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Commons Chamber

Volume 564: debated on Tuesday 11 June 2013

House of Commons

Tuesday 11 June 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]

Consideration of Bill, as amended, opposed and deferred until Tuesday 18 June (Standing Order No. 20).

Oral Answers to Questions

Department of Health

The Secretary of State was asked—

Clinical Commissioning Groups (Funding)

1. What plans the Government have to change the NHS formula for funding clinical commissioning groups; and if he will make a statement. (158866)

Allocations to CCGs are the responsibility of NHS England. However, I have been advised that NHS England will rely on advice from the Advisory Committee on Resource Allocation (ACRA) for changes in the CCG formula.

The failure of the Government to use the long-established funding formula for the NHS in dividing the budget between CCGs in north Yorkshire has left us with glaring anomalies, so that in York, the funding is £1,050 per head, but for Scarborough and Ryedale, which is served by the same NHS foundation trust, the funding is £1,234 per head. That is quite unsustainable and will lead to further postcode rationing. The same funding formula must be applied to all CCGs throughout the country. When will that happen?

I share the hon. Gentleman’s concerns about the way that NHS funding is allocated to different parts of the country. The allocation in my constituency is about the same as in his constituency, and I have long worried that things like age and rurality are not factored into the final amounts in the way that they need to be. However, in this case NHS England decided that if it was to follow precisely the ACRA recommendations, it would lead to higher growth for areas with better health outcomes and lower growth, or even cuts, for areas with less good outcomes, which it thought would be inconsistent with its responsibility to reduce health inequalities. That is why it is conducting a fundamental review, which it says it hopes will inform the next set of allocations for 2013-14.

The Secretary of State will be aware that in my area of north Somerset, in Weston-super-Mare, the actual allocations versus the intended amounts of cash which should arrive with us based on the existing formula, are well below what they should be; so even without changing the funding formula, we are still getting dramatically less cash than we should. I urge the Secretary of State to look at that swiftly and see what can be done, within the existing spending envelopes, to make the allocations fairer.

As I said, I share my hon. Friend’s concerns about the way funding works at the moment. We are in a very difficult situation because if we were to move closer to the formula proposed by ACRA—I am sure he would agree with me that it is right that it is done independently of Ministers, and in this case it is done under NHS England—it would mean cuts in real terms for the budgets in other areas. Given the pressures overall in the NHS, that was obviously a decision that NHS England was very reluctant to make.

The last Government matched health funding to health need and reduced the gap in male life expectancy and infant mortality, but this Government have reduced the weighting for health inequalities. The Secretary of State’s public health allocations mean that the areas he has identified today with the biggest health challenges do not get a fair share. The area with longest male life expectancy, Kensington and Chelsea, gets £133 per head, but Liverpool gets £89, Manchester £86, Luton £61, and Slough just £37. If he really wants to do something about health inequalities, should he not match his words with deeds and give more to the areas with the greatest challenges?

The right hon. Gentleman really cannot have it both ways. The budget for public health is also decided by an independent body, and we gave everyone a real-terms increase and then used any remaining money to even out the differences, to get everyone as close as possible to the independent formula. But if we are talking about spending, I think the right hon. Gentleman needs to say precisely whether he stands by his assertion that Governments should cut spending on the NHS by £600 million—[Interruption.] He says he has never said it before, but actually, up till now he has always said that it was irresponsible for the Government to increase spending in real terms. We have increased it; we have increased it by £600 million. He needs to come clean on whether he still wants to cut the NHS budget.

Given that age is the main driver for an individual’s health care needs, why has not age been given more weighting in the funding formula in the past? I urge the Secretary of State to request NHS England to give as much weighting as possible to age in any future funding formula.

I recognise that my hon. Friend has campaigned on that issue a great deal, and I have great sympathy, because areas with high age profiles do have much greater needs for the NHS. That obviously must be weighted against things like social deprivation, which also have an impact. It is right for these things to be decided independently, which they are. The question is how we get closest to those independent allocations, and I know that that is preoccupying NHS England at the moment.

Pre-natal and Post-natal Care

2. What steps his Department is taking to ensure consistent and continuous provision of pre-natal and post-natal care. (158867)

The Government are committed to improving continuity of care during pregnancy and the post-natal period. To give women the personalised care that they deserve, we have increased the number of midwives by nearly 1,400 and the number of health visitors by more than 1,000 since May 2010. In addition, there are a record 5,000 midwives in training.

Will my hon. Friend visit Southend university hospital, and tell residents at first hand what steps the Government are taking to ensure that post-natal care meets clinical guidance and the Government’s aspirations to ensure that the maternity experience is continuous, with patients having one dedicated midwife?

I would be delighted to visit my hon. Friend’s constituency. He has been a tremendous advocate for maternity services, both nationally and in his constituency, in his time in the House. As I am sure that he has realised, if we want a genuinely personalised maternity service, we need to ask women about their experiences of care. That is why the Government are introducing a friends and family test in maternity from October this year.

The Minister knows full well that post-natal depression is the thing that is most likely to kill a healthy young woman, and we know how to deal with it, but in many areas across the country we are cutting the number of visits from midwives after births, and the support given. We know how to tackle post-natal depression. Why should it be that in some parts of the country the support is wonderful, and in others, it is non-existent?

The hon. Gentleman is absolutely right to highlight that there has, in the past, sometimes been unacceptable variation in the quality of post-natal care. That is why we are increasing the number of midwives and have done so by nearly 1,400, and why we are putting money and effort into increasing the number of health visitors, who play a vital role in supporting mums, babies and families in securing that important bond, and in supporting mums so that they get the right help when they suffer from post-natal depression.

Children's Heart Surgery (Yorkshire and the Humber)

3. What plans he has for the future of children’s heart surgery provision in Yorkshire and the Humber. (158868)

I asked the Independent Reconfiguration Panel to undertake a full review of the “Safe and Sustainable” review of children’s congenital heart services. I have received and am currently considering that advice, and will make my decision known shortly—perhaps very shortly.

I am grateful for that answer. Will my right hon. Friend accept that the Leeds unit has undergone the greatest scrutiny of any of the units included in the review, and has met all the standards required? Will he therefore assure patients, families and staff that both he and NHS England have every confidence in the performance and standards of the Leeds unit? If we are to have informed choices on the future of heart units, surely all units must be subject to the same scrutiny.

First, I want to congratulate my hon. Friend on the sustained campaigning that he has done for that children’s heart unit, and on the very responsible way that he has conducted himself in what has been an extremely difficult campaign for the people of Leeds. I have full confidence in children’s heart surgery at Leeds; I know that the Leeds unit does an excellent job. He will understand, as I do, that when there are safety concerns, they have to be investigated, but I am delighted that those issues have been resolved, and that surgery is continuing.

The hon. Member for Pudsey (Stuart Andrew) is right that the Leeds unit has been subject to greater scrutiny than any other unit, and the decisions in its case have been more seriously flawed than in the case of any other unit. What guarantee can the Secretary of State give those families across Yorkshire who depend on this major, life-changing surgery that the unit will not simply be removed from our county and put beyond their reach, taking away this vital service for them and their families?

The right hon. Gentleman will understand that I cannot prejudge the decision that I will take on reflection, having read the Independent Reconfiguration Panel report, so this morning I cannot give him an answer as to what will happen. However, I can reassure families in Yorkshire, and throughout the country, that where there are safety concerns, we will take them very seriously indeed and investigate them promptly, and where there are difficult reconfiguration debates to be had, we will not duck them, but in all cases, the interests of patients—patient safety and reducing mortality—must be our primary concern.

18. There seems to have been little reliable evidence for the suspension of services at Leeds, but rather for the safe and sustainable review itself. Will the Secretary of State now do what NHS England has so far refused to do to the Independent Reconfiguration Panel, despite the recommendation of the health and overview scrutiny committee in Yorkshire, and finally publish all the official e-mails between the Joint Committee of Primary Care Trusts and the National Specialised Commissioning Team between 2008 and 2013, so that he can finally learn the truth about the review and what has gone so wrong with it? (158883)

I know that NHS England is totally committed to transparency and when I make my final decision on the Safe and Sustainable review, we will publish a lot of information. But all the things that he refers to are subject to normal freedom of information processes, and I am sure that he will pursue those.

Tobacco Packaging

4. What his policy is on the introduction of standardised tobacco packaging; and if he will make a statement. (158869)

9. When the Government plan to respond to their consultation on standardised packaging of tobacco products. (158874)

The Government have yet to make a decision. We are still considering the lengthy consultation, and in due course we will publish a report on that.

We heard on the radio this morning about the poor state of the country on levels of cancer. The Government have an opportunity to reduce those levels by the Bill and by the minimum price for alcohol, but when it comes to the Queen’s Speech, have they again been persuaded by the blandishments of lobbyists, and instead of putting the health of the nation first, have put the needs of big business first?

I certainly do not agree with the latter part of that. Just because something was not in the Queen’s Speech does not preclude us from introducing legislation should we take that decision. The hon. Gentleman makes some important points when he talks about the link between mortality and choices about how much alcohol one drinks or whether one chooses to smoke, but we await a decision from the Government.

Many of my constituents, including Cancer Research UK ambassador, Elizabeth Bailey, are asking a simple question: why is it taking the Government so long to respond to this consultation? Is not the truth that they are caught up in interdepartmental squabbles while public health suffers?

No, it certainly is not, and I have given my views. The hon. Gentleman will know that like many decisions on public health, these are complicated matters. Most importantly, it is vital that we take the public with us. I have said before that I welcome a debate, and perhaps he and the hon. Member for Newport West (Paul Flynn) might come to you, Mr Speaker, and ask for a debate in this Chamber or in Westminster Hall. Let us have the debate, because taking the public with us is always important when we make these sorts of difficult and controversial decisions.

Does the Minister agree that some of the proposed standardised packaging is more colourful than the existing packaging, and given that we have a display ban on cigarettes, what on earth is the point of having standard packaging for something that cannot be displayed?

Unfortunately, I do not have enough time to advance all the arguments, but I am more than happy to meet my hon. Friend to discuss this with him at length and show him a packet of the said cigarettes from Australia, and he may see the light.

Does the Minister agree that there is nothing plain about plain packaging? It just shows the reality of gangrene of the foot with graphic images, which is not very attractive to hand round at a party.

The Minister is aware that smoking is the biggest single cause of health inequality, and she will know that the Labour Government took difficult, complicated and controversial decisions that were successful in driving down smoking from 27% to 20%, saving thousands of lives. Why are this Government stalling? When will they announce a decision? Or is it that the business interests of Lynton Crosby matter more to these Ministers than the health of the nation?

I am sure that Mr Crosby would be grateful for that bigging-up. I can assure the hon. Lady that, as she knows, if standardised packaging was as simple as she tries to suggest, no doubt the last Government would have introduced it in some way. I am proud of the fact that we have made sure that the point of sale legislation has been achieved. As she knows and as I have said before, this is a difficult and complex issue. It requires a good and healthy debate. Let us bring on that debate. Perhaps the Opposition would like to use one of their Opposition days to bring it forward. I will be more than happy to take part.

NHS Hospitals (Bed Occupancy)

Average annual bed occupancy rates for all NHS beds open overnight have remained stable between 84% and 87% since 2000. The Government do not set optimal bed occupancy rates for the NHS. NHS hospitals need to manage their beds effectively in order to cope with peaks in both routine and emergency clinical demand.

I listened carefully to what the Minister said, but the Royal College of Physicians has warned that this winter there were more black alerts—when a hospital has no beds available—than there were over the previous 10 years combined. What urgent action are the Government taking to reduce bed occupancy levels and prevent next winter being even worse?

We had this debate last week. The long-term pressures on the NHS, as we know, are the result of an aging population, with increasing numbers of older people arriving in A and E with complex needs, so the challenge is to ensure that they are better treated in the community. That is why my hon. Friend the Minister of State launched the integrated care pilots last month. We are also seeing more patients treated as day cases than ever before. About 80% of elective admissions are now treated as day cases, which shows a massive improvement in the speed and quality of care in the NHS.

Kettering general hospital is located in an area that has one of the fastest growing populations in the country and above-average growth in the number of patients aged 80 or over. What more can be done to send the correct signals to local authorities that they need to act quicker to get elderly patients out of hospital once they have been treated so that they can have the care they need in the community, thus freeing up hospital beds?

My hon. Friend is absolutely right that local authorities have a key role to play in integrated care. That is why in April this year the Government set up local health and wellbeing boards, which will bring about greater integration of care between the NHS, housing providers and social care locally. That will hopefully ensure that across the country we have a much greater focus on local health care needs and, in particular, on better supporting older people and people with long-term disabilities at home and keeping them out of hospital.

A moment ago the Minister mentioned more elderly people coming in through A and E, and I want to present the House with new, deeply troubling evidence of that. Nobody wants to think of a very frail elderly person with no other support at home having to come to A and E by ambulance, but that is what increasing numbers of elderly people are having to do. Buried in the general A and E figures is an appalling increase in people aged over 90 coming to A and E by blue-light ambulance, which is up by 66%, equivalent to more than 100,000 of the most vulnerable people in our society. That is an appalling failure and a sign of something seriously wrong in the way we care for older people, and it is set to get worse as home care is cut further this year. Will he investigate that increase urgently and act now to prevent the collapse of social care?

The right hon. Gentleman is absolutely right—there is almost an outbreak of consensus across the Dispatch Boxes on this issue. We both recognise, rightly, that there is a long-term challenge in providing more integrated, joined-up care to better look after older people. However, it is ironic that he should raise that concern, because a previous Minister in the other place, the noble Lord Warner, has made the case very clearly that the previous Government failed to invest adequately in elderly care throughout their time in office. That is why this Government—I hope that we can count on the right hon. Gentleman’s support for this—are investing in health and social care, more integrated services at a local level through health and wellbeing boards and—

Order. The answers are too long. They need to get shorter, because we have a lot to get through. It is very simple and very clear.

Given that we have the lowest ratio of intensive care beds in the EU, what are the Government doing to monitor possible risks in future?

The hon. Gentleman is right to point out that historically there have been challenges with intensive care beds. We are now seeing increases in some areas of intensive care, particularly paediatric intensive care and paediatric cots, to ensure that there is greater support in that service, but he is absolutely right that we need a greater emphasis on specialist centres focused on intensive care. That is something that the NHS Commissioning Board, NHS England, is focused on delivering. We need to ensure that across each region of the country there is more focused care and more specialist intensive care.

Cancer Waiting Times

Cancer waiting time standards set out a maximum two-month wait from urgent GP referral for suspected cancer, through to diagnosis, to the first definitive treatment. Quarterly performance in the past 12 months has consistently exceeded the performance measure of 85%; indeed, the current data show that 86.3% of patients were treated within this time frame.

I am a firm believer in bringing cancer care closer to people’s homes. My constituents have to travel thousands of miles during the course of their radiotherapy treatments. Will the Minister support my campaign for a satellite radiotherapy unit to be based at Lister hospital in Stevenage?

I pay tribute to my hon. Friend’s campaign, which he has been running for some time, and to all the great work that he does for Lister hospital. I am slightly worried that if I give him any support it might be the kiss of death for his campaign, but I wish him all the very best and all power to his elbow.

One group of people greatly affected by a cancer diagnosis are the carers who suddenly find themselves to be carers of people with cancer. Yesterday I met some people who are carers of people with cancer, and they told me that they did not get the information, advice and support that they needed to tackle that important caring role. Does the Minister agree that it is about time that we recognised those carers and started to give them the advice and support that they need because they suffer financial loss, hardship, loss of career and impacts on their own health?

I very much do agree. That is why I am so pleased that the Care Bill that is making its way through both Houses has special provision for people who are caring for others with cancer in the way that the hon. Lady describes.

Last week Monitor, the regulator for foundation trust hospitals, said that cancer patients are now waiting longer for treatment and diagnosis because of the A and E crisis in hospitals. Official NHS figures published that same day show that the number of patients waiting over three months for cancer, heart disease and other life-saving tests has more than doubled compared with only last year. Is it not obviously the case that this Health Secretary’s failure to cut the spin and get a grip on the A and E crisis is now seriously damaging patient care?

That was a very interesting speech but I am afraid that I do not accept the hon. Gentleman’s analysis at all. All cancer waiting time standards are being met, with over 28,000 patients being treated for cancer following a GP making an urgent referral for a suspected cancer. We have already heard about the action that this Government are taking to address the situation in accident and emergency; it was very well explained in last week’s debate

NHS Accountability

We have transformed accountability in the health system by setting up Healthwatch and introducing stronger local democratic accountability through health and wellbeing boards.

Croydon PCT’s accounts for 2010-11 showed a £5.5 million surplus; it subsequently turned out to be a £23 million deficit. The former chief executive and two former finance officers have adamantly refused to give evidence to a scrutiny committee set up by councils in south-west London. Does the Secretary of State agree that that is unacceptable and that NHS managers must be held to account, and given that two of these individuals still work in the NHS, does he have the power to compel them to give evidence?

Accountability is extremely important. Local authorities can require members or employees of local health service commissioners to appear and answer questions, and NHS organisations and individuals should co-operate with that. I am extremely concerned by what my hon. Friend says. He knows that I have received a report on this from the joint overview and scrutiny committees for six south-west London boroughs, and I will be responding shortly.

Does the Secretary of State agree that accountability would be improved if the private providers who are increasingly providing NHS services were subject to the Freedom of Information Act 2000? Will he ensure that as more and more services become privatised under this Government, those people are subject to the same freedom of information provisions as those in the NHS, because otherwise no committee can hold them to account?

Perhaps I could gently remind the hon. Lady that the previous Labour Government did not do this, despite making huge efforts to get more private sector involvement in the NHS. Providers must operate on a level playing field, and so the inspection regime that we are setting up, with a new chief inspector of hospitals, will apply equally to the private sector and the public sector.

Does my right hon. Friend agree that the introduction of health and wellbeing boards represents a very welcome introduction of democratic accountability into the management of the health and care system? Does he further agree that the acid test of health and wellbeing boards will be their ability to increase the pace of integration between health and care so that the service we deliver is more closely matched to the needs of patients?

As is so often the case, my right hon. Friend speaks extremely wisely on this issue. Integrated services will be the big thing that transforms the service we offer vulnerable older people, which the right hon. Member for Leigh (Andy Burnham) mentioned earlier. Health and wellbeing boards will have an extremely important role to play in bringing together local authorities and clinical commissioning groups so that we have joint commissioning of services for those very vulnerable people.

On accountability, whenever I have asked the Secretary of State how lives might be saved by downgrading Lewisham’s A and E he has cited the medical advice of Sir Bruce Keogh. My colleagues and I have repeatedly sought meetings with Sir Bruce and it is unprecedented in my experience to not receive a response to such a request. Is the Secretary of State satisfied with that? Is Sir Bruce free to meet Lewisham MPs, or has the Secretary of State told him not to?

Sir Bruce is free to meet anyone he likes. Actually, he had a meeting with MPs last month, which the right hon. Lady could have attended if she had wanted to do so, and there was extensive engagement with local south-east London MPs before the decision on Lewisham hospital was made.

Accident and Emergency Departments (Ministerial Visits)

I regularly visit a range of services across the NHS. Since taking up post in September 2012, I have visited 28 NHS front-line services, including seven A and E departments.

Will the Secretary of State confirm that a freedom of information request to the Department of Health revealed that he did not visit an A and E unit until April 2013, a full six months after his appointment and despite a clear A and E crisis over the winter-spring period under his supervision?

As ever, the Labour party is being selective in its use of information. As I have said, I visited seven A and E departments, including over the Easter period when we had some severe A and E pressures that I wanted to investigate for myself. Let me tell the hon. Gentleman about another thing that this Government have done that his Government never did: it is not just Ministers who are going out on to the front line; we have asked all our civil servants to go on to the front line for up to four weeks. I am extremely proud that my Department will be the first to connect with the front line in that way, and am even prouder of the response from my own civil servants, who embraced the scheme with great enthusiasm.

Could we have some accountability for the strategic planning of A and E services across London? Nine of them face closure and 28 ambulances were redirected to Lewisham, which the Secretary of State intends to downgrade. Without a strategic approach, how can patients be confident that their best interests are being served?

We do have a strategic approach, but we also have some very important safeguards that any big change in approach has to go through before it is implemented. That is why I asked for a report from the Independent Reconfiguration Panel on the plans for north-west London, and I will consider that report very carefully before I make any decision.

When considering issues relating to A and E closures, particularly the proposed closure of the A and E department at St Helier hospital, which serves my constituents, will the Secretary of State ensure that those who propose such plans make sure that there is also a costed plan for developing out-of-hospital care, which is an essential prerequisite for any changes to acute services?

I agree with my right hon. Friend on this issue. It is extremely important that all these plans take a holistic view both locally and nationally. That is why, in looking at how to resolve the A and E issues we have faced and the severe pressures last winter, we are looking not just at what happens inside A and E departments, but at primary care alternatives and the integration of social care services, which are all equally important.

Perhaps it took the Secretary of State so long to visit an A and E unit because he could not get in. In the midst of England’s A and E services experiencing their worst waiting times for a decade, the Secretary of State criticised hospitals for coasting. Does he regret waiting for six months before first visiting an A and E unit and finding out for himself what damage his policies were doing to the front line of the NHS? Hospital consultants, A and E consultants and patients look forward with interest to hearing his answer.

We will take no lessons on being connected with the front line from the party that missed 50 warning signs about what was happening at Mid Staffs. The hon. Gentleman cannot make the narrow point about how many A and Es I visited during a particular period without addressing the broad point about how connected Ministers in his party were when they were in power. They rejected 81 requests for a public inquiry because they did not know what was happening at Mid Staffs.

NHS Resource Allocation

Allocations to the NHS are the responsibility of NHS England. However, I have been advised that it will rely on the advice of the Advisory Committee on Resource Allocation for changes to the allocations formula.

While many wealthy areas are overfunded, Cornwall is more underfunded than anywhere else in the country. In the past six years, it has received in excess of £200 million less than the Government say it should receive. It also receives the lowest tariff in the country for acute care. Is the Secretary of State prepared to meet me and other representatives from Cornwall to address the serious issues that that is causing in front-line care?

My hon. Friend has had meetings with my ministerial colleagues on that issue and knows that such decisions are made at arm’s length from Ministers by NHS England. The allocation for NHS Kernow is £1,235 per head and the average baseline clinical commissioning group allocation is £1,184 per head. However, I recognise that there are issues with rurality and the age profile of the population. That is why a fundamental review is taking place of the approach that ACRA takes.

In response to a parliamentary question that I tabled, the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), stated that circa £15 million in underspend was handed back to Public Health England by the now dissolved primary care trusts on Merseyside. Given that Liverpool has been identified as having some of the greatest health inequalities, will the Secretary of State guarantee that every penny of that £15 million will be spent in Merseyside alone?

What I can guarantee is that there will be a real-terms increase in the public health budget for all local authorities under a two-year settlement, which they did not have before. I hope that the information that was published this morning, which shows how cities that are comparable to Liverpool are managing to get better health outcomes, will help the local authority in Liverpool to improve its results.

Mental and Physical Health

11. What progress he has made in delivering parity of esteem between mental and physical health. (158876)

One of NHS England’s objectives is to ensure that mental health and physical health are given equal priority. By March 2015, we expect the NHS to demonstrate measurable progress towards achieving parity of esteem, so that everyone who needs them has timely access to evidence-based services.

Freedom of information figures that were obtained by Mind from Southern Health NHS Foundation Trust reveal that in my constituency, the number of people with mental issues who are admitted to hospital, rather than treated by specialist crisis resolution and home treatment services, is higher than average. What steps is the Department taking to ensure that everyone has access to mental health crisis care services that provide alternatives to hospital admission?

I applaud the work that Mind is doing to demonstrate the stark differences between the treatment of people with mental health problems who are in crisis and that of people with physical health problems. Its work demonstrates that without proper liaison services, people end up in hospital, at increased cost to the NHS. I have asked all the relevant bodies to get together to agree a plan to ensure that there is urgent crisis care for people with mental health problems, like that experienced by people with physical health problems.

I am most concerned that as well as the problems at the crisis level, there is not enough support for people with low-level mental health issues so that they do not get into crisis. Although I welcome what the Minister has said about improvements by 2015, does he not agree that we need stronger and more defined targets to get the progress that is needed towards the mental health services that are required across the country?

I agree that the more we invest in preventive care, the more we will save problems down the track and stop people’s health deteriorating. Areas that have managed to integrate mental health with primary care have seen good results, with better treatment, quicker access to treatment and less deterioration of health. That is the approach that we need to take.

NHS Services (Local Commissioning)

By April 2013, 211 clinical commissioning groups were authorised to commission the majority of NHS services for their local populations. CCGs are now empowered to design and deliver services based on the needs and choices of their patients, and NHS England will support CCGs to deliver high-quality outcomes.

I thank the Minister for that answer. My constituency struggled under a particularly inefficient primary care trust. It is, of course, early days, as the Minister has explained, but Surrey Downs CCG is already saving costs in bureaucracy so as to invest strategically in cutting counselling waiting lists, increasing funding for children with multiple disabilities, and setting up virtual wards run by a matron to supervise care in the community. Will the Minister join me in welcoming those important GP-led improvements in local care?

I applaud the CCG for the priorities it has set. Reducing waiting times for access to psychological therapies is a really good move, and the virtual ward has the potential to keep people out of hospital, maintaining their health better and reducing cost to the NHS.

Hackney CCG was one of the first to be up and running in shadow form. It is now operational but it is still persisting with a tendering approach to out-of-hours services. Will the Secretary of State write to the CCG to explain what has been said in this House—that tendering is not a requirement—and make it absolutely clear where the law lies?

The point I have tried to make all along is that this is about the judgment of the clinical commissioning groups, and nothing is imposed by the Government in what is required of them. European procurement rules existed under the Labour Government and this Government, but it is up to CCGs, working within the health and wellbeing board arrangements, to commission as they see fit for the benefits of their population.

Despite Witham town’s growing population, our GP ratio remains above the national and regional average. Does the Minister agree that the local commissioning model, and the CCG in particular, would urge GPs to explore ways to expand Witham’s health care provision to meet the needs of the growing local population?

I know that my hon. Friend has campaigned vigorously and consistently on this issue and the needs of her local community, and I agree that GPs ought to explore all ways they can of improving health care for her community.

May I declare my interest, and ask the Minister whether he is satisfied with the progress being made by CCGs in the provision of diabetes prevention work?

I understand that all clinical commissioning groups have a lead on diabetes care, but we can do an awful lot more to improve prevention work. We know that if we guide people in self-care, we can achieve massive improvements in their own health and well-being, and reduce the number of crises that occur. I am happy to work with the right hon. Gentleman to ensure we do everything we can to improve diabetes care.

East Midlands Ambulance Service

13. What recent representations he has received expressing concern about the service provided by the East Midlands Ambulance Service. (158878)

Over the past year we have received more than 40 letters from MPs in the east midlands, including my hon. Friend the Member for Daventry (Chris Heaton-Harris), local authorities and members of the public, about the service provided by the East Midlands Ambulance Service NHS Trust and its being the best programme. My hon. Friend will also be aware that there was an Adjournment on the matter earlier this year.

The Minister will recall that I have raised a number of constituency cases with his Department and the Care Quality Commission about the standard of services provided by EMAS to my constituents, and how it treats its staff. Will he assure me that the Department will continue to monitor EMAS’s performance in the coming months?

My hon. Friend can be reassured that the trust development authority and the local chief commissioner for Erewash CCGs are closely monitoring the situation. Today, the Marsh review into the east of England ambulance service has been published, and lessons from that review about how management processes can improve front-line care for patients can be learned and applied across other ambulance services.

My constituency is also served by EMAS and it is evident that my constituents have cause for concern. Coupled with uncertainty about the future of the Leeds children’s heart unit and higher than average mortality rates in local hospitals, the situation is causing considerable concern. Will the Minister agree to meet me and neighbouring MPs to discuss those problems?

National Cancer Drugs Fund

In April 2013, NHS England published a national list of drugs available from the fund. The list was updated recently following a meeting of the national cancer drugs fund clinical panel. Clinicians can apply to the fund for the inclusion of a drug within the approved list.

The cancer drugs fund is due to come to an end in less than a year. Given that more than 28,000 patients have received treatment since the CDF was introduced, what discussions has the Minister had with NHS England on continuing funding for it after the end of the current arrangements?

My hon. Friend has campaigned vigorously to ensure that as many people as possible get access to the drugs they need. The fund has been a great success. More than 30,000 have I think now benefited from it. We want to do all we can to ensure that the good lessons we have learned from it continue.

Antimicrobial Resistance Strategy

15. What progress has been made on implementation of the UK five-year antimicrobial resistance strategy. (158880)

We will shortly be seeking cross-Government clearance to publish the UK strategy, which addresses the challenges raised in the chief medical officer’s annual report and sets out the priority areas for action, such as slowing down the spread of resistance, maintaining the efficacy of antimicrobials and supporting the development of new antimicrobials.

In January, the chief medical officer warned that the threat from antibiotic-resistant infections was so serious that it should be added to the Government’s national register of civil emergencies, the national risk register, alongside deadly flu outbreaks or catastrophic terrorist attacks. My hon. Friend is preparing a new cross-Government strategy on antibiotics. Given the growing evidence linking the routine use of antibiotics on intensive farms with antibiotic-resistant infections in humans, can she confirm that the strategy will tackle that reckless practice, regardless of pressure from industry?

I could give my hon. Friend a long answer, but in short, the matter will be raised at the next G8 meeting. Further to that, as a result of his excellent debate earlier this year, I undertook to write, and have done so, to my hon. Friend the Minister of State, Department for Environment, Food and Rural Affairs. He has replied that the Government recognise that we should look at the guidance issued to farmers. I am more than happy to share the Minister’s letter with my hon. Friend.

St Helier Hospital

I am sorry, Mr Speaker, I am all over the place and do not have now the answer to give the hon. Lady. I believe the programme was signed off in 2010—[Interruption.] In fact, I am right—[Laughter.] Well—[Interruption.] Now, now; that is very naughty from the right hon. Member for Leigh (Andy Burnham). As you get older, Mr Speaker, you sometimes start to forget things—[Laughter.] Not you, Mr Speaker, of course; you would never do such a thing, and in any event you are much younger than I am.

The Government re-approved the business case for the redevelopment of St Helier hospital in May 2010—I was right—as part of the review the previous Government’s spending commitments. As the hon. Lady knows, because of the various configurations and proposed configurations, no final decision has been made yet. We need to ensure that all the plans come to some sort of fruition.

At my age, I share with the Minister a problem with memory loss, but I do not forget the years when we were trying to get the £219 million redevelopment of St Helier hospital agreed, or that the proposal was supported by the Chancellor in his first Budget. The money is now being used as a slush fund by Better Services Better Value, but its idea is to increase the sizes of A and E and maternity units of all the hospitals around while closing those at St Helier. Does the Minister agree that that was not the intention of the money, and that any future development plans must go back to the Department of Health for agreement?

I pay tribute to the hon. Lady, who campaigns hard for her hospital, and quite rightly so. I have met my right hon. Friends the Members for Sutton and Cheam (Paul Burstow) and for Carshalton and Wallington (Tom Brake) and am more than happy to meet her to discuss all the important matters she raises.

Topical Questions

There have been two important developments since the previous Health questions. First, in response to pressure on A and E departments, my Department, together with NHS England, has started work on a vulnerable older people’s plan that will act quickly to address the underlying causes of the issues, including services that are not integrated, poor IT systems, confused emergency care offered to the public and poor primary care alternatives.

Secondly, following the tragedy at Mid Staffs, I am delighted to announced that Professor Sir Mike Richards has been appointed as England’s first ever chief inspector of hospitals. He is an inspirational leader who has personally championed huge improvements in cancer survival rates. He will lead the vital work of driving up standards of safety and care throughout NHS hospitals.

I thank the Secretary of State for that statement. Will he give the House an assurance that he will look at GP contracts, with a view to amending them to ensure that better care is given to older patients?

My hon. Friend makes an important point. Talk to any A and E department in the country, and they will say that poor alternatives in the primary care sector are one of the things that are driving the pressures on them. It is important that we look at the structures put in place by the 2004 GP contract to see whether they are the right way to provide the care we need to give to older people.

Last week, the Select Committee on Health took expert evidence on the increased pressures in emergency departments and the causes of the worst A and E crisis in a decade. On Wednesday, the Chair of the Committee told this House that the 2004 GP contract

“is not why those pressures exist.”—[Official Report, 5 June 2013; Vol. 563, c. 1605.]

Will the Secretary of State tell us whether the right hon. Member for Charnwood (Mr Dorrell) is wrong?

I advise the hon. Lady to listen more carefully to what the Chair of the Select Committee said. He actually said that he agreed with much of what I said on the GP contract. While the Opposition are defending the status quo of the 2004 contract, independent support for reforming primary care is coming from the College of Emergency Medicine, the Royal College of Physicians, the NHS Alliance, the Family Doctor Association and even the head of the Royal College of General Practitioners.

T2. In my borough of Southwark we have higher than average smoking rates, and the Cabinet member responsible for health has said that hundreds of people are dying early because they smoke. Can Ministers help me to persuade our Labour council that it is inconsistent to say “Don’t smoke” on the one hand and invest £2.6 million of pension funds in British American Tobacco on the other? (158892)

That is a good point, but I have to say that I am not convinced that it is just a Labour-run council that might have chosen to invest their staff pensions in this way; I strongly suspect that all political parties are guilty of this. While this is, of course, a matter for local authorities, it is also the sort of great campaigning work that MPs can do with their local councillors. It is even more important that they do that, given that they now have this great responsibility for public health.

T3. I welcome the leading role that the Department is taking in the formulation of a national strategy for TB. Its importance was reinforced by a recent all-party group report on resistant forms of the disease. One of the key points in the report was the importance of joint working in the development of the strategy, and that it should be public health-led. Does the Minister agree that NHS England also has a crucial role to play in the development of the strategy? Will she ensure that it works closely with Public Health England to develop it? (158893)

The short answer is yes. I pay tribute to the hon. Gentleman for the work of his APPG. We had a good meeting in December and I am looking forward to our follow-up meeting tomorrow when we will discuss this matter further.

T7. Now that public health responsibilities have, as has been discussed, moved to local authorities and Public Health England, can the Government confirm that raising awareness of the signs and symptoms of cancer and early diagnosis, which is of course so important, will be key priorities for those bodies? Will the Minister tell the House how the Government will assess progress? (158897)

Again, that is a very good point. I completely agree with my hon. Friend and pay tribute to the work of his all-party group on breast cancer. Screening is important. This is also a good opportunity to pay tribute to the Secretary of State’s announcement today of the publication on the website of such outcomes, which will not only drive huge improvement in public health, but, most importantly, ensure that we reduce health inequalities. The previous Government failed to do that; this Government are determined that we will improve them.

T4. An enormous number of people—largely women—involved in on-street prostitution are caught in a cycle of drug and alcohol abuse, and are working to feed their habit, but at the same time, beyond managing drug dependency, many drug and alcohol services do not offer any practical pathways out of prostitution or even ask whether the client wishes to exit prostitution. Will Ministers look into this issue, consider issuing guidance and write to me? (158894)

Absolutely yes on all those very important points. The hon. Gentleman makes an extremely important point to which I absolutely subscribe. I have regular meetings on this matter, and I hope that our sexual health strategy addressed exactly those points, but I am more than happy not only to write, but to meet him to discuss the matter further. If I might say, I think that all Members, whatever the party political divide, could do far more both here and locally to reduce the number of women who find themselves working on the streets as prostitutes. I have long taken the view that these are some of the most vulnerable people in our society, and without exception I have never met a prostitute—I used to represent many of them—who has not herself been abused, usually as a child. They are vulnerable people and we should recognise them for that.

T8. More than 5,000 schools across the UK now serve good-quality, sustainable meals with the Food for Life catering mark, but only three hospitals have achieved the same. It is often said that hospitals cannot do so because of the cost implications, but the three that have done so not only have incurred no extra costs, but, in the case of Nottingham hospital, have actually saved significant amounts. May I urge my hon. Friend actively to encourage take-up of the Food for Life catering mark as a model of best practice? (158898)

We will certainly look into the issue that my hon. Friend raises, but he will be aware that there are campaigns throughout the NHS focused on supporting local food producers, which is important in many constituencies, particularly rural ones, and developing best practice and encouraging nutrition. Chefs such as James Martin have been involved in helping to drive up standards of care, particularly in Yorkshire and other parts of the country.

T5. I listened carefully to the Public Health Minister’s answer just three questions ago, but the Government have disproportionately cut funding to the most deprived local authorities, including Liverpool, and these local authorities have today been shown to have higher mortality rates. How does the Secretary of State expect to close, rather than widen, health inequalities? (158895)

We actually gave a real-terms increase to all areas, including Liverpool, and followed the independent advice. If funding for public health in Liverpool is lower than it should be, that is because the last Government set the baseline way lower than it should have been.

T9. For the last decade, in the face of constant threats of closure to Heatherwood and Wexham Park, I have campaigned alongside local councillors, activists and residents to try to get the right balance of services across my constituency. The people I work with are very reasonable, as is the Secretary of State, so will he meet me and a small delegation from Windsor to discuss their options? (158899)

T6. Three Health Ministers have indicated their support, and one even voted for it, so will the Secretary of State either introduce his own legislation or back new clause 17 to the Children and Families Bill to ban smoking in cars with children present? (158896)

Well, it is a very good point, and the hon. Gentleman knows my own feelings. [Laughter.] No; it is important that we always get the balance right between good public health measures and not getting the accusation from both sides of being a nanny state. [Interruption.] No, no; it is all right his getting agitated, but he knows my view, and I am happy to give him any assistance I can—my door is always open.

Does the Secretary of State agree that any criminal investigation into the 200 to 300 deaths at Mid Staffs should extend not only to front-line staff, who risk getting scapegoated, but to all managerial levels, Department of Health officials and the heart of Government, so that we get answers about who knew what and when, and what action they took or—more importantly—did not take that could have prevented this tragic scandal?

I congratulate my hon. Friend on her determined campaigning on this issue. She will agree that we must allow the law to follow its course. The police are looking at the five reports on hospital safety that were undertaken, the inquests and the lists of patients who appear to have been treated badly, and they are talking to the relatives of those patients. We must allow them to do their work, but no one is above the law, and particularly in this case it is important that justice be done.

T10. With the Department of Health having awarded Cleveland fire brigade £198,000 from its social enterprise investment fund, will the Minister confirm, pursuant to concerns raised by the Fire Industry Association, that his Department undertook an assessment as to the compliance with the European state aid regulations of the state’s funding of community interest companies that compete to take business away from the private sector? (158900)

I would be very happy to look further into the issue and to meet the hon. Gentleman to discuss it.

Does the Minister agree that children’s heart surgery units such as the one in Leeds now need certainty so that they can continue to attract the highest calibre of staff?

I agree with my hon. Friend and the sooner we can make a decision and announce it, the better. This issue is of huge importance to the people of Leeds and I want to do all I can to expedite the process.

When a patient is ill and visits their GP, they will do as the doctor orders. One hundred thousand people will die of lung cancer this year. When will the Government do as the doctor orders and bring in plain packaging for tobacco?

I refer my hon. Friend to answers that I have given beforehand. I know the great work that he does on lung cancer and I am pleased to see that, yet again, we will have a national campaign following the great success of the last one. We can talk further.

This is cervical screening awareness week. What plans does the Minister have further to encourage women aged 60 to 64 to attend cervical screening, given the declining levels of screening uptake and the increasing levels of incidence in this age group?

Screening is one of the most important aspects of the work of Public Health England and we are keen to make sure that it is addressed both nationally and locally. Great work can be done by local authorities in making sure that women have this vital screening.

Is the Secretary of State aware of the alcohol treatment centre in the middle of Cardiff, which treats people who are drunk on Friday and Saturday nights and therefore takes pressure off A and E, ambulance services and the police? Will he look at this model, as we are in Swansea, and pilot it elsewhere?

That is definitely worth looking at and is exactly the kind of proposal that we could think about for NHS England. It could make a very big difference.

Will my right hon. Friend clarify the position regarding NHS spending, in light of the recent comments from the shadow Health Secretary? My understanding is that spending increased from £99.7 billion in 2009-10 to £106 billion in 2012-13; an increase of £600 million, or 14,000 nurses or 6,000 doctors. Does not this show that the shadow Health Secretary’s reference to cuts is just irresponsible scaremongering?

My hon. Friend is right. There has been a £600 million real- terms increase in spending, something that the right hon. Member for Leigh (Andy Burnham) said was irresponsible. He will have to do a U-turn on this, and it will be an embarrassing one. He has talked about cuts in every single debate in the House and it turns out that those cuts never happened.

Life expectancy in Liverpool is 10 and a half years less than it is in Kensington and Chelsea. Does the Secretary of State think that he has any responsibility to address that?

Yes I do, which is why we have published a website today that gives much more detail than there ever has been before about health inequalities. it is why, nationally, the Government have been responsible for a huge amount of initiatives to boost public health, including calorie labelling in restaurants, action on point of sale display tobacco advertising, alcohol unit labelling and a range of other things. We will play our part.

In April, the BBC’s “Casualty” programme highlighted the vital role that health professionals have in spotting young girls at risk of being taken abroad or of having female genital mutilation carried out on them in this country. We are approaching the most difficult time of the year over the long summer holidays, when girls are most at risk. Will Ministers do all they can to draw the attention of health professionals to the vital role that they have in these critical next two months?

Absolutely, and I pay tribute to my hon. Friend and to other hon. Members on both sides of the Chamber for the great work that they have done on FGM. I am really proud that the Government have produced the FGM passport, which is available to many young women. It does—I hope that it will continue to do so—protect women, especially younger women who are going abroad for this appalling abuse to be carried out upon them. We have done great work already with health professionals who increasingly realise, first, that they must be aware of it; secondly, that they must report it; and thirdly, that they must take action to prevent this appalling abuse of women, especially young women.

I listened to the answer to Question 7 earlier, but surely the best way to improve accountability in the NHS would be much greater consumer choice and competition when it comes to GP services, for which there are virtually no comparative data at the moment. With modern IT, why can patients not choose to have their own medical records and then ring round to find a GP who will treat them when they want to and not when their own GP deigns to see them?

What the hon. Gentleman says has a lot of merit. We need to have transportable digital medical records that can be accessed anywhere in the system. That would make better out-of-hours care much more possible than it is at the moment.

Order. I am sorry; demand always exceeds supply at Health questions, rather as in the health service, so we must now move on.


With your permission, Mr Speaker, I would like to make a statement on the future of examinations.

There is now a widespread consensus, underpinned by today’s authoritative report from the Select Committee on Education, that we need to reform our examination system to restore public confidence. That is why today we are publishing draft details of new GCSE content in core academic subjects. The independent regulator Ofqual is publishing its own consultation on the regulation of reformed GCSEs. We are publishing the draft content in English, mathematics, science, history, geography and modern and ancient languages alongside this statement. We will consult on that content over the next 10 weeks. We expect that these subjects, with the exception of languages, should be ready for first teaching in September 2015, with the first exams being taken in the summer of 2017. Languages and other subjects will follow soon after, with first teaching from September 2016 and the first exams being taken from the summer of 2018.

The new subject content we are publishing today has been drawn up in collaboration with distinguished subject experts, all with expertise and experience in teaching. I would like to thank them for their dedicated work. In line with our changes to the national curriculum, the new specifications are more challenging, more ambitious and more rigorous. That will mean that there should be more extended writing in subjects such as English and history. There should be more testing of advanced problem-solving skills in mathematics and science and more testing of mathematics in science GCSEs, in order to improve progression to A-levels. We should have more challenging mechanics problems in physics, a stronger focus on evolution and genetics in biology and a greater focus on foreign language composition, so that pupils require deeper language skills.

This higher level of demand should equip our children to go on to higher education or a good apprenticeship. We can raise the bar confidently, knowing that we have the best generation of teachers ever in our schools to help students to achieve more than ever before. Our education reforms—the growth in the number of academies and free schools and the improvements in teacher recruitment and training, as well as sharper accountability from improved league tables and a strengthened Ofsted—are raising standards in state schools. That means that new GCSEs will remain universal qualifications—accessible, with good teaching, to the same proportion of pupils as now.

The specifications that we are publishing today also give awarding organisations a clearer indication of our expectations in each subject. Under the previous system, specifications were often too vague. This caused suspicion and speculation that some exam boards were “harder” than others, undermining the credibility of the exam system as a whole. Including more detail in our requirements for subject content should ensure greater consistency and fairness across subjects and between exam boards. By reducing variability in the system, we hope to ensure that all young people leave school with qualifications that are respected by employers, universities and those in further education.

While making GCSE content more rigorous, we must also correct the structural problems with GCSEs that the coalition Government inherited. As today’s report from the Education Committee confirms, the problems with English GCSEs generated last summer proved beyond any doubt that the current system requires reform. Both the Education Committee report and Ofqual recognise that controlled assessment, which counted for 60% of the English GCSE qualification, undermined the reliability of the assessment as a whole. I therefore asked Ofqual to review the regulatory framework for GCSEs to judge how we might limit course work and controlled assessment and to reflect on how we could lift a cap on aspiration by reducing the two-tier structure of some GCSEs. I also asked Ofqual to explore how we might reform our grading structure, the better to reflect the full range of student ability and reward the very best performers.

Ofqual’s consultation sets out how reformed GCSEs can be more rigorous and stretching while encouraging students to develop and demonstrate deep understanding. It is proposed that course work and controlled assessment will largely be replaced by linear, externally marked end-of-course exams. It is proposed that the current two-tier system will end, except where it is absolutely essential: in maths and science. In those subjects, Ofqual is consulting on how to improve the current arrangements to deal with the concerns that we and others have expressed about capping aspiration. Ofqual is also consulting on a new grading system that will give fairer recognition to the whole ability range.

Young people in this country deserve an education system that can compete with the best in the world—a system that sets, and achieves, high expectations. Today’s reforms are essential to achieving that goal. By making GCSEs more demanding, more fulfilling and more stretching, we can give our young people the broad, deep and balanced education that will equip them to win in the global race. I commend this statement to the House.

I thank the Secretary of State for giving me advance sight of the statement and the consultation documents.

Here we are again. Last summer, we had “Bring back CSEs and O-levels”: dropped. Then it was the English baccalaureate certificate: dropped. Just last week, it was going to be I-levels, but there is no sign of them today. The Secretary of State is cutting back on resits for students, but he affords himself a fourth attempt at GCSE reform. The problem last summer was that he started with qualifications when he should have started with the curriculum. He was putting the cart before the horse—a grade A lesson in bad policy making.

When we were in government, we raised standards across schools. On the performance measure of five A* to C grades including English and maths, we went from 35% in 1997 to 59% in 2010. Let me give the House a quote:

“Schools got better over the course of the last 15 years.”

Those are not my words but those of the Secretary of State a year ago. The improvements were the result of a laser focus on literacy and numeracy, better teaching and better schools.

Parents are worried that, by allowing unqualified teachers into classrooms, this Government are damaging education standards. They want to know that the changes to the curriculum and qualifications will help to equip their children for the jobs of the future. Let me set three tests for the changes. First, will they strengthen rigour and raise standards, by introducing the rigour of the future that rejects a choice between knowledge and skills? We need both. Secondly, are the changes driven by the evidence of what actually works, here and elsewhere? Thirdly, will they command consensus and stand the test of time?

On the curriculum changes, we will study the detail of today’s proposals. We want to strike the right balance between setting out entitlements to high-quality education and freedoms for schools and teachers to innovate. What is the Secretary of State’s evaluation of how academies have used their freedoms, and of the implications of that for the future national curriculum? When will he bring forward plans for other subjects that are not covered by today’s announcement? In particular, what about the young people who want to study high-quality technical and practical subjects? For too long, they have been the forgotten 50%, yet there is no reference to them in today’s statement.

We support the reform of controlled assessment, but we do not support its wholesale abandonment across almost all subjects.

“Moving towards linear assessment will reduce the reliability of GCSE. Less coursework means less assessment time which leads inevitably to lower reliability—this is about as cast iron a rule in assessment as there is”.

Those are not my words; they are the words of Prof Dylan Wiliam, one of the distinguished experts to whom the Secretary of State referred in his statement.

What body of evidence supports this wholesale switch on controlled assessment? The Secretary of State has previously expressed doubts about tiering. I welcome the principles Ofqual has set out today. Has he changed his mind on tiering in maths and science?

On grading, I accept that there is a good case for more differentiation at the top end, but I am concerned about consolidation at the other end. Surely it is vital that there is challenge and stretch for all students across the ability range? There is a strong argument for moving to what Ofqual has described as scaled scoring, giving students the actual percentage mark subject by subject. I know Ofqual feels we are not ready for that yet, but does the Secretary of State share my aspiration to move towards such a system in the future?

In conclusion, there is a clear lesson from this past year: this is no way to conduct system reform. Future change should be informed by the evidence and should properly engage with professionals. If we do that, I think we really can achieve lasting and successful reform.

May I, first, thank the hon. Gentleman for his witty and discursive response? Picking through the thickets of the comments he made, I think there was a broad welcome for the direction of travel we have set out today, and in our efforts to achieve consensus across the House—which has always been my aim—I am grateful for that.

May I also thank the hon. Gentleman for his acceptance that Ofqual is right to recognise the case for tiering in mathematics and science? He asked what my view is: my view has always been that we should, wherever possible, seek to remove any cap on aspiration, but we have listened to the experts, and they conclude in this case that tiering in maths and science is appropriate.

The hon. Gentleman also asked whether I believe, as some do, that we should move from not just an alphabetical to a numerical skill, but to scaled scores. The consultation provides an opportunity for those who believe that that is appropriate to make their case. Ofqual will make a judgment, and I will listen closely to what it says, but I think the need to change the way in which we award grades reflects the improvement in teaching, to which he alluded and which I entirely endorse.

The hon. Gentleman asked about technical and practical subjects. As I have confirmed before, technical and practical subjects are our highest priority in the Department for Education, which is why our reforms started with vocational qualifications and the publication of the Wolf report. I recently wrote to the hon. Gentleman to ask him if he still stood by his endorsement of the Wolf report. I still await a reply, but I know he is a busy man and I shall wait patiently to hear what he has to say.

The final thing I should say is that the hon. Gentleman asks for evidence for the case for change, and all I need do is commend to him the superb work done by the Select Committee in its report today, which points out that it was the introduction of changes by the last Government that fundamentally destabilised GCSEs. The hon. Gentleman himself has acknowledged that there was grade inflation on Labour’s watch. Let us be clear: yes, there were improvements, thanks to changes in our education system and a higher quality of teaching than ever before, but they were put in doubt by Ministers’ failure to ensure that the gold standard was adequately protected. We are, at last, protecting the standards on which all our children depend.

Instead of all this perpetual messing about with the education or examination system, would it not be better and simpler to return to the arrangements of my distant youth, in which in order to matriculate—that magic but now disappeared word—pupils had, as the Secretary of State knows very well, to get six credits at school certificate level, one of which had to be in mathematics and one in a foreign language? If they got those six credits, they went on to the higher certificate, and if they could get two distinctions in higher certificate they automatically got a state scholarship and a guaranteed free university education. Everybody understood it, it worked very well, so why do we not go back to it?

First, may I say to my right hon. Friend that his youth is not that distant? He is still in the prime of life and the full vigour of all his abilities, and the system he has outlined, with credits for a broad range of subjects, is very similar to the English baccalaureate measure we have introduced. I did not know that, in introducing the English baccalaureate, I owed so much to my right hon. Friend, but I am happy to say that the virtues of the education system that existed in his youth have been reinstated. However, impressive as the education he enjoyed was, we also need to move with the times, and we are making a number of changes that better reflect the competitive nature of the 21st century.

Taken together, the three new reports announced today are not as bad as some of us may have feared. May I put it to the Secretary of State, however, that employers and post-16 providers want young people who have learnt how to learn, have been able to demonstrate that they are able to work in teams and are able to speak English as well as to write it? My experience through night school was that the old O-levels, with the final exams, were easy for those of us at the time who had a good memory. What we surely need to be moving to in the continuing consultation is removing the worst of the past and the over-emphasis on a modular approach and assessment, while not throwing the baby out with the bathwater. Will he continue to listen?

I am very grateful to be praised with faint damns by the right hon. Gentleman, and I entirely agree with him; it is important that speaking and listening sits alongside the composition, written and analytical skills in English language. That is what we propose to do, by ensuring that speaking and listening, which is inherently more difficult to assess, in what is a benchmark qualification, is assessed alongside the written component of English. I always look forward to hearing from the right hon. Gentleman, who is far, far more often right than wrong.

May I thank hon. Members from all parts of the House for their kind words and support since my accident?

I congratulate the Secretary of State on today’s statement. We have the broad outlines of the right policy and, unlike the shadow Secretary of State, I think that a Secretary of State who puts forward ideas, listens to the response and changes a Government policy as a result is making policy in the right way. However, may I put it to the Secretary of State that this has a tight timetable, so will he assure the House, parents and teachers that he will always ensure that getting it right is more important than sticking to the timetable he has set out?

I thank my hon. Friend for his generous words and may I say how good it is to see him back in his place in the House? May I also thank him for the fantastic work that his Committee has done in its report on what happened to GCSEs last summer, which is published today? I entirely take on board his endorsement of the Department for Education’s Hegelian approach to policy making of thesis, antithesis and then synthesis. We will make sure that the timetable is kept under review. We have already extended the timetable for A-level implementation to take account of precisely the concerns he has so wisely articulated.

The Secretary of State deserves an A* for his ability to cherry-pick the parts of the Education Committee report he agrees with while ignoring those parts he disagrees with. On grading, we all agree that there are good reasons for more differentiation at the top end, but surely it is not the top end that is our problem. So what in today’s proposals will support and challenge those 50% of children at the bottom end?

It is a very fair challenge from the hon. Lady, who has devoted a great deal of time in this House to reminding us how important it is that we tackle that tale of underachievement. We want to consult on exactly how the grading system can fairly reflect the full range of ability, but we also need to ensure that students who sit these examinations are supported long before they come to sit a GCSE so that they are able to achieve more effectively. We are making a series of interventions, ranging from the introduction of the pupil premium and the extension of 15 hours of free pre-school education to the poorest two-years-olds to the endowment from the Education Endowment Foundation fund to support research into how we can support the poorest students, which were intended to deal with precisely those children who are the strongest concern of both of us.

I welcome the Secretary of State’s statement that we are committed to one qualification, open to all, and to looking at how we can raise aspiration for all students. If the evidence from the consultation shows overwhelming support for some element of coursework in arts and humanities, as well as in the practical subjects, will he retain an open mind on it?

First, I thank my hon. Friend for all the work he has done throughout this process to ensure that it better reflects the needs of teachers, for whom he speaks so effectively. I have a real concern that coursework or controlled assessment in benchmark qualifications such as English and mathematics creates problems, but I listened to Ofqual when it argued that there should be an element of coursework to test bench skills—practical skills—in science, and I remain open to all arguments. I have a strong disposition, but it is not incapable of being swayed by strong evidence.

The Secretary of State will appreciate that I cannot speak about the detailed implementation of his reforms, but does he agree that an emphasis on rigorous qualifications and on obtaining core academic subjects is not, as is sometimes argued, contrary to the interests of working-class children and of black and minority ethnic children? On the contrary, precisely if someone is the first in their family to stay on past school leaving age, precisely if someone’s family does not social capital and precisely if someone does not have parents who can put in a word for them in a difficult job market, they need the assurance of rigorous qualifications and, if at all possible, core academic qualifications.

I am in love! The hon. Lady is absolutely right, and if I had been a member of the Labour party I would have voted for her to be leader.

I congratulate my right hon. Friend on his statement and, in particular, the reforms to ensure that essay writing skills are tested in English and history GCSEs, and the reforms that ensure a deeper understanding of and facility with mathematical processes and formulae in the maths and science exams, with less predictable and more demanding questions. Will he assure me that the exam boards, chastened as they are by universal criticisms of their failure on the stewardship of grade values, will not allow grade inflation to creep into these newly reformed GCSEs?

I thank my hon. Friend and pay tribute to him for the fantastic work he did in office to lay the foundations for some of the changes we are announcing today. I do think that the exam boards are chastened and that their current leadership recognise that the credibility of the qualifications they offer depends on their policing standards with even greater rigour than ever before.

The Secretary of State will know that rigour and reliability are quite elusive, that many Governments have tried to combine those two and that it is difficult to do so. May I welcome today’s report and what he said to the House, and the fact that this is going to be subject to consultation? However, may I say to him that sometimes he should learn the lesson that I learnt during 10 years as the Chair of the Select Committee, which is that you have to carry people with you—you have to carry parents, students, teachers and the broader community with you—and that he sometimes falls into the trap of being more in favour of disruptive innovation than building a consensus for change, which he really will need?

What are the Government doing to ensure that a putative future Labour Government will not falsely inflate the grades of schoolchildren, as Labour has done before?

My hon. Friend makes a very good point. We cannot guarantee that a future Government, of whatever political colour, will not be tempted to try to flatter itself by bringing in a little grade inflation. We have in Ofqual and in its current regulator a strong leader determined to ensure that that will not happen. It is a pity that we do not have the same robust system of regulation in Wales, for example.

The CBI has said that we need to produce “rounded and grounded” young people, but I understand that these plans will not assess those important competences, which business require. Why is the Secretary of State not listening to business organisations?

I very much enjoy listening to business organisations, even those such as the CBI that have historically perhaps been wrong on big issues—for example, the euro. Nevertheless, there is a lot that the CBI has said about education that I do commend, and I think that the introduction of a greater degree of rigour in English language writing skills and a higher level of demand in mathematics meet exactly the request from all sorts of businesses to ensure that there is higher attainment among the students they wish to recruit.

Does the Secretary of State agree that as a majority of people believe that GCSEs have become easier in recent years, these substantial reforms are essential to restore the confidence of employers and further education establishments in the GCSE system?

My hon. Friend is absolutely right. I know he is committed to education—we first met in a school in his constituency—and I know he absolutely believes that we need to restore confidence in these examinations. The only people who are let down if there is not public confidence in these examinations are young people, and he is absolutely right to point out that confidence has been eroded over time.

It is vital that the GCSE brand is consistent, and is respected, across the United Kingdom. Will the Secretary of State therefore tell the House what consultations he has had, or will have, with the devolved Administrations, including the Northern Ireland Assembly? Will he ensure that agreement and consensus can be reached, so that GCSE qualifications will not be compromised in any region of the United Kingdom?

The hon. Gentleman—my hon. Friend—will know that I am absolutely committed to the unity of this kingdom and I want to do everything possible to ensure that Ulster remains British. That is why it is important that we say to people in Northern Ireland, and in particular to Northern Ireland’s current Education Minister and the devolved Administration, that the changes that he might make to GCSEs have attracted the attention of the regulator, Ofqual, here. I do want to work with him and the many superb teachers in Northern Ireland to ensure that there can be as close as possible an alignment between our education systems.

Does the Secretary of State agree that our children deserve the best education we can give them, and that they get only one chance of that? Does he also agree that the extensive use of coursework has masked the true picture of some of our pupils’ abilities?

My hon. Friend is absolutely right. There are some subject areas—art and design, design and technology—where it is important to show practical skills through coursework, but there are other areas, particularly English and mathematics—particularly English—where, unfortunately, coursework and controlled assessment have not reinforced the rigour that we all want.

Following on from that last comment, why does the Secretary of State not believe that properly assessed and moderated coursework demonstrates a depth of understanding of a subject that simply learning facts to be churned out at an exam does not?

The hon. Lady misunderstands the fact that at the moment, as the Select Committee report points out today, coursework and controlled assessment can lead to over-marking and inconsistency. It is also the case that the modularisation of GCSEs, which occurred under a Labour Government, led to precisely the sort of cram-and-forget style of learning that I think neither of us approves of.

I warmly welcome today’s announcement. What representations has the Secretary of State had from employers’ organisations showing that they feel these changes are likely to add to the economic competitiveness of this country and make it easier for them to select credible candidates for employment?

My hon. Friend makes a good point. The CBI has pointed out that the number of employers who are dissatisfied with school and college leavers’ basic skills remains stuck at around a third; the Institute of Directors has said that the value of GCSEs has declined; and the Federation of Small Businesses has said that eight in 10 small businesses do not believe that school leavers are ready for work. Business recognises that we need rigour, and that is why business supports the coalition Government.

Teachers—even head teachers—who are responsible for delivering the Secretary of State’s curriculum have expressed little confidence in him on the nature and timing of his changes. When will he really listen to the professionals in schools who actually teach and plan and know what they are talking about?

It is an unfortunate myth that the profession is united. There is a range of views within the teaching profession and among head teachers. What is striking is that an overwhelming number of those who lead outstanding schools and are developing outstanding practice support the drive for higher aspirations that this coalition Government are leading.

Education is the best opportunity for poorer children to change their life chances. Does the Secretary of State agree that we need an exam system that employers and teachers have confidence in, to help those poorer pupils achieve in life?

My hon. Friend is absolutely right. Few people know more about the chalk face than he does, given that his partner is a primary school teacher. He is absolutely right that we need to change our examination system, to restore confidence that has unfortunately been dented.

The Secretary of State’s entire statement is about the importance of qualifications, and I am sure parents will appreciate that, but can he give parents an assurance that no unqualified teachers will be teaching these GCSE courses?

One thing I can say is that teachers are better qualified than ever, and the new head of the Teaching Agency and the national college, Charlie Taylor, has been responsible for changes that ensure that we have more highly qualified young people, teaching to a higher standard than ever before.

I declare an interest: my daughter is a teacher in a state school.

Does the Secretary of State agree that he is in danger of winning over teachers, winning over the Opposition and doing a very good job? Is that the way we should be proceeding?

I am grateful to my hon. Friend. He is absolutely right: sometimes we need to be divisive and pugnacious, but today I am glad that consensus on a number of issues appears to exist across both Front Benches.

Will the Secretary of State accept that his proposals will blight the value of the qualifications of those taking examinations in the next four years and break the union of qualification currency between England and Wales? Should he not have tried harder to get a compromise, instead of simply leaking the contents of his meetings with the Welsh Government to the press?

Into every life a little rain must fall. May I say to the hon. Gentleman that the fault lies, I fear, with those who have not been as anxious to preserve the rigour in the examination system as our regulator, Ofqual. I will say no more.

I welcome the removal of grade inflation—we owe it to our young people to have a value system that everyone recognises. However, as someone of Welsh heritage, who got all my qualifications in Wales, I am very concerned that certain qualifications will now have greater merit than others, which will disadvantage poorer communities, and some employers will not understand the two sorts of qualifications that may come about.

My hon. Friend puts her finger on a really important issue. One thing that I am anxious to do is to secure, with the help of the regulator, a proper understanding that can help us to encourage those responsible for qualifications in Wales to recognise which changes are appropriate and which are not.

As the Secretary of State knows, we have some of the best secondary schools in the country in Hackney, where rigour is very important. As the Secretary of State’s approach to education policy seems to be that it is in one day, out the next—he is playing hokey cokey—can he assure head teachers, parents and pupils in my area and around the country that there will not be a lot more changes down the path?

A clear direction of travel has, I hope, been set today and we will of course consult and listen, but the hon. Lady is absolutely right. In Hackney, a high level of ambition has been embedded for years, and I know there are head teachers and teachers in Hackney who welcome the direction we have set today.

I declare an interest, in that my wife is a teacher. The Secretary of State has already referred to the opinion of the Federation of Small Businesses that eight in 10 of its members thought that school leavers were not ready for work. How will these reforms address that problem?

Small businesses, like all businesses, want to ensure that students have the English language skills necessary to communicate with confidence in a business setting and the arithmetical and mathematical skills necessary to compete effectively in the 21st century. I believe that the changes we are making to English and maths—the benchmark qualifications—will meet the needs of business.

Would that every young person who had failed their resits on three occasions was able to claim that they were merely engaged in a process of Hegelian dialectic with the examining authorities, although I would prefer a more Socratic dialogue, such as has been engaged in in Wales. It is a real shame that the Secretary of State has set himself against coming to a common position across the whole of the United Kingdom. What I really do not understand for the life of me is why he thinks that learning vast quantities of “The Wreck of the Hesperus” or “The boy stood on the burning deck” or “If” will make young people better equipped for the work environment.

There are two things that I would say. First, I am always anxious to reach consensus with colleagues in Wales, but it takes two to make a consensus. [Interruption.] At least two. The second thing that I would say is that when it comes to learning English, yes it is important to have the utilitarian skills that business demands, but it is also important that children from every background are given a chance to appreciate beauty—the best that has been thought and written. I know that the hon. Gentleman appreciates beauty in many spheres of human endeavour—

And he is quoting Keats now. All I would say is that he is not the only person who has an interest in poetry. I was delighted when John Cooper Clarke, one of my favourite poets, said only last week that our approach to the teaching of poetry was absolutely right.

What discussions has my right hon. Friend had, or does he intend to have, with the Welsh Government on the issue? It is crucial that we retain the integrity and credibility of Welsh pupils in the eyes of employers and universities across the United Kingdom. Has he considered suggesting to the hon. Member for Hackney North and Stoke Newington (Ms Abbott) that she go to the Welsh Assembly to speak to her political colleagues about a positive way forward?

My hon. Friend is absolutely right. I respect the devolution settlement, and it means, of course, that the Education Minister in Wales can make the appropriate decisions which he considers to be right for Wales, but I want to ensure that we can work together in future to bolster confidence in all the examinations that young people take. I have already had a meeting with the Welsh Education Minister, which was frank and cordial; I hope that we can have further such meetings.

Further to the question by my hon. Friend the Member for South Antrim (Dr McCrea), the timetable is tight, and discussions and interaction with the devolved Administrations are vital. We should be ever mindful that they also have a legislative process to go through. What steps will the Secretary of State take to ensure that the timetable is not too rigid, so that delivery in all parts of the United Kingdom of Great Britain and Northern Ireland can be achieved?

That is a very good point, and we will work with the devolved Administration in Northern Ireland, and with Westminster representatives like the hon. Gentleman, who takes a close interest in these matters, to make sure, if we can, that there is proper alignment.

I thank the Secretary of State for his announcement, which is a huge step, putting more rigour and higher standards in academic subjects. May I press him on when we can expect the draft curriculum programme of study for design and technology, and in which year he expects that to be taught?

My hon. Friend is absolutely right. When we put forward draft programmes of study for different curriculum areas, some of them attracted more controversy than others. It is fair to say that design and technology was one of the most controversial. We have listened to some of the critics, and a new draft will be forthcoming in a few weeks’ time.

I pay tribute to the Secretary of State, who is responding to the demands of employers and higher and further education providers, and to the needs of pupils, by reintroducing rigour to the exam system. Does he share my concern that pupils in Wales, who may want to seek employment opportunities across the UK and beyond, could be disadvantaged if the Welsh Government refuse to follow this reform? Will he agree to make the qualification available, irrespective of the Welsh Government’s judgment, to those schools that want to pursue this new rigorous GCSE?

Absolutely—this qualification should be available to all state schools that have high aspirations for their students. Next Monday, I look forward to meeting Andrew R.T. Davies, the gifted gentleman who leads for the Conservatives in the Welsh Assembly. I will also talk to Welsh Conservative MPs, of whom there are a growing number, to see how we can take this forward effectively.