House of Commons
Wednesday 21 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—
1. What assessment he has made of the effectiveness of steps taken to rebalance the economy in Wales since 2010. 
The previous Government were content to allow the British economy to become dangerously imbalanced with far too much reliance on the financial sector in London and the south-east. During this time Wales became poorer and fell to the bottom of the economic league tables, but we are determined to turn that around and achieve a stronger and more geographically balanced economy through a long-term plan, which is already starting to bear real fruit for Wales.
I thank my right hon. Friend for that answer—and offer him belated birthday wishes.
With regard to the rural economy of Wales, I heard talk when I recently returned to St David’s university college in Llanbedr Pont Steffan of moves to reopen the Carmarthen to Aberystwyth railway line that passes through the Teifi valley. What effect does my right hon. Friend think this would have in reinvigorating the local rural economy, and might it help to rescue my alma mater from the parlous state various vice-chancellors since Lord Morris of Castle Morris have allowed it to descend to?
I thank my hon. Friend for his question and his good wishes. I am a believer in investment in infrastructure. I recognise the important role investment infrastructure plays as a driver of economic growth. We have discussed at previous Wales Office questions the reopening of the Aberystwyth-Carmarthen line. He will be interested to know that I will shortly meet the campaign group Traws Link Cymru to discuss the business case for reopening the line and what support we can give, if appropriate.
I am sure the Secretary of State agrees that one of the best ways of rebalancing the economy is to ensure the interface between universities and the private and public sectors, and I know he recently visited my constituency and the new Swansea university campus at Crymlyn burrows. I am also sure he would wish to join me in congratulating the leader of Neath Port Talbot county borough council, which has developed a wonderful partnership with the university, and Councillor Ali Thomas on the honorary fellowship he will receive next week at Swansea university.
I thank the hon. Gentleman for that question, and I absolutely do concur with his sentiments about the role local partners have played in taking forward the bay campus development. I was there on Friday, at the hon. Gentleman’s recommendation, and it is indeed a truly fine example of partnership-working. We know that success in the 21st century will belong to those economies that can harness knowledge and innovation, and having world-class university sites is part of that.
Has my right hon. Friend noted the recently published report of South Wales chamber of commerce, which notes that confidence in the Welsh economy has been high throughout 2014 and that it looks to remain the same for 2015? Is he as pleased as I am that real business people in Wales are so enthusiastic and keen to talk up the Welsh economy, unlike the hon. Member for Pontypridd (Owen Smith), who devoted his recent article in the Western Mail to talking it down?
I thank my right hon. Friend for that question, and he is absolutely right: the sentiment among businesses in north Wales, south Wales and west Wales is very confident and optimistic, and what they tell me every week as I criss-cross Wales talking to them is in stark contrast to the message we hear from the Opposition, who regularly now talk down the Welsh economy and the efforts of Welsh business.
On the economy, how does the right hon. Gentleman respond to today’s research by the university of Oxford and the London School of Hygiene and Tropical Medicine that only a fifth of claimants who have had their benefits sanctioned and then taken away have found work? Surely this will not rebalance the economy or make it stronger, let alone make it just, and it is diabolically punitive.
I have not seen that report so I am not going to get drawn into commenting on the specifics, but I have seen the latest figures for the performance of the Work programme in Wales, which should give us encouragement that we have a set of measures in place that is helping to bring down long-term unemployment.
The right hon. Gentleman shakes his head, but I encourage him to look at the figures for long-term unemployment in Wales: they are coming down yet again this month, which is positive news. There is much more to be done, but the emerging picture is a very strong and positive one.
Tourism is very important to Wales, and to rural Wales in particular. It has been suggested that reducing VAT on visitor attractions and accommodation, as other EU countries have, would stimulate tourism and result in a higher tax-take. Does the Secretary of State agree with that view?
I am familiar with the VAT arguments from the tourism sector. Of course these matters are the responsibility of the Chancellor of the Exchequer and he keeps them under review, but I would just point out to my hon. Friend the most recent tourism visitor figures, which showed about an 8% increase last year in international visitors coming to Wales. That has to be a good sign that the tourism sector is on the up in Wales.
12. The new year has seen another rise in the tolls on the Severn bridge, and many businesses across Wales tell me that the bridge is now becoming a barrier to business and trade. Will the Secretary of State have urgent talks with the Chancellor of the Exchequer about reducing VAT on the tolls? 
The hon. Gentleman is right to talk about the burden that the increased tolls place on businesses and on visitors to Wales. We recognise that that is happening. They are, for example, a major burden on the small vans crossing the bridge. I have asked the Under-Secretary of State for Wales, my hon. Friend the Member for Vale of Glamorgan (Alun Cairns), to lead a body of work to look into the options for the Severn bridge, and he is having discussions with the Department for Transport. We also look forward to hearing the views of Members on both sides of the House.
Accident and Emergency Departments
2. What discussions he has had with Ministers of the Welsh Government on waiting times at A and E departments that serve patients from both sides of the England-Wales border. 
My ministerial colleagues and I regularly raise concerns with the Welsh Government about the provision of health care along the England-Wales border and we are reviewing the current arrangements to ensure that they meet patients’ needs.
When my constituents in Montgomeryshire need to attend A and E, they are taken either to hospitals in England, where 87% of patients are seen within four hours, or to hospitals in Wales, where, shockingly, the figure is only 63%. Does my right hon. Friend agree that the Welsh Government and the UK Government should work together constructively to deliver reforms to ensure that only genuine emergencies attend A and E?
As ever, my hon. Friend makes a strong and constructive point. At this time of year, the NHS is facing severe pressures across the whole of the UK, and he is right to say that there is a disparity between the outcomes in Wales and those across the border in England. It is right that we should work together to address those disparities, but Welsh Government Ministers in Cardiff should be held to account for the decisions that have led to some of the problems.
Is the Secretary of State aware of the innovative medical centre at the end of Wind street in Swansea, which treats intoxicated people on the spot, freeing up ambulances, police and accident and emergency departments? Will he inform the Secretary of State for Health in England of the success of that venture, and suggest to him that similar facilities here could help to reduce the pressures caused by the removal of walk-in centres?
I am not familiar with that facility, although I am familiar with Wind street—from what I have read, not from what I have experienced. However, we will certainly look at that project in some detail and I will raise the matter with Health Ministers.
Since we last met, the Secretary of State has warned his Cabinet colleagues to mind their language when talking about the NHS in Wales. He said:
“I want them to take care how they speak about health services in Wales…I don’t want to hear anyone talking about a second-class NHS in Wales”.
Is he therefore disappointed that the Prime Minister has overruled him in continuing to bad-mouth the Welsh NHS?
I am surprised to hear this from the hon. Gentleman. We on this side of the House are not shutting down the debate on, and scrutiny of, the performance of the NHS. We stand on the side of patients in England and in Wales, and it is quite wrong of him to act as some kind of cheerleader for the Labour party by seeking to shut down the scrutiny and the debate on the Welsh NHS.
I take it from that answer that the Secretary of State is disappointed that the Prime Minister has overruled him. I believe that the Prime Minister has done that because talking about the Welsh NHS is his favourite way of distracting people’s attention from the failings of the NHS in England. Given that there is a crisis in hospitals near the border in Telford, in Shropshire, and in Cheltenham and Gloucester, where Welsh patients are traditionally sent, is it not now time for the Secretary of State to renew his efforts to get the PM to stop talking about Offa’s Dyke as though it were a line between life and death?
On the subject of health, there are two apologies that we need to hear from the Opposition today. The first is an apology from the hon. Gentleman on behalf of the Welsh Labour party for the way in which its Ministers in Cardiff have run the Welsh NHS into the ground. The second is from the Leader of the Opposition for his disgraceful and inappropriate suggestion that the NHS should be “weaponised”.
3. What assessment he has made of trends in the level of infrastructure investment in Wales since 2010. 
We have been ambitious in our infrastructure investment plans to address the historic underinvestment in Wales by previous Governments. We are enabling businesses in Wales to expand and explore new markets by investing in better train links, less-congested roads and faster broadband speeds.
I thank the Minister for that answer. Given the commitment to fund the northern hub in full and the ambition for HS3 to improve connectivity right across the north of England, what is his Department doing to ensure that north Wales can take full advantage of those welcome developments?
My hon. Friend is right to highlight the significant infrastructure investment being made across the whole of the UK, but of course it is important that north Wales links into the rest of the UK. The fact that Crewe is the HS2 hub is important, and I look forward to hosting a transport summit in the next week or so to discuss how we best link north Wales with the rest of the UK.
13. What recent discussions he has had with the Secretary of State for Transport on investment in rail in north Wales. Will the Minister confirm that the UK Government have diverted funding previously allocated for the phase 1 and phase 2 modular rail signalling upgrade in north Wales to support investment in rail projects in south Wales? 
I can categorically reject that. The UK Government are making significant investment in north Wales, at the Halton curve, and in south Wales, in the electrification of the main line right through to Swansea and in the valley lines and Vale of Glamorgan line services. I am proud of our record of electrifying railways in Wales. The previous Administration left us as one of the three nations across Europe without any electrified rail; Wales, sadly, was left with Albania and Moldova, and this Government are changing that.
Will the Minister congratulate the Welsh Government on providing funding for infrastructure investment in Rhyl? They have provided £28 million for new housing in Rhyl; £22 million for a new community hospital; £10 million for a new harbour; £25 million for a new Rhyl high school; and £12 million for flood defences. Will he also condemn the coalition Government, who have closed down Rhyl county court, Rhyl Army recruitment centre and Rhyl tax office, with the Crown post office possibly being relocated out of Rhyl?
The hon. Gentleman is somewhat selective in the data he shares. I am proud of the infrastructure investment record of this Government; he failed to mention the north Wales prison and the Halton curve, as well as the investment across the whole of Wales, not only in the north.
In recent months, I have been working with the communities of Salem, Cwmdu, Talley and Pumsaint, which have been without landline provision while waiting for damaged lines to be repaired. Communication problems have been exacerbated by a lack of mobile coverage, so will the Minister ensure that mobile not spots in Carmarthenshire benefit from the recently announced investment in mobile infrastructure?
I am grateful to the hon. Gentleman for raising that important issue. Openreach and British Telecom need to get on top of replacing those lines when they fall because of adverse weather. Let me also congratulate the Secretary of State for Culture, Media and Sport on the innovation he is showing in trying to close those not spots by using both private money and the mobile infrastructure plan, which will make a major difference in these areas.
4. What steps the Government are taking to support the dairy industry in rural Wales. 
The Government are very aware of the severe pressures currently facing the UK dairy sector. I have discussed the situation in Wales with my ministerial colleagues, as well as with key stakeholders, including numerous dairy farmers. There are major short-term global factors pushing down prices, and we are calling on banks, supermarkets and major processors to show flexibility and understanding at this time.
I thank the Secretary of State for that answer. We all understand the global challenges facing the industry, but will he urgently speak to his Department for Business, Innovation and Skills colleagues about extending the role of the Groceries Code Adjudicator to the whole supply chain—to all dairy producers—and, crucially, enacting the adjudicator’s power to fine? The next review of the role is not expected until 2016, and many of our farmers will not be functioning as farmers unless we have urgent action now.
First, I commend the work my hon. Friend does on the dairy sector in Wales; he is a powerful voice on behalf of dairy farmers in his constituency and throughout Wales. We strongly support the work of the Groceries Code Adjudicator. Its jurisdiction is currently limited, but a review will take place next year. I take my hon. Friend’s point about the short-term pressures, so we look forward to receiving information and updates from him on action we can take.
As a Member representing Pembrokeshire, the Secretary of State will be well aware that the dairy industry in Wales still contributes about 10% to the whole of the UK’s production, but that since 1999 its level has fallen by 51%. Will he look at yesterday’s report by the Select Committee on Environment, Food and Rural Affairs, which says exactly what the hon. Member for Ceredigion (Mr Williams) says: give the adjudicator greater teeth to tackle unfair pricing?
I thank the right hon. Gentleman for his question, and we are looking exactly at that report. A very severe short-term crisis faces the dairy sector at this time. Nobody pretends that expanding the role of the adjudicator will fix the global problems—big market challenges need to be addressed—but we are doing everything we can to work with the dairy industry and protect the supply base.
On the market challenges that the right hon. Gentleman refers to, what steps is he taking to urge his Government to work with the Welsh Government to implement policies we have suggested—for example, the dairy equivalent of Hybu Cig Cymru to market Welsh milk, the use of rural development funding to develop supply chains to counteract volatility, and procurement in the local Welsh sector?
The right hon. Gentleman might be surprised to hear that we do follow the policy recommendations of Plaid Cymru and I have looked at the recommendation for that new body. When huge global imbalances are putting such severe pressure on dairy farmers throughout Europe, reaching for a bureaucratic solution and setting up a new quango probably will not make that much difference, but we will look at the proposal in further detail and have that discussion.
With dairy prices at 20p a litre, First Milk collapsing last week and the discount supermarkets cutting prices day by day, it is hardly surprising that one dairy farmer goes out of business every 10 days. Does the Secretary of State agree that in addition to the efforts of the EU and national Government, we need to see far more action from the Welsh Government? There is a great deal they could do to support Welsh farmers, as well as farmers in North Wiltshire.
I thank my hon. Friend for that question and make two points in response. First, First Milk did not collapse last week. It faces some pressures and there are specific impacts for dairy herds, but that co-operative is still very much functioning. Secondly, on the Welsh Government, we work constructively and co-operatively with them on agriculture issues.
The Secretary of State rightly recognises the severe crisis in the dairy industry, so with the Environment, Food and Rural Affairs Committee’s dairy price report criticising the grocery adjudicator’s role as too narrow and left toothless by this Government’s failure to set the level of fines that she can impose, will he now act with a sense of urgency, push for an immediate review of the adjudicator’s role and give that assurance to Welsh farmers?
I am surprised by the tone that the hon. Lady takes. Under the Government that she supported, no progress whatever was made on implementing a code of practice or an adjudicator. As a Government we have been taking forward these measures. We will look at the specific recommendations of the Select Committee report, but we will take no lessons from the Labour party on the dairy sector.
My right hon. Friend will know that independent grocers such as Spar in Tywyn in Gwynedd stock Welsh milk, which is clearly marked with y ddraig goch—the red dragon. What steps can he take to ensure that people in Wales drink Welsh milk rather than European milk, which will stimulate the market and support Welsh farmers?
My hon. Friend is right. Welsh produce is the best in the world, and when it is labelled as such it gives consumers powerful signals, which they respond to. That is one of the ways in which we have been able to boost exports of Welsh agriculture produce in the past two years, but we will look at what further steps we can take to support labelled home-grown produce.
Welfare Reform: Social Housing
5. What assessment he has made of the implications for the Government’s policies of the Auditor General for Wales’s report on “Managing the Impact of Welfare Reform Changes on Social Housing Tenants in Wales”, published in January 2015. 
6. What recent estimate he has made of the number of households in Wales that have received a reduction in benefits since the introduction of the under-occupancy penalty. 
7. What assessment he has made of the implications for the Government’s policies of the Auditor General for Wales’s report on “Managing the Impact of Welfare Reform Changes on Social Housing Tenants in Wales”, published in January 2015. 
This Government will not shy away from the financial and social responsibility of reforming the way in which housing benefit is allocated. There are no plans to change Government policy following the report from the Auditor General for Wales. We plan to use this report to support local authorities to respond better to local needs.
As the Minister will know, there has been a large number of Government reports on the Government’s welfare policies. A Sheffield Hallam university report, for example, shows that the south Wales valleys will experience a £430 million cut in income, endangering 3,000 local jobs as a direct result of Tory welfare reforms. Is not the Minister ashamed?
The report that the right hon. Lady mentions is an important contribution to the debate, but it focuses on only one element of Government policy. It does not take into account the wider package of welfare reform—something that the previous Administration, sadly, shied away from. This Administration will not do so, because of the important need to tackle Government finances.
The 1,500 people in Flintshire who are impacted by the bedroom tax face no choice but to cut their incomes, which are already low, because there are no properties available. Will the Minister tell me how many two-bedroom and one-bedroom properties are available in Flintshire today?
The right hon. Gentleman raises an important point because the number of new social properties built in Wales over the past three years is, proportionately, far fewer than the number built in England over the same period. The Welsh Government have a responsibility to deliver in that area. The Wales Audit Office report also highlights the fact that 47% of tenants had no advice given to them on how better to manage the spare room subsidy and the obligations that it would bring.
Will the Minister explain why it is right to force disabled people out of a home and into a smaller property—should one exist in the first place—rip out all the adaptations that have been made to that property and, presumably, put new ones into a second property? Apart from being cruel, how can such action possibly be cost-effective?
This Government have made additional money available through the discretionary housing payment to help individuals facing difficult circumstances. Only three out of 22 local authorities in the whole of Wales—Cardiff, Caerphilly and Conwy—applied for additional discretionary housing payments. The hon. Gentleman’s local authority did not do that. Let us be clear: the roots of the removal of the spare room subsidy lie deeply in the Labour Benches, because it was a Labour Administration who took it away from the private-rented sector. We are merely extending that principle to the social-rented sector.
My own local authority runs a useful forum for local agencies to plan a response to the bedroom tax, but its work is bedevilled by a lack of certainty over central Government support through the discretionary fund. Will the Minister prevail on his colleagues to give more certainty to future funding, which would help our work?
The discretionary housing payment is completely flexible and local authorities should use their discretion to see that it is used in the best way. The Wales Audit Office report provides excellent data and highlights some authorities such as Caerphilly and Cardiff that provide excellent practice and support their tenants in meeting the obligations of the spare room subsidy. After all, it is about returning the long-term unemployed back to the workplace, as that offers them the best opportunities and the best prospects.
8. What assessment he has made of the level of growth in the high-tech sector in Wales since 2010. 
Wales has the potential to be a beacon of hi-tech excellence and innovation. Since 2010, thousands of new jobs have been created in the advanced manufacturing, ICT and life sciences sectors. The growth in those sectors is contributing to the rebalancing of our economy, which is so vital to future economic success.
Does my right hon. Friend agree that it is remarkable that half the world’s mobile phones contain wafer semi-conductor technology that has been made in Wales?
My hon. Friend is exactly right. Remarkable transformations are occurring inside the Welsh economy. Much more work needs to be done, but the picture is a positive one. That view stands in stark contrast with what the Labour party would have us believe, as it consistently—week in, week out—talks down the achievements of Welsh business.
Shared Services Jobs
9. What recent discussions he has had on increased shared services jobs in Gwent. 
The Wales Office continues to hold discussions with the Ministry of Justice on the future of the Shared Services Connected Limited offices in Newport. The Justice Secretary has been clear that he would not support any proposals to offshore jobs from Newport.
The city of Newport has provided a splendid successful habitat for thousands of civil service jobs. Will the Minister renew his efforts to ensure that shared services, which were pioneered in Newport, are now strengthened and recognised as centres of excellence?
I am grateful to the hon. Gentleman for raising that issue. It is quite obvious that the pooling of the expertise and experience in Newport provides the shared services facility a great opportunity to try to attract work from both the private and public sectors, and we are determined to do what we can in that area.
10. What assessment he has made of the prevalence of anti-Semitism in Wales. 
Incidents of religious and racial hatred are thankfully very low in Wales. But as we approach Holocaust memorial day, it is right that we look again at the efforts we are making to prevent such incidents and to say with a clear and united voice that anti-Semitism and all forms of racial and religious hatred are not compatible with the freedom values that are cherished by the people of Wales. [Interruption.]
Order. This question is about Holocaust memorial day and the scourge of anti-Semitism. The House should listen to the question and to the answer.
Thank you, Mr Speaker. The Jewish community across the whole of the United Kingdom is feeling under increasing threat. Will the Secretary of State ensure that the part of the United Kingdom that he is responsible for is as vigilant and as supported as every other part of the United Kingdom, so that his Jewish community can feel that it has our support?
I thank the hon. Gentleman for the question. He is exactly right: no member of the Jewish community anywhere in the UK should have to live in fear. He may be interested to know that tomorrow I shall be meeting Rabbi Michael Rose in Cardiff, to talk about those concerns as they affect Wales.
Will my right hon. Friend take the opportunity to remark not only upon Rabbi Michael Rose, but also upon the work done by Mr Saleem Kidwai, Secretary General of the Muslim Council of Wales, who has been working so very hard in Cardiff for good community relations for many years?
My hon. Friend will also be interested to know that I am meeting the Muslim Council of Wales tomorrow. We had a remarkable and powerful demonstration of unity on the Sunday evening after the Paris attacks, when Rabbi Rose and the Muslim Council of Wales leader stood hand in hand, in unity, supporting freedom values in Wales.
The Prime Minister was asked—
Q1. If he will list his official engagements for Wednesday 21 January. 
This morning I had meetings with ministerial colleagues and others. In addition to my duties in this House, I shall have further such meetings later today.
Niluk is seven and he has autism. He desperately needs security and routine, but high London rents and insecure tenancies mean that he and his devoted family have moved four times in 18 months. As a result, he has had a breakdown and been admitted to hospital. Does the Prime Minister agree that insecure six-month private tenancies are no place for a family with children, and particularly not for children with autism?
I agree with the hon. Lady about how important it is that people do have security, particularly when they are looking after disabled children and they need that help. That is why we have been encouraging longer-term tenancies alongside the standard six-month tenancies, and we want to see those developed in the market.
First they sold our gold reserves at a record low and then they tried to freeze our energy prices at a record high. Does not this latest display of economic illiteracy confirm that only this Government can prevent us, to be blunt—
James Blunt. Does not that confirm that only this Government can prevent us from returning back to bedlam?
I think I caught some of that, although I may need to buy the album to get the rest of it, but the point is a good one. The Opposition’s policy of freezing energy prices at the top of the market would be denying the price cuts that are now coming through to customers around this country. But the key to all this is to stick to our long-term economic plan, which again today is seeing unemployment fall and the number of people in work rise to record levels—something which I am sure we are going to welcome right across the House of Commons.
Let me start by saying, on the Iraq inquiry, that it was set up six years ago and I agree with the Prime Minister that it should be published as soon as possible.
On the economy, as the election approaches, can the Prime Minister confirm that we now know this will be the first Government since the 1920s to leave office with living standards lower at the end of the Parliament than they were at the beginning?
First of all, let me agree with the Leader of the Opposition that we want to see this Iraq inquiry published promptly, but let me make this point. If everyone in this House, including Opposition Members, had voted to set up the Iraq inquiry when we proposed, it would have been published years ago. So perhaps he could start by recognising his own regret at voting against the establishment of the inquiry.
The inquiry was established six years ago, after our combat operations had ended, and frankly, my views on the Iraq war are well known and I want this inquiry to be published.
I notice that the Prime Minister did not answer on the economy. Families are £1,600 a year worse off. He said in his 2010 manifesto that living standards would rise. Can we therefore agree that Tory manifesto promises on living standards are not worth the paper they are written on?
First of all, let us be clear: the right hon. Gentleman voted again and again and again against establishing the inquiry—but, as ever, absolutely no apology.
Let me deal very directly with living standards and what is happening in the economy of our country. The news out today shows a record number of people in work and a record number of women in work. We are seeing wages growing ahead of inflation, and we are also seeing disposable income now higher than in any year under the previous Labour Government. As for the right hon. Gentleman’s figure of £1,600, it does not include any of the tax reductions that we have put in place again and again under this Government. That is the truth. The fact of the matter is that he told us there would be no growth, and we have had growth; he told us there would be no jobs, and we have had jobs; he told us there would be a cost of living crisis, and we have got inflation at 0.5%. He is wrong about everything.
The Prime Minister has raised taxes on ordinary families, he has raised VAT, and he has cut tax credits. The reality is that people are worse off on wages and they are worse off on taxes under this Prime Minister.
The Prime Minister thinks everything is hunky-dory. Did he even notice this week the report that came out that said that half of all families where one person is in full-time work cannot make ends meet at the end of the month? You can work hard and play by the rules, but in Cameron’s Britain you still cannot pay the bills—that is the reality.
I study every report that comes out. The right hon. Gentleman is referring, of course, to the Rowntree report, which says that
“the risk of falling below a socially acceptable living standard decreases as the amount of work in a household increases.”
Under this Government, we have got over 30 million people in work, we have got the lowest rate of young people claiming unemployment benefit since the 1970s, long-term unemployment is down, and women’s unemployment is down. We are getting the country back to work. In terms of living standards, we have raised to £10,000 the amount of money people can earn before they start paying taxes, and people who are in work are seeing their pay go up by 4%. If we had listened to the right hon. Gentleman, none of these things would have happened. If we had listened to Labour, it would be more borrowing, more spending, more debt: all the things that got us into a mess in the first place.
The Prime Minister is the person who has failed on the deficit. This Prime Minister says—[Interruption.]
This Prime Minister says that we have never had it so good, and he is totally wrong. He does not notice what is going on because life is good for those at the top. Can he confirm that while every day people are worse off, executive earnings have gone up by 21% in the last year alone?
The right hon. Gentleman criticises me on the deficit—he is the man who could not even remember the deficit. Also, he has now had four questions and not a single word of welcome for the unemployment figures out today. Behind every single one of those statistics is a family with someone who can go out to work, who can earn a wage, and who can help give that family security. We are the party that is putting the country back to work; Labour is the party that would put it all at risk.
That is total complacency about one month’s figures when the Prime Minister has had five years of failure under this Government. Under this Prime Minister we are a country of food banks and bank bonuses; a country of tax cuts for millionaires while millions are paying more. Is not his biggest broken promise of all that we are all in it together?
Oh dearie me—you can see the problem that Labour Members have got. They cannot talk about the deficit because it is coming down. They cannot talk about employment because it is going up. They cannot talk about the economy because the International Monetary Fund and the President of the United States all say the British economy is performing well. So what are they left with? I will tell you, Mr Speaker. They have got an energy policy to keep prices high, they have got a minimum wage policy that would cut the minimum wage, and they have got a homes tax that has done the impossible and united the hon. Member for Hackney North and Stoke Newington (Ms Abbott) with Peter Mandelson. To be fair to the right hon. Gentleman, we learned at the weekend what he can achieve in one week in Doncaster, where he could not open the door, he was bullied by small children, and he set the carpet on fire—just imagine what a shambles he would make of running the country.
This is a Prime Minister—[Interruption.]
Order. It may well be that this session will take a bit longer, but questions and answers—[Interruption.] That is fine by me, but however long it takes, the questions and the answers will be heard.
I have to say to the Prime Minister: if he is so confident about leadership, why is he chickening out of the TV election debates?
This is the Prime Minister who will go down in history as the worst on living standards for working people. He tells people they are better off; they know they are worse off. Working families know they cannot afford another five years of this Government.
Why don’t we leave the last word to the head of the International Monetary Fund? She is often quoted by the shadow Chancellor, who today seems to be having a quiet day: I can see why—because our economy is growing, and people are getting back to work. She said that the UK is
“where clearly growth is improving, the deficit has been reduced, and where…unemployment is going down. Certainly from a global perspective this is exactly the sort of result that we would like to see: more growth, less unemployment, a growth that is more inclusive, that is better shared, and a growth that is…sustainable and…balanced.”
That is the truth. Every day this country is getting stronger and more secure, and every day we see a Labour party weaker, more divided and more unfit for office.
Does my right hon. Friend fully recognise the contrast in efficiency of the inquiries into the Crimean war and the Dardanelles campaign compared with the disgraceful incompetence of the Chilcot inquiry into widely held suspicions that Mr Blair conspired with President George W. Bush several months before March 2003, and then systematically sought to falsify the evidence on which action was taken?
I obviously bow to the knowledge of the Father of the House about the previous inquiries. I would say that the one thing all three inquiries have in common is that I am not responsible for the timing of any of them. The truth is that it is extremely frustrating that the report cannot come out more quickly, but the responsibility lies squarely with the inquiry team. It is an independent inquiry, and it would not be right for the Prime Minister to try to interfere with that inquiry, but I feel sure that when the report does come out, it will be thorough and it will be comprehensive. Let me repeat again: if the Labour party had voted for the inquiry when we first put it forward, the report would be out by now.
Q2. The Deputy Prime Minister dared to debate with Nigel Farage. Why won’t the Prime Minister? 
I have made my views very clear: if we are going to have one minor party, we should have all the minor parties. When this happens, one point I will make is what Mr Farage said in 2012 about the NHS—the hon. Gentleman comes to the House week after week to talk about the NHS in Kent—when he said that
“we are going to have to move to an insurance-based system of healthcare”.
That is the UKIP policy—privatise the NHS; I say, “Never.”
Q15. An estimated 13 million people—30% of those who should be eligible to vote—are registered incorrectly or are not registered at all on the individual electoral registration system. In the year of the election, will the Prime Minister ensure that the Government fully support national voter registration day on 5 February, and will he commit himself to taking part in Bite the Ballot’s leaders live event? It might help him in making his decision to know that the Greens have agreed to take part in that debate. 
It is important that people register to vote. That is why local authorities have been given over £7 million to help in that process. Individual voter registration will help to cut out some of the fraud and some of the systems that were used in previous elections.
Q3. This week, Channel 4’s “Dispatches” did an excellent job of exposing the reality of life for millions of people who are in low-paid, part-time and insecure work. Can the Prime Minister not see that his failure to promote decent jobs with decent pay is still a fundamental problem for our economy? 
If the hon. Lady looks at the figures, she will see that eight in 10 of the jobs that have been created in the last year are full-time jobs. The Labour party comes here trying to make a case, but I am afraid that all the evidence has moved away from it. Originally, it was said that no jobs would be created. We now see more people in work than ever in our history. Then we were told that all the jobs would be part time. We now see that the majority of the jobs are full time. Then we were told that the jobs would not pay more than inflation. We now see wages rising ahead of inflation. Of course, that is helped by the cuts in income tax that we have made to help people who are low-paid and take them out of income tax altogether. That is the programme that we are pursuing. There is not an ounce of complacency, because there is a lot more work to do, but we are on the right track.
This year marks the 800th anniversary of the signing of Magna Carta. Will the Prime Minister support the Magna Carta roadshow, a project that I am running in schools in Erewash to make all children aware of this important document and, more importantly, of the constitutional history of our great country and the rights and freedoms that we hold so dear?
I absolutely join the hon. Lady in making that point. This is an important anniversary, and it is important that this country and our Parliament commemorate it properly. We must teach children in schools how our constitution has evolved and what rights we have, because pride in those things is important in understanding what a precious jewel we have in a functioning democracy under the rule of law.
Q4. The target of a maximum two-month wait from an urgent referral for suspected cancer to first treatment for all cancers is being breached. Is there a bigger sign of his Government’s failure than the Prime Minister’s inability to uphold key rights for cancer patients that are enshrined in the NHS constitution? 
It is vital that cancer patients get urgent treatment. Under this Government, half a million more people are getting referred for cancer treatment. That is why cancer survival rates are going up. Let me give the hon. Gentleman the figures for his own hospital area: 96.8% of patients with suspected cancer are being seen by a specialist within two weeks, which is an improvement on 2010; 100% of patients diagnosed with cancer are beginning treatment within 31 days, which is an improvement on 2010; and 94.8% of patients are beginning cancer treatment within 62 days of a GP referral, which again is an improvement on 2010. The reason we have been able to make those improvements is that we put resources into the NHS when the Labour party told us that that was irresponsible. We have also got rid of the bureaucracy in the NHS in England, which is why it is performing better than the NHS in Wales.
I share the Prime Minister’s disappointment over the delay to the Chilcot report, particularly given that the issue in 2009 was whether it would be published in time for the 2010 election, let alone the 2015 election. Does the Prime Minister agree that the invitation of the Foreign Affairs Committee to Sir John Chilcot to give evidence to us, not to point the finger of blame, but to give him a chance to explain the reasons for the delay, should be accepted to ensure that this situation never happens again?
Obviously, my view is that when people are asked to appear in front of a Select Committee, and when they are public servants, they should try to meet that obligation. How that is processed is a matter for the House and my right hon. Friend’s Committee. The most important thing right now for Chilcot and his team is to get the report ready and ensure it can be published as soon as possible after the election.
Q5. Last summer my constituent, Mr Kenneth Bailey, suffered a major stroke while out shopping. The emergency call was classed as a Red 2 priority, yet it took Yorkshire ambulance service an hour and four minutes to get to him. That is just one example of a crisis that is now nationwide. What will the Prime Minister do about that situation? 
What we are doing for the ambulance service is ensuring that there are 1,700 extra paramedics, and we have put £50 million more into the ambulance service over the winter. I hope something that all sides of the House can unite over is that it would be completely wrong for the proposed ambulance strike to go ahead next week. I unreservedly condemn any attempts to go on strike and threaten our services, particularly at this time of heightened national concern, and I hope that members of the Labour party, irrespective of which union they are sponsored by, will do the same thing.
Q6. The Leader of the Opposition will not, but will the Prime Minister welcome the International Monetary Fund saying this week that Britain has the “fastest-growing advanced economy” in the world? Will he welcome today’s announcement that unemployment is falling in Dover, Deal and across Britain, and does he agree with President Obama that we “must be doing something right”? 
I thought it was very kind of the President of the United States to make that point about doing something right, and the IMF is absolutely clear. It said:
“The UK is leading in a very eloquent and convincing way in the European Union. A few countries, only a few, are driving growth:”.
That is what the IMF thinks about the British and American economies. Obviously that is helping in Dover where the claimant count is down by 28% since the election, but we should not be satisfied until everyone who wants a job in our country is able to get a job in our country, and until our employment rate is the best in the G7. That is what I would define as achieving what we want, which is full employment in our country.
Q7. The Prime Minister’s crisis in the national health service has its roots in general practice, and the changes the Government made to GP pensions saw a huge number of GPs retire early. In my area in Chesterfield, 40% of places for the future recruitment of GPs are left vacant. How can we expect the country to recruit the number of GPs we need when so few of them have any confidence in the Prime Minister’s running of the national health service? 
The figures show that 1,000 more GPs are working in the NHS today than when I became Prime Minister, and in the hon. Gentleman’s area there are 25 more GPs than in 2010. I agree that we need further changes to ensure that our GP and family doctor service works really well. Four million people already have access to seven-day opening at GP surgeries, and I want that expanded to the whole country. That is a step forward after the step back taken by the last Labour Government, who took GPs out of out-of-hours care altogether.
Q14. The east of England helped boost the nation’s economic recovery, and we could do even more if the East Anglian rail manifesto was implemented. Will the Prime Minister encourage colleagues to fund that with modern rolling stock for the Greater Anglia main line, and infrastructure improvements through Essex? 
I want to see real improvements in the Greater Anglia service, and the hon. Gentleman is right about the economy in the eastern region of our country, which has 224,000 more people in work compared with 2010. The Chancellor said in the autumn statement that we would provide funding for improved rolling stock, and as well as improvements in Essex we want to help achieve the Norwich in 90 campaign. We also want a service from Ipswich that will get to London in under an hour. That will take investment, but that is part of our long-term economic plan.
Q8. The delay in the publication of the Chilcot report is widely considered to be a scandal. Does the Prime Minister appreciate that it is important to find out exactly what has gone wrong? We have a major forthcoming inquiry into child sex abuse. The public would not understand if powerful people that might be named in that report are able to delay publication year after year, as seems to have happened with Chilcot. 
I agree with the hon. Lady that it is important that the inquiries are done thoroughly and rapidly. My understanding is that there is no mystery in why it is taking so long. It is a thorough report. The people who are criticised in a report have to be given the opportunity to respond to all those criticisms. That is what is happening at the moment. From what I understand, I do not believe that anyone is trying dodge or put off the report—we all want to see it—but we have to go through the proper processes.
Let me make one other point clear. There is no question of the report being delivered to me and of my deciding not to publish it before the election. The whole report will not reach the Prime Minister’s desk, whoever that is, until after the election.
Will the Prime Minister join me in congratulating Havering chamber of commerce and industry and the Havering branch of Mind, which are coming together tomorrow evening in an event to promote employment opportunities for people with mental health problems?
I will certainly do so. It is right that mental health is getting a much higher political profile today than in the past. We have given mental health parity of esteem in the NHS constitution, but my hon. Friend is right that one of the key challenges is helping people with mental health conditions to get in to work. Business can do a lot more by engaging with the charities to help people in that situation.
Q9. As we know, next week it will be 70 years since Auschwitz was liberated by the Russians. Is it not important that, when issues such as Palestine are raised—I have raised it and will continue to do so—it should be no excuse for anti-Semitism, a murderous disease that took the lives of millions of innocent people during my lifetime? 
I agree 100% with the hon. Gentleman in everything he says. Anyone who has been to Auschwitz—I went recently—cannot help but be struck by the appalling end that came of the hatred and prejudice fostered across Europe. The sight of all those children’s clothes, toys and bags, and human hair, stays with people for a very long time after they have seen them. Ensuring that the Holocaust Commission that we have established reports soon has all-party support. We will take that work forward and continue to ensure that young people in our schools can make the harrowing but very powerful trip to see Auschwitz for themselves.
As someone who voted with his colleagues against the Iraq war, I have sought to follow the Chilcot inquiry very closely. May I tell my right hon. Friend that I am aware of no evidence that any witness has sought to alter the progress of the inquiry by delay? I am aware of reports of instances of illness, including in one case a severe illness, among members of the inquiry. After the experience of the Saville and Chilcot inquiries, is not the lesson that the proper template for future inquiries should be Leveson—judge-led, but with a strict timetable?
My right hon. and learned Friend makes a strong point in the stance he takes. I agree with him. I have not heard anything to say that anyone is trying artificially to delay the report. He is absolutely right about some of the things that have happened to the inquiry panel members, most notably to the most brilliant biographer of Churchill, Martin Gilbert. I am sure the best wishes of everyone in the House go to him. My right hon. and learned Friend makes the fair point that, as inquiries are set up, we should give more thought to trying to ensure they are completed in very good time.
Q10. The Prime Minister said that his policies would eradicate the deficit in this Parliament. Unfortunately, he was mistaken—a very large deficit remains. What is the reason, in his view, why his economic plan has fallen so far short? 
We inherited from Treasury Ministers, including the right hon. Gentleman, the biggest deficit of any country in the western world. As a share of GDP, we have cut that in half. We have done that through a combination of reducing public spending, making sure we have responsible tax policies and strong economic growth. That is what we have delivered. All the way through, the Labour party’s proposals have been for more spending, more borrowing and more debt. They have not even got to base camp of working out why the deficit matters.
As the Member privileged to represent the home of the British Army in Aldershot, which I can tell the Father of the House was established as a direct result of the inquiry into the Crimean war and the failures thereof, may I ask my right hon. Friend the Prime Minister to reassure me that press reports this morning about discussions on reducing the regular Army from the already low level of 82,000 to 60,000, are wholly unfounded and that, so long as he remains Prime Minister, no such cuts will be contemplated?
I can absolutely give my hon. Friend that assurance. Those ideas are absolutely not on the table. As long as I am Prime Minister, the regular Army will stay at its current size.
Q11. I very much welcome the reduction in UK unemployment announced this morning. I have to add, however, that that is not the case in my constituency, where unemployment has actually risen very slightly. I am sure the Prime Minister has that in his notes in front of him. For those who are in work, the value of their wages has dropped in the past year by 1.5%, while the wages of the Prime Minister’s constituents continue to rise above inflation. Is the Prime Minister proud that under his watch the poor continue to be poorer and the rich keep getting richer? 
If we look at Scotland as whole, on the year unemployment is down by 20,000 and the rate of unemployment in Scotland is also down. The rate of unemployment in Scotland is lower than the rate of unemployment in, for instance, London, so the idea that this recovery is being felt only in the south of our country is simply nonsense. The hon. Lady mentions wages. Obviously, one of the most powerful things we can do to help people with the cost of living is to take them out of income tax. In Scotland, we have taken 23,000 people out of income tax altogether, and over 2 million people are benefiting from the personal allowance changes that have already helped people to the tune of more than £700 a year.
Q12. The dairy industry underpins the economy of rural Britain, including that of my constituency of Montgomeryshire. The dairy industry is currently in difficulty. Does the Prime Minister accept that the Government must consider all ways to bring stability to this important sector, including whether the powers of the Groceries Code Adjudicator should be extended and strengthened? 
I very much agree with my hon. Friend. It is important that we look at how we can support Britain’s dairy farmers at a time of very low milk prices. This is an important industry for our country and I think there are a number of things we can do; first, make sure that Her Majesty’s Revenue and Customs is prepared to provide the time to pay to support our dairy farmers. There is more we can do in terms of leading exports for British food producers—I know the Secretary of State is very keen on that. Specifically on the Groceries Code Adjudicator, something we have established, it is time to make sure that that organisation has the power, if necessary, to levy fines so that it can get its will obeyed. I also think it is time to look at whether there are ways in which its remit can be extended to make sure it looks at more of this vital industry.
Q13. West Dunbartonshire desperately needs a pay rise. A quarter of our children are living in poverty, and this Prime Minister’s policies are failing them and their families. A year ago, the Chancellor suggested that he wanted to see a £7 national minimum wage from this October. Will the Prime Minister tell me why his Government’s evidence to the Low Pay Commission makes no mention of this at all? 
Our evidence to the Low Pay Commission says we need another increase in the minimum wage. It is only under this Government that we have seen a minimum wage increase ahead of inflation, which never happened while Labour was presiding over economic chaos. That is the truth. Let me explain to the hon. Lady. She will have to explain to her constituents why Labour’s minimum wage policy would actually cut the minimum wage in the next Parliament. That is how incompetent and useless those on the Opposition Front Bench are. The best thing we can do is to keep growing the economy, keep creating jobs and keep cutting taxes, because we are on track and the plan is working.
There has been a spate of dog thefts across the Bradford district, where a rally has been held to bring people’s attention to the plight of Murphy, a husky stolen recently. It is very distressing for the owners and dogs concerned, who are devoted to each other. Some of these dogs are used in practice for dog fighting, and who knows what fate awaits some of the other stolen dogs? Will the Prime Minister use his good offices to draw attention to this problem and ensure that the authorities investigate these crimes and take them as seriously as any other crime?
My hon. Friend makes an important point. We are a nation of dog lovers—people are very attached to their pets—and it is appalling when they get stolen, particularly for the sorts of purposes he talked about. Obviously, the changes we have made on compulsory chipping should help, but my heart goes out to anyone who sees a much-loved pet taken from them.
Several hon. Members
Last but not least, I call Mr Nigel Dodds.
As the Prime Minister looks back over his achievements in the past five years and considers what he might—or might not—be doing in the first few months of the next Parliament, and further to the question from the hon. Member for Aldershot (Sir Gerald Howarth), will he commit to maintaining defence spending at 2% of GDP to ensure that our commitments to our NATO allies are met and that our country is secure and strong at home and abroad?
We are one of the few NATO countries that do achieve 2% of spending on defence, and because of that, we will see, in the coming months and years, a defence equipment programme that is second to none in Europe: two aircraft carriers, new joint strike fighters, hunter-killer submarines and new frigates. We can see a strong defence industry, supported by our commitment that the defence equipment programme specifically should be protected.
In 2015, the Houses of Parliament, along with the people of the UK, commemorate two important anniversaries: 800 years since the sealing of Magna Carta in June 1215 and 750 years since the calling of the Simon de Montfort Parliament in January 1265. These historic events can be seen as marking the start of a journey towards our modern-day rights and representation. So this week, exactly 750 years since Simon de Montfort summoned that Parliament to meet in the chapter house of Westminster Abbey on 20 January 1265, is an important week for the House of Commons in particular.
It was not the first English Parliament, and the Scottish and Welsh Parliaments have parallel histories, but, because it was the first Parliament in which representatives from towns were summoned, alongside the knights, it is seen as the earliest forerunner of the modern Parliament. I look forward to attending the commemorative events in Westminster Abbey tomorrow, together with Members of both Houses and, importantly, with Members of the UK Youth Parliament. Another important occasion takes place in February, when the four existing copies of the 1215 Magna Carta will be displayed in the House of Lords.
This year sees other anniversaries too, including the 50th anniversary of the death of Sir Winston Churchill, the 200th anniversary of Waterloo and the 600th anniversary of Agincourt. We will also be marking the 20th anniversary of the Disability Discrimination Act, the 40th anniversary of the Sex Discrimination Act, the 50th anniversary of the first Race Relations Act and the 600th anniversary of the role of Serjeant at Arms.
These will all be commemorated in a programme being organised jointly by both Houses of Parliament out of existing budgets. This programme of celebrations, entitled “Parliament in the Making”, is designed to raise awareness of our democratic heritage. Our programme aims to increase public understanding that Parliament is at the heart of our democracy and that its work matters to everyone. It aims to mark our history in innovative ways that are relevant to contemporary society.
I hope that many colleagues will now have seen the first manifestation of that intent in the shape of the banners in Westminster Hall, which give fresh artistic interpretations of key moments in our 800-year journey. I know that colleagues will wish to play a full part in this programme—indeed, there have been hundreds of nominations from Members of Parliament for the schools flag project. Flags designed by schools from all the historic counties of the United Kingdom will fly later this year in Parliament square and at the national Magna Carta celebrations at Runnymede in June. There will be other opportunities to participate, too, with a number of lectures and public arts projects, as well as a major public celebration entitled “LiberTeas” on Sunday 14 June. Details are available on the parliamentary website.
I am grateful—and I feel sure that all colleagues will similarly be grateful—to all the staff of both Houses who have worked hard and imaginatively to make these events possible, and to the Speakers’ advisory group on the 2015 anniversaries, which has advised both the Lord Speaker and me on the programme. In particular, I am sure that the House would want me to thank the group’s Commons Chairman, the hon. Member for Mid Worcestershire (Sir Peter Luff) for the energy and wisdom that he has brought to the task.
It is a happy coincidence that these significant anniversaries fall in an election year. It is less reassuring to note the many challenges to democracy around the globe, recently made manifest in the horrific and devastating events in Paris.
Parliament is not everything about our democracy, but our democracy is not worth anything without this Parliament. That is why it has rightly been at the centre of national attention throughout the centuries and why it must continue to be so. The contest for influence here has ranged from Cromwell to the Chartists, Lords to the Levellers and Speakers to suffragettes. Importantly, it is not only—or even mainly—a matter of decisions imposed from the top down, but of pressure from the bottom up, that has shaped our institution to be what it is today. While the nature and size of the electorate represented here have changed enormously over the generations, the principle of representation has remained remarkably consistent across all that time. It is that principle that, very properly, we commemorate and celebrate this year.
Points of Order
On a point of order, Mr Speaker. May I thank you for those kind words and express my own appreciation to you and to the Lord Speaker for your enthusiastic endorsement of the whole “Parliament in the Making” programme? May I also endorse what you said about my colleagues on the Speakers’ advisory group and, above all, the energetic team, led by Caterina Loriggio, who are working so hard to deliver the programme?
The banners now hanging in Westminster Hall are a powerful reminder to Parliament that defending the rights of all the people is one of the most important things we do. So finally, Mr Speaker, through you, may I invite colleagues across the House to seize the many opportunities provided and so help us to achieve our objectives of inspiring people about the 800-year history of our rights and representation, educating a new generation about that history and encouraging participation in civil society and our democracy?
I repeat my thanks to the hon. Gentleman for his work and my appreciation of his courtesy in respect of everybody else’s efforts. Thank you.
Further to that point of order, Mr Speaker. I have done a bit of research, and have established that the first Speaker was Sir Thomas Hungerford, who took his place in your Chair in 1377. I am afraid that means that you are only 638 years old, Mr Speaker, although it does not feel like that to those of us who sit under your speakership. It also means that in 12 years we shall have another happy anniversary, and we all wish you well for that, too.
I am extremely grateful to the hon. Gentleman, and I thank him for what he has said.
On a point of order, Mr Speaker. Given your understanding and co-operation on behalf of the few, and speaking as a former RAF officer, may I highlight another anniversary—the 75th anniversary of the battle of Britain?
The hon. Gentleman has done so, and he has done so with his usual eloquence—and very succinctly.
If there are no further points of order, we shall move on to a matter of great importance to the House: a Division correction. I have received a report from the Tellers in the Aye Lobby about the Division on Trident renewal that took place at 6.59 pm yesterday. They have informed me that the number of Members who voted Aye was erroneously reported as 35 instead of 37. The Ayes were 37, and the Noes were 364.
(Urgent Question): To ask the Secretary of State for Foreign and Commonwealth Affairs if he will provide an answer to an urgent question of which he has been given notice.
I have been asked to reply.
As the House will be aware, violence in Sana’a has escalated. Heavy clashes broke out yesterday between the Houthis and Yemeni security forces, and the situation is evolving rapidly. Although a fragile ceasefire was negotiated, its implementation has been, at best, partial. The presidential office and President Hadi’s home are now under Houthi control.
I am deeply concerned about the situation in Yemen. I urge all parties to step back from conflict in Sana’a, Ma’rib and other parts of the country, and to ensure that the ceasefire holds. Those who use violence, the threat of violence and abductions to dictate Yemen’s future are undermining the security of all its citizens and eroding the political progress that has been made since 2011.
The UK is playing an active role in encouraging all parties to work peacefully together to implement and enforce a ceasefire and return to dialogue within the framework of the Gulf Co-operation Council initiative, the outcomes of the national dialogue conference, and the peace and national partnership agreement reached between President Hadi and the Houthi leadership last September. The PNPA is a framework for peaceful political transition, and I call on all parties to work through the cross-party National Authority—which is effectively a national assembly—to implement the agreement, which should include the establishment of a new constitution.
I spoke to our ambassador in Yemen yesterday. The British embassy in Sana’a remains open and all our staff are safe, but we are obviously keeping the situation under close and active review. Since March 2011, we have advised against all travel to Yemen.
I thank the Minister for his answer, and thank you, Mr Speaker, for granting the urgent question.
As the Minister has said, Yemen is on the brink of an implosion that threatens to shatter the entire region. The Shi’a Houthi rebel group has encircled, bombed and stormed the presidential palace. When the House debated the death of UK-born hostage Luke Somers in December last year, all the warning signs of an impending crisis were there. No one doubts the Government’s commitment to providing aid for Yemen—last week I met the Department for International Development Minister, the right hon. Member for New Forest West (Mr Swayne), to hear what they were doing—but that aid is not enough. There are troops in the streets, and thousands have already died in sectarian violence during this and last year. The country is of such strategic significance that we cannot afford to allow it to fail.
As the House knows, I was born in Yemen. I left with my mother and sisters in 1965, but I have returned repeatedly in my capacity as chair of the all-party group on Yemen, and I personally cannot say nothing while Sana’a burns.
This is now the time for urgent action. It is an important moment in Yemen’s history. What additional support are we prepared to provide to the Government of Yemen? Yemen is a key ally in the region against extremism and terrorist groups, including those responsible for the attacks in Paris. There is an immediate and extreme danger for British citizens in Yemen, who are estimated to number 2,200. That includes our embassy staff. The US has deployed naval warships to evacuate the US embassy, so what measures are we taking? Will we evacuate our personnel?
Although the UK Government have a good record of providing assistance to Yemen, I fear that our friends and allies do not recognise the importance of the region. What steps is the Minister taking to try to encourage the Friends of Yemen to do much more, specifically Saudi Arabia and Oman? We can all appreciate the work done by the former Foreign Secretary, the right hon. Member for Richmond (Yorks) (Mr Hague), the Prime Minister and others in assisting Yemen during and after the Arab spring. I also applaud the appointment by the Prime Minister of the right hon. Member for Rutland and Melton (Sir Alan Duncan), who I know cares about the country, as his envoy. We need to act. Our focus is on Syria and Iraq, but we cannot allow Yemen to collapse.
Finally, al-Qaeda in the Arabian Peninsula, the group that trained and directed the Charlie Hebdo terrorists, has already exploited the political instability in Yemen. This is where some international terrorists are trained. If Yemen falls, the front line of the conflict will be the streets of London, Birmingham and Leicester. We simply cannot allow this beautiful country to become a haven for terrorism and violence. To fail to act would be a betrayal not just of the Yemeni people but of the bonds of history that bind our two countries together.
I pay tribute to the right hon. Gentleman, with his personal connections to the country, for the expertise he brings to the House and for his leadership as chair of the all-party parliamentary group. I appreciate the urgency of the question, but we were not going to make a statement because the situation continues to be fluid. What we say today could well be outdated by tomorrow. The Prime Minister is under house arrest, the President has moved to the south and the leader of the Houthis made a 75-minute statement on television yesterday but did not declare that he was now the leader of Yemen. The situation remains extremely fluid.
The right hon. Gentleman sums up the situation accurately and I agree with him. Strategically, Yemen is an important country for Britain. We have historical connections with it and we have devoted much work to it. I am pleased that he has had the opportunity to speak to my counterpart in DFID about the work we are doing to provide political stability and economic direction as well as improvements to security. He mentions the attack on Charlie Hebdo, and that is a reminder to all countries—not just those in the region but those further off, including Britain—of how terrorism and extremism can leave a region and move much closer to home. We heed his words very carefully.
The right hon. Gentleman mentioned the United States embassy. It is located in a different part of the city from ours and has its own evacuation programme. Each embassy must make its own judgment on what is necessary. The number of Britons operating in Yemen is extremely low and there are good connections between the embassy and those who choose to go against the travel advice I mentioned earlier.
The right hon. Gentleman also mentioned the Friends of Yemen. Let me elaborate on that. That is the organisation run through the United Nations that is co-chaired by Saudi Arabia and Britain. It comprises more than 40 countries and the past couple of years up to $8 billion has been granted to Yemen to help with political, economic and security reform. We must obviously assess the changes that have taken place, but the peace and national partnership agreement is critical. That is a document that has been signed by the President and agreed by the Houthis and given the sentiment expressed in the 75-minute speech I mentioned, we hope that all parties can come around the table and work towards a peaceful solution.
Finally, the right hon. Gentleman is absolutely right that al-Qaeda in the Arabian Peninsula is a spoiler and an example of extremism. The worry about the Ma’rib region, which the Houthis are now pushing into, is that there are pockets of al-Qaeda and there will be a conflict of extremism there unless there is an agreement. That is what we are now working towards.
I welcome the question of the right hon. Member for Leicester East (Keith Vaz) and agree with the sentiment contained in it, as well as with the Minister’s response. I welcome his tone. The Minister says that our embassy remains open, but can he assure me that if the situation deteriorates measures will be taken to get our staff out and to protect them? Finally, there are media reports about a connection between the Charlie Hebdo attack and the situation in Yemen. Is the Minister in a position to comment further on that?
I am grateful to the Chairman of the Select Committee on Foreign Affairs for his question and the manner in which he asks it. He asks at what point we should evacuate the embassy. I will speak to the ambassador later today and evacuation plan is already in place, but it has not yet been activated. I will speak to the ambassador and ensure that the House is updated if the situation changes. He asked about the connections between al-Qaeda and the Charlie Hebdo attacks. It has been reported that there is a link and that the individuals were trained in Yemen. The French authorities are working on that and we are working closely with them to provide support in their endeavours.
I thank the Minister for his response to the urgent question. Will he say something about the involvement of Saudi Arabia, Saudi Arabia’s military operations and any possible incursions into Yemen? Will he assure us that there is no possibility of any British armed forces being sent to the area, either?
Saudi Arabia and many of the countries that neighbour Yemen have an interest in the country, particularly Saudi Arabia, which, as I have said, is co-chair of the Friends of Yemen. I will speak to the embassy in the next couple of days to take stock of the changes that are taking place. I will ask about any military engagement that might take place, but as I have said we call for all parties, whether they are in the country or not, to come together and return to the peace and national partnership agreement, to which the Saudi Arabians have also signed up.
I cannot praise too highly the bravery and work of our ambassador, her embassy personnel and DFID staff. I spoke last night to the Yemeni Prime Minister, who was trapped and besieged, and the danger is that Yemen will end up without a legitimate Government and will become ungoverned anarchic space, leading to unchecked terrorist training, civil war, proxy conflict and humanitarian disaster. The right hon. Member for Leicester East (Keith Vaz) is absolutely right to highlight the importance of this country. Will the Minister confirm that the United Kingdom will, as a matter of urgency and as a top diplomatic priority, work with all our Gulf allies, the United States and the United Nations to try to haul Yemen back from the brink of the cliff edge on which it rests?
I thank the Prime Minister’s envoy to Oman and Yemen, particularly as he has kept me up to date over the past few days with his contacts and his thoughts and advice. He is absolutely correct that we do not want ungoverned space to develop in Yemen and with all the activities and challenges going on in the middle east, this area does not have the same profile as others. It has now moved up the agenda by virtue of this urgent question and it is important that we give assistance to the country to ensure that all parties come together, not only those in the country but those in the United Nations and the United States, to work towards a peaceful solution.
As we have already seen, the situation in Yemen is a matter of considerable concern for Members on both sides of the House and for many of our citizens of Yemeni heritage in long-established Yemeni communities, including in the borough of Sandwell. As the security system in Sana’a has worsened, there have been reports of Houthi rebels shelling the President’s home in Sana’a and seizing control of the presidential palace.
The UN Security Council has rightly condemned these latest attacks, and clearly the priority must be to resolve this situation peacefully and quickly. In the wake of this sustained violence, may I first ask the Minister what emergency provisions have been put in place to help ensure the safety and security of British citizens still based in Yemen? We know there are many brave and committed NGO workers in Yemen, as well as a dedicated team of UK Government officials. Their work continues to be vital and their commitment to the country is long standing, so can the Minister give the House an assessment of the number of British citizens potentially affected by the recent violence? Will he also set out, as far as he can, what contingency arrangements are in place, should there be an urgent need to evacuate British citizens and personnel from the affected areas?
A statement adopted by all 15 members of the UN Security Council made it clear that President Hadi was “the legitimate authority” of the country. He was reported to be inside his house when it was shelled. The Minister said that the President is now under house arrest. Can the Minister offer any further assurances about the President’s safety and whereabouts?
Clearly, as well as restoring calm to the country, the implications of renewed violence in Yemen are far-reaching given al-Qaeda in the Arabian Peninsula has established it as their base, especially in its efforts to destabilise Saudi Arabia. In light of this, can the Government set out what long-term support is being offered to the Yemeni authorities to help counter the threat of AQAP, and how is this support being affected by the recent attacks? An end to the violence is the urgent priority, and we know that all sides have agreed to ceasefires in the past, but given that today’s attacks followed the breakdown of a ceasefire that had been in place less than 24 hours before, what can international partners do to try and encourage a return to ceasefire talks, and also to secure more lasting agreements?
Yemen faces not only a worsening security situation, but continuing political and economic challenges. Recent progress towards a political transition, including drafting a new constitution and holding a referendum as well as general elections, were welcome, but even this limited progress is now at risk of being undermined by these latest attacks. As the Minister said, the UK is chair of the Friends of Yemen group, so what steps will the UK Government be advocating to focus all parties’ efforts on the need to secure an effective political transition? UN Security Council resolution 2140 was unanimously adopted in February last year and included a sanctions committee responsible for implementing the restrictive measures under that resolution. Can the Minister confirm whether the committee has published any new recommendations or guidance in the light of the recent attacks?
The international community must remain determined to help achieve the transition that is needed within the country, while the UK Government will also have our support in doing what is necessary to ensure the protection of British citizens in the affected areas.
First, may I thank the right hon. Gentleman, the Opposition spokesman, for the cross-party support on this? He speaks about the UK diaspora. It is important that it is informed and kept up to date with what is happening in the country. He also spoke about the role of the UN, and I wish to put on record my thanks to the UN special representative to the Secretary-General, Jamal Benomar, who I have met a number of times, including at the UN General Assembly in September, when UN resolution 2140, which the Opposition spokesman referred to, was agreed.
There is, as I have mentioned, a well-rehearsed evacuation plan. The number of Britons based in Yemen is minimal, and the embassy assures me that plan is ready to be activated if required, but that is not currently the case.
My understanding is that the Yemeni Prime Minister is under house arrest. I have no further information on that at present. The right hon. Gentleman is right to underline the spoiling activities of AQAP, and that has already been underlined in the House. AQAP continues to undermine and harass the Government and to undertake targeted assassinations and mass bombings. This makes the situation ever more complex, with the Houthis moving in from the north-west.
The right hon. Gentleman spoke about the constitution and the referendum. They are the building blocks that lead us to a better political space, and they are part of the national partnership for peace agreement, which I mentioned in my opening remarks.
I am grateful to the right hon. Member for Leicester East (Keith Vaz) for bringing this important matter before the House and to the Minister for his thoughtful and informative replies. Does the Minister agree that in supporting the legitimacy of President Hadi, we must be wary of imposing a simplistic anti-terrorist narrative on the reported coup, given that it is likely that the coup’s origins are in more localised tribal, factional or sectarian sources?
I should make it clear that, historically, Yemen is a country that has never been broken down along sectarian lines and we hope that is not gong to be the case here. We remain firmly committed to supporting both the integrity of the Yemeni state and President Hadi’s elected Government to implement this peace agreement, along with all parties, including the Houthis.
First, may I associate myself very much with the comments of my right hon. Friends the Members for Leicester East (Keith Vaz) and for Warley (Mr Spellar) and the right hon. Member for Rutland and Melton (Sir Alan Duncan)? The situation in Yemen is of great concern to many constituents of mine in Cardiff, particularly in Butetown and Cardiff bay, many of whom are of Yemeni heritage. What advice does the Minister have for those who may be worried about friends, family and relatives who are British citizens but who may not have followed the travel advice and may be in Yemen at the moment? Can he suggest what specifically they should do, and can he also give an assurance that the UK Government will give this issue a much higher priority, not only because of the current situation, but because of the poverty and insecurity that there have been in Yemen for far too many years?
The hon. Gentleman raises two very important points. First, while this subject may not have had a high profile in the media, that does not mean it has been a low priority for the Foreign Office, the United States and the Friends of Yemen—including in our work with Saudi Arabia. It is of huge concern, but it has not been on the front pages.
Secondly, I agree that many of our constituents will be concerned about what is going on and for loved ones and friends. I advise the hon. Gentleman to encourage his constituents to look at the FCO website, where there will be updates and information on ways to get in touch with the Foreign Office desk. If there are any complications, I would ask him to get in touch with me personally and I will make sure that that communication link is established.
Mr Speaker, there is a considerable irony in the fact that this debate on the crisis in Yemen comes immediately after your welcome statement on the British experience of the rule of law and democracy. What financial assistance are the Government providing to help stabilise Yemen?
My hon. Friend makes an important point about the British assistance being provided. We are working not only with the Friends of Yemen, but with the Deauville partnership of nations—a group that came together to support the countries that went through the Arab spring. We also have conflict pool money going into the country, and we are providing security assistance to the Yemeni armed forces. We provided over £173 million from 2011 to 2014, and then we committed a further £78 million for this year—2014-15. That funding comes from the development stabilisation programme.
It has been alleged that the Houthi rebels are receiving support and backing from Iran. If that is true, will the Foreign Office consider whether it is in our interests to reopen an embassy and diplomatic relations with that country while it continues to meddle in such a malign way in this part of the world?
There is no doubt that Iran has influence in this area, and it can choose to be part of the solution or part of the problem. I very much hope it wants to be part of the solution and to play a helpful and productive role. It is no country’s interests to see Yemen descend into civil war.
On the embassy, we can either shout from afar and complain about behaviour, or we can have a far closer relationship and put these things directly to the country and the Government. That is the objective of reopening the embassy, when the agreement is finally signed.
Further to that question on Iran, will the Minister update the House on what influence Iran can have over the Houthis to make sure they act in a positive way, so that we get a solution in Yemen that recognises democracy and the broad range of people who live within that state, and we ensure this coup comes to an end and people can live in peace?
My hon. Friend makes an important point. It is important that all neighbouring countries that have any influence over the various parties involved in Yemen should exert that influence to encourage the warring factions to come back to the table. I hope that Iran will heed that advice, so that we can move towards getting the partnership agreement back in place.
The right hon. Member for Leicester East (Keith Vaz) showed considerable personal courage in visiting Yemen, as do our ambassador and her diplomatic staff and the other UK nationals there. Will the Minister visit Yemen if the security situation allows?
It is certainly important to show support for our embassy personnel, and the more we can go to these places and engage with people, the better. Given the security situation, however, and the travel advice telling all Britons not to go there, it would be inappropriate for me to turn up there myself.
I thank the Minister for his statement, and the right hon. Member for Leicester East (Keith Vaz) for bringing this matter to the attention of the House. This affects us all in the United Kingdom, whether or not we have people from Yemen living in our constituencies. Will the Minister tell us what help the United Kingdom Government have given in the form of practical assistance, including additional intelligence surveillance equipment, extra technical and military aid for the army and, in particular, security scanning devices to prevent suicide bombings? Those three items would give practical help to reduce the level of warfare in Yemen.
The hon. Gentleman is right to suggest that the security situation in Yemen matters to people in Britain. From a strategic perspective, what happens in Yemen can have a consequential impact much further afield. We have a security relationship with the country, and if I may, I will write to the hon. Gentleman with more details of the areas in which we are working with the Yemeni armed forces.
Fracking (Measurement and regulation of Impacts) (Air, Water and Greenhouse Gas Emissions) Bill
Presentation and First Reading (Standing Order No. 57)
Geraint Davies, supported by Kelvin Hopkins, Mr David Winnick, Jim Sheridan and Jim Shannon, presented a Bill to require the Secretary of State to measure and regulate the impact of unconventional gas extraction on air and water quality and on greenhouse gas emissions; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 27 February, and to be printed (Bill 158).
Onshore Wind Turbine Subsidies (Abolition) Bill
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 provide for the prohibition of the use of public funds to subsidise the development of onshore wind turbines; and for connected purposes.
President Reagan once turned down $50,000 that Congress had authorised for redecorating the White House, but he did accept private donations to spruce up the presidential home on the sound basis that one man’s subsidy is another man’s tax burden. There is no better example of that than the burden of a levy on everyone’s energy bills to cover subsidy payments to renewable energy firms and landowners who happen to have wind farms or individual turbines on their land—the irony being that those who are already asset-rich become even more wealthy at the expense of hard-working taxpayers.
It is fair to suggest that renewable energy should be subsidised to some degree to help stimulate a market, and I agree with that. I am not against all renewable energy subsidies, but we should be supporting technologies that are effective in producing power when we need it and not just when the wind blows. There are technologies that get a relatively poor deal from the subsidy market, and when we look at the efficiency data for onshore wind, we can see why wind is a bad deal for taxpayers. Onshore wind farms are dependent on the wind blowing at the right speed in order to reach maximum output. Because wind speed is variable, so too is the output of Britain’s onshore wind farms. As a result, onshore wind farms are unable to respond to spikes in demand, in contrast to other forms of low carbon generation such as the biomass conversion projects that are being so ably demonstrated at Drax power station in my constituency and that I hope will shortly be introduced at Eggborough power station.
Onshore wind farms generate below 20% of their stated maximum output for 20 weeks a year, and below l0% for nine weeks a year. That means that wind farms are, effectively, failing to reach maximum output capacity for more than half the year. On average, they exceed 90% of their rated output for only 17 hours a year. That is about as much use as a chocolate fireguard. Worse still, Britain’s onshore wind farms are routinely paid large sums of money not to generate electricity—as much as £l million in each week of 2014. Those payments, described officially as constraint payments, ultimately end up on consumers’ bills, meaning that the British public are effectively subsidising the UK’s onshore wind industry not to produce electricity.
Research by the Renewable Energy Foundation shows that Whitelee in Scotland, the site of Britain’s largest onshore wind farm, was paid more than £22 million in constraint payments last year. In other words, it was paid £22 million of taxpayers’ cash not to produce anything. Very nice work indeed if you can get it! Last year, a total of £53 million was paid in constraint payments to wind farms—both onshore and offshore—which is the most since 2010. Wind farms are being paid more than £1 million a week to switch off their turbines.
I am sure that the wind industry will tell us that this method of electricity generation is a way to create jobs. The industry's trade body, RenewableUK, states that the industry
“is set to employ up to a further 70,000 people by 2023”.
The promise of those jobs is totally dependent on the building of large-scale wind farms at sea and the construction of factories in Britain to manufacture the turbines, which are almost all built abroad at the moment. The Scottish energy Minister published figures last year showing that 2,235 jobs were connected directly to onshore wind at 203 wind farms across Scotland, so with an annual subsidy of £344 million, that works out at a cost of £154,000 per job.
The renewables obligation was introduced by the Labour Government to encourage investment in and development of the renewable energy industry. The cost is added to all energy bills, meaning that not only households but industry and employers pay, adding to the cost of all our goods and services. Labour also signed us up to meeting legally binding green energy targets by 2020, with the prospect of financial penalties if we failed to do so. Surely the only possible justification for subsidising these technologies is to drive down costs, but Labour ignored that principle and decided to use subsidies to meet arbitrary and foolishly high targets for green electricity in a very short time scale.
I should like to mention single turbines. These are usually applied for and sited on farmland and they operate under a different regime, the feed-in tariff. Farmers are paid to generate even if they use the power themselves, and they are paid a further amount on top of that for any power fed into the grid. For example, the basic tariff on a 50 kW turbine is 17.78p per kWh, which is £177.80 per MWh, and a further £47.70 for power fed into the grid. If a farmer with such a turbine uses 80% of the power himself, which is not unrealistic, the power fed into the grid and therefore paid for by the consumer will cost a staggering £936.70 per MWh, which is nearly 20 times the wholesale market price. In the case of the owner of a 500 kW farm turbine who uses half the power generated, the price paid by the consumer for the power fed into the grid would be £344.10 per MWh, which is more than six times the wholesale market price. That does not make sense. Those examples show the extent to which the electricity market and, potentially, the farming market are being distorted by this subsidy. A farmer who can get an income of more than £200,000 a year from a turbine has a lesser incentive to improve the competitiveness of his farming activities.
A report produced by Frontier Economics on behalf of the Department of Energy and Climate Change concluded that Britain’s wind energy subsidy was 35% more expensive than the international average. Two countries in particular, Germany and Denmark, have been at the forefront of promoting wind energy. Germany pays £80 per MWh for its electricity from onshore wind, while in Denmark the cost is less than £60 per MWh.
In the last few weeks, we have discovered—thanks to private conversations between the industry and the Labour party—that if, God forbid, Labour was to return to power, it would want to see even more turbines erected across the country. At least neither our comrades the Liberal Democrats nor the Green party—[Hon. Members: “Where are they?] They are not here; they are conspicuous by their absence. At least they have never tried to hide their love of these carbuncles in our countryside. Voters now know that the Labour party, alongside the Lib Dems and the Greens, has no issue with voters paying more for their energy bills and that it cares little about the impact that large turbines have on rural communities.
If wind power really is the cheapest form of renewable energy, as its supporters claim, it should now be able to stand on its own feet without using any more taxpayers’ money and increasing our bills. I am delighted that my right hon. Friend the Prime Minister has said that if the Conservatives achieve an outright majority after the election, subsidies for onshore wind will end. That is welcome news to my constituents in Thorpe Willoughby, Hambleton, Gateforth, Hillam, Riccall, Kirkby Overblow and Spofforth, and right across the beautiful part of North Yorkshire that I represent. I know it is also welcomed by constituents of many of my right hon. and hon. Friends.
I do not blame farmers and landowners for wanting to join in this gold rush. They do not set policy; the Government do, and it is time to call time. We have more than 8,000 onshore wind turbines operational in this country, with 1,300 under construction, 5,200 awaiting construction and almost 6,000 in planning. I agree with Thomas Pursglove, our candidate in Corby and the chairman of Together Against Wind, when he says that enough is enough. My Bill is designed to help communities that feel threatened and powerless in the face of wind farm applications, and to ensure that our constituents are getting good value for the money they pay on their bills. The Bill will also allow other, more efficient technologies to benefit from Government support, and I commend it to the House.
Question put (Standing Order No.23).
I am sure the hon. Member for Wellingborough (Mr Bone) will be well familiar with the principle that vote should follow voice. It is a fundamental tenet of our parliamentary proceedings, of which the hon. Gentleman, a noted constitutionalist, will be very conscious.
21 January 2015
The House divided:
Question accordingly agreed to.View Details
That Nigel Adams, Chris Heaton-Harris, Sir Paul Beresford, Mr Philip Hollobone, Philip Davies, Jackie Doyle-Price, Mark Garnier, Andrew Bridgen, Mike Weatherley, Mr Ian Liddell-Grainger and Sir Greg Knight present the Bill.
Nigel Adams accordingly presented the Bill.
Bill read the First time; to be read a Second time on Friday 6 March, and to be printed (Bill 159).
[14th Allotted Day]
National Health Service
I beg to move,
That this House notes comments from leading experts that the NHS is under unprecedented levels of pressure and that this is putting patient care at risk; further notes that attendances at hospital A&E departments increased by 60,000 in the last four years of the previous Government and 600,000 in the first four years of the current Government; believes that this is linked to decisions taken by this Government, including cuts to adult social care, the abolition of NHS Direct, the closure of almost one in four walk-in centres and removing the GP access guarantee; and calls on the Government to match the Labour Party’s plans to raise an extra £2.5 billion a year for the NHS, funded by measures including a tax on properties worth over £2 million, to help ease the current pressure and ensure that the NHS is fit for the future.
We have called this debate today to see if we can establish a shared analysis across the House of the causes of the current crisis in accident and emergency departments, and from that, shared solutions. I hope we can all agree that the staff of the national health service and of the ambulance service are working wonders in the most trying circumstances, and that it behoves all of us to put forward our ideas today to relieve the pressure on them, but more importantly, to reduce the risks that too many patients are facing right now.
As I have said to the Secretary of State before, things cannot carry on as they are. As the British Medical Association said last week,
“these ongoing challenges are placing patient care and safety at risk.”
Very poorly people are waiting hours for ambulances to arrive, hours to be seen in A and E, and hours on trolleys in corridors, and too many elderly people are then being held on hospital wards, trapped for days, weeks, even months or, in one case that I will come to later, a full calendar year.
Can the right hon. Gentleman establish for the benefit of the House whether the figure quoted in his motion applies to England and Wales or to England only?
I am not sure which figure the hon. Gentleman is referring to, but the figures in the motion apply to England. I will say more about them in a moment.
The stories of failure keep coming. Today we read that a 38-year-old man in Bristol died of meningitis after an ambulance took four hours to arrive. This is by no means an isolated example. The response time target for the most serious calls has been missed for the past six months in a row. We need to hear today what the Secretary of State is doing about this. Rather than work to improve response times, the only proposal we have heard so far is to allow a pilot relaxing response time standards. There will be two pilots, one in the south-west and one in London. London, as the right hon. Gentleman knows, is the worst-performing ambulance service in the country right now, and we hear today that the chief executive of London ambulance service, Ann Radmore, has resigned. The Secretary of State will need to explain to us today why it makes sense, in the middle of a difficult winter, to run an experiment in the most troubled ambulance service in the country.
Several hon. Members
I give way to the right hon. Member for Wokingham (Mr Redwood).
I am grateful to the shadow Secretary of State. Can he explain why Labour only ever now has any interest in England’s health service? We would like to hear about Labour’s conduct of the Welsh health service and its message for Scotland. Does Labour not know that this is an English devolved matter?
It is my responsibility to hold the Government to account on behalf of patients in England for what is happening in England now. That is my job, and I will make no apologies to the right hon. Gentleman or anybody else for doing it.
The response times in the ambulance service are not good enough, nor is the plan to introduce an experiment in the middle of winter, but the problems are not confined to the ambulance service. We need, too, to relieve the pressure on hospitals. Last week just seven out of 140 hospital A and E departments in England met the Secretary of State’s lowered A and E target. Hospital staff are trying their best, but it is as if the Government have simply given up on it. If that is so, it means that they are giving up on the thousands of people waiting hours to be seen. What is his plan to stop the decline and bring A and E back up to acceptable standards? It is time he told us.
Several hon. Members
I give way to the Chair of the Health Committee.
I thank the right hon. Gentleman for giving way. I am concerned. Does he understand the difference between a pilot and an experiment? Does he not think it is right that the Secretary of State should listen to clinically led advice about how we might improve ambulance waiting times, rather than just roll out changes without a pilot, not an experiment?
I do not think there is a massive difference between a pilot and an experiment. My objection is that that is being introduced in winter—and a difficult winter at that—in the most troubled ambulance service. I am not against a pilot, but it should be conducted at a quieter time of year. I should have thought that bringing it in now would strike the hon. Lady, with her long experience of the NHS, as more than a slightly risky thing to do.
I need to hear today the Secretary of State’s plan. What is his plan to bring standards in ambulance services and A and E back up to where they should be? If he waits much longer to tell us, people will conclude that he simply does not have one. The simple truth is that our hospitals are full and operating way beyond safe bed occupancy levels. It is a system that is visibly creaking at the seams.
Several hon. Members
I shall give way in a moment.
Another recent case symbolises just how bad things have got. Michael Steel, a dad of two, aged 63, was moved from his ward to a store cupboard while being treated for an inflamed liver. Mr Steel was unable to sleep because he was wheeled in and out of the cupboard while staff went to get drugs from the fridge. One nurse apparently told him it was “absolute chaos”. His son Tom took pictures of the ordeal, including a photo of the ward’s whiteboard where nurses listed his dad’s location as “stock room”. This is the NHS on the Secretary of State’s watch.
I agree with the Chair of the Health Committee that the Secretary of State and his Ministers should listen to the professionals on the front line. If they had listened three years ago, we would not have been lumbered with the Health and Social Care Act 2012, because everyone at the professional end of the health service said, “Do not do it.” But they were ignored by the Secretary of State.
What we can see is that this decline began when the Government made the monumental misjudgment of bringing forward a top-down reorganisation that should never have happened, that nobody voted for, and that took 1.5 million eyes off the ball in the NHS. The Government should have been looking at the front line and maintaining standards there, instead of which they looked backwards, and focused on the reorganisation and the jobs merry-go-round that then carried on. It is really disgraceful that they did that and plunged the NHS into the chaos that it is today.
Last Friday evening, I spent time at Whiston A and E talking to doctors and nurses, who do an unbelievable job. I heard about the problem of getting elderly people back into the community when they have undergone treatment. There were also issues around recruiting and retaining nurses and the tariff there, but there does not seem to be any answer coming from the Government.
My hon. Friend describes the problems well. I know the hospital because I have been there with him. He is right that older people are becoming trapped in hospital. The support is not there for them in their own homes, and nursing home places are not available. I will come back to that theme in a moment.
On exactly that point, the Health Committee looked at the A and E crisis last week and was told by the president of the College of Emergency Medicine that delayed discharges were due to underinvestment in the community, by which he meant social care, GPs and district nurses. Indeed, one third of delayed discharges were down to social care. One third of frail elderly people, or vulnerable people, cannot go home because of the issues with social care, which has been cut by £3.53 billion under this Government.
We have record numbers of delayed discharges in the NHS right now. The number may even go past the 1 million mark—I am talking about days lost in the past year. That reorganisation that I mentioned a moment ago cost at least £3 billion, probably more. The budget was flat so where did that money come from? As my hon. Friend rightly says, it came from cuts to the general practice budget, cuts to the community services budget, cuts to the mental health budget and cuts to the social care budget. That is why the community has been stripped bare and people are trapped in hospital. This is a mess of the Government’s making.
Does my right hon. Friend not agree that the same explanations apply to ambulance response times, by which I mean the closure of the NHS Direct service, the cuts to the social care and the difficulties in seeing a GP?
That is exactly my argument.
Several hon. Members
I will make some progress.
I mentioned record numbers of delayed discharges. There are also record numbers of people visiting A and E, record numbers of frail people being admitted through A and E, record numbers of people waiting on trolleys and record numbers of people trapped in acute hospital beds. This is the simple question that has not yet been answered by this Government: why is there this unprecedented pressure in accident and emergency? Until there are proper answers to that simple question—and agreement about the true causes of the A and E crisis—we will not be able to move forward with a proper solution, and that is the point of today’s debate.
When the Secretary of State came here to answer the urgent question two weeks ago, he was asked by my hon. Friend the Member for Halton (Derek Twigg) what he saw as the causes of the increased attendances at A and E. Let me remind the House of what he said:
“We have looked into that matter in huge detail. There are probably three broad factors that are behind the increase in demand. One is the ageing population...The second factor is changing consumer expectation among younger people who want faster health care…The third factor is a refusal by NHS trusts to do what they were pressurised to do in the past, which is to cut corners to hit targets.—[Official Report, 7 January 2015; Vol. 590, c. 280.]
In other words, “Nothing to do with us, Guv.” It is the same old story with this Secretary of State. It is always someone else’s fault: older people’s fault, younger people’s fault, the previous Government’s fault—anyone but him.
My right hon. Friend knows Warrington well. As well as increasing ambulance response time and having fewer GPs than we had in 2010, we are now seeing one of the last specialisms—spinal services—moved from Warrington to Walton with no public consultation whatever. Does he agree that this is exactly the result of the Government’s reorganisation in which no one is accountable for any decisions and the future of hospitals such as Warrington is at risk?
My hon. Friend is right; I do know Warrington well. Speaking up for my own family who live in Warrington, I will not accept a situation in which their services are taken away without them having the democratic right to challenge those decisions. But that is what has been growing under this Secretary of State. We had the decision on Lewisham—the most outrageous example—in which he tried to close a successful A and E that was serving a very deprived part of London, without any proper process, and he lost in the High Court. Then we had a clause brought before the House that tried to close hospitals anyway. That is what the Government want to do; they want to ride roughshod over local people and close services where they want to, and we will not let it happen.
Several hon. Members
I will give way to my hon. Friend before making more progress.
If the causes of the A and E crisis are deep and structural, as the Secretary of State has implied, why is it that the number of people in London waiting outside A and E in ambulances rose by 66% in one month—between November and December?
As usual, my hon. Friend puts her finger on the issue: the crisis is not as the Secretary of State describes. I will come on to that right now, but the first request I will make of him today is to publish the research that proves that the three top reasons he gave in this House two weeks ago are indeed the reasons for the increased demand in A and E, because I do not believe that they are. Perhaps they have made a small contribution, but they are not the real reason for the crisis. Our analysis of what is behind the extra pressure is very different from his. Let me introduce an important and revealing fact into this debate, which picks up on my hon. Friend’s point.
Over the past four years of the previous Government, annual attendances at A and E increased by 60,000. Over the first four years of this Government, they have increased by 600,000. That is a dramatic increase, which is explained not by those long-term structural issues, but by decisions taken by this Government.
Under the previous Government, Crawley’s accident and emergency was closed. Will the right hon. Gentleman now commit to increasing funding on the NHS, as this Government have done every single year of this Parliament, and promise to do for the next?
Changes we made were done in a planned way, with measures to increase capacity at neighbouring accident and emergency departments, and they were done for reasons of patient safety. Have a look at west London, where plans to close A and E departments are being railroaded through, leaving intolerable pressure on the remaining A and E departments. It is not acceptable, and the hon. Gentleman should challenge his own Government on what they are doing.
Does the right hon. Gentleman agree that with private health firms now on course to win more than £9 billion of NHS contracts, one of the real problems is the fragmentation of the NHS in front of our eyes. Is that a good reason to oppose further privatisation of the NHS, and will he admit that the process that set in train the privatisation of Hinchingbrooke should never have happened?
I have said that the market was let in too far, and, as Health Secretary in 2009, I changed policy away from what was a version of “any willing” or “any qualified” provider to “NHS preferred provider” and I stand by that. I agree with the hon. Lady that the market is simply not the answer to 21st-century health and care. When the Prime Minister stood at the Dispatch Box about an hour or so ago and said no privatisation on his watch, he was not being straight with the public. Services across the country are being put out to open tender and then transferred to the private sector. That is the Government’s record and the people of this country know it.
Does my right hon. Friend agree that it says everything about this Government’s attitude to the NHS that general practices that serve the most needy and vulnerable patients, like Devonshire Green and Hanover medical centres in my constituency, are under threat because of the withdrawal of the minimum practice income guarantee introduced by Labour? Does he agree that the Government should immediately stop the phased withdrawal of funding and review their decision to end MPIG?
I said earlier that there had been cuts to the GP budget, and that is one of the implications of those cuts. The Government have developed a plan to phase out the guarantee that secures practices in some of the more deprived communities. In east London there have been campaigns against practice closures; I know there are similar concerns in Sheffield. That process should be reviewed and if necessary stopped, because no practice should close as a result of any of those changes. That is the commitment I give to my hon. Friend today.
Several hon. Members
I want to make some more progress; I will give way later.
We need to know the reasons for the increase in A and E attendance. Safely meeting that demand would require an extra eight accident and emergency departments in England, but the Government have been closing, not opening, A and E’s. That is why there is so much pressure in the system.
There has been an even more dramatic increase in the last year. NHS England figures show that there were an extra 446 extra visits to A and E in the 2014 calendar year. That is a dramatic change on the Secretary of State’s watch and the time has come for some honesty from him about the real reasons for it. Until he faces up to those reasons, however uncomfortable they may be for him, he will not be able to develop a proper solution and the situation will get worse. We cannot let that happen.
Let me list what I believe are the decisions of this Government that led to the increase. I will identify four and take each in turn. The first, as Opposition colleagues mentioned, is the decision to scrap NHS Direct and replace it with the flawed NHS 111 service. NHS 111 was originally intended to be a call-handling service, and indeed was conceived by the previous Government. It was intended to simplify access; it was intended to patch people through to the relevant agency, be it the GP out-of-hours service or NHS Direct.
However, when the present Government came into office, they made a major change: they decided that NHS 111 would not signpost NHS Direct but replace it. That was a major mistake. The established and trusted NHS Direct model, a single national contract in the public sector, was replaced with 46 patchwork contracts in the public and private sectors across the country. They replaced the model of nurses on the end of the phone, to provide reassurance for families, with call handlers and computer screens. As a result, where 60% of calls to NHS Direct were handled by nurses, with NHS 111 it is only 20%.
But the present system of call handlers and computer screens is not a case of “computer says no”. The problem is that too often it is a case of “computer says, ‘Go to A and E.’” NHS England figures show that there has been a dramatic increase, in the last year, in the number of people calling NHS 111 who are referred to A and E, or to whom an ambulance was dispatched. In November 2014, there were 67,000 referrals to A and E—a 26% increase on the same month in 2013—and 108,000 ambulances dispatched—a 20% increase on November 2013.
All these problems have led to an increase in the number of days that people are taking off as a result of stress—nurses especially. Thousands of days are being lost to the system, adding to the crisis. Should we not be appreciating the staff in our NHS hospitals, and maybe starting by awarding them the 1% pay rise that the pay review body recommended for all of them?
The Secretary of State’s decision to reject the independent advice of the pay review body about what was fair and affordable, and to single out NHS staff for exclusion from the promise that the Chancellor had made that the public sector, as part of his restraint policy, would get 1%—to say that NHS staff would get less than that—was a kick in the teeth, and was to risk staff morale just at the moment that the NHS needed to be recognising and rewarding those staff, who are working so hard to keep things going. To make inflammatory comments such as those that the Secretary of State has made in the newspapers today is the wrong response. He should be getting back round the negotiating table with those staff. He should be working with them to find solutions. They are keeping the NHS going right now, and they deserve a bit better than they have had off this Secretary of State.
May I return my right hon. Friend to something very important that he said? He pointed to the distress of our constituents who are being told to go to A and E rather than having reassurance from a nurse on the end of the phone. This is the experience of all our constituents right now, and I would far rather all my constituents had access to a qualified nurse than were just told to go to A and E.
My hon. Friend calls it just right. One thing the Government could do right now would be to get more nurses on the end of those phones, to provide that experienced voice, that reassurance, that people with young children need before they decide to get in the car and go to A and E. I remember using NHS Direct in such circumstances myself. That reassuring voice has gone, and that is why NHS 111 is placing additional pressure on our A and E. The Secretary of State would not recognise it, with the reasons that he gave, but it is. Staff know it is. The ambulance service know it is. It is time we had a Government who faced up to that reality. My question for the Secretary of State today is: will he now concede that that flawed 111 service has contributed to the 600,000 annual increase in A and E attendances?
The second policy decision that I shall discuss is the closure of NHS walk-in centres. Colleagues who have been in the House for some time will recall that there was a winter crisis in A and E in most, if not all, winters in the 1990s. Then, in the late ’90s, NHS Direct was launched and NHS walk-in centres were opened, with the specific intention of giving people alternatives to attending A and E, which were then under major pressure. The locations of the first wave of walk-in centres were carefully chosen, often where an A and E had recently closed, including at Leigh infirmary in my constituency. In the decade from 2000 to 2010, around 230 walk-in centres were opened across England. Many of those centres became an established and understood alternative to A and E.
However, despite strong evidence to support them, a review by Monitor has found that almost one in four walk-in centres have closed under the coalition Government. Many more are under threat today. Monitor’s review surveyed people who used walk-in centres, and one in five said they would have gone to A and E if that alternative had not been available. Here is my next question for the Secretary of State: will he now concede that, in the areas where those centres have closed, there will have been extra attendances at A and E, and that was it a mistake to close those centres?
Thirdly, I will mention GP services, but let me start by clearing something up. The Prime Minister claimed today at Prime Minister’s questions that there are more GPs now than when he took office. I am afraid, as so often is the case at Prime Minister’s questions, that claim is simply not true. The last census of the GP work force conducted under the previous Government, in September 2009, found that there were 35,917 GPs working in England. The latest census for which figures are available, September 2013, finds 35,561 GPs working in England. When will Ministers start giving out facts from that Dispatch Box, rather than the spin we get week after week?
I asked the Prime Minister some weeks ago about the number of nurses in the NHS. In December, the number of NHS nurses in the system had been reduced by over 900 since May 2010, but we were told in November that it was up by about 2,500. The Government were using the figures, and the Prime Minister was answering questions, in terms of hours worked. As we know, nurses are working massive amounts of overtime on single-rate time. Nominal headcount nurses, at this moment in time, are minus over 900 compared with May 2010.
My hon. Friend makes his point very well. This is what we must challenge as we move forward. Before the general election, people need the facts about what is happening to the NHS. There has been a big drop in the number of nurses working in the community, as my hon. Friend mentioned, and these are the facts that we need to bring home to people.
It is not just the fact that the GP headcount has gone down. One of the present Government’s first acts was to scrap the guarantee of an appointment within 48 hours and incentives to open GP surgeries in the evenings and at weekends. That, combined with cuts to the GP budget, means that it has got harder and harder to get a GP appointment in recent years. The constituents of all the Members present say, “I am ringing the surgery at 8 or 9 every morning and being told that nothing is available for days.” In 2010, the vast majority—80%–of people said they could get an appointment within 48 hours; now, according to the GP survey, one in four people say they must wait a week or more to see a GP.
One of the problems in my constituency is that GP surgeries are relying on locums because it is not possible to find GPs to recruit on a full-time basis. Those locums provide a very erratic service; sometimes there is not even a locum available. That is adding to the problem, because as a result, all that is left to people is to go to A and E. I am sure that my right hon. Friend agrees that that is one of the contributory factors, and it proves his point that a chronic shortage of GPs has come about under this Government.
That is an absolutely vital point. It is not just about GP locums; there are also A and E locums. The Government have, throughout, cut training places, which were another victim of the reorganisation. Ever since then, the number of places commissioned for doctors—and nurses, I might say—has gone down. That leaves us with a bill for agency staff that is literally out of control—it has gone through the roof—and that means that money is now being siphoned out of the NHS at an alarming rate. That is mismanagement; that is what has happened. How must staff working in the NHS feel when they see the bill for agency staff spiralling in this way and know that they will not even get a 1% increase from this Government? They will draw their own conclusions about how this Government value them.
The shadow Secretary of State has spent quite a large part of his speech on diagnosis, but at the beginning he asked for solutions, so in that spirit I offer a creative solution. He will be aware that East of England ambulance service has had very poor response times for a number of months—in fact, a couple of years. Would he support a merger of the Red 1 and Red 2 ambulance response services with the fire and rescue service in the east of England, because such a combined force might be in a better position to provide quicker response times? Does he agree with that idea?
I am prepared to look at it, but I think that the future of the ambulance service should be in integrating better with the rest of the NHS—with GP out-of-hours services and NHS 111. Greater Manchester’s health service is piloting a critical response service to support the ambulance service, and I do not have any objection to that. However, this Government have not got it right when they say that the future of the ambulance service is to merge with the police and fire services as a single 999 service. For me, the ambulance service is a clinical service that should integrate better with the rest of the NHS, and I would prefer to go in that direction.
I said a moment ago that people could not get a GP appointment, and that is also what the GP survey tells us. An extra 290,000 patients say that they have turned to A and E when they cannot get a timely GP appointment. That includes the Secretary of State, who admitted in this House that he had done exactly the same. So will he today accept that the growing problem of people being unable to get GP appointments has played a significant part in contributing to the increase of 600,000 in the number of visits to A and E?
Fourthly, I turn to social care. In my analysis, this is the root cause of the problems we are now seeing. At the start of this Parliament, I warned the Government about their public spending plans and, in particular, warned them against raiding social care to stack up a claim that they were protecting the NHS budget. Government Members should be familiar with the quote because the PM quotes it every week at Prime Minister’s questions. To be more accurate, they will be familiar with half the quote, because that is all he uses, so let me give the House the full version. I said that it would be irresponsible for the Government to increase NHS spending if the way they did it was by raiding the social care budget. I said further that if that goes ahead, they will hollow out social care to such a degree that the NHS will not be able to function, because a collapse in social care support would end up dragging down the rest of the NHS with it.
That is precisely what is unfolding before our eyes right now in the NHS. A report today from Age UK shows how
“hundreds of thousands of older people who need social care are being left high and dry.”
If we were unfortunate enough for Labour to win the forthcoming general election, by how much would it increase councils’ adult social care budgets?
I am talking about creating a single budget. There is a big difference between that and what the hon. Gentleman says. I am saying that the time has come to merge the adult social care budget and the NHS budget. More than that, we are going to put an extra £2.5 billion into that integrated system. He should not come here today telling me what I need to do: where is his plan to put more money into the national health service?
My right hon. Friend is giving the House a very good analysis of the social care system. He may have looked at the National Audit Office analysis published in March 2014, which said:
“The intention in the 2010 spending review was to protect spending on adult social care”.
Despite that, because Ministers cut central Government funding for local authorities by 26%, councils have cut nearly £1 in every £10 spent on adult social care in the past four years, leaving Age UK’s director to describe the system as being in calamitous decline. That is clearly a central cause of the current A and E crisis, exactly as my right hon. Friend is arguing.
My right hon. Friend has absolutely nailed it. Those Ministers on the Front Bench decided—it was a political decision—to cut councils to the bone, and in doing so cut social care to the bone. That was precisely the warning that I gave back in 2010, having just left the Department of Health, where I remember being told that allowing social care to be cut would be a false economy of massive proportions because it would lead to huge inefficiency in the NHS. Hospitals would be unable to function because they could not get people home, and therefore the NHS would back up and the pressure would become impossible. That is what is happening. Those Ministers have done it, and they must be held to account for it.
Several hon. Members
I will give way one more time.
At the start of his speech, the right hon. Gentleman said he was calling for common ground and consensus in this debate, although he seems to have become somewhat deflected from that path. He knows that I very much agree with his criticisms of the Health and Social Care Act 2012 and other things. He has said, on a constructive basis, that he wants to bring health and social care together. There is potential consensus and common ground in that regard. I would like to hear what more he can say constructively on the areas where, I think, we can find, across all parties, common ground and a way forward.
To find common ground, one has to tell it straight and put on the table the real reasons why there is pressure in A and E. I bet the hon. Gentleman would not disagree with a single reason I have given: NHS 111, closure of walk-in centres, difficulty in getting GP appointments, the collapse of social care—[Interruption.] Yes, he says he does not disagree with any of those things. If we have a shared analysis, then he and I will have a basis on which to devise solutions. I will come to those solutions later.
Several hon. Members
I said that I am going to make progress.
Today’s Age UK survey finds that the number of over-65s receiving care has fallen by 380,000 under this Government. Half of the 1 million people who struggle to wash or bathe now get no help at all. Two thirds of the 250,000 people who struggle to feed themselves every day are now left to fend for themselves. There are over 100,000 fewer day care places and over 50,000 fewer people getting meals on wheels. Age UK says:
“Our state-funded social care system is in calamitous, quite rapid decline.”
But worse, it is dragging down the NHS.
Will the right hon. Gentleman give way on that point?
In a moment. I said that I had given way for the last time, but I will do so once more for the hon. Lady.
Record numbers of very frail, elderly people are arriving at A and E due to a lack of support in their own homes. Between 2009-10 and 2012-13, there was a 48.1% increase in the number of people aged over 90 being admitted to A and E via blue-light ambulance—in other words, 100,000 very frail, very frightened people in the backs of ambulances going round our towns and cities to be dropped off at a busy A and E. That is what is happening on this Government’s watch.
Today’s Age UK report contains aggregated England data. Does the right hon. Gentleman not agree that all over our country there are councils integrating social care with the NHS, and, indeed, increasing their social care budgets? Does he not recognise the good work that is going on in the integration pilots in Cornwall, for example?
I have repeatedly praised Torbay council in the hon. Lady’s part of the world, which was the well regarded pioneer of integrated care. Yes, there are examples of councils around the country trying to do the right thing, but let me make two points: first, the Torbay model has been broken apart by the Health and Social Care Act; and, secondly, councils are trying, but they have been battered by the massive cuts to their budgets about which Age UK is warning today, and which are setting back the cause of integration.
The reality is that elderly people are going into A and E and getting trapped there. As I have already mentioned, there is the sad case of an elderly women in Lincoln who spent an entire calendar year in hospital because a care home place could not be found. That is simply wrong on every level, and it is unsustainable in human and financial terms. The collapse of social care is a root cause of the current A and E crisis because it has led to increased pressure at the entrance door of the hospital, and to the exit door becoming blocked.
For those who still get some support, 15-minute visits are becoming the norm. Richard Hawkes, chairman of the Care and Support Alliance, has said that A and E
“is forced to pick up the pieces when people become isolated, can’t live on their own and slip into crisis.”
My last question to the Secretary of State is: does he agree with Richard Hawkes that cuts to social care have contributed to the extra 600,000 people who now attend A and E every year?
The evidence is clear: on NHS 111, on walk-in centres, on GP services, on social care—this is a mess of the Government’s making. I am sure that the text of the Secretary of State’s speech is full of the usual spin and self-serving excuses, but he must not sit down until he answers directly the four questions I have put to him, not for my benefit, but so that he does not insult the intelligence of the people watching. He is in charge, not me. People are looking to him for answers and solutions, so let me give him some in the time I have left.
As I have said, let us get nurses back on the end of the phones at NHS 111, and let us have a review of the 111 service. I hear that contracts are about to be signed—for instance, to take a contract off an ambulance service—and they will extend this flawed model of care. Will the Secretary of State intervene to stop those contracts being signed until there has been a proper review?
Will the Secretary of State review the plan to relax ambulance response times in the pilot? That is surely the wrong response during this very difficult winter. Is he absolutely convinced that now is the right time to experiment with relaxing established standards? Does it not make sense to delay it until a quieter time of the year, and not to do it in the most troubled ambulance service in the country?
On walk-in centres, would not one of the simplest things the Secretary of State could do to stop the A and E situation getting worse be to commit to halt any further closures? We know that walk-in centres in Jarrow, Nuneaton and Chelmsford are under threat. Would it not help everybody if he just removed that threat today? On GP services, has he considered putting a GP in every A and E?
Will the right hon. Gentleman give way?
I have said that I will not give way again.
All those measures could help in the short term, but the truth is that all parties must recognise that there will not be a long-term solution to the A and E crisis until we face up to the crisis in social care, and rethink how we care for the most vulnerable older people. It is not just about money; we need radical changes in the way we use existing budgets for health and care. We need to merge them so that we can change the way in which we care for older people. We need a model of care that starts in the home and supports people there, so that we can drastically reduce the numbers unnecessarily ending up in hospital and becoming trapped there.
Although that model is not just about money, it is partly about money: if such a transformation is to happen, extra investment will be needed to stimulate it. The Secretary of State likes to hold up the better care fund, but I am afraid that councils and the NHS simply do not share his optimism. It robs Peter to pay Paul: the money transferred to councils is nowhere near enough to backfill the cuts to social care, and it leaves a deepening hole in NHS finances. [Interruption.]
The Secretary of State asks where I would get the money from, and I will tell him. The Opposition have committed to provide extra money for an integrated NHS—£2.5 billion a year over and above what he has committed—with social care as part of a single service for the whole person. By contrast, under the public spending plans the Government have set out for the next Parliament, it is clear not only that the A and E crisis will deepen every year, but that it will soon become a full-blown NHS crisis.
The NHS used to be the Prime Minister’s priority; now it does not feature in his top six election themes. We know that there will be no money for it beyond what the Government have promised, because the priority is tax cuts for higher rate taxpayers, although they have not yet identified where the money for that will come from. If the outlook for the NHS is grim, it is utterly dire for local government and social care. Taking public spending back to 1930s levels will absolutely decimate what is left of our social care system, and if the system goes into freefall today’s problems in the NHS will become entrenched. Will the Secretary of State go back to the Chancellor, argue for a better deal for the NHS and social care, and match Labour’s pledge to prevent a permanent care crisis in the next Parliament?
The NHS is now at the crossroads, and the coming election presents an enormous choice between Labour’s plan to lift the NHS out of its current crisis by investing £2.5 billion in the NHS of the future, and the coalition approach under which—with the Government unable to face up to the mess of their own making in A and E or to produce a plan to turn it around, and unwilling to find the extra money it needs—the NHS is dragged down by a toxic mix of cuts and privatisation. The stakes could not be higher. This crisis cannot go on: patients have suffered enough. They need an election, a change of direction and a Labour Government to secure the NHS.
What utter, disgraceful nonsense! I will rebut every single thing that the right hon. Member for Leigh (Andy Burnham) has said.
This has been a tough winter for the NHS, and I first want to pay tribute to the hard work of staff on the front line who have been working exceptionally long hours in very challenging circumstances. What they want right now is practical help, a vision for the future and a sensible plan to get there—all of which this Government are delivering. They do not want to be turned into a political football. The public have noted that while Labour Front Benchers sometimes sound restrained in parliamentary debates, they are the opposite in the TV studios, where they do everything possible to whip up panic and a sense of crisis. That is not the behaviour of a responsible Opposition.
As NHS England and the King’s Fund have said, the NHS is coping well under real pressure and, in the words of Dr Cliff Mann, president of the College of Emergency Medicine, trying to weaponise it for political purposes is “toxic”. Indeed, Professor Chris Ham, of the King’s Fund, said this week:
“This is a long-term issue not to do with this particular government—the previous government faced many of the same challenges...patients who are really poorly will still get a very good and very quick service.”
In contrast to what we have heard from the Opposition, will my right hon. Friend join me in welcoming the seven-day-a-week GP surgeries opening up across Ealing and Acton and the plans for the new walk-in health centre for Acton? Will he join me in condemning the Labour-led council’s decision last night to cut the public health budget?
That is the reality: there are new and improved services for the NHS up and down the country, but what we get from the Labour party in my hon. Friend’s constituency is scaremongering leaflets saying that hospitals are being closed when they are not. Labour should apologise for scaring very vulnerable people. It claims to stand up for them, but by scaring them it is doing the exact opposite.
Unfortunately, the right hon. Member for Leigh (Andy Burnham) did not do me the courtesy of giving me a right of reply when he mentioned the walk-in centre in my constituency. Does the Secretary of State not think that it was completely irresponsible for the right hon. Gentleman to make such comments, given that the issue was raised by a whistleblower and that the information does not come from the clinical commissioning group that is considering walk-in centres in my constituency?
Exactly. My hon. Friend makes the point very well, and I will tell him something else about the hospital in his constituency. The George Eliot hospital was a failing hospital with very high mortality rates, and its deeply entrenched problems were swept under the carpet by the previous Labour Government, but this Government have turned it around and it is now a successful hospital. It is doing incredibly well because we faced up to the problems that Labour ignored.
Sickness-related absence is going up around the country. In Barnsley, it has gone up by two percentage points in the past two weeks. A one percentage point increase equates to £1 million a year. Not only will that hit budgets, but it is a real sign that the NHS is under severe pressure.
The NHS is under pressure, so the hon. Lady will welcome the fact that Barnsley Hospital NHS Foundation Trust in her constituency has 34 more doctors and 74 more nurses, and that we are currently doing about 2,000 more operations every year for her constituents. Yes, there is pressure, but this Government are investing on the back of a strong economy so that we can put more money into the NHS and give her constituents a better service.
I am going to make progress, but I will give way later.
I want to look at the pressures that the NHS is facing, because the right hon. Member for Leigh asked about the direct causes. There are more than 1 million more over-65s than there were four years ago. Many older people become particularly vulnerable when it is cold, which is why winters are always difficult for the NHS. The truth is that over successive decades, we have made older people more dependent on emergency care by under-investing in primary and community care, reducing the responsibility of GPs for out-of-hours care, removing the personal responsibility for patients from GPs, and failing to integrate health and social care.
The right hon. Gentleman spoke as if that was nothing to do with Labour. However, he knows what damage was caused by the GP contract changes in 2004, he knows that his Government failed to integrate health and social care for 13 years, and he knows that where Labour runs the NHS today—in Wales—the performance is even worse. Instead of debating constructively, he chose to start this year by putting up a scaremongering poster that implied that the NHS would cease to exist if this Government were re-elected. That is not good enough. The whole country can see that, for him, it is not about the ward, but the weapon; it is not about the patients, but the politics. For this Government, it is about the patients.
Does my right hon. Friend understand Labour’s attack on privatisation? Under Labour, the NHS always had private-sector contractors as GPs— and nothing has changed; and it always bought all its pharmaceuticals from competitive, profit-making pharmaceutical companies—and nothing has changed. What is the shadow Secretary of State’s grievance?
Privatisation is one of the most pernicious fears that Labour is seeking to stoke up—not least because, as Secretary of State, the right hon. Member for Leigh allowed the decision to go through that Hinchingbrooke hospital should be run by the private sector. He has been running away from that decision faster than anything that anyone has seen before, because he is still trying to curry favour with the unions.
The companies on the shortlist for Hinchingbrooke hospital were Circle, Serco and Ramsay Health Care. He could have stopped that as Secretary of State, but he did not. He knows—[Interruption.] Those were the three bidders—the private sector-led bids. He could have stopped that process when he was Secretary of State, but he chose not to. That makes my point very well.
The Secretary of State and the right hon. Member for Wokingham (Mr Redwood) asked what had changed. Under Labour, we did not have tendering for £1.2 billion of cancer and palliative care services, as we are seeing now in Staffordshire and Stoke, where the majority of those tendering are private companies. We did not have that.
What the last Government did, that was right, was to say that—[Interruption.] I am just saying what the last Government did right. The hon. Member for Worsley and Eccles South (Barbara Keeley) might want to hear this, because I do not usually compliment the last Government.
To bring waiting times down to 18 weeks, the last Government said that they would support the NHS by allowing the private sector to do some operations. We have continued that policy, not changed it. The result, the hon. Lady will be pleased to know, is that 6,000 more operations are happening every year in her constituency under this Government than in 2010.
For this Government, it is about the patients. That is why we increased the NHS budget; why we hired 9,000 more doctors and 6,000 more hospital nurses; why we are doing nearly 1 million more operations a year than four years ago, with fewer long waits than ever; why we have increased cancer referrals by half, saving an estimated 1,000 lives every single month; and why we have learned the lessons of Mid Staffs by putting in place safe staffing, having independent inspections and turning around six failing hospitals.
Patients say—[Interruption.] The right hon. Member for Leigh should listen to what patients say, because he did not do that when he was Secretary of State. Patients say that their care is safer and more compassionate than ever, with the independent Commonwealth Fund saying that under this Government, the NHS has become the best health care system in the world.
I give way to the former Secretary of State.
Will the Secretary of State confirm that the only reason why he has been able to recruit British doctors is that the previous Government increased recruitment into medical schools by 35%?
I welcome the fact that the previous Government increased training places, but as the right hon. Gentleman will know, having been Secretary of State, those doctors have to be paid for. The NHS budget has not been cut, as the shadow Secretary of State wanted, so we can afford to pay for those doctors. There are 219 more doctors serving the constituents of the right hon. Gentleman because of the decision that this Government took to protect the NHS budget.
Even more important than what we have done for patients in this Parliament is the fact that, under this Government, the NHS has developed its own plan for the next five years, the “Five Year Forward View”. Because we have a strong economy, we can back that forward view with a record £2 billion extra for the NHS front line next year alone.
Part of our commitment to the NHS—this is a real difference between the Government and the Opposition—is that we face up to difficult decisions, including on pay. No one wants to be more generous to staff who work long hours than I do, but the official advice that I received as Secretary of State was clear: the cost of accepting the pay review body’s recommendation would be £450 million, which would mean that hospitals might lay off between 6,000 and 14,000 nurses.
It is easy for Labour to support a pay strike, but it is deeply cynical if it cannot pay for its promises, as it knows it cannot. Labour claims to stand up for staff, but will it today stand up for patients by condemning the strike right in the middle of winter, which was supported by only 4% of NHS workers, or do the votes and financial support of the unions matter more? The test of a party that aspires to govern is not the easy decisions that it makes, but the tough ones. We have seen nothing brave or principled from Labour today.
I have a direct question and I would appreciate a direct answer. If the agency bill in the NHS was the same as the one I left behind, would not the Secretary of State be able to afford the modest, below-inflation increase that the Chancellor promised to all NHS staff?
Let me tell the right hon. Gentleman why the agency bill has gone up. It has gone up because hospitals are trying to recruit doctors and nurses to tackle the problems of Mid Staffs that he left behind. As they improve their staffing, they will gradually get more full-time nurses, but in the short term, they do not want to put patients’ lives at risk.
I want to return to the situation this winter. To relieve the immediate pressures, we have given the NHS a record £700 million, which has allowed it to recruit an extra 796 doctors, 4,700 nurses and 3,094 other staff, making a total of 8,590 additional staff, and to increase bed capacity by 6,400. We have more staff, more beds, more GP appointments and more GPs in A and E than ever before for winter.
What is the impact of the extra support that we have given the front line? The target is to see and treat people in A and E within four hours. Compared with the last full year for which Labour was in office, 3,000 more people are being seen, treated and discharged within four hours every single day. The mean time that people wait for a first assessment has fallen from 77 minutes to 30 minutes, and nine out of 10 people, even under the pressure of the additional visits, continue to be helped within four hours. That performance is better than anywhere else in the United Kingdom—and, indeed, better than in Canada, Australia, New Zealand, Sweden and any other country in the world that measures A and E performance.
While the NHS is straining every sinew to meet high standards, the public will not accept the cynical politics that demands that we call it a crisis in England, while refusing to call it a crisis in Wales, where Labour is in charge and the problems are far worse. According to the House of Commons Library, in Wales, double the number of people are kept waiting in A and E, and nearly double the number of people wait too long for an urgent ambulance. For Labour, poor care matters only when there is a political point to be scored. For a party that aspires to run the NHS, that is simply not good enough. How Nye Bevan would turn in his grave if he knew that the party that founded the NHS was turning its back on patients with such contempt in his own back yard!
Although I appreciate that there will inevitably be a battle between the two parties to a certain extent in this debate, the Secretary of State is at his strongest—this is what I hear from all the health care professionals in my constituency—when he talks about his patient-centred vision for the health service of the 21st century and when he looks away from the here and now and towards the future that we all know is desperately needed by all our constituents: a patient-centred NHS. I hope that he will say a little more about that.
I will, and that is what this is about—putting patients first. That is why we need important reforms such as ensuring that every vulnerable older patient has a named accountable doctor—I will mention that later in my remarks—and why we must remove barriers between the health and social care systems.
It has been well known in the NHS for decades that an ageing population means that more needs to be spent in real terms each year on the NHS than in the year before. In 2010, when the Government came to power, 8.2% of our gross national income was spent on the NHS, but that has now fallen to 7.9%. How can that possibly be an increase in the Conservative party’s commitment to the NHS?
Because the only way we could return the economy to growth was by tackling the deficit left by the Labour party—the worst deficit in the developed world. Labour left us with that problem; we have sorted it out and are turning the country round. If the hon. Gentleman wants to increase spending on the NHS, as I do, the only way to do that is through a strong economy, which is what the Government are delivering.
Several hon. Members
Let me make some progress. In A and E, as everywhere in our hospitals, it is important that whatever the pressures, people are given safe, compassionate care. Our NHS is one of the safest systems in the world, but we still have around 1,000 avoidable deaths every month. We still put the wrong prosthesis on someone once a fortnight, operate on the wrong part of someone’s body once a week and leave a foreign object in someone’s body twice a week. Just five years ago, we had the tragedy at Mid Staffs, which, we should never forget—[Interruption.] I am quite shocked that people are laughing when we are talking about harm that happens in the NHS every month and about what happened at Mid Staffs. We must not forget that Mid Staffs was hitting its A and E targets for much of the period that that same department was tolerating the most horrific care. Whatever the pressure to hit targets, the Government want every vulnerable person to be treated safely and with the highest standards of dignity and respect.
Two years ago, we introduced the toughest inspection regime anywhere in the world. The result was over 6,000 more nurses on our hospital wards, cases of MRSA and clostridium difficile halved over this Parliament and more than 200 NHS organisations have signed up to halve avoidable harm and avoidable death over the next three years. Care is getting safer. While we lead the NHS through that painful process, what is the reaction from Opposition Front Benchers? They criticise us for running down the NHS and still maintain—as the right hon. Member for Leigh did in December—that it was a mistake to hold a public inquiry into Mid Staffs. He talked about listening to patients, but this is what Julie Bailey, a Mid Staffs campaigner whose mother was a patient at Mid Staffs said about his comments in December:
“The message he is sending out is that it is better to cover things up than to criticise the NHS, however bad things are. The inquiry uncovered huge failings in the NHS and he thinks it shouldn’t have taken place at all. It is very worrying because if he becomes Health Secretary again at the election it is clear we would go straight back to the bad old days of covering up.”
One problem last month in my local hospital, the Princess Royal university hospital, was the lack of space, and ambulances were backed up. It is not just a staffing problem; it is a spatial problem. Does the Secretary of State agree that if we had more space in A and E departments, we could get people off the streets?
Space is a problem in some A and Es, which is why we have expanded A and E capacity. Other places have different problems, but the long-term solution is to have improved capacity outside hospitals in community care. That is the real challenge and what the “Five Year Forward View” is about.
Given what the Secretary of State has just said, may I gently remind him that I was the Secretary of State who appointed Robert Francis QC to inquire into what happened at Mid Staffs, against the advice of the Department of Health, and that report was published before the last election. If he is being fair, he should bear that in mind at all times.
The Secretary of State reeled off a list of things that are wonderful in the NHS today—everything has got better; everything is fine; and it is the best in the world. At the beginning of the debate, I reeled off cases of people waiting hours or even dying while waiting for ambulances, or being treated in cupboards. I hope that he will not conclude his remarks without addressing the very real suffering and poor care that is happening across England right now.
If the right hon. Gentleman did such a wonderful job and wants to talk about Mid Staffs, why are patient campaigners so outraged by his comments and feel that he did everything he could to brush those problems under the carpet?
Will the Secretary of State give way?
I will give way to the former Secretary of State in a moment, but I want to finish—[Interruption.] Exactly. I have read the Francis report and I have acted on it. [Interruption.] I have just listed what we have done: £700 million, 4,700 more nurses and 800 more doctors.
It’s not working.
But the right hon. Gentleman’s constituency has more doctors and more nurses who are seeing more people every year within four hours and doing 4,000 more operations every year. That is working for his constituents, but there is pressure out there and we need to support people through a difficult winter.
The right hon. Gentleman mentions stories that are, of course, very tragic, but never once has he brought up stories about the problems happening in Wales. Too often, we get the impression that, for Labour Members, poor care under a Labour Government—whether in Wales today or Mid Staffs previously—does not matter as much as poor care under this Government when they can make a political point. A party that really cared about the NHS would be as outraged about problems when they are in power as they are when in opposition. For this Government, poor care is poor care, and we will deal with it wherever and whenever it happens.
Does the Secretary of State remember the words of the Prime Minister when he stood at the Dispatch Box and presented the report from Stafford? He said that what happened at Stafford was not the fault of any previous Secretary of State, including my right hon. Friend the Member for Leigh (Andy Burnham). The Prime Minister was a statesman on that occasion; it is a shame that the statesmanship has slipped since.
I have a great deal of respect for the former Secretary of State, but if he had followed the debates on Mid Staffs in this Chamber he would know that my disagreement with the shadow Health Secretary is over the reaction to Stafford and whether we will learn from those mistakes. When I have made speeches talking about the problems of poor care in the NHS today, he goes straight out to the TV studios and says that that is running down the NHS. That is not acceptable when we are taking difficult decisions to turn round failing hospitals and face up to problems in exactly the way suggested by the Francis inquiry.
Several hon. Members
I will make some progress because I want to answer some of the questions asked by the right hon. Member for Leigh. One reason for the pressure I have outlined is that people increasingly expect to get medical care 24/7, just as they are able to bank, shop and book their holidays 24/7. The NHS cannot be King Canute and try to stop that—I am not blaming patients, but that is how patient expectations are changing, and we need to give them better alternatives to turning up in A and E.
Over the past two years, we have expanded weekend and evening GP appointments for more than 5 million people. We have also rolled out the 111 service, which now handles—these are the facts—three times more calls every year than its predecessor, NHS Direct. The right hon. Gentleman criticised 111, so let us look at the facts. Of those who call 111, 30% say they would have gone to A and E but decided not to as a result—that is 2 million journeys to A and E and around 600,000 ambulance call-outs avoided because of 111. Unlike NHS Direct, one third of all 111 centres can now access a summary of people’s GP records, and that will apply to nearly all 111 centres this year. Not only can people talk to a doctor or nurse, as they did with NHS Direct, but if they give consent they can do something that they could never do under NHS Direct and talk to someone who knows about them and their medical history.
Another big challenge facing A and Es is the increasing complexity of the illnesses that people are presenting with, including many older people with conditions such as dementia, diabetes or asthma. Such people often end up being admitted to hospital rather than treated and sent home, and that is not just challenging for the system; it is often wrong for the individual. A busy A and E can be the worst possible place for a frail, older person with dementia, which is why in our vision for the NHS every vulnerable person has a doctor who is continually responsible for their care, whether or not they are in hospital, and who ensures that they have proper care wrapped around them, thereby reducing the likelihood of emergency hospital admissions. Too often, that does not happen. Too often, the buck stops with no one. That is why, this year, we reversed the 2004 decision and brought back named GPs with personal responsibility for everyone aged 75 and over. That is helping 4.5 million people. With 800,000 of the most vulnerable people, we are going even further, giving them guaranteed rights to prompt and proactive care from their GP.
On social care, for too long, some of the most vulnerable people in our country have suffered from disjointed care with NHS and social care systems that, rather than talk to each other, constantly try to pass the buck. For the first time from this April, we have required all local authorities and NHS organisations to work together to plan care in a joined up and seamless way, as part of the better care programme.
Will the Secretary of State give way?
I am going to make progress.
When that happens, we should see, for the first time ever, not an increase but a reduction in emergency hospital admissions. For patients, that will mean something important: a doctor or nurse will be in charge of every person in the social care system; medical records will be shared, so that people get safer and more joined-up care; and joint teams will work together across the NHS and social care systems, rather than the silos and boundaries that have plagued the system till now.
The Government have never pretended that the challenges facing the NHS are straightforward, but with more doctors, more nurses, more operations and safer care than ever before, we have shown our commitment to that most precious institution. We have put our money where our mouth is, with protection for the NHS budget during cuts, financial help this winter and support for the NHS’s plan for the future. More important than the money are the values behind it: our passion for the highest standards of compassionate care for every person who needs the NHS. Good care, not clever politics, is the future for our NHS.
Several hon. Members
Order. I should inform Members that 28 Back Benchers are seeking to take part in the debate this afternoon. I hope that it will not be necessary to have time limits, but I ask each Member to consider speaking for only eight minutes approximately, or 10 minutes maximum. If any Member speaks for too long, it will subsequently be necessary to have a time limit, which could be quite severe on the last few speakers. That would be unfortunate, so if that could be borne in mind and if Members watched the clock, that would help enormously.
Thank you, Madam Deputy Speaker. I will do my best to comply with your instructions.
As the Secretary of State was talking, my mind went back to the “responsible opposition” of the right hon. Member for South Cambridgeshire (Mr Lansley). I remember the efforts that went on for more than 40 years around Manchester to tackle the appalling level of infant mortality by reconfiguring maternity services. As the local newspapers said, that was stopped at every stage by politicians defending bricks and mortar. In the end, when that change went through, it was the Opposition who tried to reopen the issue. Before my noble Friend Lord Ara Darzi became a Minister, he did a very important review on London, where there were more single-handed GP practices than anywhere else in the country post-Shipman, and people attending A and E was a bigger problem than anywhere else. Lord Darzi put forward sensible proposals, which were agreed by clinicians and the NHS in London, but the right hon. Member for South Cambridgeshire opposed them. He issued an unfortunate press release about polyclinics—unfortunately, he spelt it “polly”, but it was not a clinic for parrots. I said to him, “Don’t adopt a policy that you can’t spell.” There are numerous examples of the previous Opposition doing that.
I bet I am not the only one in this House—I bet there are Members in all parts of the House—who rues the day when the right hon. Member for South Cambridgeshire got his hands on the NHS. His ideas for what to do, which culminated in the top-down reorganisation, were not new—I remember them from my first day as Health Secretary. He is not a bad man who hates the NHS, by the way. In many ways, he has great affection for the NHS, but he got things totally wrong. He slung across his draft Bill on what the NHS would look like after his top-down reorganisation. I read it that evening and it was horrendous.
The Government have done two things to erode confidence in politics in this country. The first is the Liberal Democrats’ conversion from opposing tuition fees to the extent that they wished to abolish them to supporting tuition fees to the extent that they agreed to treble them. The second is the Conservatives’ conversion from a pledge that there would be no top-down reorganisation of the NHS to the implementation of a top-down reorganisation so huge that, in the words of the previous NHS chief executive,
“you can see it from space”.
That is a vivid but not inaccurate description of a reorganisation that closed 170 organisations, created 240 new ones, made 10,000 staff redundant and re-employed 2,200 of them.
I will not highlight the right hon. Gentleman’s role in tripling tuition fees. The shadow Secretary of State said that, when he came into office—this is part of his defence— he got rid of the pro-privatisation agenda that he inherited. Who does the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) believe the shadow Secretary of State was criticising in that comment?
I do not understand the hon. Gentleman’s point about my role in trebling tuition fees. I certainly was the higher education Minister who introduced tuition fees, against fierce opposition. I supported them and made the arguments—all the arguments we now hear from Liberal Democrats—against the opposition of the Conservative party.
In terms of privatisation, we did introduce independent treatment centres. At every stage, we asked the local NHS, “Have you got the capacity to get these waiting lists down? Have you got the capacity to carry out the elective surgery without denuding emergency services?” which happened all the time. Hon. Members will be surprised how many found that capacity when we said, “Okay, we’ll introduce an independent treatment centre.” Suddenly, consultants stopped going to the golf course and taking Saturdays off. They got the waiting times down. In places that did not have capacity, we introduced independent treatment centres. The role of the NHS is to treat patients, and I am very proud of the record that we and my successor, my right hon. Friend the Member for Leigh (Andy Burnham), stood on in 2010.
Does the right hon. Gentleman agree that, since the late 1980s, every Secretary of State from both political parties, with the exception of the right hon. Member for Holborn and St Pancras (Frank Dobson), accepted that one could raise the quality of patient care by introducing competition and choice of provider in the system? The right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) quite sensibly pursued that policy, as did Alan Milburn, with particular vigour, and the shadow Secretary of State when he was in office. Will the right hon. Gentleman try to encourage his successor not to go back on that, because the health service is now much better at coping with the problems of changing demand than it was 20 or 30 years ago?
The right hon. and learned Gentleman knows, because we have debated this before—I will come on to some of the history—that the big difference between what he and other Governments did during the 1980s and what we did is the single tariff. They competed on price. We had a single tariff that meant that, wherever that operation took place, it was paid for at the same rate.
With that top-down reorganisation that we could see from space, all the Conservative party’s efforts to convince the public that they could be trusted with the stewardship of the NHS were thrown into disarray at a stroke. The fact that the NHS tops the list of public concerns as we approach a general election can be traced to that self-inflicted wound.
The Conservative party leader’s efforts to detoxify the Tory brand vis-à-vis the NHS could be described as an attempt to return to the consensus that existed prior to the 1980s. The great historian of the NHS, Rudolf Klein, says that following its contentious birth there followed 35 years when the NHS was “cocooned in consensus”. That changed in 1982, when the Thatcher Government’s internal think-tank, the Central Policy Review Staff, produced a paper with the option of replacing the NHS, a tax-financed health service, with a system of private insurance. This option—the right hon. and learned Member for Rushcliffe (Mr Clarke) will probably remember this—was, incidentally, presented to Ministers not by the Secretary of State for Health but by the Chancellor of the Exchequer. It was defeated thanks to the efforts of Norman—now Lord—Fowler, but it expressed for the first time the idea that a tax-funded NHS was wrong and broke that 35-year consensus.
From that moment, through weird and wonderful ideas, right up to 2005 when Conservatives Members stood on the platform of the ridiculous patient passport, their policy has been about taking money out of the NHS and changing the very principles of the service. I could not describe it better—I think there would be agreement on this—than the great American clinician and health care expert, Donald Berwick, who I believe the Secretary of State has used during his time in office as an adviser. He describes the NHS as
“one of the truly astounding endeavours of modern times”
and, in a wonderful phrase, as
“a towering bridge - between the rhetoric of justice and the fact of justice.”
This ideological battle is not over. Indeed, it has just been joined by the ultra-Thatcherite leader of UKIP. The hon. Member for St Ives (Andrew George) is no longer in his place, but he was perhaps right in thinking that we should get back to a consensus on the NHS.
We could raise relevant arguments about many aspects of the NHS. Indeed, my colleagues in Hull and I are talking to the Secretary of State about some issues central to Hull. However, in this speech I do not want to talk about clinical health or the successes of the NHS. I want to talk about one of its failures. At the tenth anniversary of the NHS in 1958, there was a debate in this Chamber. Nye Bevan, the great architect of the NHS who was mentioned earlier, stood up and said what a great success it had been, but that the failure had been mental health. He spoke, using the language of the time, of the disgraceful conditions in our mental hospitals. Of course, there has been a huge improvement since 1958, but it remains a fact that mental health is a poor relation of the NHS, and children and adolescent mental health is a poor relation of that poor relation.
I would like to cite three awful statistics published by the Office for National Statistics. First, 10% of children between the ages of five and 16—or to put it another way, three in every class—experience mental health problems. The second disgraceful statistic is that that figure rises to 60% when applied to children in care. The final disgraceful statistic is that 95% of imprisoned young offenders have a mental health disorder. Many of those young offenders should not be in prison at all. I have raised the case on the Floor of the House of my constituent, Vince Morgan, a young man with a severe psychotic illness who committed suicide in a prison cell having been failed by every single organisation and authority that was meant to help him. Section 136 of the Mental Health Act 1983 is still being used to incarcerate children, mainly as a result of the failure to provide sufficient in-patient tier 4 child and adolescent mental health services facilities.
Forgive me for being parochial, but this is a crucial issue in our area. In Hull and East Riding, we were served well by an in-patient unit called West End for 20 years. When NHS England assumed responsibility for tier 4 services as a result of the changes from the reorganisation—all other tiers being the responsibility of the local clinical commissioning groups—it changed the specifications for tier 4 units, saying that they had to be open seven days a week, 24 hours a day. There was no consultation with anyone. This was done in March 2013. As West End was open only from Monday to Friday, with children spending the weekends at home—a regular feature of CAMHS treatment—the unit was closed. The option of extending the provision, so that it was a seven-day service, was never offered. Parents of children who had benefited from this important part of the NHS had no input whatever in a decision made by a huge quango that had no local accountability and no local presence. So much for the glib slogan, “No decision about me without me”.
I raised this issue in the Chamber on 23 October. The Minister of State, Department of Health, the right hon. Member for North Norfolk (Norman Lamb), who is in his place, gave me a sympathetic response. I am convinced that he cares deeply about the problems of mental health, but he appears to be entirely powerless to do anything about them. Since then, there has been a review of tier 4 services by NHS England, which, as the Health Committee has said:
“does not provide a conclusive answer on the reasons for the current problems, nor on whether there are sufficient beds”.
In addition, that Health Committee report, published in November, pointed out that NHS England had
“presided over a system which has resulted in children being sent hundreds of miles to access care.”
There has been no resolution on this issue in Hull and East Riding, or in other parts of the country, such as Devon and Cornwall. We have a foundation trust provider that recognises the problem and has identified a site for a new seven-day in-patient service, but the commissioner at NHS England has yet to commission. The CCGs are powerless. The acute trust often has to open its adult wards to children.
Let me tell the House what this means to the victims of such failure—to the children who were once so well served by the West End unit. Maisie Shaw is a 13-year-old who has had serious mental health problems since her father died two years ago. Her mother, Sally, is a teacher. Clearly, children need to be close to their family when they are undergoing treatment. Family involvement is a crucial aspect of their recovery. In December, Maisie took an overdose after breaking into a locked medication box at her home in Hessle. As it was a Saturday, there were no CAMHS staff on duty and, of course, no in-patient facility. She was taken to Hull royal infirmary on Saturday and cared for in a locked ward at the maternity hospital, with a 24-hour guard until Monday morning. She was sent to Stafford, which is almost 200 miles away, and then to Sheffield, which involves a round-trip of 120 miles by her family to visit her. As part of her treatment, she will be home at weekends, but when her mother asked what help would be available for this very disturbed child if there was an emergency, she was told to ring 999.
The subject of my debate in October 2013 was Beth Hopper, who is now 15. Beth’s mother, Kathy, is a staff nurse for the NHS. Beth is an extremely intelligent girl who has, according to her school, huge academic potential. She suffered a severe mental breakdown at the age of 11 and spent nine months at the West End unit, which opened at weekends specifically to tend to her needs. Kathy believes that the unit saved her daughter’s life. Since West End closed, Beth has been sent away 19 times. She has been to Cheadle, 103 miles away. She has been to Liverpool. She has been to Warrington. She has been Nottingham. She has been Widnes. Of course, while there is no argument that to travel further for more expert care is a factor in physical health, it is rarely the case with mental health, particularly when the patient is a child. Indeed, Maisie and Beth’s clinicians in Hull often have to travel to care for her in these distant locations, thus adding to the cost of that care. It is no exaggeration to say that the condition of Beth and Maisie is actually being made worse by this treatment. It is truly scandalous.
So that Beth’s voice is heard in this debate, I will read out a letter that she sent to her mother the other week. She wrote this:
“I really just don’t know what to do or what I want, or what is best for me anymore.”
Forgive her grammar.
“I aren’t happy here. I am happy at home, but I am scared that things might go like they were before. I just want normality. I want to have the chance to be a kid for once, before it is too late. I feel as though nobody is listening to me. I am so isolated here I am scared to join the groups and don’t want to make new friends anyway. I want my old friends, who I miss.”
We need to hear these children’s voices.
I am listening with sympathy and concern to the case histories that my right hon. Friend is describing. He might be surprised to learn that a constituent of mine with mental health problems was sent to Hull, without any consultation with his family.
It could not have been a CAMHS service, because we have no tier 4 service available in Hull.
I have cited two long-standing cases from my average-sized constituency, but I have recently heard about another case—that of Jordan Hatfield, a 15-year-old who, last May, took 45 paracetamol tablets in an attempt to end her own life. She spent six days on a medical ward and has been in Cheadle for the past week. Her mother does not drive and has small children, so it is impossible for her to visit. My colleagues in east and north Hull, and across the East Riding, will have other examples, because, as the Select Committee and NHS England, in its obscure way, pointed out, there is a lack of services in this huge swathe of eastern England.
On the wider question of mental health, we will not achieve parity of esteem by cutting funding. NHS trusts providing mental health care have lost £250 million of funding since 2012—the first fall in a decade. In addition, as my right hon. Friend the shadow Secretary of State pointed out, two thirds of local authorities have reduced their CAMHS budgets since 2010, while more than three quarters of adults who access mental health services had a diagnosable disorder before they were 18, yet only 6% of the decreasing mental health budget is spent on under-18s.
The report of the taskforce on mental health in society, commissioned by my right hon. Friend the Leader of the Opposition, and published on Monday, has much to recommend it, particularly the right to mental health treatment in the NHS constitution; expansion of the enormously successfully IAPT—improving access to psychological treatment—programme; and the introduction of waiting-time standards for access to CAMHS. These are good ideas, and they need to be put into practice, regardless of which parties are in government. However, somebody needs to get a grip of this issue now. We cannot go on letting our children down in this horrendous way.
I will do my best, Madam Deputy Speaker, to stick to the eight-minute guideline—without casting any aspersion on the previous speaker, the illustrious former Secretary of State. I shall be watching the clock.
So much has been said about the situation nationally, and I found the speech by the shadow Secretary of State, which I listened to carefully, very political, controversial and adversarial. I shall do my best not to speak in that manner. Instead, I would like Members to listen to my personal experiences in the Watford area, from speaking to people and visiting, several times, the A and E department, the general hospital, the clinical commissioning group, and so on. As a Back-Bench Member, that is about the best I can do. It is very confusing watching these tennis matches—as soon as the Secretary of State says something, the shadow Secretary of State is on television saying completely the opposite. It is confusing for people who work in the NHS and the rest of our constituents.
As the Secretary of State said, there is unquestionably pressure on the NHS. Everybody knows that. We all know the statistics about people getting older and needing more medical care. I frequently have to ask my mother, when she phones the GP every other day, “Is it necessary?”, and I am sure she thinks it is always necessary, because when people get older, they need care, and the Government have to respond to that. However, these insinuations and open statements by the Opposition that NHS spending has been cut are untrue, and they frighten people. It is a fact—it cannot be disputed—that spending has increased in cash terms every year since the coalition came to power and by £13 billion overall, and will increase by £2 billion alone next year.
I have spoken to consultants and nurses at Watford A and E—I have been there nearly every week since the beginning of the year—and I have seen ambulances backing up, and all the things that people on both sides of the House have mentioned. When I ask the A and E consultants why, they say, “These are not people with trivial illnesses, but people with serious concerns.” It is not a question of people with sore thumbs phoning the national number and being sent to A and E—I am certain of that, having spoken to many people in reception. We are not talking about people who should be going to see a nurse or a walk-in centre; these are serious matters, and there are a lot more of them. The extra GP hours will help, but I will come to that later.
The Watford area is making progress, however. Northwick Park hospital has just opened a big A and E, which I am sure will take off some of the pressure; the Herts Valley CCG has had a 5.5% increase; and there are more than 1,000 extra doctors in the region since 2010—I have seen them; they are not just a statistic. I have spoken to them and the management. They are real people. Similarly at Watford general, we have 142 more full-time nurses. I opened a new ward last week at Watford general, and there is a £1.6 million ambulatory care unit. There are lots and lots of new things, yet Labour did a party political broadcast from Watford hospital that really annoyed the staff, the management and my constituents, because it frightened people and gave the impression that the service was disintegrating and disappearing.
On the important subject of GPs, there is no question but that it was a mistake by previous Governments to restrict GP working hours. I commend the Watford Care Alliance for being among the first to get money under the Prime Minister’s fund to finance seven-day opening for GP services till 8 o’clock, which has made a significant difference. In Watford alone, there will be 16,000 extra appointments this year, which is a lot.
I am delighted that the Health Secretary came to visit Dr Mark Semler, whom I hope he will agree was inspirational in the way he spoke about the programme. He is a local GP who has taken this challenge on. Of course, there are big challenges with IT and explaining it to other staff in the area, but he is an inspirational man, and I think we had a constructive conversation with all the doctors about the implications of this policy. They have taken on the extra hours, and they know it is providing a service. In time, it will help significantly in providing a service to my constituents and taking some of the pressure off A and E.
I am pleased that Watford was one of the first in the country to do that, and I think it has been a success. I know the Government’s ambition is to roll it out to the rest of the country, which would be a major step forward. The actual infrastructure—the offices, the surgeries, the premises—are there, and to anyone from a background outside the public service, it would seem strange to have all those assets and not to use them for the benefit of the customers, who, in this case, are the patients. I commend the Government for that and I thank the Secretary of State that Watford was one of the first places in the country to do this.
Finally, I want to comment on the air ambulance service, which, as he often does, my hon. Friend the Member for Bedford (Richard Fuller) mentioned earlier. I have seen it and think the service is very impressive, and I hope the Government will consider giving it some of the LIBOR funding—it would be an excellent use of that money.
I thank my hon. Friend for his constructive speech. It is incredibly helpful, because a lot of people get very concerned when we play “Punch and Judy” occasionally. Does he recognise the role of pharmacies, which are a key part of our NHS that we need to make greater use of?
My hon. Friend makes a good point. Some pharmacists feels under threat from internet pharmacists—not illegal ones abroad, but proper ones—but the personal contact with pharmacists and the advice they offer can provide them with an enhanced role in the internet era. So I agree with him totally.
And that, Madam Deputy Speaker, concludes my comments.
Whatever people like or dislike about the language, I do not think anyone could deny that the NHS at the moment is struggling to care for patients in the way that the hard-working staff in the NHS would like to be able to care for them and to deal with them as promptly as they would like. Everyone recognises that the NHS is managing to cope only because of its amazingly dedicated staff doing amounts of work and quality of work far above the call of duty. I have to say that a nurse from one of the two great hospitals in my constituency, to which the Secretary of State referred, said to me, “If he says how wonderful we are and then defends us not getting a pay increase, I will throw up.” I do not think she intended doing it in front of patients, but the hypocrisy of the approach she describes seems to me to be indefensible.
This situation is not entirely novel. A and E has been facing difficulties and has been overstretched in many parts of the country, even during the summer. That is largely because too many people are having to go to A and E or are being taken to A and E because they cannot be looked after properly at home. That is one of the main reasons. If people are kept in, there are not enough beds. I noticed that the Secretary of State quoted the King’s Fund. Having been interested in health care in London for 40-odd years, all I can say is that the main contribution of the King’s Fund has always been to demand reductions in the number of hospital beds; then, where there are not enough of them, it comes up with a million reasons why there are not enough—none of them being that there are too few beds; it is always some other factor rather than the shortage of beds itself that it manages to blame.
The reason why people, particularly the elderly and the physically and mentally disabled, have to go into hospital is that they cannot be safely looked after at home. Once they are in hospital and occupying a bed, they cannot safely be discharged home. So, they are brought in because there is no adequate care at home, and they cannot go back out of a hospital bed because there is no adequate care at home. The Government simply cannot get away from the fact that there have been massive reductions in care at home, particularly for the elderly. Logic suggests that if there are more elderly people who are chronically ill, there should be an expansion of the service to meet the increased need. In fact, however, services have been contracting.
The excellent work done by my hon. Friend the Member for Leicester West (Liz Kendall) a fortnight ago—just a small aspect of it—demonstrated that there had been almost 200,000 fewer people getting meals on wheels. I do not know whether the Government ever deigned to consider the impact of that, but if old people who previously relied on meals on wheels were not getting them, they were probably no longer being properly fed, and if they were not being properly fed, they were more likely to need nursing care. If no additional care was available, they were more likely to go to A and E and, once they had gone into a hospital bed, they were less likely to be safely discharged simply because they were no longer getting meals on wheels.
The meals on wheels service does not have the function only of providing food. On every day that a person gets meals on wheels, somebody is checking how they are doing, and it gives those who are lonely some human contact. The disappearance of all those meals on wheels will undoubtedly have led to more elderly people having to go to A and E, and fewer elderly people being able to be treated safely at home.
I am listening carefully to what my right hon. Friend is saying. He has the perspective of a London MP. In Hull over the Christmas period, we had the longest wait for A and E in the country—and this at the same time as we have seen a quarter of the local authority budget being cut, which impacts on social care. It seems to me that the two are very closely related. Does my right hon. Friend agree?
I entirely agree with that. The fact is that the services that can be provided at home need a higher priority than they have had in the past—under any Government. They need more staff with more time, because many of the people attempting to provide a service are given a quarter of an hour to dash in, help somebody wash or cook and then dash out again to rush along to somewhere else. If one person takes up more than a quarter of an hour, they will be late for the next person they are supposed to be looking after. What is more, all these people get lousy pay. In fact, the level of pay that such people get is a disgrace.
We also need a massive improvement in the co-ordination of services between hospitals, GPs, health visitors, nurses and the people providing those practical cleaning services and so forth. This will cost more. Anyone who pretends that we will not have to pay some more to get a service that works to replace one that does not is either just misleading themselves or—in the worst version—misleading other people.
Previous Governments have not expanded the services in line with the need, but the recent response of this Government has been to contract the service available, which is indefensible. Proposals under the new regime—if that is the right term, Madam Deputy Speaker—have brought about fragmentation, competition and binding legal contracts between various providers of these services. If anybody thinks that will improve co-ordination, they are again either deceiving themselves or attempting to deceive the rest of us.
In this country and in this House, we have to wake up to the fact that if we want a first-class service, we are going to have to pay a first-class fare. That was something I wrote in a long and entirely personal memorandum to the Prime Minister, not long before I foolishly resigned as Health Secretary. I pointed out that a massive increase in investment was needed. I am quite proud of some of the things I did when I was Health Secretary. That might have been the most important thing I did, because about two years later, the Government put an extra £40 billion into the health service. To be fair to the Prime Minister, I received a note from him saying, “Your long personal note triggered what we did.” I felt pretty glad about that.
When we talk about these issues, we need to bear in mind that our NHS is easily the most cost-effective system in the developed world. The total we spend on health care is 9.4% of gross domestic product: the Germans spend 11.3%, the French 11.6% and the United States, which has an insurance system like the one the leader of UKIP wants to introduce here, spends 16.9% of their GDP on health, and life expectation there is lower than ours.
The other really startling point, when we get people such as the King’s Fund and others demanding reductions in the number of hospital beds, is that for every 1,000 people we have three hospital beds, while the French have more than six and the Germans eight and a half. So far as I know, there is no daft consensus in either of those countries to get down to the British level.
It was a pleasure to listen to the right hon. Member for Holborn and St Pancras (Frank Dobson). I was particularly struck by the point he made about the important case for investing in our health and care system. I dare say that the note that he mentioned will in due course be published under the 30-year rule, and that we shall then have a chance to read the full text. It must be said, however, that it took nearly four years for the argument he was advancing to be understood and acted on, and that those were lost years during the a 13-year Labour Administration.
I should point out that, partly as a result of earlier negotiations, we had secured an increase of £20 billion.
I may return to that point later, but first I want to talk about my own experiences of my local national health service, and in particular about a visit that I paid to my local trust, Epsom and St Helier University Hospitals NHS Trust, at the beginning of the month. During the visit I had a chance to meet staff, including A and E staff. I pay tribute to the hard work that is done in the trust, and especially to the work that is done in the A and E department. Last week Epsom and St Helier was placed sixth among all the London trusts in terms of the time for which people were having to wait in A and E, when measured against the standard, and, according to figures that were published yesterday, 99% of people are seen within the standard four hours. That is an example of great performance. The trust is facing great pressure, but it is doing a fantastic job none the less, and that side of the story ought to be told. We ought not to focus only on hospitals that may not have learnt some of the lessons that have been learnt by my local trust.
The A and E staff members whom I met made it clear that there was no single cause of the pressures in their department. In fact, the precise mix of factors varies from one hospital to another, and from one area to another. St Helier, however, has made excellent use of the winter funding it has received. It has added capacity to A and E, and has introduced examples of good practice. For instance, there are daily reviews of patients to ensure they are being given the right treatment in the right place; patients who are ready to be discharged are identified on the previous day so that arrangements can be made in good time; and there is a system of “ward buddies”, enabling corporate staff to provide additional administration support at times of extreme pressure—such as the present time—in order to assist safe discharge. A further welcome boost is the news that an extra £325,000 has been provided to assist people’s safe discharge to their own homes or to step-down care.
A piece of work examining the position in the Sandwell and west Birmingham area revealed huge variations between attendance rates by practice. Its authors found that some people considered A and E attendance to be the norm, and that a fifth of attenders made a conscious decision to go to A and E on the previous day. They also found that many A and E attenders believed that it was not even worth trying to access primary care in the first place. There are issues relating to communication, understanding of the system, and how we explain it. That cannot be dealt with in a universal, national way; it must be tailored to patients’ preferences and their expectations of the system at local level. That piece of work has already helped those in Sandwell to think about how to target messages more effectively in order to ensure that people have access to the support they need at the time they need it.
Does my right hon. Friend agree that there should be a proper investigation into winter planning in each area? As he says, factors vary greatly. In my area, for instance, the factors affecting Addenbrookes hospital are very different from those affecting the Lister hospital in Stevenage. I think that planning needs to improve. This year, the same thing happened throughout the country. The A and E departments asked for £700 million, the Government gave it to them, and yet there have been all these problems.
I think it important for the system to learn lessons from the areas where winter planning has worked well, and for us to ensure that those lessons are transferred and replicated around the country. The NHS is not always as good as it could be at ensuring that lessons are not just stuck in one place.
Will the right hon. Gentleman give way?
I must make some progress if others are to have a chance to speak.
The NHS has grappled with a productivity challenge during the current Parliament, but it should be noted that it was first set up and signed off by the last Administration. The target was £20 billion, and it was to be delivered within a shorter period than the coalition Government set in their 2010 spending review. The Labour productivity programme was set in 2009, and it was clear then that the NHS was on notice that it faced a very tough settlement regardless of which party was in government after the 2010 general election. Reducing management overheads has been a key part of our efforts to balance the books during this Parliament. Focusing on the management overhead costs of the commissioning side of the NHS in the legislation that went through the House at the beginning of the Parliament was sensible, and increasing clinical involvement in commissioning was another important move.
Will the right hon. Gentleman give way?
I will not, because I want others to have a chance to make their speeches. I hope that the right hon. Gentleman will forgive me.
In fact, that legislation did not change the configuration and organisation of hospitals, although that is how it is routinely portrayed by Opposition Members. As a result of the change to commissioning, £1 billion a year is now being saved, and there are 13,000 more front-line staff in the NHS. Having laid the blame for the pressures on A and E on a reorganisation of the NHS, which is the central proposition advanced by him today, the shadow Secretary of State then tells us that the solution is another comprehensive reorganisation. Is he now suggesting that that is not the case?
Will the right hon. Gentleman give way?
I will, unlike the right hon. Gentleman on many occasions earlier.