House of Commons
Tuesday 26 March 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 16 April (Standing Order No. 20).
Oral Answers to Questions
Deputy Prime Minister
The Deputy Prime Minister was asked—
2. What progress the Government have made on resolving the West Lothian question. (149755)
With this, I will also answer Question 2. The McKay commission, which the Government established to consider how the House of Commons deals with legislation that affects only part of the UK, reported yesterday. We are grateful to the commission for its work. This is an important issue, which is why the Government asked the expert commission to look at it. The report presents a positive step forward, and we will give it very serious consideration before responding substantively.
I, too, thank the McKay commission for such an erudite report. The commission outlines a principle: that decisions at UK level with a separate and distinct effect for England should normally be taken only with the consent of a majority of MPs for constituencies in England. Will the Minister argue with her boss, who is a passionate believer in political and constitutional reform, to implement that sensible principle in the next Session?
I commend my hon. Friend for her work on this important matter—she has campaigned long and hard and taken the time to go into the detail. As I have said, the Government take the report extremely seriously. We believe it is a positive step forward, and I am happy to talk to all members of the Government about its merits and otherwise.
Does the Minister accept that constituents of mine who use the health service in England, work in the public sector in England and use public transport in England, but who are represented by me as a Welsh Member of Parliament, want a say on matters relating to England? Does she accept that there are problems, but not always solutions?
I ought to accept that the right hon. Gentleman wants to do a very good job for his constituents, which I am sure he does. However, I note that the McKay commission report refers to England matters and England and Wales matters. Those serious issues require extensive consideration.
13. Next September’s referendum will, I hope, deliver a substantial no vote against separation. May I suggest that that would be an ideal time to implement the McKay commission’s sensible proposals and evolve the devolution settlement into one that will be acceptable on both sides of the border? (149767)
I thank my hon. Friend for his contribution. I hear his view on the timing of what the Government must do next. We will take that decision seriously alongside the substantive issues in the report. I agree with him and many others that the people of Scotland should choose to stay in the UK next September, and am confident they will do so.
I wonder whether the resolving of the West Lothian question will help us to understand why the Liberal Democrats voted against air passenger duty in opposition, but voted for it while in government, as we saw last night.
I do not believe that even I could persuade the McKay commission to cover that level of detail. However, as I said in answer to the previous question, the people of the UK are stronger together than they are apart. I hope the hon. Gentleman transfers that message to his constituents.
The biggest threat to the UK might be not the Scottish referendum next year, but the increasing sense in England that the current constitutional settlement is not a fair one. Does my hon. Friend agree that we already have two different classes of MPs, in the sense that Scottish and Welsh MPs have colleagues in the Scottish Parliament and Welsh Assembly who perform some of the role that English MPs do?
Political and Constitutional Reform
The Government continue to work on political and constitutional reform, particularly devolving more powers from Whitehall to our cities and regions. Work also continues on the implementation of individual electoral registration and developing proposals on recall and lobbying reform.
As the hon. Gentleman may know, we are still reflecting on exactly how to proceed on lobbying, but we will do so. I cannot give him a precise date for when we will come forward with our proposals after the consultation, which provided a lot of feedback, but we will do so in due course.
The European convention on human rights offers basic human rights protections for 60 million people in this country and is critical to the devolution settlement. Will the Deputy Prime Minister therefore echo calls from the Opposition to resist the radical right behind him, and to keep the Human Rights Act and the United Kingdom as a proud signatory to the convention?
As the hon. Gentleman well knows, there is a difference of opinion among the coalition parties on the status of the Human Rights Act and the ECHR which it incorporates. I have always been very clear that I think that the rights and protections in the Act are very valuable for all British citizens, and I will continue to defend them.
The mere fact that the answer mentioned cities and regions does not mean that we are not also concerned about islands. I very much hope that by the end of this Parliament we will see a discernable shift of power and decision-making authority from Whitehall to all parts of the United Kingdom, whether islands, counties, cities or regions.
I strongly agree with my hon. Friend. Not only has political power been centralised for far too long, but so has the way in which we run our economy. The Labour Government over-relied on one sector—financial services—in 1 square mile of the City of London, ignoring the needs and economic potential of 100,000 square miles across the country. We must devolve political decision making and ensure that our economy is also more decentralised.
The Deputy Prime Minister will be aware that the document “The Coalition: our programme for government” states:
“We will fund 200 all-postal primaries over this Parliament”.
Will the Deputy Prime Minister inform the House of the progress on this promise and whether any pressure has been brought to bear on him by the Prime Minister, who may regret having primaries to select some of his Members of Parliament, bearing in mind how independently minded some of them have been recently?
We will make an announcement on that component of the constitutional and political reform programme in the coalition agreement in due course. As the right hon. Gentleman knows, it was slightly in abeyance as long as the debate about the boundary changes was still a live issue. As that has now been settled for the time being—if not satisfactorily in everyone’s opinion—we will of course return to the issue of all-postal primaries and make our views clear.
House of Lords
As stated in the programme for government, appointments will be made to the House of Lords with the objective of creating a second Chamber that reflects the share of the vote secured by the political parties at the last general election.
What I see is an avoidance of the reality of what happened after 2010, which was that the list of appointments contained the picks of the right hon. Member for Kirkcaldy and Cowdenbeath (Mr Brown) and Labour became the largest party in the Lords despite having lost the general election.
As part of the pre-legislative consultation on the draft Northern Ireland (Miscellaneous Provisions) Bill, consideration has been given to the elimination of dual mandates not only between the House of Commons and the Northern Ireland Assembly, but between the House of Lords and the Assembly. What is the Minister’s view?
In September 2010, the Deputy Prime Minister said that the Government wanted to reduce the cost of politics. To date, 128 new peers have been appointed at a cost of £131,000 each per year, with more planned. Why are the Government no longer concerned about reducing the cost of politics?
It seems that some would like to promote me, which is no doubt a question for a commission to look into.
The Government are committed to doing all they can to maximise registration. We have published detailed research, which has informed our plans to use data matching, targeted engagement with under-registered groups and new technology to modernise the system to make it as convenient as possible for people to register to vote.
I am sure the Minister is aware that, in principle, I am a supporter of individual voter registration, but I am concerned about the current low levels of voter registration. Will she therefore give an assurance that the steps taken with regard to data matching will ensure that there is no fall in the level of registration? Hopefully there will be an increase, but what will she do if it does not work out that way?
I share the hon. Gentleman’s concerns to see the greatest possible levels of both accuracy and completeness in the electoral registers, and I look forward to working with him and others to do that. Solving the problem of under-registration is not the responsibility of the Government alone; it is the responsibility of all politicians and many people across the community to work together to drive up rates. As I hinted in my previous answer, we are taking a number of measures as part of the individual electoral registration programme including: data matching, phasing in the transition over two years, a carry-forward to allow some of those not individually registered to vote in the next general election, a write-out to all the electorate in 2014, a publicity campaign and doorstep canvassing as at present.
The areas where the electoral roll is most inaccurate in Chester are those with large student populations. Some students register in Chester where they are at university, some register at home, some register at both and some register at none at all. Has the Minister given any consideration to the registration of students under individual voter registration?
My hon. Friend raises an important point. As I mentioned in my previous answer, we all wish to see the greatest possible level of registration across all groups in society. We are running data matching scheme pilots aimed specifically at students and young people who are about to obtain the franchise. I look forward to his help on that in his university area, and that of other Members.
Working-class areas across the United Kingdom are quite often the areas where voter registration is lowest. Will the Minister ensure that they are targeted by both the Electoral Commission and the Electoral Office for Northern Ireland to ensure maximum registration in those areas?
I can reassure the House that we are working with both the Electoral Commission, and, of course, electoral registration offices and administrators in all parts of the United Kingdom, to make the programme a success. In response to the hon. Gentleman’s particular concern about people in both his constituency and others, we expect EROs of particular local authorities to know their areas best and to work with us.
I share the concerns of the hon. Member for City of Chester (Stephen Mosley) about student registration, which is a big issue in my constituency. I heard what the hon. Lady said. Will she be working with universities, colleges and student unions to ensure a strong campaign to get every student registered?
We are already doing that. Work has been undertaken with the National Union of Students. I welcome the hon. Gentleman’s enthusiasm for that campaign. I also note that one of the points of the programme is to encourage individual registration, and I hope that many students—highly educated as they are, after all—would recognise the benefits of doing so.
Will the Minister update us on the administrative need to provide one’s national insurance number on registration and say whether she has modelled the impact of this on take-up?
I certainly can confirm that the national insurance number will be used in registration. It is an important part of the process and one of the primary identifiers that we will be using. There will be others, as part of the exceptions process, which will perhaps be important to the people the hon. Lady may be concerned about. I would be happy to provide her with more detail as she requires.
It seems to me that every time someone comes into contact with their local council, makes a benefit application, buys a house or rents a property, someone should ask them, “Are you on the electoral register?” What can the Minister do to encourage Government agencies, local government agencies and private companies to ask that question?
My hon. Friend underlines the point I was making earlier, which is that there is a responsibility across society to encourage people to take part in politics by registering to vote. I am sure he will be working with a range of groups in his constituency to do that. I can also confirm that the programme is using extensive data matching to ensure that records can be shared where appropriate, certainly between public sector bodies, to do the best job we can.
I am grateful for the welcome from the Opposition Benches.
As Deputy Prime Minister, I support the Prime Minister on a full range of Government policy and initiatives. Within Government I take special responsibility for this Government’s programme of political and constitutional reform.
I strongly agree with my hon. Friend that, having not only crashed the economy, Labour also left an immigration system in chaos, in which the public had absolutely no confidence whatever. Just as we are repairing, reforming and rebuilding our economy, we are having to do the same to the immigration system, which Labour left in such a lamentable mess. I agree with him that unless the public have confidence that the immigration system is competently administered, it is difficult to persuade people that we should remain the open, generous-hearted country that we are.
In last week’s Budget it was announced that there would be a Government-backed mortgage scheme for homes up to a value of £600,000. Will the Deputy Prime Minister make it absolutely clear that it will not be available for people buying a second home?
As the Chancellor made very clear, that is absolutely not the intention of the scheme. The intention of the scheme is to allow people to buy new homes, but as the right hon. and learned Lady very well knows, this is a complex area. There are anomalies that we need to address. For instance, we would need to ensure that the rules allow divorced couples to access the system just as much as anybody else. The Treasury is working on the details of the scheme to ensure that it does exactly what it is intended to do.
It is not a question of complexity or detail: the Treasury is very familiar with the notion of sole or main residence. The Deputy Prime Minister has not answered the question. It is not about the intention; it is a question of whether the Government are ruling that out. Let me ask him about something else—not a detail, but something fundamental—and see whether he can be clearer about that. Will he make it clear that the Government have ruled out making this Government-backed mortgage help available to people who are not domiciled in this country?
As the right hon. and learned Lady knows, the reason we have developed Help to Buy—which has two components: Government equity in new build construction and mortgage assistance —is of course not to subsidise people who have no stake in this country, nor is its intention to provide subsidies for people buying second homes. It is there to restore confidence in the housing market as a whole and ensure that the construction industry is given a significant boost, so that we employ more people and give people the opportunity to own their own homes.
T2. Thank you, Mr Speaker. My apologies; I was held up on London transport. With the local elections coming in May, will my right hon. Friend comment on the initiatives he is taking to combat postal vote fraud and impersonation at polling stations? (149770)
As I hope my hon. Friend will know, the principal intention of the Electoral Registration and Administration Act 2013, which we are seeking to implement as quickly as we can, is precisely to deal with the high levels of fraud in certain parts of the country, which most people of all parties felt was unacceptable.
That is not something that the coalition is going to deliver. I am personally persuaded of the case for lowering the voting age, but it was not included in the coalition agreement, so it is not something that the coalition Government will deliver during this Parliament.
T7. Will the Deputy Prime Minister join me and the all-party group on North Korea in welcoming last week’s historic resolution by the UN Human Rights Council to establish a commission of inquiry to investigate the grave violations of human rights in North Korea? I thank our Government for their vital work on this subject, and I ask the Deputy Prime Minister to thank those many civil rights organisations, such as Christian Solidarity Worldwide, that have campaigned on this issue for many years. (149776)
I certainly join my hon. Friend in applauding the fact that the UN resolution was passed. As she knows, the Foreign Secretary and the Foreign Office have been working tirelessly on this issue. My hon. Friend has been an outspoken observer and critic of the behaviour of the North Korean regime, which continues to imperil peace and stability both in the region and globally. It is an issue that this Government and Governments across the world take very seriously indeed.
T4. Local authorities are being forced to cut back the money they spend on electoral registration. Is the Parliamentary Secretary, Cabinet Office, the hon. Member for Norwich North (Miss Smith) concerned about that and, if so, what does she intend to do about it? (149772)
I would be happy to send the hon. Lady the figures, but I think it is simply not the case that local authorities have been forced to cut back on the resources they provide to electoral registration officers. Local authorities are, as we know, under financial pressure generally, and about a quarter of all public expenditure is passed through local councils, which is twice the amount of money we spend on defence. Given that the Labour party left us with no money, I am afraid that savings need to be made.
T5. Perhaps I can think of one. Ministers have said that the second set of NHS privatisation regulations due to come into effect on 1 April will not force clinical commissioning groups to put health services out to competitive tender—in spite of legal analysis showing that they are just as bad as the first such regulations. Since the warnings about the Health and Social Care Bill have turned out to be true, if NHS services are privatised, will the Deputy Prime Minister resign? (149773)
This is typical scaremongering from the Labour party. It was the hon. Lady’s party that wasted £250 million of taxpayers’ money subsidising the private sector in a deliberate act to undermine the NHS. It is the Government who have made it illegal, directly in the Health and Social Care Act 2012, to have competition based on price rather than on quality. The hon. Lady would know, if she looked in detail at the new regulations—the so-called section 75 regulations—that they make it quite clear that clinical commissioning groups are not forced to open services to competition unless they think it is clinically justified in the interests of patients to do so.
We do not presently have any plans to do what my hon. Friend recommends, and which he has recommended consistently over a long period. I hope that he acknowledges, however, that we have already launched eight city deals to give new powers to the eight largest cities outside London and the south-east. That will be followed this year by 20 further city deals, which are still to be concluded, and a massive devolution of financial power to local councils so that they retain business rates, starting next month.
T8. It is not only unfair but poor value for money for disabled people in specially adapted homes to be hit by the pernicious bedroom tax. Will the Deputy Prime Minister commit the Government to look again at making it mandatory to exempt disabled people from that disgraceful tax? (149777)
As the hon. Gentleman knows, the spare room subsidy is not available to thousands upon thousands of families who receive housing benefit in the private rented sector but it is available to families who receive the benefit in the social sector. Therefore, we are trying to ensure that the two systems are fair. A total of 1.8 million households are on the social housing waiting list, yet taxpayers are subsidising 1 million bedrooms that are not being used. That is what we are trying to sort out, but I accept what he says: there will be difficult cases that we need to be able to address adequately. That is why we have provided millions of pounds extra to the discretionary housing payment pot, which now totals £150 million, and made a number of other changes. During the implementation of the policy, we will look at those cases and take further measures where we think they are justified.
I certainly agree that there is a chronic need to reform the way in which the European Court of Human Rights processes cases. It takes too long. Not enough people in the Court in Strasbourg are equipped to deal with cases expeditiously. That is why the former Secretary of State for Justice was right to get an agreement with all signatories to the Court to ensure, under the Brighton agenda, that the Court’s procedures are reformed. That is the kind of sensible reform we can all agree on.
As I say, we have made a number of changes already to the detail of the spare room subsidy. We have provided a considerable amount of extra money for discretionary housing payments. Councils, including the council of the hon. Gentleman’s constituent, have discretion to use that money and to change the way the policy is adapted in practice. However, we will, of course, look at these difficult cases, work with councils and, if we need to, further adapt the way in which the policy is implemented.
I do not know which big mayoral figure my right hon. Friend might be thinking of, but I agree with him about the model of co-operation between local authorities of different political persuasions in Greater Manchester, which operates under the city deal system. Greater Manchester is pioneering the earn-back system, where Greater Manchester will be able to keep more revenue for infrastructure investment in the local area to the benefit of the people in Greater Manchester. That may prove to be a model that others seek to emulate elsewhere.
T10. The Deputy Prime Minister will be aware that independent researchers have concluded that the Budget and recent welfare reforms will substantially increase child poverty and material deprivation among children. Is he proud of that? (149779)
As the hon. Lady will know, we have set out some ideas on child poverty. In addition to the existing poverty targets, which we are duty-bound to seek to meet, we have tried to ensure that the factors that hold back children from fulfilling their potential—whether it is poor housing or poor education—are addressed through measures such as the pupil premium; there is £2.5 billion of extra money to help the most deprived children in school. In addition, as of this September, the Government are making 15 hours of free pre-school support available to two-year-olds from the most deprived families, something that her Government never delivered.
The Deputy Prime Minister said that he wants to see cross-party consensus on solutions to the airport capacity issue, so can he explain why he and his party have welcomed the re-inclusion of Heathrow into the Davies commission, given that his party had already ruled it out for ever? Surely that means he risks wasting an awful lot of money and everyone’s time.
My hon. Friend rightly says that I and my party are not persuaded at all of the case for Heathrow expansion, but equally we should not seek, and no party on either side of the House should seek, to tie the hands of the independent commission looking at this issue in the round. We will await with interest, as I guess everybody will, the results of the interim report of Howard Davies’s commission and its final report after the next general election.
T13. Given the Deputy Prime Minister’s feeble response to the question from the shadow Deputy Prime Minister, in which he gave no safeguards that people, including people from abroad, will not be able to buy second homes with the mortgage subsidy, can he deal with two other problems? First, all the analysts say that this measure will create a housing bubble and inflate house prices. Secondly, it will trap many people who would not otherwise get on to the housing market in sub-prime mortgages that they cannot afford in the long run. (149783)
One would have thought that a party that crashed the economy, sucked up to the banks and let them get away with blue murder, and presided over a massive housing boom and bust would have a hint, a note of contrition in its questions about the housing market. Why does the hon. Gentleman want to deprive his constituents of the ability to get their feet on the first rung of the property ladder? Why does he want to deprive young families who want to have a home they can call their own of the ability to do so? Instead of constantly carping about our attempts to fix the mess he and his colleagues left behind, perhaps for once he should come up with some ideas of his own.
Does the Deputy Prime Minister agree that the measures in the coalition’s Budget for small and medium-sized businesses, including introducing the business bank, changes to national insurance and the industrial strategy, all add up to a massive confidence boost for the small business sector? That is great news for our economy, and we should be right behind those measures.
I agree with my hon. Friend. Of course, we all know that times are very difficult and that the British economy is taking time to heal. That is why it is a great tribute to the Chancellor and his team that in the Budget we have none the less found measures that will take 2 million people on low pay out of paying income tax altogether, that will give small employers and businesses around the country £2,000 off to allow them to employ more people, and that included £1 billion extra for the aerospace industry. It means that people will not face the higher petrol and fuel prices they would have faced under Labour, and it has got rid of the beer escalator and made sure that we ease the squeeze on household budgets.
Given that the Deputy Prime Minister has changed his mind on cash bonds for some visitors coming to the UK—a very different policy from the one he advocated in his Opposition days—could he put in the Library a list of the items he believed in and argued for before the election, but which he no longer believes in and, indeed, has totally changed his position on?
What I would put in the Library, if the hon. Gentleman wishes, is the fact that the last Labour Government removed exit controls on our borders, so they had no idea who was leaving this country and who was coming in. The reason why we can pilot the so-called security bonds for people coming here on temporary visas is that, unlike his Government, we are reinstalling the exit checks that we have been campaigning—as Liberal Democrats and now in government—to reinstall for many years.
Business growth in Basildon and Thurrock, supported by Essex county council, is three times higher than the regional average. Does my right hon. Friend therefore agree that the recently introduced employment allowance will encourage those new businesses to take on their first, or an additional, employee, thus supporting both businesses and those seeking work?
I agree with my hon. Friend. This new employer’s allowance is a very exciting way of encouraging small and medium-sized businesses, which are the backbone of the British economy, to take on more people. When it comes into effect it will mean that a small employer will be able to employ someone on up to about £22,000 without paying any national insurance whatsoever.
Did the Deputy Prime Minister have any hand in the air-sea rescue helicopter service being sold off or given to a Texan company rather than to the British Navy and Air Force? Is he responsible for that? Does he approve of it, as it seems a rather strange decision?
I do if the service is better and if the Department for Transport, which has run this tender, is clearly persuaded that this is the best way to ensure the safety and security of the British people in the future and to do so at the best value for taxpayers’ money. Those are precisely the criteria on which everyone—any reasonable person—would judge this decision.
Cornwall may not look like a city but, as my right hon. Friend knows, it has both the ambition and the building blocks to negotiate a deal with the Government on devolved powers. Will he ensure that those ambitions can be fast-tracked to reality?
My hon. Friend has been a tireless campaigner, with his Cornish colleagues, for emulating the idea of a city deal but adapting it for the needs of Cornwall, now and in the future. I applaud him for that, and I will make sure that he and his colleagues can meet the Minister for cities and decentralisation, to make the case directly for a bespoke deal for Cornwall at some point in the future.
The key way to make sure that there is no repeat of the disastrous mismanagement of the housing market that we saw under the previous Government is to ensure that more homes are built. That is why one significant component of the Help to Buy announcement that the Chancellor made last week is precisely that Government equity being put towards the construction of new homes should lead to extra construction activity and a further supply of housing. The Budget also included an announcement of a further 15,000 social homes being built, in addition to the several thousand more that are already in the pipeline.
The Attorney-General was asked—
Rule of Law
I have not received any recent representations on this subject, but I am clear that the United Kingdom’s enviable reputation for upholding the rule of law is closely linked to our country’s commitment to the European convention on human rights and to ensuring that those rights are enshrined in our own laws.
I thank the Attorney-General for that answer. Some Government Members are talking about exiting the European convention on human rights. Will he assure us that that will not happen? I know that he believes in the convention, so may I tell him that he will have the support of Opposition Members in the battle to ensure that we remain in it?
Is it not possible to be proud that this country created the European convention on human rights in 1948 to counter communism and fascism while also being dismayed that, because of judicial activism, the Court is interfering in the rights of this democratic Assembly to come to its own conclusions on issues such as prisoner voting rights?
My hon. Friend is right to say that the United Kingdom has not been uncritical of the way in which the European Court of Human Rights has operated. That is why we initiated the negotiation with other countries which led to the Brighton declaration. We believe that the principles of subsidiarity should be re-emphasised, that the selection of judges should be improved and that the backlog of the Court needs to be addressed. Those are important reform packages. We were successful in getting agreement on them last year, and we intend now to see that they are implemented.
Does the Attorney-General agree that it is simply not possible or right to start picking and choosing which decisions of the European Court of Human Rights we agree or disagree with? We are signed up to that charter, which guarantees the human rights of people all over Europe, including in this country. Surely that is something of which we should be proud rather than trying to undermine it all the time, as many of his Back Benchers consistently do.
The convention is an international legal obligation that we take extremely seriously and I have no doubt that our adherence to it is extremely helpful in raising standards of human rights elsewhere and in countries that have much poorer track records. The advantages to be derived from such an international legal obligation applied across countries need to be weighed in the balance when people are critical of how it is sometimes interpreted.
I am quite sure that all my right hon. and hon. Friends always strive for accuracy in this department. It has to be said that I sometimes open my newspaper and am quite surprised to read some of the material published on the subject, so if anyone relies on such newspaper articles, it may be that they are likely to be misled.
Will the Attorney-General confirm very simply that the European convention on human rights was founded by the Council of Europe and is nothing to do with the European Union, and that it is legitimate to be against the European Union while being supportive of the European convention on human rights?
I would be hesitant to make such a comment. It is true that the judges are sometimes appointed from academic backgrounds, but it is worth bearing in mind that our national judiciary, apart from the fact that they have sometimes sat part time as judges, are not formally trained for judicial office even domestically. One must be a little wary of making such a sweeping statement, but there is no doubt, as I said, that the quality of the judiciary needs to be improved.
Given that one of the early backers of the European convention on human rights was Winston Churchill, does that not add an historical tone as to why it would be irresponsible to remove oneself from the convention?
I certainly agree with the hon. Gentleman that Winston Churchill was a great proponent of the convention’s coming into force. It was supported on both sides of the House. There were some hesitations at the time, but it was undoubtedly seen as a marked step change in improving human rights on the European continent.
As a member of the interdepartmental ministerial group on human trafficking, I keep the effectiveness of prosecutions for that very serious form of crime under review. Wherever possible, the Crown Prosecution Service brings prosecutions for human trafficking or other related offences.
Has the Solicitor-General asked for advice on the letter signed by a dozen charities on 28 April, which predicts that when the EU trafficking directive comes into force on 6 April the UK will be in breach of the following: the protection of victims during criminal procedures, access to compensation and legal assistance, and the provision of a guardian for trafficked children during legal proceedings? What is he going to do about that?
As the hon. Lady will know—I hope she will forgive me—we do not, as Law Officers, explain when and where we have given advice. Her point is very important, however. Victims of human trafficking need to be identified and it is important that they should not be prosecuted or treated disrespectfully once that is known. That is one of the points being discussed in the interdepartmental ministerial group and she is right to highlight it.
My hon. Friend referred to the interdepartmental ministerial group. Is not one of the problems that there are lots of different Acts of Parliament? Would there be any merit in pulling all the different Acts together in a consolidation Act on modern day slavery?
I pay tribute to my hon. Friend for his work in this area. It is possible to consider putting a number of laws into a consolidating statute, but the problem is that we tend as a House of Commons to say, “We have these laws. Do we want to spend time consolidating them when we might have other matters to deal with?” Taking such an action was recommended in the recent report from the Centre for Social Justice, however. I have discussed it with the authors and the interdepartmental ministerial group will consider it.
Northern Ireland has had a number of convictions for human trafficking, and there are cases pending. Legislation will soon be introduced in the Northern Ireland Assembly by my colleague, Lord Morrow. Will the Solicitor-General outline the co-operation across all regions of the United Kingdom to tackle human trafficking?
As the hon. Gentleman will know, there has been considerable co-operation and co-ordination of effort, particularly over intelligence and how those offences can be disrupted. Of course, there is an issue about the new National Crime Agency and exactly how it will operate—he will be aware of the situation and the ongoing discussions. It is important that there is that co-ordination of effort, which happens across the United Kingdom and the wider world, in trying to tackle the problem.
Serious Fraud Office
The SFO has a 71% conviction rate by defendant for the current financial year to date. It prosecutes highly specialised cases, the number of which is small, so year-on-year change in the rate is not a particularly good indicator of trends. Although there is always room for improvement, I am broadly pleased with the SFO’s conviction rate. The report by Her Majesty’s Crown Prosecution Service inspectorate in November last year found that the outcomes in SFO cases demonstrate that it can deliver under pressure. There will be a follow-up inspection within the next year.
SFO investigations have increased in duration to 28.8 months on average, success rates are down, as the Attorney-General has just told us, and its previous director handed out £1 million to departing staff without authorisation. Can the Attorney-General tell us how much money will have to be set aside on his watch for legal fees and damages as a result of botched investigations by the SFO?
I take it that the final part of that was the question and the rest was comment. The position is that at the moment the SFO is handling ongoing civil litigation within its budget. In so far as it requires further resources, it will speak to the Treasury.
My hon. Friend is right that the statistics for SFO cases were previously based on the number of defendants sentenced, rather than those convicted. Consequently, because the number of cases is very small, we can get huge statistical shifts simply by looking at it in a different way. That is why, as I explained earlier, I do not think that trends in the statistics are a good indication of performance. Overall, I prefer to rely on HMCPSI’s report.
As the Attorney-General knows, the offence of misconduct in public office occurs when a public officer, without reasonable excuse,
“wilfully neglects to perform his duty and/or wilfully misconducts himself… to such a degree as to amount to an abuse of the public’s trust in the office holder.”
Is he aware of any reason why the former director of the SFO, Richard Alderman, should not be investigated for misconduct in public office over the circumstances of his failure, as senior accounting officer, to obtain authorisation for payments to senior staff members of over £1 million?
The SFO received 2,731 tip-offs from members of the public last year but launched only three investigations into information supplied by the public. If members of the public report something to the SFO, can they have confidence that it will be investigated?
Yes, they can be confident that the reports will be looked at. Indeed, there are other routes by which reports might come to the SFO, including through the City police and Action Fraud. There is clearly a requirement for prioritisation, but the SFO will examine and consider any reports it receives.
The Crown Prosecution Service secures convictions in over 17 out of every 20 cases. The Director of Public Prosecutions has concentrated particularly on improving rape and domestic violence outcomes for victims, and conviction rates for both have improved substantially over the past two years. As for the statistical performance of the Serious Fraud Office, my hon. Friend will have heard the answer I gave to the hon. Member for Cardiff West (Kevin Brennan).
I thank the Attorney-General for that answer. For all the controversy over terrorism legislation, LIBOR rate rigging and tax-dodging, terrorism convictions plummeted by 77% over the past five years, convictions for false accounting fell by 73%, and convictions for tax evasion slumped to 107 under Labour. What action is he taking to plug the gaping prosecutorial deficit left by the previous Government?
The Home Office is responsible for producing official statistics on casework outcomes in terrorism. The latest published Home Office data for the year ending September 2012 indicate that 24 out of 29 defendants were convicted, at a conviction rate of 82.8%. At that time, 134 prisoners classified as terrorists or domestic extremists were convicted and remanded. On fraud, the number of prosecutions has increased by 25% since 2010 and the conviction rate remains at 86.2%. On tax evasion, in the financial year to date 86% of cases originating with Her Majesty’s Revenue and Customs have resulted in conviction. I should like to write to my hon. Friend about the overall figures on this.
Does the Attorney-General share my concern about the memo leaked by the CPS that showed there was a risk of CPS prosecutors deliberately choosing cases that were likely to crack because of lack of evidence, in order to save costs?
I think that the conviction rates speak for the efficiency of the CPS. I have seen nothing to suggest that cases are not being pursued outside the ordinary tests of public interest and the reasonable prospect of getting a conviction. Obviously, if those do not apply then there should not be a prosecution at all. I am certainly not aware of there being any fiddling and of decisions being made not to prosecute certain cases that should be prosecuted.
The Crown Prosecution Service is generally very effective in the pursuit of high-value confiscation orders. My office and the CPS are represented on the Home Office-led criminal finances board, at which asset recovery performance is discussed. Asset recovery is a long process. Assets are often hidden. Third-party litigation, appeals against conviction and confiscation orders all mean that the enforcement of such orders may take a significant amount of time. Due to the way in which the value of a confiscation order is calculated, in many cases it is not possible to recover the full amount that has been ordered.
I assure the hon. Gentleman that I will raise the matter with the CPS, but I have no reason to think that it is not doing that. The evidence suggests overall—I cannot break it down for VAT fraud—that year on year the amount being confiscated is rising from what was a very low and rather unsuccessful level after the Proceeds of Crime Act 2002 first came into force. In the past year, £107 million was realised through confiscation. I will write to him about his specific point on VAT.
Minimum Wage: Evasion
The Crown Prosecution Service decides whether to prosecute national minimum wage cases, but the cases are investigated by Her Majesty’s Revenue and Customs. Since 2010, three cases have been referred to the CPS by HMRC, two of which resulted in convictions, most recently in February 2013, where the defendant was fined £1,000.
It is important to bear in mind that HMRC has two sorts of powers that it can use: criminal investigation, which we have already discussed, and the civil powers that enable it to look at the books and then to impose penalties and recover arrears. It is for HMRC to decide on the best way forward. The hon. Lady is right that these are important matters.
These are important matters and I will pass the hon. Gentleman’s comments on to Treasury Ministers. It is important that this matter is taken seriously and that there is proper enforcement. The Government certainly consider it to be an important matter.
7. What recent assessment he has made of the effectiveness of the Crown Prosecution Service in rape prosecutions. (149751)
It is difficult to prosecute some cases. Often, it is the word of one person against the word of another. It is important in those circumstances to ensure that the victim who is the witness is properly supported. In addition, it is vital to have corroborative evidence and to use it effectively. It is sometimes said that there are a lot of incorrect allegations, but recent research by the CPS shows that there are very few cases of that sort. There has been a big improvement in the conviction rate, but we cannot be complacent. As the hon. Gentleman says, it is important to tackle this matter.
I have to notify the House, in accordance with the Royal Assent Act 1967, that Her Majesty has signified her Royal Assent to the following Acts and Measures:
Supply and Appropriation (Anticipation and Adjustments) Act 2013
Presumption of Death Act 2013
Mobile Homes Act 2013
Antarctic Act 2013
Welfare Benefits Up-rating Act 2013
Jobseekers (Back to Work Schemes) Act 2013
Diocese in Europe Measure 2013
Clergy Discipline (Amendment) Measure 2013.
Mid Staffordshire NHS Foundation Trust
With permission, Mr Speaker, I would like to make a statement on the Government’s response to the Mid Staffordshire NHS Foundation Trust public inquiry.
I congratulate my predecessor, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), on setting up the public inquiry and on the many changes that he made in foreseeing its likely recommendations. I also pay tribute to Robert Francis QC for his work in producing a seminal report that will, I believe, mark a turning point in the history of the NHS.
Many terrible things happened at Mid Staffs, in what has rightly been described as the NHS’s darkest hour. Both the current and former Prime Minister have apologised. However, when people have suffered on such a scale and died unnecessarily, our greatest responsibility lies not in our words, but in our actions. Our actions must ensure that the NHS is what every health professional and patient wants: a service that is true to NHS values, that puts patients first, and that treats people with dignity, respect and compassion.
The Government accept the essence of the inquiry’s recommendations and will respond to them in full in due course. However, given the urgency of the need for change, I am today announcing the key elements of our response so that we can proceed to implementation as quickly as possible. I have divided our response into five areas: preventing problems from arising by putting the needs of patients first; detecting problems early; taking action promptly; ensuring that there is robust accountability; and leadership. Let me take each in turn.
To prevent problems from arising in the first place, we need to embed a culture of zero harm and compassionate care throughout the NHS; a culture in which the needs of patients are central, whatever the pressures of a busy, modern health service. As Robert Francis said,
“The system as a whole failed in its most essential duty—to protect patients from unacceptable risks of harm and from unacceptable, and in some cases inhumane, treatment that should never be tolerated in any hospital.”
At the heart of this problem is the fact that current definitions of success for hospitals fail to prioritise the needs of patients. Too often, the focus has been on compliance with regulation rather than on what those regulations aim to achieve. Furthermore, the way hospitals are inspected is fundamentally flawed, with the same generalist inspectors looking at slimming clinics, care homes and major teaching hospitals—sometimes in the same month. We will therefore set up a new regulatory model under a strong, independent chief inspector of hospitals, working for the Care Quality Commission. Inspections will move to a new specialist model based on rigorous and challenging peer review. Assessments will include judgments about hospitals’ overall performance, including whether patients are listened to and treated with dignity and respect, the safety of services, responsiveness, clinical standards and governance.
The Nuffield Trust has reported on the feasibility of assessments and Ofsted-style ratings, and I am very grateful for its thorough work. I agree with its conclusion that there is a serious gap in the provision of clear, comprehensive and trusted information on the quality of care. In order therefore to expose failure, recognise excellence and incentivise improvement, the chief inspector will produce a single aggregated rating for every NHS trust. Because the patient experience will be central to the inspection, it will not be possible for hospitals to get a good inspection result without the highest standards of patient care.
The Nuffield Trust rightly says, however, that in organisations as large and as complex as hospitals, a single rating on its own would be misleading. The chief inspector will therefore also assess hospital performance at speciality or department level. This will mean that cancer patients will be told of the quality of cancer services, and prospective mothers the quality of maternity services. We will also introduce a chief inspector of social care and look into the merits of a chief inspector of primary care to ensure that the same rigour is applied across the health and care system.
We must also build a culture of zero harm throughout the NHS. This does not mean there will never be mistakes, just as a safety-first culture in the airline industry does not mean there are no plane crashes, but it does mean an attitude to harm that treats it as totally unacceptable and takes enormous trouble to learn from mistakes. We await the report on how to achieve this in the NHS from Professor Don Berwick. Zero harm means listening to and acting on complaints, so I will ask the chief inspector to assess hospital complaints procedures, drawing on the work being done by the right hon. Member for Cynon Valley (Ann Clwyd) and Professor Tricia Hart to look at best practice.
Given that one of the central complaints of nurses is that they are required to do too much paperwork and thus spend less time with patients, I have asked the NHS Confederation to review how we can reduce the bureaucratic burden on front-line staff and NHS providers by a third. I will also be requiring the new Health and Social Care Information Centre to use its statutory powers to eliminate duplication and reduce bureaucratic burdens.
Secondly, we must have a clearer picture of what is happening within the NHS and social care system so that, where problems exist, they are detected more quickly. As Francis recognised, the disjointed system of regulation and inspection smothered the NHS, collecting too much information but producing too little intelligence. We will therefore introduce a new statutory duty of candour for providers to ensure that honesty and transparency are the norm in every organisation, and the new chief inspector of hospitals will be the nation’s whistleblower-in-chief.
To ensure that there is no conflict in that role, the CQC will no longer be responsible for putting right any problems identified in hospitals. Its enforcement powers will be delegated to Monitor and the NHS Trust Development Authority, which it will be able to ask to act when necessary. We know that publishing survival results improves standards, as has been shown in heart surgery, so I am very pleased that we will be doing the same for a further 10 disciplines—cardiology, vascular, upper gastrointestinal, colorectal, orthopaedic, bariatric, urological, head and neck, and thyroid and endocrine surgery.
The third part of our response is to ensure that any concerns are followed by swift action. The problem with Mid Staffs was not that the problems were unknown; it was that nothing was done. The Francis report sets out a timeline of around 50 warning signs between 2001 and 2009, yet Ministers and managers in the wider system failed to act on those warnings. Some were not aware of them; others dodged responsibility. That must change. No hospital will be rated as good or outstanding if fundamental standards are breached, and trusts will be given a strictly limited period of time to rectify any such breaches. If they fail to do that, they will be put into a failure regime that could ultimately lead to special administration and the automatic suspension of the board.
The fourth part of our response concerns accountability for wrongdoers. It is important to say that what went wrong at Mid Staffs was not typical of our NHS, and that the vast majority of doctors and nurses give excellent care day in, day out. We must ensure that the system does not crush the innate sense of decency and compassion that drives people to give their lives to the NHS.
Francis said that primary responsibility for what went wrong at Mid Staffs lies with the board. We will, therefore, look at new legal sanctions at corporate level for organisations that wilfully generate misleading information or withhold information that they are required to provide. We will also consult on a barring scheme to prevent managers found guilty of gross misconduct from finding a job in another part of the system. In addition, we intend to change the practices around severance payments, which have caused great public disquiet.
The General Medical Council, the Nursing and Midwifery Council and other professional regulators have been asked to tighten their procedures for breaches of professional standards. I will wait to hear how they intend to do that, and for Don Berwick’s conclusions on zero harm, before deciding whether it is necessary to take further action. The chief inspector will also ensure that hospitals are meeting their existing legal obligations to ensure that unsuitable health care support workers are barred.
The final part of our response will be to ensure that NHS staff are properly led and motivated. As Francis said,
“all who work in the system, regardless of their qualifications or role, must recognise that they are part of a very large team who all have but one objective, the proper care and treatment of their patients”.
Today I am announcing some important changes in training for nurses. I want NHS-funded student nurses to spend up to a year working on the front line as support workers or health care assistants as a prerequisite for receiving funding for their degree. That will ensure that people who become nurses have the right values and understand their role. Health care support workers and adult social care workers will now have a code of conduct and minimum training standards, both of which are being published today. I will also ask the chief inspector to ensure that hospitals are properly recruiting, training and supporting health care assistants, drawing on the recommendations being produced by Camilla Cavendish. The Department of Health will learn from the criticisms of its own role by becoming the first Department in which every civil servant will have real and extensive experience of the front line.
The events at Stafford Hospital were a betrayal of the worst kind—a betrayal of patients, families, and the vast majority of NHS staff who do everything in their power to give their patients the high-quality, compassionate care they deserve. I want Mid Staffs to be not a byword for failure but a catalyst for change, and to create an NHS where everyone can be confident of safe, high-quality, compassionate care, and where best practice becomes common practice, and the way a person is made to feel as a human being is every bit as important as the treatment they receive. That must be our mission and I commend this statement to the House.
I thank the Secretary of State for his statement and for the measured way in which he introduced it.
The NHS is 65 this year, and if it is to be ready for the challenges of this century, it must learn from the darkest hours of its past. The NHS was founded on compassion and, as the Secretary of State said, what happened at Stafford was a betrayal of that. Rightly, apologies have been given, but it is now time to act and make this a moment of change.
Robert Francis delivered 290 careful recommendations after a three-year public inquiry and, like the Secretary of State, I pay tribute to him today. In response, the Prime Minister promised a detailed response to each recommendation by the end of this month. Although the Opposition welcome much of what the Secretary of State has said today, his statement falls short of that promised full response and contains serious omissions on which I would like to press him, in particular, on four of Robert Francis’s flagship recommendations, which I shall take in turn.
First, we welcome the move to place a duty of candour on health care providers and believe it could help bring about the culture change the NHS needs. The Francis report, however, goes further and recommends a duty of candour on individual members of staff. Will the Secretary of State say more about why he has only accepted this recommendation in part and not applied it to staff? Has he ruled that out or is he prepared to give it further consideration?
Will the Secretary of State assure the House that the duty will apply equally to all providers of NHS services, including private providers? His statement was a little vague on that point. More generally, with more private providers coming into the NHS, is it not the case that we will not get the transparency we need unless the provisions of freedom of information apply fully to all holders of NHS contracts and information cannot be withheld under commercial confidentiality?
Secondly, on patient voice, the Government have announced new chief inspectors of hospitals and social care. Those were not Francis recommendations and, while we give them a cautious welcome, I am sure that the Secretary of State will agree that regulation alone will not be enough to prevent another Mid Staffs. Instead, we need a powerful patient voice in every community that is able to sound the alarm if things are going wrong. Rather than pulling down the shutters, as the NHS has a tendency to do, complaints should be embraced as opportunities to learn and improve.
It is just a matter of days until the new NHS comes into being and the concern is that patient voice has not been embedded at the heart of the new system. A third of councils say that their local healthwatch will not be up and running by the 1 April deadline, and there are wide variations in both structure and membership. Will the Government accept Robert Francis’s recommendation of a consistent basic structure for healthwatch programmes throughout the country before it is too late and they go their separate ways?
Thirdly, on regulation and training, Robert Francis has made a very clear case for a new system of regulation of health care assistants to improve basic standards—a case that we made during the passage of the Health and Social Care Act 2012—yet it did not feature in the Secretary of State’s statement. Have the Government accepted in principle the regulation of health care assistants?
We support moves to rebalance nurse training and to include more hands-on experience, but student nurses already spend 50% of their time in clinical practice and face significant financial barriers when completing their training. Will the Secretary of State assure the House that requiring a year on the ward will not increase the financial barriers to young people entering nursing and, if more trainees are to be on the wards, will he ensure that there are enough staff with the time to train the extra students?
That takes me to my fourth point and the most glaring omission from the Secretary of State’s statement, namely safe staffing levels. We will never get the right culture on our wards if they are understaffed and over-stretched, but there is evidence that things are going in the wrong direction and the Secretary of State was silent on the issue today.
The CQC has recently reported that one in 10 hospitals in England do not have adequate staffing levels. Just last week, work force figures showed that there had been a reduction of 843 nurses between November and December last year. Does that not sound the clearest of alarm bells that some parts of the NHS are already in danger of forgetting the lessons of its recent past by cutting the front line too far? Do not communities need a clear, objective benchmark so that they can challenge staffing levels on wards, and would it not be a great help to them for the Francis recommendation on staff-patient ratios to be accepted? We learned last week that the Department has handed £2.2 billion from last year’s budget back to the Treasury. Surely that money would have been better invested in the front line and in bringing all hospitals in England back up to safe staffing levels.
Finally, I want to turn to Stafford hospital itself, which Monitor has recommended should be placed in administration. This doubt about the hospital’s future will be causing real concern to the people of Stafford. After all they have been through, I think we can all agree that they deserve a safe and sustainable hospital, and I hope the Secretary of State will soon set out a plan to achieve that.
Learning the lessons of Stafford cannot be done overnight. We all have to play our part. The Government have made a start today, but much more needs to be done and we will hold them to that.
The right hon. Gentleman talks about glaring omissions in the Government’s response, but there were glaring omissions in his response too. Where was the apology for Labour’s targets culture that led to so many of the problems; the apology for failing to set up a regulatory structure that had proper safeguards; and the apology for missing all those warning signs? This was not just the darkest day in NHS history, but the darkest day in Labour’s management of the NHS. It is time the Labour party recognised the policy mistakes it made.
Let me go through what the right hon. Gentleman says are omissions. First, on the duty of candour, we accept the principle of the duty of candour when it applies to hospital boards, but we want to be absolutely sure that there are not unintended consequences of applying it to hospital staff, because another part of the Francis report is on the importance of a culture of openness and transparency, and we do not want a culture of fear. We have therefore not ruled out criminal sanctions for hospital employees who breach a duty of candour—they already have a contractual duty of candour —but, as I said in my statement, we want to wait for the result of Don Berwick’s report on zero harm to ensure that we do not take any measure that impedes the openness we need in hospitals.
The inspection regime will apply to all providers. It is important that it should, but I remind the right hon. Gentleman, who mentioned private providers, that the problems happened at an NHS hospital. Trying to turn this into a debate on privatisation tells people that Labour is missing the point in the response to Francis.
We will not introduce statutory regulation of health care assistants, but we will introduce minimum standards of training for them. We will not introduce statutory regulation because we believe there is a risk that a database of 0.5 million to 1.5 million people could end up being a box-ticking exercise that fails to raise standards in the way we need. We believe we have another way to achieve the same end, which is what we will implement.
On nurse training, we believe it is important that nurses have hands-on experience of the front line, because nurses, when they are properly qualified, will be managing health care assistants. It is therefore important that nurses understand what it is like to be a health care assistant. We will be very careful in how we implement that to ensure that we do not create financial barriers because, obviously, we want to attract the best people into nursing, regardless of income.
On staffing levels and nursing numbers, I remind the right hon. Gentleman that the problems at Mid Staffs happened when Labour was in power, when budgets were going up quite significantly, and when numbers were going up. To distil the problem to one of numbers is, again, to miss the point. This is about the values of the people on the ward. If he wants to talk about numbers, he must accept that, because this Government have protected the NHS budget, which he wants to cut from its current levels, there are 6,000 more clinical staff in the NHS today than there were at the time of the last election.
On Stafford hospital, it is extremely important that, when we have problems such as the ones at Mid Staffs, we create a structure that makes it impossible not to deal with them. That is a difficult process. We are announcing today a time-limited process to ensure that Ministers and the system cannot duck difficult decisions when we have a failing hospital. Obviously, we will follow the Monitor trust special administrators’ recommendations and look at them carefully, but it is important to address the issues. The wrong thing to do would be to fail to do so, because that would lead to clinical failure.
I welcome the fact that the right hon. Gentleman broadly accepts the Francis recommendations. He asked whether we would respond to all of them. The inquiry was a public inquiry, which he refused to set up. As a result of that detailed public inquiry, there are 290 recommendations. It takes time to go through all of them in detail, but I thought it was right to come to the House today with our initial response so that we can get cracking with the important things right away.
Order. Dozens of colleagues are seeking to catch my eye, but I remind the House that the Government have scheduled today three ministerial statements on important matters, and colleagues will note that there are three Back Bench-inspired debates to follow, in which 48 hon. Members are interested in speaking. There is therefore a real premium on time, and I must appeal for single, short supplementary questions and characteristically pithy replies.
I thank the Secretary of State for coming to the House and making a statement that helps to restore our confidence in the NHS, which has been so badly undermined by Labour’s appalling stewardship. Will he take steps to ensure that any complaints procedure provides protection to patients and relatives who raise concerns?
My right hon. Friend makes an important point. The thing about complaints procedures is that we must have a system that is not about process and whether there is a response to a complaint in three days. The question is whether a hospital looks at and learns from a complaints procedure and changes its behaviour. That is what the right hon. Member for Cynon Valley (Ann Clwyd) and Professor Tricia Hart are looking into. Hospitals will be inspected against best practice to try to encourage as many of them as possible to adopt the very best complaints procedures.
The Secretary of State has announced that he will consult on a barring scheme to prevent managers who are found guilty of gross misconduct from finding a job in another part of the system. To how many managers of Mid Staffordshire would he expect that to apply?
The hon. Lady will know that, when it comes to individuals—appalled as I am, and as appalled as all hon. Members are, by what happened at Mid Staffs—I must try not to prejudge due process. If we are to bar people from employment, we must have a fair process and system and a right of appeal, which is required under our law anyway. However, I would not expect any manager responsible for the kind of things that happened at Mid Staffs to be able to get a job in the health service ever again.
I listened to Peter Walsh’s thoughtful contribution to the “Today” programme this morning. We will consider carefully whether to apply the statutory duty of candour, backed up with criminal sanctions, to hospital employees. The review on zero harm and creating the right culture in hospitals will report not in a long time, but before the summer break, so it is right to wait until we have it before making our final decision.
The Francis report said that three areas went wrong: the first was unprofessional behaviour; the second was a lack of leadership; and the third was that the overwhelming prevalent factors were lack of staff in terms of both absolute numbers and appropriate skills. Given that we have lost thousands of nursing posts in the past few years, is the Secretary of State missing the point?
If the right hon. Gentleman had listened to what I have said, he would know that the number of clinical staff has gone up by 6,000 since the last election, which would not have been possible had we cut the NHS budget, which is what Labour Front Benchers want. It is important to ensure that we have the right numbers in wards to care for people. That is exactly what the new chief inspector will look at. There is evidence that hospitals that have the highest and most respected standards of care ensure they have adequate numbers not just of nurses, but of health care assistants. The whole NHS needs to learn the lesson that it must not cut corners when it comes to care.
My right hon. Friend’s welcome statement shows just how important the inquiry was, and how vital its lessons will be for patient care and safety. The royal colleges have a great responsibility. Will he call them together on a regular basis to discuss how they are checking and raising standards in their professions to ensure first-class care for patients?
First, I thank my hon. Friend for his extraordinarily tireless work and for the extremely measured and mature attitude he has taken to the problems in the hospital, which is on his patch. Hon. Members on both sides of the House welcome that. He is right about the role of the royal colleges. There are some challenging suggestions in the Francis report for some of those colleges, but when we are seeking to raise standards, it is important that setting up that scorecard for the new chief inspector happens with the help of the royal colleges, whose business it is to raise standards in the NHS.
I thank the Secretary of State for his statement, and we welcome the continuation of this discussion at the Health Committee. One of the recommendations of Francis was for the Secretary of State to look at the overlap between the CQC and Monitor, both of which were involved and have accepted they were part of the failings. Under the new inspection regime, will the chief inspector report to the Secretary of State or to the NHS Commissioning Board?
Neither. The chief inspector will report to the CQC. The hon. Lady is right that one of the problems is the overlapping roles and the confusion of roles. What we are announcing today is a significant change in the responsibilities of the CQC. It will no longer be involved in putting right problems in hospitals: its job will simply be to identify problems, so it is not compromised in its ability to be the nation’s whistleblower-in-chief. The responsibility for putting right problems will lie with Monitor, the NHS Trust Development Authority, the NHS Commissioning Board and the wider NHS system. We want to make sure that the chief inspector is unconstrained and unconflicted, when his or her team goes into hospitals, from shouting loudly if there is a problem and continuing to shout loudly until it is solved.
These changes all come against a background of other changes in the NHS, such as clinical commissioning groups, Healthwatch and health and wellbeing boards, and I wonder whether my right hon. Friend would be kind enough to put in the Library a plain person’s guide, so that we can understand how these new regulators, inspectors and various other bodies fit in with each other—who is accountable to whom—so we as constituency MPs will know whom to approach and on what occasion. I am sure that all these changes are very welcome, but we need to understand how they relate to each other.
I am sure that my hon. Friend’s sentiments are shared on both sides of the House. Indeed, I could have done with such a guide when I started this job last September. I am happy to do as he requests, but from today’s announcement the most important thing that the country should know is that when it comes to failures in care, the buck stops in one place. It will be the chief inspector’s job to identify such failures and shout publicly about them, and that will be an important clarification that the system needs.
The Secretary of State talks about severance and follow-on employment. Does he think it is acceptable that when the former chief executive of Morecambe Bay hospitals trust had to step down in February last year, because of the problems there, he was kept on the books in secret and paid £250,000 from local trust budgets—which could otherwise have gone to local health care—and was transferred to the NHS Confederation where his responsibilities could include teaching future leaders and helping to redesign the system?
I very much welcome the return of student nurses to the wards for a year of their training. Project 2000 has much to answer for. On the subject of resourcing and staff to patient ratios, may I remind my right hon. Friend that many of the reports we have seen in the last few years, criticising hospitals for poor care and lack of dignity in the care of older people in particular, have shown that wards in the same hospitals have had very different standards of care? How can that be about resourcing?
My hon. Friend makes an important point. It is important that these assessments are made not just at an organisation level, but drill down into the different parts of a hospital, and we have taken that message on board from the Nuffield report on ratings. She is right that it is not just about resources, but sometimes it is about resources. Parts of a hospital can be understaffed when it comes to people who are required to perform basic and important roles in terms of care. Because it is a complex picture—and because numbers can be part of the problem, but are certainly not the whole problem—we want a chief inspector who will take a holistic view of every aspect of the performance of a hospital and be able to give proper feedback that a hospital can use to improve its performance.
May I press the Health Secretary on this point? I have raised several times the point that adequate staffing levels are crucial to patient safety and good care, but we seem to dodge around saying that it is a question of values, not of numbers. Francis said clearly that one of the issues was numbers. I have given examples of my local hospital, which views it as crucial that it has the right staffing mix, which it adjusts every single day, for the patients that it has. Will he stop avoiding this question and address it directly, because one in 10 hospitals do not have adequate staffing levels?
I am not avoiding it. I agree that adequate staffing levels are essential to patient care. I remind the hon. Lady that the shadow Health Secretary said to the Francis inquiry:
“I do not think that the Government could ever mandate a headcount in organisations. Whilst we could recommend staff levels, we were moving into an era when trusts were being encouraged to work differently and cleverly, and take responsibility for delivering safe care whilst meeting targets”.
The Secretary of State rightly talks about a betrayal of trust of the worst kind, and he is right. He is also right about zero harm, and about much else that he has done. But there is one serious omission—of accountability—and that must be robust and include the resignation of Sir David Nicholson. I also apportion responsibility to those former Secretaries of State who were not called to give evidence but bear a heavy responsibility for not having done the right thing at the right time.
My hon. Friend knows that I have a different view of the level of responsibility of Sir David Nicholson, but I agree that everyone working in the system at that time shares some responsibility for what happened. We must make sure that it can never happen again. The accountability that we are introducing, including criminal sanctions for boards that fail in their statutory duties, will be a significant change. The body that was responsible for what went wrong at Mid Staffs, according to Francis, was the board of the hospital, so that is where our focus must be. Today is also about getting the right structures outside the hospital to make sure there is accountability there too.
The Secretary of State has referred to the fact the chief inspector will inspect hospital performance at specialty or department level. How will that be done? If records, paperwork and bureaucracy are being reduced in hospitals, will hospitals’ own records be used to make those assessments or will the inspector use other information?
Of course we need to rely on good information being supplied by hospitals, and that is why we have said today that it will be a criminal offence for hospitals knowingly to supply wrong information. This goes back to an earlier question, and we will work closely with outside bodies, such as the royal colleges, to ensure that we establish the best way to judge, for example, cancer survival rates. One of the lessons of the success of measuring heart surgery survival rates is the importance of having a good risk-adjustment process in place. We will do that across the other 10 specialties that I announced today.
Although I acknowledge the Secretary of State’s genuine desire to improve hospital standards by the introduction of his new inspectorate, I am concerned about the further reliance on systems above individual responsibility. Will he assure the House that his new inspectorate will not become yet another component of the merry-go-round of management employment schemes currently found in the NHS? Will he also assure me that those implicated in previous hospital management scandals will not be employed as inspectors in the future?
My hon. Friend is right: we have to ensure that the inspectorate works in the successful way that Ofsted has worked in the school system, and does not make the mistakes that have been made by other regulators inside the NHS system. It is important that it is based on respected peer review, is thorough and is respected in terms of the input that it is able to give hospitals on improving their performance. We will work hard to make sure that we deliver that.
Every time there is a scandal, the response of the British political establishment is to load more controls, accountability and bureaucracy on professionals, yet every nurse and doctor I meet is fed up with what already happens. As a result of the reforms, will the Secretary of State assure us that we will now trust professionals to get on with the job they love?
I agree with those sentiments strongly. In parallel to this process and these changes, I have asked the NHS Confederation to recommend how we can reduce the bureaucratic burden on hospital front-line staff by a third, precisely because I want to avoid the issues that my hon. Friend mentions. This is about freeing up time for people at the front line, and one way is to have an inspection system in which everyone has confidence. Once there is the confidence that problems will be identified, it becomes much easier, as has happened in the education system, to give more freedom to people on the front line.
I thank the Secretary of State for his statement. The public inquiry has been thorough, with new standards put in place and lessons learned from the NHS in Staffordshire. Health in Northern Ireland is a devolved matter. Will he confirm that the report will be sent to the Northern Ireland Assembly Health Minister, Edwin Poots, so that improvements and guidelines can be improved for everyone in the United Kingdom of Great Britain and Northern Ireland?
May I commend my right hon. Friend’s emphasis on leadership? In Colchester, we have seen periods of good and bad leadership, and good leadership is self-evidently the right answer to hospital management. Can I therefore ask him to lay more emphasis on what constitutes good leadership and trust between good leaders and their employees in the health service right through the system, including from Sir David Nicholson downwards, and not to rely overmuch on regulation, which is no substitute for good leadership?
I agree wholeheartedly. It is very important that we understand that the benefit of the new inspection regime will not just be that it identifies failing hospitals, but outstanding hospitals too, so that we have a good model of leadership in the system from which other managers can learn. Yes, it is really important to have the right relationships between managers and their staff, but we should not mandate or regulate that from the centre. We want to have a system where people can learn from each other.
I received a distressing piece of constituency casework yesterday that underlines the importance of the announcement my right hon. Friend has made today. Does he feel that his reforms will build more of a culture of compassion in nursing care?
That is at the heart of what the reforms intend to achieve. An organisation as complex and as large as the NHS needs corporate objectives and targets—for example, we need to do a lot better on dementia—and we do set system-wide objectives. However, we have to ensure that those objectives, set by whichever party happens to be in power, never compromise the fundamental care and compassion that needs to be at the heart of what the NHS does. We are putting in the safeguards that ensure that that cannot happen.
Does the Secretary of State agree that the decision to grant foundation trust status to Mid Staffs in 2008 was catastrophic in terms of the trust taking its eye off the ball and focusing on targets rather than on care, and that, now it is being abolished just five years later, never again must a Government pressurise a trust into a particular organisational form just to validate its ideological policy, rather than because it improves the care of patients?
I would also like to thank my hon. Friend for the work that he does for his local hospital in difficult circumstances directly involved in this terrible scandal. I agree with him: the corporate objective to become a foundation trust overrode everything else in the hospital, at huge expense to patient care. We must never allow that to happen again.
What most people want when they use the NHS is a reliable, accessible service, and to know that when something goes wrong somebody will be held to account and brought to book. Clearly, that has not happened. What can the Secretary of State say to reassure our constituents that people will be held accountable on an individual level, and that we will not see this happen again?
That accountability is extremely important and happens on many different levels. In particular, we have professional codes of conduct for doctors and nurses, so that in the exceptional situations where those codes are breached, we know, as members of the public, they will be held to account. Those are done at arm’s length from the Government by the General Medical Council and the Nursing and Midwifery Council, but we are talking to them about why it is that still no doctor or nurse has been struck off following what happened at Mid Staffs—I think that is completely wrong.
I know I repeat myself, but adequate registered nurse-to-patient ratios are often at the heart of these failings, yet on page 68 of the report my right hon. Friend rejects the idea of any kind of national benchmarking or guidelines with regard to patient ratios. Will my right hon. Friend keep an open mind and meet me, Professor Elizabeth Robb of the Florence Nightingale Foundation and others from the profession so that we can explore this issue?
We are not saying that minimum standards of adequate staffing levels are not needed, but we reject the idea that they should be mandated from the centre—I think there is cross-party agreement on that. The chief inspector will look at and highlight the reasons for poor care and, if they are due to inadequate staffing levels, ensure that something is done about it.
On the rare occasions when a clinician or other member of hospital staff raises a problem and it is not taken care of, may I suggest that employers have a box in which to put in a note saying what the problem is? There should be a receipt so that if there is an inquiry later, it can be shown what the hospital should have paid attention to right at the beginning.
Staffing levels are important, but so are bed numbers. Many of the 41,000 beds lost under the previous Government were in my constituency. Consequently, we have massive pressure on beds, wards on purple alerts and very high mortality rates. Will any inspection regime include an assessment of safe bed levels?
The inspection regime will of course cover such issues as part of its inspection of whether basic standards of care are being met. Yes, of course such issues matter, but there are challenges beyond what an inspection regime can deliver which we will need to address to deal with these issues. In particular, a problem we are wrestling with at the moment is who will take responsibility for the frail elderly when they are discharged from hospital. One reason why they stay in hospital for a long time is because geriatricians are nervous about sending them back into the community. They do not think anyone will take responsibility for them and that is something we have to look at.
On the respective roles of CQC and Monitor, can my right hon. Friend indicate that he expects Monitor to use the full regulatory tools at its disposal and give appropriate challenge to the boards of foundation trusts and hospitals where failure is indicated?
My hon. Friend is absolutely right. One of the changes we are announcing today is that, in the case of foundation trusts, CQC will be delegating its enforcement powers to Monitor so that it has more powers to insist on necessary changes and ensure that fundamental standards are not being breached.