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Commons Chamber

Volume 588: debated on Tuesday 25 November 2014

House of Commons

Tuesday 25 November 2014

The House met at half-past Eleven o’clock


[Mr Speaker in the Chair]

Oral Answers to Questions


The Secretary of State was asked—

Mental Health Services

Parity of esteem has been set out in law, and we are delivering it for people. More than 2.6 million people have entered talking therapy treatment through the Improving Access to Psychological Therapies programme since 2008, and we have secured an additional £120 million over 2014-15 and 2015-16 to support the introduction of the first ever waiting time standards in mental health services.

According to the recent chief medical officer’s report, mental illness is responsible for 70 million sick days a year, at an estimated cost to the economy of around £100 billion a year, so parity of esteem is essential. What more can be done through early intervention to help people with mental health illness by preventing their chronic problems from becoming acute?

My hon. Friend is absolutely right about the importance of early interventions. Next year, we are introducing for the first time a six-week maximum waiting time standard for access to psychological therapies to start treatment for conditions such as anxiety and depression, and a two-week standard for starting treatment for those suffering a first episode of psychosis. I am also calling on every FTSE 100 company to sign up to Time to Change, so that they can show leadership in how they deal with their employees.

It is one thing to say it, but completely another to do it. I am sure that the whole House will recognise improvements that happen, but does the Minister understand the scale of the crisis, not simply in the NHS but in the education system where more and more young people are increasingly finding that they simply cannot get anything like the support they need at increasingly difficult points in their lives?

I completely agree with the hon. Gentleman about the importance of children and young people being able to access treatment and support. If the truth be known, it has always been like this. It has always been the Cinderella of the Cinderella service, which is why we established a taskforce this summer, bringing in a whole load of experts and, importantly, consulting children and young people so that we can develop a modern health service for the mental health problems of children and young people. We hope to report early next year.

19. As the Cabinet taskforce sets out on this important work, will the Minister reassure me that it will bear in mind the important finding of the Health Committee’s inquiry into CAMHS—Child and Adolescent Mental Health Services—that it is the tier 1 and tier 2 services that really make the difference in preventing the need to access the service when children are much more unwell? (906238)

I very much appreciated and supported the findings of the Health Select Committee report into children and young people’s mental health services. The hon. Lady is absolutely right that we need to focus far more on preventing ill health and preventing a deterioration of it. If we can get into schools and work much better at maintaining people’s mental well-being, we can achieve much better results.

Despite what the Minister says, in South Shields, financial challenges have contributed to the closure of Bede wing mental health ward. This means that acute in-patient services are no longer provided in our borough. Can the Minister explain why mental health services are, in fact, being eroded under this Government?

Over the past decade and a half, there has been a very substantial reduction in bed numbers, and it is a trend that we should thoroughly support because we want to move away from institutional care towards supporting people at home in their communities. With children’s mental health, we have invested an extra £7 million this year to ensure that children get access to beds close to home when they need them.

Will the Minister ensure that the taskforce he mentioned considers the evidence that one in five mothers suffers from mental health problems during pregnancy or within a year of giving birth because the costs of that to society are massive and three quarters of those costs are borne by the child and subsequent generations? Is it not time to make sure that we focus on perinatal mental health because it can make such a big difference?

I very much agree with my right hon. Friend. Accompanied by my hon. Friend the Member for Torbay (Mr Sanders), I visited a brilliant perinatal mental health service in Torbay recently. My right hon. Friend is absolutely right. The London School of Economics has done a lot of work, showing evidence that if we invest in perinatal mental health, we get a return on the investment, but most importantly, we change people’s lives. I am determined to pursue that.

The Minister talks about parity of esteem, but it is under this Government that mental health budgets have been unfairly cut, and 1,500 beds and 3,300 nurses have been lost. He has already received a damning Select Committee report on child and adolescent mental health services. Ill people are being locked in police cells, or are travelling hundreds of miles to find a bed. The Minister could not have brought about more disparity if he had tried—and now we hear that there is to be yet another review. He is the Minister in charge. I ask him again: what action is he going to take today?

Inexplicably, when the last Labour Government introduced access and waiting time standards, they left out mental health. That was an extraordinary decision, and it drives where the money goes. The introduction of mental health waiting time standards next year, for the first time ever, will help to achieve equality for mental health. We have also published a vision of the next five years explaining how we will secure genuine equality for mental health, which is something that the last Labour Government did not achieve.

The Minister will know that the statutory guidance of the adult autism strategy in England is the keystone of the provision of services under the Autism Act 2009. The updating of that guidance is now imminent, and concern has been expressed to me about the draft wording produced by the Department. Can the Minister assure me that the Department does not intend to weaken the requirements for local authorities to provide services for people with autism and their families?

I am delighted that my right hon. Friend has become chair of the all-party parliamentary group on autism. She has fought for many years to secure a fair deal for people with autism. I am grateful to her for alerting me to the issue that she has raised, and I shall be sure to look at the guidance. It is absolutely not the intention to water down guidance for local authorities in any way.

Student Health Services

All patients are eligible to register with local primary medical care services, and that includes students who are moving away from home and starting university.

I do not think that the Minister has entirely engaged with the question. Those who run the student health services at Bristol university are warning that young people’s health is very much overlooked and underfunded—particularly mental health, which accounts for a quarter of all consultations. They are being hit by the GP funding changes and by cuts in public health spending on sexual health advice, and they have had to introduce their own meningitis vaccination programme because the Government have not introduced one. What support can the Minister give specifically to student health services?

I certainly remember being actively encouraged to register with a local GP when I was a student at Bristol university, and I understand that that continues today. As for the important question of children’s and young people’s mental health, the children’s mental health and well-being taskforce is looking at the mental health and well-being of students. Student Minds is involved in the process, and that in particular will help to inform the work of the taskforce in improving access to students with mental ill health.

Students do register with a practice in their university cities, but I was told recently by one of my constituents that she had experienced difficulty in gaining access to timely health care as a temporary resident when she was back at home. What options are available to ensure that students remain registered in the place where they are likely still to be spending half the year?

We recommend that all students register with university services, or with a GP in their university areas, but if patients are away from the GP with whom they are registered for more than 24 hours and less than three months—and that would include students—they can see a GP in the area where they are staying as temporary residents. GPs should be aware of that entitlement.

Students with long-term illnesses such as diabetes find it extremely difficult to manage their conditions, and there is evidence that a number of students are skipping their insulin injections. What further steps can be taken to make them aware of the necessity for them to take that important medication?

This is an incredibly important area of health care. How do we support young people through periods of transition? We know that people with long-term illnesses may struggle particularly, and diabetes and epilepsy are two of the conditions that have been identified. NHS England is currently examining transitional care tariffs to support people during the transition between children’s and adult health services, and educational support is part of that ongoing work.

My right hon. Friend the Minister for Universities, Science and Cities recently announced that there would be no cap on the number of students wishing to study pharmacy. Does my hon. Friend agree that Plymouth university should now press ahead with the setting up of a pharmacy school given that it is the Peninsula medical school?

My hon. Friend makes an important point. I visited the Peninsula medical school and his local university to highlight some of their excellent work in training medical and dental students. I believe that there is ample scope to expand provision to train other health care professionals in what is becoming an outstanding medical and health care training facility.


3. What representations he has received on exemption of the NHS from the provisions of the transatlantic trade and investment partnership. (906220)

The Government will not allow TTIP negotiations to harm the NHS. Any suggestion to the contrary is both irresponsible and false. I am grateful to the former Labour shadow Health Secretary for confirming that.

That is an interesting answer but, without specific exemption from TTIP, how can the Secretary of State give any reassurance that predatory organisations such as the Hospital Corporation of America, which was prosecuted for fraud in the US, will not use the TTIP provisions to seek contracts in our NHS?

The best assurance I can give the hon. Gentleman is not what I have said, but what the EU Trade Commissioner, Karel De Gucht—I challenge colleagues in Hansard to spell that correctly without looking at my notes—has said. In an interview in September, he said:

“Public services are always exempted—”

from TTIP—

“there is no problem about exemption. The argument is abused in your country for political reasons but it has no grounds.”

Colleagues in Hansard may not even rely on the Secretary of State’s notes; they may have their own source material. They are very special people those reporters.

I thank my right hon. Friend for that concise answer. I reiterate the message to the unions, which are sticking up billboards in my constituency, that Cameron and Hunt are not selling off the NHS.

I thank my hon. Friend for his comments. I was quite amused to see that I have a future career as an estate agent, along with the Prime Minister, when our hopefully long careers in politics are over, but the point is that this is scaremongering and it is wrong to scaremonger about something as important as the NHS. To suggest that the NHS is being privatised is fiction. What is not fiction is Labour’s legacy of poor care.

The Secretary of State’s definition of “harm” is not the definition that Labour Members have. My Bill, which was passed overwhelmingly on Friday, would require the Secretary of State to bring the matter back to this House should TTIP apply to the NHS in any way whatsoever. Will he support my Bill going into Committee without delay, so that we can discuss the detail and answer the questions he has?

Given the uncertainty of the French and German Governments on the investor-state dispute settlement mechanism, as well as the indication by EU Commission President Juncker that he will not back it, why have this Government not done more to protect the health service from a practice that would leave it vulnerable to private sector intervention?

This is what the EU chief negotiator said to the former Labour shadow Health Secretary, who is chair of the all-party group on TTIP:

“the rights of EU Member States to manage their health systems according to their various needs can be fully safeguarded…There is no reason to fear either for the NHS as it stands today or for changes to the NHS in future as a result of TTIP.”

It could not be clearer than that.

Patient Episodes

4. How many patient episodes there were at Kettering General Hospital in (a) 2010 and (b) the last year for which figures are available; and what assessment he has made of the reasons for the change in the number of such episodes. (906221)

In 2012-13 there were 85,497 in-patient finished consultant episodes at Kettering General Hospital NHS Foundation Trust, compared to 84,602 in 2011-12. There has also been an increase in the number of accident and emergency attendances, from 76,099 in 2010-11 to 84,055 in 2012-13. That increase is largely attributable to a high demand for services from a growing, ageing population.

Kettering general hospital serves one of the areas with the fastest population growth and greatest ageing in the whole country. Today’s report from the Care Quality Commission shows that, while the hospital has some of the most caring staff in the whole of the NHS, many areas of the hospital require considerable improvement. Will the Minister ensure that future NHS funding decisions are better targeted at areas such as Kettering which have such costly demographics?

My hon. Friend will be aware that the NHS funding formula is set independently, free from political interference. It is reviewed annually. I should like to reassure him that the Nene and Corby clinical commissioning groups have both received higher than real terms growth in their funding allocations and will do so again next year, to move them closer to their target allocations.

I have been working closely with the hon. Member for Kettering (Mr Hollobone) in recent years on a campaign to support the hospital. We recognise the issues that the CQC has raised, and we support the journey that the hospital is taking towards improvement. When the hon. Gentleman and I come to see the Minister in a few months’ time, will he look favourably on our bid for £20 million of funding to improve our accident and emergency department, whose physical environment has been described by experts as being among the worst in the country?

I am looking forward to that meeting in the new year. I should like to reassure the hon. Gentleman and my hon. Friend that the Department has provided a total of £5 million of temporary public dividend capital funding and a further £1 million of emergency capital to the trust in the past three months, so support is going into the delivery of high-quality services.


Cannabis is classified as a class B drug under the Misuse of Drugs Act 1971, as my right hon. Friend knows. To sell cannabis or preparations made from it as a medicinal product would necessitate obtaining a licence from the Medicines and Healthcare products Regulatory Agency. Cannabis in its raw form is not authorised as a medicinal product in the UK. However, certain cannabis extracts are contained in Sativex spray, which is the only medicine produced from the cannabis plant that is approved for use as a medicinal product in the UK. It is licensed for use in treating spasticity in multiple sclerosis and was approved in June 2010.

Over the last year or so, I have met a number of credible people from all walks of life and with a range of medical conditions who have told me that the only substance that helps their medical condition is cannabis. However, they cannot secure it through the NHS and they risk getting a criminal record if they try to obtain it for themselves. Will the Minister look at the much wider availability of cannabis for medicinal purposes in other countries and try to find a way to help those in need in our country?

As a former Home Office Minister, the right hon. Gentleman will be aware of the difficulties of getting this policy right. I do not believe that anyone in the House thinks that we ought to allow the prescription of a controlled substance willy-nilly without good evidence. I should like to draw his attention to this evidence from Cancer Research UK, which states:

“At the moment, there simply isn’t enough evidence to prove that cannabinoids—whether natural or synthetic—work to treat cancer in patients, although research is ongoing. And there’s certainly no evidence that ‘street’ cannabis can treat cancer.”

We continue to keep this matter under close observation, and there is good evidence of science being done by companies and by the National Institute for Health Research.

Has the Minister assessed whether the use of cannabis can result in paranoid and deluded behaviour, leading people to believe, for example, that it is possible in this country to mount a huge conspiracy to pervert the course of justice involving the police, the ambulance services, the security services, the Government of the day and the media, and to pretend that someone who had killed themselves had actually been murdered?

The hon. Gentleman makes an interesting parliamentary point, but my responsibilities cover only the licensing of cannabis for medicinal purposes.

Cannabis no doubt has some limited medicinal benefits for some illnesses, but will the Minister put it on record that it is not the Government’s intention further to liberalise any licensing of cannabis, especially in the light of the Institute of Psychiatry’s empirical evidence that abuse of the substance can lead to severe mental illness?

My hon. Friend makes an important point, and I am happy to give him that undertaking. We have to be careful to maintain a distinction between recognising the damaging effects of the recreational use of cannabis and the specific medicinal benefits of some of its derivatives, when tested and proven, in medicinal products. We intend to make that distinction very clear.

Cancer Drugs Fund

6. How many patients have received treatment through the cancer drugs fund since the inception of that fund. (906224)

More than 60,000 patients in England have received treatment through the cancer drugs fund since its inception in October 2010. They and their relatives will be very concerned at the suggestion made by the shadow Health Secretary last month that a Labour Government could abolish the fund.

I congratulate the Secretary of State on that very high figure. Is he aware that some of those people who are being treated have had to sell up their homes and move here from Wales, where they are routinely denied life-prolonging cancer drugs by the Labour-run Welsh Assembly Administration. What does that teach us about the respective differences between the health services in England and Wales?

I thank my hon. Friend for raising that point. The last Labour Government did leave us with one of the lowest cancer survival rates in western Europe, which is one of the reasons why we introduced the CDF. Unfortunately, the current Labour Government in Wales are continuing with those policies, which is why 6,500 Welsh cancer patients were admitted for treatment in English hospitals last year. [Official Report, 12 January 2015, Vol. 590, c. 5-6MC.]

So will the Secretary of State then publish the assessment of the CDF by the chemotherapy intelligence unit before 7 May 2015?

We are, on the NHS, the most transparent Government in history, and I can see no reason why we would not publish that. We are very proud of what the CDF has achieved. We are very proud that the level of cancer diagnoses has increased by more than 50% compared with what it was under the previous Labour Government, and so we are finally starting to win the battle against cancer.

We all remember the horror stories before the CDF existed locally, and all Government Members certainly support its continued use. Before any drugs are delisted from the CDF, will the Secretary of State make available the scoring of those drugs? Will he also outline what the provisions will be for consultation with patients and their families?

We will absolutely go through a transparent process on that. My hon. Friend is right to talk about the CDF’s success, which is why we have put its budget up by 40%. As part of the fund’s success, we want to make sure that it is allowing access to the latest drugs and to drugs that really work. Obviously, science has moved on since the fund was set up four years ago, which is why we want to make room for new drugs and take off existing drugs where there is evidence that they are not working as well as possible. However, the process must be transparent.

Last Wednesday, the Prime Minister denied that there is a problem with cancer care, yet the target for cancer patients to start their treatment 62 days after a general practitioner referral has been missed for nine months in a row. Cancer Research UK says that this target is vital for ensuring swift diagnosis and treatment so that we have the best survival rates in the world. Some 15,000 patients have already waited too long. This is a serious problem requiring serious action, so what is the Secretary of State going to do?

I think cancer patients in the hon. Lady’s constituency will welcome the fact that under this Government Leicester hospital has 194 more nurses and 120 more doctors, many of them involved in cancer care.

Let me answer the hon. Lady’s question directly. There is pressure on one of the cancer standards, and that is because every year we are now diagnosing 460,000 more people than happened under the last Labour Government, who left us with such a disappointing survival rate. When that many people are being diagnosed, it of course puts pressure on the diagnostic labs and the people doing those processes. But Cancer Research UK is also saying that we are seeing record increases in survival from cancer, and that is happening because of this Government’s policies.

Tobacco Packaging

7. Whether the Government have made a final decision on whether to introduce standardised packaging of tobacco products. (906225)

The Government have not yet made a final decision on whether to introduce standardised packaging. We are carefully considering a large number of responses from the summer consultation, together with detailed responses from EU member states.

I thank the Minister for her answer, albeit a disappointing one. Given the majority support for standardised packaging in this place and the fact that elected Members have backed it, perhaps she could explain why the Government have not come to a decision? Will she consider having a debate in the House on the subject, with a vote that people can take forward so that they believe that this Government actually care about people who are trying to stop smoking?

We are taking this forward. Not everyone in the House may be aware that we are obliged to go through a process with Europe, whereby we notify this policy to EU member states and there is a statutory three months during which member states can give a detailed response. If any member state does so, there is a six-month pause. Four states—Bulgaria, the Czech Republic, Portugal and Romania—have given that detailed opinion, and the window has not yet closed. The House might be interested to know that Ireland received eight detailed responses on this subject. That is part of the process.

I welcome the Minister’s statement that she will wait for the evidence before moving forward rather than relying on emotion. She knows that the policy, if implemented, would threaten 1,000 jobs in my constituency. Furthermore, will she agree to await the outcome not only of the evidence from Australia but of the tobacco tax directive that is being pushed through Europe?

I am encouraged by the evidence from Australia. We have seen some really impressive statistics regarding the cessation of smoking. The Government have not yet made a final decision on the matter, but Health Ministers are on the record as saying that we are minded to move forward on this, and we want to make progress. I regret the loss of jobs in the hon. Gentleman’s constituency, but I know that he will be working hard to assist his constituents in looking for other employment.

If plain packaging were introduced, what assessment has there been on whether that will make life easier or more difficult for the counterfeiters?

That is one issue that we will weigh up before making a final decision. Obviously, we received a large amount of evidence from the consultation, and we are looking at it in detail. Some of it was around that matter, although it is also the case that Sir Cyril Chantler made some robust statements in his report, rebutting some of the claims, but that is all part of the final consideration that the Government will make.

Innovative Medicine and Health Care Technology

8. What steps his Department is taking to accelerate access to innovative medicine and health care technology in the NHS. (906226)

Accelerating access for patients to innovative medicines and health care technology is central to my mission as the UK’s first Minister for life sciences. Breakthroughs in genetics and the use of data are unlocking a new era of precision medicines, earlier diagnosis and remote monitoring, which can dramatically improve patient outcomes, and the efficiency of our health service. That is why I announced last week a major review of the role of the regulators, the Medicines and Healthcare Products Regulatory Agency and the National Institute for Health and Care Excellence, in accelerating innovation in the NHS.

I know that the Secretary of State has already visited Airedale general hospital to see its telemedicine service. Earlier this month, I visited Marsden Grange care home in Nelson to look at the service from a patient’s perspective. The service is reducing pressure on the ambulance service, local GPs, A and E departments, and, crucially, improving patients’ experiences. How can we ensure that telemedicine is much more widely used?

My hon. Friend makes an excellent point. As with Airedale, the Marsden Grange care home initiative shows that we can improve patients’ outcomes, deliver more health for the same amount of money and make our system much more efficient. That is why we so strongly support telemedicine, why NHS England has undertaken a rapid review of the 3 million lives programme and why, last week, we launched our review to accelerate the adoption of innovative med-tech and e-health technologies into the NHS.

What is the good of innovation if we do not use it? For the 1 million people who suffer from atrial fibrillation, the three new NICE-approved drugs are a life saver; they make life worth living. But only about 6.5% to 7% of people have been prescribed the new drugs, as they are being blocked by clinical commissioning groups and GPs. What will the Minister do about that?

The hon. Gentleman is right to raise the matter. We have all seen it coming in recent years. Extraordinary advances in science are developing a huge range of new products, which our system is having to adjust to cope with, and that is precisely why I launched the review last week with NICE and the MHRA. We must look at these transformational technologies that bring new opportunities to our services and at how we can design a system that is better able to target innovations to the patients who need them.

18. Dementia is an abhorrent disease that affects thousands of people across the UK, and a significant number in my constituency of Fylde. With that in mind, what steps is the Minister taking to ensure that dementia sufferers have access not only to the most innovative medicine but to the most advanced early diagnosis? (906237)

My hon. Friend makes an important point. Dementia is one of those diseases where the loved ones and the carers of patients often suffer every bit as much as the patients. That is why, under the Prime Minister’s leadership, we have launched the G8 dementia summit to bring together the world to tackle the disease. We have launched a dementia strategy. Diagnosis rates in Britain have gone from 42% to 55% in two years. We have launched a new dementia service and doubled research spending. We will have 250,000 staff trained by next March, and, from April, we will be investing £3.8 billion into the Better Care fund. It is an important disease that deserves our priority.

The Ear Foundation recently published a report that estimates that the real cost of adult hearing loss is at least £30 billion a year. I hope that the Minister has read it. What is he doing to ensure that adults who could benefit from improved hearing technologies, including cochlear implants, do so, and when does he plan to publish the action plan on hearing loss that has long been promised?

I am not aware of the veracity of the £30 billion figure, but I will happily look at it, and I happily undertake to look at the progress of the report and the work that the hon. Lady raised.

20. It is a well-established fact that type 1 diabetics who have insulin pumps are much more able to control their condition than those who do not, yet the take-up of insulin pumps in the UK compared with Europe and America is pitiful. What is the Department doing to increase the commissioning of insulin pumps? In the long run, the costs go down with better control. (906239)

My hon. Friend raises a important example of an innovation that, despite costing a little extra at the beginning, saves substantially downstream. One of the challenges in our national health service is tackling a series of ways in which the system is not well geared to incentivising such innovations. NHS England recently set out its five-year forward view, which has, for the first time, a strong commitment to tackling such issues, and we are working with it to see what we can do to remove barriers and promote incentives for earlier adoption.

What steps are being taken to ensure that emerging treatments for Duchenne muscular dystrophy that receive conditional approval are available through the early access to medicines scheme as early as possible?

I was delighted, when we launched the early access to medicines scheme earlier this year, to see the very strong support that we got from the Duchenne dystrophy group. Dystrophy is one of those terrible diseases that desperately need the fast-tracking of new medicines. As I said, last week we launched a major review of our landscape for the earlier adoption of innovative medicines in the NHS, so that patients in the most severe clinical need can take part in cutting-edge research and we get drugs to patients more quickly.

Off-patent Drugs

9. What recent representations he has received on access to off-patent drugs; and if he will make a statement. (906227)

The hon. Gentleman will be aware of the debate in the House two weeks ago in which I gave a very full statement of the Government’s position on off-patent and off-label drugs. We want to promote their wider use, but we do not believe that the Bill presented to the House is the right mechanism for achieving that.

Will the Minister borrow from the approach taken with the Medical Innovation Bill, and commit to consulting on whether the Government should support, or how they might pursue, the key purposes of the Off-patent Drugs Bill?

As I said in the debate, we absolutely support the Bill’s intention, which is to promote the greater use of off-label and off-patent drugs, but that must remain a decision for clinicians exercising their judgment about what is best for their patients. We do not think it right that the Government should be put in the position of effectively sponsoring new drug licence applications to the Medicines and Healthcare Products Regulatory Agency. I have convened a round table working group with all the stakeholders to try to look at how we can maximise information to clinicians to promote the use of off-label and off-patent drugs.

NHS Trusts and Foundation Trusts

Thirty-three NHS trusts and 60 foundation trusts are forecasting an end-of-year financial deficit, with the remaining 65 NHS trusts and 87 foundation trusts forecasting an end-of-year surplus.

Earlier this year, Monitor announced that the number of trusts in financial breach had nearly doubled over the previous 12 months. How confident is the Minister that the number will not double again next year?

I am very confident that the measures already in place to drive efficiencies in the NHS are on course to save £20 billion during this Parliament. Many of those efficiencies are being delivered by improved procurement practice at a trust level. The Government have also invested £15 billion during this Parliament, which is a real-terms increase of £5 billion in NHS funding to support trusts.

The Government have invested hugely in the NHS in Harlow, including millions of pounds to our accident and emergency unit. However, for historical reasons the Princess Alexandra hospital has financial difficulties. Will my hon. Friend look at this and see what the Government can do to help?

Of course. As my hon. Friend is aware, every local health area—every clinical commissioning group—is receiving an increase in the funding available to it year on year. I would be happy to meet him to discuss the matter further, if that would be helpful.

As the Minister knows, North West London Hospitals is one of the NHS trusts that is in deficit. It has seen the accident and emergency departments at two nearby hospitals close, and its hospital board estimates that an additional 123 beds are necessary. Will the Minister meet me to discuss the problems of its historical deficit and the need for additional funding to make sure that those 123 medical beds are provided?

I can reassure the hon. Gentleman that, in the words of the medical directors of all the hospitals affected, there is a very high level of clinical support for the programme across north-west London, and the changes will save many lives each year and significantly improve the services that are available to local patients. I hope that is reassuring to the hon. Gentleman and to local patients.

Running a deficit can demonstrate short-term problems which, once resolved, will allow a trust to return to balance. Does my hon. Friend agree that there must be flexibility in the system, particularly for trusts such as North Cumbria, which have been in special measures?

It is absolutely right that trusts such as North Cumbria need to face up to challenges when those affect the quality of patient care, and that the focus of Care Quality Commission inspections and special measures is to drive up standards of care. It is also important that we continue to invest and support trusts where we can. That is why we are pleased to be increasing the NHS budget by £15 billion during this Parliament.

Is the Minister aware that the Manchester primary care trust ought not to be incurring a deficit because it does not spend sufficient of its money and resources on investigating cases referred to it and on responding to hon. Members such as myself when they write to it over a period of months? Will he look into this incompetence and examine similar behaviour, or lack of it, by the Care Quality Commission?

It is very important that the NHS faces up to the situation when things have gone wrong so that it can put them right for the benefit of patients in future. If the right hon. Gentleman has concerns about his local NHS not investigating complaints that he has raised with it on behalf of his constituents who are patients of the local trust, I am very happy to investigate those issues for him if he would like to write to me about them, and see what I can do to ensure that he gets the answers that he and his local patients deserve.

I understand that pretty much every hospital in Essex faces a yawning deficit, including Colchester hospital. Can the Minister guarantee that we can address the deficit without having to dramatically and radically reconfigure local services in Essex?

It is important to outline that for the first time this Government have put in place, via section 42 financial agreements with trusts where there is a requirement for interim financial support, measures that will ensure that trusts are held to account for delivering efficiencies—for example, reducing agency staffing costs, improving procurement practice, more efficient estate use and land disposal, and pay restraint of very senior managers. I am therefore confident that the local NHS can continue to deliver efficiencies to direct money to front-line care.

Cancer Drugs Fund

11. Whether it remains the policy of the cancer drugs fund to provide drugs which NICE has rejected for general use in the NHS. (906229)

I pay tribute to my hon. Friend for his tireless campaigning on the issue of cancer drugs. I can assure him that the cancer drugs fund now administered by NHS England continues to fund effective cancer drugs which have been not been recommended by the National Institute for Health and Care Excellence. Over 60,000 patients in England have benefited from the fund since October 2010. That is why we announced a £160 million boost to the fund earlier this year.

Will my hon. Friend look again at the CDF’s proposal to delist 42 cancer drugs, including Abraxane, which was put on the list only nine months ago and is the first new drug in nearly 40 years to produce an extension of life for pancreatic cancer patients?

I am grateful to my hon. Friend for his notice. I have spoken to NICE. It is appraising the use of Abraxane for pancreatic cancer and has not yet published its final guidance. It would not be appropriate for me to intervene at this point. Obviously, we respect NICE’s clinical independence. Abraxane is available through the CDF for patients meeting specific clinical criteria. I understand that the NHS England’s CDF panel plans to reassess the inclusion of Abraxane in the national list, but no decisions have yet been made.

It is a pleasure to follow the hon. Member for Lancaster and Fleetwood (Eric Ollerenshaw). Everyone in every part of the United Kingdom wants to improve access to cancer medicines. When the Prime Minister launched the cancer drugs fund in the home of Clive Stone, he promised to get

“more drugs to people more quickly”.

Mr Stone recently criticised proposals to remove a number of drugs from the fund, writing in his local newspaper that

“People are going to die, there is no doubt about it. Why don’t people keep their promises?”

Additionally, the Breakthrough Breast Cancer campaign has said that it is

“deeply concerned that several very effective breast cancer drugs appear on the list of drugs at risk of delisting”.

We all know someone affected by cancer in some way. What does the Secretary of State have to say to those patients relying on those drugs that are being removed from the fund?

The first thing I would say is that we have given an undertaking that any patients currently on drugs will not have the drug removed. Secondly, we are dealing with some very difficult issues. We have had extraordinary breakthroughs in the progress and rate of development of new cancer drugs, and we need to have a system for ensuring that the cost-benefits—the health economics—are done properly. NICE leads the world in making these difficult clinical judgments and we support its independence in doing so, but we need to ensure that we are not turning this issue into a political football. I notice that the shadow Health Secretary said that this was good politics but not good policy. It is really important that we ensure that when we set a benchmark on this debate we are guided by what is best for patients.

Access to GPs

The Prime Minister’s £50 million challenge fund is improving GP access for more than 3 million patients across England, helping them to get evening and weekend appointments.

Many people in South Ribble will be able to see their GPs in the evening and at weekends, thanks to a locally led initiative by Chorley and South Ribble clinical commissioning group and Greater Preston CCG to extend GP surgery opening hours this winter. Does my right hon. Friend agree that such initiatives, which will give greater flexibility to patients and alleviate pressures on other areas of the NHS, particularly A and E, are exactly what is needed in the busy winter months?

I do agree with my hon. Friend. I took my own children to an A and E department at the weekend precisely because I did not want to wait until later on to take them to see a GP. We have to recognise that society is changing and people do not always know whether the care that they need is urgent or whether it is an emergency, and making GPs available at weekends will relieve a lot of pressure in A and E departments.

I am afraid it is yet more spin from the Government. Everybody knows that it is getting harder not easier to see a GP under this Health Secretary. He has as much as admitted today that emergency departments across England have failed to hit the Government’s A and E target for 70 consecutive weeks, and that is in part because people are struggling to get a GP appointment in the first place. Will he now get a grip on this problem, and call on his Chancellor of the Exchequer in next week’s autumn statement to use £1 billion from banking fines to help ease pressure on the NHS this winter, as the Labour party has pledged?

We will not take any lessons from the Labour party about general practice. It is not just the disastrous 2004 GP contract. The president of the Royal College of General Practitioners says that the shadow Health Secretary’s plans

“could destroy everything that is great and that our patients value about general practice and could lead to the demise of family doctoring as we know it.”

Patient Choice

This Government are committed to patients having greater choice and control over their health care, and decisions as to which treatments are available on the NHS are taken by GPs on the basis of available scientific evidence.

Does my right hon. Friend have any plans to increase personal health budgets, and will he ensure that there is greater awareness of the health professions that are regulated by the Complementary and Natural Healthcare Council, the Health and Care Professions Council and the Professional Standards Authority, which has recently accredited the Society of Homeopaths and the British Acupuncture Council?

I am a strong supporter of personal budgets. People who have complex medical needs want, above all, to have personal control over their own health care, and they will be extremely worried that the Labour party has now said that it wishes to abolish personal budgets.

With regard to reducing patient choice, can the Secretary of State explain the sudden move to remove dialysis from being regarded as a specialised commissioning service, which is of great concern to a constituent of mine who is a renal patient and to the renal community? Will the Secretary of State now agree to a proper consultation—not over the Christmas holidays—and will he think again about that risky move?

We hope to have a public consultation on the matter. We are not seeking to restrict access to dialysis—far from it. We want to make it easier for people to access those vital services, and we have been putting more money into the NHS budget because we recognise just how important they are.

Topical Questions

As we look forward to world AIDS day next Monday, the whole House will want to pay tribute to the 30 NHS volunteers who left for Sierra Leone at the weekend to help in the fight against Ebola. They stand for the very best of the NHS and make us all proud. Last week I formally launched the MyNHS website. It contains 395,000 pieces of information and is the first website of its kind anywhere in the world. It will help people compare vital information about the performance of their local hospitals, GP surgeries, councils, mental health trusts and residential care homes. It will be a vital way to ensure that patients are not kept in the dark about the quality of their NHS services.

Further to the Secretary of State’s answer to the hon. Member for Worsley and Eccles South (Barbara Keeley), he must know that treating renal failure requires complicated, integrated care and that no one part of it can be separated. He must also know that there are 23,000 dialysis patients in the UK, and transplant patients have overlapping clinical needs. Handing responsibility for commissioning dialysis to commissioning groups is unacceptable, especially as it has been done without any consultation. Can he explain the rationale for all this, and will he meet me and colleagues from the all-party kidney group to discuss the matter?

I am happy to arrange a meeting between either me or one of my Ministers and members of the APPG to discuss the matter. I stress that we recognise how important those specialised services are. We want to get the benefits of nationally co-ordinated commissioning with the local integrated care that CCGs are in the driving seat to deliver. That is why we are having this discussion.

T2. Public Health in Cornwall has estimated that 300 people in Cornwall might die from the cold this winter because they are living in cold homes. Last week the Government introduced the first proper fuel poverty strategy to eradicate that totally unacceptable situation by 2030. Will my right hon. Friend join me in praising the work being done in Cornwall by a partnership of over 30 organisations in the Winter Wellness programme to ensure that people stay warm and well this winter? (906244)

Order. On both sides of the House the questions have been too long. It is not fair on other Members who are waiting to contribute. Please cut it out.

I commend my hon. Friend, who, as many of us know, has worked enormously hard on a whole range of health issues in her constituency. In particular, I know that she has helped deliver the Winter Wellness programme with a number of local organisations. It is important to highlight what help and advice is available for people who need it most in order to stay warm. The Government’s cold weather plan has a series of cost-effective and simple measures that people can take to reduce the harm caused by cold weather.

Two weeks ago, news emerged of serious problems at Colchester hospital. People there still do not know the precise details, as Ministers have not made a statement and the Care Quality Commission has not published its report. But Colchester is not the only hospital in difficulty; we have learnt that hospitals in Scunthorpe, Middlesbrough and King’s Lynn have been turning patients away and others are already on black alert, and that is before winter has even begun. We do not have an accurate picture of what is happening in the NHS right now, because NHS England was due to begin publishing weekly reports on 14 November but has failed to do so. Why has that information not been published, and will the Secretary of State today instruct NHS England to do so without delay?

That information is published at the decision of NHS England—[Interruption.] It has said that it will publish it in a fortnight’s time. Let me just say to the right hon. Gentleman that it was this Government who decided to publish that information on a weekly basis, something he never did when he was Health Secretary.

I am afraid that is just not good enough. Who is in charge here? It is not just A and Es that are under pressure; there is a knock-on effect on ambulance services. Reports are now surfacing of serious failures in patient care. Last month, a six-year-old girl from Sunderland was left for three hours with a suspected broken back despite five 999 calls. At the weekend, it was reported that a 56-year-old stroke patient from Huyton was taken to A and E by police on a makeshift stretcher made from window blinds from the man’s home, and he later died. Yesterday, it emerged that a 57-year-old cancer patient from Bishop Auckland died after three ambulances were diverted to other calls. Is it not clear that the situation in the NHS right now is far more serious than the Government have acknowledged, and should not the Secretary of State now make an urgent statement to Parliament setting out what he is doing to reduce the risk of harm to patients this winter?

There are huge pressures in the NHS. That is why we have put a record £700 million into the NHS to help it to get through this winter. May I gently suggest to the right hon. Gentleman that he should not try to politicise every single operational problem? When the NHS is all about politics, patients get forgotten—as he should know, because that is what happened when he was Health Secretary. Whether in Medway, Colchester, Burton or George Eliot, patients were forgotten because for Labour it was politics before patients every time.

T6. Will the Secretary of State look again at the funding formula for hospital trusts so that some adjustment can be included to recognise the issues in trusts such as University Hospitals of Morecambe Bay NHS Foundation Trust which cover large and difficult geographical areas? (906248)

I recognise those issues, and I am very happy to take that suggestion away. I particularly want to put on the record that the scare stories put out by Labour in Lancaster about the potential closure of Royal Lancashire Infirmary are false. It is totally irresponsible to scare people in Lancaster in that way.

T3. My constituent Corron Sparrow was left lying in the road for two hours with a compound fracture of his leg despite a call from a policeman to the North East Ambulance Service pleading for help. Eventually the service responded by sending an ill-equipped St John Ambulance team who then had to call for professional assistance. There are many more failures. It is now three weeks since I wrote to the chief executive, Yvonne Ormston, asking for an inquiry into this, but she has not even acknowledged my letter. Will the Minister intervene and tell the North East Ambulance Service that it cannot just ignore these matters? (906245)

I am very sorry to hear about the difficulties experienced by the hon. Gentleman’s constituents, and of course I am happy to look into those and do what I can to help him with that. However, I would also like to make it clear on the record that because this Government have put £15 billion more into the NHS during this Parliament, we are making sure that we are keeping services running efficiently through the winter for the benefit of patients.

T7. Eighteen NHS trusts have been placed in special measures, while so far six have come out. What progress is being made with the other 12? (906249)

I am happy to answer that, because for the first time we have a proper independent inspection regime. Labour tried to vote that down so that we could not have it, but we pressed on. A third of these trusts have been turned round. We are making good progress across most of the other 12 hospitals in special measures, including 1,500 more nurses, 200 more doctors, and 53 changes at board level. Where there were problems before, we are sorting them out.

T4. Patients with mental health problems who are referred for psychological therapies wait, on average, less than 40 days for treatment, but in York the wait is 125 days. My constituent, Laura Goodacre, has now waited nearly 350 days. Will the Minister look at this worrying case and the need for our mental health trusts in York to reduce waiting times? (906246)

I will absolutely look at that case, and I am happy to talk to the hon. Gentleman about it. This is precisely why we are introducing, for the first time ever, an access standard—a maximum waiting time of six weeks for access to psychological therapies from next April.

T8. After all the cover-ups of the past, what is being done to ensure that the culture of the NHS is always improving, particularly in that patients are treated with dignity and respect and always have the highest standards of safety? (906250)

I thank my hon. Friend for his question. After the Francis report, we now have 5,000 more nurses on our hospital wards. The scores that patients themselves are giving for whether they are treated with dignity and respect are up by 10%. We want to put poor care behind us and behind the NHS. It is time that Labour got on board with this agenda instead of constantly saying that we are running down the NHS by sorting out poor care.

T5. Recent reports indicate that the extent of child sexual exploitation and abuse is more widespread than previously recognised. The trauma of sexual abuse can have massive, life-long consequences on the physical and mental health of victims. Will Ministers consider designating child abuse and child sexual exploitation as a public health priority in the same way as smoking, alcohol, drug use and obesity? (906247)

The hon. Lady is quite right to say that those are incredibly important issues, and we do see this as an important public health issue. We are committed to tackling child sexual abuse. In May the Department published its response to the recommendations of the independent health working group report on child sexual exploitation and we accepted the recommendations in full. We are taking this very seriously.

T9. Do Ministers agree that the patient transport guidance should be interpreted with an understanding of rural needs, rather than telling my elderly constituents to report to a hospital 60 miles away and to get three buses there and three back that do not connect with each other in order to have treatment or consultation? (906251)

It is particularly important in rural areas that patients with complex medical needs who have difficulties mobilising or who perhaps do not have access to a car are supported by the local NHS to access the services they need. There is provision for local hospitals, as well as for CCGs, to give financial assistance to support patients in accessing services and to give them lifts to hospitals, as appropriate.

T10. When I asked the Prime Minister two weeks ago about the financial crisis facing Devon NHS, he seemed completely unaware of it, so could the Health Secretary please explain why Devon NHS faces an unprecedented £430 million deficit and what he is doing to stop the rationing, cuts and total withdrawal of some services that is now being proposed? (906252)

We are not rationing services. In fact, we are doing 1 million more operations every year than were done under the previous Government. I will tell the right hon. Gentleman why that financial pressure exists: we have an ageing population, with nearly 1 million more over-65s than four years ago, and huge pressure to deliver good care in the wake of the Francis report. The NHS will be supported if we have a strong economy that can fund real-terms increases in health spending—something that never happens if the deficit is forgotten.

My constituent, six-year-old Sam Brown, is one of 100 people with the rare disease Morquio. His family live in a state of anxiety because they do not know whether the drug Vimizim will be approved for further use on 15 December. Will a Minister please meet me and Katy and Simon, Sam’s parents, to give Sam the Christmas present he needs and to keep Sam smiling?

Last month one patient waited 35 hours in Medway’s A and E, and in the past year 10 patients have waited more than 24 hours. I was grateful to the Secretary of State for taking up my invitation to visit the hospital. What progress has been made specifically on turning around the A and E department?

There are more doctors and more nurses operating at Medway hospital and I know that when the hon. Gentleman was sitting on this side of the House he was very pleased with the progress that was being made in turning it around from special measures, but, like UKIP’s policy on the NHS, everything changes.

May I welcome the recent launch of MyNHS? Does my right hon. Friend agree that transparency of NHS performance, whether it be that of hospitals, GPs or surgeons, will be a major driver in improving patient care, as international evidence suggests, and help us avoid a scandal such as Mid Staffs, which happened under that lot over there?

Two thirds of the information we are publishing on MyNHS was actually collected by the previous Labour Government, but they refused to publish half of it. That is the difference.

Do Ministers agree that it is a scandal that cold homes are costing the NHS in England more than £1.3 billion every year, with kids growing up in cold homes twice as likely to contract diseases such as asthma? Do they also agree that it is hugely disappointing that not one penny of Treasury infrastructure funding is devoted to energy efficiency? Will they speak to their Government colleagues about that?

The hon. Lady will know from the answer I gave to my hon. Friend the Member for Truro and Falmouth (Sarah Newton) that the Government published the first fuel poverty strategy for England, which aims to address that very issue. It is also really important that all Members do everything they can locally to publicise the Government’s cold weather plan. Members can really assist local public health officials and their local NHS to get the word out to all communities about the simple measures we can take to keep our constituents warm and safe this winter.

One of the key challenges in improving access to GPs is improving recruitment of GPs. Will the Secretary of State work with the Royal College of General Practitioners and other medical groups to see whether there might be merit in introducing a mandatory stint of working in a GP surgery for junior doctors?

I am sure that my hon. Friend will welcome the fact that there are now just over 1,000 more GPs working in the NHS and training than when we came into government, but there is more we need to do. We have committed to delivering 5,000 more GPs for the NHS, and part of that work will be working with the Royal College of General Practitioners to ensure that we can support return-to-practice initiatives for GPs who have taken career breaks.

Order. The level of interest in Health questions today has broken box office records. I am sorry not to be able to accommodate remaining demand, but we must now move on.

Murder of Lee Rigby

Today, the House of Commons Intelligence and Security Committee has published its report into the murder of Fusilier Lee Rigby. He was a British soldier who stood for our country and for our way of life, and he was killed in broad daylight on the streets of our capital city. It was an appalling, sickening act, and a stark reminder of the threat we face from home-grown terrorists and extremists plotting to murder our people. At the same time, we should be clear that it was also a betrayal of Islam, and of the Muslim communities in Britain who give so much to our country.

I am sure the thoughts of the whole House are with Lee Rigby’s friends and family at this time. When I spoke in the House in the aftermath of the attack, I said we would bring those responsible to justice, and learn the lessons of what happened in Woolwich. The two murderers, Michael Adebowale and Michael Adebolajo, have since been convicted and sentenced to life in prison.

Today, this report answers the questions we had about what our security services knew about these murderers, and the lessons we can learn to help to stop similar attacks in the future. I am grateful to my right hon. and learned Friend the Member for Kensington (Sir Malcolm Rifkind) and his Committee for their comprehensive report. It contains an unprecedented degree of detail on the current workings of MI5, the Secret Intelligence Service and GCHQ. I wanted us to get to the truth as quickly as possible, without a prolonged judicial process, and that is exactly what has been done with this exceptional report. Few countries in the world would publish this degree of detail about the activities of their security services. It reflects the way we have strengthened the Committee with new powers to hold our security services to account. For this report, the agencies have carried out the same searches they would for proceedings in the law courts.

Before I turn to the key findings, let me be clear that this is a very serious report, and there are significant areas of concern within it. I do not want anyone to be in any doubt that there are lessons to be learned and things that need to change. On the key findings, I am sure the House will welcome the fact that the Committee does

“not consider that, given what the Agencies knew at the time, they were in a position to prevent the murder of Fusilier Lee Rigby.”

Furthermore, the Committee says:

“It is greatly to the Agencies’ credit that they have protected the UK from a number of terrorist plots in recent years”.

As the Commissioner of the Metropolitan Police says, at least four serious plots have been foiled this year alone. So much of what our agencies do necessarily goes unreported. They are Britain’s silent heroes, and the whole country owes them an enormous debt of gratitude.

There are four broad areas where things need to change: first, dealing with the delays in the process of investigating potential terrorists; secondly, dealing with low-priority cases and so-called self-starting terrorists; thirdly, the role and responsibilities of internet companies in helping to keep us safe; and, fourthly, tackling foreign fighters travelling abroad for terrorist purposes. I want to take each in turn.

First, the report identifies a number of serious delays and potential missed opportunities. The Committee expressed concern over the four-month delay in opening an investigation into Michael Adebolajo following his return from Kenya in 2010, and the eight-month delay before Michael Adebowale was first actively investigated in 2012. The report concludes that an application for intrusive surveillance on Michael Adebowale in 2013 took

“nearly twice as long as it should have”,

and that had the original target been met, these further intrusive

“techniques would have been in place during the week before, and on the day of, the attack”.

Crucially, the report goes on to say that

“there is no indication that this would have provided advance warning of the attack: retrospective analysis of all the information now available to the Agencies has not provided any such evidence.”

The report also finds that the two murderers were in contact 39 times between 11 April and 22 May, including seven attempted calls and 16 text messages on the day before the murder. Again, we should be clear that post-event analysis shows that

“none of these text messages revealed any indication of attack planning or indeed anything of significance”.

However, although the Committee accepts that those delays and missed opportunities did not affect the outcome in this case, it is clear that processes need to be substantially improved.

MI5 is improving guidance and training for investigators for its online teams, and looking at new automated processes to act on extremist material online. The MI5 initial lessons learned document has been published in today’s report, and I have asked the Security Service to provide a further detailed report to the Home Secretary and to me in the new year, setting out progress on implementing each and every one of the lessons learned. In all of this we must remember the extreme pressure that our agencies are under. As the director general of MI5 put it in evidence to the Committee:

“We are not an army that has battalions waiting in barracks for deployment.”

Everyone it has is always out there working.

Secondly, one of the most challenging tasks facing our agencies is how to prioritise the many and various potential threats to our security. That is incredibly difficult and it is not an exact science. During the weeks prior to the Woolwich attack, MI5 was running several hundred counter-terrorism investigations, and as the Committee notes, at any one time it is monitoring several thousand subjects of interest. It is obviously essential to focus on the highest priority cases, especially those where there is specific intelligence that terrorists are planning an attack in the UK.

The report details how Michael Adebolajo and Michael Adebowale were both known to the security services for some time. Michael Adebolajo had featured in five separate Security Service investigations since 2008, and MI5 had put significant effort into investigating him as part of several of those investigations. Michael Adebowale featured in two lower priority investigations. Although none of those investigations revealed any intelligence of an attack, the Committee recommends improvements to the processes for dealing with recurring subjects of interest, low priority cases, and so-called “self-starting” terrorists.

This Government have protected budgets for counter-terrorism, and the security services have been clear with me that they have always had the resources they need. However, the increasing threat we face—including from so-called “self-starting” terrorists—means that we should now go further in strengthening our capabilities. My right hon. Friend the Chancellor of the Exchequer will therefore make an additional £130 million available over the next two years, including new funding to enhance our ability to monitor and disrupt those self-starting terrorists.

The report also makes clear the important role of all public bodies in dealing with the threat of self-starting terrorists and extremists. Our counter-terrorism and security Bill, which will be introduced tomorrow, will include for the first time a clear legal obligation on our universities, prisons, councils and schools to play their part in tackling this poisonous extremism. New funding being made available today will include additional resources for programmes to prevent radicalisation.

Thirdly, let me turn to the role of internet companies. The Committee is clear that it found

“one issue that could have been decisive”.

In December 2012, five months before the attack, Michael Adebowale had a crucial online exchange in which he wrote about his desire to kill a soldier, but the automated systems in the internet company concerned did not identify that exchange. When it automatically shut down other accounts used by Michael Adebowale on the grounds of terrorism, there was no mechanism to notify the authorities. This information came to light only several weeks after the attack as a result of a retrospective review by the company. The Committee concluded that

“this is the single issue which—had it been known at the time—might have enabled MI5 to prevent the attack.”

This is a very serious finding.

The report does not name the company, and it would not be appropriate for me to give a running commentary on the level of co-operation from different internet companies. However, the Committee is clear—and I agree—that it has serious concerns about the approach of a number of communications service providers based overseas. This summer, the Government introduced emergency legislation to put beyond doubt in UK law that the Regulation of Investigatory Powers Act 2000 applies to companies based overseas that deliver services in this country. I appointed Sir Nigel Sheinwald as a special envoy on intelligence and law enforcement data sharing to address concerns that there could be a conflict between UK and US law in this area.

Since then, a number of companies have improved their co-operation, but, as I said in my speech to the Australian Parliament earlier this month, there is much further to go. We are already having detailed discussions with internet companies on the new steps they can take, and we expect the companies to report back on progress in the new year. The truth is this: terrorists are using the internet to communicate with each other. We must not accept that those communications are beyond the reach of the authorities or the internet companies themselves. We have taken action. We have passed emergency legislation and we will continue to do everything we can. Crucially, we expect the internet companies to do all they can, too. Their networks are being used to plot murder and mayhem. It is their social responsibility to act on this, and we expect them to live up to that responsibility.

Fourthly, the report raises a series of issues directly relevant to the increased threat in recent months from British citizens travelling to fight abroad—so-called foreign fighters. The Committee expresses concern about what they describe as a “deeply unsatisfactory” response to Michael Adebolajo’s arrest in Kenya. They highlight the importance of tackling British citizens travelling to fight with terrorist groups in Syria and Iraq. The report recommends further powers, including considering whether existing proscription powers should be amended to enable further prosecutions. Tackling foreign fighters is an absolute priority for our agencies. To be fair to the agencies and the police, in the case of Michael Adebolajo he was arrested on his return from Kenya to the UK. Their operational effort has been stepped up, with more than 120 arrests this year for Syria-related offences, compared to just 27 in the whole of 2013. The Committee is right, however, to ask whether we need to give our agencies stronger powers to tackle extremists. Our Counter-Terrorism and Security Bill, which will be introduced tomorrow, will include essential new powers to seize passports to prevent travel, to stop suspects returning unless they do so on our terms, and to relocate suspected terrorists to other parts of the country and away from their extremist networks. I very much hope we can take this Bill forward on a cross-party basis, so our agencies are able to start using these vital powers as soon as possible.

Finally, the Committee criticises the Secret Intelligence Service for the handling of allegations of Michael Adebolajo’s mistreatment in Kenya. This Government took the important step of publishing the consolidated guidance in 2010 on the obligations of our agencies and the Ministry of Defence in relation to detainees held overseas. But, of course, there are cases that fall outside the scope of this guidance, for instance when people are entirely dealt with by overseas agencies but where the Secret Intelligence Service still might have an operational interest. In those cases, the agencies are clear that they always seek assurances on the treatment of detainees and that, in future, they will record the outcome of their investigations and inform Ministers if mistreatment has in any way occurred.

It is of course right that there is vigorous oversight of this issue, so the Government will put the oversight role of the Intelligence Services Commissioner on a statutory footing. I will issue a direction under the Regulation of Investigatory Powers Act 2000 in the coming days to formalise Sir Mark Waller’s role in overseeing the guidance on detainees. Sir Mark will have full access to all the material referred to in the report and will be able to examine the concerns raised by the Committee on the Government’s responsibilities in relation to partner counter-terrorism units overseas.

Today’s report contains a number of very detailed recommendations. We will publish a full response in the new year to all the points raised. We will not shrink from doing what is necessary to keep our people safe. The terrorist threat we face cannot be ignored or contained. We have to confront it. We have to equip our security services with the powers and the information they need to track down these terrorists and stop them attacking our people. We have to confront the extremist ideology that drives this terrorism by defeating the ideas that warp so many young minds. Of course, none of this will be easy. We will need stamina, patience and endurance, but we will in the end defeat this extremism and protect our people and our way of life for generations to come. I commend this statement to the House.

I welcome the Prime Minister’s statement. Fusilier Lee Rigby served our country with huge courage. He was a brave soldier and his murder was an appalling act. For his family and friends, reading the report will mean painfully reliving his brutal killing. They should know that today, across this House, our thoughts are with them. It is welcome that his cowardly killers have been brought to justice. I also thank the members of the Intelligence and Security Committee for their investigation. It is right that it took place, and it is the most detailed account of the agencies’ work ever published.

The security services and the police play a vital role in keeping us safe, often in incredibly challenging circumstances, and do a difficult job in seeking to identify those who pose a risk to our country. However, while perpetrators of terror need to succeed only once to further or achieve their vile aims, our agencies and others need to be successful every time to keep us secure. Insofar as there are criticisms of the agencies in the ISC report, they need to be understood in that light.

As the Prime Minister said, the ISC report details how the two men who killed Lee Rigby, Michael Adebolajo and Michael Adebowale, were under investigation at various times before the murder. I welcome his announcement today of additional resources, but what does he believe is required, beyond additional resources, to put in place a better strategy for dealing with those, such as Adebolajo, who are recurring subjects of interest on the periphery of several investigations, as the report chronicles in detail? In addition, the report points to a lack of co-ordination at times between the agencies and the police, so will he further outline the steps that will be put in place to strengthen the working relationship between the different agencies—MI5, the Secret Intelligence Service and GCHQ—and the police?

As the Prime Minister said, the report also highlights the issue of returning foreign fighters and the missed opportunities in relation to Michael Adebolajo. Of course, we will engage constructively with the Bill being published tomorrow, and we welcome the other decisions made, particularly on reinstating relocation powers. As he says, Michael Adebolajo was arrested, but the report states that his case was not then followed up, so this is not simply about the powers available; it is about how cases are then followed up. Will he assure us that there will be a more rigorous and systematic approach to dealing with returning foreign fighters in the future, as the report recommends, including on the issue, which we have raised before, of mandatory referrals to de-radicalisation programmes, which can play a role?

The report also highlights the fact that these two individuals, particularly Michael Adebowale, were radicalised over several years, including by accessing extremist material online. Precisely because of the risks posed once this has happened, the report compellingly makes the case for an expansion of the Prevent programme and states:

“The scale of the problem indicates that the Government’s counter-radicalisation programmes are not working.”

The amount of money being spent in communities on the Prevent programme has dropped alarmingly over the past few years, as we have mentioned before in the House. Will the Prime Minister explain how the welcome resources announced today will be allocated to the Prevent programme and on what scale? On another issue we have discussed before, will he also assure us that local community groups, organisations and others will be mobilised as part of the Prevent programme? They have an incredibly important role to play in countering the growth of extremism and stopping people being radicalised.

The Prime Minister rightly raises the issue of internet companies, as detailed in the report. There are two issues: first, about whether companies have a responsibility to draw authorities’ attention to potential terror threats; and, secondly, about whether major companies based outside the UK regard themselves as compelled to comply with UK warrants. On the first point, the report states that companies might sometimes

“decide to pass information to the authorities when they close accounts because of links to terrorism”,

but that in this case they did not. This suggests that part of the problem is the existence of different company practices and the absence of agreed procedures.

In cases of child abuse images, a procedure is in place for companies to take action and refer abuse to the authorities, and when it comes to terrorism, there should be much stronger procedures and obligations on companies as well. Does the Prime Minister agree? Is there scope to agree that with the companies? Will he update us on the work being done by Nigel Sheinwald to improve our ability to get information, with a warrant, from companies based overseas, particularly the US?

On detention, we welcome the Prime Minister’s announcement that oversight will be strengthened, but we think we will eventually have to go further. We have said for some time that the framework of commissioners is not strong enough. Will he confirm that David Anderson’s review, which we agreed in the summer, will also cover the strengthening of oversight and the role of the commissioners?

To conclude, this report is a reminder of the threats we face in keeping our country safe. The murder of Fusilier Lee Rigby was an appalling act. We must learn the right lessons, and this is what the ISC report seeks to do. It does so thoroughly and with diligence, and in seeking to put those lessons into practice, the Government will have our full support.

I thank the right hon. Gentleman for his remarks and for how he has approached this subject. He was right to praise the ISC—it has done a good job—and our agencies; and of course he was right that whereas the terrorist only has to get lucky once, our agencies need to succeed on every occasion.

I shall try to respond to the right hon. Gentleman’s questions. He said we were right to increase resources, and although these are modest additional resources, it is worth pointing out that funding for the security and intelligence services has increased by 5% in cash terms since 2010. Compared to other departments, therefore, it has had a very good settlement, as is right, and that has continued in the 2013 spending round.

The right hon. Gentleman said it was necessary to learn lessons on more rapid decision making and better triaging of cases, particularly when they appear on the fringes of more than one investigation. MI5 has said something about that already in its response today, but I think we will hear more next year. On co-ordination between the agencies and the police, MI5 is confident it now has better systems in place.

On the question about referrals to Prevent, which are considered on a case-by-case basis, the Committee rightly pointed out that referral should at least be considered in every case, but that it did not seem to have been in these two cases. On the issue of money, Lord Carlile’s review of Prevent in 2011 concluded that it should be split, with the money for integration going to the Department for Communities and Local Government, where it is now spent, and the remainder being spent on the Prevent programme, specifically to guide people away from extremism and terrorism; and the money for the latter has gone up from £35 million in 2012 to £40 million in 2014. Lord Carlile found cases of groups we would now consider to support an extremist ideology having received funding, and obviously we want to stop that happening again.

Crucially, on internet companies, the right hon. Gentleman made the sensible point that just as we are getting internet companies co-operate on the definition of unacceptable images of children and child abuse—the Government have done a lot of work on that—so exactly the same needs to happen on terrorist information. We are pushing them on that and will use today’s report to lead a debate about their social responsibility. All the action we have taken—passing legislation, employing Nigel Sheinwald to talk to the Americans and so on—is leading to better co-operation between internet companies and the agencies, but more needs to be done, although for obvious reasons I do not want to give a running commentary on each and every one.

Finally, the right hon. Gentleman asked about David Anderson. His role is very broad—he can look at the threat, the response, the capability and the important safeguards—and I think he has done excellent work on all those grounds.

I thank the Prime Minister and the Leader of the Opposition for their welcome for the Committee’s report. I also draw attention to the unprecedented support and co-operation we have had from the intelligence agencies, particularly MI5, which have provided us with all the classified material. In the 190 pages of our report, we have been able to publish for the public more such material than ever before in the history of these matters. There are redactions, but none of them, even if they could be read, would affect the substance of our conclusions and recommendations.

We make some severe criticisms of the agencies, as can be seen in the report, but we have seen no evidence that, even had these errors not been made, the tragic murder of Fusilier Rigby could have been avoided. As the Prime Minister said, there was one online exchange, which came to knowledge some months after the murder of Fusilier Rigby, revealing that Michael Adebowale, months before the murder, had discussed his desire to kill a soldier and that he made various other comments that we refer to in the report. If that intelligence—the one piece of hard evidence that we have seen—had been available to the intelligence agencies at the time, it is at least possible that the murder of Fusilier Rigby could have been avoided.

The Prime Minister has indicated the problem with regard to United States communications providers—the internet companies—and I want to put one question to him. If these United States internet companies feel able to cancel the accounts of some of their clients when their systems demonstrate that either terrorist activity or serious criminal activity are being conducted through these internet exchanges, is there any basis on which they could have an ethical or privacy objection to sharing with the authorities evidence of terrorist intent when that also appears in these same exchanges?

My right hon. and learned Friend puts the matter into clear perspective. Once it has been discovered on someone’s e-mail account that they are planning or plotting a terrorist outrage, it is hard to think of any justification for not passing that on to the authorities. That is exactly what my right hon. and learned Friend’s Committee finds:

“the companies should accept they have a responsibility to notify the relevant authorities when an automatic trigger indicating terrorism is activated, and allow the authorities, whether US or UK, to take the next step.”

That is absolutely right and I hope that this will trigger a debate among the internet companies themselves about the action that needs to be taken.

First, I commend the Intelligence and Security Committee report, as the Prime Minister and the Leader of the Opposition have done. I also echo what the Prime Minister and the Home Secretary have said about the extreme difficulties that the intelligence and police services face when there is an expectation of success in respect of every investigation. These agencies, and the police, have people who are very highly skilled and dedicated and who are working very long hours—but, with the best will in the world, they are human. There will be some cases where the terrorists escape detection and there will therefore be terrorist outrages, as there have been in previous terrorist campaigns.

Lastly, may I press the Prime Minister again on the issue of the United States-based internet companies and ask him to take it up with the US at the highest level? Is there not a cultural problem among the leadership of some of these companies, which have a distorted “libertarian” ideology and believe that somehow that allows them to be wholly detached from responsibility to Governments and to the peoples whom we democratically represent in this country and abroad?

I agree with everything that the right hon. Gentleman has said. First, on the work done by MI5 and our agencies, I will repeat the quote from the director general of MI5 that says it all:

“We are not an army that has battalions waiting in barracks for deployment. We are fully deployed all the time so the only way to go on high priority cases is to stop low ones.”

That gives a sense of the pressure that, inevitably, organisations such as this are under; they are trying all the time to think of how they best triage these cases and make sure that they have the maximum input into the most dangerous cases.

The second point that the right hon. Gentleman made was about taking up personally with the US the engagement on the importance of communications data. I can guarantee absolutely that that happens at every level, including with the President. It is a shared challenge for both of us to get this right. We are very clear: wherever these companies are headquartered, if they provide services in the UK they should be subject to UK law. The point he makes with respect to the companies is absolutely right. Of course they worry about their public image in terms of wanting to be in favour of data security, and one can understand that. But they also need to worry about their public image if they are being used by terrorists to plot attacks and they have information about those attacks that they do not pass on. We need to make that point tell in the conversations to come.

The intelligence services do a magnificent job but we spend on all three services in a year what we spend on the national health services every six days. The funding settlement has indeed been generous as the Prime Minister said, but is he satisfied that the problems set out in the report are problems of procedure and practice and not of funding priorities? In other words, are the intelligence services big enough to do the job we are asking them to do in this increasingly dangerous era?

My right hon. Friend asks a very good question. The fact is that we spend over £2 billion a year on our intelligence and security services. We have protected that spending, as we did for counter-terrorism policing. But the truth is that there is no upper limit on what we could spend if we wanted to do more and more activity. We have to make a judgment about what is right.

As I say, I meet the heads of our intelligence agencies regularly and talk to them about the pressures they are under. The reason for providing some extra money today is that there is a specific and growing challenge from these self-starting—they are sometimes called “lone wolf”—jihadis, who have been radicalised on the internet because of what has been happening in Syria but are not necessarily linked up with other terrorist networks. That puts extra pressure on and we need to respond to that. But it is a permanent judgment about how much to spend. We try to give the agencies a long-term perspective so they can plan and bring all their resources to bear.

Lee Rigby was a Middleton lad and his family live in my constituency. Will the Prime Minister give assurances to the family, who are bound to have questions about the statement, that he will arrange a meeting with them if necessary and that he will endeavour to ensure that all their questions are given full answers?

The hon. Lady raises an important point. As the Leader of the Opposition said, the pain that the family will feel on reading this report and reliving everything should be uppermost in our minds. A police liaison team is still working with the family, and they should know that whatever meetings they want, they can ask for and they will get.

I hope that my right hon. Friend will excuse me for returning to the issue of resources. My quick calculation is that a sum of £130 million over two years amounts to an increase of about 3%. We are facing an unprecedented set of challenges, a matter that is publicly acknowledged not only by the Home Secretary and the Foreign Secretary but by the Commissioner of the Metropolitan Police—and, indeed, the heads of the agencies themselves.

Can we really be satisfied that an increase of the kind that my right hon. Friend has mentioned—which is obviously welcome—will be adequate to deal with a problem that is not static and is almost certainly likely to increase in the years to come? Will he at least consider a review, at every possible stage, of the resources available to those who have the primary responsibility for guarding our security?

I say to my right hon. and learned Friend, for whom I have great respect, that this is under permanent review. This is a discussion that can be had at any time if there are particular pressures. In the spending review in 2013 we put up spending on the intelligence agencies by 3.4%, at a time when other Departments were, on average, being cut by 2.77% in real terms, on top of the 19% average departmental reduction over the previous four years. They have had a much more generous spending settlement and quite rightly so.

There is also the issue—we discussed this in the National Security Council—of how much to spend on counter-intelligence and how much to spend on counter-terrorism. The argument is often made that it is time to reduce the spend on counter-terrorism. My own view is that that is not the case and that the pressures on counter-terrorism are still very great. As the Home Secretary said yesterday, the threat is greater than for many years, so we need to keep the focus on that part of the work.

I join the Prime Minister and the Leader of the Opposition in commending the report by the Intelligence and Security Committee and in welcoming the proposals that both he and the Home Secretary have made over the last few days, which I hope will be subject to proper parliamentary scrutiny.

On the issue of returning British citizens, the Prime Minister will know that tomorrow marks the fourth anniversary of Adebolajo’s return from Kenya. The Kenyans were very clear that it was the British Government, or their associated agencies, who asked for the return of Adebolajo to the UK. That mirrored the return of Mohammed Ahmed Mohammed from Somalia. Is the Prime Minister now telling the House that from now on, when a British citizen commits an offence in another country, we will not seek their return until the criminal processes are completed?

Let me first guarantee to the right hon. Gentleman that there will be proper scrutiny of this legislation. It is fast-track legislation, we hope, rather than emergency legislation. It is not being rushed through in just a couple of days—in the other place, for instance. The time between the stages will be shortened, but the overall amount of time will not be.

Much of this legislation comes from ideas that I put forward back in September and some of it comes from the extremism taskforce, which I set up after the murder of Lee Rigby many months ago, so this is not emergency, knee-jerk legislation, but well thought through. It is not starting from scratch either, because we have very good counter-terrorism legislation in this country. This is about seeing where there are potential gaps and making sure they are filled in.

On the question about people returning from overseas, the power we are taking in the new legislation is to make sure that people can come back only if they do so on our terms. That is the key. We will make sure that if people are to be prosecuted, we are ready to prosecute them and that if they are going to be subject to a TPIM, they will be subject to a TPIM.

One thing not mentioned in the Prime Minister’s statement—and for good reason—was communications data. Whatever one thinks about the Communications Data Bill, our report did not focus on this matter at all significantly because it played no relevant part. Nevertheless, there was a serious leak at an early stage from the unredacted draft of the report, which was reported in a Sunday paper, saying that the report was going to concentrate on this area. Does the Prime Minister agree with me that if MI5 is going to continue to share so much secret material with the Intelligence and Security Committee, leaks of our drafts are absolutely to be deplored and might imperil our ability to do this sort of work in the future?

I completely agree with my hon. Friend. All leaks are to be deplored, but leaks of this particular sort of material, when we have trusted the Committee with such important and delicate work, are particularly reprehensible. Communications data are vital not just in respect of terrorism, but when we are trying to find abducted children or solve rapes and murders. They are used in almost all serious crimes. What we did in the Bill was simply to stop the situation from getting worse. What we need now is to go forward with more full-throated legislation. I think we need an honest and open debate about that across the House.

This was a brutal murder of a young man who was serving his country, so all our thoughts today are with his family for the months to come. I welcome the Prime Minister’s statement. Neither of the individuals involved was referred to the Prevent programme. I believe the Prevent programme has been under-resourced and not given the priority it should have had within the Contest strategy. If we can stop the pipeline of people being drawn into extremist behaviour, the money will be extremely well spent. I believe that because such activity has been viewed as something of a soft end to the counter-terrorism strategy, it has been seen as a cultural issue and has not had priority.

I welcome the Home Secretary’s commitment to new legal powers and I welcome the Prime Minister’s commitment to further resources, but we have to change the perspective. The threat we now face, with 500 people out in Syria and Iraq and 250 of them coming back—some of them radicalised and well trained—amounts to a different scenario. I think the Prevent programme must no longer be viewed as a soft and fluffy end of community engagement, but as a hard, targeted counter-ideological strategy and a counter-narrative that stops people from creating a climate for extremism.

I wholly agree with the right hon. Lady. What we did by separating the integration work from the Prevent work was to make sure that this is not seen as some soft and fluffy programme, but a tough and robust one. It will become more robust because additional funding has been secured; it will become more robust because we are putting it on a statutory footing; and it will become stronger because Channel will be put on a statutory footing, too.

I do not think anyone should underestimate the importance of putting this legal duty on all these organisations. When the right hon. Lady came to our extremism taskforce, I think she could see how the aim was to make sure that whether it be schools, prisons, universities, community centres or whatever, all have a legal duty to prevent extremism and terrorism. That is what we are aiming to do.

Adebolajo and Adebowale are both in prison for life, which should provide permanent security to the British public—from them, at least. However, three weeks ago it was made clear in the Investigatory Powers Tribunal that the agencies have, at least since 2010, been breaking the absolute protection on privileged information between lawyers and suspects. If that happened during the course of a terrorism trial, we could find ourselves in a position where that has undermined or even fractured the conviction of proven terrorists, and we could end up having proven terrorists back on the streets. Have the Government considered that problem, and do they have any plans to deal with it?

I believe that our agencies have appropriate procedures for dealing with legal material. As my right hon. Friend says, it is very important that they do that because we want to make sure that justice is done and that these people remain behind bars.

I welcome the Prime Minister’s statement and this Committee’s important report. Our thoughts and prayers are with the family and friends of Lee Rigby today once again.

On the issue of new powers and the counter-terrorism and security Bill, the Prime Minister will be aware that as well as the threat from returning jihadists and Islamic terrorism, we still face a severe terrorist problem in Northern Ireland from dissident republicans, which could spread to the UK mainland. Can the Prime Minister assure the people of Northern Ireland that the increase in attacks from that quarter is still taken extremely seriously and that all the necessary resources will be put in? Can he outline the impact of the new powers in the Bill being brought forward tomorrow on countering that severe threat for UK citizens as well?

Let me first reassure the right hon. Gentleman and everyone in Northern Ireland that just because there is a growing terrorist threat from citizens of our own country and from people being radicalised in Iraq and Syria, that does not mean that we have taken our eye off the ball of Northern Ireland-related terrorism in any way. Yesterday we had a National Security Council meeting, which was attended by the head of the Police Service of Northern Ireland, and we discussed in some detail what more could be done to enhance the excellent work it is doing. For every one attack made, it is stopping three or four. It is doing an excellent job, and we continue to keep anything else we can do to help under review—respecting, of course, that under this Government, policing and justice in Northern Ireland has been devolved.

Lee Rigby was killed wearing civilian clothes, and all soldiers are easily identifiable whether in civilian clothes or not. Seeing our armed forces in uniform on the streets gives me great pleasure and pride. People may think that wearing uniform incites or indeed attracts attention from these terrorists. It does not. These terrorists will identify our soldiers, sailors and airmen if they want to. I thus add my voice to those of people who say, “Keep our soldiers on the streets in uniform.”

My hon. Friend is absolutely right, and no one is proposing anything different. The point he makes about the tragic murder of Lee Rigby is right, and we have no plans to change that.

The Prime Minister may recall that in May 2009, the Intelligence and Security Committee produced a report on the London bombings, in which we concluded that there were real problems with tracking those on the periphery of investigations or whose names popped up on a regular basis. The recommendation was that there needed to be a proper regular review process in place. The Prime Minister will be aware that a similar conclusion is drawn in this report. Does he not think it is about time that somebody took responsibility for ensuring that these cases are reviewed on a regular basis so that, where necessary, in cases such as those of Adebowale and Adebolajo, the level of surveillance can be increased?

The right hon. Gentleman, who is a member of the Intelligence and Security Committee, makes an important point. It comes out very clearly in the report, which makes a recommendation about how to deal with these low-level suspects. The agencies’ view is that they are putting in place new measures to ensure that low-level subjects are picked up by the joint programme that they now run with the police, and it is important to see that through. We want to see their actions taken set out in the new year and followed through.

There is also the issue of where subjects of interest appear on the periphery of various investigations. Again, MI5’s view is that it is putting in place a strategy to address that, which it sees as a core part of its investigative process. As I said in my response to the report, no one should be in any doubt that, although the finding was that no specific information was available to get MI5 to stop the dreadful thing that happened, there were many lessons to learn. There is no way that anyone is going to shy away from that. All these points need to be followed through, and then we need to check up that action really has been taken.

Does my right hon. Friend agree that our intelligence services operate best in the shadows, and that we must be vey careful indeed not to undermine them when we shine the democratic spotlight on them and follow up cases such as this?

I do agree with my hon. Friend. The important thing about secret intelligence services is that they are secret. There is, however, a wider consideration. We now have a very good system in place. We have a scrutiny Committee in Parliament, and an Intelligence Services Commissioner. Any warrant to listen to someone’s telephone or intercept their e-mails must be signed personally by the Home Secretary. We have a system of which we can be proud. It is that democratic accountability and that system that enable us to say, whether to internet companies or to others, “You should be co-operating with us properly, because we do this in a proper and decent way.” I think that the safeguards that we put in place not only mean that we scrutinise our intelligence services, but should help to make us safer.

May I add a word of caution? The new measures to deal with this murderous threat to our people must not be counter-productive, as measures were from time to time when we were dealing with the IRA murder campaign. It was 40 years ago last week that 21 people were murdered in two Birmingham pubs. In the west midlands, certainly, we have not forgotten that. The IRA did not win, despite all the murders, and neither will these latest murderous fanatics.

I agree with the hon. Gentleman that we will never defeat terrorism if we undermine the freedoms that terrorists want to attack, but successive Governments have found that simply standing back and saying “We will just use the traditional criminal justice system of investigation, prosecution and imprisonment” is not enough. That is why there have been control orders, TPIMs and other such measures. Successive Governments have found that more is needed to face what is a really existential threat from a group of people who not only do not mind if they are killed in the act of carrying out their murderous intent, but positively welcome that. I do not think it would be responsible to stand here and say that there is never anything that we need to do. This is not a knee-jerk or emergency measure; it has been carefully thought through, and it adds to the weapons in our armoury.

This is an impressively detailed report on a brutal murder. It refers to a long list of mistakes: actions not carried out, failures to keep adequate records, delays, months of inaction, and insufficient co-ordination. One key failing is identified on page 108. Apparently, by 2 May there was such a serious risk of Adebowale being involved in terrorist actions that an application was made for further intrusive measures, but that submission was delayed until 21 May. The Prime Minister says that such intrusive surveillance measures would not have made any difference, but how can he be so sure that those detailed intrusive measures could not have prevented this?

The reason I can be sure is that the Committee subsequently went through, in great detail, the content of the communications that were not being monitored, and found that nothing in them would have given information about an attack. However, the hon. Gentleman is absolutely right to say that there should not have been a delay in putting the intrusive measures in place. They should have been put in place more quickly, because that might have made a difference in another case. Nevertheless, it is very important to read those pages carefully.

As a new member of the Intelligence and Security Committee, I was not able to hear all the evidence that led to the conclusions in the report, but I have observed the extensive leaks about its conclusions. Those leaks concern me deeply, because I think that they undermine the impact of the report, and they seem to have been designed to lead people to a particular conclusion. How will the Prime Minister use his office to prevent such leaks from happening from within Government in future?

The hon. Lady has made an important point, and I shall be happy to discuss with the Chairman of the Committee whether he wants to take further action to try and find out how those leaks happened.

I really care about this, because I think that too often, when something terrible has happened, we in the House immediately reach for the judicial inquiry, or the inquiry that will take place outside the House. In this case, an institution of the House has proved what a good job it can do in garnering all the information, doing a huge amount of hard work, and coming up with very sensible but tough recommendations. I do not want that way of doing things to be undermined by leaks.

My regimental colleagues, whether serving or not, will greatly welcome the words of the Prime Minister and, indeed, the Leader of the Opposition about Fusilier Lee Rigby, and the assurances given by the Prime Minister in regard to his family. Does the Prime Minister accept, however, that with potentially hundreds of jihadists returning to this country, one of the key lessons of the report is that we must minimise the delay between the gathering of intelligence and the taking of appropriate action?

My hon. Friend is absolutely right. There are some worrying instances in the report. Some delay is inevitable, because, as I have explained, when a huge range of cases is being covered, from the highest-priority cases to those that are given a less high priority, and more high-priority cases suddenly arise, people have to be removed from something, and that sometimes results in delays. However, I think the report shows that there are sometimes delays that are over and above what is normal in such cases, and that is clearly not acceptable.

Does the Prime Minister agree that we are facing a struggle with an ideology—the ideology of violent Islamist jihadism, which, although it is only a small minority ideology in the Muslim community, is linked to the phenomenon of the self-starting terrorist? Does he agree that we need not just our state institutions but the whole of our society to challenge, confront and defeat that ideology?

I agree with every word that the hon. Gentleman has said. I think we sometimes make the mistake of looking at a particular area of the world and thinking that that is where the problem is coming from when the problem is actually extremism itself, which manifests itself in the parts of the world with the greatest amount of civil war and trouble and so forth. The problem is the extremist ideology, and, as the hon. Gentleman has said, we do not defeat that just by military means. We defeat it by ensuring that we drive it out of universities, colleges, prisons, schools, community centres where appropriate, and mosques, because some of them have been taken over by extremists on occasion. That is why this public duty, and the funds that we are providing, are so important.

I thank the Prime Minister for his statement. Does he agree that all the thousands of peace-loving members of the British Muslim community in my constituency will be as supportive of the measures announced this week to strengthen the fight against terrorism as everyone else in my constituency?

My hon. Friend is absolutely right. I think that that is what the “Not in my name” campaign is all about: it is about Muslims throughout our country saying that this very small minority fringe of people who have been radicalised and who buy this extremist ideology do not speak for Islam. It is very important for us to make that point. British Muslims want to see robust anti-terrorism and criminal justice powers as much as anyone else.

The Prime Minister will recall coming to Woolwich in the aftermath of the killing of Lee Rigby—to whose memory we all pay tribute—and he will recall the commitment of the local community to preventing this horrific incident from damaging community relations and opening the door to extremism. May I urge him to look again at the issue of Prevent, which has been highlighted by two of my colleagues? I remind him that the Intelligence and Security Committee’s report refers specifically to

“the relatively low priority (and funding) given to Prevent”,

and goes on to say:

“This misses the value that Prevent can offer: successfully diverting individuals from the radicalisation path”.

Let me reassure the right hon. Gentleman, who has spoken now, as he did then, for the people of Woolwich in standing up to this horrific murder. We definitely think that Prevent is important. That is why we are putting it on a statutory footing, why the funding is going up, why extra resources are being made available today, and why we are backing it with a duty that is being placed on all public bodies in the United Kingdom.

Does the Prime Minister agree that these vicious murderers who so barbarically took the life of an innocent young soldier have not only betrayed the Muslim community in my constituency, but betrayed Muslim communities throughout the United Kingdom—communities that contribute so, so much to our country?

My hon. Friend is absolutely right to say that this has no place in the religion of Islam, which is a religion of peace. That is why so many British Muslims have come out so strongly to condemn what happened. One senses their incredible frustration that a small minority of people who have bought into the extremist mindset and rhetoric are causing so much damage. The more people can stand up and say that, the better.

Four years ago, I set up a working group with all the major internet companies and the Anti-Defamation League, and I have met most of the people who moderate content. Does the Prime Minister agree that a voluntary approach will not be sufficient because the internet companies do not have and will not have the expertise to make the decisions? What is needed is legislation or an intergovernmental agreement that ensures that we have the expertise in our police and our security services so that we can draw down the information we want, rather than relying on young, inexperienced moderators of content who will make the wrong call at some stage, to someone’s detriment.

The hon. Gentleman makes an important point. There is an element of this that is about having legal powers. That is about the ability to gather communications data or to intercept telephone calls, e-mails and other internet communications, which is vital—all done legally, on the basis of a signed warrant. There are also the practices that internet companies should themselves want to take up. Some people say, “You cannot change this and nothing can be done.” I do not accept that. In the case of child pornography, to start with, when we made suggestions about, for example, not returning search items on disgusting child pornography terms, we were told that that was impossible. Now the internet companies have put that in place. Therefore, there is a place for legislation but there is also a place for bringing people together and encouraging proper practice.

Will my right hon. Friend confirm that our security services are this country’s unsung heroes? He knows—many others do not—that they are regularly responsible for tremendous successes, which we hear nothing about. Does he agree that the report shows that social media firms should take action immediately to ensure that their services do not become terrorist safe havens, from where terrorists can almost with impunity launch plots against this country? Internet companies must co-operate and not become some modern version of a mediaeval sanctuary.

My hon. Friend is right on both bases. We cannot always praise and point out what the security and intelligence services have done, but since I have been Prime Minister there has been at least one major plot every year and this year already at least four plots have been avoided by the work of the security services, so we should thank them for what they do.

On the issue of the internet, I would put it like this. Historically, Governments have always decided that, whether it is people sending each other letters, making fixed-line telephone calls, mobile telephone calls, or sending e-mails, in extremis, on the basis of a warrant signed by the Home Secretary, it is okay to intercept that call, letter or e-mail. The question we must ask is: are we prepared to have a means of communication—the internet and a number of modern methods—that we are not able to intercept? My answer is clear: we should not accept that. We should legislate to ensure that that is the case. I think that that is in the finest traditions of having law that is in favour of security but also in favour of liberty. However, the whole House at some stage will have to come to a view on that.

I associate myself with the comments of my right hon. Friend the Member for Greenwich and Woolwich (Mr Raynsford). Greenwich borough has a long association with the garrison at Woolwich and the murder of Fusilier Lee Rigby was felt particularly powerfully by our local community. May I press the Prime Minister a little more on internet companies? It seems extraordinary that we do not have the co-operation of the companies that are overseas. It seems to me that we need to negotiate and take action at Government level. What is taking place at that level to ensure that, where such companies do not co-operate, regulations are put in place to compel them to do so?

The hon. Gentleman asks the key question. We are both updating—we did that over the summer—and applying our legislation on the basis that we believe that what matters is whether companies provide services in this country, not where they are based. On that basis, companies should comply with warrants and requests. Therefore, we are progressing that, but at the same time we are trying to deal with one of the sources of the problem, which is the interaction between UK law and American law, specifically the US Wiretap Act. Sir Nigel Sheinwald is holding conversations with America-based companies and the American Government to try to find a way through so we get higher levels of co-operation. However, the levels of co-operation have increased, not least because of the important legislation that this House passed in the summer.

Further to the last question, does not the Intelligence and Security Committee report indicate that social media companies need to do more to put in place systems to spot terrorist groups that are using their services to plan attacks?

My right hon. Friend is right. The companies have to do two things. They have to have systems in place to spot key words, key phrases and other key things that could be part of terrorist plotting. They also need to have a system in place, in our view and as my right hon. and learned Friend the Member for Kensington (Sir Malcolm Rifkind) said, to report that to the authorities. This is linked to the point that I made in response to my hon. Friend the Member for South Dorset (Richard Drax). Because we have such a robust system of safeguards in this country, I do not think that it should be a problem for any of these companies to do just that.

I associate myself with the comments of the Prime Minister and many other hon. Members about Fusilier Lee Rigby. The Prime Minister has repeatedly referred to the importance of schools and universities in tackling the threat from radicalisation, yet I have spoken to many young people who are concerned about the absence of, or lack of consistency in information provided to them about how to report and tackle extremism that they find online. I am concerned that it appears that there have been no inter-ministerial meetings about that issue between the devolved Administrations and UK Ministers with responsibility for education and universities. Will the Prime Minister commit to working with education and universities Ministers across the UK to ensure that consistent information is provided to our young people, teachers and youth workers?

The hon. Gentleman makes an important point. That is one of the reasons for having the public duty on public bodies, including universities, to combat extremism and terrorism. We will set out the guidance on that as the legislation goes through the House. It is important to ensure that this happens on a UK-wide basis. Combating terrorism is a reserved, UK-wide responsibility. We need to discuss with the devolved authorities exactly how they put that in place, but obviously whether it is done is a matter for the UK Government.

It is the job of the House to pass laws to require internet companies to help to prevent terror attacks, but does the Prime Minister agree that companies such as Facebook, Twitter and other social networks have a moral responsibility—they owe it to the memory of Lee Rigby—to introduce systems, similar to the ones we have introduced to deal with child pornography, to identify terror threats? When they do identify them, they should have a Rigby rule and pass them to the authorities.

My hon. Friend is absolutely right. Obviously, we can put down legal obligations in terms of complying with warrants from the Home Secretary and legal requirements on providing communications data that are vital in solving crime, but there is a moral responsibility, too. If companies know that terrorist acts are being plotted, they have a moral responsibility to act. I cannot think of any reason why they would not tell the authorities. The debate that will happen following the publication of the report will help to keep us safe.