House of Commons
Tuesday 21 May 2013
The House met at half-past Eleven o’clock
[Mr Speaker in the Chair]
Business Before Questions
Humber Bridge Bill
Bill read the Third time and passed.
London Local Authorities and Transport for London (No. 2) Bill [Lords]
Motion made, That the Bill be now considered.
Bill to be considered on Tuesday 4 June.
Oral Answers to Questions
The Secretary of State was asked—
Judicial Review (Reforms)
The impact assessment of 23 April and the Government response to the consultation clarify the costs and benefits of our reforms, which are intended to tackle delays and reduce the burden, while upholding access to justice.
Figures published by the Minister’s Department confirm that the proportion of judicial review applications for planning and environmental cases has remained unchanged since 2005. Does she agree that, rather than facing a culture of so-called meritless judicial review applications, what we actually face is a meritless attack on people’s fundamental constitutional rights to challenge unlawful behaviour by public bodies and protect their environment, without a shred of evidence to substantiate the changes she is rolling out?
I do not agree with the hon. Lady. Judicial review is a critical check on the power of the state—and it will remain so—but it is also subject to abuse, stifling innovation, frustrating reforms and imposing unnecessary costs on individuals, business and the economy. Our reforms will tackle the burden while maintaining the benefits of the rule of law, access to justice and the right to a fair hearing.
In welcoming my hon. Friend’s remarks, may I urge her to look at other, wider areas where judicial review might be considered to some extent to be supplanting Parliament by interfering with the answerability of Government? I am thinking of some immigration tribunals and areas of the benefits system, where judicial review has been misused.
How can the Minister possibly claim that these changes are not damaging access to justice, when she knows full well that by reducing the possibility of taking cases to judicial review, public authorities and the Executive cannot be held to account by ordinary citizens? Why is she destroying what is so important in our justice system in this country?
Does my hon. Friend agree with the principle that public power should not be exercised to abrogate fundamental common-law values, at least unless abrogation is required or those concerned are empowered by clear primary legislation? If we have better and clearer primary legislation, we are likely to have less judicial review.
Offending by Probationers
On 9 May, I announced “Transforming Rehabilitation: A Strategy for Reform”, which sets out how we will transform the way in which we rehabilitate offenders to make progress in driving down reoffending rates. Under our proposals, for the first time in recent history, every offender sentenced to less than 12 months in prison will receive statutory supervision and rehabilitation in the community when they are released from custody. Alongside that, we will open up the market to a diverse mix of providers, freeing them to innovate and paying them by results, so that they focus relentlessly on reducing reoffending.
I would like to take this opportunity to praise the innovative work that my local Kirklees probation service is doing to bring down offending rates. Rates in West Yorkshire are down by 10% and in Kirklees the reduction is nearly 17%. I spent time with my local service over the Easter recess. What effect will the extension to a minimum of 12 months’ supervision in the community now have?
Good work is being done in many parts of our probation service, but overall, rehabilitation is not delivering what we expected it to, and reoffending rates are rising. However, I expect the teams that are delivering excellent work on the ground in our probation service to play an important part in the future that we have unveiled. In many areas, we will see those probation officers forming their own social enterprises and partnerships to deliver a high-quality service to us.
When I visited the Kirklees probation service, which is based in Huddersfield, I found people who were very demoralised by some of the Government’s proposals. They feel that they are undervalued, and I agree with them. The probation service is probably the most effective and efficient part of the criminal justice system. Are not the Government undermining its morale?
I am afraid that the hon. Gentleman is simply not right. The Select Committee found recently that only 25% of the time probation staff spent at work was spent working with offenders—the Committee’s Chairman is here today and he will recall this—yet the biggest block of offenders who are likely to reoffend get no support at all. That is why change is necessary.
We very much support the Government’s moves to extend supervision, but they also want private security firms to take responsibility for supervising medium-risk offenders in the community. That would include people who have committed violent and sexual offences. How do the Government plan to ensure that those private security firms have the appropriate skills and training to protect the public?
It is a pleasure to see the hon. Lady in her place today. I have begun to forget what the shadow Secretary of State looks like. His team regularly attends these events, but there are some faces missing.
The whole point of what we are trying to do is to address the glaring gap in the system that is leading to reoffending rates that are simply unacceptable. The mechanisms that we are putting in place to manage risk will provide a simple means of transferring offenders from a medium-risk category to a high-risk category if their situation changes and if a risk assessment carried out by the public probation service requires such a transfer. The public probation service will always remain responsible for dealing with the highest-risk offenders.
Does the Secretary of State agree that one way of maintaining continuity in the records of ex-offenders under his new regime would be to welcome in-house spin-offs such as those being proposed in Wiltshire? These would involve the existing probation service becoming a separate and private individual organisation.
I very much welcome the discussions that are taking place. Support is being provided by the Cabinet Office, including financial support, for those members of our probation teams who want to set up their own spin-offs, and I would positively encourage them to do so.
Employment and Support Allowance (Appeals)
The provision of feedback on reasons for tribunals’ decisions is always a matter for the judiciary. As the hon. Lady will be aware, new arrangements for this were put in place in July 2012. Her Majesty’s Courts and Tribunals Service is continuing to work with the judiciary, the Department for Work and Pensions and the other organisations involved to find ways of improving feedback.
The problem is that the feedback mechanism, which involves the use of a drop-down menu, is very brief. For example, the reason given for 40% of the overturned decisions was “cogent oral evidence”. That does not give decision makers in the DWP any real help in understanding how they can make changes that would result in fewer appeals. Surely it is necessary for the Department, which bears the cost of the appeals, to do something about this.
The waiting times for appeal hearings for employment and support allowance claims are far too long. The waiting time at the Leicester venue is now 40 weeks, which is a complete disgrace. What is the Minister going to do to sort this out?
My hon. Friend makes a good point. It is important to deal with these cases in a timely manner. National waiting times for ESA appeals are actually down, from 21.5 weeks in December 2011 to 16.7 weeks in December 2012. The figures are even better in Scotland, but of course more needs to be done.
That is a very good tie, by the way, Mr Speaker.
Does the Minister agree that so many incorrect first decisions having to be overturned by judges not only causes massive grief for the families concerned but incurs significant additional cost to the taxpayer? That is a double whammy. Surely it is time we got this right.
The judiciary provides feedback, which is being considered. In November 2012, over 60% of appeals allowed by tribunals had reasons for the decisions attached. As I indicated in response to the question before last, we are looking at a new pilot, and I will write to the hon. Member for Edinburgh East (Sheila Gilmore) about it.
The Minister told us earlier about what she views—wrongly in my view—as the exploitation of judicial review. Is it not the case here that poor decisions by Atos are piling work on the tribunals service and therefore costing the public more money? Why does her Department not liaise properly with the Department for Work and Pensions, or is this another case of one arm of the Government not knowing what the other is doing?
The hon. Member for Stoke-on-Trent South (Robert Flello) says “such as” from a sedentary position. Those measures include recruiting more judges, securing additional venues and more Saturday sittings in addition to striving continually to improve original decision making.
As part of our transforming rehabilitation strategy, we will create a new public sector national probation service, which will work to protect the public and build upon the expertise and professionalism already in place. The national probation service will work alongside new contracted rehabilitation providers and, in the future, the skills and expertise of probation professionals will be utilised across the public, private and voluntary sectors.
The Government say that private providers will support lower-risk offenders and will be paid by results, but private providers are already saying that they will accept only a small proportion of their fees from the results that they achieve. What is the real risk that providers will take and what proportion of their fee will genuinely be payment by results?
The hon. Lady will understand that in respect of these contracts there will be a requirement for providers to meet the expectations of the courts, so in relation to court orders there will be limited room for manoeuvre as to what is done, and offenders on licence will be expected to meet the requirements of those licences. These contracts could never be 100% payment by results. We will determine the percentage they will put at risk—they will put their own money at risk in this—by consulting all those involved in this business and all those involved in rehabilitation in the future. We will reach the right conclusions; we will work through this with all those involved.
18. I congratulate the Minister on his proposals to change the way in which the probation service works, particularly in respect of short-term prisoners. Will he clarify what the criteria will be to determine whether someone has successfully completed that period of probation? (156192)
My hon. Friend puts his finger on one of the big design challenges with which we have had to wrestle in designing this system. It is, of course, important that those providing rehabilitation services should be rewarded for a complete stop in someone’s offending. That is what the public are looking for here. However, we also want to make sure that there are no perverse incentives and that providers will continue to work with those who are difficult to manage and those whose lives are difficult to turn around. We will have a mechanism for payment by results that reflects not just a binary “did they stop offending altogether or did they not” measurement, but one of progress in respect of the number of times someone offends. By combining those two, we think we will get to the right measurement.
Employment of Ex-offenders
5. What plans he has to assist ex-offenders into employment. (156178)
We have already ensured that prison leavers aged over 18 who claim jobseeker’s allowance on release or shortly afterwards are referred to the Work programme immediately. We have also introduced work in prisons on a much larger scale than before, providing offenders with the real work experiences. Our transforming rehabilitation reforms will see new rehabilitation providers working to tackle the root causes of offending by using innovative approaches such as mentoring and by helping ex-offenders to find housing, training and employment.
We most certainly do seek to deport foreign national offenders, and my hon. Friend will be encouraged to learn that 4,500 or so were deported during the last year for which we have figures. However, we also think it important to remove such offenders while they are still serving their sentences if that is possible, which is why we seek to negotiate compulsory prisoner transfer agreements such as the one that we signed with Albania in January. We are working towards a similar arrangement with Nigeria. We want offenders to leave our shores, during the currency of their sentences if possible but otherwise immediately thereafter, because the right place for foreign criminals is not in our country but back in their own.
What involvement does the Minister expect the voluntary and community sector to have, and how does he expect it to dovetail with the Work programme in helping ex-offenders to find stable jobs? More importantly, how does he expect it to work for the purpose of resettlement, which, as we know and as the Select Committee said in its report, plays a major role in diverting people from reoffending?
As my hon. Friend says, and as the Select Committee has made clear, resettlement is hugely important. We agree that the voluntary and community sector can play a major role, and we think it important for that role to begin while offenders are still serving the custodial part of their sentences. The reforms that we have in mind will enable those who are dealing with rehabilitation to make contact with offenders early, and to see them through the prison gates and out into the community. One of the main ways in which we expect them to help offenders to go straight and stay straight is by finding jobs for them to do, for, as we know, keeping a job is one of the best ways of keeping out of crime.
The Minister is doubtless aware of National Grid’s young offender programme, under which 80 companies are now delivering training and jobs to those who are heading towards release. Does not a reoffending rate of less than 7% suggest that private providers can play a big part in the rehabilitation revolution?
I certainly think that it demonstrates that a range of different organisations have a significant part to play. I am familiar with what National Grid does, and I know that it does an extremely good job. One of the questions that it has raised with me is whether there are better ways of enabling it to work with offenders in a limited number of prisons. I think that the restructuring of the prison estate that we have in mind, which will ensure that prisoners can be released into the community from only a certain number of prisons, will help it to do even more good work along the lines that my hon. Friend has described.
I agree that mentoring is likely to play a significant part in what providers choose to do in order to turn lives around. I also agree that involving ex-offenders is a good way to start to find the mentors whom we will need. A great deal of very effective mentoring already takes place in prisons, with older and more established prisoners mentoring younger and newer ones. We want that to continue outside the prison gates, so that we can provide the kind of support that my hon. Friend has described.
Dealing with alcohol misuse and dependency is a major problem for many ex-offenders who need to find work. What discussions is the Minister having with the Department of Health, and indeed with those who are likely to provide probation services in the future, about improving alcohol treatment in prisons and after prisoners have been released?
I agree with the right hon. Gentleman that this is a hugely important issue. Given his knowledge of the subject, he will recognise that a consistent approach is also important. As I said a moment ago, the work should start while prisoners are in custody and continue as they go through the prison gates and out into the community, so that supervision and support for those with drug or alcohol problems can be maintained throughout the process to ensure that they do not relapse and go back to their old ways. We will certainly think about how we can engage with not just health service providers but rehabilitation providers, and do so over a longer period.
Offenders with drug addictions often lead very chaotic lives, and often relapse several times before they secure the help that will enable them to embark on the path towards a more normal lifestyle. They need a great deal of work over a long period, and they are often not directly ready even to start looking for a job. How will the Minister’s system of payment by results, and his efforts to get more offenders into work, take account of the work that will need to be done over, perhaps, a number of years?
As the hon. Lady says, this is a difficult and faltering path for many people with serious drug addiction problems. The system that we are designing, however, is based on the central tenet that people should do what works to reduce reoffending, and that those who do so will be rewarded for it. If someone has a major drug problem, it will be necessary for providers to address that in order to ensure that that person does not reoffend. I am confident that they will focus on those issues, and will do what is necessary to turn people’s lives around. If what is necessary in the case of a particular individual is getting him off drugs and keeping him off them, I am sure that that is what they will do, but we will need to bring in a number of agencies to work with them.
In Magilligan prison in my constituency there is a very good scheme preparing prisoners for the outside world and employment, and reducing reoffending rates. What measures can the Minister implement in conjunction with the devolved structures to ensure that such best practice is replicated across the entire United Kingdom?
I am grateful to the hon. Gentleman for that question. He will know that I do not have direct responsibility for the prisons in Northern Ireland, but he makes a good point. There will be examples of good practice across other Administrations from which we can learn, and we will certainly seek to do so.
Unfortunately, there is scant evidence of rehabilitation in the recent inspection report on Serco and HMP Thameside. Instead we hear of bad management, gang-related violence, and prisoners sleeping away the day spending up to 23 hours locked in their cells. We also now have irregularities in the tagging contracts and the sudden resignation of the G4S chief executive. Does the Minister not agree that this is more evidence of why we should be wary of rushing headlong into handing over our probation service to these same companies? A failure repeated outside the relative safety of prison walls would see dangerous offenders walking our streets completely unsupervised.
I think that what there is good evidence of is the need for reform. We need to make sure more work on rehabilitation is going on within prisons, as well as more work through the gate and out into the community. As the hon. Lady well knows, the truth is that there are good and bad reports on private prisons, just as there are good and bad reports on public prisons. We will want to make sure that we do everything we can to engage in rehabilitation while people are in prison. More work in prison will certainly help: 800,000 more hours were worked in prisons last year than the year before. Progress is being made, but there is certainly more to do, hence our reforms, which I hope the hon. Lady will support.
Youth Justice and Criminal Justice Act 1999
The Ministry of Justice is actively looking at the practical issues around implementing section 28 of that Act. Putting victims and witnesses first must be a common goal for everyone working in the criminal justice system. That is why this work has involved us working closely with the judiciary, the police, the courts and the Crown Prosecution Service, and it should be completed shortly.
I thank the Minister for his response. One victim of child sexual exploitation was aggressively cross-examined by seven barristers for three weeks in the Telford trial. Another was repeatedly called a liar until she broke down. Justice is not served by bullying vulnerable witnesses already scarred by their experiences. When does the Minister expect to be able to report further on the implementation of section 28, which allows pre-recorded witness evidence and cross-examination outside court, making the trial process less of an ordeal for victims?
I know that the hon. Lady has a long and distinguished record of activity in this area, and I am not asking her to be patient for much longer. As I said in my initial answer, we should come to a decision shortly. This is the last of the Act’s measures to protect particularly vulnerable witnesses to be implemented. I entirely share her concern that, within the confines of having trials conducted properly, vulnerable witnesses should receive proper protection.
We accept that section 28 is not easy to implement, but given the many recent appalling cases involving character assassination and the bullying of vulnerable witnesses, is it not now time to implement, as one measure, the approach proposed by many, including the Advocacy Training Council in its report “Raising the Bar”, of introducing compulsory training and certification for barristers in cases of this kind?
I am grateful to the hon. Gentleman for saying there are practical difficulties in implementing this. We are looking at a range of measures. He will be aware that our consultation on the victims’ code closed only a few days ago, and the Minister for victims, my hon. Friend the Member for Maidstone and The Weald (Mrs Grant), will be publishing a response this summer. Obviously, that must align with the witness charter as well. I hope all these things will come to fruition shortly.
We are consulting on proposed reforms of the legal aid system, as set out in our consultation document, “Transforming Legal Aid”, which was published on 9 April. We are seeking views on proposals to ensure that the criminal legal aid system in this country operates more efficiently, that we live within our means, and that we have a system in which the public can have confidence.
That information is already available to a degree. It is available to hon. Members and has been published under the Freedom of Information Act. It is very important that at the same time as ensuring we have a proper legal aid system that provides access to justice to all, we ensure that the payments we make are payments we can afford.
How can Ministers be confident that under their proposals there will be a genuine market and not just a few very large businesses that would have no great incentive to maintain quality once they got a fixed proportion of the business?
That is a very important point. First, I have absolutely no intention of ending up with a legal aid market dominated by a small number of very large firms. A central part of the tendering process will involve a quality threshold that ensures that we have the quality of advocacy and litigation support in this country that we need and expect.
The Secretary of State talked about the quality threshold, but his own Department’s consultation document warns against the danger that some advice might go above the quality threshold and therefore be too expensive. What does he have to say to that and how will he ensure that criminals get a proper defence?
The current graduated fee system is clearly broken and is costing a huge amount of money to administer. Will my right hon. Friend look carefully at constructive proposals to streamline the system and improve the system of criminal fees?
I can absolutely give my hon. Friend that assurance. I have been very clear in saying to both barristers and solicitors—to the whole legal profession—that this is a consultation. I have challenges to meet financially, but I am very open to means of improving the current system in a way that makes it affordable while maintaining the quality and effectiveness of provision.
Is it not the case that the Secretary of State intends to award legal aid franchises on the basis of price and not on anything else? That means that the lowest common denominator will prevail and one of the basic founding tenets of the legal aid system, equal access to justice, will be at an end.
How will the Government ensure that the proposed residence test does not leave many victims of human trafficking, unaccompanied child immigrants and victims of domestic violence with no access to justice? Is there not a real danger that our attempts to look tough on immigration will leave many vulnerable people without the justice they deserve?
Under the new systems we have put in place, the Legal Aid Agency has discretionary funding to deal with the very unexpected cases. However, I do not think that it is unreasonable to say that if someone is going to come to this country and access public support, they should have been here for a period of time and paid taxes before they do so.
More than 70% of the public, according to a poll in today’s papers, think that the Secretary of State’s cuts to criminal legal aid will lead to innocent people being convicted. Does he really think that miscarriages of justice are a price worth paying for his mismanagement of the justice budget?
I still do not think that the Opposition understand the nature of the financial mess they left behind and what we have to do to balance the books. I also think that the public would expect me to do what I can to maintain a strong prison system and a strong court system at the same time as having a legal aid system that provides justice while being affordable. That is what we are doing.
The hon. Gentleman will appreciate that over 45,000 personnel records are held by the National Offender Management Service and to determine firearms offences for all staff would involve extracting information from those files at disproportionate cost, but I can reassure him that all new recruits to the service undergo security vetting, and as part of this procedure, checks are made on criminal convictions. Any criminal conviction or caution received by staff or recruits is assessed carefully before a decision on recruitment or continued employment is made.
Rebecca Knighton was sacked using fabricated evidence, Steve Casey resigned following the illegal use of CCTV, and now, I understand, a senior manager has been convicted of a firearms offence but not sacked. Will the Minister meet me to discuss the managerial chaos at Ranby prison?
Depending on their individual risks and needs, offenders with a military history are eligible for the full range of NOMS interventions and offender services. Many prisons have a designated support officer for veterans in custody. Often these officers have served in the forces themselves, and they provide support tailored to the experiences that veterans may have had while on active service. Several probation trusts have an equivalent role for support in the community. The MOD has also made its veterans mental health services available to ex-service men and women in custody.
Since 2008, 300 veterans have gone through the veterans treatment court system in Buffalo, New York state. Not one has reoffended. That has been so successful that 103 similar courts have been set up across the USA. Will the Minister agree to meet me and others who support this process to see whether there are lessons that we can learn from the USA and adapt for this country?
The Minister, sadly, missed out on an excellent visit that the Secretary of State paid to my constituency recently, when he met offenders who were on the Royal British Legion Industries scheme; they had been through the criminal justice system and are now in work. Although it is essential that a cross-departmental approach is taken to help ex-service personnel re-integrate into society to stop them entering the criminal justice system, it is even more important to do so after they have been through it. What are the Government doing to raise awareness of the schemes that are out there to provide support and help?
I am grateful to my hon. Friend, who makes a good point. As I said, spreading information about best practice is extremely important. That is the basis of many of the reforms that we are introducing through the criminal justice system. If she perceives an information gap somewhere, I will be happy to discuss this with the Minister of State, Ministry of Defence, my right hon. Friend the Member for Rayleigh and Wickford (Mr Francois), who is the Minister with responsibility for veterans and who has significant overall responsibility in this area.
We have heard a lot this afternoon about our plans for transforming rehabilitation. It is worth restating to the House what I believe is a crucial part of those reforms: the alignment of the prison service geographically to areas into which people are going to be released, through the creation of a network of resettlement prisons. I think that will make as big a difference to the process as any other part of our reforms.
A recent report from the Charities Aid Foundation welcomed the opportunities that payment by results will create for the voluntary sector, but it also warned that many organisations will need support to ensure that they can become credible providers of services on a much larger scale. What help is the Minister putting in place to ease this transition?
We are doing two things. First, through the Cabinet Office, which has responsibility for liaison with the voluntary sector, we are putting in place widespread support to help the voluntary sector prepare for this process. We have also put in place a justice data lab, which is designed to allow smaller voluntary sector organisations that have a track record in working with offenders to quantify the impact of their work on rehabilitation so that they can sell a story about what they can do to partners in the bidding process.
I pay tribute to my hon. Friend for the work he did as Justice Minister on improving the availability of work in prisons. It is to his credit that we saw an increase of 800,000 in the number of hours worked in our prisons last year. My hon. Friend the Prisons Minister is building on that work and it is my hope and expectation that we will see that increase continue.
As my hon. Friend knows, on 9 May we published our strategy for transforming rehabilitation. The reforms we set out in that strategy will see new market providers delivering rehabilitation services alongside a single national probation service from autumn 2014.
As the Minister knows, there is great concern in the North Thanet and South Thanet constituencies about people on probation being located next door to vulnerable people, and also people with criminal backgrounds. Is this the right location? Should there be more risk assessment of where people on probation are relocated with their rehabilitation programmes?
My hon. Friend knows that risk assessment is always taking place, and it is important that it does so. She knows also that we are looking carefully at the specific circumstances that she raises in the area that she represents, and we will come back to her as soon as we can draw some firmer conclusions.
My ministerial team and I have met with a number of stakeholders since the launch of our consultation on legal aid reform. Among others, I have met the chair of the Bar Council, the president of the Law Society, members of the senior judiciary, the circuit leaders and a number of solicitors representing Law Society members.
I am sure that my right hon. Friend will have heard the same concerns that I have about restricted access to justice. Having started out as a young advocate a number of years ago, may I say that there is real concern that there will be less access to the profession, particularly for young barristers, with lower fees while they are trying to pay off their student loans?
We have taken care with these proposals to put together a package based on our statistical analysis which we think will protect incomes at the lower end of the Bar particularly. It is my intention that where we have to impose changes on the profession, they come through either the reorganisation of businesses or income changes at the top end of the income scale.
The Justice Secretary knows full well that his plans for price competitive tendering in criminal legal aid are completely opposed by the profession. They are unworkable. Will he now sit down with the chairman of the Criminal Bar Association and discuss a way forward out of this mess?
As the hon. Gentleman will know, the principle of price competitive tendering was first proposed in a report commissioned by the last Government eight years ago. We have looked carefully at the best way in which we can deliver better value in our legal aid system, which we have to do to meet financial targets. We will do so in a way that protects the interests of the justice system, but no change is simply not an option.
I understand the drive to try to save money in this area, but the Justice Secretary will be aware of many of the concerns. Will he look carefully at ideas that have been raised with him such as making more use of frozen assets to pay for cases or dealing with fraud cases more efficiently, to try to reduce the legal aid bill in that way?
I have a lot of sympathy with what my hon. Friend says on frozen assets. Of course, they are already used to fund police, the Crown Prosecution Service and victims’ services, so this is not an untouched resource. In the Crime and Courts Act 2013, we have taken powers to extend the use of frozen assets, but I do not believe that the amounts of money available are sufficient to make a material difference to our proposals.
I am not aware that I have received a letter concerning that. I obviously have regular meetings and exchanges with the Northern Ireland Minister. I will come back to the hon. Gentleman if I have received such a representation; I am not aware of having seen it.
Is not a defendant’s freedom and ability to instruct a solicitor of their own choosing the fundamental basis of our criminal justice system? Will not these proposals restrict the numbers of corporate entities, with vested interests and conflicts of interests, running prisons, probation services and representing defendants? And if Eddie Stobart gets a contract, why do not the Government go the whole hog, put the magistrates court in the back of the wagon and be done with it?
I am afraid that that contribution is what I would expect from the Labour party. This is not about creating an opportunity for giant firms. It is about saying to small and medium-sized firms, “You will need to change the way you do things to bring down costs, to share back offices, in a way that enables us to get better value for money for the taxpayer.” If Opposition Members really want me to place financial constraints elsewhere in the system, to close courts and to have fewer probation officers, rather than having a more efficient criminal justice system in the legal aid arena, that is their choice. I know which route I am taking.
Drug Addiction in Prisons
The Government are committed to helping prisoners with a drug dependency to live drug-free lives. We are working with health services to reshape drug treatment in prisons, establish wings in prisons that focus on recovery and abstinence, and connect offenders with community drug recovery services in custody and on release. We are also keen to use our new reforms, particularly the through-the-gate provision and the reconfiguration of the prison estate, to build on that collaboration.
I thank the Minister for that answer. The Rehabilitation for Addicted Prisoners Trust estimates that if just 10% of drug-addicted prisoners received abstinence-based rehabilitation, we might be able to save almost half a billion pounds a year. What progress has been made on replacing methadone prescriptions with abstinence programmes in our jails?
I entirely agree that we need to see more abstinence from drugs. My hon. Friend will know that one of the obstacles to proceeding down that path with many drug-addicted offenders is that they stay in prison for a very short period and there is no confidence about what happens when they leave custody. [Interruption.] Our through-the-gate reforms mean that we will be able to move more offenders on to that pathway much more quickly and be confident that they will be supported when they leave custody.
Victims of Crime
For many years victims have felt overlooked and completely unsupported by the criminal justice system. The Government are determined to put that right, which is why we are implementing a range of reforms that will put victims at the very heart of the criminal justice system, which we say is where they belong.
Today we will hear more about the tragic case of Maria Stubbings and how she was dealt with as a victim of domestic violence. Ministers have acknowledged that delays in our courts system disproportionately affect victims of sexual violence. Will they acknowledge that too many female victims in Britain get a raw deal in our criminal justice system, and what do they intend to do about it?
I categorically do not agree with what the hon. Lady has said. The Government are absolutely committed to tackling domestic violence and violence against women and girls. We have set up a national taskforce, led by my right hon. Friend the Minister for Policing and Criminal Justice, to protect children and vulnerable people from sexual violence. We have also opted into the EU directive on combating child sexual exploitation and will continue to do everything we possibly can to ensure that vulnerable people are protected from the devastating crimes that can do serious long-term harm.
I would like briefly to update the House on our proposed changes to the regime in our prisons. I think that the public rightly expect that prisons should be a place of punishment and rehabilitation. For too long prisoners have been handed privileges such as in-cell television, DVDs and association time as a reward for simply keeping out of trouble. That is not just unfair at a time when the rest of the country is doing without; it is a shamefully wasted opportunity. That is why we have announced a major overhaul of our incentives and earned privileges schemes in prisons. We want to see prisoners earning their privileges by working hard to turn their lives around. We have banned certificate-18 DVDs, subscription TV will be removed by the summer, prisoners will in future have a longer working day, and if they behave badly or do not engage with rehabilitation activities they will be stripped of their privileges. That is designed to improve confidence in our prison regime and to encourage positive rehabilitation activities within our prisons.
I would like to ask the Secretary of State about his plans to privatise the probation service. Following the Olympics security debacle, why does he believe that companies such as G4S are suitable providers to manage low and medium-risk offenders, including prolific burglars, drug-users and those convicted for domestic violence, if they could not manage Olympic security? How will he guarantee public safety?
What I want for our probation service is the best of the public, private and voluntary sectors: the public sector has high-quality skills in managing the risk of harm; the private sector can deliver a more efficient system, so that we can release funds to support those offenders who get no support at the moment; and the voluntary sector has the kind of mentoring skills we so desperately need to help people turn their lives around.
T4. Our criminal justice system may be the most expensive in the world, perhaps by a factor of two or three times, and yet we continue, as a state, to pay many practitioners several hundreds of thousand pounds a year more than we pay surgeons or scientists. This practice is of course enthusiastically supported by the Bar Council, and apparently by Opposition Front Benchers. Can the Secretary of State confirm that his consultation will at last bring to bear competition and market forces? (156201)
It certainly brings competition to bear. We are trying to take tough decisions on legal aid in a way that, where possible, impacts on the top end, not the bottom end, of the income scale. That is what we believe in, and I am surprised that Labour Members appear to disagree with us.
Has the Secretary of State read his interview with the Law Society Gazette this week? I would not blame him if he had not, because it is a bit of a car crash. Does he stand by the passages where he says that he has no evidence of a lack of public support for legal aid but has received “lots of letters”, where he is “unsure” where £160 million of Department spending has gone, and where he defends taking away a choice of solicitor because
“people in our prisons and…courts come from the most difficult and challenged backgrounds”
and are not
“great connoisseurs of legal skills”?
Not surprisingly, I do stand by interviews I give. We are now three years into this Government and Labour Members have no answers to any of the challenges we face. We have big financial issues to deal with and we need to create a system that is affordable. They have no alternative suggestions about how to do that.
The Justice Secretary has one answer: payment by results.
Last Friday, the Justice Secretary was forced to investigate alleged overpayment to G4S and Serco on the tagging contracts. Today the Financial Times is reporting that he has suspended outsourcing prison contracts to Serco, Sodexo and Amec. Should not he review all current contracts with the chumocracy of private firms who get the MOJ’s shilling, including Capita’s disastrous running of the interpreters contract, and should not he suspend plans to hand out another £500 million of probation contracts to more of the cosy cartel?
Sometimes Labour Members are breathtaking. I am not going to say much to the House today about the investigation that we are carrying out into the tagging contracts; I will provide that information in due course. I simply say to Opposition Front Benchers that the contracts we are investigating date back to 2005 and were signed and put together by the previous Government.
Our whiplash consultation closed on 8 March. We looked into the use of independent medical review panels and increasing the small claims compensation threshold. A response to the Government’s consultation will be published in autumn this year after the Transport Committee’s inquiry into whiplash.
We have already introduced changes that ban referral fees, and we are looking at other reforms that will tighten up the whole culture that exists around personal injury and similar claims. There is good work in parts of the legal profession in doing genuine work on behalf of genuine claims. However, there are too many question marks in the system. Now that we have made those changes, the challenge is for the insurance industry to bring down policy prices. If it does not do that, we will not hesitate to take action in the other direction.
T10. I strongly back the Government’s plans to get prisoners to do a full day’s work, but how can we make sure that they do not undercut the jobs of other UK workers whose businesses have higher costs than businesses in prisons? (156207)
My hon. Friend is absolutely right; there is a balance to be struck in this respect. We want more prisoners to be working, but we also want to make sure that jobs outside prisons are not unfairly undercut. That is why, as he knows, we have a code of practice that we have recently strengthened to ensure that that does not happen and that, where we can, we bring work in from abroad to be done in our prisons or use work in prison to support contracts that provide work outside the prison gate.
T5. Our criminal justice system is strengthened in its ability to deal with international crime through our co-operation in the EU’s justice and home affairs policies. Does the Secretary of State agree that this is another powerful reason why we should remain a full member state of the EU? (156202)
Chris Huhne and his former wife were released from prison recently after serving just two months of an eight-month sentence. In surveys that I have conducted, an overwhelming majority of my constituents believe that prisoners should serve their sentences in full. Aside from locking them up for longer, Mr Speaker, will the Secretary of State say how long he thinks people should serve in prison before they are released?
It is not the policy of the coalition Government to withdraw from the European convention on human rights. My party is looking at what proposals we want to put to the country at the next general election. The vast majority of the population want changes to our human rights framework. If the Labour party disagrees, I look forward to having that debate.
Further to the Secretary of State’s statement about prisons at the start of topical questions, does he agree that far too many drugs are still circulating in prisons? How far is he getting with his zero-tolerance policy, which is aimed at staff and visitors because the drugs are not coming into prisons with the prisoners?
My hon. Friend is right that too many drugs are still coming into prisons, but he will be reassured to know that the rate of positive drug tests is coming down. As he will know, we must also tackle the misuse of prescription medication in jails. We are addressing all those problems to the best of our ability and will continue to do so.
T7. There are some excellent local voluntary sector organisations that have valuable experience of working with offenders. How will Ministers ensure that small organisations with expertise are not shut out from rehabilitation work, while a handful of large private sector companies with little experience but deep pockets stitch it up? (156204)
The answer to the hon. Lady’s question has two parts. First, when we assess the bids for rehabilitation work, the bidders must demonstrate that they will support smaller organisations to carry out the work with them. Secondly, there must be contract management to ensure that as the contracts proceed, the smaller organisations are looked after and have a sustainable future. We will do both those things.
In common, I am sure, with colleagues across the House, I am dealing with the case of a chaotic, long-term drug addicted prisoner who has been in and out of the revolving door of prison. I could not be more supportive of the Government’s rehabilitation revolution. However, before anybody will take that person on, he has to demonstrate behaviour that, being chaotic and addicted, it is very hard for him to demonstrate. It seems to me that that is a small gap in the new arrangements. Will the Minister meet me to talk about how we can bridge that gap and get people to the stage where they can take advantage of the new arrangements?
I am very happy to discuss that matter further with my hon. Friend. I hope that she will be reassured that all offenders who leave custody or receive a community order will be allocated to a provider and will be expected to undergo whatever rehabilitation is appropriate.
T8. I welcome the extension of supervision to short-term prisoners, but I am concerned that Ministers continue to refuse to give an estimated additional cost for that provision, claiming that it depends on competition. Ministers must have made an estimate for the fixed fee that will be paid up front before any bonus for success. Will the Minister say what the fixed fee is likely to cost? (156205)
I understand why the right hon. Gentleman finds our position frustrating, but we cannot give a specific figure because it depends entirely on what price the bidders tell us they can do it for. I can tell him that the cost of providing for the additional 50,000 offenders will be covered by the savings that we make through competition. Opposition Members who dislike the idea of competition in this field must tell us whether they support the extension of the provision to short-term offenders. If they would not pay for it through competition, how would they pay for it?
Given that I do not have the time at the Dispatch Box that I might choose to discuss the matter, I would simply say that the European Commission’s recent decision to publish a justice scorecard assessing justice systems across Europe, and making recommendations for their improvement, is one that this country neither welcomes nor intends to co-operate with.
I am very confident that what we are doing, which involves encouraging the litigation part of our system to operate more efficiently and making changes to the top end of the income scale for the Bar, but also protecting incomes for the junior Bar, will be the best way of delivering an effective balance between proper justice and something that is affordable to the taxpayer.
Off the top of my head I think there are about 10,300 in our prisons at the moment. We are making progress, as I explained earlier, not only with individual compulsory prisoner transfer agreements such as the one that we have already negotiated with Albania, but with more effective use of the European Union prisoner transfer agreement. Something like 200 cases under that agreement are currently being considered for deportation by the Home Office.
A Bar Council and ComRes poll published this morning shows that more than 70% of the British public are concerned that the legal aid cuts will result in injustice, and lawyers in Newcastle believe that they will increase costs to the taxpayer. Will the Secretary of State meet me and a delegation from Newcastle to listen to concerns on that vital issue?
I have already met a number of lawyers from the north-east and Newcastle, and I will listen to all the representations that I receive to try to get this as right as I possibly can. However, the hon. Lady should not believe, and no one in the House should believe, that the Administration can avoid difficult financial decisions. I am trying to take those decisions in the way that provides the best balance between justice and value for the taxpayer, and that is what I will continue to do.
There seem to be ways of both making substantial savings and providing a better service and improving the way in which the courts operate, particularly by using more digital information so that documents do not get lost and fail to arrive in court at the correct time. What work has the Ministry of Justice been doing to try to achieve that?
I completely agree with my hon. Friend that the digitisation of the whole criminal justice process, not just in the courts but including the police, is absolutely essential to ensuring not only that we continue to provide proper justice but that we do so more speedily and efficiently. A huge amount of work is going on inside the Department, and announcements will be made.
The hon. Lady is absolutely right that that is a significant problem among young offenders both inside and outside custody. She may know that the comprehensive health assessment tool is currently used to identify those problems as early as we can, so that we can do something about them. As she knows, we believe that it is important to have a greater focus on education for all young offenders in how we structure the secure custodial estate for young offenders, and we are looking at that carefully having just closed a consultation on it.
We are looking seriously at the matter, which is one for Members of all parties to consider. If any hon. Member has experience of it in their constituency, we would like to hear about it, including the impact that it has had on businesses. We in the House have perhaps more awareness than anybody else about what is happening on the ground, and I would like to hear from hon. Members about it.
I am very grateful, Mr Speaker. I was going to ask the Secretary of State about legal aid. A vulnerable constituent of mine was charged on four separate occasions, and her solicitor, whom she appointed, was able to support her throughout. That ability is under threat from the legal aid proposals. Why is the Secretary of State proposing restrictions on access to legal aid for the vulnerable and those who cannot afford to pay?
I am not proposing that access to legal aid for the vulnerable be removed. Every person brought before a court or into a police station, and every person charged with an offence, will have access to legal aid for a defence unless they have sufficient means to pay for it themselves.
As the right hon. Gentleman knows from his previous ministerial experience, risk assessments are made for every prisoner when they arrive in prison. The changes we have announced to the prison regime are about ensuring that prisoners understand at the earliest possible stage that if they comply with the regime and engage with rehabilitation, they will be able to earn privileges. If they do not, they will not, but that does not affect the risk assessment process. I also point out that where there are exceptional reasons due to a particular vulnerability, governors have discretion not to apply those provisions.
A and E Departments
A and E departments are under great pressure, and the whole House will want to pay tribute to the thousands of doctors, nurses and health care assistants who work extraordinary hours in very challenging conditions. They are there for us when we need them, and we owe them a great debt.
More than 1 million more people visit A and E every year compared with just three years ago—those are additional numbers—and the simple fact is that if growth continues at that rate it will be unsustainable. It also means that when there are short-term pressures on the system, such as a very cold winter, teething problems with NHS 111 or bank holidays, the system cannot cope as well as it needs to and the quality of care is affected.
Let us be clear: A and Es are currently hitting the 95% target. The latest figures show that 96.3% of patients are seen within four hours, and people are waiting on average 55 minutes for treatment. However, if A and E services are to be sustainable, we need both short-term and long-term measures to address the underlying causes of the pressure they are under.
Last week, NHS England announced that it would change the basis on which tariff money for certain A and E cases is spent. For the first time, hospitals will have a say in how money is spent to alleviate demand when that money is withheld for numbers exceeding the 2009 baseline. We also need to address more fundamental issues, which is why I announced to the House on 13 May that the Government will publish in the autumn a vulnerable older people’s plan that will tackle those long-term underlying causes of pressure in our A and Es, particularly for the frail elderly who are the heart of many of the issues we face in both quality of care and service performance.
The changes the Labour Government made to the GP contract took responsibility for out-of-hours care away from GPs. [[Interruption.] Labour Members may not like to hear the facts about the consequences of those changes, but let us go through them—they asked the question. Since those changes, 90% of GPs have opted out of providing out-of-hours care, and they got a pay rise in addition. As a result of those disastrous changes to the GP contract, we have seen a significant rise in attendances at A and E—4 million more people are using A and E every year than when the contract was changed. As researchers from the university of Nottingham found, to give just one example, a reduction in out-of-hours services provided by patients’ usual family doctors is a direct cause of increased A and E attendance by children.
There are other issues too, including the lack of integration with social care, and vulnerable patients being discharged from hospital with no one co-ordinating proper health and social care to support them in their own homes. That lack of integration was something else that the previous Government failed to address over 13 long years.
Then there are the problems inside A and E departments caused by the disastrous failure of Labour’s IT contract. When people are admitted to A and E departments, the departments are unable to see their medical records, which could have an enormous impact—[Interruption.]
Order. First of all, the Secretary of State should not have to shout to be heard. Secondly, the more heckling there is, the slower progress tends to be. I want to accommodate colleagues, but as a matter both of courtesy and of practicality the Secretary of State should be heard in silence.
We will address those problems inside A and Es and the system-wide issues. It is not all about the GP contract, but that is a significant part of it, because confidence in primary care alternatives is a key driver in decisions on whether to go to A and E. We will take responsibility for sorting out those problems, but the Labour party must take responsibility for creating a number of them.
The Secretary of State could brief the newspapers last night, but he could not give a straight answer to my question today. He has not outlined his plans to change GP services.
The facts are that A and Es are under severe pressure and people are waiting hours on trolleys in corridors or in the back of queuing ambulances to be seen. Last week, a third of major A and Es missed the Government’s lowered targets—some were seriously adrift. At University Hospitals of Leicester, 78% of patients were seen within four hours. Seventy-nine per cent. of patients were seen within four hours in Portsmouth. Things have taken a more serious turn today, with news that 20 senior A and E doctors say they are unable to guarantee patient safety.
For weeks, the Opposition have warned the Secretary of State to get a grip. His only substantive response was to tour the TV studios to blame the 2004 GP contract. We today read that his answer is yet another costly NHS reorganisation, this time of GP services. Where is the evidence to support his contention that that will solve the A and E crisis? Why did he not outline his plans to the House—he has already given the news to newspapers?
This morning, the chief executive of the NHS Confederation told the Select Committee on Health that there is no link between today’s pressures on A and E and the 2004 contract, echoing expert analysis from the King’s Fund. If the GP contract is the root cause, as the Secretary of State claims, will he explain why 98% of people were seen within four hours in 2009, five years after the contract was signed? That figure has deteriorated sharply under his Government, and mainly on his watch. Major A and Es have missed the target in 33 of the 35 weeks when he has been Health Secretary. His complacency is dangerous. Is it not time he stopped blaming GPs to divert attention from a mess of the Government’s own making and addressed the real causes?
Two weeks ago, NHS England told the Secretary of State what those causes were. He needs to provide convincing answers on each. What steps is he taking to prevent the collapse of adult social care in England? What is he doing to ensure that all A and Es in England have enough doctors and nurses to provide safe care? Will he update the House on the status of his plans to cobble together a £400 million A and E crisis fund, news of which was leaked a fortnight ago? Will he halt the closure of NHS walk-in centres and personally review all planned A and E closures? What is he doing to sort out the failing 111 service? Did he not speed up implementation against official advice?
The truth is that this is a mess of the Government’s own making. It will not be solved by the Secretary of State’s spin or by blaming GPs. He has been found playing politics when he should be dealing with the real causes of today’s chaos. Faced with a real crisis, he has been found wanting. He needs to cut the spin and get a grip.
The right hon. Gentleman says, “Forget Wales,” but why has he never once been prepared to condemn the appalling failures in A and E in Wales, caused by the Welsh Labour Government’s decision to cut NHS spending by 8%? What he says would have some credibility were he at least prepared to condemn what has happened in Wales, but he never does.
The right hon. Gentleman asks for the evidence, and I will tell him. Patrick Cadigan of the Royal College of Physicians says that the pressures on A and E are caused because many people assume that, after 5 pm, the lights in the NHS go out everywhere except A and E departments—a direct consequence of those disastrous 2004 changes to the contract. Nottingham university conducted an independent study, and last year’s GP patient survey found that only 58% of patients know how to contact their local out-of-hours service, 20% find it difficult to contact their out-of-hours service, and 37% feel that the service is too slow—problems that we are trying to address. Perhaps he should visit some A and E departments and talk to consultants, doctors and nurses, because they will tell him that the changes to the GP contract, which he says have nothing to do with the pressures on A and E, have had a huge and devastating impact.
He talks about taking responsibility for these problems. Let us see if he is prepared to take responsibility. Is he prepared to take responsibility for the target-at-any-cost culture in some parts of the NHS under Labour, which led to the disaster of Mid-Staffs? Is he prepared to take responsibility for the IT failures that mean that A and E departments cannot access GP records? Will he nod his head if he is prepared to take responsibility? [Interruption.] He is not prepared. Is he prepared to take responsibility—
Order. Let us get this back on track. There are two very simple points: first, those on the Opposition Front Bench should not be yelling at the Secretary of State; secondly, for the avoidance of doubt, the responsibility of the Secretary of State is to answer questions, not ask them.
And I would always seek to do so, Mr Speaker.
Finally, the right hon. Gentleman constantly seeks to run down the performance of the NHS. Where is the recognition of the outstanding performance of the NHS under this Government: the fact that under this Government 400,000 more operations are happening every year than under Labour; the fact that the number of people waiting for more than a year for an operation has gone down from 18,000 under Labour to fewer than 1,000 under this Government; the fact that MSRA rates have been halved; and the fact that mixed-sex wards have nearly been eliminated? We will stick up for the great achievements of our NHS and we will not allow people to run it down. However, we will also tackle problems honestly and ensure that we address crises, many of which were caused by the previous Government.
Does my right hon. Friend agree that patients seeking urgent care will go to that part of the health service where the lights are on, and that the failure of the Opposition, over 13 years, to create genuinely integrated emergency care is the fruit we are now harvesting?
As ever, my right hon. Friend speaks with great wisdom. When it comes to the frail elderly, the key is to have a system that heads off problems before they arrive so that people do not find that they end up having to be rushed into A and E in the middle of the night. That can often be the very worst place for someone with advanced dementia or any condition that makes them extremely fragile and vulnerable. We need to integrate systems properly, and that did not happen under the previous Government. One of the key work streams of the vulnerable older people’s plan will be to look at barriers to integration, particularly the barriers to joint commissioning of social care and health. We intend to make good progress on that front.
Does the Secretary of State accept that when NHS Direct was operating, nurses had the professional competence to decide not to refer people to A and E, and to provide reassuring advice? They have been replaced by call handlers who, understandably, opt to send people to A and E because they have neither the professional competence nor the professional confidence to do anything else?
I agree that there have been teething problems with 111 and we are addressing those problems. [Hon. Members: “ Teething problems?”] There is laughter on the Opposition Benches. We are hitting our A and E targets at the moment, and 111 is available in more than 90% of the country. We are dealing with those teething issues, but I take on board the right hon. Gentleman’s point. The 111 service needs to be quicker at getting advice to people from a GP or a nurse. The fundamental issue with 111 is that giving the public an easy number to remember has highlighted how inaccessible GP out-of-hours services have become. We have to address that if we are to restore public confidence in 111.
If someone cannot get an appointment with their family doctor, they are undoubtedly more likely to end up in A and E, but does the Secretary of State agree that we will not increase capacity in primary care unless we address the work force shortage in general practice and broaden the skill mix of those who can see people in primary care?
I agree with my hon. Friend. Under this Government, we have 6,000 more doctors than we had under Labour, but we need more people going into general practice as well. [Interruption.] Yes, the training might have started under the Labour Government, but the funding happened under this Government, and it would not be possible if we cut the budget, which is what the Labour party still wants to do. She is right to point out those issues, however. One way of making general practice more attractive is to restore the personal link between GPs and the people on their list and a sense of personal responsibility and accountability. We need to find the right way of doing that, given the pressures on general practice at the moment, and I hope to work with her and many others to do that.
May I tell this complacent Secretary of State that in 28 out of the last 30 weeks Southampton general hospital has missed the waiting time A and E target? In the week beginning 7 April, only six out of 10 patients were seen within four hours. It is clear that this is a crisis of the whole health system. Given that in the last six months his own specialist advisers have praised the Southampton health economy for the role that primary care has played in reducing pressures on A and E, will he think again before simply blaming one group of doctors for a problem that runs right through the health system and into social care?
I am not blaming any doctors; I am blaming the Labour party for making disastrous decisions in office. We are addressing the issues that his party failed to address. If Southampton is not meeting its A and E targets, that is unacceptable. We are talking to all the hospitals struggling to meet those targets, but they all say—I am sure that people in Southampton would say this as well—that we need to look at the fundamental issues, which are barriers between the health and social care systems, poor primary care alternatives and problems inside hospitals with how A and E is handled. We are addressing all those issues.
Better co-ordination of ambulance trusts and A and E departments is essential, but it will not happen by accident. Are we not now missing the strategic health authorities, given that ambulances are being sent to units already working at full capacity?
By getting rid of the layers of bureaucracy we had with strategic health authorities and primary care trusts—a brave and important decision made by my predecessor—we have been able to invest in more front-line staff. The NHS is doing much more, in terms of the number of operations, out-patient appointments and people being seen by A and E, because we are investing in the front line, but it is the responsibility of the new clinical commissioning groups to ensure proper co-ordination, and I would expect them to do that.
The Secretary of State attributes the current crisis in A and E in part to a contract that doctors signed back in 2004 and the fact that large parts of the NHS turn off the lights at 5 pm or 6 pm, which they have done for 60 years. Is there anything for which this Government have been responsible in the NHS since 2010?
Yes, we have been responsible for a huge increase in performance, many more people being operated on, the virtual elimination of mixed-sex wards, MRSA rates being halved, more operations than ever before, more outpatient operations than ever before and more GP appointments than ever before.
I am struck by the fact that no mention has yet been made of the drivers of the reported chaos in A and E and the pressures on primary care out of hours. What of ageing? What of obesity? What of the changes in behaviour, the absence of stoicism, the increase in medical technology costs? Whatever the system that either the Government or the Opposition talk about, it will come under pressure. When will we have some reality in this Chamber about the causes of this problem, because the sooner we have, the better we will all be?
I recognise my hon. Friend’s clinical background. When I talk to clinicians in A and E wards, they tell me that the long-term drivers of the pressures they are under are an increase in the number of older people and an increase in the acuteness of the conditions of people coming through the doors. That is why at the heart of our long-term solution is a vulnerable older people’s plan that ensures we look after them with the dignity, compassion and respect they deserve.
Why does the Secretary of State not increase access to primary care during normal working hours by reintroducing the requirement on primary care services to see patients within 48 hours, as happened under the Labour Government?
That target led to many problems, as the hon. Lady well knows. She might remember, from the 2005 general election campaign, the issues of people being denied appointments for three, four or five days because GP surgeries were being paid to meet specific 48-hour appointments. That is one issue. Too often, if people call GPs for an appointment, they are told that the earliest they can have one is in two, three or four weeks, which makes them think, “What are my alternatives?” and leads them into A and E. We must think about how we can change that and alter the incentives in GP contracts so that they can give the kind of service to their lists they would like to.
Do I need to remind my right hon. Friend that the outgoing Labour Government in 2010 left a note on the desk of the Chief Secretary to the Treasury saying, “There’s no money left”? Is not the challenge the need to make the NHS work on more or less flat funding—though we are doing our best to increase it—while dealing with huge increases in demand? Is not the only answer to do more in the general practice setting, where it can be done more responsibly, more local to patients’ needs and more cheaply, in order to take the pressure off A and E services?
My hon. Friend speaks extremely wisely. We must do just that, particularly for the frail elderly, people with long-term complex conditions, because they are the people for whom an A and E department can be a bewildering place, especially if it knows nothing about them and cannot access their medical records. Prevention is far better than cure, and I agree that that is one way of doing it.
The Secretary of State advises us to visit A and E departments. Were he to visit the one in the excellent Ealing hospital in the constituency of my hon. Friend the Member for Ealing, Southall (Mr Sharma), he would see the grotesque, confusing and expensive sight of a spatchcocked urgent care centre next to an A and E department, one acting as a gateway for the other. It is confusing, divisive and expensive. Is he entirely comfortable with this concept?
The hon. Gentleman makes an important point. We have failed as an NHS to give the public confidence in there being anything between an A and E department and a GP surgery. Whether they are urgent care centres or other centres, the public do not have that confidence and do not understand their role. We need other things, besides those two extremes, and to do a better job of informing the public about how they work. That is part of the reason for reforming primary care.
May I invite my right hon. Friend to visit Frimley Park hospital, which serves his constituents and mine? I went there on Friday and saw the magnificent new A and E facilities in which it has invested. Yes, it has been under pressure in the past year or so, but it has managed and the out-of-hours service is being provided by GPs. I encourage him to come and see what a magnificent service is provided. Its excellent chief executive, Andrew Morris, raised with me the question of the tariff. Will my right hon. Friend explain a bit more his proposals to recompense hospitals such as Frimley Park, which are doing a fantastic job in A and E, for the additional burden they have had to assume?
I agree with my hon. Friend: Frimley Park is a terrific hospital and Andrew Morris a first-class chief executive. In fact, I am visiting Frimley Park in the next month and I will certainly have that discussion with him. My hon. Friend is right that one issue that A and E departments frequently raise is the tariff and the fact that they get paid only 30% of it for any A and E admissions over the 2009 baseline. That was why NHS England announced an important change a few weeks ago. Previously, hospitals had no say over how the money that is withheld from them is spent—it is meant to be used to reduce demand. We are now setting up urgent care boards, and hospitals will have a seat round the table to ensure that the money is spent in a way that reduces pressures on their A and E departments.
I have not seen any plans for the closure of St Helier. I know that NHS London is looking at possibilities to improve services in those areas, but, as the hon. Lady will know and should take comfort from, if a major reconfiguration is proposed and then referred to the Secretary of State by the local overview and scrutiny committee, I will not approve the change unless I am convinced that it will improve patient care.
Does my right hon. Friend agree that we could make better use of the ambulance service and that if we had more fully trained ambulance men who could assess whether a patient needed to go to hospital, we could reduce A and E admissions that way?
My hon. Friend rightly draws attention to the importance of the ambulance service, which is also feeling the pressure on A and E departments. We need to help the ambulance service to do its job better too. One thing that it always strikes me would make a huge difference to ambulance services is if staff could access the GP records of someone they were picking up on a 999 call, so that they would know that the patient was a diabetic with mild dementia and a heart condition, for instance. That kind of information can be incredibly helpful. I hope that by sorting out the IT issues with which the last Government struggled, we can help ambulance services to do that.
The Select Committee on Health heard evidence today from the College of Emergency Medicine about a 50% shortfall in trainee doctors and consultants. On average, trusts—I was going to say PCTs—spend £500,000 on locums. What does the Secretary of State intend to do about that?
We certainly intend to address A and E departments’ recruitment issues, which I recognise are one of the causes of the pressure. Over-reliance on locum doctors is not a long-term solution to improving the performance of A and E departments either, so those are both areas that we will be looking at.
The Government—Governments generally—cannot legislate to predict or control accidents or genuine emergencies, but they can direct resources. Hospital bed numbers have been cut by about 30% in the last 10 years. Does my right hon. Friend agree that it is difficult for A and E departments to function effectively if they do not have adequate bed capacity behind them?
I do agree, but what hospitals say is that the issue is not the number of beds, but the people in them who are not being properly discharged into the social care system. I was at King’s College hospital last week, where I was told that the hospital had probably two wards full of people who could be discharged into the social care system but had not been. Breaking down those barriers—something that I am afraid the last Government did not get round to doing in 13 years—will be an important priority.
The A and E department at Wolverhampton’s New Cross hospital recently saw a record 365 patients in one day. Those pressures will increase with the downgrading of Mid Staffordshire hospital. Does the Secretary of State agree that it will be deeply unfair to patients in both Wolverhampton and Staffordshire if the added burden on Wolverhampton’s New Cross A and E department is not met with increased resources from him, in terms of size and staff, to cope with the increased pressures?
Does the Secretary of State agree that the new role that GPs will play in commissioning will greatly assist the production of better community services and more integration with social care, all of which has been championed so frequently by the King’s Fund?