House of Commons
Tuesday 13 January 2015
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 Care (Pregnant Women)
The Government have prioritised improving mental health care and support for pregnant women and new mothers in its mandate to NHS England, with a clear objective to reduce the incidence and impact of post-natal depression. In order to implement the Government’s priority to improve perinatal mental health services, Cambridgeshire and Peterborough NHS Foundation Trust is working closely with local authority commissioners in Peterborough to develop a joint perinatal mental health strategy to improve care for women.
The Maternal Mental Health Alliance has estimated that the long-term cost of mental health care for new mothers is £8 billion, which is perhaps not unconnected to the fact that only 3% of clinical commissioning groups have a perinatal mental health strategy. Does the Minister think that this is a very serious issue and needs immediate action?
My hon. Friend is absolutely right to highlight the challenges posed by perinatal mental illness. The damage it does to women’s lives, and indeed to the wider family, was highlighted in the recent independent inquiry into maternal deaths. It is therefore important for the Government to invest, as we are doing, in improved care for the perinatal mental health of women. That is why we have made it a priority for each and every maternity unit to have staff specially trained in perinatal mental health skills by 2017.
The Minister will know that I have been part of an all-party group campaigning on post-natal depression, which is the most likely thing to kill a healthy young woman. Is he aware that this area of mental health is under-resourced, and that mental health facilities for children and young people are desperately under-resourced? That is partly because clinical commissioning groups have been commissioning in the wrong way, which has disturbed existing arrangements and demoralised staff.
The hon. Gentleman makes the important point that there has been an historical disparity between the priorities given to mental health and physical health conditions. That is why we have legislated for parity of esteem between mental and physical health, why we are introducing access targets for patients using mental health services for the first time—that is a big step forward—and why we have increased funding for mental health services by £300 million this year.
In the first few weeks of a child’s life, the mother often visits their general practitioner regularly, so I applaud the Government’s work on recruiting more health visitors and midwives. Does the Minister agree that GPs need to be sharper at identifying post-natal depression in mothers, because it can be so destructive to the lives of both the mother and the child?
My right hon. Friend is absolutely right. A lot of work is going on with the Royal College of General Practitioners and the Royal College of Psychiatrists to improve GP training and skills in mental health more generally. The specific key to this is providing the right early years work force, which is why it is so important that this Government have invested in additional health visitors to give each and every child the best start in life. The latest figures from NHS England show that the number of health visitors has increased by more than 3,000 under this Government.
What steps is the Minister taking to make sure that awareness of domestic violence is incorporated in guidance for mental health care? We know that pregnancy can sometimes be the first time there is violence in the home, and we obviously need a strategy to address that.
The hon. Lady makes very important points. I have certainly seen in my clinical practice that some women present when there are domestic violence issues or other issues in the home, and such issues can be heightened and exacerbated during pregnancy. A lot of work is now going on to improve the awareness of all NHS staff of domestic violence and, more broadly across training, of mental health issues.
For many people with mental health problems, the first emergency service with which they come into contact at a point of crisis is the police. What steps are the Government taking to ensure that such a crisis is treated as a health crisis, not a criminal incident, and will the Minister undertake to do whatever he can to ensure that no children end up in a police cell as a place of safety?
My hon. Friend makes an important point. It is absolutely right that we do not want people with mental health problems to be looked after in police cells. A lot of work has been going on. The Government have set up the crisis care concordat to look at exactly that issue, and as a result the number of people with mental illness going to police cells is now falling rapidly.
Ambulance Response Times
2. What steps he is taking to improve ambulance response times. (906954)
The Government have provided an extra £50 million of funding to ambulance services as part of our record package of support for the NHS this winter.
Notwithstanding what the Secretary of State has just said, the North East ambulance service has warned that it is under severe pressure caused by delayed ambulance turnaround times at hospitals such as Sunderland Royal. When Ministers embarked on their top-down reorganisation of the NHS, were they warned at any point that chaos would ensue in A and E departments?
The reforms the hon. Lady mentions mean that we have 9,000 more doctors, 3,000 more nurses and 2,000 more paramedics in the ambulance service. The point is that those reforms are putting money on to the front line, which means that the NHS is better equipped to deal with winter pressures than ever before.
In England around 75% of ambulances meet the target response time, as opposed to 60% in Wales. Will the Minister tell the House why ambulance response times are so much better in England than in the area of the United Kingdom run by the Labour party?
What is so disappointing about the health debate is that Labour Members tour TV studios trying to whip up a sense of crisis in the NHS in England, and then deny that things are even worse in Wales. Services are better in England because we have put more money on to the front line and less into management.
Prior to Christmas, a motorcyclist in my constituency with serious leg injuries was left lying on the ground in the rain for an hour and 40 minutes waiting for an ambulance. Local people had to bring out blankets and hot water bottles to try to keep him warm, but because no ambulance arrived, the police had to commandeer a council minibus to take him to hospital. Is the Secretary of State ashamed to stand at the Dispatch Box and tell the House that the NHS is not in crisis, when that is what is happening on the ground?
Let me tell the hon. Lady what we are doing—[Interruption.] This is what I think is so shocking: Labour Members are not actually interested in what is happening to avoid precisely the kind of things that the hon. Lady mentioned. We are putting £4.6 million of extra support into the North West ambulance service this winter, and that money is being used to employ more paramedics, to train people so that they can see and treat patients on the spot, and to help more people on the phone so that they do not need an ambulance. The hon. Lady should perhaps have listened to the earlier question, because where Labour is running the ambulance services, results are even worse.
Does the Secretary of State agree that the rules for commissioning ambulance services need to be looked at again to ensure that ambulances serving rural areas such as South Lakeland which do not have an acute centre of their own and therefore export their ambulances further afield need to be compensated with additional ambulances to take account of the fact that so many of our vehicles are out of county most of the time?
My hon. Friend makes an important point about the way targets are set up. It is possible for ambulance services to hit their targets while not delivering a satisfactory service to the most rural areas, and we have discussed that issue a number of times. Because we are in the middle of a challenging winter, we do not think that now is the right time to review the issue, but he should rest assured that we are keeping it under review.
Although focus has been on A and E, it is becoming clear that the knock-on crisis in the ambulance service is more serious than people realise. Evidence is emerging of services unilaterally abandoning national standards and putting patients at risk. We know of one ambulance service that left patients at the door of A and E without handing them over to A and E staff, and last night East of England ambulance service was forced to release an internal report on the downgrading of thousands of 999 calls, including calls made by terminally ill patients. The report covered only a sample, but it showed that at least 57 of those patients died after a decision was taken not to send an ambulance. Withholding ambulances from terminally ill people is the most cruel form of rationing imaginable. Will the Secretary of State today order a full, independent investigation into how that happened, and into every death or adverse incident?
We investigate deaths and adverse incidents carefully, and the East of England ambulance service got £3.6 million of extra support to help it this winter. Let us look at what is happening in the ambulance service. Year on year, the number of the most serious category A calls—those that need to be answered within eight minutes—has increased by 26% over one year, and the number of ambulances dispatched within eight minutes has increased by 22%. That is 1,900 extra ambulance journeys arriving within eight minutes, which is a record of an ambulance service doing well under a lot of pressure. The right hon. Gentleman should be getting behind the paramedics and ambulance services, not trying to politicise the issue.
I raised a very serious issue, which came to light last night, regarding 57 terminally ill patients. As that was only a sample, it is not the whole story. I am surprised that the Secretary of State did not answer the very specific question about a serious failure in the East of England ambulance service. The truth is that this is not confined to the ambulance service in the east of England. Last year, we heard of a 77-year-old great-grandfather from Bolton who waited for more than four hours on a freezing pavement and a 92-year-old grandmother who tragically died after waiting for five hours in agony on the floor of her home in Muswell Hill.
Whatever the Secretary of State says, those are not isolated cases. New figures last week showed that in November a staggering 17,000 critically ill patients who were classified as needing an urgent category A 999 response waited longer than 19 minutes for an ambulance to arrive. Will the Secretary of State agree that this chaos is now putting lives at risk and cannot carry on? Will he tell the House what precise steps the Government are taking to bring responses to 999 calls back up to acceptable standards?
But we are taking measures. That is why we have 2,000 more doctors and 5,000 more nurses compared with a year ago. Frankly, the last thing those doctors and nurses on the front line want is scaremongering by the right hon. Gentleman—posters saying that the NHS might cease to exist under this Government; and leaflets like the one I have here from Lancaster saying that the local hospital might close. We are backing the NHS with more doctors, more nurses, more resources and a long-term plan. Will he now back the NHS by disowning this kind of scaremongering and stop trying to weaponise the NHS?
The latest GP survey results suggest that the majority of patients can get GP appointments at a time convenient to them, but we want to do more. We are offering 7.5 million more people evening and weekend appointments through the Prime Minister’s £100 million challenge fund. NHS England does not directly collect data for GP waiting times.
I think many people up and down the country will be surprised by the Minister’s answer, including my constituent Lynne Taylor who had a chest infection but was sent to A and E by a locum because of a lack of appointments at her GP surgery. That was done on the phone without seeing her. The A and E doctors told her that she certainly should not have been sent to A and E. Will the guarantee of a GP appointment within 48 hours help patients like Ms Taylor who need to see their own doctor? Would that not also be a big step in reducing the huge pressure on A and Es?
I hope the hon. Gentleman will be reassured to hear that, according to the latest GP survey, 87% of patients in Southport and Formby clinical commissioning group were able to get an appointment or to see somebody they wanted to see at an appropriate and convenient time. It is important to note that Labour’s 48-hour target did not work. From 2007 to 2010, the percentage of patients who were able to get an appointment within the 48-hour target actually fell.
Last month, I contacted one of my excellent GPs in Chesham concerning the waiting time for one of my constituents. In his response, he reminded me that Buckinghamshire patients receive less funding per head than almost anywhere in the country. What can be done to address that inequality, so that my constituents can benefit from the same level of funding for services and treatment enjoyed by other parts of the country?
As my right hon. Friend will be aware, the funding formula is now reviewed regularly. That is done independently and is free from political interference. Looking at areas such as hers, where there are a lot of frail and elderly patients, is now more paramount in the funding formula. In the future, I am sure that the funding formula will better reflect local health care needs.
One in four patients now wait a week or longer to see a GP. Last week’s official NHS survey revealed that almost 1 million people had to turn to A and E because they could not get a GP appointment. Will the Minister accept that his Government have made it harder to see a GP, and have caused the A and E crisis in the process? Will he respond to Labour’s call for GPs to be placed in major A and Es to help ease the pressure?
I do not think that people wanting to see their GP was at all helped by the previous Labour Government’s disastrous decision to contract out the GP out-of-hours service. Many patients are now struggling to receive appointments in the evenings and at weekends. The previous Government also broke the link with family doctors. To reassure the hon. Lady, the latest GP patient survey results suggest that less than 2% of patients who want GP appointments have to resort to walk-in centres or A and E departments. Under this Government, we have put in place an extra 1,000 GPs.
Accident and Emergency Departments
4. What progress his Department has made on its long-term plans for easing pressures on A and E departments and preparing the NHS for the future. (906956)
A strong NHS needs a strong economy, and because this Government have put Britain back on the road to recovery, we are able to invest an additional £2 billion in the NHS front line next year. This is a down payment on NHS England’s “Five Year Forward View”—the NHS’s own plan to transform care in the community and reduce pressure on hospitals.
Does my right hon. Friend agree that the NHS 111 service has been unfairly criticised by the Opposition, despite their key role in establishing it, and that it has provided impressive support this winter to our A and E departments by suggesting to patients convenient and effective alternatives to the emergency department?
My hon. Friend is absolutely right. Part of the solution to the pressure in A and E is providing good alternatives, and in the last year for which we have figures, the 111 service took 12 million calls, which is three times more than the 4 million calls that NHS Direct took in its last year of operation, and 27% of people said that had they not called 111 they would have gone to A and E. That is a huge success.
The Secretary of State will be aware of the additional pressure on Sherwood Forest hospitals trust as a result of the £40 million a year disastrous private finance initiative deal signed by the last Government. Will he meet me, my hon. Friend the Member for Newark (Robert Jenrick) and representatives from the hospital to discuss how we might move forward and deal with this terrible PFI deal?
I am aware of the problems with that deal, signed back in 2005, which is now consuming 17% of the trust’s income. It would like to spend that income on more doctors and nurses, but it cannot because of the shockingly bad deal signed. I would be happy to meet my hon. Friend to discuss what is possible in the current circumstances.
There are many causes of the pressure on A and E, and in more rural areas direct access to services can be difficult and costly. As such, will the Secretary of State consider investing further money in new technologies that could drive a revolution in health care facilities, and if such opportunities present themselves, may I promote York and north Yorkshire as an ideal testing ground for these technologies, given its ageing population and rurality?
I remember my hon. Friend’s campaigning on superfast broadband in north Yorkshire from my last portfolio. He is absolutely right that technology has a big role to play. That is why a year and a half ago the Prime Minister announced plans to expand weekend and evening GP appointments through the use of technology, which is already helping 5.5 million people and by March will be helping 7.5 million people. We must absolutely consider this as a solution.
In 2005 under the previous Labour Government, Crawley hospital’s A and E department was closed, but I am pleased to say that in recent years health and other emergency services have been returning to the facility. Will my right hon. Friend consider centring more emergency centres in Crawley, as the natural sub-regional population centre?
I congratulate my hon. Friend on his campaigning for Crawley hospital and pay tribute to staff at the hospital, which was rated “good” by the Care Quality Commission last year as part of the new inspection regime. He will welcome the fact that since 2010 the number of doctors at the hospital has increased by 97 and the number of nurses by 107. Of course, we will always consider ways to improve services for his constituents.
22. The Home Secretary talked about the £2 billion he has put aside for the NHS, some £1.5 billion of which is for clinical commissioning groups and specialised commissioning. Why are more than 50 CCGs in the south of England to receive a 3.6% increase in funding to the detriment of the north, where my own CCG is to receive only 0.24%, which is below inflation and a pittance compared with the south? (906974)
These things are decided independently by NHS England, which made the decision on the basis of which CCGs were most off their target allocation and on social deprivation and the number of older people. I remind the hon. Gentleman that there are many older and vulnerable people in the south, too, and they need a fair settlement from the NHS. That is why the decision was made.
I have had a number of discussions with the College of Emergency Medicine and what it actually says is that the system is working pretty well—[Interruption.] Well, that is what the College of Emergency Medicine says. The country’s A and E doctors welcome the fact that with the winter pressures money, there are now 800 more doctors and 4,700 more nurses, but we always want to make sure that the money is getting through as quickly as possible, so if the hon. Lady has any particular examples, I would be happy to look into them.
I agree with that, and I hope that the hon. Gentleman will campaign to make sure that the Northern Ireland Executive put the extra money they have received as part of the Chancellor’s autumn statement into precisely that—good GP services for the people of Northern Ireland.
It is increasingly recognised that the causes of the A and E crisis include the closure of walk-in centres, such as the one in Little Hulton in my constituency and this Government’s savage cuts to council budgets, leading in Salford to 1,000 fewer people getting care packages funded this year. When will the Health Secretary start to take responsibility for his own Government’s policies and do something to ensure investment in social care to ease that pressure on A and E? The better care fund is not the answer.
I am sorry, but this says it all about the Labour party’s campaign. It talks about savage cuts to social care and then the shadow Chancellor says he is not going to do anything to reverse them. It really has to be consistent. On the walk-in centre, Labour Members were saying earlier today that they want GPs present in every A and E department and that is exactly what has happened at Salford Royal. The walk-in centre was closed so that GP services could be moved closer to the A and E at that hospital. Perhaps the hon. Lady should talk to Sir David Dalton, her local chief executive, who will tell her why this is doing a better job for her constituents.
The Secretary of State is absolutely right to highlight the success of the coalition in delivering a better economy, which is allowing us to invest £2 billion from April this year. Will he address the point put to him about the importance of social care, and seriously consider investing some of that £2 billion in social care, not just in our health care system.
May I reassure my right hon. Friend by saying that I agree with him? I want to pay tribute to him for campaigning on this issue for some time, both in office and out of office. The truth is that there is a strong link between what happens in the social care system and what happens in the NHS. This year, we are putting £1.1 billion of support from the NHS into the social care budget. Next year, that increases by another £2 billion. We need to recognise that these two systems need to be brought together as one system—and with the better care fund, that is what is happening.
I think we need to look at the emergency medicine contracts. One thing said by the College of Emergency Medicine—I have a lot of sympathy with this view—is that emergency doctors want not more money, but the right to the same holidays that other doctors get. It is the time off that is important to them. They have to work 24/7 and they get extremely tired; they want some compensation for that in being able to spend extra time with their families. We are getting more people into emergency medicine, but we should look at anything we can do to make it better.
NHS staff are working extraordinarily hard to deal with not only the extra demands, but the increased complexity of patient cases in all parts of the urgent care system. Will the Secretary of State set out what more can be done to make sure that people access the right part of the system and that all parts of the system work together?
As a former GP, my hon. Friend understands this issue better than most. For me, the single most important thing for patients with the most complex needs, particularly for vulnerable older people, is having a system where the buck stops with a doctor. Someone must be accountable for ensuring that such people get the right care wrapped around them. We have brought back named GPs for all over-75s this year as a first step, but there is much more to do.
The Secretary of State did not answer the question put by my hon. Friend the Member for Houghton and Sunderland South (Bridget Phillipson). Surely the unprecedented problems we are now seeing in A and E and the wider NHS can be traced back directly to the risks of the huge top-down reorganisation, which were set out for Ministers in November 2010, but ignored. One of the current Ministers and his predecessor said, as reported in the House:
“We have every intention of publishing the risk register in due course, when we think the time is right.”—[Official Report, 10 May 2012; Vol. 545, c. 156.]
Four years on, will the Secretary of State now publish this risk register and let people see for themselves what warnings he was given about current problems and how far he has been hiding the truth on the NHS?
It was published, because it was leaked. The fact is that there is one part of the United Kingdom that carried out those reforms and has the best A and E performance in the country, and another part of the United Kingdom—Wales—that set its face against those reforms and has one of the worst A and E performances in the country.
Princess Alexandra Hospital
The West Essex system, which includes Princess Alexandra hospital, has received an additional £4 million in winter resilience funding. Of that, £842,000 has been spent on additional community beds, £211,000 on putting GPs into A and E departments, and £205,000 on reducing delays in the discharge of medically fit patients.
Harlow’s A and E has seen more attendances per bed than some of the biggest hospitals in the country. Although the staff at Princess Alexandra hospital are outstanding, they are still more than 40 nurses short. The chief executive says that recruitment is difficult because pay is better in the neighbouring London hospitals, although they are not far away. I welcome the 6,000 extra nurses, but will the Secretary of State consider what more can be done to help recruitment in Harlow and ease pressure on my local hospital?
I expect the additional £4 million for winter resilience to be directed towards the recruitment of additional front-line staff when that is appropriate, but there is flexibility in the current “Agenda for Change” pay scales to allow for the provision of recruitment and retention premiums if there are problems with recruitment.
East Kent Hospitals NHS Trust
I am pleased to report that East Kent Hospitals NHS Trust has started to make good progress since it was placed in special measures last August. That includes improved incident reporting rates, a revised policy enabling staff to raise concerns, and the creation of a cultural change programme.
Does not the Secretary of State’s answer highlight the fact that the best way of dealing with long-term and deep-set problems is to put patients first and ensure that there is a culture of transparency? Does that not contrast sharply with the denial and cover-ups that we have seen too often in the past?
Absolutely. I think that what shocks people is Labour trying to make political capital out of winter pressures in the NHS, and then sweeping the poor care that happened on its watch under the carpet. We are making great progress at East Kent Hospitals NHS Trust: there are 82 more nurses, and more than 100 more doctors. That is because we are facing up to the problems, not running away from them.
Adult Autism Strategy
7. With reference to his Department’s publication “Transforming care: A national response to Winterbourne View Hospital”, published in December 2012, if he will take steps to ensure that the statutory guidance implementing the adult autism strategy uses clear language and is mandatory. (906959)
The revised autism statutory guidance will be written in clear and accessible language. It will include existing obligations from the 2010 strategy and recent legislation such as the Care Act 2014. Local authorities and NHS bodies are required to take the guidance into account, or provide a good reason for not doing so.
The Minister will be aware that, under the Mental Health Act 1983, people with autism can be compulsorily detained for assessment and treatment although there is no evidence of mental illness. Will he join the National Autistic Society and others in endorsing the Justice for LB Bill campaign and seeking to end that wholly unacceptable practice?
The right hon. Gentleman has raised an incredibly important point. I, too, pay tribute to the campaigning of Justice for LB. We are strengthening the guidance relating to the code of practice under the Mental Health Act, and that strengthened guidance will be published shortly. We are considering whether amendments to the Act are needed, and we are also drafting a Green Paper. I should be happy to discuss the issue further with the right hon. Gentleman, and to have further meetings with campaigners.
Is my right hon. Friend aware that there is clear evidence that homeopathy is effective in treating autism, especially when doctors have not found a solution? Now that the Society of Homeopaths is regulated by the Professional Standards Authority, will he make more use of homeopathy in the health service generally, and in this particular instance?
I have to say that I was not aware of the information provided by the hon. Gentleman. I should be happy for him to send me more information, but I make the general point that it is always important for us to base our decisions and expenditure on evidence.
Calderdale Royal Hospital
There are no plans for the closure of A and E at Calderdale Royal hospital.
The hon. Lady and I have debated this topic before on the Adjournment. This is a locally led process. Nothing has been ruled in or out, no decision has been made, and first and foremost comes the safety and efficacy of local health services. May I commend to the hon. Lady the approach of her constituency neighbour, my hon. Friend the Member for Calder Valley (Craig Whittaker), who at all times has championed the best outcomes for his constituents’ health, rather than seek to make politics out of this?
Hospitals (Winter Demand)
The Government have prepared for this winter earlier than ever before, with a record £700 million to help the NHS through winter, including £3.6 million to help my hon. Friend’s local area.
The Norfolk and Norwich university hospital has declared a major incident and is also being examined by Monitor for its waiting times. Its medical director stresses that services are safe, but we all know that there is a need to ensure that people can move on from hospitals into other parts of the health care system. Can my right hon. Friend reassure me that he would expect the use of the resources he has provided to be jointly planned out with social care?
Obviously this is very important, and that is what is happening now for the first time. We are seeing the true integration of health and social care through the better care fund and record working, and in my hon. Friend’s area, despite the pressures they have been feeling this winter, they have made some good progress. They have put an urgent care centre next to the A and E. They are seeing within four hours nearly 12,000 more people every year, and they are doing about 12,000 more operations every year as well.
In the Chancellor’s announcement last year of extra funding for the NHS, my clinical commissioning group got a 0.24% increase, whereas Windsor, Ascot and Maidenhead got 3.7%. The Secretary of State blamed the NHS for this when he responded to my hon. Friend the Member for Middlesbrough South and East Cleveland (Tom Blenkinsop), but is it not because this Government have taken need out of the formula—a similar thing to what they have done in local government—which means the movement of money from the north to the south?
No, we have not. The NHS funds were allocated on the basis of a formula and the extra money was given to the places that were most off-target on the basis of the number of older people, the level of social deprivation and a range of other important factors. All I would say to the hon. Gentleman is that we have increased the NHS budget in real terms in his area, whereas those on his own Front Bench wanted to cut it.
May I take this opportunity to salute the efforts made by Frimley Park hospital, the first hospital in the land to have been awarded outstanding status by the Care Quality Commission? Is it not the case that it has responded well to the pressures and elicited praise from my constituents, which is down in large measure to the leadership of Sir Andrew Morris, who was rightly awarded a knighthood in the new year’s honours?
I think it is, and my hon. Friend is right that it is a brilliant hospital; it serves my constituents as well. One of the things it is doing is helping to turn around Heatherwood and Wexham Park hospitals trust, which was in special measures, including its A and E department, which is doing much better. Sir Andrew Morris has been running that hospital for 26 years, and that kind of stability in leadership makes a huge difference.
The NHS “Five Year Forward View” sets out a range of actions to help sustain smaller local hospitals, and we have backed that with almost £2 billion. NHS England is making a £200 million transformation fund available to smaller hospitals looking to develop prototypes.
Did the Minister see the recent remarks by Simon Stevens, the chief executive of NHS England, on how smaller local hospitals can play a role in providing care, particularly to older patients, many of whom prefer to be treated close to home? Does she agree that this makes the case for the future within the NHS for smaller hospitals such as St Cross in Rugby?
It is exactly that kind of flexibility that we so much welcome in the “Five Year Forward View”, recognising the potential of smaller hospitals. My hon. Friend’s local hospital, which he champions so well, can apply to be one of NHS England’s prototypes, and I would encourage it to do so.
Does the Minister accept the case made by commissioners and the trust in Morecambe Bay that, notwithstanding all the efficiencies and changes in services, the trust could not close its deficit, due to its near unique geography and health need, without significantly cutting vital services for the area?
These are clearly difficult local questions that local health leaders need to look at. If there is a particular issue the hon. Gentleman would like to draw to our attention, we will certainly be able to examine it. I recognise that unique geography is involved, but steps are already being taken by NHS England to try to close some of those gaps and to deal with those challenges that smaller hospitals face, working with Monitor and looking at, for example, the tariff regime. I encourage him to look at that, too.
There were just short of 882,000 calls triaged by the NHS 111 service in England in November 2014, and 99,808 of the calls—11.3%—had an ambulance dispatched.
I thank the Minister for that response, and I am grateful for the earlier response to my hon. Friend the Member for Romsey and Southampton North (Caroline Nokes), which is very reassuring. Any Member who has spent time with paramedics, as I have in Newark, knows that this is a hot topic for them. So we would appreciate any extra reassurance the Minister can give that the algorithms that lie behind the 111 service, and the level of clinical involvement in it, can be improved, with experience, to create a sensible number of cases going to accident and emergency.
I pay enormous tribute to the paramedics, who are working under a lot of pressure. The survey results, which showed that about 27% of people who have used 111 say that they would have gone to A and E had it not been available, are a considerable reassurance. However, we need constantly to seek to improve the service, and the urgent and emergency care review pointed to refining the 111 service so that, ultimately, people could get access through to a GP, doctor or nurse, to ensure that they receive the right guidance at the right time.
The Public Accounts Committee examined this service in Devon and Cornwall and discovered, as it has in other inquiries, a lot of issues associated with cost shunting, because it does not cost 111 when it tells someone they need to go to hospital in an ambulance. So there have been “impressive figures” on the number of people who did not go to A and E as a result of their call, but is the Department monitoring the number of people who are sent to A and E by 111 but should not have been?
As I said in response to the previous question, there is a real case for constantly seeking to refine the way the service works. The urgent and emergency care review pointed to ways in which we could do that to ensure that, in appropriate cases, people could get through to a doctor or a nurse to give them the right advice. That, in turn, would reduce the number of people turning up at A and E.
Further to the previous question, will the Minister urgently review the operation of NHS 111, as not only did it experience meltdown over the Christmas period in my area, but it is run from a call centre in Newport, 200 miles away, and it uses algorithms that involved staff asking a patient in my constituency, “Are you conscious?”?
Call volumes doubled over the Christmas period compared with those a year ago, so the system was certainly under enormous pressure. As I say, the survey results show that a lot of people were diverted away from A and E, but there is absolutely a case for seeking to improve 111.
The Secretary of State earlier complacently claimed that England has the best A and E service in the United Kingdom, but last week 86 hospital trusts in England operated below the Wales average. Suzanne Mason, professor of emergency medicine at the university of Sheffield, said that ambulance services in some parts of the country have been “brought to their knees” by 111. Does the Minister now think it was a mistake to scrap the nurse-led NHS Direct service? Will he urgently implement Labour’s proposal to get more nurses answering 111 calls, to relieve pressure on our chronically overstretched A and E departments?
I understand that about 22% of callers do get to speak to a clinician and, as I have already said, we are seeking to develop the service so that there are more referrals to an appropriate clinician. Let me again repeat the fact that the performances of A and E, ambulances and people waiting for hospital are considerably better in England than they are in Wales, and the Opposition need to recognise that.
Accident and Emergency Departments
A range of factors is contributing to increased attendances. The ageing population means that, by the end of this Parliament, there will be nearly 1 million more over-65s than at the start. The urgent and emergency care review cited pressure on GP appointments and availability or awareness of alternatives as factors that might affect A and E attendances.
NHS Providers, which represents 94% of NHS foundation trusts, says that national tariff proposals that have forced hospital trusts to find efficiencies of 3.8% are excessive and, taken with other cost pressures, undeliverable. It will take £1.2 billion out of budgets from front-line NHS services. Do the Secretary of State and his Ministers understand the implications of that proposal, and will they act to stop it given the pressures on the NHS, especially on A and E departments?
The Nicholson challenge, which was published in the last year of the Labour Government, recognised that the whole system had to deliver efficiency savings, and I think that everyone understands that. But the answer to all of this is a significant shift of emphasis towards preventing ill health and preventing crises from occurring. Under the better care fund the NHS and the care system are for the first time being properly joined together.
The Northamptonshire clinical commissioning groups and Kettering general hospital are agreed that Kettering’s A and E department is too small and outdated and needs to be replaced with an urgent care hub in line with the NHS five-year forward view. Given that the three local MPs on a cross-party basis refused to treat our local A and E as a political football, will the Minister of State encourage his colleague, the hospitals Minister, to consider that proposal seriously when we come to see him this afternoon?
Ministers have been repeatedly warned about the impact that their social care cuts are having on elderly people and that that is a key cause of pressures on A and E. Today it has been revealed that public health officials have issued an alert about a statistically significant and “sustained” decline in life expectancy in parts of the north-west. They say it is extremely unusual and that
“central government driven reductions in adult social care budgets”
are a possible cause. Will the Minister confirm that alert, say whether life expectancy is declining elsewhere, guarantee that Public Health England will urgently investigate the matter and promise that its findings will be published in full?
Although there was a fall in life expectancy for those aged 85 in 2012, preliminary analysis shows that there was no further drop in 2013. Incidentally, let me pay tribute to the people who work in social care. The system has performed remarkably well. Statistics on delayed discharges due to social care show that the number of delayed days is almost exactly the same this year as it was in 2010—a remarkable performance.
The Chancellor agreed in the autumn statement to support NHS England’s five-year forward view with the £1.7 billion of additional funding that the NHS requested. On top of that, the Chancellor allocated £1 billion of funding to transform primary care facilities, and I am pleased to announce today that a letter will shortly be sent to every single GP practice in the country, inviting them to bid for the first tranche of that funding with the aim of supporting more GP appointments and more proactive care for the most vulnerable.
Last week, one of my constituents had a fall and fractured her pubic bone. She was taken to Queen Elizabeth hospital in Woolwich because 15 ambulances were stuck in a queue outside Lewisham. She then waited 12 hours on a trolley. If the Secretary of State had got his way and been successful in his attempt to axe services at Lewisham, exactly how much longer would he have expected my constituent to wait? Is it not true that if he had got his way the A and E in Woolwich would have been totally and utterly overwhelmed?
No, and I can tell the hon. Lady that her constituents would be receiving far worse care had we not tackled the long-standing issues with the South London Healthcare NHS Trust, which the last Government ducked but which we have confronted and dealt with. If she looks at the performance of A and E in her area, she will see that 48,000 more people are being seen within four hours than when Labour was in power.
T2. The Secretary of State will be aware that the London borough of Havering has the highest proportion of elderly people of all the London boroughs, but he may not know that the average age of an in-patient at Queen’s hospital is 86. Will he agree to look at the balance of future funding between acute care and community health care, so that elderly people can be supported at home and beds freed up for people waiting for acute operations? (906944)
My hon. Friend makes an important point. It is one of the underlying causes of pressure in A and Es that for an over-75 attending an A and E in winter, there is an 80% chance that, rather than going home, they will be admitted to hospital and probably stay there a long time. That is why improving community care, as she says, is at the heart of this Government’s strategy to reduce pressure on hospitals.
If it is not too late, let me wish you, Mr Speaker, a happy new year.
The care failings uncovered by the Care Quality Commission at Hinchingbrooke hospital are appalling and unacceptable. The inspection
“found poor emotional and physical care which was not safe or caring.”
The response to call bells was so bad that some patients were told to soil themselves; drinks were left out of patients’ reach; and one member of staff was overheard telling a patient,
“don’t misbehave you know what happens when you misbehave.”
Will the Secretary of State tell us when he was first told about the problems at Hinchingbrooke? Given that the CQC inspection happened in September, why was the trust put into special measures only last Friday?
What I can tell the hon. Gentleman is that what happened at Hinchingbrooke completely destroys what Labour has been saying about privatisation, because it was this Government who introduced an independent inspection regime, which did not exist before, that roots out poor care without fear or favour. That is what we have done in 18 hospitals run by the NHS and it is what we are doing at Hinchingbrooke run by the private sector.
T3. The three GP surgeries in Chippenham were turned down by the Prime Minister’s challenge fund, despite developing imaginative plans to bring together all the town’s acute GP care at a new urgent care centre at Chippenham community hospital. They received no feedback, even from NHS England. Will the Secretary of State be more flexible when receiving further proposals from the doctors, who are, after all, very busy looking after their patients? (906945)
T4. The Bournbrook Varsity medical centre is about to face a double-whammy financial crisis, as NHS England scraps its minimum practice income guarantee and forces it to switch from a personal medical services contract to a general medical services contract. Why should that excellent practice, which has done all that could be asked of it, and its patients be victimised because a high proportion of the patients are young students? Will the Secretary of State agree to look at this disaster immediately? (906946)
T5. The recent extraordinary pressures on A and E in the north midlands underlined for me and my constituents the importance of returning the A and E at Stafford County hospital from 14 to 24-hour opening. Given that consultant-led maternity is due to transfer from Stafford to Stoke this week and the remaining serious emergency surgery next month, will my right hon. Friend set out what steps have been taken to ensure that the safety of my constituents and other users of the services is the top priority, and advise me whether he is confident in them? (906947)
I have been in contact with the NHS Trust Development Authority. I have been reassured that the safety of patients in Stafford is the primary concern and that the transfer of services should help to ease pressure on local services and improve patient care.
T7. Government-inflicted cuts on local government funding and subsequent reductions in adult social care services have increased the pressures of bed-blocking at University hospital Coventry, with a number of patients unable to be discharged as they wait for a nursing home place or a package of care in their own home. Does the Minister agree that this is a problem, and what steps has his Department taken to remedy it? Will he not do the Pontius Pilate act but take responsibility for his actions? (906949)
The hon. Gentleman is absolutely right that what happens in social care has an impact on the health service, and the answer has to be to stop seeing them as two separate systems and to look at the whole health and care system. That is why the better care fund is such an incredibly important initiative, pooling a substantial sum of health and care funds, and it must go further so that we end up pooling the entire resource.
T6. The last Government abolished community health councils, a truly independent health watchdog and voice for patients. Their replacement, the patient advice and liaison service, is not independent. Does the Minister agree that PALS must be made independent? (906948)
PALS was not the direct replacement of community health councils; a different scheme was set up for the patient and public voice independent of hospitals. My hon. Friend raises important concerns about PALS and the Government are intent on looking at the service to ensure that it performs effectively for patients.
T8. My constituent Mr Offord waited 22 minutes after a 999 call for a double-crewed ambulance, and his death was referred by the South Yorkshire coroner to Ministers because of a concern that he might have survived if he had received medical help sooner. The Yorkshire ambulance service has just settled the case brought by Mr Offord’s family out of court. When will the Secretary of State recognise the growing crisis in ambulance services and support my right hon. Friend the shadow Secretary of State’s call for an investigation? (906950)
I do recognise the pressures on the ambulance service and the hon. Lady’s local area has had £1.6 million extra to help to deal with winter pressures. We have 1,700 more paramedics in the ambulance service and they are doing 2,000 more emergency journeys every day, but none of that is any consolation to the family whom she talks about, and that is why we must always ensure that every lesson is learned.
The Secretary of State, the Department of Health and my local hospital trust inform me that there are more doctors and nurses in the local NHS and the NHS nationally than there were in 2010. This weekend, residents in north Lincolnshire received a leaflet from the Labour party saying that there were fewer doctors and nurses and less care. Who is telling the truth?
T9. Does the Under-Secretary of State remember the case that I raised in an Adjournment debate of Mrs Monica Barnes and the inadequate service she received from the health service ombudsman’s office? The ombudsman’s office has today announced a consultation on a new service charter. Does he welcome it and hope for a better service for our constituents? (906951)
There have been a number of problems with the service offered by the ombudsman. There has been a lack of expertise in the ombudsman’s office to investigate the most difficult cases. This is obviously a responsibility of Parliament not of mine, but I have had good discussions with my hon. Friend the Member for Harwich and North Essex (Mr Jenkin), who chairs the Public Administration Committee, about how the services can be improved.
The last week has been an extremely testing time for Hinchingbrooke hospital in my constituency, for its hard-working staff and for its loyal patients. Will my right hon. Friend please take this opportunity to confirm his Department’s full support for Hinchingbrooke hospital and to give some advice on the way management will be transitioned so as to minimise patient disruption?
I am happy to do that, and I reassure my hon. Friend that our top priority will be to ensure that there is a smooth transition to the new management of the hospital as Circle moves away. I thank him for the measured tone he has taken and I reassure him that his constituents’ safety and care is our top priority.
T10. At Southmead hospital in Bristol, just 81% of patients are seen within four hours and the number of blocked beds is three times the national average. At Bristol Royal infirmary it is double the national average. What is the Secretary of State doing specifically to help hospitals in the Bristol area? (906952)
All the talk about appointments concentrates on GPs and A and E, but does not seem to focus on pharmacies, which have a hugely important role to play, considering how many years pharmacists train for. My constituent Mr. Dhand of the Headingley pharmacy is undertaking a pilot to see how many people could and should have gone to a pharmacy rather than to a GP. Would Ministers support that?
I very much welcome what the hon. Gentleman’s constituent is doing locally. For many patients the pharmacy is often the first point of contact with the NHS, so the more we can do as a Government to support local pharmacists in delivering community services, the better.
Despite all the warm words we hear every week from the Government about their support for the staff of the NHS, which I welcome, the Government still refuse to pay the award recommended by the independent review body. At the same time the chief executive of the trust in my part of the world has had a 78% salary increase and the people who set the allowances, the board of governors, have had an 88% increase in their allowances. Is this what is meant by “we are all in this together”?
I believe that NHS managers have a responsibility to be sensible about their own pay. This is not decided centrally, but when we are asking NHS staff to make sacrifices in their own pay to make sure that we can recruit enough staff, NHS managers should set an example.
The Institute of Translational Medicine at Birmingham university medical school is probably the top place in Europe for genetic research into innovative cancer cures. I have visited it. Will the Secretary of State visit it, and will he ensure that funding continues for that department?
My hon. Friend is right to champion that project. The Prime Minister’s 100,000 genomes project is leading the world and has the potential to transform the future of health care. The Institute of Translational Medicine in Birmingham will accelerate access to new diagnostics, new drugs and medical devices and provide a focus for life sciences. My hon. Friend will be pleased to know that my colleague with responsibility for life sciences, my hon. Friend the Member for Mid Norfolk (George Freeman), plans to visit on 3 March.
The Secretary of State refuses to meet Hartlepool borough council and me on the issue of hospital services in Hartlepool. On Wednesday in this House he said:
“I take responsibility for everything that happens in the NHS.”—[Official Report, 7 January 2015; Vol. 590, c. 277.]
If so, will he respond to the 12,000 people who signed the petition organised by the Hartlepool Mail, the 1,000 people who marched on Saturday morning, Hartlepool borough council and me on this issue? Will he stop snubbing the people of Hartlepool, work with us and make sure that hospital services can return to Hartlepool?
I do take responsibility, but I hope the hon. Gentleman will be responsible in his campaigning in Hartlepool and welcome the extra doctors, extra nurses, extra operations and extra number of people seen within four hours in his constituency. It is a record of success, of which this Government are proud.
As it becomes increasingly obvious that the public insist on receiving urgent care in a hospital setting, will the Government move to incentivise the delivery of a new generation of urgent care centre, as specified in the end of the phase 1 report on the urgent and emergency care review?
I have visited my hon. Friend’s local hospital. I commend him for his interest and I commend the hospital for the remarkable turnaround. From being a hospital in special measures, it has done extremely well. We want to implement the proposals in that review and we want also to make sure that for the oldest and frailest people there are alternatives that mean that they do not have to visit hospital.
Order. I am sorry to disappoint colleagues. Including the main Order Paper questions, we have got through 78 inquiries today. Box office records have been broken. I leave it to Back Benchers and the ministerial and shadow ministerial teams to argue among themselves about who wishes to claim credit for that. We will have to leave it there for today. [Interruption.] The Secretary of State for Energy and Climate Change makes a very generous and loyal remark from a sedentary position that modesty prevents me from repeating.
Nuclear Management Partners (Sellafield)
(Urgent Question): To ask the Secretary of State for Energy and Climate Change if he will make a statement on Nuclear Management Partners and Sellafield.
I thank the hon. Member for Rutherglen and Hamilton West (Tom Greatrex) for his question.
As I have informed the House today through a written ministerial statement, the Nuclear Decommissioning Authority has today announced a change to its commercial model at Sellafield, its largest and most complex site.
Dealing safely with the UK’s nuclear legacy is a key priority of my Department. It is important for the communities involved and for the future of nuclear power in this country. We work closely with the Nuclear Decommissioning Authority and its contractors to ensure that decommissioning is undertaken as effectively as possible, but as we are guardians of the public purse, we must also make sure that clean-up is done in a way that delivers the best value for money.
Over the past year, the NDA has been conducting a thorough review of its business model in the unique context of Sellafield to consider what contractual model might best deliver improved performance and value for money. In April last year, we endorsed the Nuclear Decommissioning Authority’s decision to roll the current parent body organisation contract—PBO—forward into the second term to ensure that the progress made in the first five-year term could be built on. The complexity and technical uncertainties at Sellafield are unique and need a management structure best suited to meeting the specific challenges faced by the site. Sellafield is the most complex industrial site in Europe. It is home to some of the oldest nuclear facilities in the world—the legacy ponds and silos that were constructed in the 1940s and ’50s—as well as the UK’s plutonium stockpile.
Because of these unique challenges, Sellafield is less well suited to the transfer of full site-wide responsibility to the private sector via a PBO structure. The NDA has now recommended to Government that management arrangements are simplified. In future, the private sector will be retained as suppliers of Sellafield Ltd rather than as owners of the site. Sellafield Ltd will remain a publicly funded company owned by the NDA. The team will be appointed and governed by a newly constituted board of the site licence company. The new model will, in due course, see a strategic partner appointed by Sellafield Ltd to strengthen the programme management and commercial capability at the site, as well as playing a key role in managing capital projects and contracts. This approach is recognised as best practice in other major projects such as Crossrail and the Olympics.
The NDA and Sellafield Ltd will manage the transition to the new arrangements, which is expected to take about 15 months to complete. This will be done in close co-operation with work force representatives, Nuclear Management Partners, the supply chain, the regulators, and the local community. The continued safe and secure operation of the Sellafield site will remain the overriding focus during the transition, and it will remain so under the new structure. This new structure is the best way to ensure that safety and value for money are pursued in tandem.
I thank the Secretary of State for his answer. He will appreciate that this an issue of very serious concern for the 10,000 dedicated, professional and highly valued workers employed at Sellafield and for all of us who, as taxpayers, have just seen a £20 billion public procurement decision partly reversed. I want to ask him a few specific questions on the details of his decision and his statement.
In 2013, just 15 months ago, the right hon. Member for Sevenoaks (Michael Fallon), then a Minister in the Secretary of State’s Department, allowed the Nuclear Decommissioning Authority to continue into a five-year contract extension for Nuclear Management Partners. This was despite a National Audit Office report from November 2012 that concluded that the contract led to
“poor project design and delivery by Sellafield Limited and weaknesses in the”
Why was that advice ignored, and why is this decision now being made today? Is it because, in reality, the situation was getting worse and not better?
The Secretary of State has suggested that in 2013, at the review point, the Government accepted the problems with the NMP contract but did not have an alternative solution prepared. What is the point of a review point if one is unable to consider other options? Will he illuminate for the House what termination fees apply to the cancellation of this contract and whether those fees could have been recovered at any stage? What assessment has his Department made of the risk of legal action from NMP to recover further funds?
Last year, it was revealed under a freedom of information request that in September 2013 KPMG completed a 277-page internal review of the contract for the NDA that was highly critical. To quote the Public Accounts Committee, it found that
“there was a mis-alignment between the objectives of NMP and the…Authority’s commitment to deliver value for money for the taxpayer, and…potential conflicts of interest associated with contracting by Sellafield Limited with NMP’s affiliate companies.”
Will the Secretary of State confirm how much was spent on that advice from KPMG by the NDA, which reports to him—advice that was then ignored and, it seems, is now being adopted?
In February last year, the PAC reported that even after the contract was extended with NMP, it
“has not provided the clear leadership, strong management and improved capabilities needed to deliver the performance required at the site.”
Fifteen months on from having overseen that contract extension, why have the Government come to the conclusion that it was the wrong decision? Will the right hon. Gentleman describe the immediate arrangements for the 10,000 people employed at Sellafield, and tell us what impact today’s decision will have on the running of other sites? Will this create the need for a review of the Nuclear Decommissioning Authority’s other operations, where similar contracts that might give poor value for the taxpayer could still be in place?
Can the Secretary of State clarify why this announcement was extensively trailed in the press last night and this morning, rather than being made in the first instance before the House today? Is it not the case that what we have seen today is a frantic U- turn, an abandonment of the extension of a contract and the reversal of a decision that should probably never have been taken in the first place? Does the Secretary of State not appreciate that such casual disregard for the evidence and conclusions of the National Audit Office and the Public Accounts Committee has resulted in wasted time and public money and may risk a loss of confidence in the important decommissioning work at Sellafield? Does he acknowledge that insufficient care and due regard were taken by the Ministers in his Department who have ultimate responsibility for these matters? Does this not eloquently make the case against part-time, part-time energy Ministers and is it not now time that the Secretary of State got a grip, stopped playing stupid inter-coalition games and got his dysfunctional and misfiring Department into shape?
The hon. Gentleman was doing quite well until his peroration. I will explain why it was a big political mistake for him to go down that route, but first I shall answer his specific questions, because they were important. He began by praising the staff, and I agree that they deserve huge praise because they are tackling one of the most difficult and dangerous jobs in Britain today. I can confirm that their terms and conditions are not affected by this at all. There will be full discussion with work force representatives. At this point, I should like to pay tribute to the hon. Member for Copeland (Mr Reed), who has worked assiduously on this issue.
The hon. Member for Rutherglen and Hamilton West asked why we allowed the contract continuation in 2013, given the findings in the National Audit Office’s report of weaknesses in it. The Nuclear Decommissioning Authority recommended that the contract be continued, and we had to endorse that recommendation. It was not a question of approving it; we endorsed it. At that time, when I looked at the structure that we had inherited from the last Government, I was concerned about the model. It was the model that I started asking questions about, and it is the model that has been reviewed. I have already explained a little about the review process; it is the model that we feel needs changing for the long term.
The hon. Gentleman asked why there was no alternative solution. The contract renewal process looked at the performance, which had not been good enough, but it is worth putting on record the fact that the performance of Nuclear Management Partners since the contract renewal has improved significantly, so this decision has not been taken on account of the performance of NMP. If we look at its performance over the past year, we can see that it has delivered on things that no one has delivered on for years. For example, the sludge-packing plant, which is needed to take out the toxic sludge from B30—a pond that has been there for decades—has now been commissioned and is ready for operation. That is a big achievement and I pay tribute to NMP for that. The decision has not been taken on account of performance; it has been taken because Ministers and the NDA questioned the model that we inherited from the last Government. We then put in place a proper review of that model.
The hon. Gentleman asked about the termination fees, and I can tell him that they are very low. The mechanisms under the current contract allow for termination and appropriate fee awards of less than 1% of the annual fee, and those mechanisms will be adhered to. Of course, during the transition, NMP will earn the fees that it would normally earn under the existing contract while it is still carrying out the work, but the termination fee is very small.
The hon. Gentleman also asked about the cost to the NDA of the KPMG report. I do not have that figure with me but I would be happy to write to him about that. He also mentioned the parent body organisation model that we are getting rid of at Sellafield, and asked whether we should get rid of it elsewhere. Our argument is that we should not. Let me explain why Sellafield is different.
At other nuclear power plants that are being decommissioned, such as Dounreay, the PBO model is working well. At Dounreay and other decommissioning sites, it is easy to specify the performance, the activities and the outcomes that are required. Those requirements are more certain and clear, and therefore easier to contract for. At Sellafield, because it is so complicated and because of the huge uncertainties about some of the materials that they are trying to clear up, it is very difficult to do that. Those huge uncertainties make the risks of contracting much more difficult, which is why the PBO structure needs to go there but not elsewhere.
The hon. Gentleman asked why the announcement was trailed in the press. I am afraid that it was not, and I am pleased that it was not, but there was some sort of leak. I do not know where that came from. He then suggested that this was a frantic U-turn, which is complete rubbish. We have been working on the issue carefully and diligently for some time. The NDA set up a review of the model, which I think was required. It made recommendations to officials who looked at them and made recommendations to Ministers and we have been looking at them for some time. Indeed, I asked questions when I got the initial recommendations to ensure that during the transition any risks were properly mitigated and I was not prepared to take the decision until I saw a proper risk mitigation plan for the transfer.
Ministers have been involved in the process, and given that the hon. Gentleman made a political point at the end of his peroration, let me make a political point back to him. These contracts and this model were drawn up under the previous Labour Government. The contract came into effect when the Leader of the Opposition was doing my job, so the hon. Gentleman should be addressing his questions about the model and the contract to the Leader of the Opposition, his own party leader. Once again, we have had to clear up the mess left by the Labour party.
I welcome the Secretary of State’s emphasis on safety and value for money in making this decision and his clear explanation of the difference between Sellafield, with its difficult history and unique circumstances, and the other sites where this work takes place. In the light of what he has just said, is it his view that this model was never appropriate for Sellafield, given its unusual situation, whereas it might be working perfectly satisfactorily elsewhere?
I must say that when I first saw the diagram of the model I expressed great surprise and asked why someone had come up with such a model. That is why questions were asked to review it. The NDA and others involved were perplexed about why they had been given the model in the first place as Sellafield is a complicated site. Let us be clear that in the past year NMP has significantly improved its performance, so the model can have some success. The key strategic question is whether, given the lessons we have learned from the operation of that model for Sellafield and given its complexities, this is the right model to ensure effectiveness and value for money. We concluded that it was not and that is why we are changing it.
To give credit where it is due, this decision was actually made by the Department of Trade and Industry some time ago and predates the Department of Energy and Climate Change, so it had nothing to do with the Leader of the Opposition.
I thank the Secretary of State for his announcement today and the shadow Minister for how he has raised these issues. With continued Sellafield operations and the imminent construction of new nuclear reactors, west Cumbria has the potential to become one of the fastest-growing sub-regional economies anywhere in the United Kingdom. Removing NMP from the Sellafield contract and changing the operating model of the site will mean that significant additional financial resource is now made available. This is public money and must be used carefully. Consequently, the terms and conditions of the Sellafield work force must be protected—I welcome the Secretary of State’s commitment on that—and NMP’s socio-economic commitments to my community must as a minimum be honoured. In addition, the 15-month transitional arrangement must be undertaken in a practical and consensual fashion, and changing the operating model should also make it possible better to maximise existing commercial operations and pursue new ones. Will the Secretary of State commit to meet me and work force and community representatives to ensure that today’s announcement contributes towards those ambitions?
I am grateful to the hon. Gentleman for that speech and I agreed with almost every word of it. I am not sure that I agreed with the bit at the beginning, where he was trying to scapegoat the DTI. We will work with the work force, local representatives such as the hon. Gentleman, all key stakeholders and the regulators to bring this plan to fruition. It represents better value for money and will deliver what we need to deliver at Sellafield more quickly.
This decision will not come as a great surprise to anybody who understands the legacy, complexity and size of Sellafield. The key requirement for any contract is the scoping beforehand, and that is particularly difficult at Sellafield. On the PBO at Dounreay, where considerable scoping was possible prior to laying the contract, will my right hon. Friend assure me and all those who work so well and effectively at Dounreay that, notwithstanding the slight adjustments currently being made, that contract is working well and his Department has full confidence in the NDA, the contract and the workers at Dounreay?
When I visited Dounreay I was incredibly impressed by its work force and management team and I know how much my right hon. Friend has been supporting them over a considerable period. I can give him the reassurances he seeks. The contract with the PBO has worked because it has been easier to specify the scope, as my right hon. Friend rightly pointed out. As a result, significant efficiencies have been made and significant savings to the taxpayer have been accrued, so the PBO model has worked well on that site.
May I thank my hon. Friend the Member for Copeland (Mr Reed) for his leadership? He has been calling for this decision for some time. Will the Secretary of State assure us that he will work with my hon. Friend and the community to ensure that the change in management structure properly gives the area an opportunity to use the incredible civil nuclear engineering expertise available in west and south Cumbria to reach out to new markets and create new growth opportunities?
This is clearly a significant development not just for west Cumbria, but for other parts of Cumbria, including my constituency. Will the Secretary of State confirm that the change will not in any way affect the prospects of a new nuclear build at Sellafield?
In 2008, I had an Adjournment debate to point out that the huge costs and risk of the operation would be borne by the taxpayer and not by the private company. It was a mistake to start the operation and a mistake to renew it, but it is also a mistake not to learn the lesson. Have not the Government just risked another £10 billion as a gift to a foreign company at Hinkley Point and agreed a price for electricity that will continue, guaranteed, for 35 years? Again, the public bear the risk and the cost, and private people from abroad—from China and France—will take the profit.
Let me try to agree with something the hon. Gentleman said. The costs of decommissioning are huge. Two thirds of my Department’s budget goes towards decommissioning nuclear power stations from the past and dealing with that legacy, so we need to think about value for money as we do that vital work safely. That is one of the reasons that, with the new nuclear programme, it is vital that the contracts and prices we agree include the costs of decommissioning and waste management, and they do.
The Secretary of State has made it clear that there will be no redundancies at Sellafield Ltd in Cumbria or Warrington. Does his migration plan identify any redundancies in AMEC, URS or AREVA, and what is the time scale for his appointing a strategic partner to assist the programme?
We, and particularly the NDA on the ground, will be strongly working with the NMP and its consortium bodies. The exact time scale for the appointment of a new supplier organisation is yet to be determined, because this is the beginning of what is likely to be a 15-month transition. My hon. Friend asks me to speculate on issues that have not yet finally been addressed, so I am afraid I am not able to give him the specific answer he requires. I can tell him, however, that the NDA will be working very closely with the NMP to manage the process smoothly.
I visited the Sellafield site at the end of October to see the scope for storing submarine reactors; obviously, I will seek clarification from the Ministry of Defence about the time scale for that. I was impressed by the calibre of the locally developed management tier, including the head of operations, Andrew Hope. Will the Secretary of State reassure the House that the world-class work force will be supported and enabled, so that nationally important projects can proceed?
Yes, I can give the hon. Gentleman that reassurance. Members from both sides of the House have voiced support for the staff and the need to ensure that they get all the training required and that information about the change is properly conveyed to them. I believe that the staff will support the changes.
I visited Sellafield with the Public Accounts Committee in 2012 and was struck by the difficulty of challenging those who say that the issues involved require vast expenditure over vast time scales. Recently, there have been a significant number of vacancies on the NDA board. Is the Secretary of State satisfied with the experience and management independence of the NDA, and what is he doing to ensure that it delivers the scrutiny and challenge that it should deliver?
The NDA has approached some of its key decisions incredibly professionally, including the renewal of the contract and the review of the model that led to the recommendation to me for the change under discussion. I pay tribute to the NDA for the work it has done. It will, of course, be taking on a bigger role in the new model, so it will need to skill up, hire more expertise and fill the vacancies referred to by my hon. Friend. That was part of the questioning that I and others undertook to ensure that the transition process and the resulting process are successful.
Obviously, we need to deal with the cost of legacy waste, but as well as announcing the change in the contract the NDA has announced an increase in the estimated cost of cleaning up the site, which now comes to a staggering £110 billion over 120 years. Given those figures and that time scale, how can the Secretary of State possibly give the assurance he gave to the hon. Member for Newport West (Paul Flynn) that the costs of new nuclear will be met by the companies, which may well not be around in anything like 120 years?
Let us be clear that those costs relate to decommissioning the legacy waste. In answer to the hon. Member for Newport West, I was referring to the negotiations with EDF and its partners on the strike price for the new build at Hinkley Point C. That will include the cost of decommissioning, so that is in the price. Legislation went through this House under the previous Government to set up the nuclear liabilities fund and to ensure that it is independent and ring-fenced so that the moneys that go into it are properly managed. We have done a huge amount of work to ensure that that ring-fenced resource will grow and meet the future decommissioning costs.
The great thing about a National Audit Office report is that it is consensually agreed between the Department and the NAO. I am afraid that rather disproves the points that the Secretary of State has tried to make. He tried to locate the original plan in 2008 under the now Leader of the Opposition, but the report says that the previous plan was designed in 2007. The Secretary of State called this the revised plan, but the NAO report is very clear that, in fact, the
“Authority accepted the revised plan in May 2011”,
so this is a revision of the revision that his predecessor approved. Finally, the report was produced in 2012, when the Secretary of State was in post, and states that there were significant uncertainties back then. Why did he not act on the uncertainties that he agreed with the NAO existed then and work up an improvement for the time break in the contract?
Mr Speaker, I think I understood what you just said.
I must tell the hon. Member for Brent North (Barry Gardiner) that he possibly should have listened a little more carefully to what I said. The original contract was engaged with and drawn up by the Minister who preceded the Leader of the Opposition, but it came into force when the right hon. Gentleman was doing my job.
The issue we have looked at is that of the model, which was designed under the previous Government and which we inherited. The contract that the hon. Gentleman talked about was looked at and then rolled forward, but the issue at stake is the model. We are changing the model of the management structure for the better, because the one we inherited was complex and expensive.
On the final point, I have said that I will write to the hon. Member for Rutherglen and Hamilton West (Tom Greatrex); I do not have that figure with me. On the cash figure, I will write to the hon. Gentleman with the precise amount. I gave it in percentage terms—it is 1% of the annual fee—but I believe that it is less than £500,000 in cash terms. I put on the record that I will need to clarify that in writing.
The Public Accounts Committee characterised the lack of speed in decommissioning at Sellafield in terms of missed targets, escalating costs, slipping deadlines and weak leadership. How confident is the Secretary of State that the new model will accelerate decommissioning, cleaning up the legacy waste and dealing with the ponds that presented problems last year?
The hon. Lady is right that performance at Sellafield has been mixed—we would not have taken the decision if it had all been going terribly well—but I repeat what I have already told the House, which is that performance improved significantly last year. That is why the focus is on the model. She asked whether we believe that the model will improve performance, and we absolutely do: it will reduce costs and improve the effectiveness of management on that complex site.
What measures is the Secretary of State taking to ensure that the process, particularly for the selection of the strategic partner for Sellafield Ltd, will be proof against a repetition of elements of the fiasco we have heard about today?
The different model will ensure that the involvement of the private sector is far more effective and, indeed, more cost-effective. The NDA is obviously responsible for the selection of the strategic partner. The model is now much simpler and is in line with best practice for procurement for such complex operations. That is why I made the analogy with Crossrail and with the Olympics in my answer to the hon. Member for Rutherglen and Hamilton West. The Olympics was a very complicated project, and Crossrail is a very complicated one, while Sellafield is the most complex industrial site in Europe. Given the complexity of the operations, it does not really make sense to have the complex model set up under the previous Government, and that is why we have taken this decision.
Given the criticisms of the NAO and the PAC, is the Secretary of State really telling us that he knew there were concerns about the model, but did not think that he could change it? Will he explain what monitoring procedures he and the then Minister with responsibility for energy, the right hon. Member for Sevenoaks (Michael Fallon), put in place to keep a close eye on the company? Will he tell us what meetings they had, what figures they required and what evidence they wanted from the very beginning of the process for renewing the contract?
To be clear, the renewal of the contract was the NDA’s decision, which we endorsed. When we endorsed it, we obviously asked the chief executive, the chairman and the board of the NDA some serious questions, including about the model, and that led to the review of the model and to today’s statement.
In relation to the renewal of the ongoing contract, I of course met executives from the NMP. I cannot give the hon. Lady details of all the meetings that my Ministers or I had. I am happy to write to her about them; there is nothing secret about them. The key thing was to ensure that the contract renewal covered improved performance during the ongoing review of the model, and the facts show that performance has improved.
Three of the world’s top 10 engineering challenges are at Sellafield. As other hon. Members have said, it is a very complex site. Will the Secretary of State ensure that he and his fellow Ministers undertake very complex monitoring to make sure that the value-for-money challenges identified by the National Audit Office and the Public Accounts Committee do not slip again? I mean value for money in not just the cost of the contract but, as my hon. Friend the Member for Barrow and Furness (John Woodcock) said, the impact on the supply chain, because Sellafield should not deaden the local market, but build it and help it to thrive.
I certainly agree with the hon. Lady that the project on the site is hugely complicated. Anyone who visits it can see that for themselves. I should tell her, however, that the prime responsibility for managing it lies with the Nuclear Decommissioning Authority. The NDA was quite rightly set up under the previous Government—with cross-party support—and we believe that it is the right model.
The NDA needs to be involved in all local decisions. It would not be very sensible for that to be managed by Ministers and officials in Whitehall—the NDA is on the front line—but it is the job of Ministers and, indeed, this House to hold the NDA to account. We do that through regular reports and through the officials who regularly work with the NDA, and the House does it through the Energy and Climate Change Committee and the Public Accounts Committee.
As my hon. Friend the Member for Newport West (Paul Flynn) mentioned, the French company AREVA, which is part of the NMP consortium, also has a very big interest in Hinkley Point. I know that the sites are very different, but will the Secretary of State use this opportunity to give assurances that the challenges and risks talked about today have been fully addressed at Hinkley Point?
The risks are very different in all senses of the word. The new build at Hinkley Point C has already undergone huge regulatory processes. There is the time needed for the generic design assessment for a new nuclear reactor—in this case, for the EPR reactor, it took three years—and then regulatory approvals are needed for the site itself. The regulatory oversight of the new build at HPC is therefore of a very different nature. However, it is certainly extremely detailed, and I hope that that gives her the assurance she seeks.
Local Government (Planning Permission and Referendums)
Motion for leave to bring in a Bill (Standing Order No. 23)
I beg to move,
That leave be given to bring in a Bill to allow objectors to appeal against the granting of planning permission in certain circumstances; to make provision about binding local referendums; and for connected purposes.
My Bill contains two main proposals: introducing an element of fairness into the planning system and expanding the use of local referendums to give our local communities a greater say in their future.
First, my proposals for the planning system will bring in an element of greater fairness, which is something we all espouse and want to achieve. I am sure that at some time or other we have all been involved in major campaigns when our constituents, often in very large numbers, opposed planning applications that they felt would change the character of the village or part of town in which they live and to which they feel very attached.
In my 26 years as a councillor, I can think of many such campaigns. Indeed, I regard one of the successes as one of the most satisfying achievements in my time as a councillor. The Scartho Top housing development in my then ward will eventually reach 2,200 dwellings, but the original plans included building right up to the main road at the entrance to the estate. We fought that part of the application, and the entrance to the estate is now through a pleasantly landscaped area. It was previously known as Scartho park, but was recently renamed to commemorate Matthew Telford, a soldier who lived on the estate and gave his life in the service of his country.
The campaign was long and stretched over many years. Ironically, it came to its conclusion during a period when local people had decided that I needed a rest from my council duties, as was often the fate of those who stood under the Conservative banner in the 1990s. Such campaigns often reveal how strongly residents feel about the area in which they live, and lead to people getting more involved with their local communities, sometimes even standing as councillors. However, many campaigns end in failure and people rightly feel aggrieved. Why? Because they know that had the decision gone against the applicant, they would have been able to appeal.
I do not suggest that every planning application that has attracted objections should automatically have the right of appeal. It is possible to argue that case, but the system would be too overloaded to cope with cases that had just a handful of objections, or in some cases only one. An application to extend a conservatory might irritate the neighbour if approved, but it will not change the whole character of an area. If, however, the development of a new housing estate is approved, that could change a semi-rural edge-of-town parish into an extension of the town. I suggest that a hard-copy petition from, I stress, local residents should be able to trigger an appeal to the Planning Inspectorate. What should the threshold be? I suggest 10%, although that is a matter for debate.
Although I favour a petition, another alternative would be to say that if plans are approved contrary to the local plan, objectors would automatically have the right of appeal. That would perhaps be easier to administer, but it would deliver only limited powers to local residents. There should certainly be an automatic right of appeal where no local plan exists. Such a situation exists in North East Lincolnshire where, after pressure from me, Ministers, the local press and public opinion, the council has brought forward the publication date for its new plan from November to February 2017. That is unacceptable and leaves villages such as those in the Humberston and New Waltham ward open to a stream of applications. Some of those applications might be speculative, but they cause endless discontent among local people.
I choose that ward not because it is unique—the villages of Waltham and Laceby have also been affected—but because Humberston has received far more than its fair share of applications. It is not the quality of proposals that is in question, but the fact that local services and infrastructure are inadequate. There is a point when the whole character of an area can be changed and strategic gaps between town and country are set to disappear, and it is only right for local residents to be given an opportunity to appeal.
Parish councils work hard to reflect local opinion, as do councillors who serve at district or unitary level, but their views can often be squeezed out. I do not seek to stop development; we all appreciate that we need new homes, but we need them in locations that carry the full blessing of local people. Of course there must be a balance; the system must not stifle development or become a tool used to promote nimbyism. My proposals are not designed to prevent building, but merely to allow development in locations that carry a broad measure of public support. As I said at the beginning of my remarks, it is a matter of fairness. Of course the appeal may be lost, but both sides will have had the same opportunities to argue their case.
Our citizens are feeling somewhat alienated from the political process, and when they see that obvious lack of fairness in the system they understandably feel yet more alienated. We must do more to involve local people in shaping their communities—indeed, sometimes local people know better than the planners. Consider some of the properties built in high-risk flood areas. Had more notice been taken of those who serve on internal drainage boards or as flood wardens, or members of the farming community, and had they had a second opportunity to contribute, we might have had better decision making. Members across the House will share my aim to make the planning system fairer and increase public confidence.
The second part of my proposals would make it easier for local residents to initiate a local referendum. Powers exist for councils to stage a referendum under section 116 of the Local Government Act 2003—indeed, in 2006 I initiated one to abolish Immingham town council. It is easy to understand why I got a 2:1 majority in favour of abolition when I tell the House that the parish precept exceeded £100 per property. The costs were minimal and the poll coincided with local elections. The question was simple: should Immingham have a town council? Some 1,755 people said no, and 905 thought that it should. That was a clear majority, but the result was not binding and the top-tier authority kicked it into the long grass, and it eventually disappeared. The verdict of the people was ignored. No wonder the political process is seen as out of touch by many of our constituents.
I would like an opportunity for local people to initiate a binding local referendum on significant local issues, not at random but within defined criteria. A significant issue could be the location of a new football stadium or the development of an out-of-town shopping complex. We all, understandably, speak up for our town centres, but what if local residents regard their town centre as run down with little prospect of attracting the big name stores? Perhaps—just perhaps—they would see the traditional centre as better off if it were in effect moved to the edge of town. I do not advocate that and we all know the possible consequences, but a local poll could take place and result in a campaign and a serious debate.
In North East Lincolnshire there is a proposal to demolish six blocks of multi-storey flats, with the risk that the whole area could be derelict for a considerable time. The character of the area will be completely changed, so surely the local community should have a voice and effective consultation in that decision. Councils, like Governments, spend millions on consultations, many of which pass most people by. When complete, the result is delivered, the public are disillusioned, and nothing happens.
The recent Scottish independence referendum showed that people will engage when they understand the relevance of an issue to them and their families, and that they can influence the actual decision. A referendum is democracy in its purest form. In Scotland Alex Salmond’s vote counted as one vote, just like that of every other voter. When the European Union referendum comes—as it surely will—my vote and that of the Prime Minister will each count as one vote, just like those of our constituents. People feel disconnected with the political process. My proposals will give everyone an opportunity to get involved in real decision making, as is right and fair.
Question put and agreed to.
That Martin Vickers, Andrew Percy, Sir Edward Leigh, Zac Goldsmith, Mr David Nuttall, John Stevenson, Austin Mitchell, Nic Dakin, Nigel Mills and Jacob Rees-Mogg present the Bill.
Martin Vickers accordingly presented the Bill.
Bill read the First time; to be read a Second time on Friday 6 March, and to be printed (Bill 152).
Charter for Budget Responsibility
I beg to move,
That the Charter for Budget Responsibility: Autumn Statement 2014 update, which was laid before this House on 15 December 2014, be approved.
The charter sets out the next steps we take to turn Britain around and ensure that the mistakes of the past are not repeated. People will remember the fiscal crisis facing this country five years ago: a deficit that stood at more than 10% of our national income; a Government borrowing £1 in every £4 they spent; a Treasury whose departing Chief Secretary left a note saying simply that there was no money left; a country described by international bond investors as sitting on the financial equivalent of a bed of nitro-glycerine; and a British economy whose ability to pay its way was questioned in the world. That was the appalling inheritance left to us by the last Labour Government.
The Chancellor mentions a British economy with an ability to pay its way. When did the UK last pay its way? When was it last not in deficit?
The last time it was not in deficit was when people followed Tory spending plans: there was a surplus at the end of the 1990s and 2000. That is what we advocate again.
At the moment of maximum danger five years ago, as much of the rest of Europe became engulfed in a sovereign debt crisis, Britain faced a choice: did we have the resolve to cut our spending, cut our deficit and set a course for economic stability, or did our country go on borrowing and spending our way to economic ruin?
But surely we cannot relax for a moment. When we say we have cut the deficit by half that is good, but it gives the impression that the problem is solved and we are still borrowing £90 billion a year. The debt is still at about £1.7 trillion. Therefore, we cannot relax for a moment and we cannot allow there to be any sort of Government who let the anchor off. We therefore have to say no to a Labour Government.
My hon. Friend is absolutely right. Having brought the deficit down, we have to complete the job. We have to run a surplus and get our national debt down—that is what this debate is about. We remember Opposition Members in this House five years ago urging on us a ruinous course of more borrowing and more spending, the very same people who had presided over the borrowing and spending that had put Britain into such a perilous position.
I will give way in a moment, but I want people to remember that the country knew better than to listen to Labour again. The country supported this Government as we took the difficult decisions required to cut our spending, reduce our borrowing and get our country living within its means. Then, when the problems in the eurozone became acute and the currency union on our doorstep was threatened with collapse, we heard again, as we hear now, the siren voices luring us on to the economic rocks. “Stop the cuts,” they said, “Spend more, borrow more, adopt a plan B”. But Britain stayed the course. We did not spend more. We did not spend less. We worked through our plan. The result, in the verdict of the International Monetary Fund, is that no other major economy has achieved such a substantial and consistent reduction in its structural deficit over recent years.
The Chancellor told this House that if Britain was to lose its triple A credit rating it would be a disaster for Britain. Can he remind the House when Britain lost its triple A credit rating? Was he the Chancellor at the time? When are we going to get it back?
We retain our triple A credit rating with some credit rating agencies. I can tell the right hon. Gentleman one thing for sure: the only way we will get back our triple A credit rating is by dealing with our debts, cutting our spending and making sure this country can live within its means. If anyone thinks the answer to Britain’s debt problems is to borrow £170 billion more, which is what the Labour party is proposing, they will be leading Britain back into economic ruin.
We remember what the shadow Chancellor said was going to happen if we pursued this plan. He said we would choke off growth and that there would be a double-dip recession. Britain has grown faster than any other major European economy in the past four years. We have grown faster than any major economy in 2014 and the one recession we had was the one big recession, the great recession, on Labour’s watch.
It was of course a Labour Government, led by James Callaghan, who went cap in hand to the IMF, and the Blair-Brown Government left us with a record deficit. Does the Chancellor share my view that it does not matter what that lot say today? History repeats itself and, when it comes to Labour, we cannot trust them with the public finances.
You cannot trust the Labour party with people’s money. Every Labour Government leads this country into bankruptcy. Every Labour Government left office with unemployment higher than when it came to office. That is what Labour does when it gets into office. People remember that and they will not trust them with the public finances again. We remember what Labour said was going to happen to jobs: they said that 1 million jobs would be lost. Instead, we have 1.7 million more people in work. Unemployment is falling. Youth unemployment is down by more than half. Full employment is in sight. They said that public services would be decimated and crime would rise. Crime has fallen and satisfaction with local government services is up. They said that the north of England would suffer the most, just as it had suffered the most in their great recession. Now, the fastest growing part of our economy is the north of England and we are building that northern powerhouse.
I wonder if my right hon. Friend, during his busy schedule, was able to notice the comment of the Labour leader of Leeds city council, who said that he has to hand it to George Osborne because he is doing more in the north of England than a Labour Government ever did.
There has been a constructive alliance between Labour civic leaders in the north of England and Conservatives to bring an elected mayor to Greater Manchester and deliver High Speed 2. We have done so in the face of the opposition of the Labour shadow Chancellor, who has tried to frustrate all these things all along. Thankfully, Labour civic leaders are not listening to those on their own Front Bench anymore.
Although the deficit has been halved, at 5% of our national income, it is too high. Our national debt, at 80% of our national income, is too high.
There have probably been about half a dozen attempts to try to buttress fiscal policy with rules in the past 30 years. Most of them have collapsed at some point during the business cycle. To get something that works, does the Chancellor not agree that we need something credible, not just for dealing with the deficit but for reducing the stock of debt, and that that must mean over the cycle running a surplus?
My hon. Friend is absolutely right. It is not enough to eliminate the deficit. We then have to get our national debt down. It is too high and leaves us exposed to the next economic shock. We do not want to go into the next economic shock with a debt-to-GDP ratio of 80%. That is precisely why, in good economic times, we need to be running an overall budget surplus. That is the only credible and sustained way to get national debt down. That is the way to fix the roof when the sun is shining.