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Commons Chamber

Volume 569: debated on Wednesday 30 October 2013

House of Commons

Wednesday 30 October 2013

The House met at half-past Eleven o’clock


[Mr Speaker in the Chair]

Oral Answers to Questions

Cabinet Office

The Minister for the Cabinet Office was asked—

Disaster Planning

1. What assessment he has made of current arrangements for disaster planning in the UK; and if he will make a statement. (900778)

The primary responsibility for emergency planning sits with local responders. The Cabinet Office works with other Departments, devolved Administrations and emergency responders to enhance the country’s ability to prepare for, respond to and recover from emergencies.

The whole House will want to thank the emergency services, local authorities and the Met Office, who did a brilliant job working together to prepare effectively for and respond to the effects of Monday’s storm.

What specific mechanisms will the Minister put in place to ensure that the lessons highlighted in the forthcoming Hillsborough inquest will be incorporated in his Department’s policies and practice?

When the results of that come through, we will obviously look at them urgently. It was a profoundly tragic event, and many lessons will need to be learned from it. We will look at it seriously when it emerges.

In the Minister’s initial response, he praised responders and local authorities. Will he also praise parish councils—those unpaid heroes in many of our communities—which provide emergency responses, and encourage those that do not presently do so to create and implement emergency plans?

My hon. Friend makes a really good point. A lot of the response needs to be done on an extremely local basis. Many parish councils take this seriously, with volunteers who rise to the occasion superbly—a huge amount of which happened on Sunday and Monday in preparation for and in response to the storm.

Senior Civil Service Staff (Reductions)

2. What assessment he has made of the effect on the functioning of government of reductions in the number of senior civil service staff; and if he will make a statement. (900779)

Since April 2010, the number of senior civil servants has reduced by 16% and the senior civil service pay bill has reduced by 20%. Last year, civil servants helped to deliver more than £10 billion in efficiency savings by changing the way in which Whitehall and central Government operate. We are determined to drive even greater value for the taxpayer while continuing to provide exceptional public services.

Is not the truth that Government cuts have seen many senior civil servants take early retirement, with an enormous loss of expertise and capacity, with increasing staff churn and work overloads, leading to problems like the west coast main line franchise chaos, delays in replying to Members’ correspondence and much else besides?

I wish to take this opportunity to praise civil servants for the work that they have done. With a civil service that is significantly smaller than that which we inherited in May 2010, productivity has improved markedly. The civil service is delivering at least as much as it was before, with fewer people. Engagement scores have stayed high, and I want to praise them rather than run down what they do.

I join my right hon. Friend in commending the senior civil service for operating in the way it does. Does he agree that its capability is not enhanced by the degree of churn in the top jobs in the civil service, and what will the Government do to address that?

There has been concern over a long period about senior civil servants—and not just senior civil servants—not staying in post long enough. We are seeking to address that, and I know that the leadership of the civil service takes the issue very seriously. One of the effects of moving to fixed tenure for permanent secretaries will, I suspect, be to lengthen the period they stay in post rather than, as some have feared, shorten it.

Have the Government yet worked out when we will reach the tipping point at which reducing further the number of senior civil servants will not improve the service they provide but will impinge on it?

As I say, there have been significant reductions. Productivity has improved and we believe that significantly more productivity can be gained. Current departmental plans show a continued reduction in the size of the civil service through to May 2015. We are finding different ways of doing things better with fewer people and at lower cost.

Is it not absolutely right that the effectiveness of public services is more important than the number of civil servants who are employed? What measures is my right hon. Friend taking to measure the productivity of civil servants so they can no longer be a drag on our economy, but enhance it?

At is best, the civil service is not a drag on the economy; it is an important component of the economy working successfully. The leadership of the civil service identified significant deficiencies in capability, which are now being addressed. Frankly, they had been left unaddressed for far too long. Urgent action is now being taken and we need to drive it through.

National Citizen Service

The National Citizen Service is growing fast and is proving enormously popular with young people. The research shows clearly that it helps to develop life skills that employers value, and that for every £1 of public money we invest, society is receiving £3 of value back.

I thank the Minister for that answer. I was privileged to attend a challenge network campaign day in my constituency, where social action projects were put into effective and lasting programmes across the constituency. What steps will the Minister take to roll out the National Citizen Service further and expand it, and will he join me in congratulating the efforts of Enfield youngsters?

I certainly join my hon. Friend in congratulating Enfield youngsters and all youngsters across the country who have participated in the National Citizen Service on their efforts. He may be interested to know that to date the young people have contributed more than 1 million hours of their time to volunteer and do good work in communities. They get a huge amount out of that process, which is why we are ambitious to grow it and have said that we will make at least 90,000 places available next year.

Over the summer, I was delighted to see the excellent work of the National Citizen Service team in Chester, who were redecorating Blacon young people’s project. Has my hon. Friend made an assessment of the monetary value of the work that NCS volunteers do for their local communities?

I thank my hon. Friend for the keen interest he has shown in the NCS, and many other hon. Members who took the time to visit programmes over the summer. As I said, young people have to date contributed more than 1 million hours of their time to do good work in their communities. Part of the calculation of £3 back for every £1 we spend is the value attached to the voluntary time they are giving. The other part is their increased employability, which reflects the life and work skills they are gathering through participation.

Is the National Citizen Service not heading for that same graveyard of three-word prime ministerial gimmicks like back to basics, the third way, the citizens charter, the cones hotline and the big society?

Not for the first time, I could not disagree more with the hon. Gentleman. NSC is proving its value across communities. Many Opposition Members visited the programme over the summer and Opposition Front Benchers have nice words to say about it. We are determined to embed it in the youth sector and for it to be part of the landscape of programmes that try to help young people achieve their full potential. We are extremely proud of it. [Interruption.]

The hon. Member for Gloucester (Richard Graham) was gesticulating as though he was training to be an opera singer. I have no idea why, but let us hear from the hon. Gentleman.

The gesture was one of frustration and disappointment that some Opposition Members do not seem to understand how valuable the National Citizen Service is. Does my hon. Friend agree that what Gloucestershire college has been doing in my constituency to help people on to this wonderful course, which it is now replicating with a mini course for the new sixth form at the Gloucester academy, is an example of how the NCS can spread into the school curriculum too?

I could not agree more, in sharp contrast to my response to the hon. Member for Newport West (Paul Flynn). I look forward to visiting my hon. Friend in Gloucester to see in practice what he is talking about. The NCS is growing fast. We are seeing schools and colleges embrace it precisely because they see the value to their pupils of participating in a programme that helps young people develop the confidence, self-esteem and skills that will be valuable to them in life.

Can the Minister confirm that Serco has cut the funding it makes available to charities under the National Citizen Service? What impact does the Minister think that will have on the charities delivering this important initiative?

Serco leads a consortium that includes many large and small charities. It is an important provider. We manage our providers very carefully, and when there are signs of underperformance, we take action to protect the taxpayer. The hon. Gentleman would not know anything about that because he represents a party that over time has not represented the taxpayer sufficiently. In the case of Serco and that consortium, we took action to protect the taxpayer, and I am proud of that.

Last year, 6,000 places on the NCS summer scheme went unfilled, while youth services, which provided continuity, stability and a lifeline for many young people, disappeared. With one in three organisations that provide youth services facing closure, what has the Minister got to say to those young people?

First, I congratulate the hon. Lady on her promotion. I think she is the fifth shadow Minister I have faced across this Dispatch Box, and I hope she enjoys her time.

There is a serious point about cuts to local youth services by local authorities. We have taken over responsibility for youth policy and want to engage with local authorities to try to protect and enhance those services, but the hon. Lady misses a fundamental point about the NCS: it funds grass-roots youth organisations across the country to work with young people throughout the year—spring, summer and autumn—and therefore it is part of the solution.


We have committed an additional £210 million to the national cyber-security programme for 2015-16, underlining our commitment to tackling cyber threats. This year, we have launched the cyber-security information-sharing partnership and increased specialist capability in police forces, and we are currently setting up UKCERT, the national computer emergency response team.

Following the Snowden leaks in the US, where a contractor working for Booz Allen was able to cause untold damage to US and international intelligence services, what steps is the Minister taking to put in place restrictions on contractors and staff vis-à-vis access to this programme?

My hon. Friend has taken a close interest in this matter and made some extremely robust and helpful comments. We take contractor security extremely seriously, and following this breach, which took place in the United States, we are obviously redoubling our efforts to ensure that it is as secure as it can be.

When assessing the leaks from Edward Snowden and the reporting by newspapers, including The Guardian, will the Minister and the Government take clear account of the statement from President Barack Obama last week that some of the activities of the National Security Agency in the US raised legitimate questions for friends and allies?

I hear what the hon. Gentleman says, but I would just like to make this point about GCHQ: it comprises very, very dedicated, hard-working Crown servants who do incredibly valuable work to protect our safety and security every day of the week, and they deserve solid support from right across the Chamber and from both Front Benches. I hope that that will be made absolutely clear.

The Government are rightly trying to tighten up on British cyber-security. Does the Minister share my concern that anybody who weakens encryption methods or puts in back doors exposes us all to greater risk?

My hon. Friend is very knowledgeable on this subject, and everything he says about it must be taken extremely seriously. Yes, there is a point there to which we need to have proper regard.

According to the Government’s own figures, 87% of small businesses experienced a cyber-security breach last year and were attacked, on average, 17 times, yet more than four fifths of the Government’s cyber-security budget goes on the intelligence services, big business and government, leaving small businesses and consumers to fend for themselves. Now we learn that the Minister has set up his own wi-fi network in the Cabinet Office to bypass all that expensive security. When will he stand up for small businesses and consumers and get a grip on cyber-security?

I am glad to say that the most recent rankings of countries in relation to cyber-security had the UK in top position, but we are not at all complacent; much more needs to be done. The hon. Lady is very interested in the wi-fi arrangements in my office, which were installed by the Cabinet Office IT supplier and are fully compliant. We take all this extremely seriously, but the threats are changing all the time and we need to be agile in how we respond to them.

Post Office

6. What recent discussions he has held with his ministerial colleagues on the use of the Post Office as a front office for Government services. (900783)

The hon. Gentleman will know that the Post Office already delivers a number of valuable front-line services for the Government, and it has proved successful in competing for contracts. The Cabinet Office’s engagement at the moment involves conversations about how the Post Office and others might help us to give better support to citizens who are not yet online.

The Minister is correct: the Post Office already delivers a lot of Government services. It has the technology to enable it to back up the Government’s digital agenda and to be the front office for the Government. For example, people without internet access could make universal credit applications through it. Post offices are at the heart of our communities, and I urge the Minister to encourage all Government Departments to make more use of the Post Office.

I hear that message loud and clear. We are engaging with the Post Office and a number of suppliers about how they can help us with our agenda of encouraging more of our citizens to get online and become digitally capable—and to access Government services online, because that is the direction of travel that we are taking—as well as with the assisted digital programme, which will ensure that none of our citizens is left behind in that process.

One area of business that was taken from the post offices some time ago was the issuing of TV licences. Has the Minister had any discussions with his ministerial contacts about bringing that service back to the post offices? Many old people still do not have access to the internet.

As I have said, our conversation with the Post Office is about the broad agenda of digital by default, and about how we can get more of our citizens online. Some 11 million of them are estimated still to be offline, so that is a big challenge. Alongside that, programmes are necessary to ensure that people who do not want to be online can still access Government digital services. I am sure that the Post Office and others will be able to help us in that process.

Is the Minister aware that the National Federation of SubPostmasters has reported that the income generated by the Government services that its members provide is fairly small? I am all in favour of sub-post offices providing Government services, but the Government must surely be made to pay for that properly.

Obviously, if post offices are going to provide a service, they need to have the capacity to do that. I have had conversations with postmasters in my area. In the Pinner post office, for example, I have tried out the new technology that is helping citizens to get online and access services locally and to become more digitally capable, and I did not get a sense from that postmaster that there was a problem.

Procurement (SMEs)

8. What recent steps he has taken to reduce barriers to small and medium-sized enterprises participating in Government procurement. (900787)

This Government remain extremely committed to the process of trying to increase the participation of SMEs in central Government procurement, and we believe that at least an additional £1.5 billion has flowed into the SME sector through that process since 2010. That represents progress, but we know that there is still a lot to do.

The Minister has just claimed that direct spend with SMEs has increased since the last election, but will he confirm that the recorded rise in the Ministry of Justice since April 2011 is in fact down to his officials, including law firms, offering legal aid services? When is he going to correct those figures to remove that inaccuracy?

I am not going to take any lessons from the party opposite. What we inherited in terms of SMEs participating in public procurement was no ambition and no data. This Government are supplying the ambition and trying to ensure that the data are as good as they can be. We are not taking any lectures from the party that had no ambition and no data.

My hon. Friend is absolutely right to support small businesses, but will he look at the systems in which small businesses are sometimes unable to bid? And may I see him after this Question Time to tell him precisely what I mean by that?

I am very glad to hear that extension to my hon. Friend’s question, and I certainly accept his invitation. We are absolutely determined to try to remove the barriers to small business participation. For example, we have recently announced the fourth supplier framework for the procurement of Government cloud technology services, and I am delighted to tell him that 84% of those suppliers are SMEs. [Interruption.]

Order. There are far too many noisy private conversations taking place in the Chamber. That is unfair on the Members asking questions and on the Ministers who are trying to make their answers heard.

Topical Questions

My responsibilities as Minister for the Cabinet Office are for the public sector efficiency and reform group, civil services issues, industrial relations strategy in the public sector, Government transparency, civil contingencies, civil society and cyber-security.

Last Friday afternoon, the Cabinet Office snuck out details about special advisers, showing that there are more of them and that their cost has risen by more than £1 million last year. At a time when the Government are demanding cuts and claiming that they are necessary, is it right that such profligate spending by the Cabinet Office on special advisers is allowed to go uncontrolled?

The requirements of a coalition Government mean that there is more requirement for special advisers. Their cost is still only 2% of the cost of the senior civil service.

T2. What outcomes does my right hon. Friend hope to see from the Open Government Partnership summit being held in London tomorrow? (900794)

We are looking forward to welcoming to London the representatives of 62 Governments who have chosen to belong to this unique partnership both between Governments and with civil society organisations. Transparency is an idea whose time has come, and we will celebrate the progression of the open data and transparency agenda over these two days.

Last Friday afternoon, the Cabinet Office finally released some information, but the Government failed yet again to release the Prime Minister’s annual Chequers guest list, which has not now been published since July 2011—an interesting definition of “annual”. This follows repeated failures adequately to answer parliamentary questions and freedom of information requests about visits to No. 10 by the Prime Minister’s adviser, Lynton Crosby—despite the Government answering exactly the same questions about other individuals in other Departments. When are the Government going to release this information, including about that cigarette lobbyist running around at the heart of Downing street?

I am sure that when the hon. Gentleman was in residence in No. 10 Downing street in the last Government—when the degree of transparency was virtually nil—it would never have been disclosed, as it will be, that the hon. Member for North Ayrshire and Arran (Katy Clark) was at Chequers helping the then Prime Minister to plant a tree.

T4. This time last year, Ministers announced a radical overhaul of facility time. With Royal Mail, teacher and fire brigade strikes inflicting disruption on the public and with the appalling behaviour of Len McCluskey in Grangemouth, FOI data I have received show that the overall public subsidy from Whitehall to the unions has gone up, not down. What further action is my right hon. Friend taking? (900797)

The events at Grangemouth illustrate the problems that can arise when full-time union officials are paid for by the employer. I am glad to be able to tell my hon. Friend that the number of full-time union officials on the civil service payroll has halved and that the cost has more than halved.

T3. In response to the question of my hon. Friend the Member for Newcastle upon Tyne Central (Chi Onwurah), the Minister said that he took very seriously the threat of cybercrime to small and medium-sized businesses. However, cybercrime has cost SMEs £800 million in the last year, yet the Government are giving only £5 million to spend on it across the board. What are the Government doing to tackle that problem? (900796)

I accept that awareness of cyber-threats by all businesses is still too low. As the rankings show, the threat is higher in Britain than it is in most countries, but awareness is not good enough and too many businesses have left themselves vulnerable. We are working hard to raise their awareness. My right hon. Friends in the Department for Business, Innovation and Skills are leading that work, but there is much more that we can and should do.

Will the Government support my private Member’s Bill on 29 November, which is intended to give charitable status to religious institutions? Will they support it?

I have already told my hon. Friend that we will not. I understand that there is a lot of concern on both sides of the House about the Plymouth Brethren case, on which we are all united in wanting to see a quick and speedy resolution to that issue.

T5. The coalition agreement pledged to limit the number of SpAds—special advisers. Given that the number has risen to 97, what limit do the Government actually want? (900798)

There is a limit, and we announced it last week. However, it will be subject to change from time to time.

When my right hon. Friend came to office in 2010, what cross-Government work had been done to tackle fraud, error and debt?

None. I now chair a cross-Government taskforce on fraud, error and uncollected debt, as a result of which, in the last year, we saved the taxpayer £6.5 billion that would otherwise have been wasted.

Prime Minister

The Prime Minister was asked—


This morning I had meetings with ministerial colleagues and others. In addition to my duties in the House, I shall have further such meetings later today.

Under this Government, there are more than 1 million new jobs. That has happened with the help of companies such as Lantoom Quarry in South East Cornwall, which is investing in and training young people. We were told that the Government had a programme that would clearly lead to the disappearance of a million jobs. Is it not time for the Opposition, who said that, to admit that they were wrong and to apologise?

My hon. Friend is absolutely right. The British economy is on the mend. We see unemployment coming down and the number of people in work going up, and our growth rate is now forecast to be almost three times as fast as the German growth rate. The Labour party and the Leader of the Opposition told us that we would lose a million jobs, but the Leader of the Opposition was absolutely wrong, and it is time that he got to his feet and told us that he was wrong.

Having listened to the Select Committee hearing yesterday, will the Prime Minister tell us what is the difference between his—[Interruption.]

Order. May I just say to the Prime Minister’s Parliamentary Private Secretary that his role is to nod his head in the appropriate places, and to fetch and carry notes? No noise is required.

Having listened to the Select Committee hearing yesterday, can the Prime Minister tell us what is the difference between his policy on energy and that of the energy companies?

Not a word of apology for predicting that a million jobs would be lost! The Opposition got it wrong, and they cannot bear to admit it. [Interruption.]

Order. The questions must be heard and the answers must be heard, however long it takes. Some people need to get used to the fact that that is what the public would like to see from the House of Commons.

What we need in the energy market is more competition and lower levies and charges to drive profits and prices down, but what we have learnt in the last week is this: competition should include switching. At the Dispatch Box, the right hon. Gentleman said:

“I will tell the Prime Minister what is a con: telling people…that the answer was to switch suppliers”.—[Official Report, 23 October 2013; Vol. 569, c. 295.]

However, what have we found out over the last few days? The right hon. Gentleman switched his supplier. Yes—he went for one of these insurgent companies to cut his bills. Is it not typical? The right hon. Gentleman comes here every week and attacks Tory policy; then he goes home and adopts Tory policy to help his own family.

The only thing that people need to do if they want someone to stand up against the energy companies is to switch the Prime Minister, and that is what they know.

Perhaps, as the unofficial spokesman for the energy companies, the Prime Minister can answer the question that they could not answer yesterday. Can he explain why, although wholesale prices have hardly moved since a year ago, retail prices are rising by about 10%?

Because we need both competition and rolling back the costs of charges. Switching is part of competition and the company the right hon. Gentleman switched to has this to say about his energy freeze. Let us listen to the people providing his energy:

“A policy like this is potentially…problematic for an independent provider…bluntly, it could put me under.”

That is the right hon. Gentleman’s policy: not listening to the people providing his energy, but having less choice, less competition, higher prices. It is the same old Labour.

The right hon. Gentleman had no answer to the question, and I will explain something quite simple to him: most energy companies do not want a price freeze and most consumers do. That is why the energy companies are against a price freeze. He is so on the side of the energy companies that we should call them the big seven: the Prime Minister and the big six energy companies. In Opposition, he said there was a problem in the relationship between wholesale and retail prices, and he went on to say, “The first thing you’ve got to do is give the regulator the teeth to order that those reductions are made and that is what we would do.” Why when it comes to the energy companies has he gone from Rambo to Bambi in four short years?

Who was it who gave us the big six? [Interruption.] Yes, when Labour first looked at this there were almost 20 companies, but, because of the right hon. Gentleman’s stewardship, we ended up with six players. The Opposition talk about a price freeze but down the Corridor they have been voting for a price rise. That is right: they voted for a decarbonisation target that everyone accepts would raise prices. If he wants a price freeze, why has he just voted for a price rise?

It is just so hard to keep up with this Prime Minister on green levies. This is what he was saying in January: believe it or not, he was boasting about the size of his green levies. He said—I kid you not: “ECO was many times the size of the scheme it replaced.” So when it comes to green, as short a time ago as January he was saying the bigger the better, and now he says the opposite. Here is the problem: on competition—[Interruption.] Here is the problem: he wants a review of energy policy, but that is exactly what the energy companies want—a long inquiry, kicking the problem into the long grass. How will a review that reports next summer help people pay their bills this winter?

We want a competition inquiry that starts straight away: that is our policy. On the point about voting for a price rise, the right hon. Gentleman has to answer, because this is what the former Labour energy spokesman Lord Donoughue said in the House of Lords. The right hon. Gentleman should listen to this because Lord Donoughue was their energy spokesman:

“I have never spoken against a Labour amendment in my 28 years in this House, but…I am troubled by the consequence…for ordinary people…The amendment will…raise the cost of living and is in conflict with a future price freeze.”—[Official Report, House of Lords, 28 October 2013; Vol. 748, c. 1357-1359.]

That is it from Labour’s own policy spokesman in the past in the Lords. The fact is that the whole country can see that the right hon. Gentleman is a one-trick pony and he has run out of road.

If the right hon. Gentleman wants to talk about what people are saying—[Interruption.] If he wants to talk about—[Interruption.]

Order. Members should try to recover some semblance of calm. It would be good for their health and beneficial for their well-being. They must try to grow up, even after the age of 60.

If the right hon. Gentleman wants to talk about what people are saying, his own former Tory Environment Secretary, the man he put in charge of the Climate Change Committee, says his figures are false. That is what he says. Instead of having a review, the right hon. Gentleman has an opportunity to do something for the public next week. He has an Energy Bill going through Parliament. Instead of sitting on his hands, he could amend that Bill to institute a price freeze now. We will support a price freeze: why does he not act?

Because it is not a price freeze—it is a price con. The fact is that the right hon. Gentleman is hiding behind this economically illiterate policy because he cannot talk about the economy, because it is growing; he cannot talk about unemployment, because it is falling; and he cannot talk about the deficit, because it has come down. He has got nothing else to say. He is just a weak leader with no ideas.

I will tell you who is weak—it is this Prime Minister. He is too weak to stand up to the energy companies. Nothing less than a price freeze will do, because that is the only way we can deal with the energy companies overcharging. It is time he started acting like a Prime Minister and standing up for consumers, and stopped acting like a PR man for the energy companies.

I will tell you what is weak: being too weak to stand up and admit to economic failures; being too weak to stand up to Len McCluskey, who tried to wreck Scotland’s petrochemical industry; and being too weak to stand up to the shadow Chancellor on HS2—[Interruption.]

Let us just examine what has happened on HS2 this week: the shadow Chancellor has been touring the radio studios, telling everyone it will not go ahead; and Labour local authority leaders have been begging the Leader of the Opposition to stand up for this infrastructure scheme. And what has he done? He has cowered in his office, too weak to make a decision. To put it another way: Britain deserves better than that lot.

Q2. Last year, businesses created three times as many jobs in the private sector as were lost in the public sector. So is it not high time that those who made duff mystic predictions that we would not be able to create as many private jobs as were lost in the public sector admit that they got it wrong? (900764)

My hon. Friend is absolutely right to say that the Opposition should admit they got it wrong. Let us just remember what the Leader of the Opposition said as late as March 2012. He said that we were not going to be able to replace the jobs in the public sector quickly enough with jobs in the private sector. The fact is that we have now got 1 million more people employed in our country—1.4 million private sector jobs—but the Opposition are too weak to admit that they got it wrong.

Q3. Does the Prime Minister believe that the accident and emergency crisis in the NHS has anything to do with the fact that he has cut 6,000 nurses since coming to power? (900765)

What we see in the NHS is 23,000 fewer non-clinical grades—bureaucrats and managers taken out of the NHS—and 4,000 more clinical staff, including over 5,000 more doctors in our NHS. That is the change we have seen. Just imagine if we had listened to Labour and cut the NHS budget. We believe in the NHS and we have invested in it.

Q4. Hampshire chamber of commerce reports, in the last quarterly economic survey, real business optimism, with a rise in the number of local firms employing more staff, an increase in UK orders and a 10% increase in sales. Does my right hon. Friend agree that that is evidence that the Government’s economic plan is working and that the Labour party got it wrong? (900766)

My hon. Friend is right; we had to take tough decisions, but growth is there, unemployment is falling, the number of people in work is rising and we have 400,000 more businesses in this country. If we had listened to the shadow Chancellor, who said that we were in for a “lost decade” of growth, we would have higher debts and higher interest rates—it would be the same old outcome under the same old Labour.

Q5. In a recent uSwitch survey, 75% of people said that they switched their heating off on one or more occasions last winter. Does the Prime Minister expect that number to go up or down this winter due to his inability to stand up to the energy companies? (900767)

Fuel poverty went up under Labour. This Government have maintained the winter fuel payments; we have increased the cold weather payments; and we have increased the benefits that the poorest families get in our country. That is the action that we have taken, and we can afford to do that only because we have taken tough and sensible decisions on the economy.

A few days ago, I launched the business case for the electrification of the Harrogate and Knaresborough rail line, which will mean more trains, faster services and better rolling stock. As the previous Government electrified just 9 miles in 13 years, will my right hon. Friend continue to prioritise rail electrification?

My hon. Friend makes a very good point. The previous Government did just 9 miles of electrification in 13 years, an absolutely pathetic record, whereas we are putting £1 billion into modernising railways in the north of England. Let us look again at HS2: we all know we need cross-party agreement to make that important infrastructure scheme go ahead. What a pathetic spectacle we have seen this week. One minute the Opposition are for it, then they are against it, and the Leader of the Opposition is too weak to make a decision.

Q6. I have come across a very interesting interview given by the Prime Minister to The Times, during which he had to stop off at his constituency office as, in his words, he needed “to turn the heating on just so it’s a bit nicer when I get back this afternoon”.How many of my constituents does he think will be able to afford such niceties as we approach this winter? (900768)

What the hon. Gentleman’s constituents will understand is that Labour’s price freeze is a price con. Prices would go up beforehand, prices would go up afterwards and as the Leader of the Opposition himself has admitted, Labour would not be able to keep its promise because it does not control gas prices. That is why everyone knows that it is a con.

Q7. My 20-year-old constituent Liam Burgess, from Llansteffan in Carmarthen, left school involuntarily at 16 and was told that the only choice ahead of him was in which prison he might end up. Four years later, he runs and owns one of Wales’s best chocolate brands, nomnom. Does the Prime Minister agree that the record number of new business start-ups and the positive economic signs are as much down to people such as Liam Burgess as they are to the excellent work of the Chancellor? (900769)

I certainly join my hon. Friend in paying tribute to his constituent for how he has turned his life around and is contributing to our economy. We see 400,000 more businesses up and running in our country—[Interruption.] Of course Labour Members do not want to hear about success stories. They do not care about enterprise; they do not care about small businesses. It is this enterprise and this small business that are turning our country around.

Q8. A new flat has just been launched in my constituency, which has been built partly as a result of public money under the Government’s affordable housing scheme, known as Share to Buy. It is a two-bedroom flat in Pear Tree court and it costs £720,000. Does the Prime Minister believe that to be affordable and, if so, to whom? (900770)

We need to build more houses in our country and that is why we are reforming the planning system, which Labour opposed, why we have introduced Help to Buy, which Labour opposed, and why we have put extra money into affordable housing, which Labour opposed. Labour is now the “build absolutely nothing anywhere” party and as a result housing will become less affordable.

Over the past few decades, hundreds of millions of people have been lifted out of poverty in India and China. As those people have increased their living standards, their energy demands have increased, too. Does my right hon. Friend agree that if we are to have sustainable, long-term and cheap energy, the innovative deal that the Chancellor heralded a few weeks ago through the Chinese initiative is crucial and much better than short-term political gimmicks?

That was an important step forward in encouraging inward investment into our country to help fund our nuclear programme. That means that we will have dependable supplies of low-carbon electricity long into the future. People might oppose foreign investment—it sounds now like the Labour party opposes foreign investment and with all the flip-flops the Opposition have done this week, I would not be at all surprised if they did not start to oppose nuclear energy, too—but getting that foreign investment means that we can use our firepower to build hospitals, to build schools, to build roads and railways and modernise our country.

Considering that Royal Mail in the past was losing billions of pounds, the whole country is far better off with Royal Mail in the private sector. I just talked about flip-flops and here is another from the Labour party. Who said that we needed to privatise Royal Mail in the first place? Anyone? Where is Peter Mandelson when you need him? Labour said that we needed private capital—I agree; they said we needed private management—I agree. It has taken this Government to deliver the policy.

With 1.5 million jobs created by business and 400,000 new businesses, last month’s figures in Worcestershire showed the biggest monthly fall in unemployment on record. Unemployment is now down more than 30% since its peak under Labour. Does the Prime Minister agree that by backing business and supporting businesses to grow, we can undo Labour’s legacy of unemployment?

My hon. Friend is absolutely right. Whoever was in government right now would have to make difficult reductions in the public sector, and obviously that leads to the reduction of some public sector jobs, so we need a strong private sector recovery. That is what we have seen—1.4 million more jobs in the private sector, meaning that overall there are 1 million more people employed in our country. That is 1 million reasons to stick to our plan and reject the medicine suggested by the Opposition.

Q10. Current legislation to protect agency workers was designed to stop the exploitation of migrant workers and also to protect the wages and conditions of our indigenous workers. I know that the Prime Minister has been lobbied on this issue, but can he reassure the House that he will resist any temptation to dilute even further the protection for agency workers? (900772)

What I want to see are more jobs in this country, and that means making sure we keep our flexible work force. What the hon. Gentleman did not tell us, of course, is that he chairs the Unite group of Labour MPs. Perhaps he ought to declare that when he stands up. While he is at it, perhaps he could have a word with Mr McCluskey and say that we need a proper inquiry into what happened in Unite and a proper inquiry into what happened in Grangemouth, because we all know that the leader of the Labour party is too weak to do it himself.

Q11. The economy has grown 1.5% in the past six months, during which time in the Chippenham constituency the number of jobseekers has fallen by a fifth. Raising living standards requires greater productivity from a work force who are highly skilled, but in Chippenham hopes were dashed five years ago when the national college building programme ran out of money. Will the Prime Minister join me in backing Wiltshire college’s bid to the Skills Funding Agency to rebuild our Chippenham campus to make it fit for local students to gain the skills that employers demand? (900773)

I very much agree with what my hon. Friend says. We all remember the huge disappointment when Labour’s planned investment in so many of our colleges collapsed. I saw exactly the same thing at Abingdon and Witney college, and it is this Government who are now putting the money in to see that expansion and improvement and to put quality colleges in place. I am sure that that can happen in Wiltshire as well as in Witney.

Since two thirds of the green levies on people’s energy bills were established under this Government, why has the Prime Minister been attacking himself?

The right hon. Gentleman is wrong. [Interruption.] The fact is that many of the green levies were put in place by Labour. Let me remind him that one of the first acts of this Government was with the £179 renewable heat initiative, which the leader of the Labour party wanted to put on the bill of every single person in the country—and we took it off the bill.

Q12. Will the Prime Minister join me in congratulating the work force at Toyota in my constituency, as well as manufacturers across the country, whose hard work has ensured that car production went up by 10% in the past year? (900774)

I certainly join my hon. Friend. I remember my own visit to Burnaston in Derby—[Interruption.] Again, Opposition Members do not want to hear good news about manufacturing. They do not want to hear good news about our car industry. The fact is that this country is now a net exporter of cars again and we should be congratulating the work force at Toyota. We should be congratulating the work force at Jaguar Land Rover. We should be praising what they are doing at Nissan. These companies are leading a re-industrialisation of our country. I was at the Cowley works on Monday, where the Mini, which is doing brilliantly, is leading to more jobs, more apprenticeships, more employment, more skills—all things that we welcome under this Government.

Thank you, Mr Speaker, for launching our report on electoral conduct yesterday, which found some shocking examples of racism and discrimination during election campaigns. Will the Prime Minister back our call to get political parties, the Electoral Commission and the Equality and Human Rights Commission to work more pro-actively now in areas of tension so that the next general election can be a battle of ideas, not race hate and discrimination?

I very much welcome what the hon. Lady says and the report of the all-party parliamentary inquiry into electoral conduct, which I will study closely. If there is anything we can do on a cross-party basis to ensure that we keep that sort of disgusting racism out of politics, we should certainly do it.

Q13. Thanks to the Government’s regional growth fund, £8.8 million is being spent reopening the Todmorden curve rail link, which will cut travel times between Burnley and Manchester in half. However, better rail connections to the south of England are also vital. Does the Prime Minister agree that it is absolutely outrageous for the Labour party to be challenging HS2 at the present time, putting in jeopardy jobs and investment in the north of England? (900775)

My hon. Friend is absolutely right to stand up for his constituents and for the north of England, because there is a real danger with Labour’s antics that it is letting down the north of England and the midlands. Let me remind the shadow Chancellor what he said about these transport investments:

“Nowhere is…consensus more essential than on our national infrastructure…successive governments…have ducked or delayed vital decisions on our national infrastructure, allowing short-term politics to”

get in the way. By his own words, he is found guilty of short-termism and petty politicking, rather than looking after the national interest.

I am surprised that the Prime Minister, along with the Justice Secretary, is prepared is gamble on his proposals for the probation service, especially given that the early tests and trials have been called to a halt. Is he prepared to gamble with the lives and daily safety of my constituents and others in this country, and will his gambling luck hold out?

What we want is a probation service that is much more focused on getting results on stopping reoffending and making sure that we give people rehabilitation services from the moment they leave prison, which does not happen today.

It is interesting that at 26 minutes past 12 we have not heard one question from Labour Members on the economy. They have nothing to say and nothing to offer. They are embarrassed that prediction after prediction was completely wrong.

Q14. Like my right hon. Friend, I welcome the fall in unemployment, which is down to 3.7 % in my constituency, but does he recognise, as I do, that one of the biggest problems is getting young people with special needs, particularly autism and Asperger’s, into work, and will he congratulate the London borough of Redbridge and the Interface parents group, where the project I initiated has now started and the first young people with special needs are in work? (900776)

I know of my hon. Friend’s close attention to this issue and his deep care about it. I certainly pay tribute to Redbridge and all those who help children with special needs. Through our reform of special needs, we have tried to focus the help on those who need it most to ensure that they get the help they need.

I have a question on the economy for the Prime Minister. Does he agree with his own advisers that the Government’s Youth Contract is failing to tackle

“the appallingly high levels of youth unemployment”?

What we have seen with the Youth Contract is thousands of young people getting work through our work experience scheme. It has been more successful than the future jobs fund but has cost six times less. Through the Youth Contract we have also seen more than 20,000 young people get work opportunities. That is why we see the youth claimant count coming down so rapidly in our country. There is still far more to do to get young people into work, but the fact that we have backed more than 1.5 million apprenticeships is a sign of how much we care about getting young people into work.

Q15. Does the Prime Minister agree with President Obama that additional constraints on how we gather and use intelligence are needed and that we need to weigh the risks and rewards of our activities more effectively? Will he follow the President’s lead? (900777)

What I have said in the House and will repeat again is that obviously we will always listen to what other countries have to say about these issues, but I believe that in Britain we have a good way of having intelligence and security services, having them overseen by a parliamentary Committee, having their work examined by intelligence commissioners, and ensuring that they act under a proper legal basis. I take those responsibilities very seriously, but I believe we have a good system in this country and we can be proud of the people who work in it and of those who oversee it.

We have recently learned that energy security in this country is being outsourced to the Chinese and the French, that the lights may go out, that pensioners will freeze this year, and that we have no control over the big six. Does the Prime Minister have any regrets about the cack-handed privatisation of the utilities by the former Tory Government and the decimation of the most technically advanced coal industry in the world?

What I would say to the hon. Gentleman in terms of energy security is that he backed a Government who in 13 years never built a single nuclear power station. Oh, they talked about it—boy, did they talk about it—but they never actually got it done. In terms of Chinese and French investment, I think we should welcome foreign investment into our country, building these important utilities so that we can use our firepower for the schools, the hospitals, the roads and the railways we need.

In my constituency there are shortly to be more than 100 wind turbines and there are about 30 or 40 more in the planning system. These turbines are paid for by constituents but they are not constructed here or creating any jobs in my constituency. When the Prime Minister rightly reviews green taxes, will he ensure that the changes to green subsidies ensure that jobs in that energy sector are here in the United Kingdom?

I know how hard my hon. Friend has worked with other MPs on a cross-party basis right across the Yorkshire and Humberside region to try to attract investment into our country, and we should continue to target that investment.

Will the Prime Minister join me in paying tribute to the positive role played by trade unions in the work of the Automotive Council, which has brought about the renaissance in the UK car industry?

The Automotive Council has been extremely successful. Where trade unions play a positive role, I will be the first to praise them, but where, frankly, we have a real problem with a rogue trade unionist at Grangemouth who nearly brought the Scottish petrochemical industry to its knees, we need to have a proper inquiry—a Labour inquiry. If Labour Members had any courage, any vision or any strength of decision making, they would recognise the need to have that inquiry and get to the bottom of what happened.

Changes to Health Services in London

With permission, Mr Speaker, I would like to make a statement on the “Shaping a healthier future” programme, a locally led review of NHS services across north-west London.

The NHS is one of the greatest institutions in the world. Ensuring that it is sustainable and that it serves the best interests of patients sometimes means taking tough decisions. The population of north-west London is growing and will reach approximately 2.15 million by 2018. About 300,000 people have a long-term condition. However, there is great variation in the quality of acute care. In 2011, there was a 10% higher mortality rate at weekends for emergency admissions, and the number of hospital re-admissions differs considerably across the area. The Independent Reconfiguration Panel expressed concerns that the status quo in north-west London was neither sustainable nor desirable, and might not even be stable.

In order to address these challenges, the NHS in London started the “Shaping a healthier future” programme in 2009. It proposed significant changes to services, including centralising accident and emergency services at five rather than nine hospitals; 24/7 urgent care centres at all nine hospitals; 24/7 consultant cover in all obstetric wards; a brand new trauma hospital at St Mary’s hospital, Paddington; brand new custom-built local hospitals at Ealing and Charing Cross; seven-day access to GP surgeries throughout north-west London; the creation of over 800 additional posts to improve out-of-hospital care, including a named, accountable clinician for all vulnerable and elderly patients with fully integrated provision by the health and social care systems; and increased investment in mental health and psychiatric liaison services.

These changes represent the most ambitious plans to transform care put forward by any NHS local area to date. They are forward-thinking and address many of the most pressing issues facing the NHS, including seven-day working, improved hospital safety and proactive out-of-hospital and GP services. The improvements in emergency care alone should save about 130 lives per annum and the transformation in out-of-hospital care many more, giving north-west London probably the best out-of-hospital care anywhere in the country.

The plans are supported by all eight clinical commissioning groups, the medical directors of all nine local NHS trusts, and all local councils except Ealing. It was as a result of a referral to me by Ealing council on 19 March 2013 that I asked the Independent Reconfiguration Panel to conduct a full review.

The panel submitted its comprehensive report to me on 13 September 2013 and I have considered it in detail alongside the referral from Ealing. I am today placing a copy of the panel’s report in the Library, alongside the strong letters of support for the changes that I received from all local CCGs and medical directors. The panel says that “Shaping a healthier future” provides

“the way forward for the future and that the proposals for change will enable the provision of safe, sustainable and accessible services.”

Today I have accepted the panel’s advice in full and it will be published on the panel’s website.

The panel also says that while the changes to A and E at Central Middlesex and Hammersmith hospitals should be implemented as soon as practicable, further work is required before a final decision can be made about the range of services to be provided from the Ealing and Charing Cross hospital sites.

Because the process to date has already taken four years, causing considerable and understandable local concern, I have today decided it is time to end the uncertainty. Therefore, while I accept the need for further work, as the IRP suggests, I have decided that the outcome should be that Ealing and Charing Cross hospitals should continue to offer an A and E service, even if it is a different shape or size from that currently offered.

Any changes implemented as part of “Shaping a healthier future” should be implemented by local commissioners following proper public engagement and in line with the emerging principles of the Keogh review of accident and emergency services.

I have today written to the chair and vice-chair of the health and adult social services standing scrutiny panel of the London borough of Ealing council, the chair of the IRP Lord Bernie Ribeiro, the chief executive of NHS England and local MPs, informing them of my decision.

These much-needed changes will put patients at the centre of their local NHS, with more accessible, 24/7 front-line care at home, in GP surgeries, in hospitals and in the community. More money will be spent on front-line care, which focuses on the patient. Less will be wasted on duplication and under-performing services.

Let me be clear that, in the joint words of the medical directors at hospitals affected, there is a

“very high level of clinical support for this programme across NW London”.

Local services will be designed by clinicians and local residents and will be based on the specific needs of the population.

None of these changes will take place until NHS England is convinced that the necessary increases in capacity in north-west London’s hospitals and primary and community services have taken place.

I want to put on the record my thanks to the IRP for its thorough advice. As the medical directors of all the local hospitals concerned said in their letter to me, these changes will

“save many lives each year and significantly improve patients care and experience of the NHS.”

When local doctors tell me that that is the prize, I will not duck a difficult decision.

I commend this statement to the House.

People at home will have listened carefully to what the Secretary of State has just said, and they will have one simple question in their mind: why is this man trying to close so many A and Es when we are in the middle of an A and E crisis? At least seven A and Es across the capital are under threat, at a time when all London A and Es are working flat out and are full to capacity. As we stand here, thousands of people are waiting to be seen, stuck on trolleys or held in the back of ambulances that are queuing outside A and E. When the A and Es we have are struggling to cope, how on earth can it be safe to close or downgrade so many?

That brings me to what I see as the major flaw in what the Secretary of State has announced. These plans have been in development for four years, as he said. Four years ago, A and E was not in the crisis that it faces today. The reality on the ground in London has changed. In 2013, A and Es in London have been getting worse and worse and worse. Across London, 200,000 people have waited in A and E for longer than four hours in the past 12 months. Here is the statistic that should make people stop and think: taking all its major A and E units together, London has missed the Government’s A and E target in 48 of the last 52 weeks.

Any further changes to this fragile and overburdened system must proceed with the utmost caution. Will the Secretary of State give me a categorical assurance that he personally gave in-depth consideration to the latest evidence of the pressure on London A and Es and to the changed reality that 2013 has brought before making his decision? I understand how tough such decisions are. Sometimes, difficult changes need to be made, as I found when I reorganised stroke services in London before the last election. When he does the right thing, based on a clear clinical case that lives will be saved, we will support him, as we did on children’s heart surgery. The problem with the closure programme, as managers admitted to Members of the House at the outset, is that it is primarily about saving money, not saving lives.

Even though the Secretary of State has made some minor concessions today, he is still performing pretty brutal surgery on west London’s NHS. It is the single biggest hospital closure programme the NHS has ever seen. Has he considered the impact of the changes on people in those communities who are on low incomes? They will face much greater costs and journey times in getting to hospital.

Will the Secretary of State be straight with us on the much-loved Charing Cross and Ealing hospitals? I listened carefully to what he said. What is the “further work” that he referred to? He spoke of their A and Es being of a different size and shape. Is that not spin for saying that the units will be downgraded and become urgent care centres? Alternatively, is he giving those units a permanent reprieve today? If he cannot answer those questions directly, local people in those areas will take what he has said as weasel words.

The Secretary of State said that there will be investment in communities before the changes go ahead. He said that to the hon. Member for Enfield North (Nick de Bois) in respect of Chase Farm hospital, but he is closing that unit next month. What guarantee do people have that he will follow through on this promise, when he broke the promise that he made to his hon. Friend?

The Secretary of State has made a statement on London health services. People will not have missed the fact that he has failed to mention Lewisham hospital and what happened at the Court of Appeal yesterday. Is that not a staggering omission? The victory that was won by the people of Lewisham will give hope to people who are disappointed by today’s announcement.

The humiliation of the Secretary of State in court again raises major questions about his judgment and his ability to manage such important decisions. In the summer, we explicitly warned him to accept the first court ruling. Instead, he ploughed on, throwing around taxpayers’ money in a cavalier fashion, to protect his pride and defend the indefensible. I have a simple question: how much has he spent on appealing that decision? When he decided to appeal, did the official legal advice from the Government recommend an appeal or did he overrule it? Will he confirm today to this House and to the people of Lewisham that there will be no further appeal against the court’s ruling? Will he give the people of Lewisham and the staff who work at Lewisham hospital a commitment that their A and E and maternity services will be protected? Finally, will he apologise to the people of Lewisham for the unnecessary distress and worry he has put them through?

It will not have escaped people’s notice that the Secretary of State is trying to put powers through the House quite soon to grab further powers for himself and drive through financial closures of A and Es without proper consultation, so that in effect he can do what he tried to do to Lewisham to every community in England. That will send a chill wind through those communities that fear to lose their A and Es, and that is why we will oppose those powers when they are considered by the House.

In conclusion, the Government have come a long way since the Prime Minister stood outside Chase Farm hospital days after the last general election and promised a moratorium on all hospital changes. Local people in west London will not have forgotten the Prime Minister standing outside Ealing and Central Middlesex hospitals and promising the same. People are seeing through a Prime Minister whose broken promises on the NHS are catching up with him. Has it ever been clearer than it is today that people simply cannot trust the Tories with the NHS?

I am afraid the right hon. Gentleman is sounding more and more desperate. Today the Government have taken a difficult decision that will improve services for patients. It was a moment for him to show that he understood the challenges facing the NHS, but that was not to be. He said that we should not proceed with the changes given winter pressures on A and Es, but he should read the document. The proposals are for more emergency care doctors, more critical care doctors, and more psychiatric liaison support that helps A and E departments, and they are supported by the medical directors of all nine trusts affected. He said that if evidence can be produced to show that the proposals will save lives, Labour will support them. What more evidence does he want? He should be shouting from the rooftops to support the proposals, but instead he is putting politics before patients.

The right hon. Gentleman mentioned A and E performance, and I am happy to tell him about that. On average a person now waits 50 minutes in A and E before they are seen; when he was Health Secretary it was 71 minutes. The number of patients seen in less than four hours every day is 57,000—nearly 2,000 more than when the right hon. Gentleman was Health Secretary. Our hospitals are performing extremely well under a great deal of pressure because we are taking difficult decisions of the kind that we are talking about today.

The right hon. Gentleman also talked about hospital closures. Again, he should read the proposals: a brand new trauma centre at St Mary’s hospital in Paddington; two brand new elective care centres at Ealing and Charing Cross; seven-day NHS care that will save lives; 24/7 obstetric care; 16 paediatric care centres. Those are big improvements in hospital care—[Interruption.] I will come on to Lewisham. I am acting to end uncertainty because I made the decision today that whatever the outcome of further discussions that the Independent Reconfiguration Panel recommends, there will remain an A and E at Ealing and Charing Cross. That is the best thing I can do for those residents.

The right hon. Gentleman mentioned Lewisham, but let us remember that the problem started because his Government saddled South London Healthcare NHS Trust with £150 million in private finance initiative costs. I judged that the right thing for patients was to sort out a problem that was diverting £1 million every week from the front line. Yes it is difficult, but I would rather lose a battle with the courts trying to do the right thing for patients than not try at all.

Finally, these are difficult decisions, but the party that really has NHS interests at heart is the one that is prepared to grip those decisions. We are gripping the problems in A and E, and in terms of hospital reconfigurations. That is why the NHS is safe in our hands and not safe in those of the Labour party.

Does my right hon. Friend agree that we tackle health inequalities, and improve health outcomes and access to accident and emergency departments, by facing up to the need to make difficult decisions to change the way care is delivered to keep it up to date? Does he further agree that today we have seen a Government who are prepared to face those challenges, and an Opposition spokesman who has demonstrated a determination to duck them? Who cares about the NHS?

I thank my right hon. Friend for that comment. He is right that this is about facing up to difficult decisions. One aspect of the proposals that is so exciting for people who want a transformation in services is that they involve employing 800 additional people for out-of-hospital care. The real way we will reduce pressure on A and E units is by ensuring that people, particularly the frail and elderly, are looked after better at home. That is what we must do. We must recognise that, fundamentally, the problems will not be solved by trying to pour in money in the way that it has always been poured in. We must rethink the model. This is a positive and ambitious programme. If the shadow Secretary of State were in my shoes, he would speak differently of the proposals, because they represent the way forward for the kind of integrated care he normally champions.

Let me remind the Secretary of State that the High Court ruled that his actions in trying to remove services from Lewisham hospital to save a separate failing trust were illegal. He then lost the appeal. Will he now stop throwing good public money after bad, leave Lewisham hospital alone, and learn to respect the views of the people who work in our hospital and those who use its services?

I respect those views and the right hon. Lady for her campaigning. I understand why the people of Lewisham were unhappy about those changes but, as Health Secretary, I had to take a decision in the interests of all patients in south London. That was the first time the powers—the trust special administrator powers—were used. My interpretation was different from the courts, but I respect them as the final arbiter of what the law means. However, when we have to make difficult decisions about turning round failing hospitals—south London has some of the most serious problems in the country—it is important that the local NHS can take a wider health economy view of what changes are necessary. As I have said, I will respect what the Court has decided, but it is important that I continue to battle for the right thing for patients.

The Secretary of State, his predecessor and the Prime Minister are well aware of my continued opposition to the decision to downgrade Chase Farm. However, today, will he join me in condemning the shadow Secretary of State, who has said that Chase Farm is closing? It is not closing. Against my wishes, there is a proposal to downgrade the A and E unit. The hypocrisy and politicking is worse because the previous Labour Government initiated the process and authorised the downgrade in the first place.

My hon. Friend speaks wisely. It is disappointing that we are not having a more intelligent debate. When Labour was in power, it closed or downgraded 12 A and E units in 13 years. The then Government realised that there were problems. He is right that they started the problem in Chase Farm. That is why, when we are facing such difficult decisions, it is important to have a responsible debate. I accept that MPs have views on their constituencies, but we have to start looking above the parapet to the wider interests of patients. That is a difficult thing to do, but I would have hoped for more leadership from the shadow Secretary of State, who used to be Health Secretary.

The Secretary of State is destroying services in four great London hospitals, two of which are in my constituency, in the biggest closure programme in the history of the NHS. Why is he closing A and Es in two of the most deprived communities in London—Brent and White City—and why, rather than certainty, is he installing chaos into Ealing and Charing Cross hospitals? What is happening to the 500 beds at Charing Cross? What is happening to the best stroke unit in the country? What does he mean by A and Es that are different in size and shape? When will he answer those questions? This is a cheap political fix. How can anyone have confidence in the Secretary of State—

Order. We understand the general drift of the observations—[Interruption.] Order. I understand how strongly the hon. Gentleman feels, but he should really ask one question. The Secretary of State is a man of dexterity and no doubt will meet the hon. Gentleman’s needs as he sees fit.

Thank you, Mr Speaker. I will. The hon. Gentleman does no credit to himself or his party with such hyperbole. Let me remind him that the leaders of the clinical commissioning groups, including the ones in his area, which are there to look after his constituents, have said that

“delivering the Shaping a Healthier Future recommendations in full will save many lives each year and significantly improve patients’ care and experience of the NHS.”

That is what the doctors are saying, which is what I want to follow.

At the Central Middlesex hospital, we have well qualified doctors and nurses waiting for patients to arrive but, at the same time, we have long queues at Northwick Park hospital. That makes no sense. Will my right hon. Friend assure me that any reduced resources at Central Middlesex hospital will be transferred in full to Northwick Park so that patients can be seen far more quickly and in a far better manner?

I assure my hon. Friend that the resources taken out of some acute services will be used to give better, safer and more high-quality services to his constituents. Northwick Park is one of the best examples of that. Stroke services in the north-west London area were centralised in Charing Cross and Northwick Park. As a result of those changes, which were introduced by the right hon. Member for Leigh (Andy Burnham), stroke mortality rates in London have halved. That is a very good example of why it makes sense to centralise certain more specialist and complex services if we are to get the best results for patients.

The Secretary of State talked about putting politics before patients, but I remind him that the Prime Minister, when he was Leader of the Opposition, went to Chase Farm to say that the Conservatives would stop all configurations. That simply has not happened, but yet the Secretary of State continues to have a role. Patients and local residents are firmly opposed to the reconfiguration at that hospital and he will end up in court very soon over the matter. There is still time for him to reconsider that decision.

We did not agree with how the previous Government went about reconfigurations. I have announced a better way of achieving them, with better public and clinical support. My predecessor as Health Secretary paused on reconfigurations because he wanted to introduce a better structure, including the four tests, one of which was the need for local clinical support, and another of which was the need for effective public engagement. That is why we are in a better place today than we were with the previous Government’s reconfigurations.

My constituents in Brent will be very disappointed with the Secretary of State’s announcement of the A and E closure at Central Middlesex hospital. However, given that the hospital trust began moving acute services out to Northwick Park hospital many years before the process began, they will probably not be surprised. Does he agree that there is an urgent need for health managers to work closely with Transport for London to ensure good transport links for my constituents in Harlesden to get to Northwick Park? It is currently extremely difficult to do so. Will he write to health managers to express that view?

The hon. Lady makes an important point. I accept that there will be changes in transport arrangements. I am happy to work with her and to talk to TfL about how improvements can be made in respect of the changes I have announced today.

I hope that the hon. Lady talks to her constituents about the positive aspects of the proposals. Hers will be the first part of the country in which all GP surgeries are open seven days a week—at least, there will be seven-day access to GP surgeries throughout her constituency and north-west London. North-west London will be the first part of the country where we have full seven-day working and we eliminate the fact that mortality rates are 10% higher if people are admitted in an emergency at the weekend. The positive aspects of the proposals will mean that her constituents find that they get better, safer care and live for longer.

I represent wards with some of the highest morbidity and lowest life expectancy in north-west London. Clinical support for reform and restructuring was based on adequate funding during the period. Hillingdon clinical commissioning group has written to the Secretary of State to express its concern about the current funding formula, which could undermine service delivery unless there are additional resources. Will he meet representatives from the CCG and Hillingdon hospital, which he has denied additional winter money this year, to talk about the long-term future of our health economy?

Hillingdon CCG supports the changes because it recognises the profound impact they could have in addressing health inequalities. I know that that is precisely what concerns the hon. Gentleman. His constituents will be big beneficiaries of the changes we are announcing today. The funding formula is an extremely difficult issue. We have decided to depoliticise it by making it a matter for NHS England—it is decided at arm’s length from politicians because we believe it is very important that things are decided on the basis of an independent formula.

I thank my right hon. Friend for his statement. We in Hillingdon are very pleased for our near neighbours in Ealing and in Charing Cross for this reprieve—rather than stay of execution—and it will take pressure off our residents. I echo the words of the hon. Member for Hayes and Harlington (John McDonnell), however, about the pressures we are facing in Hillingdon. Perhaps we could have a meeting with my right hon. Friend to discuss some of these issues, including the funding formula and the winter pressures.

It is the first time I have responded to a question from my right hon. Friend, so I shall take the opportunity to congratulate him on his knighthood. I am more than happy to meet him and his neighbour as long as they understand that the funding formula is not in my gift—it is decided by an independent body. As for the winter pressures money, the allocation was not decided by Ministers: it was decided by the people who are responsible for making sure that we head off winter pressures. They decided to concentrate resources in the third of the country where the problems were most severe, and that is how that selection was made.

The whole House knows that all the medical directors in the hospitals involved in north-west London support the reconfiguration. Does the Secretary of State really understand the importance of bringing ordinary people with him? Londoners are especially cautious about these reconfigurations because of the historic problems with access to GPs and the many excluded communities for whom A and E is their primary care, and because these institutions are often major employers in their area and people identify with them. Does he realise that unless he brings ordinary people and patients with him on these reconfigurations, Londoners will continue to fight them and, as in the case of Lewisham, they will continue to win?

Apart from the very last sentence, I actually agree with what the hon. Lady says. It is important to carry the public with us in these reconfigurations. Governments of both parties have struggled to do that in these difficult reconfigurations, which is why the new structures that we have introduced will put doctors in the front line to argue for changes. It is not just the medical directors of trusts supporting them, but the CCG leaders, who are all local GPs, making that case. That is why there is much stronger support for these changes. All the elected representatives on the local councils, apart from Ealing, supported these changes, and that is a very big change from what we have seen previously. I agree with the hon. Lady: we need to do more work and it is very important to carry people with us.

It is fair to say that today’s announcement leaves my constituents in a much better place than they were over a year ago when we set out to save our four local A and Es. Obviously, there is disappointment about the loss of the A and Es at Hammersmith and Central Middlesex, but huge relief that the bigger A and Es at Ealing and Charing Cross will be saved. My right hon. Friend says, rightly, that it will be for the local CCGs to take responsibility for the future of these A and Es. Can he give us a little more detail on how he sees the services being delivered and improved by the CCGs, and can he reconfirm that the A and Es at Ealing and Charing Cross will be saved as A and Es?

I can absolutely confirm that A and Es will remain at Charing Cross and Ealing hospitals, thanks in no small part to the remarkable campaigning that my hon. Friend has done for her constituents, both in public and in private. I commend her for that. The process that has to happen is clearly set out in what the IRP says and in my reply. There must be full consultation. There will be changes to the way in which services are provided, but they will be changes made in the interests of patients. Whatever those changes are, A and Es will remain at those two hospitals.

It is a bit rich for the Secretary of State to accuse the Opposition of being desperate when he has been told by the court not once, but twice that he acted unlawfully in relation to Lewisham. The Secretary of State’s amendment to the Care Bill would enable him to do to other hospitals what the courts said yesterday he could not do in south London. Will he admit that under those changes no hospital would be safe, and that in fact he wants to inflict the blatant injustice that he tried to inflict on Lewisham on hospitals not only across London, but up and down the country?

I understand why the hon. Lady is rightly representing the concerns of her constituents, but she must also understand that I have to look at their interests as patients, as well as at the interests of the broader south London population. It is important to make that amendment to the Care Bill because hospitals are not islands on their own. We have a very interconnected health economy, and what happens in Lewisham has a direct impact on what happens in Woolwich and vice versa. If we are to turn around failing hospitals quickly—something that the last Government sadly did not do—we need to have the ability to look at the whole health economy, not at problems in isolation.

Will my right hon. Friend look again at Barking, Havering and Redbridge trust? As he knows, the difficulties that Queen’s hospital has had simply meant that, in its own admission, it would not be able to cope without an A and E at King George hospital for many years to come.

I commend my hon. Friend for raising this issue with me consistently. I know his very real concern is to make sure that when those changes are made they do not have an adverse impact on his constituents. I will go back and make absolutely certain that no changes will be made until it is certain that they are clinically safe.

Why does the Secretary of State find it so difficult to realise that he is not above the law? Both the Court of Appeal and the High Court have made it plain that his flagrant disregard for the law in trying to destroy Lewisham hospital cannot stand. Why does he not have the decency to abandon his proposals; apologise to the people of Lewisham and the staff and users of Lewisham hospital; and share his humiliation with the Leader of the House, the previous Secretary of State, who launched this illegal programme in the first place?

There is no humiliation in doing the right thing for patients, and I will always do that. Sometimes it is difficult and we have battles with the courts, but no one is above the law. I have said that I respect the judgment made by the court yesterday, and that is what I shall do.

Are there not three lessons to learn from the Secretary of State’s statement and the response from the shadow Secretary of State? First, we should listen to the opinions of local doctors. Secondly, delay puts at risk patient safety. Thirdly, we should not play politics. For Enfield, is it not the case that we should recognise that local doctors have united to say that we need to get on and implement changes, because delay would put at risk patient safety this winter, not least at our new, expanded North Middlesex hospital in Enfield? The future of Chase Farm is secure, but it could also be put at risk if we do not allow the implementation of good changes. We should not play politics, but Enfield council is doing so by trying to challenge the changes.

As so often, my hon. Friend speaks wisely. It is very important that in all this we do the right thing for patients. My view on all these big changes is that once we have decided what to do, it should be done as quickly as possible, but within the bounds of what is clinically safe. It is very important that safeguards are in place and I would always follow the advice of local doctors as to the right moment to proceed with an important change in safety.

Will the Secretary of State commit to doing better against the four-hour A and E waiting target in London in the future? Will he put on the record today his acknowledgement of the value of the contribution being made by those A and E units—too few at the moment—that are doing well against that target at the moment?

There are a number of hospitals that are doing extremely well, and we are doing everything we can to support those that are in difficulty. I absolutely recognise how hard front-line NHS staff are working: we are working with them in an incredibly detailed way on a hospital-by-hospital basis, not just in London but across the country, to see what additional support we can give to people as we go through a difficult winter. We have already announced £250 million of support for the third of trusts in the greatest difficulty, and we are looking at what other, non-financial means we can use to support other trusts. The search continues, because we recognise how challenging winters are for the NHS under this Government as under previous ones.

Given the difficult legacy of the financial arrangements in London and south-east London in particular, and the Court of Appeal judgment yesterday, will the Secretary of State give an assurance that in future decisions will have the support of GPs in the areas affected; will not put at risk other viable and successful parts of the London health family; and will not suddenly impose new management structures and create huge disruption—for example, at King’s College hospital, Guy’s hospital and St Thomas’s hospital—as London health partners appear to be suggesting?

I certainly agree with two of the three points. I do not think it is credible to say that we will not make any changes to the NHS, even if they are in the interests of patients, unless there is unanimous support from local GPs. The reality is that that would always be difficult to achieve. We would end up with paralysis, which would be against the interests of patients. However, I do think that GPs should be in the driving seat and be the advocates of these changes, and we should listen to them above all people on whether to proceed with the changes. The whole purpose of the Government’s reforms to the NHS is to create less bureaucracy not more, so I would be concerned if there was any suggestion that more was being created.

We must always ensure that changes do not have an adverse impact on successful neighbouring areas. However, we need to encourage all areas to work together, because we have an interconnected health economy, particularly in London.

I cannot find the words to express how disappointed the residents in my constituency, and elsewhere in west London, will be on hearing the statement. We are not clear about what will happen to Ealing hospital. You are not clear in your statement, before the final decision is made, about the range of services that will be provided from Ealing and Charing Cross hospitals. What work will be done? Will you consider or ignore, like you totally ignored the thousands of people who marched in the rain outside Ealing hospital in west London two weeks ago—

Order. I am extremely grateful to the hon. Gentleman, but may I just say to him that I will not be doing any of the things that he suggested? I think his inquiry was directed at the Secretary of State, rather then me. I have no responsibility for health services in London or anywhere else.

I am disappointed that the hon. Gentleman is disappointed. I am interested to know what his definition of “totally ignored” means, because we have decided that we will not close Ealing A and E, and that is a big decision. With respect to how his constituents feel, I completely understand that many people will be nervous about any changes. I hope he will become a big advocate of these changes, because his constituents will be among the first in the country to have seven-day access to GPs and a seven-day NHS, which means there will not be a higher mortality rate for admission to hospitals at the weekends and that there will be 24/7 consultant obstetric cover for people who need it when giving birth. They are big and important changes that will benefit his constituents.

Order. I should just say to the House, almost as a courtesy, that I am prioritising London Members. However, non-London Members should take heart. If they exercise their knee muscles they may have an opportunity in due course.

The hon. Member for Hackney North and Stoke Newington (Ms Abbott) was absolutely spot on in her question to the Secretary of State, not least with regard to variability and accessibility of GP services. A few months ago, I asked him whether he would make it a requirement for plans to expand out-of-hospital care to be in place before hospital changes occur. Can I take it from his statement that it is his intention that, when recommendations from the Independent Reconfiguration Panel are before him, he will require plans to build capability for community health services and primary care services to be in place before they go ahead?

The right hon. Gentleman campaigns assiduously for his constituents. I recognise that there are worries about potential changes in his constituency, an issue he often raises. Yes, we must ensure, if there are transitions or changes, that proper plans are in place to ensure they can be made safely. If he reads the report, he will derive a great deal of comfort from the stress the IRP puts on the necessity of having proper alternative provision in place before any changes are made.

The Secretary of State’s statement has left us even less clear than we were on the implications for hospital services for Westminster residents. Frankly, that is quite an achievement. Planned non-emergency hospital services have already moved away from St Mary’s Paddington to pre-empt the closure programmes that he is now telling us will not happen. That was done on the basis that St Mary’s would become the premier emergency hospital for west London, so where does that leave the provision of additional emergency services? Will that leave my constituents having to travel to Hammersmith, Ealing and Central Middlesex hospitals for their treatment, something the local authority was not even consulted on? Many GPs did not even know where their patients were being treated.

I hope that I have provided clarity by saying that there will remain an A and E at Ealing and Charing Cross, and that I support what the report says, which is that there should be five major A and E centres, of which St Mary’s Paddington will probably become the most pre-eminent trauma centre in the country. This is a big step for the hon. Lady’s constituents who use St Mary’s, and I think that they will be pleased with what I have said today.

I congratulate the Health Secretary on his important announcement regarding the A and Es at Charing Cross and Ealing. My constituents in Chiswick will feel reassured about the ongoing service at Charing Cross, and I thank him for that. Does he agree it is important that at the centre of any decision he makes about health care are improved patient care and saving lives across London?

My hon. Friend is absolutely right. When the dust settles on these decisions—there is rightly so much local passion, concern and uncertainty relating to hospitals, such as Charing Cross, which has a great tradition—what people will notice is whether their local NHS services are getting better. I am afraid that one of the legacies from the previous Government was the abolition of named GPs in 2004 and a sense that it has become more difficult to access one’s local GP. The proposals mean that her constituents will be some of the first in the country to have seven-day GP services, a big step forward that her constituents will welcome.

Will the Secretary of State give me an assurance, following the huge debate that took place over the future of the A and E department of the Whittington hospital—and, by extension, the neighbouring Royal Free hospital—that its future is secure and that he will not try to reconfigure services once again in north London? Does he recognise that during that debate, my right hon. Friend the Member for Leigh (Andy Burnham), who was then Secretary of State, intervened to assure the future of the Whittington A and E department? I would like the same assurance from the Secretary of State, if that is possible.

I think the best reassurance I can give the hon. Gentleman is that, unlike when the Labour party was in power, the Secretary of State does not sit behind his desk planning reconfigurations in every part of the country. This is a locally driven process. We have put in place safeguards to ensure that, where there is a reconfiguration proposal from a local NHS, it meets certain criteria. It has to be supported by local GPs and there has to be proper engagement with the public. If his constituents are worried, I hope they will take heart from the thoroughness of the process that has happened today. It is the right process and a good process, and it will lead to better outcomes for the people involved.

My own general hospital, in keeping with many throughout the country, has come in for unfair criticism owing to the increasing pressures exerted on its A and E department. What does the Secretary of State think has caused those pressures, and will he reassure my constituents by telling us what he is doing to help relieve A and E departments?

My hon. Friend is right to draw attention to the pressures. I am sure that most A and E departments, including his own one in Northampton, would say that the biggest single cause has been the increase in the frail elderly population and the inadequacy of the care those people receive outside hospital. We are trying to put that right by having named, accountable GPs responsible for out-of-hospital care, reversing the historic mistake made in 2004, when that personal link between GP and patient was abolished.

This decision is devastating for my constituents. The Secretary of State will know that in the last winter period, Northwick Park hospital and Central Middlesex hospital, which comprise the North West London Hospitals Trust, were the worst-performing hospitals when it came to meeting A and E targets not only in London, but in the country. The trust scored 81.03%. That is an appalling record. What he has done today, by announcing the almost immediate closure of Central Middlesex, can only make that much worse. The College of Emergency Medicine has said that his reconfigured hospitals should have at least 16 consultants in their emergency departments, but his decision will give them 10—and that is not for major trauma centres. Will he elaborate on what he will do to bring the number of consultants up to the level required by the college?

Has the hon. Gentleman, who is so against these proposals, not noticed the proposals for more emergency care doctors, more critical care doctors and more psychiatric liaison support for A and E departments, which will reduce pressure on A and Es and mean that people admitted through A and Es for emergency care will not have a 10% higher chance of mortality if they are admitted at weekends? His constituents will be among the first to benefit from that. I would caution him, therefore, against saying that this is devastating for his constituents. We were reminded in Prime Minister’s questions earlier of how Labour suffered from predicting massive job losses, when in fact there was an increase in jobs. This announcement is good news for the hon. Gentleman’s constituents, and he should welcome it.

Does my right hon. Friend agree that, difficult though it may be, all NHS trusts will have to live within their budgets, because, with both Front Benches effectively having agreed public spending limits for several years to come, the amount of money that can be spent on the NHS will be finite whoever is in government?

My hon. Friend speaks wisely. Let us bear in mind the challenges facing north-west London, which are similar to those across the country, including in Oxfordshire. In the next two decades, its population is predicted to increase by 7%, and life expectancy has risen by three years in the last decade alone. Furthermore, the uncertainty over public finances means that the trust cannot bank on substantial increases in the NHS budget, so it has to do the responsible thing and look for better, smarter, more efficient ways to use that money to help more people. It has been brave and bold in doing this, and I think that many other parts of the country will take heart from what has happened today and come forward with equally bold plans.

Your House, Mr Speaker, is being made dizzy this afternoon by the surfeit of spin we are suffering. We are being asked to believe that this benevolent Government are partly motivated by a desire to end uncertainty. The death sentence ends the uncertainty of life, but it is not necessarily something I would recommend. Will the Secretary of State please provide a little information about what exactly a different shape and size A and E department looks like? The people of Ealing deserve to be told precisely what it means, otherwise they will think the worst.

I hope the hon. Gentleman will be pleased that today the death sentence on A and E at Ealing has been not just reprieved, but cancelled; it will keep its A and E. The definition of A and E is not something that politicians decide. We said in the statement that what the A and Es at Ealing and Charing Cross contain must be consistent with Professor Sir Bruce Keogh’s review of A and E services across the country, which they will be, and that any changes made in service provision must have full consultation with his constituents, which will happen. On the basis of an IRP report that simply says, “More work needs to be done,” I cannot answer all his questions, but I hope I can give him greater certainty than he had this morning that there will be an A and E for his constituents in Ealing.

Clinically led, evidence-based changes to services save lives. That is straightforward and clear. It is also clear that we have to make these changes happen if we are to live within our means and the health service budget. How are we going to make reconfigurations such as this one more straightforward, because the cost and time are unacceptable? Likewise with mergers, how are we going to streamline this process?

My hon. Friend speaks wisely. It concerns me, as it does her, that these processes take so long. When it comes to changes in A and E and maternity services, exhaustive public consultation is necessary, because they cause such great public concern, but we also need to deal with these issues in a much more timely way, particularly when it involves sorting out the problems of failing hospitals. I agree with her, therefore, and I am looking at what can be done to speed up all these processes, while retaining the appropriate consultation with the public.

Does the Secretary of State have any idea of the concern he is causing up and down the country? In Wigan, we value our 24-hour A and E service; we do not want it downgraded, and we do not want it closed. Will he clarify his proposal for the future of Ealing A and E? Is he proposing a type 1 service? Also, will he give me a cast-iron guarantee that any future decision about our local hospital will be made on the basis of people’s lives, not cost?

I can assure the hon. Lady that decisions about the future of A and Es will be based on what is best for patients and on what will save lives and get the best outcomes—that will apply in her constituency, as it will in mine and every other constituency—but that will sometimes mean a difficult decision if we have a change that doctors strongly support, but about which members of the public are anxious. I have said that services at Ealing will change, but that there will be proper public consultation and that at the end of the process there will still be an A and E. The recommendation from the process was that the A and E should close, but I said, “No, I think there should be an A and E at the end of the process.” I am injecting that much certainty, therefore, but I am not going to micro-manage the local NHS by saying precisely what those services should be.

It is not only A and E units in London that are under pressure; Derriford hospital’s A and E unit is also under pressure, because of our night-time economy. Is my right hon. Friend willing to meet me and potentially representatives from the English Pharmacy Board and my own Devon pharmacists to discuss how they can help to relieve some of the pressure on A and E units, especially down in Devon?

I would be more than happy to meet my hon. Friend and his local pharmacists. There is a lot that pharmacists can do. One change we are making that could make a big difference, where proper protections are in place for patients, is allowing pharmacists to access GP records so that they can give people the correct medicines, know about people’s allergies and things like that. There are lots of other things as well, though, and I look forward to the discussion.