Members agree with the programme motion for the simple reason that, as my hon. Friend the Member for Ogmore (Huw Irranca-Davies)—the Total Politics Member of the month—said, most of the discussion on Second Reading focused on fines. As the Minister said, the Government listened on that issue, although “caved in” is probably more like it, and decided to include fines in the Bill, under extreme pressure not only from Labour Members but from many organisations and, indeed, from some of her hon. Friends. Had I known that the hon. Members for Christchurch (Mr Chope) and for Shipley (Philip Davies) had tabled so many amendments, we might have asked for more time through the usual channels. However, given that we are where we are and that we are relatively happy and content with what came out of Committee, we will support the programme motion.

I am always suspicious when a deal is done between the usual channels, and that is what has happened in this case. The Minister said that she thinks it reasonable that there is less time to debate the Bill on Report than was originally intended on 19 November because we do not need more than three hours to scrutinise it. That is very paternalistic. She then argued that because the Committee spent less time discussing the Bill than it might have done, we need less time to discuss it on Report. Surely the reason we need more time on Report is that only then do Members who were not members of the Committee that considered the Bill in detail have a chance to participate in the debate and to table amendments.

My hon. Friend is absolutely right. Does he agree that there is bound to be no proper scrutiny in Committee because the Government pack it with people who agree with them—supporters of the Bill whom they want to be there?

My hon. Friend is right. I am not aware of anybody on the Committee feeling that the Bill was too strong and should be weakened; the only people there either supported it or wanted it to be strengthened. That shows how unrepresentative the Committee was. We now have three groups of amendments and only three hours in which to debate them, after deducting such time as we will spend on considering this programme motion.

Does my hon. Friend agree that the problem arises because the Executive decide on the time for debate? Within just a couple of months, the Government are going to bring forward proposals for a House business Committee. Will that not solve the problem?

Thereby hangs a subject for a separate debate. The coalition agreement contained a commitment to have a House business Committee by the third year of this Parliament. We now know that that is being interpreted as meaning the end of December 2013, which is rather an extension of the use of the English language. However, that may be the subject of another debate on another occasion. As my hon. Friend suggests, this shows, in essence, that Front Benchers are not to be trusted on these issues, and until they prove their point and we are satisfied, we will be suspicious.

As a member of the Committee that my hon. Friend criticises, it is difficult not to take offence. Surely he must recognise that the debate that he is forcing now will reduce the amount of time that we have to scrutinise the Bill, and surely the quicker we can get on to that debate the better off we will be.

My hon. Friend scores a bit of an own goal. If we had had the original programme motion, we would have been able to continue the debate until 7 pm. If, as I imagine, he will support this programme motion, he will be supporting a curtailment of the debate.

An outrageous slur has been made on my hon. Friend the Member for Christchurch (Mr Chope), who has made it clear that he wants more time for debate. The simple answer is that when the House divides on this programme motion and we defeat it, the previous programme, which gave us a whole day for debate, will be in place. I think that my hon. Friend the Member for Sherwood (Mr Spencer) should apologise to my hon. Friend.

I do not expect hon. Members to apologise to me. I think actions speak louder than words on these issues.

My hon. Friend said that there would be only an hour to debate each of the three groups of amendments because there are three hours and three groups. He was being overly generous, because any Divisions will eat further into that time, so there may be only a maximum of 45 minutes for each group.

My hon. Friend is right.

I am going to finish soon because other people want to participate in this very short debate. Before I do so, let me point out that the Minister says that one of the justifications for curtailing the amount of time to debate the Bill on Report is that the Committee changed the Bill to introduce an ability for the adjudicator to fine without that having to be the subject of regulations in future. That is a fundamental change to the Bill. I would have thought that that is an argument for having more, not less, discussion on Report.

The hon. Gentleman stated that actions speak louder than words. Will he point to where he or the hon. Member for Shipley (Philip Davies) raised issues of contention during the Second Reading debate, which surely would have been the opportunity to telegraph to Front Benchers the fact that there were such issues that needed more time for debate at this stage?

I do not think that Front Benchers needed any telegraph messages from my hon. Friend the Member for Shipley (Philip Davies) or me, because one of the precursors to this Bill was a private Member’s Bill in the previous Parliament that my hon. Friend fought against line by line, in which I joined and supported him. The Bill before us is one that several colleagues and I are still very concerned about. The fact that I did not speak on Second Reading is not an argument that can be used against me, because now we have the chance to consider amendments, whereas on Second Reading we would only have been able to flag up general concerns, and I did not think that necessary because I had done so previously.

I am grateful to the hon. Gentleman, and I do not wish to prolong this debate on the programme motion. Is it not fair to say that at the time of Second Reading the country was not engulfed in the anxiety about the food chain that has arisen subsequently, and that it would be a disaster if there were not enough time to debate at least amendments 34 and 35, which cover matters that are on the public’s mind?

The hon. Gentleman makes a good point. The amendments in the first group include two new clauses in my name, which have been driven by the fact that this issue concerns more than just the United Kingdom. We are talking about a very complicated global supply chain, and we need further explanation of how the Bill will impact on that.

I have severe reservations about changing the programme motion. It is indicative of the fact that this Government are lacking in self-confidence. Why do they not have the self-confidence to allow us to debate these issues for a whole day on Report, as they originally intended? Why do they wish to close down debate? Are they frightened of scrutiny?

It is a great pleasure to follow my hon. Friend the Member for Christchurch (Mr Chope).

I want to query a couple of things that the Minister said. She is a first-class Minister, and I think that had she been a shadow Minister, she would have been arguing for more scrutiny. I notice that she has now been left alone on the Front Bench with just one Whip, which seems to indicate that nobody in Government wants to be associated with this programme motion. When the Deputy Leader of the House sat on the Opposition Benches, he was a fine proponent of opposing programme motions, and it must be very sad for him to have to take this line today.

There is an intellectual flaw in the Minister’s argument. If she is saying that this is not controversial and that three hours gives us plenty of time for debate, why bring in another programme motion, because the debate will automatically finish within three hours anyway? The centralist, Stalinist approach of this Executive is such that they want to be wedded to programme motions.

I know that that is not the Prime Minister’s view, because in his excellent speech “Fixing Broken Politics”, which he made in May 2009—I am sure that every Member has read it—he roundly criticised programme motions and said that they reduced scrutiny. Basically, a Bill is thought up in Downing street, pushed through its Second Reading and then goes to a Committee that is stuffed full of Members who support it. There is no way of getting on a Committee unless the Whips support the decision. Then, when the Bill comes back to the Chamber to be considered, Back-Bench Members who are interested in it but who could not get on the Committee do not have enough time to make amendments or discuss it. I guarantee that that is exactly what will happen today if the programme motion goes through. Amendments will not be reached and they will not be discussed, and that, of course, is fundamentally what the Government want. They do not want scrutiny of this Bill. Such a situation occurs when Members on both Front Benches are in league together. The shadow Minister, the hon. Member for Edinburgh South (Ian Murray), has let slip that he is happy with the programme motion and that the usual channels have agreed to it.

How does my hon. Friend square that argument with the fact that every single Government member of the Committee criticised the Bill on Second Reading?

I hate to criticise the Whips Office, but it was clearly not doing its job properly when it let hon. Members such as my hon. Friend—serious parliamentarians who want to scrutinise the Bill—slip through.

I think that what my hon. Friend the Member for Sherwood (Mr Spencer) was trying to say was that every Government member of the Committee was critical of the Bill because it did not go far enough and they wanted it to be strengthened. In effect, that is what the Government wanted them to say, because they could then say, “We’ve had so much pressure put on us that we’ve had to strengthen the Bill.” Those Government Members were put on the Committee not to be unhelpful, but to be as helpful as possible.

I am afraid that that rings true. On occasion, I myself have been asked to do things on behalf of the Whips and I am afraid that sometimes I have succumbed and made noises that appeared to be contrary to the Government’s views but that turned out to be what they thought all along. The European Union Act 2011 is a fine example of that.

I want to make a brief point of principle. The problem with the timing results from the fact that the programming of Parliament is controlled entirely by the Executive. Parliament has already agreed to a timetable motion, which in my opinion it did not need to do. It does not need programme motions; we should be able to scrutinise Bills for the time that Parliament thinks necessary. The programme motion, which went through on Second Reading, gave a whole day to consider the Bill and give it its Third Reading. That is what we should be doing today. The only reason why the debate is being restricted—again, the shadow Minister let this slip out—is that amendments have been tabled by my hon. Friends the Members for Shipley (Philip Davies) and for Christchurch. The Government are trying to restrict scrutiny.

The Deputy Leader of the House is back in his place—

The hon. Member for Somerton and Frome (Mr Heath) is not the Deputy Leader of the House— he is a Minister in the Department for Environment, Food and Rural Affairs now

Oh, sorry. Good God! I apologise to my hon. Friend the Minister. I now understand entirely why he has to be here—had he been Deputy Leader of the House, he would not have been present. I understand that he is now part of the great Government machine and that when someone on a sofa in Downing street decides something, it has to be forced through. I apologise for misunderstanding why he is sitting on the Front Bench today.

The Under-Secretary of State for Business, Innovation and Skills, the hon. Member for East Dunbartonshire (Jo Swinson) is a very good Minister and she is doing a fine job, but if she believes her own arguments that the Bill is uncontroversial and that three hours is enough to debate it, why not withdraw the programme motion and let the House take its own course? She would then be a star of Parliament—she already is a star, but she would be an even greater star—and that would show the public that the Government are not afraid of scrutiny.

Does the hon. Gentleman agree that the quickest way to get through this afternoon’s business would be for the Minister to agree with all our amendments? We could then move on to the other debates.

No. That is exactly the wrong reason. We want to discuss the issues and argue about them. The hon. Gentleman’s amendments might be very good and when I listen to the debate I might support them, but alas we might not get to many of them, because of the restriction of time. Clearly, there is disagreement in the House. Would it not just be easier to withdraw this programme motion and go back to the previous one, which went through, I think, without dissent? I had hoped that the Minister would agree to that, but we will now have to see whether the House will divide on this programme motion.

This is another case of the Executive doing what they want at the expense of Parliament. It is a shame on this Government. It is not what I expected when the new Government came to power. What they promised beforehand with regard to parliamentary scrutiny has not come to pass. The sooner we get a business of the House Committee to run Parliament, this place will be far better.

Groceries Code Adjudicator Bill [Lords]

Consideration of Bill, as amended in the Public Bill Committee.

New Clause 1

Exception for suppliers with high turnover

‘Suppliers are not allowed to refer cases to the Adjudicator and cannot have cases referred on their behalf if their turnover exceeds £500 million per annum.’.—(Philip Davies.)

Brought up, and read the First time.

With this it will be convenient to discuss the following:

New clause 2—Supplier turnover—

‘Suppliers are not allowed to refer cases to the Adjudicator and cannot have cases referred on their behalf if their turnover exceeds £1bn per annum.’.

New clause 3—Sunsetting—

‘This Bill will expire in seven years from the date it receives Royal Assent.’.

New clause 4—Supplier headquarters—

‘Suppliers are not allowed to refer cases to the Adjudicator and cannot have cases referred on their behalf if they have their principal headquarters outside the European Union.’.

New clause 5—Supply source—

‘The provisions of this Act shall not apply to any supplies which are produced, manufactured or processed, in whole or in part, outside the European Union.’.

Amendment 28, in clause 12, page 4, line 32, at end insert—

‘(a) the nature and type of arbitrations to be conducted under section 3 including:

(i) the law applicable to an arbitration; and

(ii) where the arbitration should be conducted.’.

Amendment 3, in clause 13, page 5, line 18, at end insert—

‘(2) The Office of Fair Trading shall be required to publish a response to the Adjudicator on the recommendations set out in subsection (1) explaining whether they will be acted upon or not.’.

Amendment 30, page 5, line 18, at end add—

‘(3) In assessing changes that could be made to the Code, the Adjudicator shall give due consideration to—

(a) the territorial extent of the Code, especially in relation to activities of large retailers outwith the UK, including work done by subsidiaries of large retailers;

(b) whether intermediaries in the supply chain should be covered; and

(c) whether commercial pressures or criminal activity pose risks to consumer interests by potentially compromising standards of food safety, hygiene and food authenticity.’.

Amendment 33, page 5, line 18, at end add—

‘(3) In assessing changes that could be made to the Code, the Adjudicator shall give due consideration to—

(a) the territorial extent of the Code, especially in relation to activities of large retailers outwith the UK, including work done by subsidiaries of large retailers;

(b) whether intermediaries in the supply chain should be covered.’.

Amendment 34, in clause 14, page 5, line 31, at end insert—

‘(4A) The report must include details of any incidents that have come to the Adjudicator’s attention during the reporting period in which breaches of the Groceries Code or commercial pressure on retailers have led or may have led to actual or potential cases of compromised—

(a) food safety;

(b) food hygiene; and

(c) food authenticity.’.

Amendment 35,  page 5, line 34, at end add—

‘(c) the Food Standards Agency.’.

Amendment 27, in cause 25, page 11, leave out lines 7 to 12 and insert

‘This Act shall come into force two months after Royal Assent.’.

New clause 1 stands in my name and that of my hon. Friend the Member for Bury North (Mr Nuttall).

I do not want you to think, Mr Speaker, that my speech would be better suited to a debate on Second or Third Reading, but it is important that I give some context as to why new clauses 1, 2 and 3—which all stand in my name—are important.

I do not have any interest to declare, but I do have considerable experience that is relevant to the Bill. Before entering Parliament in 2005 I spent the previous 12 years working for Asda. I spent four years working in-store and eight years working at the head office in Leeds, so I have first-hand knowledge of how the supermarket industry works. To be perfectly honest, it works in a completely different way from the way in which people might be forgiven for thinking it works if they listened to previous debates on the matter. We have been given to believe that terrible, shocking, awful, nasty supermarkets care nothing about their suppliers, that their only role in life is to screw their suppliers into the ground and leave them destitute—bankrupt, if we are to believe previous debates—and that the only way to prevent that from happening is to have this ridiculous adjudicator, which is the Bill’s premise. That argument is complete and utter nonsense—that is not how it works at all.

I think that I have raised this point with the hon. Gentleman in the past, but the supermarkets’ power means that they are able to tell suppliers, “Provide this product at this price or do two-for-one offers at your cost, or we will go somewhere else.” Does the hon. Gentleman not accept that that is an unacceptable power in some cases?

I am afraid that the hon. Gentleman is highlighting the misconceptions. The Office of Fair Trading is already able to enforce a grocery code of practice. It is already in place. It is not being introduced by this Bill. The code of practice already exists under the auspices of the OFT. If the hon. Gentleman has any concerns about how supermarkets are operating with regard to their suppliers, he can take his complaint to the OFT and ask it to investigate it. The adjudicator is not supposed to introduce a new code of practice, although we fear that they might. The code of practice already exists. If the hon. Gentleman has evidence of supermarkets breaking the code of practice, I would be happy for him to come forward and tell me about it. If anybody has evidence of supermarkets breaking the code of practice, let us hear about it today and we can all decide what the best course of action is. However, there is no evidence that the code of practice is being breached.

With all due respect, the hon. Gentleman fails to understand one of the fundamental points that was made in Committee, which is that many of the examples of abuse in the supply chain concern primary producers who are literally afraid of coming forward. That is why the anonymity and protection of those producers is built into the Bill.

I understand the point that the hon. Gentleman makes, but he is basically highlighting that he can give no examples of abuses of the groceries code of practice.

I respect the consistent position that the hon. Gentleman takes on this matter. However, he cannot ignore the fact that in 2008, the Competition Commission concluded that supermarkets were transferring excessive risk and unexpected costs to suppliers, and that that was having a detrimental effect not only on the suppliers, but on consumers. It proposed the introduction of the code, but made it clear that on its own, the code would not be sufficient. A referee was needed to enforce it, otherwise no complaints would be brought forward. Simply saying that we have to find the evidence ignores the Competition Commission’s conclusions.

The hon. Gentleman, likewise, has taken a consistent view on these matters. In fact, he has been so consistent that he wanted an adjudicator before a new code of practice had even been introduced, let alone bedded down. He has always been in favour of this solution, even when there was no problem.

The Office of Fair Trading controls the groceries code of practice and is there to investigate any abuses of fair trade within the sector. If the hon. Gentleman has any evidence, he can take it to the Office of Fair Trading. It has all the powers that it needs to investigate any cases. The problem is that there are no such examples.

I am grateful to the hon. Gentleman for giving way again. The Grocery Market Action Group, which I am privileged to chair on behalf of a large number of organisations, gave evidence to the Competition Commission inquiry. That is one reason why it came forward with the clear and firm conclusions that are now being carried forward by the Government. That is the right thing to do.

The hon. Gentleman keeps making the same assertion. He should take the matter to the Office of Fair Trading. That is the body that oversees the groceries code of practice.

I am going to talk about something completely different. The Isle of Wight has three locations where ferries land. It was found that the ferry companies were not being reasonable. They could not find a solution and neither could anybody else. Exactly the same thing that the hon. Member for St Ives (Andrew George) is describing with food is happening with ferries.

My hon. Friend is a fantastic representative of the people of the Isle of Wight. However, I would not want you to tell me that I am going off course, Mr Speaker, so if my hon. Friend will forgive me, I will avoid the ferry analogy and stick to the adjudicator and the groceries code.

Let me get to the point that I have been trying to make from the beginning. It is amazing that all the people who would have been happy to vote for the Government’s programme motion to restrict the debate are anxious to intervene as often as possible on my speech, thereby prolonging the debate. I am sure that there is an irony in there somewhere.

The genesis of my new clauses is that the idea that supermarkets will flourish by making their suppliers bankrupt is the most ridiculous premise known to man. A supplier does not have much of an outlet for their goods if they are not bought by a supermarket. Equally, a supermarket does not have much of a shop if it has nothing on its shelves to sell. This is not a one-way street. The supermarket cannot manage without the supplier. The nature of the free market means that they have to work together on each other’s terms. If a supermarket upsets Heinz and has no Heinz beans on its shelves, it will not be a supermarket for very long.

The hon. Gentleman makes the point about the markets in which the supermarkets operate, but does he at least concede that the power imbalance between the supermarket and the supplier is often very unfair, and that supermarkets have consistently pushed the costs and risks of doing business on to the supplier at the end of the food chain?

No, I do not agree with that at all. I will come on to this point in a bit more detail soon, but the hon. Lady is forgetting something. The big supermarkets, without a shadow of a doubt, are massive companies that have hundreds of stores in their chains. By definition, a viable supplier to a supermarket chain has to be a very big company as well, otherwise it would not have the wherewithal to supply all the supermarket’s branches. When I get to the detail of my new clauses, I will talk about the thresholds that the Bill should apply. She will see that far from it being the case that vast supermarkets are being awful to very small suppliers, many of the suppliers are bigger than the supermarkets that they are supplying. She ought to bear that in mind.

My hon. Friend misunderstands the whole supply chain in the UK. There are organisations that provide hubs to supply supermarkets, but those hubs are supplied by very small primary producers such as family firms. Those firms are microscopic in comparison with the supermarkets.

My hon. Friend makes a good point. If he has a big problem with the middleman, so to speak, for example in the dairy industry, he should pursue his complaint with the middleman, rather than having a go at the supermarket.

The hon. Member for Alyn and Deeside (Mark Tami) made a point about special offers. There is a view that supermarkets have been forcing suppliers against their will to do special offers, such as buy one, get one free or buy three for two. Let me tell the House, as somebody who has worked in this environment, what happens in the real world, rather than in the invented world that people want to talk about.

My hon. Friend the Member for Fylde (Mark Menzies) is here and he will know what happens as well as I do because he worked for Asda at the same time as I did. He will recall that, before I left, Asda decided that it did not want to do special offers any more and that it would have no special offers in its stores. It did not want any buy one, get one frees or three for twos. It asked its suppliers instead to just sell it the product at an everyday low price and to put what they would have invested in a promotion into providing that price. It was not companies such as Asda that were forcing suppliers to do buy one, get one frees; suppliers were falling over themselves to do special offers in the supermarkets and to get their products in the promotional areas.

Some of those firms have massive marketing budgets. They have marketing budgets that supermarkets would love to have. They use that budget to do offers such as buy one get one free or three for the price of two. They are trying to persuade people who buy Daz for their washing, for example, to move to Persil. To persuade people to do so, they give them a buy-one-get-one-free offer.

I will in a second, because it was the hon. Gentleman who started me off discussing this misconception in the first place, so I will happily let him come back in.

A special offer such as “Buy one, get one free” on Persil is intended to encourage people to buy Persil in the hope that by the time the special offer ends, they will stick to that brand. It is a way of promoting a brand, and it has absolutely nothing to do with the supermarket.

The hon. Gentleman is talking about very large companies, but does he accept that some smaller companies are almost totally reliant on the supermarkets for their business, and whatever the supermarket says goes? Does he also accept that one thing that we have to recognise from the horsemeat scandal is that if we keep driving prices down, some suppliers will look to cut costs by whatever means they can in order to survive?

I am grateful to the hon. Gentleman, because he seems to have indicated—I will take it as such—that he will support my new clause 1 or new clause 2. He gets to the nub of the point, although I suspect he has not even bothered to read the new clauses, because if he had he would not have led with his chin in the way that he just has.

I wish to make it clear at this point that, with your permission, Mr Speaker, I would prefer to press new clause 2 to a Division than new clause 1, but I will be guided by you later on that.