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Westminster Hall

Volume 597: debated on Wednesday 1 July 2015

Westminster Hall

Wednesday 1 July 2015

[Mr David Crausby in the Chair]

English Votes for English Laws and North Wales

I beg to move,

That this House has considered English votes for English laws and North Wales.

It is good to see so many hon. Members from across the United Kingdom who are interested in North Wales. That was the purpose of this debate. We live in interesting constitutional times and I welcome the opportunity to put the case for Wales, and North Wales in particular. In the 1880s we had the Irish question. In the latter part of the 20th century, there was devolution to Scotland, Wales and Northern Ireland and we had the West Lothian question. Today, we have the North Wales question, which is an important constitutional issue.

Although I support it, devolution is unbalanced, asymmetrical and needs adjusting, but I do not believe the Government’s proposal for English votes on English laws is the answer. The UK Parliament is creaking and the devolution settlement is messy, but we need to deal with it objectively through a UK constitutional convention. That is the basis of my argument.

I want to make it clear that I support devolution. I supported it in the 1970s, when the majority of my party did not, and I supported it in 1997-98, when it was the will of the Welsh people, and the people of Scotland and Northern Ireland. It is important to remember that part of that devolution settlement was the creation of the London Assembly and the establishment of the Mayor of London, giving powers to the largest city in England. That was important, but we should have gone further. I am not just saying that with hindsight; I was arguing for it at the time, before I was a Member of Parliament, because I could see that it was an uneven settlement. I should have liked the regions of England to have an element of devolution, too, because that would have provided balance.

I go a step further than my party: I believe in a federal United Kingdom. I think we should have an English Parliament within the UK. We should retain the UK Parliament for foreign affairs and other bigger issues that concern the whole United Kingdom. I know, because I am a realist, that this is not an issue for today, but we must look to the future for a UK convention on constitutional rights.

Will the hon. Gentleman explain whether there would be a separate House of Commons in a federal organisation, compared with the English basis, or can they be combined?

I appreciate that intervention from a fellow islander. I was in Jersey yesterday, watching the Island games and cheering Isle of Wight on. The hon. Gentleman makes a serious point. We need a proper convention to consider these issues, because some of the arguments have not been dealt with in great detail in this House. The knee-jerk reaction of having English laws and English votes is not the answer; it is a sticking plaster and it will cause more problems than it will create solutions.

Is the hon. Gentleman acknowledging that the devolution settlement established in 1999—the creature of the Labour party, of course—is grievously flawed?

The call for devolution in the ’70s was so strong that there had to be a reaction to it from the UK Parliament. I mentioned in my opening remarks that there should have been a more balanced version, with more English devolution, at the time it was introduced. I am sure that the right hon. Gentleman would have supported that, because he is now a pragmatist and in favour of the current constitutional settlement.

Yes, but did not the people of the north-east reject devolution to the English regions when it was put to them?

Obviously, that happened. If it had been done at the same time as the London Mayor, and perhaps at the same time as another region, perhaps others would have clamoured for it later. I accept that that was an error. However, the right hon. Gentleman’s party, which opposed devolution at that time, has now wholly embraced it, so the Labour party has done his party a favour, moving it forward in many ways. The right hon. Gentleman, a pragmatic Secretary of State who wanted more devolution for Wales and for the rest of the UK, is evidence of that. I welcome the fact that many Conservative Members of Parliament have taken this journey, but I want the direction of the journey to be clear in future.

This is an important subject. Does my hon. Friend agree that there are many types of devolution? He talks about English devolution. Once upon a time, I served as a borough councillor in London and I think the emphasis there would be on London-wide devolution, with virtually no interest in English devolution. Does he also agree with his predecessor, the late, great Cledwyn Hughes, who spoke of an authority for North Wales? I am not necessarily advocating that as a model, but there are different types of devolution and all have to be considered in the round.

I am grateful for that intervention. I will develop my argument a little further, but my point is that devolution needs to be close to the people. In the original Welsh devolution settlement, the Assembly had regional bodies where we discussed many issues. I do not want devolution to be just a movement of powers from Westminster to Cardiff Bay: within Wales, I want it to go to Colwyn bay and Cardigan bay, and to Cemaes bay in my constituency. That is real devolution and that is what I am advocating. Devolution should not just be for one part of the UK. We need even distribution of devolution across the UK.

Of course, the reality is that the decisions of the Assembly have led to power being centralised in Cardiff, out of the regions of Wales. That is a product of the very devolution that the hon. Gentleman professes to support, and it happened because of decisions taken in the Welsh Assembly by elected Welsh representatives. Is he arguing against the devolution that has happened in Cardiff?

The hon. Lady was a North Wales Member of the Assembly. My criticism is not just about the institution or the Government in Cardiff Bay. North Wales Assembly Members should be making a stronger case for North Wales. That is what I am doing today, as a North Wales MP. I will argue, when I have a chance to develop my argument without interventions, that there needs to be representation from North Wales MPs in this debate.

The debate has gone a bit sterile post-Scottish referendum, partly because of the Prime Minister’s reaction on the morning after the referendum result, which I very much welcomed. Instead of being statesmanlike and trying to strengthen the Union after the referendum result, he chose to talk about one part of the UK: England. The Union is not strengthened by isolating and talking about one part of it. Unionism must be about the whole UK. That is why I am arguing for North Wales MPs having a strong voice and being equal in this UK Parliament. We are all elected under the same franchise and we should be allowed to debate and vote on the same rules and regulations that are before this House, and there should be no exemption. No Parliament will succeed if it has two tiers of representative. We all have the same mandate and we are here to represent our constituents and the UK, but we will not be able to do that if we go down the avenue proposed by the Conservatives. That is the gist of my argument. I will put some detail on it in the next seven or eight minutes, after which I will sit down and allow other hon. Members to contribute.

Devolution has to be more than just a theory: it has to be practical and real because it concerns services, such as health and transport, which are often provided east-west in the UK. Most decisions on transport that affect Wales are made here in the Department for Transport. The debacle over the west coast main line affects not just my constituents, but the whole of North Wales and the whole of England. It is an interconnector and a corridor between Ireland and London, going through North Wales. It would be crazy for North Wales MPs not to have a say or not to be able to question the Secretary of State when big decisions go wrong, such as when millions of pounds of taxpayers’ money is squandered by errors in the franchise process. That affects my constituency and services to my constituents. I travel on that train every week, and I know the composition of its passengers: they are from North-West Wales, other parts of North Wales and England. We need to have a voice in this House when we debate such issues, so that we can express our views and vote on big decisions that affect our constituents.

I am extremely grateful to the hon. Gentleman, who is being very kind in giving way. While I agree with the thrust of his argument, is he not choosing a rather bad example, because railway services are not a devolved issue?

I am trying to make a number of points, but I am being intervened on every couple of minutes; I am trying to develop a stronger argument about transport and other public services—health, for example. The right hon. Gentleman and I sat on the Welsh Affairs Committee many years ago, and we realised that there were anomalies. People from North Wales use specialised services in English hospitals, such as the Christie, Alder Hey and the Walton Centre; those specialisms cannot be delivered in general hospitals across the UK. They are specialist UK institutions providing some of the finest services in the world, and I want my constituents to be able to access them, but I also want a say if big decisions are to be made on whether to cut those services, because that would affect my constituents. I am not making the argument from an ideological point of view; it is about real services for real people. That is the principle here.

My hon. Friend is making an excellent point about North Wales, but what he says is equally true of South Wales. Some 48% of the Welsh population lives within 25 miles of the border, so in constituencies such as mine, many people use the English NHS and English schools and travel to work in Bristol and elsewhere.

My hon. Friend is absolutely right. This debate is about North Wales, but there are important issues in South Wales and southern Scotland and England that need to be looked at, which is why we need a proper UK constitutional convention, so that we can deal with all these points properly and in a sober manner. We need decentralisation, but in a balanced way, rather than simply devolving powers from one capital city to another.

I agree with the point that the hon. Member for Eddisbury (Antoinette Sandbach) made about over-centralisation in some smaller countries after devolution. Instead of devolving power closer to the people, there is a tendency to have political control at the centre. I make no bones about it: in the 1970s, I was arguing against decentralisation. Some of the best devolution in the British state has been the Driver and Vehicle Licensing Agency move to Liverpool, the British Council move to Manchester and various bodies’ move to Scotland. Moving institutions helps to create local economies and a more balanced United Kingdom. I am certainly not happy with everything that has happened in the devolution settlement, but I believe that the response of the Conservative Government and the previous coalition Government is a sticking plaster that will cause more problems than it will create solutions. That is the reason for this debate.

I want a UK Parliament to look at defence and other issues if we are to have an English Parliament, but I am a realist and I do not think there is the appetite for that at the moment. However, the answer is not exempting Welsh, Northern Irish and Scottish MPs from issues that Parliament is discussing. I do not think there is a Parliament anywhere that has different degrees of power within the legislature. Yes, some Parliaments have more than one Chamber to discuss things in detail, but the proposals in front of us, drawn from different reports and different exercises that the coalition Government put together, are wrong for a number of reasons.

I made the point that we are all elected equally on an equal franchise. We should have Second Reading debates where everyone can take part.In Committee where detailed amendments are discussed—for example, amendments dealing with health and how an English trust is run, which may affect my constituents, so they are important—I should have some input, or a chance to be on the Committee. If I do not get on that Committee, I can debate such measures on Report on the Floor of the UK Parliament. UK parliamentarians should be involved in that process. If we go down the road the Government propose, what is next on the agenda? What procedures will be passed upstairs that will exempt English Members from talking about different parts of England? That logic can be applied to the proposals as they stand, which is worrying.

I will give way one more time, because I want to hear the English dimension on this issue. I know that the hon. Gentleman wants to speak for England.

I speak as the person who was the shadow Secretary of State for Scotland for the shortest ever time: five days. That was a result of making untoward remarks on “Newsnight” in favour of some form of federal solution of the kind the hon. Gentleman describes. I want to pick up on the point he was making a moment ago on the importance of him having a say on health matters, because his constituents use the health service in England. That is true of course and I do not disagree with him, but my constituents may well use the national health service in Wales, and I can have no say in how the NHS in Wales is run. Why should it be one way and not the other?

I understand why the hon. Gentleman makes that point, but I am talking about specialisms, not general hospitals or general practitioners. Hospitals in England used by patients from North Wales were built by North Wales people specially in those locations to serve England and Wales and the rest of the United Kingdom. Let us be honest; we cannot have specialisms in every region of England and every part of Wales, Scotland and Northern Ireland. We have some of the best hospitals in the world in certain areas of the UK, and we need to be able to discuss them in the UK Parliament. It is not right to exempt MPs from that. I understand the hon. Gentleman’s frustration at having no say on general health issues in Wales, but it is more important to look at specialisms and the reality of what our constituents face, rather than the theory to which he refers.

The hon. Member for North Wiltshire (Mr Gray) makes a valid point about a frustration he faces, but he can still speak on equal terms in this Parliament to the Secretary of State for Wales or the Department of Health and raise those issues. Under the Government’s proposals, he would not be able to speak or move amendments on those issues at all.

Other Members, if they catch your eye, Mr Crausby, will be able to give examples of using services closer to the border in far more detail than I will, but I am laying out the context. It is a dangerous constitutional move to exempt UK Members in a UK Parliament. We are all here as equals. I do not want to be a second-class MP. I want the same rights and responsibilities as other Members.

We should have a written constitution to underpin all this. The present situation is a mess. We celebrate 800 years of Magna Carta, but we do not have a 21st-century constitution. The world has changed in those 800 years. We did not have NATO, the UN or the EU back then. We need to look at our constitution and the bloody battles we had instead of resolving this around the institutions.

I do not think the Conservative party and the coalition looked at the issue seriously. I do not agree with the Scottish National party when it talks about independence, but I do think it has the right to have that debate. Scotland had the debate and the vote. Its Members of Parliament were elected under the same franchise as the Welsh, Northern Irish and English Members and they have the same rights in this place, which is what I am defending. However, the North Wales case is special because of our east-west relationship in transport, health and the economy. We have large employers in England and large employers in Wales, and there are cross-border issues in that regard that are dealt with by the UK Parliament. I would have spoken for longer on some of the technical issues, but this debate is about empowering people and maintaining the right of MPs to speak on their behalf.

We need to have a proper UK convention on the constitution. We cannot go on piecemeal; we need to look at this in a broad context, and it cannot be done behind closed doors or in corridors. A Conservative manifesto is being pushed through without thought to exempt a large number of MPs from debates who represent areas that have been represented here for centuries. One reason we had the Act of Union when Wales became a part of the United Kingdom was to have equal representation, and that has not changed. I understand the need to have fewer MPs from areas where there are devolved Administrations, but we should not exempt those Members from voting on laws in the UK Parliament.

Let us have a proper debate. I hope that today’s discussion will help to highlight the North Wales question in some way. The Leader of the House has said that he wants a proper debate on English votes for English laws, but I want to debate the whole issue, and I want to protect my constituents’ right to elect an MP who can speak on their behalf.

Order. I intend to call the first of the three Front-Bench speakers at 10.30 am, which gives us about 40 minutes. Ten Members have risen to speak, so if they can keep their contributions to around four minutes, everyone will have an opportunity to speak.

It is a pleasure to serve under your chairmanship, Mr Crausby.

Four minutes is not a long time to discuss the issues raised by the hon. Member for Ynys Môn (Albert Owen), whom I congratulate on securing this debate. He is a champion for his constituency and for North Wales, and there is no doubt that he has raised some genuine concerns that are felt across the region and, indeed, recognised in the wider United Kingdom. Nevertheless, it is a shame that the main thrust of his argument was that we should establish a UK constitutional convention along the lines proposed in the Labour party manifesto for the 2015 general election. If there was ever a need for such a convention, it has long since passed.

The truth is that we have a devolution settlement that was not particularly well thought through. I agree with my right hon. Friend the Member for Clwyd West (Mr Jones), who highlighted the fact that the devolution settlement we have was created without any real thought as to how to ensure that it was fair and equitable. Nevertheless, we are where we are. We must address how we move forward equitably and reasonably.

It is interesting to note that many Members from North Wales will say that they want to retain the ability to influence the services provided by, for example, the English NHS—the hon. Member for Ynys Môn spoke about the health service. It is true that people from North Wales go to Greater Manchester or the Merseyside area for specialist services, but it is also true that people from England come to Cardiff for specialist services. My cousin is a consultant in a hospital in Cardiff, and he treats people from South Wales and people from England. The point still stands: it is clear that, as Welsh MPs, we have no ability to influence most of the health services provided by the Welsh Assembly, but English MPs have no ability to influence how their constituents are treated if they require support.

The situation in North Wales is very clear: specialist services are generally provided from England, but the same is not necessarily true in all parts of the kingdom. The issue remains: how do we reach an equitable situation so that Members from North Wales and England have the ability to influence decisions? It is important to recognise that there is a feeling of unfairness, even along the North Wales coast. Having spoken to people who have moved into North Wales from England, I know that there is a feeling that there is something inequitable in the devolution situation.

Saying that we need a constitutional convention to try to address the inequities is over-egging the cake. We have not been talking about the West Lothian question only since 1977, when Tam Dalyell started to talk about it; Gladstone talked about it back in the 19th century. We can talk about it until the cows come home, but really we need to take action. I genuinely believe that the current inequity is a bigger threat to the devolution settlement than doing nothing. I am afraid that the example from Scotland and other parts of the UK is that, often, constitutional conventions are set up when there is a desire to kick something into the long grass.

We need to ensure that laws that relate only to England can be influenced by Members from Wales, Scotland and Northern Ireland, but the main decision-making on those specific laws that are deemed English-only should be made by English MPs.

That is a key point. We have to have some confidence in the ability of this House and Parliament as a whole to come to a conclusion and define a specific law as English, English and Welsh, or UK-wide. The hon. Gentleman has highlighted a crucial point: we are talking as if a deal has been done, but the detail of the Government’s proposals has not yet been announced—

In my view, it is clear that many Bills will be categorised as English and Welsh. In many cases, they will be categorised as UK-wide. Nevertheless, we have to accept that there is a principle that needs to be dealt with.

Finally, my hon. Friend the Member for Eddisbury (Antoinette Sandbach), who was previously a colleague of mine in North Wales, made an important point: anyone who believes in devolution cannot be very pleased with how the Welsh Assembly has worked, because it has sucked power into Cardiff. I want to stress, however, that that is not necessarily a failure of devolution; I would argue that it is a failure of how the Labour party has dealt with devolution in Wales.

I speak today as an English MP elected for the first time only a few weeks ago. I have already discovered a number of instances where decisions are made in Wales that affect my constituents, but it is difficult to influence them or make representations. Members on the other side of the border clearly face the same challenge in reverse. I want to highlight some of the inequities in the system that need to be resolved before we press ahead with further change.

The western boundary of my constituency, Ellesmere Port and Neston, forms part of the border with Wales—indeed, I can leave my home and be in that great country within 10 minutes. The western side of the constituency faces the River Dee, which forms a natural barrier, but, going inland, the border is firmly on the eastern side of the river, which lies on the cusp of English settlements, going so far into the neighbouring constituency, City of Chester, that it dissects Chester City football club’s ground.

We have physical proximity, but we also share much in common with our colleagues over the border, culturally, economically and socially. For example, a great many people work on one side of the border and live on the other. Indeed, many of my early temporary jobs were in Deeside, and my most recent employer before entering the House had offices in both England and Wales—in Chester and Wrexham. Let us not forget that England and Wales share a common legal system. I hope that any proposals take that into account.

I want to highlight the work of the Mersey Dee Alliance, a partnership of Cheshire West and Chester Council, the University of Chester, Denbighshire County Council, Flintshire County Council, Glyndwr University, Wirral Borough Council, Wrexham County Borough Council, the Welsh Assembly and Merseytravel that has been around since the 1990s. The alliance put it perfectly when it said that

“the area represents a single economic sub-region with a population of close to 1 million”

that just happens to be divided by a national boundary.

Transport is another key issue on which England and Wales cannot easily be separated. A recent example is at the Posthouse roundabout at the junction of the A483 and the A55, which set a record as a single set of roadworks causing chaos in two countries. In recent years, significant central Government funds have been invested in the local sustainable transport fund, thanks to a programme run by Cheshire West and Chester Council that recognises that the economic sub-region covers Chester, Ellesmere Port, Deeside, Wrexham and areas of Merseyside. I have already expressed my concern in the House about how the proposed devolution of the Borderlands Line rail franchise, as part of the Wrexham to Bidston proposals, will affect my constituents, it being the main route from Neston into Liverpool and Wales.

My constituents are at risk of being overlooked because there is no formal mechanism for conveying their views. The situation is unacceptable, and I intend to argue on behalf of my constituents so that they have a voice. It demonstrates amply the dangers of pushing ahead with a settlement that fails to give proper thought to how those who live either side of the border are properly represented.

Recently, issues have arisen that have highlighted the frustrations of cross-border concerns. I met constituents who are cockle fishers on the River Dee. They pay a licence fee to Natural Resources Wales but have no ability to influence decisions or make representations. The old adage, “No taxation without representation,” springs to mind. I am sure there are many similar examples.

Within a few weeks of entering Parliament, I have already found two significant examples of a failure to appreciate how decisions taken in one country can affect people in another. We need clarity on what matters are reserved for the Welsh Assembly and the mechanisms available for those on both sides of the border to make representations and influence decisions. Ultimately, we need to find a way to ensure accountability. I am concerned that, if we push ahead without much thought, we will end up with a system that is crude and simplistic, lacking in democratic legitimacy and accountability. Such a system will also be a barrier to economic growth in the area.

It is a huge pleasure to serve under your chairmanship, Mr Crausby. I commend the hon. Member for Ynys Môn (Albert Owen) on securing an important and timely debate. It is timely, of course, because we are considering a lot of constitutional legislation, including the Scotland Bill, which continues in Committee today, and the proposed procedural changes to the rules of the House.

I agree with most of the thrust of the hon. Gentleman’s argument. That said, the issue of fairness must also be considered. It cannot be fair that a Member of Parliament for a part of the country in which powers are totally devolved should have a vote—possibly a determinative vote—on matters that do not affect either that Member or their constituents. I am pleased to follow the hon. Member for Ellesmere Port and Neston (Justin Madders), who illustrated the cross-border problems quite nicely. He neatly demonstrated the frustration of English Members that they often have no voice in any democratic assembly on issues concerning them and their constituents. That cannot be right.

The problem is that the devolution settlement imposed in 1999 is frankly not fit for purpose. It does not work; it is a lash-up and it needs to be revisited. The hon. Member for Ynys Môn talked about a constitutional convention, but the fact that he had to do so shows that he also recognises that what was put in place by the Blair Government back in 1999 is not fit for purpose and ill serves the people of both England and Wales.

I will be brief, as I have already spoken at some length. As Secretary of State for Wales, the right hon. Gentleman’s answer to the problem was more devolution. He just added to the devolution settlement. We need a constitutional convention so that we can pause to consider and reflect on the matter at a UK level.

I certainly believed in more devolution of taxing powers and was a firm advocate of that. The hon. Gentleman makes a different point, which I will focus on in the time remaining.

What we have in North Wales, as the hon. Gentleman rightly says, is a wholly different state of affairs from that which prevails in South Wales. The Welsh devolution settlement was put in place by South Wales politicians who did not really understand North Wales, did not understand that North Wales is part of the north-west economic region, did not understand the need of North Wales patients to access medical treatment in the north-west of England and did not understand the historical and cultural ties that bind the people of the north-west of England and North Wales.

I will support the procedural changes to the rules of the House provided that they fully reflect the interests of the people of North Wales and their representatives. I will join the hon. Member for Ynys Môn in pressing for that when the matter is considered by the House. More importantly, the Wales Bill to be introduced later in this Parliament presents an opportunity to address the whole issue of devolution and to sort out the problems that were identified by the hon. Members for Ellesmere Port and Neston and for Ynys Môn. We should take the opportunity to try to improve a devolution settlement that is unfit for purpose.

I appreciate the opportunity to speak in this Westminster Hall debate on English votes for English laws and North Wales. The Government have managed to get themselves in a right guddle over this. Despite much conversation and much posturing, there is still a total lack of clarity about what will be classed as English only and what will be considered by the whole House. The SNP is clear that Scottish or Welsh MPs should not be given second-class status in the House of Commons. We face the prospect of MPs being barred from votes, reducing our ability to help our constituents.

The process of certification as “England only” will be highly contentious and no doubt debated as the matter goes forward. Although I have much respect for both the office of Speaker and the Speaker himself, I cannot say that I envy the task he may be presented with. If the decision is taken to give the role to the Speaker, it is clear that provision needs to be written in for devolved legislatures to be consulted in advance of the Speaker’s decision. That happens in Scottish situations when neither Government have indicated a need for a Sewel motion in draft legislation, so the procedures are there. I am sure that none of us wants such issues to be decided in the courts, but it is surely of concern that the process of change through Standing Orders, rather than legislation, would mean that a contentious certification decision could not be challenged in any way, including through the courts. That is not right if people in Scotland, Wales or Northern Ireland are disadvantaged by legislation that their democratically elected MPs have been excluded from considering.

The problem with going through the courts is the endless delays. We saw that in Wales with the Supreme Court’s decision regarding the Agricultural Wages Act 1948, which fundamentally altered the Act and moved Wales on to a reserved powers model. That is undemocratic because it is judicial decision making.

The point is that the core process is there. We need a process of legal challenge. We need to allow people to challenge decisions that are taken here. Making the change through the Standing Orders removes that right.

The key point is this: it would be ridiculous and undemocratic for Scottish or Welsh MPs to be excluded from any decision that could have a detrimental impact on the budgets of the devolved Administrations. Forty-five per cent of the Scottish people voted for independence and 55% voted to stay in the Union. Not one of them voted to cede to others the ability to legislate. It would be utterly bizarre for such a significant constitutional change to be made by a change to the Standing Orders.

I will not, as I have only a short time remaining.

It would also be improper and unprecedented for any changes to the Standing Orders to be made without proper scrutiny. Such significant constitutional changes require significant scrutiny and debate, not a hurried announcement less than three weeks before the summer recess and with much scrabbling around to formulate a coherent policy. I urge the Minister, as I have in many written questions already, to allow extensive scrutiny of the matter. We do not need a change in the rules to determine what we can and cannot vote for. Scottish MPs already exclude ourselves from purely England-only votes. It is pretty ironic that, on a day after English MPs vote down the will of the Scottish people on the Scotland Bill, a discussion is being held on how best to exclude Scottish MPs from English legislation. We simply cannot have this rushed through without proper consideration of the consequences.

I congratulate the hon. Member for Ynys Môn (Albert Owen) on securing this debate. I represent a constituency that is three seats into Wales, but none the less I have many constituents who daily cross the border into England, just 30 minutes away. We do not tend to hear about constitutional matters on the doorstep.

My hon. Friend makes a valid point about constitutional matters being a sleeping pill for most of the electorate. Does he agree that one of the greatest frustrations during the election campaign was the confusion over who is responsible for what? That great exasperation probably damages the reputation of politics in the eyes of the public. Whatever we do, we must address that point. rather than just talking about ourselves to ourselves.

My hon. Friend is quite right: we must address those issues. I will come on to that point in a minute. On the doorstep, some people pointed out the unfairness of the current situation—with particular regard to Scottish MPs, in fact; Wales was mentioned to a lesser degree—and that unfairness is ultimately a consequence of devolution. The First Minister in Wales has said that laws that affect Wales should be made in Wales—meaning by Welsh politicians. The follow-on from that is that laws that affect England should be made in England by English politicians. People cannot have it both ways.

The proposals certainly have a good deal of pragmatism behind them. That said, Wales is in a different position from Scotland in many respects. In North Wales, many live near the border, and the political boundaries do not reflect the reality of people’s day-to-day lives—where they live and work. Yes, roads, universities, energy projects and environmental issues in England affect our constituents, but having said that, they need to travel out of North Wales for that to be the case.

Today I want to highlight the issue of health. As a doctor, I am well aware of the issues that have been brought up about hospitals in the north-west. The Countess of Chester hospital, where I have worked, was built on the basis that about a third of the patients would be from Flintshire, which is still the case in many respects. Alder Hey, Gobowen, Broadgreen, Liverpool women’s, Arrowe Park and Walton are all hospitals that rely on the throughput of North Wales patients—

And many of the staff live in Wales, of course. The services at those hospitals exist because of the North Wales patients. This happens the other way around, but to a lesser extent; there are not many services in North Wales to which English patients travel. That said, there are English patients registered with Welsh GPs and vice versa. North Wales is a particular case; services in north-west England are designed for and accessed by North Wales patients. That perhaps does not apply in other areas.

Unfortunately, as my hon. Friend the Member for Carmarthen West and South Pembrokeshire (Simon Hart) mentioned, many voters are unaware of the devolution settlement, or disregard such things. Some of the issues, to be honest, challenge the rationale of Welsh devolution, certainly in so far as North Wales is concerned. In summary, the key thing for me is that the decision as to what is an English-only matter will be difficult, requiring much consideration to ensure that the voices and interests of North Wales residents are not overlooked. I foresee that many issues will be both English and Welsh, and not English only.

I entered the Chamber this morning equal to every other Member attending the debate. I have been a Member of Parliament for 23 years, during which time I have been equal to other Members. That includes the time when the right hon. Member for Wokingham (John Redwood) was Secretary of State for Wales, even though the Government of which he was part had no mandate from elected Members of Parliament in Wales, and, likewise, the time when Lord Hunt was Secretary of State for Wales. I have been an MP at times when we had Labour Secretaries of State for Wales, and when the right hon. Member for Clwyd West (Mr Jones) was Secretary of State for Wales.

Wales has a 170-mile border, and 50% of the population of Wales live within 25 miles of it. That means that my constituents access services, employment and a range of other things in England as well as Wales. It is important to recognise that, and to look at the key challenges mentioned by my hon. Friend the Member for Ynys Môn (Albert Owen). We need to examine how we develop a constitutional settlement that reflects the needs and the real challenges of people who represent seats in England, but feel that they have no say on matters in Scotland, Wales and Northern Ireland.

A number of my constituents work for the fire service in Merseyside, Cheshire or Shropshire. I have key transport links in Crewe; the Halton curve provides a key link between Liverpool and services in North Wales, but it is in England. My hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) mentioned the line to Bidston from Wrexham, which goes through north Wales and is a key issue on both sides of the border. Arriva Trains Wales is devolved, but Virgin Trains provides a service that is not devolved.

There are health services in my constituency that are serviced by providers in England. Specialist services are at Clatterbridge, the Christie and the Royal Liverpool, because of the nature of our region. A third of my constituents were born in England—many at the Countess of Chester hospital, but some, like me, were born elsewhere in England. That even includes people who have played football for England, although they resided all their lives in Wales; they qualify for England because they were born in a hospital in England.

My next-door neighbours are teachers in England. I have constituents who are police officers in Merseyside, Cheshire or Shropshire. The nearest airports to my constituency are Liverpool and Manchester. I have constituents who work at Vauxhall Ellesmere Port in the constituency of my hon. Friend the Member for Ellesmere Port and Neston, or in Chester at the banking and financial institutions there. Why is that important? When Vauxhall Ellesmere Port was under pressure and delegations went to the Secretary of State for Business, Innovation and Skills in England about support funding to keep jobs in the area, I was able to participate. Furthermore, farmers from the constituency of the hon. Member for Eddisbury (Antoinette Sandbach) come to Mold market in my constituency. They come from England to sell their produce in North Wales. What matters in England matters to my constituents in Wales.

I only have a short time and I want to ask the key question: who decides what is a Welsh issue? Under the proposals, the Speaker is supposed to decide. What openness, transparency and representations will there be? How will the Speaker determine what is an English-only matter, particularly when the Government have said that they will extend the principle of English consent to financial matters? Who decides, and what does that mean for not only votes but key questions in the House of Commons? Will I be able to table parliamentary questions in the House of Commons as an equal Member? Will I be able to speak in Westminster Hall as an equal Member? Will I be able to ask for a meeting with the Minister of an English-only Department about matters to do with the fire service, the police, health, schools or employment in my area?

Will I be able to undertake—[Interruption.] The answer to the question, as my hon. Friend said, is that we do not know. We do not know as yet, because the proposals are not there. We need clarity.

Finally, this issue is important to the unity of the United Kingdom. I cannot believe that the Conservative and Unionist party has made such proposals. I made this point in the main Chamber the other week: Gordon Brown represented a seat in Scotland and was Prime Minister of the United Kingdom; Jim Callaghan represented a seat in Wales and was Prime Minister; and Andrew Bonar Law and Alec Douglas-Home represented seats in Scotland and were Conservative Prime Ministers. Are we saying that no such Prime Minister can ever stand at the Dispatch Box again, or that they would say, “I’m very sorry, I can’t answer that question, because it is devolved to Scotland, Wales or Northern Ireland”? If that is the position of the Conservative and Unionist party, it has come an awful long way from the Conservative party I once knew.

Thank you, Mr Crausby, for calling me to speak. I am grateful to the hon. Member for Ynys Môn (Albert Owen) for securing the debate. In reality, it is easy to answer the question of the right hon. Member for Delyn (Mr Hanson) about how to identify which votes are on English-only matters and which are not. We simply look at the Wales Act 2014, for example, and decide which powers have been devolved to Wales and which are reserved; that will identify them. It happens all the time in the National Assembly for Wales, with the process delegated to the Presiding Officer. I would, however, have a great deal more sympathy with the position of the right hon. Gentleman if he had not voted for that asymmetrical and uneven devolution settlement, described by the hon. Member for Ynys Môn. We need to remember that all the arguments were made when the Government of Wales Acts were before Parliament. All those issues were identified.

I have a great deal of sympathy with the hon. Member for Ellesmere Port and Neston (Justin Madders) on his frustrations with Natural Resources Wales, a body that is incredibly inefficient and should never have been set up; I opposed it when I was in the Assembly. However, the hon. Gentleman still has an ability to influence it, and to contact it on behalf of his constituents, although he does not have an ability to vote on setting up such a body—but that is the position that my constituents are in.

As described by the right hon. Member for Delyn, I have farmers who go over to Wales to sell their products in the market at Mold. They are subject to Welsh tuberculosis restrictions on pre-movement testing of cattle, but cannot vote on the matter. That constitutional settlement was put in place by the Labour party. All the arguments we have heard today were rehearsed then—we have been hearing them for years.

I accept all the points made by Members on both sides of the House about our strong links and ties, which have been there for generations, but we have to deal with the unfairness affecting England. That issue has been raised on the doorstep. The hon. Member for Aberdeen North (Kirsty Blackman) ought to realise that it is a great cause for concern when education or health matters, which are wholly devolved to the Scottish Government, can be voted on by Scottish MPs. In reality, she will have an opportunity to vote on financial matters that may affect her constituents, because there will be a vote on the Budget and an opportunity to debate those matters.

The unevenness of the constitutional settlement was recognised by the fact that the Conservative party secured a majority with an election manifesto commitment to deliver English votes for English laws. My hon. Friend the Member for Vale of Clwyd (James Davies) was right to say that we cannot have it both ways. If something is in the Scotland Act 1998 or the Government of Wales Act 2006, it is devolved, so what constitutes an English or Scottish matter will be very clear to the Speaker. Everyone will vote on the Budget—there is no suggestion that that will not happen—but English votes for English laws is a matter of fundamental fairness in this House, and needs to be addressed. If matters are devolved to Scotland or Wales, it should be English MPs who have the vote on those matters in England. Failing to address that fundamental unfairness undermines the integrity of this House.

May I ask what the difference is between the system we are proposing and one that includes a long-term think about things, which is basically what the Labour party favours?

The short answer is that I do not know, but the last time there was a constitutional convention, it took years; it was kicked into the long grass. Quite frankly, this situation needs to be dealt with now.

It is a pleasure to serve under your chairmanship, Mr Crausby. I thank my hon. Friend the Member for Ynys Môn (Albert Owen) for securing this important debate.

I represent a border area, but in reality the border does not exist. As others have mentioned, many thousands of people from North Wales travel across it to go to work at Vauxhall in Ellesmere Port, and at many other employers in the north-west. Equally, many people from England travel the other way to work at Airbus, Toyota, Deeside industrial park and many other places. Our road and rail networks work east to west, but do not work particularly well north to south. The Mersey Dee Alliance has worked well to promote the region as economically important not only to North Wales but to the north-west of England.

I and many other MPs from North Wales rightfully think that we should have a view on what happens on both sides of the border, as it affects the people we represent, but clearly the Government, with their usual approach, are trying to find a short-term solution to a long-term problem and have come up with a bit of a dog’s breakfast.

The hon. Gentleman speaks of short-termism. Does he not agree that the devolution settlement was lashed up hastily by the Labour Government?

I do not. The right hon. Gentleman is always blaming someone else. He and his party have been in government for some time now. Surely they should take some responsibility.

Time is short, so I will set out just one example: healthcare. People in Alyn and Deeside use healthcare on both sides of the border, as has been touched on. Our children’s hospital is the Alder Hey, our heart hospital is Broadgreen, and we use services at Gobowen, the Christie and Clatterbridge.

The hon. Member for Vale of Clwyd (James Davies) mentioned the Countess of Chester hospital. It may be in Chester, but it was built to serve the people of Chester and Deeside. The previous MP for Chester used to stand up in the Chamber and talk about thousands of people from north-east Wales flooding across the border to go to that hospital. It is their hospital; it was built to serve the people of both Chester and north-east Wales—in particular the people of Alyn and Deeside. There are representatives on its council of governors from Flintshire and Wrexham. They have their view, and rightfully so. If those Welsh patients did not use it and the hospital served only the catchment area of Chester, I question whether it would be viable. Many people in Alyn and Deeside are registered with doctors and dentists on the English side of the border and vice versa. We are a particular and very different region.

Where does this start and end? Are the Government saying that because policing and transport powers are devolved to the Mayor of London and the London Assembly, London MPs should not have a view on those issues—is that what we are saying? We are talking about giving powers to city regions—will the MPs from those areas not be allowed to have a view? The question that no one has answered, although lots of Members have asked it, is: what is an English-only law? The Government need to decide where they stand. Are they going to treat people equally, and do they actually believe in the United Kingdom?

Order. Two Members are indicating that they still wish to speak, and there is not much time left, so I hope they will keep their remarks short.

I will be brief, Mr Crausby. The definition of an English-only law is crucial to this debate. The problem is that the Government are leaving us completely in the dark. We are having this debate only because my hon. Friend the Member for Ynys Môn (Albert Owen), whom I congratulate, initiated it. I tabled a question for the Secretary of State for Wales about what consultation he had had with the people of Wales on proposals for English votes for English laws. That question was transferred to the Leader of the House. I believe that virtually no consultation has taken place.

I do not have time to give way, as the hon. Gentleman well knows.

Not only has the Secretary of State not consulted the people of Wales, but he has not consulted Members of Parliament. There has been no discussion whatever with MPs on the issue. That is a crucial point. Mr Speaker will need to have the wisdom of Solomon to determine what is an English-only law. The first thing he should do is visit North Wales and Cheshire. Our region is unique in the United Kingdom and exemplifies why this question is so difficult.

I expect nationalists to divide, separate and try to have a culture of blame between each part of our country. I do not expect those of us who believe in the United Kingdom to argue in favour of division or separateness. Whatever our political background, we should stand together to work out a proper way of doing this, with consultation. That is what we need.

I will make a proposal. There are Members from North Wales who take a sensible approach to the matter. Representatives of the Mersey Dee Alliance are here in Parliament today. We need an all-party group for the Mersey-Dee region, to put the case in Parliament for a cross-border economic and cultural environment. We have that opportunity within the context of this debate. We need the Government to start to listen. Their ignorance is palpable, and they have closed their ears.

Devolution as given by the English nationalist party is a grudged gift. The party has never been enthusiastic for it at all, but we see it doling out little bits of power here and there, as long as doing so can solve immediate problems. Now there is a crisis, because the terrifying experience for the English nationalist party of the Scottish referendum induced panic. It went along with a vow and then came back and introduced this false solution of EVEL—English votes for English laws. That is self-defeating for the party, because the more it feeds the beast of English nationalism, which has lain dormant for a long time, the more it will deepen the divide between England and Wales, England and Scotland, and England and Ireland.

We used to talk about a slippery slope in 1979. Some people wanted devolution because they thought that it was a dangerous slippery slope, and others supported it because they knew that it was a beneficial one, but we are on a new slope now, and we are moving towards the breakup of the United Kingdom. The best way to achieve that, which I am sure is not the intention, is English votes for English laws.

It is a pleasure to serve under your chairmanship Mr Crausby. I congratulate the hon. Member for Ynys Môn (Albert Owen) on securing this short but important debate. I have visited North Wales and his constituency and I canvassed there during the by-election for the Welsh Assembly—I must concede to the hon. Gentleman that it was not for his party. I was delighted with the result we saw for Plaid Cymru that evening.

We have never had a measure quite like English votes for English laws. We have heard a little about the historical context and precedents, but we have to go back to the days of Gladstone before we find anything like it being attempted in this House. In those days, there were Members of Parliament from a nation that decided that it wanted its own constitutional future, just as there are now. We can see what happened when the Government tried to impose such a law in the House then, and history’s judgment. The Government of that day realised very quickly that the plans were unworkable and withdrew them.

One might think that something of such constitutional significance and historical importance would be subject to the utmost parliamentary scrutiny—wide-ranging consultative pre-legislative scrutiny and a full debate.

I am sorry, but I cannot give way, because I have to leave time for the Front Benchers.

Instead, the proposal has been rushed through at breakneck speed. We learned yesterday from the press that the Leader of the House of Commons intends to bring forward his proposals before recess—before anybody has had an opportunity to try to understand and assess what is going on.

My hon. Friend the Member for Aberdeen North (Kirsty Blackman) and several other Members have consistently and continually asked the Leader of the House to start to explain a little about the process and how this matter will be determined. All we hear in return is that he will bring his proposals to the House soon. I think we know that, because he has said it on several occasions, but why can he not answer basic questions about what is proposed? Is what the Government are trying to do with EVEL a state secret?

We need a debate. We have to understand what is going on, because it will impact on my rights to represent my constituents effectively in the House. It will have an impact on the ability of everyone who has contributed to the debate to represent properly the people who elected us to do our jobs here.

I do not have time to take interventions.

It is important that we have a proper debate and proper scrutiny. We know a little about EVEL because William Hague presented his Command Paper at the end of the last Parliament. We have a sort of EVEL hokey cokey. It looks as though Welsh and Scottish Members will be gatekeepers to Bills—we will all get an opportunity to debate and vote on Second Reading. Then we will all be sent away and there will presumably be some sort of English Grand Committee, where the English Members will work on a Bill and cross the t’s and dot the i’s. The Bill will then come back to us again and, bizarrely, after English Members have done all the work on a Bill, we will get an opportunity to vote it down if we do not like it. Have you ever heard anything so bizarre or absurd, Mr Crausby? We will leave the English Members to do all the work and then decide whether we like what they have done. No wonder so many English Members are furious about the suggestion and do not like the proposals. It is a bizarre way to go forward.

The proposed arrangement will place the Speaker in the most invidious political situation possible, as it will be up to him to determine whether Bills are English only. We see in the Command Paper that the only people he will consult are the Clerks. He has to do better than that. He has to consult the Welsh Assembly. He has to consult the Presiding Officer of the Scottish Parliament to ensure that there is no Scottish consequence or impact—these things need to be determined. And it will not be open to legal challenge—that is the real reason why the Government are not bringing forward legislation. The constitution unit told us clearly that if it was introduced through legislation, there would be the possibility and option of legal challenge—the constituents we represent would be able to challenge something decided in this House. The Government are pursuing the idea of Speaker certification to take it out of the hands of the law, so that no one will have the opportunity to raise questions about its legality. That is unfair and bizarre. It is no way to proceed with something so important. We must have a say. I pity the Speaker of the House of Commons; he will be placed in a political situation of determining whether something has an impact on or consequence for the constituents we represent. That is not fair. No wonder the Speaker is anxious and nervous about being given such powers.

I will finish with what has happened over the past few days. I am sure that Members from Wales, and certainly Members from Scotland, are carefully watching.

The hon. Gentleman is right. In the past few days, we have had the Scotland Bill and a series of amendments that the Scottish Parliament decided were necessary. They were agreed with the Scottish Parliament. We put the amendments to the House— 56 out of the 59 democratically elected MPs from Scotland, reflecting the will of the Scottish people in those amendments. What happened? English Members voted them down. If EVEL is good enough for them, what about WVWL, Welsh votes for Welsh laws, or ScVScL, Scots votes for Scots laws? English Members are happy to turn up to Scottish and Welsh questions, as they should, but this has to work both ways. We cannot have English Members voting down the settled will of the Scottish people that comes to this House through 56 out of the 59 MPs and then demanding that we have no say over legislation that will have an impact on—a severe one in some cases—and have financial consequences for our constituents.

There is an elegant solution. It is called federalism. It is called doing things properly, which is what we again put to the House. We do everything in terms of collecting our taxes and making our own decisions, and we come together in the United Kingdom Parliament to determine foreign affairs and defence issues. We put that elegant solution to the House. As long as we have asymmetric devolution, which never seems to satisfy English Members, our Welsh friends or us, we will always be revisiting the arrangement and it will always be untidy. There will always be problems and issues, but that is what the Government want and they will have to accept the consequences. It will never be neat and tidy. We will always have issues to deal with and tidy up.

Unless we adopt the solution, which we will offer again and again throughout this Parliament, whereby this nation comes as close to federalism as possible, as was promised during the referendum, we will never resolve a situation in which one nation makes up about 80% to 85% of the population of this country. Unless we get close to federalism, we will continue to revisit this issue, we will never resolve it and we will have debates, like this one, in which no one is happy about something in the United Kingdom. We have great unhappiness in Scotland, England and Wales. For goodness’ sake, let us sort it out and get it fixed. Let us have federalism and ensure that everybody knows what they are dealing with.

It is a pleasure to serve under your chairmanship, Mr Crausby. I congratulate my hon. Friend the Member for Ynys Môn (Albert Owen) on obtaining the debate. The debate has been attended by 23 Members, which shows the interest in Parliament, although it is odd that no Plaid Cymru Members attended. However, the nationalist position was put well by the hon. Member for Perth and North Perthshire (Pete Wishart).

The devolution genie is well and truly out of the bottle, which is probably a good thing, as it allows people to make decisions closer to their place of impact. However, here in the United Kingdom devolution is permissive, asymmetric and uneven. There is an understandable need to devolve more powers and responsibility to the English regions, but the thorny question is how to do that in a balanced, proper way. We have separate Assemblies in Wales, Northern Ireland and London, with a Parliament in Scotland, but nothing in England between the UK Government and local authorities. The space is now being filled with a rush to devolve powers to city regions such as Greater Manchester, which raises significant questions about accountability and generates a debate about the value and purpose of the United Kingdom, what powers it is appropriate to keep at which level, and what powers should be devolved and to whom. Those are difficult questions with uncertain answers.

Into that quagmire the Prime Minister went on the morning after the Scottish people spoke so clearly and strongly in favour of remaining in the United Kingdom, when he chose to proclaim boldly on the steps of Downing Street the notion of English votes for English laws. It was neither the time nor the place for him to behave as the leader of a political party rather than as the United Kingdom’s Prime Minister. Mischief making and political posturing are not the way to determine how our nation should proceed on this difficult question. It is far too important for that. The challenge demands statesmanship, careful thought and inclusive action.

We are sometimes obsessed with borders, but the reality, as today’s debate demonstrates, is that real people do not live contained and constrained by borders. As my hon. Friend the Member for Alyn and Deeside (Mark Tami) perceptively observed, in reality the border does not exist. Real life is complicated and messy. In 2012, the McKay commission was quite properly given the task of considering how the House of Commons might deal with legislation that affected only part of the United Kingdom, following the devolution of certain legislative powers to the Scottish Parliament, the Northern Ireland Assembly and the National Assembly for Wales. In the report of March 2013, McKay concluded that the

“use of a specially-constituted public bill committee with an English or English-and-Welsh party balance is the minimum needed as an effective means of allowing the voice from England (or England-and-Wales) to be heard; it would retain the opportunity at report stage for amendments to be made to a bill to implement compromises between the committee’s amendments and the Government’s view, or even— though we would expect rarely—overriding in the House what was done in committee”.

Done in the right way, that has the potential to be a sensible reform, which would strengthen English and Welsh voices without creating two classes of MP. It must now be properly and fully considered.

We must not inadvertently undermine the union of nations that is the United Kingdom by pushing forward hasty proposals drawn up in secret or pursuing partisan positions. The hon. Member for Perth and North Perthshire is right when he says that that needs the utmost scrutiny. My hon. Friend the Member for Ynys Môn is also right when he warns of the danger that English votes for English laws will be a sticking plaster that causes more problems, and when he calls for a UK convention on constitutional rights.

One of the best examples of the anomalies in the proposal was transport in London. Is that an England-only or a London-only issue? It is not just a question of the three nations outside England; questions arise within England.

My hon. Friend is right, and further devolution across England raises more such questions. That is why the issue is complicated and messy, needing time to get it right, rather than a rush to something that will make things much worse.

Hon. Members have raised important questions, which should be properly considered. We need to ensure that the voices of residents of North Wales continue to be heard through their elected representatives. Wales is a small country, but it is well integrated within England, as we have heard. It has received more powers in the 16 years since the Welsh Assembly was created: it now has primary law-making powers, and it is getting financial powers in the form of control over stamp duty, landfill taxes and business rates. The Government, as the former Secretary of State, the right hon. Member for Clwyd West (Mr Jones), reminded us, will introduce a Wales Bill later this year which will devolve further powers to Wales in the areas of energy, transport and the environment. We welcome that.

It is right that we recognise the need to reflect the devolution settlement in the way that Westminster works, but we must also take into account the integrated nature of the economy and society in North Wales. Many hon. Members, including my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders), made it clear how closely interrelated the economies are.

I am glad that the hon. Gentleman has mentioned the hon. Member for Ellesmere Port and Neston, because he identified a democratic deficit where English Members are concerned. Does the hon. Gentleman agree that the Wales Bill offers a good opportunity to address those problems?

The Wales Bill represents an opportunity to explore those issues. I did not hear my hon. Friend say what the right hon. Gentleman did; I heard something quite different.

Economically the border with Wales is porous. Some 90% of the Welsh population—2.7 million people—live within 50 miles of the border on the Welsh side, and a further 13.7 million live within 50 miles of it on the English side. In aggregate, 30% of the population of Wales and England, or more than 16 million people, live within 50 miles of the border between the two countries. It is estimated that 100,000 people travel between Wales and England for work, and just over half of that criss-cross border traffic is accounted for by people commuting in and out of North Wales. The A55 trunk road, which runs across North Wales connecting Holyhead with Chester, is crucial for business and residents.

Some people argue for Wales to take powers over income tax, but the Welsh Government already have the power to hold a referendum on whether and when to take those powers and the current Welsh Government do not see that as a priority. They argue that that the more pressing issue of fair funding is the priority that must be resolved sooner rather than later. There is a danger that if income tax were to be included in EVEL and it was handled in a cack-handed way, thousands of workers who cross the border to work could find that their elected MP had a limited say over the income tax they would pay. That would be against their democratic rights.

Many people from North Wales use health services over the border in England. We have heard about the personal experience of the hon. Member for Vale of Clwyd (James Davies) in that respect. About 21,000 English patients are registered with Welsh or Welsh-registered GPs. Approximately 15,000 Welsh residents are registered with English or English-registered GPs. That means that about 6,000 patients flow into Welsh primary care from England. In addition, approximately 50,000 Welsh residents travelled to non-Welsh providers for treatment, including emergency and elective patients. That far outweighs the number of non-Welsh patients admitted to Welsh hospitals; typically it is Welsh patients using specialist services at large hospitals in England, as we have heard in the debate.

Some 138 million journeys take place each year on roads and trains across the border—an average of 2.6 million journeys each week. The UK Department for Transport specifies and funds three of the four rail franchises that provide cross-border rail services between England and Wales, with the Welsh Government largely responsible for the fourth—the Wales and borders franchise. That franchise provides cross-border rail services to Manchester, Shrewsbury, Birmingham and Crewe, in addition to all rail services wholly within Wales, and is controlled by the Welsh Government. The UK Government have stated that Wales will benefit from HS2 because of additional capacity and reduced journey times on the west coast main line. Because of that it was considered a UK-wide project and no Barnett consequential was given to Wales.

All the areas I have outlined—the economy, health and transport—are examples of how defining an English policy area is not straightforward. That means that careful thought must be given to any proposals to restrict the voting rights of Welsh MPs. In any future arrangement, North Wales MPs need a full voice on matters affecting their people. As my right hon. Friend the Member for Delyn (Mr Hanson) perceptively said, everyone needs to be an equal Member in this House. I hope that the Deputy Leader of the House will unequivocally answer the question of what an English law is.

Diolch yn fawr, Mr Crausby. I congratulate the hon. Member for Ynys Môn (Albert Owen) on securing this debate. The title of the debate could have led to a wide range of contributions about any aspect of North Wales, although given my connections with the area, I would have felt confident addressing some of those possible queries, and that is not just because I was a candidate in Wrexham in 2005. My mother grew up there, my relatives lived there, I went to school there and, indeed, my father is buried there, so I can assure hon. Members from North Wales and from across the border that North Wales is never far from my mind or, indeed, my heart.

Updating arrangements in this House to reflect the changing nature of the devolution settlement is important. To that end, this has been a useful and interesting debate. As promised in the Queen’s Speech, the Government will bring forward changes to the Standing Orders of the House of Commons to ensure that decisions affecting England, or England and Wales, can be taken only with the consent of the majority of Members of Parliament representing constituencies in those parts of the United Kingdom. We do that in the context of further devolution to Scotland, Wales and Northern Ireland. The Government have demonstrated that they will meet their commitments to devolve further powers to those countries. It is right that that is balanced by addressing the English question. Taken as a whole, the package will deliver a fair and sustainable settlement for the whole of the Union.

I shall address some points that have been raised in the debate. If I have time at the end, the hon. Gentleman may well be able to intervene then.

The hon. Member for Ynys Môn said that we need a proper convention and that the proposals are a sticking plaster. Not only did the House not support that point of view last month in a vote, but I suggest to him that it would be a handbrake on making progress with a Wales Bill and the Scotland Bill. We are making progress with the Silk commission and, as he knows, we intend to introduce a Wales Bill, and it is important that we do not add unnecessary delay to those things.

The hon. Gentleman and some of his hon. Friends have suggested that they are being denied a voice on many issues, but there is nothing in the proposals published by the Conservative party to that effect. Although there will be many points of detail that we will discuss and debate in due course, I genuinely assure him that many of the points raised today will, I am sure, be addressed when we publish our detailed proposals, which will happen soon, and there will be time for scrutiny.

In the meantime, I will set out some points of principle that will underpin our approach, as set out in the Conservative party’s manifesto on which we won the election, including gaining a seat in North Wales—I am glad to see my hon. Friend the Member for Vale of Clwyd (James Davies) in his place. I should point out that this idea is nothing new. It was also in our 2010 manifesto, and the hon. Member for Ynys Môn contributed to a debate on the issue in 2009, so it is not novel.

In changing the way the House of Commons legislates, we have to balance the need for the Commons as a whole to express the voice of our entire United Kingdom with the need for English and Welsh MPs to express their voice on matters affecting England and Wales only. Our proposals will reflect that need and respect that balance by ensuring that all MPs continue to take part in the legislative process, but that relevant measures must also have the explicit support of a majority of MPs representing constituencies in England, for an England-only matter, or in England and Wales, as the case may be.

In that way, we will resolve the current position, which has become increasingly untenable, that English or English and Welsh laws can be made without the explicit consent of the MPs whose constituents are affected. It is particularly right to progress with these proposals so that we can rectify the situation whereby hon. Members from outwith England could have a decisive impact on legislation on English constituents, not only on subject areas for which they cannot vote for their own constituents, but contrary to the views of the majority of English MPs.

I will take interventions in a bit, including from the hon. Gentleman.

I hope that the hon. Member for Ynys Môn reflects objectively on the situation I have described. Our proposals will recognise that many laws apply to England and Wales and that the West Lothian question is as relevant in Cardiff as it is in Carlisle—I suppose it could become the Delyn or the Denbigh dilemma. That is why English and English and Welsh laws will require the explicit approval of the MPs whose constituents are affected by them.

As has been set out repeatedly by hon. Members today, and as I recognise, constituents often access services across the border, as well as councils and other trade bodies that, as we have heard, work very well together. The border is not a barrier, as the hon. Member for Alyn and Deeside (Mark Tami) recognised, and I assure hon. Members that proposals that we will introduce soon will not stop access to services for constituents nor hinder the ability of any MP to hold the Government to account or stop them voting on legislation that affects those services. This is a popular policy, and not just in England. A study in January 2015 in Scotland found that over 50% of people supported the concept of English votes for English laws.

Let me turn to some other points made today. I agree with my hon. Friend the Member for Aberconwy (Guto Bebb) and my right hon. Friend the Member for Clwyd West (Mr Jones) that this is an important point of principle. I recognise that, as the hon. Member for Ellesmere Port and Neston (Justin Madders) said, close working across the border matters. My right hon. Friend the Member for Clwyd West alluded to a potential issue, but I honestly encourage the hon. Member for Ellesmere Port and Neston to raise existing problems directly with the Welsh Assembly Government or with his Labour colleagues who are representatives in the Welsh Assembly.

As for the points made by the hon. Member for Aberdeen North (Kirsty Blackman), and stretching somewhat into those made by the Member for Perth and North Perthshire (Pete Wishart), I do not agree that what is proposed will create a second-class status for MPs. The hon. Lady referred to being barred from being able to help constituents, but she should recognise that she is barred now from voting to help her constituents on devolved matters. Indeed, in the last Parliament, I think the Education Bill was an England-only Bill, and I think I am also right in saying that SNP Members decided not to vote on the Second Reading of the Education and Adoption Bill. I would have thought that given the similar approach and the consistency that the SNP has shown, hon. Members should be genuinely assured that we are not seeking to do something different in that regard.

Does the Minister not find it extraordinary that she is calling in aid a nationalist approach to legislation within the United Kingdom to justify the approach that she is taking? Does that not mean that she is advancing a nationalist argument in favour of her case, because this is a nationalist proposal?

I disagree with the hon. Gentleman; I do not see this as a nationalist proposal. Devolution is now supported on both sides of the House, but this addresses the imbalance that English constituents feel about what has happened on the journey of devolution. I do not know why the Labour Government chose not to address this issue. Perhaps the reason was that when Tony Blair was leader of the Labour party, it won elections with a majority of MPs in England and so perhaps felt unable to do that.

Let me finish addressing the issues that have been raised. I should point out that the Speaker, who is of course elected by the whole House, is already required to certify Bills, such as money Bills—I am sure that some Scottish MPs may remember the Scottish Grand Committee being convened, but I do not think it has been in over a decade. However, the situation has not proved problematic so far. There have been no legal challenges, and during a Committee on the Floor of the House, the Speaker selects the amendments on which there will be votes, so in effect he already has the power to decide who can amend laws.

The Minister speaks of an imbalance, and I fully understand that procedural changes are necessary at this moment. In the long term, would that imbalance not be better addressed by reviewing the Welsh devolution settlement, and would a good opportunity for that not be the Wales Bill?

My right hon. Friend will have the opportunity to make that point as and when the Wales Bill is debated. Given his former office, I am sure that he is already in discussions on that point.

I am short of time—I have less than a minute—so I will not be able to.

The right hon. Member for Delyn (Mr Hanson) said that he might lose his voice, but he clearly has not. When we were talking about devolved Administrations and devolved matters last month, he said:

“I understand the need to ensure that people in England cannot have a say on some of those issues”—[Official Report, 3 June 2015; Vol. 596, c. 661.]

However, he seems to want it the other way around.

The hon. Member for Wrexham (Ian C. Lucas) asked about the definition of an English-only law, and I have referred to the Education Act 2011, which went through in the last Parliament. This is not about having a panic or break-up of the Union, but about settling that balance.

I wish I had time to cover all the other issues, but I just remind the hon. Member for Scunthorpe (Nic Dakin), who suggested that these things have been drawn up in secret, that Labour was invited to participate in the Cabinet Committee but refused to last year. Labour had the chance but decided not to do so.

In conclusion, we will take action to answer the West Lothian question and ensure that our constitutional settlement is fair and sustainable in the light of further devolution, and I believe that that will strengthen the Union.

I do not think the English question has been answered, and the North Wales question has certainly not been answered when it comes to devolution. One thing that has been left hanging, even though the Minister had the opportunity to deal with it, is whether, if there was a London transport issue, that would be voted on only by London Members or by those from the rest of England—it would not be England-only, but London-only. We are talking about the UK transport system having all UK MPs—from Northern Ireland, Scotland and Wales—all voting with equal status. That was the purpose of today’s debate. That is how we should be going forward.

Question put and agreed to.


That this House has considered English Votes for English Laws and North Wales.


I beg to move,

That this House has considered treatment of fibromyalgia.

It is a pleasure to serve under your chairmanship for the first time in this Parliament, Mr Crausby. I welcome my hon. Friend the Minister to his place. He did brilliant work in his two Departments in the last Parliament, and I am sure that he will continue to excel during this.

I want to use this debate to throw a spotlight on a not particularly well known or medically well researched, but incredibly debilitating condition: fibromyalgia. I shall set out the views of some of those suffering from the condition, highlight the treatment available to help sufferers and, ultimately, make a few suggestions as to what can practically be done to improve life quality for those debilitated by fibromyalgia.

The last debate that I held in Westminster Hall was on sentencing for dangerous driving. That attracted significant interest from and participation by fellow Members from across the House. As you can see, Mr Crausby, today’s debate has attracted more modest interest. That is not because fibromyalgia is not a serious medical condition, but simply because it is not particularly well known, not least within some parts of the medical community.

Does the hon. Gentleman agree that a critical issue is awareness— public awareness and the awareness of sufferers themselves of what help is available? To give just one example, local support groups can be tremendously helpful. This is a two-track issue: it is about public awareness and the awareness of sufferers themselves.

Yes, of course; the hon. Gentleman is absolutely right. I shall go on to provide more details of what is going on locally and perhaps what we ought to be doing nationally.

I first learnt about the condition almost by accident a few years ago, through a chance conversation with some constituents. Since then, through the work of the excellent Reading fibromyalgia support group, which meets regularly in my constituency, I have been able to learn more about fibromyalgia and meet many of the people locally who are trying to cope with the condition, as well as medical practitioners who are focused on helping sufferers.

I thank the hon. Gentleman for bringing this issue to Westminster Hall for consideration. In my constituency, many people have come to me with disability living allowance claims, which is where my interest in and knowledge of fibromyalgia comes from. What concerns me greatly as a result of the correspondence and communication that I have had with my constituents is that GPs seem not always to be aware of the symptoms of fibromyalgia. That means that the figure for diagnosis in Northern Ireland is only 3%, yet we have a significantly larger number of people who have the disease. Does he think we need greater awareness among GPs to start with and then we can address the issue?

Yes, of course; the hon. Gentleman is absolutely right. A common theme is emerging among colleagues participating in the debate.

Let me describe fibromyalgia. It is a long-term condition that causes pain all over the body. As well as widespread pain, people with fibromyalgia may have increased sensitivity to pain, fatigue, muscle stiffness, difficulty sleeping, problems with mental processes, headaches and problems with their bowel and stomach.

I congratulate my hon. Friend on securing this debate. He mentions the severe pain that sufferers endure. My constituent, Mrs Joanne Kirkby, suffers from this terrible condition. Is he aware that most of the pain relief treatment centres in mainland Great Britain are within England and that if a patient comes from Wales, it is necessary to go through an extremely lengthy and complicated bureaucratic process to access treatment at, for example, the Bath pain relief centre?

My right hon. Friend makes a very good point. Perhaps the Minister will comment on where treatment is available and where pain clinics are situated.

The exact cause of fibromyalgia is unknown, but it is thought to be related to abnormal levels of certain chemicals in the brain and changes in the way the central nervous system processes pain messages carried around the body. It is also suggested that some people are more likely to develop fibromyalgia because of genes inherited from their parents. In many cases, the condition appears to be triggered by a physically or emotionally stressful event, such as an injury or infection, giving birth, having an operation, the breakdown of a relationship or the death of a loved one. The key point is that anyone can develop fibromyalgia, although it affects about seven times more women than men.

The condition typically develops between the ages of 30 and 50, but can occur in people of any age, including children and the elderly. Exactly how many people are affected by fibromyalgia is not clear, although research has suggested that it could be a relatively common condition. Some estimates suggest that nearly one in 20 people in the UK may be affected by the condition to some degree. Of course, one of the main reasons it is not clear precisely how many people are affected is that fibromyalgia can be difficult to diagnose. There is no specific test for the condition, and the symptoms can be similar to those of a number of other ailments.

Living with fibromyalgia can be incredibly debilitating. Ahead of today’s debate, a number of local people emailed me about their experiences of coping with fibromyalgia. I want to read out some extracts from the heartfelt and moving words that they sent me. A father of young children writes:

“I have had Fibromyalgia for a couple of years now. My life and that of immediate family has changed significantly in adapting to and attempting to cope with my condition.

I am unable to continue working as a qualified accountant, as my ability to read, write and concentrate have all been significantly affected. I suffer with ‘Fibro-fog’, a difficulty in recalling words or train of thought where the mind goes blank...I find it impossible to switch off from the pain, as it is constantly moving as though it is being scattered around my body.

I, and many of the members of the Reading Fibromyalgia group, experience the lack of understanding of others due to the ignorance relating to this condition that we suffer. As we appear whole there is often a lack of compassion from others and we can be made to feel as though we are malingerers. I have always had a strong work ethic and believe in setting a good example to my children; if I could work then I would work.

My hope now is that there will be a greater understanding of Fibromyalgia and how limiting this condition can be on the individual.”

A female sufferer writes:

“My typical day starts with trying to get my body working. My joints are so stiff with pain that I have to sit on the side of the bed and massage my shoulders, lower back, my knees, elbows and hands. It takes an hour to get showered and dressed. I do feel a failure if I have to get my husband to come and help me.

After having problems with pain, exhaustion and fatigue for several years, they then turned into depression, stress and anxiety. My G.P. finally diagnosed me with Fibromyalgia.

In 2013 I went along to our local Fibromyalgia Support Group…I went in the room and saw that there was ‘nothing different’ with these people. I was reduced to tears to find that they were all like me, young and old, male or female, and that I was ‘Not a Fraud’.”

Another submission that I received was from a male sufferer. He writes:

“Living with Fibro is often difficult and it’s like we have a volume control button that is broken at maximum setting—sometimes the pain and stiffness abate with medication, exercise where we are able to do so and so forth but it always comes back later in the day or within a day or two of doing too much activity.

Depression in people with Fibro is common”

because of

“the life we used to live but many no longer can. This adds to the stress and tension and it can become a vicious circle. Exhaustion is common as well.

The lack of understanding and sympathy from other people including importantly the medical profession makes it all the harder to bear. Yet Fibromyalgia has been recognised by the World Health Organisation since the 1970s as a chronic and long-term health condition. Thousands if not millions of people worldwide have Fibro either diagnosed or not so but they display the symptoms.

Yet people still think we’re making it up, which is very disheartening to us; some even are abusive to us because they don’t understand.”

Ahead of this debate, I spoke to many fibromyalgia sufferers, and colleagues who have contributed have clearly done the same. They will have heard the same things as I heard from constituents and in emails from people across the country, detailing their own experiences of coping with this debilitating condition. Three common themes emerge. First, fibromyalgia is not well enough understood by GPs and the medical profession, as the hon. Member for Strangford (Jim Shannon) said, and there seems to be no significant research effort to find a cure. Secondly, as a result, there is no consistency of approach or care across the country in helping sufferers to deal with the effects of fibromyalgia—exactly the point made by my right hon. Friend the Member for Clwyd West (Mr Jones). Thirdly, the condition is not well enough understood by the general public or employers, and sufferers have told me that they have faced discrimination in the workplace as well as the wider community. That is completely unacceptable.

I want to mention the good work of the Fibromyalgia Association UK, which today merges with FibroAction to speak up with a louder voice for sufferers of fibromyalgia, provide national helplines and raise awareness of the condition with GPs. Although knowledge is inconsistent within the GP and health community, there are pockets of excellence. Last October, I was invited to the one-year anniversary celebrations of the re-launched Reading fibromyalgia support group. There I met with Dr Antoni Chan, a consultant rheumatologist and physician at the Royal Berkshire hospital, who gave a presentation on the ongoing research aimed at understanding the condition and developing treatments. I also met Dr Deepak Ravindran, a consultant pain specialist at the Berkshire pain clinic. The clinic offers a comprehensive service, starting with expert diagnosis and followed up by medical treatment, which is complemented by good support from specialists in physiotherapy and psychology—a truly multi-disciplinary approach. I pay tribute to Dr Chan and Dr Ravindran for the excellent work they are doing to help fibromyalgia sufferers in Berkshire.

As a result of that meeting, I wrote to North and West Reading clinical commissioning group last November, providing a copy of the pamphlet on fibromyalgia that Dr Ravindran has produced and asking the CCG to promote understanding of the condition among the local general practitioner community. Dr Ravindran recently informed me that the need for an integrated and collaborative approach to managing fibromyalgia has been recognised locally, and a community pain service in the Reading area will start in September. That will be a collaboration between the Royal Berkshire hospital and the Berkshire healthcare NHS foundation trust, and its vision is to provide fibromyalgia-specific pain management programmes. That is good news for fibromyalgia sufferers in Reading and Berkshire, but, as other colleagues and I have remarked, the approach is inconsistent across the country.

I have three asks for the Minister and the NHS. First, education and knowledge of fibromyalgia must be improved among GPs and other healthcare professionals, and awareness of new diagnostic criteria must be increased and disseminated more widely. Secondly, strategies that provide an integrated and holistic service with patient empowerment as key must be promoted and developed, because patients need to be involved in decision making and the management of their condition. Thirdly, the aim should be to set up a network of fibromyalgia clinics across the country, so that patients who have had a flare-up of the condition have somewhere to go for treatment other than A&E or hospital.

My final point is about raising awareness of the condition more generally. Jeanne Hambleton, a freelance journalist and health writer, has informed me that last year she wrote to two well-known TV soap operas and asked whether one of the characters could be diagnosed with fibromyalgia to raise viewers’ awareness of the condition. Sadly, she did not hear back from the producers of either programme. I have no doubt that many people watch debates on Parliament TV, but it is safe to venture that many, many more watch soap operas. If the producers of “Casualty” or “Holby City” are watching the debate, they may want to get back to Ms Hambleton about her suggestion. I look forward to the Minister’s response.

I congratulate my hon. Friend the Member for Reading West (Alok Sharma) on securing a debate on this important issue. In his constituency, he has shown great support for his local fibromyalgia patient group by advocating on its behalf, raising money and raising the profile of the disease, which is so debilitating for its sufferers. He has helped the group to continue its important work of improving awareness of the condition and providing advice to patients and their families. I pay tribute to the work of FMA UK, other fibromyalgia charities and the many patient support groups around the country who work tirelessly to raise the profile of the disease and support those who are affected by it. I welcome today’s merger of FMA UK and FibroAction, which will help to give a stronger patient voice to those who are affected.

Fibromyalgia is an incurable musculoskeletal condition of unknown cause that can have a debilitating impact on those who are affected. Although no exact figures are available, research suggests that fibromyalgia affects around 2.5 million patients in the UK, the majority of whom are women over the age of 40. Fibromyalgia symptoms affect the soft tissues, muscles, tendons and ligaments of the body and result in widespread and variable pain throughout the body. Poor-quality, non-refreshing sleep contributes to an ongoing cycle of chronic pain and fatigue, and, in some cases, poor concentration and short-term memory problems. Irritable bowel syndrome, restless legs, head and neck pain and sensitivity to temperature change are also associated symptoms of fibromyalgia. The symptoms and their severity differ from patient to patient.

Diagnosing the symptoms of fibromyalgia can be challenging for GPs. Some 20% of the general population consult their GP about a musculoskeletal problem each year, which amounts to more than 100,000 consultations a day. The symptoms of fibromyalgia are common to other conditions such as rheumatoid arthritis, lupus and chronic fatigue syndrome. In addition, patients with fibromyalgia can often visibly appear well, despite their symptoms. GPs face a further obstacle because there is no diagnostic test that accurately identifies the condition. A diagnosis is usually made via a process of diagnostic investigation to exclude other potential causes of the patient’s ill health. It is, therefore, important that clinicians have the training, tools and resources to help them identify fibromyalgia symptoms when a patient presents.

Musculoskeletal conditions are a key part of the generalist undergraduate MBBS medical curriculum. The General Medical Council requires that the MBBS curriculum provide enough structured clinical placements to enable students to demonstrate the outcomes for graduates across a range of clinical specialties, including musculoskeletal health. Musculoskeletal health is also a key component of GP training, and the Royal College of General Practitioners’ curriculum statement on musculoskeletal conditions sets it out that GPs should be able to diagnose and manage common regional pain syndromes such as fibromyalgia.

In addition to clinical training and experience, GPs have at their disposal a number of tools and resources. They include: the Map of Medicine, an online evidence-based guide and clinical decision support tool available to GPs and other healthcare professionals in the NHS, which has a fibromyalgia and chronic pain pathway, and helps clinicians to identify the symptoms and make the right referral; a free e-learning course on musculoskeletal care, including fibromyalgia, developed by the RCGP and Arthritis Research UK, which aims to improve skills in diagnosing and managing musculoskeletal conditions; NHS evidence services, which provide access to a vast online repository of clinical knowledge and guidance covering a wide range of conditions, including fibromyalgia; and a fibromyalgia medical guide for health professionals developed by FMA UK.

Once a patient is diagnosed with fibromyalgia, a number of treatment options are available to them. In the absence of a cure, relieving pain and restoring quality of life are the primary clinical goals. Treatment options include pain relieving medication, physiotherapy, dietary and exercise advice, counselling or cognitive behavioural therapy, and self-management programmes to give patients the skills and confidence to manage their condition. The routine assessment and management of pain is a required competency of all health professionals. Many patients can have their fibromyalgia successfully managed through routine access to locally commissioned services via GPs, and community and secondary care services. I will turn to my hon. Friend’s point about specialist clinics in a moment.

The hon. Member for Reading West (Alok Sharma) and I asked how we can raise awareness within the GP profession to ensure that GPs understand the symptoms of fibromyalgia and diagnose it earlier. As I pointed out in my intervention, only 3% of people in Northern Ireland have been diagnosed with the condition, but the number of people who suffer from it is far larger. There seems to be a gap between those who have been diagnosed and those who have not. Is that because GPs are not really aware of the condition? How can we make them more aware?

The hon. Gentleman makes an excellent point, and he is helping to raise awareness today. I will pass on the points made today to the team at NHS England with responsibility for this issue. The answer to the question on awareness is to support debates such as this, and to promote the work of the charity and the patient advocacy groups.

The routine assessment of pain is a required competency for all healthcare professionals. However, patients who remain in high levels of pain after conventional approaches to treatment have failed are able to access specialised pain services, which are nationally commissioned by NHS England. Patients referred to such services receive multidisciplinary team care from clinicians with expertise in pain management.

The Minister heard my earlier intervention, and he now mentions specialised pain relief centres, most of which are located in England. He also heard my points about the bureaucratic difficulties experienced by patients living in Wales when accessing such centres in England. Will he liaise with his colleagues in the Welsh Government on whether a smoother path can be achieved for patients from Wales?

My right hon. Friend is an outspoken advocate for addressing such needs in Wales, in health as in other issues. He will know that pain centres in England are distributed evenly, but they are a devolved matter in Wales and the other devolved Administrations. I will happily write to the relevant people in Wales to highlight the importance of this condition and what we are trying to do in England, and to encourage them to adopt similar best practice. I cannot vouch for their response and, as in other areas, it is a matter for the local Assembly, but I will happily pick that up.

In addition to the specialised pain services that are available, a number of NHS trusts provide dedicated fibromyalgia clinics, such as that at the Royal National hospital for rheumatic diseases in Bath. That clinic offers expert support and advice, as well as a fibromyalgia coping skills programme to facilitate self-management. Some constituents of my hon. Friend the Member for Reading West have raised concerns about the co-ordination of their care; I reassure him and them that improving care and support for people with long-term conditions, and improving the co-ordination of that care, is a central ambition of this Government, as reflected in our mandate to the NHS.

Is there not also a social aspect to this—the issue of sufferers being able to support each other? I am delighted to hear the Minister’s point about co-ordination, because improving co-ordination is crucial to such support being more widely and more consistently available across the UK.

The hon. Gentleman makes an important point. Such co-ordination is happening across different therapeutic areas. Charities have a role in providing a strong voice for patient empowerment. Patient networks, increasingly including social media, allow us to advance the voice of disease sufferers in research, treatment and patient support. I am delighted by the news of today’s amalgamation of the two charities, which can only be a good thing for developing wider understanding and a patient voice in new treatment pathways.

We want everyone with a long-term condition— around 15 million people—to be offered a personalised care plan that sets out their needs and preferences for care. Martin McShane, who is responsible at NHS England for improving outcomes for long-term conditions, and Peter Kay, the national clinical director for musculoskeletal care, are working hard to make that happen. I will ensure that the points raised today are passed on to them as part of that work.

My hon. Friend the Member for Reading West mentioned research. Nationally, the Department of Health has substantially increased overall medical research investment from £885 million a year in 2010 to the more than £1 billion allocated for 2015-16. The usual practice of the Department’s National Institute for Health Research, for which I am responsible, is not to ring-fence funds for expenditure on particular topics but to invite and assess research proposals in all areas. Although no fibromyalgia projects are currently funded by the NIHR, the European Commission is contributing nearly €6 million to a project seeking better ways of treating chronic pain, including fibromyalgia. I look forward to the results after the project ends in 2018, and I urge hon. and right hon. Members who are present, FMA UK and the patients it represents to feed their comments into that project and to welcome the results.

We are considering further ways to showcase the world-class research funded by the NIHR, and we are working in this place, and with the public and charities, to drive accountability. I am working with the NIHR to put together a parliamentary open day to allow Members such as those who have spoken today to see where the £1 billion a year is spent, and to work with charities and patient groups on making applications.

A number of colleagues on both sides of the House have talked about discrimination in the workplace, which is a serious concern for people both in my hon. Friend’s constituency and in local fibromyalgia support groups. It is completely unacceptable if patients with long-term conditions are misrepresented as malingerers at work. Historically, we have seen that happen with other conditions, and as research and understanding of the disease develop, we need to be aware that people who present with conditions that are not well understood may be suffering from diseases that have yet to be properly diagnosed. People with long-term disabling conditions are rightly protected from discrimination in the workplace under the Equality Act 2010. Where a disability, such as one arising from a long-term condition, has been established, the Act requires employers to make reasonable adjustments to ensure that the disabled are not placed at a substantial disadvantage compared with their non-disabled colleagues. Failure of an employer in that regard could amount to direct disability discrimination under the Act.

My hon. Friend and a number of others spoke about the establishment of a network of specialist fibromyalgia clinics. We are aware of a number of dedicated fibromyalgia clinics across the UK, including the UK’s leading centre at the Royal National hospital for rheumatic diseases in Bath, but I will write to Martin McShane, the head of long-term conditions at NHS England, to ask whether more formal networks can be established and whether, with the support of active patients and charities, there is more we can do to develop such groups and to help them to support research on developing new treatments and pathways.

I genuinely thank my hon. Friend for his tireless constituency work to raise this issue, and I congratulate him on securing this debate. So much medicine begins with the small voice of misunderstood patients who get together through charities to promote research, raise the profile of a disease in this place and elsewhere, build a head of steam, bid for research projects—the NIHR stands open and ready to receive bids—and build cross-party support. I have no doubt that, in the years to come, this work, this discussion and this topic will come to be seen as one of those occasions when the more we come to understand a condition, the more we drive research on cure and diagnosis and the more we improve treatment across the NHS. I warmly welcome his leadership in bringing fibromyalgia to the House’s attention today.

Question put and agreed to.

Sitting suspended.

Operational Productivity in NHS Providers

[Mark Pritchard in the Chair]

I beg to move,

That this House has considered operational productivity in NHS providers.

It is a pleasure to serve under your chairmanship, Mr Pritchard, and I welcome the Minister to his role. I believe this may be his first Westminster Hall debate, and I am greatly pleased that I am the Member who secured the debate.

The national health service featured heavily in the recent general election campaign. I recall speaking at several hustings and telling my constituents that I recognised that this Parliament would witness an increasing demand for NHS services. On occasion I was challenged on how the additional £8 billion highlighted by the Stevens review would be found. My response, then and now, is that the greatest efficiencies can be identified within current services without undermining patient care. Such a view is shared by Simon Stevens, but most interestingly it is a view shared by others, including my constituents Philip Braham and David Green, who established a medical recruitment company called Remedium Partners. I am pleased that both gentlemen are here today in the Public Gallery.

Having met Mr Braham and Mr Green before the election, I was eager to re-establish contact with them earlier this month to discuss their ideas about NHS efficiency in employment. It is possible that more cynical Members will say that this is more evidence of the Conservative party seeking to introduce greater private sector involvement in the NHS for others to make a profit, but that would be an incorrect assertion to make. In fact, I found our discussion focusing on opportunities to save the NHS more money and prevent its resources being plundered by unscrupulous individuals.

The publication of Lord Carter of Coles’s interim report, “Review of Operational Productivity in NHS providers”—hence the title of this debate—two days before our meeting could not have been more fortuitous. The report outlined four areas where Lord Carter believes greater efficiencies could be achieved to allow additional moneys to be spent on front-line care. One objective in seeking today’s debate was to air the issues and to place them on the public record. Lord Carter’s efficiencies within the NHS include saving £1 billion from improved hospital pharmacy and medicines optimisation, £1 billion from the NHS estate, £1 billion from improvements to procurement management, and £2 billion from improvements in workflow and encompassing workforce costs.

Workforce costs is the area that I intend to focus on in this debate, as I have discussed it directly with my constituents and because just a 1% increase in workforce productivity could achieve as much as £400 million of savings. This is a significant and important area of the work of the NHS. Lord Carter believes that the £2 billion figure would be achieved without making anyone redundant and without seeking to increase the responsibilities of staff, nor would it mean decreased levels of remuneration for future employees. What it does mean is a greater command of management control on non-productive time, which are the periods when staff emphasis is not on direct patient care—days and shifts of annual leave, sickness and training. It also includes better management of rosters, improved guidance on appropriate staffing levels and skill ranges for certain types of wards.

The NHS is one of the largest employers in this country, employing more than 1.3 million staff in more than 300 different types of roles. In the last year that figures were available, the cost to the NHS budget was £45.3 billion, the largest proportion of the £118 billion budget. The cost of nurses alone totals £19 billion, and with the increased number required for safer staffing and a third increase in the number of nurses leaving the profession in the past two years, the reliance on agency nurses will see this figure rising.

When the hon. Gentleman talks about increasing the productivity of staff, can he itemise which staff he is referring to and say how much would actually be saved?

We are talking about all the different staff. There are 300 different employment roles in the NHS, so we are talking about everyone across the NHS, but I hope later in my speech to come to the specifics of clinicians and the use of agency staff for that sort of role.

I congratulate my hon. Friend on securing this important debate. In my constituency in north Cumbria there is a hospital with a large number of agency staff, which has been a problem for some considerable time. I understand the need to employ agency staff, but does he agree that it would be far better to have staff employed directly by the hospital, as that would improve patient care and staff morale and also—to echo his point—improve the costs and productivity of that hospital?

I certainly do agree with that point, and I hope to elaborate further on that. I also wish to touch on the use of bank nurses, or bank employees, who periodically work for parts of the NHS. I agree that for patient care it would be best to have full-time permanent staff who not only know the patients and the hospitals, but know the other employees they work with on a day-to-day basis.

Most worryingly, Lord Carter identified the fact that, in some of the 22 hospitals he surveyed, bank nurses are remunerated at a level that does not discourage them from remaining with, or moving to, agencies. I looked at the website of one of the trusts that took part in the review by Lord Carter and was surprised to see the range and number of bank employees—including, ironically, the position of the e-roster co-ordinator. I will not name that particular trust, as this debate is not a “name and shame” exercise, but I raise it to illustrate the point, because if such a role is vacant, what hope can there be to ensure that other clinical positions are staffed suitably?

The e-roster co-ordinator is in the best position to monitor employment and identify irregularities in work patterns to prevent fraudulent practices. The majority of people who work for the NHS are honest, but there are a minority who seek to defraud its resources. I want to highlight the types of fraud that occur. Such fraud involves staff and professionals who claim money for services not provided or more money than they are entitled to, or who divert funds to themselves. It can also involve external organisations that provide false or misleading information, including invoices, to claim money they are not entitled to. Some of these frauds can be fairly low value, but they can often cost the NHS hundreds of thousands of pounds.

One example is Michael Botham, a hospital worker in Stoke-on-Trent who claimed nearly £20,000 for shifts he did not work. He applied for work via a recruitment agency, AMG Nursing and Care Services, in October 2007. He was then assigned as an unqualified healthcare worker to Bucknall hospital in Stoke-on-Trent, where he worked in the complex needs ward. Most worryingly, it took a ward manager to identify an overspend and to report their suspicions about Botham to the trust’s local counter-fraud specialist team. When the team analysed his timesheets, they revealed that he had submitted false claims for work from 1 January to 26 July 2009, complete with forged authorisation. In fact, he had worked only one shift during that period.

Botham also claimed payment for four shifts at Bradwell hospital, part of the same trust, in January 2009. Again, he had not worked those shifts and the authorising signatures were also false. In total, the trust overpaid £19,362 as a result of his false claims to the agency, which invoiced the trust in good faith on a weekly basis, but subsequently, to its credit, offered to pay back its fees of £3,956.50. This is a clear case of an individual deciding to defraud the NHS, but what is concerning is that the problem emerged only as a result of the scrutiny of another member of staff whose role was not to look for fraud.

I worked for a clinical commissioning group in Bristol. Does the hon. Gentleman accept that one reason why that would have happened is that all members of NHS staff have to undergo mandatory and statutory training to recognise and counter fraud?

I do, but I am saying that this should have been picked up by an individual with a strategic, holistic approach to staffing and staffing budgets, rather than leaving it to one individual on the ward who realised there was a problem with the budgets. There are processes in place to ensure that fraud does not happen, and I would like all hospital trusts to introduce such processes. In his report, Lord Carter highlights a case where one provider identified 20 cases of counter-fraud when they reviewed and strengthened their sickness and annual reporting leave. That prompts the question of why such abuses continue to be left unchecked.

There is another case of fraud that I want to highlight, which has been judged more harshly, although it can be argued that it is certainly not as deceptive because the individual actually undertook the work. Simon Olufemi Ajani was sentenced to 12 months’ imprisonment following a fraud investigation by NHS Protect after he had produced a false passport and certificate of entitlement to the right of abode in the UK. That enabled him to obtain work with patients at East London NHS Foundation Trust, South London and Maudsley NHS Foundation Trust, and other London trusts through NHS Professionals, the agency that supplies temporary staff to the NHS. His fraud was first uncovered through a data-matching exercise that highlighted inconsistencies between UK Border Agency records and NHS payroll records.

The difference between those two cases is that Ajani worked the hours that he was paid for, even though he was not entitled to be employed in this country, while Botham was just a crook stealing money directly from the NHS and patient care. These examples lead me to ask the Minister about the employment of those from outside the EU, an issue I have discussed recently with my constituents, as I mentioned. There is some criticism about the use of foreign doctors in the NHS, and some people consider that these jobs have been taken out of the reach of British people. However, we all know that the NHS does not have the numbers of doctors and nurses that it needs and there is not the capacity within the population of the United Kingdom to provide them. That is why some agency staff are required.

For some medical practitioners, however, remaining a locum is an alternative to having a permanent position. Some doctors are able to earn between £1,400 and £1,500 for a 12-hour shift, while the on-costs payable to agencies mean that hundreds of thousands of pounds a year are being charged to health trusts around the country for employment of temporary staff. One alternative to the costly system of locums could be the employment of a permanent doctor from overseas who could earn a salary of between £75,000 and £120,000. I need not ask the Minister whether he feels that this is better value for money than having a locum.

The NHS is an employer of those considered to have skills that are needed in this country, and a tier 2 visa allows “skilled workers” from outside the European economic area with a job offer to enter the UK. However, it has been established that the immigration health surcharge is levied against non-EU citizens. This requires every applicant and their dependents to pay not only their visa fees but a further £200 each year for up to three years. It strikes me as perverse that the very people needed to work in the NHS are being penalised by paying an additional amount that should perhaps be part of their terms and conditions of employment. Can the Minister explain in his summing up how the figure of £200 was reached and whether he feels that levying this tithe against NHS employees is counterproductive?

Lord Carter’s report goes on to identify opportunities in managing annual leave—what he terms the largest part of non-productive time. There are many ways in which NHS employers can ensure they manage staff leave. I am not going to stand here and say that the Minister should micro-manage the NHS in England, but even simple practices do not appear to be implemented in some NHS trusts. We all agree that, while the needs of patients must be considered when managing annual leave, people do need time off. Introducing a notice period of a month for leave requests of, say, more than three or four days would allow NHS managers the time to plan ahead, but that is not happening uniformly, thereby ensuring that agency staff are needed as an emergency measure.

Can the Minister therefore confirm that measures introduced by the Secretary of State to reduce agency locum spend will include a requirement for trusts to ensure that their employment practices and policies include such conditions as notice periods to book leave, that trusts consider employing e-roster co-ordinators and that trusts examine their employment policies so that they can compare themselves with their peers and undertake a skill mix review, the combination of which would reduce the need for spending on agency staff?

A fear raised with me by my constituents concerns the revalidation of full-time locum doctors. It is well known that locum doctors can experience a variety of challenges with revalidation, largely due to the peripatetic nature of their work, but annual appraisals are the backbone of revalidation and fundamental to demonstrating the fitness of medical professionals to practise. Revalidation should be carried out by the framework suppliers—the agencies that supply staff—but I have heard anecdotal reports that agencies do not revalidate, and it has been alleged that some health professionals are even practising outside their qualifications and skill range. Can the Minister tell us how the Department will ensure that the revalidation of all full-time locum medical professionals is carried out by the framework suppliers?

The final issue about the use of agency staff I want to raise is the use of master vendor contracts between health trusts and employment agencies. The use of this practice creates an opportunity for collusion within the employment industry to seek maximum financial gain through the use of exclusive contracts. While such contracts may be an easy option for the employer—in this case, the health trust—the agency can ask premium prices for a service that could be provided more cheaply if it were opened up to competition. Such a practice effectively introduces a closed shop and prevents smaller employment agencies from being able to enter the health market. Can the Minister advise us how the Department can ensure that the use of master vendors does not result in tacit collusion in the employment industry for exclusive contracts that cost the NHS more than it might pay for the services elsewhere?

In conclusion, this debate is not a negative criticism of employment agencies or the work of people in the NHS; in fact, it is the opposite. I congratulate the people who work in the NHS and I want to ensure that more people are employed in the NHS. I am framing this debate as an opportunity to assist the Government in ensuring that the resources needed by the NHS and identified by the Stevens review are made available. It is an opportunity to start the process by recognising where we can work smarter to ensure a better NHS for all and identify opportunities to achieve economies that do not undermine patient care, but in fact achieve the opposite, by ensuring the correct number of appropriately qualified staff in the NHS, working confidently, diligently and at a pace that ensures the best care for patients.

Thank you, Mr Pritchard, for calling me to speak.

I agree with the hon. Member for Hendon (Dr Offord) that of course there are always efficiencies to be made, and ways of considering how they can be made; NHS managers and staff, including clinical staff, spend a great deal of their time doing that. My intervention about counter-fraud was meant to suggest that that work becomes part of the way that people start thinking about their work as public servants. However, this debate needs to be widened out beyond the individual savings that have been mentioned. As the King’s Fund has said, the greatest savings achieved in the NHS since 1948 were made since 2010, largely through reductions to pay and central budgets, and some restructuring. Having said that, I am slightly sceptical about the savings that can be made through restructuring.

We need to move this debate on to a discussion about quality in its widest sense, because quality is an organising principle of the NHS; ultimately, quality will deliver greater savings and contribute towards the £22 billion target. It will also involve people much more in the management of their healthcare, so that we save money that is currently spent on public health interventions. We must also ensure that when people use the health service, they understand where savings can be made. If we were able to involve patients and others much more in that debate, we would find more good examples of what we have been discussing. There are some great examples from Bristol, particularly around environmental savings. There have been some fantastic projects to reduce consumption of energy, both at Universities Hospital Bristol NHS Foundation Trust, and at North Bristol NHS Trust. There is also the reskilling that takes place within the community services organisations, to make better use of the highly skilled community nurses and to help people with the flow in and out of hospital.

However, all these measures require the system to be stable and require some transitional support to allow the transformation to happen. At the moment, I am not sure that the NHS feels it has the support to make that happen, as individual examples that will not yield overall results are being picked out. I welcome this debate about productivity, but I hope that we can have a degree of political honesty about the scale of the challenge of the £22 billion cuts.

The hon. Member for Hendon (Dr Offord) talked about efficiency, which is one thing; productivity is something totally different. Productivity is what the individual produces, whereas efficiency is really about how the individual works. Does my hon. Frind agree?

I agree with my hon. Friend. It is the environment in which an individual works and is supported into work that helps to boost productivity. I think we would all agree that generally people want to be as productive in the service as they can be, and they are very cognisant of their role as public servants. As I say, I would like to see political honesty and discussion about the scale of the £22 billion cuts. It is hard to see where they will come from, regardless of pay restraint, cuts to services and major reconfigurations. Those changes may need to happen, but there needs to be honesty across all parties in the House to support their introduction.

There is wide-scale agreement about the problems that the NHS faces, beyond the items that the hon. Member for Hendon mentioned, but now that the election has passed it is time for us to consider the solutions that can be achieved to support staff in making that transformation, and in making the NHS highly productive, as well as one of the most efficient services in the world.

I am glad to speak in this important debate under your chairmanship, Mr Pritchard. I congratulate the hon. Member for Hendon (Dr Offord) on securing it.

Obviously, in Scotland the situation is slightly different, because the NHS is devolved, but many issues cross over, wherever our health services are located. I was very interested in some of the points made. NHS Scotland has produced a framework for efficiency and productivity going up to 2015. We recognise that it is essential to be more efficient and productive, to ensure careful use of the public purse.

To an extent, the situation in Scotland is slightly different, because the NHS budget has been protected from cuts as a result of the Scottish Government’s action. However, we still face inflationary pressures arising from demographic changes and increasing drugs and staff costs, which mean that NHS boards will need to make a minimum of 3% efficiency savings just to break even.

I was interested in what the hon. Gentleman said about the many issues faced by the NHS, particularly in England. I understand that much of the savings to date have been made by freezing staff salaries, squeezing prices paid to hospitals for the treatment they provide and cutting management costs. I wonder whether there is a correlation between those savings and the frauds and difficulties in some hospitals, which he mentioned. We all want to cut management costs, but sometimes there is a cost to doing that, because if management is cut back it cannot have the same hands-on experience of what is going on in all areas of the operation. That has to be weighed in the balance when we consider such savings.

The hon. Gentleman talked about the Carter review and the time spent by people on the frontline, whether with patients or doing other things. Again, that has to be built in. The hon. Member for Coventry South (Mr Cunningham) made a good point about the difference between productivity and efficiency. A staff member could be deemed much more efficient if they just dealt with patients, but down time for staff has to be worked into the system, because any doctor, nurse, or other NHS staff member will be working at a high level for very long periods. There are dangers if down time is not built in.

All of us would want savings made where they can be safely made, but the hon. Member for Bristol South (Karin Smyth) made an interesting point about the King’s Fund, which estimates that another £30 billion of savings will be required by 2020-21. The Government have made much of the fact that they will put another £8 billion into the NHS. Although I am sure that is welcome, it still leaves £22 billion in savings to be achieved through productivity improvements. With the best will in the world, I find it difficult to envisage £22 billion of savings being made through productivity improvements in the NHS. If it can be achieved, that is fair and well, but it does seem a very tall order, as the King’s Fund stated.

An organisation cannot keep freezing staff wages forever; there will have to be a change in that regard. Management costs cannot be cut indefinitely, because, again, management is needed to run the system.

Admittedly, it has been some years since I was involved in negotiations relating to productivity, and so forth, but the fact remains that there are consequences if people are not paid a decent wage. I worked in industries where wages were frozen and saw the consequences. The only way to increase productivity in the NHS and maybe save money—I use the word “maybe” advisedly—is by having incentives. That is the only way it can be done. It was not clear, in the speech made by the hon. Member for Hendon (Dr Offord), what percentage of people would have time off. There is a tolerable, acceptable percentage in that regard, but I was not clear what the percentages were.

The hon. Gentleman makes a good point. He is right about incentives. A happy workforce will be a much more productive workforce. There is a danger of putting increasing pressure on the workforce, especially in the NHS, where mistakes can be disastrous and can do a lot of damage in the long term, both to the system and patients. We have to be careful about some of these things. I was interested in what the hon. Member for Hendon said about the cost of agency workers. I think we would all agree on that point. It would be preferable to have full-time staff in the NHS, but agency workers are used for a reason: shortages.

The hon. Gentleman also talked about people from outside the EU working in the NHS, but again, this shows that there needs to be a more holistic Government policy. The Government recently announced an earnings threshold of £36,000, under immigration policy, for those who have been working in this country for six years. Many nurses working in the NHS throughout the United Kingdom are not earning that sort of money and have been in the NHS for many years. The Royal College of Nursing stated that if this policy was imposed, thousands of nurses could leave the NHS and could have to leave the UK. That is not in the best interests of the health service at the moment. When considering efficiency savings and how the NHS can better work for all our constituents throughout the UK, we have to think about such things .

The hon. Gentleman is making an important point. Would it not be counterproductive if NHS nurses left to work abroad? That would leave a massive gap in the NHS workforce, probably requiring an increase in agency workers, which would cost the NHS more.

The hon. Gentleman read my mind: that was my next point. Agency nurses are causing a drain on resources, because we have to employ so many already. That will not get any better if nurses cannot work in the NHS because of immigration policy. These people did not come to this country a few months ago; some have been here for many years. Many of these nurses are working in hospitals in all parts of the UK, whether Scotland, Northern Ireland or England. They are also working in the care system.

The Government are making a bad situation worse, perhaps because of other pressures on them to do with immigration, and are not dealing with the realities of the health service. Training new nurses to take the place of those who may leave will not happen overnight. It takes years to train a nurse properly. If these people have to leave suddenly, they will leave a huge hole in the NHS. That raises a question about the sustainability of the system. In summing up, the Minister might like to consider that; and perhaps he will take the matter up with Home Office colleagues and discuss the impact this policy may have on the NHS.

Efficiency savings are fine where they can be made. We are all looking for efficiency savings, and we understand that there can be some. For example, there are some interesting responses in the Carter review on medicines and prescriptions. Savings could be made there. A lot of medicines can be wasted if prescriptions are too large. Such system changes can save money, but it is wrong to look for the silver bullet that is going to change things and produce the £22 billion in efficiency and improvement savings.

If the hon. Gentleman thinks back 12 months or so, he may remember that it took a long time for the Secretary of State to reach an agreement with the pharmaceutical companies because some issues were held up. We should consider that. It seems to me that a gun was held to the Secretary of State’s head on costs.

Again, the hon. Gentleman makes an excellent point. One difficulty with the NHS is the cost of medicines. All our constituents are pushing us to get costly new medicines on the NHS for diseases, including rare diseases. They might be extremely costly in the first instance for good reasons, but demand always increases costs in the system, and it is difficult to deal with that. The pharmaceutical companies have a role to play in that, because much of their business comes through the national health service. If cost savings can be made by negotiating with those companies, that should be done. I am sure that the Secretary of State will at all times try to persuade them on that point, but I am not so sure how well he will do, given the competing pressures from constituents and Members for new drugs to be made available on the NHS. None of these issues are easy, and I have some sympathy for Ministers who are struggling with them, especially given the pressures on all areas of Government spending, but I urge caution in looking for simple solutions.

While it will be unorthodox, it is not irregular for me to call Jim Shannon, who briefly left the Chamber during a very good speech from Karin Smyth that was slightly shorter than I expected.

Thank you, Mr Pritchard. I apologise for having had to step out of the Chamber for a minute or two. I expected the speech of the hon. Member for Bristol South (Karin Smyth) to be a wee bit longer. It is always a pleasure to speak on these issues, and I thank the hon. Member for Hendon (Dr Offord) for bringing this subject to the House for our consideration.

The Carter report is important. Members will know that health is a devolved matter in Northern Ireland, and the responsibility for health falls clearly on the Northern Ireland Assembly and my party colleague Simon Hamilton, but it is important that we consider the issues and the recommendations in the report. I will speak to that in a few minutes, but first I pay tribute to all those who, despite the numerous difficulties facing us, make our NHS one of the premier care services in the world.

The tireless work of the doctors, nurses, surgeons, technicians, pharmacists, auxiliaries, cleaners, cooks, porters and those who work in admin behind the scenes has not gone unnoticed. I am sure everyone here would start by thanking them for their contributions, their efforts and the exhausting work they do. I thank them for their smiles to the patients and families, sometimes when the workers are so exhausted they can barely stand. I thank them for staying those extra 10 and 15 minutes beyond what they are paid for to make a patient comfortable. I thank them for choosing to come to work and sometimes having to face abuse from tired and perhaps frightened people. I thank them for retaining their dignity and helpful nature. In this debate, we do not stand in judgment on the NHS or the workers; rather, we look at the procedures in place and how we as Members of Parliament can help to make the NHS, which we are fortunate to have across all the regions, more effective for everyone.

The hon. Gentleman mentioned long hours. Some of the young trainee doctors are doing a 12-hour day, seven days a week. That can go on for months. That is not exactly conducive to good morale in the national health service, is it?

None of us here said that it was. It is important that our doctors and the staff are not over-tired.

The Carter report sets out how efficiencies can be delivered. The hon. Member for Angus (Mike Weir) who spoke before me clearly outlined the issues. The title of the debate refers to Lord Carter’s review of productivity in hospitals, and the interim report of that review, “Review of operational productivity in NHS providers”, which was published on 11 June. We all know that Lord Carter of Coles was appointed by the Health Secretary to chair the NHS procurement and efficiency board in June 2014, to review the operational productivity of NHS hospitals and to establish the opportunities for efficiency savings across the NHS. To do that, Lord Carter and the review board worked with a group of 22 NHS providers across England, and I think that what they have found in England will be replicated for us in Northern Ireland and for our colleagues in Scotland and Wales. There are lessons to learn, so we should take note of what the report says.

As I said, an interim report was published on 11 June outlining the work that has been carried out and the interim recommendations and next steps. The full report is to come in the autumn, and I look forward to seeing what it says. Back home, people are sick to death of the term “efficiency savings”, the idiotic behaviour of Sinn Féin and the Social Democratic and Labour party and others and the funding penalties we are facing. Our NHS is being asked to do the impossible and be more efficient than it is, but when I look at the findings of the interim report, I see things that may extend to our running of the NHS in Northern Ireland. That is what the Carter report is about, and I am sure the Minister will give his thoughts on that shortly. The report sets out ways we could ease the pressure off front-line services and enable the functioning of our country while we wait for action to cease the penalties and see Northern Ireland receiving what she is entitled to—what we would be getting, were it not for the inability of Sinn Féin to do what its Members were elected to do and work for the people. That, however, is a different debate for another day, and I accept that.

The interim report suggests that the NHS in England could look to make savings of some £5 billion per annum by 2019-20 and reports three major areas of opportunity. The first is hospitals getting a stronger grip on the utilisation of resources, particularly in four areas: workforce, hospital pharmacy and medicines, estates management and procurement. The second is achieving greater productivity in hospital workflow—how patients move through the system—and the subsequent use of assets such as operating theatres. I have always felt we could look at that, and the Carter report has examined it and offered some ideas on how it could work. The final area is gaining a better understanding of the need for hospitals to develop sub-acute services, either on their own or in collaboration with others, to facilitate the discharge of patients. It is about making it work better together.

We need a way of ensuring the highest quality of patient care, delivered at the lowest price possible to ensure that more funding can be diverted to cancer drugs. Members will know that I have advocated ensuring the availability of cancer drugs across the whole United Kingdom, rather than that being down to postcode. In Northern Ireland, we would like to use prescription charges to put some money towards cancer drugs. I know that the Government have given a commitment and that there is some help for the devolved Administrations when it comes to cancer drugs, but not to the extent that we would like. We also need more funding diverted to research and other areas.

I was surprised to see in the report that one hospital could save up to £750,000 a year by improving the way it deals with staff rosters, annual leave, sickness and flexible working. That was just one example, which would regain the £10,000 a month the hospital was losing due to people claiming too much annual leave. That is an easy way of getting money back into hospitals. Ensuring every hospital pays the best price for medicines and supplies would save money that could be invested in front-line care. One hospital with 23 operating theatres improved the way it tracks the products used during surgery and saved £230,000 in the first year alone. I am not saying that every hospital could do that, but it is an example of what can be done, and it would be unwise to ignore it.

When the Hansard report of this debate becomes available, I will send a copy to my colleague, the Health Minister in Northern Ireland, Simon Hamilton, to make him aware of the Carter report and this debate. Helpful lessons may emerge that we could use. For example, a hospital was using the soluble version of a steroid for multiple illnesses and paying £1.50 a tablet when the solid version costs just 2p a tablet. Using the soluble version only for children and patients who have trouble swallowing saved £40,000 every year. Those may be small examples, but they collectively show how something could happen. I have some concerns. Cheap is not always best, and we have many examples of the copying of tablets in China and elsewhere. Those tablets are not as effective and may be harmful, so we have to monitor how we best ensure that cheaper drugs are effective and tackle the diseases they are designed to tackle.

We must take these issues in hand if we are to see the best possible use of funding. With the publication of the full report in the autumn, we will have a better idea of where we are. I hope that that report will be seen not as a stick to beat the NHS with—if it is, that will be for the wrong reasons—but as a ray of light that will help make things better. I very much look forward to seeing what it says about how we can improve things here in England, because we will then, I hope, be able to use that example to improve things across the water in Northern Ireland and perhaps in Scotland, for my colleague and friend, the hon. Member for Angus.

It is a pleasure to see you in the Chair, Mr Pritchard. I congratulate the hon. Member for Hendon (Dr Offord) on securing this important debate. We have had a good debate, although fairly brief, and some important issues have been raised.

I formally welcome the Minister. We have had Health Questions and an Opposition day debate on health since he assumed his role, but this is my first opportunity to welcome him. I trust that his time at the Department of Health will be enjoyable and successful.

I am pleased to respond to the debate on behalf of the Opposition. The hon. Member for Hendon is right: the efficiency challenge for the coming years will dominate the debate about healthcare and shape our NHS in England for decades. As Members know—indeed, several referred to it specifically—the Government are committed to seeing £22 billion of efficiency savings in the NHS by 2020 to meet the £30 billion funding challenge. We have not yet heard any details of where the £8 billion in funding will come from; perhaps I can tease some of the detail out of the Minister. I do not wish to prejudge what may or may not be in the Budget, but it would be nice to have some indication, aside from the usual spin about a growing economy, of where he thinks the £8 billion will come from. Setting aside that question, we need to think carefully about how to meet the £22 billion gap that will remain once that £8 billion is found. To achieve savings on that scale would be a huge ask at any time, but when NHS trusts have huge deficits to tackle and providers say they are experiencing the biggest financial pressures they have ever seen, making these efficiencies will be a huge challenge.

It is probably appropriate at this stage for me to place on record my appreciation of and thanks to those who work in our national health service—at every level. It is not always popular to praise managers, but to meet the challenge the NHS will need a great deal of expert management. We therefore need to praise the work of not just the doctors, nurses, clinicians, porters and support staff, but the good managers, because they will face the real challenge of finding these efficiencies.

It is vital, not just for us but for all those who work in the NHS, that the Minister is as open and honest as he can be today about where the efficiencies will come from. One of the few people who has seen the detail of the planned efficiency savings is the former Care Minister, the right hon. Member for North Norfolk (Norman Lamb). Just last week, he said that the £22 billion efficiency savings in the five-year forward view are “virtually impossible” to achieve—words that will not fill people with confidence.

As the Minister knows, the Opposition have pressed the Government on a number of occasions to publish the assumptions underlying the £22 billion figure. I hope he will take that message back to the Secretary of State today, because we need to have a properly informed debate about the NHS’s long-term funding requirements. That is true not just of England, because the proposals will have knock-on consequences for the NHS in all the constituent parts of the United Kingdom, including Scotland and Northern Ireland, which have been represented in the debate.

We need to be honest about the fact that, whatever the scale of the efficiencies that need to be found, there will be no quick fix—a point eloquently made by my hon. Friend the Member for Bristol South (Karin Smyth). However, when budgets are tight, it is right that we debate how money can be better spent to meet the growing cost of delivering world-class healthcare.

With that in mind, let me cover a couple of pertinent areas. The first is procurement. Any doctor will tell us of sales representatives pushing every bit of kit and course of medicine under the sun—that is just the nature of salespeople, and that is what they do. In the NHS, there are around 500,000 product lines for everyday consumables, with cost variances of sometimes more than 35%, which is massive. The Carter review suggested that a catalogue of 6,000 to 9,000 product lines represents best practice. In part, the huge variety of products is a symptom of a more fragmented NHS. These days, we do not have the opportunity to use the NHS’s national purchasing muscle as much as we did, which is a shame and a wasted opportunity. However, having a reduced range of products—perhaps set out in a national catalogue, but definitely coming through the NHS supply chain—would be good for cost-effectiveness. I hope the Minister can take that point on board.

Part of the problem is the army of sales representatives, who are proliferating at all levels of the NHS. Their very existence represents a large dead-weight cost to providers. They can provide a useful service when it comes to selecting the best product for practitioners’ needs, but it is obviously not in their interests to provide products at the lowest practical cost; nor is it in their interests to promote other products or to give practitioners more information about the choices that may be available to them and their patients. It is, to some extent, an imperfect market, with smaller suppliers pushed out from the very beginning. There will always be a need for companies to provide high-end support and advice, but while representatives have a big influence on buying decisions, we must ensure that that influence is at least partly tracked.

Let me talk briefly about the cost of competition. The Minister is new to his post, but he will have paid close attention to the many debates we had on these issues before the election, so he will be aware of the Opposition’s concerns about the competition rules introduced in the Health and Social Care Act 2012. We know that the new competition framework is causing

“significant cost to the system”—

not my words, but those of the former chief executive of the NHS. Last year, we identified at least £100 million that in trusts and clinical commissioning groups alone was being spent on staff and lawyers to analyse tenders and to administer the tendering process. If the Minister is serious about making substantial savings, may I gently advise him that it would be a good start to look at the waste generated by the Act’s competition provisions?

One crucial area to analyse is the poor workflow in hospitals, and specifically the lack of adequate sub-acute services. At the moment, many discharged patients, particularly elderly ones, have nowhere to go. That is attributable mainly to the drastic cuts to adult social care we have seen in recent years. Sadly, I can only anticipate that those pressures will remain, and perhaps become more acute with coming spending reviews. We all know that if patients are not discharged, hospital beds are wasted and hospital workflow is disrupted, which costs the system an absolute fortune. That is to leave aside the fact that hospital is not the best or most appropriate place for such patients to be or for their care to be delivered.

The consequences of the 2012 Act included fragmentation of responsibility for the flow of patients through the system. Different commissioning organisations now commission primary care to support the patient outside hospital, there is separate provision of community services, and NHS England has an oversight role as well as a role in commissioning specialised services. In Bristol there are two major acute trusts that are largely commissioned by three different clinical commissioning groups, supported by NHS England and involving the Trust Development Authority and Monitor. A large room is needed for people to get around the table at meetings to consider things such as flow, and it is very complicated.

My hon. Friend hits the nail on the head, describing the complexities of the NHS in England. We have talked for several years in the House of Commons about the need for a properly integrated health and social care system. My hon. Friend has set out a prime example of the reason we need that.

I anticipate that the Minister will argue that some of the inefficiencies we have discussed will be addressed through integration. My problem is that many of the competition rules and requirements in the 2012 Act work against such an integrated health and social care system, even though both sides of the House want it. The Government will have to look carefully at the role of some of the rules and regulations they introduced, when local health economies reach the point of developing integrated care models. It is clear that representatives of a hospital trust, local authority adult social care and children’s care services, and the clinical commissioning group cannot sit around a table to plan an integrated health and social care system while many of the requirements placed on the NHS by the 2012 Act continue to apply.

To return to the issue of transfer and delays in hospitals, we all know that the NHS operates something of a just-in-time system. Such systems are used in industry, particularly for international stock control, and they make sure that nothing is wasted. There is little room for slack: if a patient is admitted for longer than necessary because of avoidable shortfalls elsewhere in the system, that can lead to the atrocious scenes that happen when desperately sick and injured people are left lying in corridors. I think that on one occasion, somewhere near the constituency of my hon. Friend the Member for Bristol South, someone was treated in a tent in a hospital car park. We hoped such images had long gone from the NHS.

I want to say politely but firmly to the Minister that the NHS is affected by what goes on in the social care system. Social care cuts are to all intents and purposes NHS cuts. I hope that he will get that message loudly and clearly and that the Prime Minister will stop insisting otherwise. All that demonstrates, as my hon. Friend the Member for Bristol South eloquently stated in her intervention, the need for a properly joined-up service. Labour Front Benchers have argued for that for some time and the previous Government were moving towards it. I am happy to provide guidance to the Minister on what we think should happen to that end, and to provide stern criticism if Ministers do not deliver.

I also want to talk briefly about the cost of agency workers, which the hon. Member for Angus (Mike Weir) touched on. The Health Secretary has belatedly sought to address that issue, but it has been years in the making. Ministers will know that hospitals have consistently cited recruitment difficulties, particularly for qualified nursing and medical staff and in accident and emergency departments. It is welcome that the number of training places has been increased in recent years, but it was a short-sighted mistake to cut the number of those places early in the previous Parliament. That has led in part to the present recruitment issues.

The Minister will know that the rising number of staff suffering from work-related stress has resulted in even more workforce pressures in the NHS. He will also know that the decision to cut nurse training posts has meant that many hospitals must either recruit from overseas or hire expensive agency workers. Health Ministers must make strong representations to Home Office Ministers, because if there was ever a sign of disjointed Government decisions, it was the recent announcement of changes to immigration policy. As we have already discussed, those changes may cause massive problems to some NHS trusts across the United Kingdom that already face challenges and have recruited from overseas.

The savings that the NHS will need to make in coming years are far more difficult than the low-hanging fruit or quick wins that some may think are available. All of us across the parties and across the constituent parts of the United Kingdom need to acknowledge that there will be no quick fixes to the challenge. There should be no mistaking how difficult things have been for many trusts in the past few years. The coming years will be just as difficult for them, if not more so. I hope that the Minister will agree in that context that we need a proper open debate, with all the facts, figures and information before us about where we can make the savings, and how we can ensure that more of the NHS’s funding is spent on what it does best—delivering high-quality patient care across the United Kingdom.

Order. Before I call the Minister I remind hon. Members of the new standing orders that allow the mover of the motion to wind up if there is time available. I am sure that the Minister will be mindful of that, with 30-plus minutes on the clock.

It is a pleasure to serve under your chairmanship, Mr Pritchard. It is indeed my first appearance in this role in Westminster Hall and, therefore, under your chairmanship here.

I congratulate my hon. Friend the Member for Hendon (Dr Offord) on securing this important debate. I suspect that, in raising the important matters that he took up in his speech, he did not anticipate the glimpse of the promised land that the debate would give us. I have never sat in a debate on the NHS in this House—I have only been here for five years—when there was such a productive, interesting and bipartisan approach to such an important matter. I hope that it will be a model for things to come.

In seriousness, the differences between us, across the Floor, are far fewer than the things we agree on when we consider the NHS. A new Member, the hon. Member for Bristol South (Karin Smyth), said in her speech that now the election is over we have a fantastic opportunity to forge a greater consensus on the NHS, which will be better for the service and patients, and especially, in the present context, for the people who work in it. They get fed up with the politicisation of the NHS, which has happened since its creation in 1948.

The hon. Lady hit the nail on the head in her excellent speech: efficiency really comes from quality. We begin to get an NHS system that is truly efficient in using the resources that the taxpayer puts at its disposal and the hard work of those who work in it when the first consideration is care quality and safety. If we try to build a system around quality and safety, the efficiencies will flow from that and excessive costs will start to fall out. Part of the problem with trying to find efficiency savings in the NHS—indeed, in any public body or private organisation—is that a purely cost-cutting approach will almost certainly fail, in terms of not only the quality of the product being delivered, but the efficiencies being sought. I very much welcome the hon. Lady’s intervention on that point, because that is where we need to begin.

All of that lies at the heart of Lord Carter’s excellent report. It is an interim report—he will publish his final report, with a great deal more detail, in the autumn—but he has understood that it is the patient who feels the effects of inefficiency first and foremost. Their experience of care is not what it should be, because of how rostering is arranged or medicines are dispensed and administered. He gave specific instances in his interim report—for example, the range of products available for hip replacements—of where choosing one product over another can mean dramatic differences in the occurrence of revisions. As the hon. Member for Strangford (Jim Shannon) said in his speech, cheapest is not always best. Sometimes, a slightly more expensive hip replacement joint can mean a much higher chance that someone does not have to come back for surgery again in a few years’ time. Such decisions about balance lie at the heart of patient care. If we get the balance right, we have a huge prize: better patient care and a more efficient, cost-effective service.

I want to run through the main points of Lord Carter’s report and reflect on them in the terms raised by my hon. Friend the Member for Hendon. The NHS provides a varied picture of efficiency. The service has some of the most efficient hospitals in the world, but also some fantastically inefficient ones. That variation lies at the heart of the problem that we have to square in the next few years, which I will come to shortly when I address the specific points about the £22 billion target. As MPs, we all have anecdotal impressions from speaking to chief executives and managers in the NHS: they have come up with great ideas locally, but one knows immediately that no one is learning from that across the system. That was the case before the 2012 reorganisation, and it was case before all the previous reorganisations; it has been problem in the NHS since its inception.

We must also learn from best practice around the world. There is some fantastic practice around, and not only in France, Spain—specifically Valencia—and Germany; some of the best practice in the world for creating efficient healthcare is in American hospitals. I find it very exciting that there is some fantastic practice coming from Indian hospitals, because it shows how the world is changing. If we can draw in that expertise, we will do better for the NHS. I hope that, at the same time, we will export some of the best practice we have developed here—much of which has come from places not a million miles from the shadow Minister’s constituency—to hospitals and health systems around the world.

The changes in efficiency and productivity gains in the past few years have been considerable. Traditionally, the NHS has lagged behind in productivity improvements, but in the past few years it has overtaken productivity gains in the rest of the economy. Some of that has come from wage restraint, but there has been a genuine improvement in productivity, although it is not as much as we hope, anticipate and need to come over the next five years from system change, rather that just from wage restraint.

Lord Carter’s review covers some of the efficiency savings that can be made, especially in the provider sector. He has identified £5 billion of savings, of which £2 billion can come from improving workflow and workforce costs and £3 billion from static costs related to pharmacies, estates and procurement. As has been mentioned already, he has identified the fact that although there is much dispersed good practice, it is not shared, and there is no common understanding of what a good hospital looks like. On the back of Lord Carter’s principal recommendation, we are going to construct a good hospital. It will be a virtual hospital, so people will not be able to visit it, but they will be able to go to parts of it, because we are going to take the best practice and codify it.

Lord Carter has created a system called the adjusted treatment index, which is a rather dry term for an exciting idea. We will say, “This index is the best that the NHS is doing and we’re going to measure you all against it.” Every chief executive, manager and clinician will be able to see where their particular unit sits against the very best in the country. That will immediately prompt some questions: “Why are we not the best? Why are we a third or half of the way down? What can we do to close the gap?”

The second output from Lord Carter’s report is to provide a suggestion, in base terms, of how the poorest performing hospitals, along with those in the middle and those near the top, can improve and become the best. His final report will give far more detail, but this is of course a living process. We want to create a manual that will help clinicians to constantly improve their performance, measured against the very best—and the very best in the NHS will be measured against the very best in the world, so that our target keeps moving upward.

Lord Carter also identified issues with staffing, agency spend and locums, which formed the meat of the speech by my hon. Friend the Member for Hendon. I will quickly go through what we plan to do. In the long term, it is clear that the expansion of nursing recruitment places will meet our objective to improve staffing ratios and the quality of care in hospitals, but we do have a backlog to fill. I do not want to break the bipartisan consensus, but the fall-off in recruitment places did begin before 2010. It picked up again in 2012-13, partly in response to the recommendations of the Francis report, but we still have some way to go to ensure that we are up to pace.

It has become clear that although there was a need for agency staffing to plug the shortfall, some have been abusing that position. Now that we are getting more and more nurses into the system, it is the right time to bear down on agency costs, which is why the measures outlined by my right hon. Friend the Secretary of State a couple of weeks ago will make such a difference, by giving chief executives the tools to ensure that they are not paying over the odds on agency spend.

On agency recruitment, does the Minister agree that we should encourage more young people to see the NHS as a good career? Young people such as those in my constituency, Bristol South, do not always get the advantages of university and further and higher education qualifications, and they do not see working for the NHS as a good and positive career. It is still a very good career—well paid and well remunerated by pensions and so on—but it is no one’s job, directly, to sell a career in the NHS in order to bring through the next generation of young people in places such as Bristol South to work in the NHS. That is not a hospital’s direct role. Health Education England is a new organisation and has that responsibility, but, in the spirit of bipartisanship and cross-departmental working, will the Minister take our advice and talk to colleagues in skills and development and support apprenticeships to encourage young people to come through and fill the gap currently filled by agencies?

I do not want to ruin the hon. Lady’s nascent reputation by agreeing with her again—happily, there are very few Opposition Members present to notice, although that is not an implied criticism—but she is absolutely right. We are lucky that nursing places are quite significantly over-subscribed. The position is popular, but she is absolutely right that we need to not only make far greater use of apprenticeships but widen the skills base in nursing full stop. We are actively working on that in the Department—I have spent much of the day on it, and I am sure there will be more to come.

To help chief executives in this interim period, we have forced all agencies that want to offer their services to ensure that they are doing so through framework contracts, and we are ensuring that there is an hourly cap on the rate that can be charged. We have also taken additional measures on managerial salaries, along with a few other measures, to ensure that managers have the opportunity to be able to manage costs as they wish. We understand, however, that this is the first stage of a much deeper programme of reform that is needed. Lord Carter’s report points in that direction by suggesting that we use our existing workforce far better, so that people are doing the job that they are suited to and qualified for and that their time is not wasted. That is the great win, not only for efficiency and patient care, but for staff enjoyment of their jobs.

The hon. Member for Coventry South (Mr Cunningham) made some helpful interventions about NHS workers’ quality of life. It has been a sad but persistent truth of the NHS for many years—decades, in fact—that staff-reported incidents of harassment and bullying have been higher than the national average and that workforce stress and illness is higher than average. Some of that is to be expected—parts of the NHS are extremely stressful working environments—but we can do much more. Part of that is about ensuring, when people turn up to work, that they are doing the job they wanted to do, with a suitable but not excessive degree of pressure, and that the system is not wasting their time. If we make them happier in their jobs, their patient care will improve and their commitment to the service will be even greater. I am therefore aware of the prize, not just in pounds, shillings and pence, but in an improvement to staff morale and therefore patient care.

One of the things that concerns me from a Northern Ireland perspective—this has also been raised in discussions with other Members in the Chamber today and outside—is that the NHS greatly relies on, in our case, Filipino workers, which is an immigration issue. Has the Minister had any discussions with the Minister for Immigration, the right hon. Member for Old Bexley and Sidcup (James Brokenshire), to ensure that there will be no shortfall when the gaps left by those who are here on work visas need to be filled and that the quality service in the NHS will not be lost? The hon. Member for Bristol South (Karin Smyth) referred to training people to ensure that keen, interested and able replacements are available. Has the Minister given any thought to that?

I was going to come on to that, so I shall do so now that the hon. Gentleman has prompted me. There have been long and deep discussions about this. Our estimate is that no more than 700 nurses will be affected by the time the new rules are in place, which is a different number from that given by the Royal College of Nursing, whose number we do not recognise. It is small challenge given the scale of the workforce and one that we will surmount at the time, but we must see it within the broader policy of reducing immigration to this country from the hundreds of thousands to the tens of thousands—a policy that has broad support across the House and certainly in the country at large. It would be wrong for the largest employer in the country—one of the largest employers in the world—to exempt itself from that overall ambition.

In the end, we will achieve a sustainable workforce in this country only if we do all we can to ensure that those who are British and have grown up here and want to work in the NHS have the opportunity to do so. That is why it is important that we widen and open the avenues into working in the NHS, as the hon. Member for Bristol South suggested, over the next few years, in order to meet the challenge to which the hon. Member for Strangford alluded.

I want to quickly run through the other issues raised by my hon. Friend the Member for Hendon. On master vendors, he has a specific issue regarding some constituents with whom he has been dealing, but I understand that master vendors are managed under a series of arrangements with the Crown Commercial Service. Officials will meet with that organisation soon to discuss the overall issues around master vendors. It is for individual trusts to make such purchasing decisions, but I understand the issue he has raised and the terms in which he put it, and I will ensure that it is investigated properly.

My hon. Friend identified two areas involving agencies and fraud. Fraud is of course unacceptable, and the NHS has quite good systems for identifying it. Given the scale of the NHS, I find it surprising—it is entirely to the credit of those who work in the NHS—that fraud makes up such a tiny proportion of the excessive costs in the NHS.

On the revalidation of locum doctors, for which the General Medical Council is responsible, some doctors find it difficult to gather all the required supporting information needed for revalidation due to the peripatetic nature of the work. To help with that, specific guidance is available for both the doctors and their employers via NHS England and NHS Employers. Locum doctors are part of a larger issue about agency spend and foreign workers working in the NHS. I imagine that the three organisations will come together in the next few years to produce a more stable situation.

[Mr James Gray in the Chair]

Let me turn to the remaining points of the hon. Member for Bristol South. On the stability of the system, I hope and anticipate that one product of the general election is that the system will be broadly stable over the next five years. We intend to continue with the current structure of the NHS. There will be some small changes, such as that identified by my right hon. Friend the Secretary of State last week concerning the NHS Trust Development Authority and Monitor, but we are broadly content with how the system is set up. We must now proceed to ensure that it works.

The shadow Minister made a point about structures and fragmentation. There will always be a genuine dilemma here, because one can approach any system and say that change can be achieved by altering structures, but changing structures can lead to the same outcome. That has been the story of the NHS since its inception. It would be a mistake to think—the hon. Member for Bristol South and the shadow Minister were not suggesting this—that a structural change would somehow produce the outcomes that we all want. The priority is to ensure that the system’s wiring works correctly—that everyone’s interests are aligned and that the incentives are correct—so that people want to sit around the table and come to a considered decision, which can too often not be the case when there is an adversarial relationship between providers, producers and purchasers. That is why I hope that the system’s stability over the next five years will allow us to focus on the significant challenges mentioned by the shadow Minister.

When discussing competition rules, we often talk of public versus private, but two public parts of the NHS can also compete. Another NHS trust might have the tender for providing a service in another area and an integrated care organisation might want to bring that back in-house.

Absolutely. There are examples of that all over the country, but there are also examples of people working together in what might be considered competitive situations, so it is about ensuring that we copy the best and delete the worst.

Before I turn to the shadow Minister’s comments, I want to reflect on the contribution of the hon. Member for Angus (Mike Weir). The SNP spokesperson on health, the hon. Member for Central Ayrshire (Dr Whitford), has used a constructive tone in the Chamber so far, bringing some of her expert experiences as a clinician and also the experiences from Scotland. It is nice to be able to sit here and hear the experiences of people in Northern Ireland and in Scotland, and it would have been nice to have heard from Wales in this debate. Indeed, we do not yet properly learn from the best in Scotland, which would be all to our good, let alone the best in America or India.

The £22 billion in savings is an estimate not from the King’s Fund but from NHS England. It formed part of its plan, devised at the end of last year and some years in the making, which identified £30 billion of additional money that needs to be put into the service over the next five years. It stated that £22 billion could be generated internally—that was Simon Stevens’ estimate—which leaves an £8 billion shortfall. That is what we are pledged to provide. None the less, he, like everyone in the Chamber, has correctly seen that £22 billion is a large number and one that will take a great deal of intellectual and moral work to deliver. I welcome the tone with which everyone has approached this challenge in the debate.

The reference to the King’s Fund was to make the point that it said that this was a tall order, as I think the Minister himself is admitting.

It is not a tall order, but it is a challenging one. Whoever was sitting in my place, from whatever party, would be facing a similar challenge, no matter how the needs over the next five years were framed. The challenge must be addressed, and it is better addressed if we all come together to do so.

The hon. Gentleman touched on pharmaceutical savings, which I have not yet addressed, and Lord Carter’s comments on them. Lord Carter will make more detailed recommendations later in the year, but the hon. Gentleman is absolutely right that there is much to be done to ensure that we save money on the provision and purchasing of drugs and by not wasting them. Lord Carter is looking at that, and the service is already implementing his initial recommendations.

New drugs are a problem faced by health services across the world. Indeed, it is a profound challenge, because the new drugs coming online are of an expense that has never been experienced in health systems before. They are also for increasingly small numbers of patients, precisely because they are personalised, which drives up the cost even further. That is why the Under-Secretary of State for Life Sciences, my hon. Friend the Member for Mid Norfolk (George Freeman), is bringing forward his accelerated access review and doing some exciting work, trying to use the muscle of the NHS—our ability to be an research lab, effectively—for those developing new drugs, so that we can use the NHS to drive costs down and provide patients with treatments earlier and more cheaply. There is a win-win there, but it requires a fundamental change in the system, which at the moment is not working.

Finally, I turn to the comments of the shadow Minister, mindful of the need to give my hon. Friend the Member for Hendon time to wrap up. I thank the hon. Member for Denton and Reddish for his kind welcome; it was good of him to say that. I hope that over the next couple of years we will be able to thrash out some of these difficult issues in the manner in which he has begun the process. If we do so, we will come to a better understanding of what is needed in our national health service.

The hon. Gentleman asked a number of questions, such as where the £8 billion is coming from. I believe it is coming from general taxation—my right hon. Friend the Chancellor will be providing greater details of that in the Budget next week. The hon. Gentleman also asked where the £22 billion was coming from. NHS England has devised the plan. It is NHS England’s plan to implement, and it will provide further detail about the £22 billion shortly. It will be an evolving plan that will necessarily change over the five years. NHS England is confident that it is achievable, but it will take some incredible heavy lifting by all of us and, dare I say it, the dropping of political shibboleths throughout the House—if one can drop a shibboleth; I am not sure.

The hon. Gentleman raised the issue of provider deficits, which is a problem across the system. He will know that there was a similar issue towards the end of the Labour Administration—in CCGs, rather than in hospitals. It does not necessarily require more money; it requires getting a grip on where the problem is. We have started that with announcements on agency spending. Many trusts in the country are doing well financially. Not surprisingly, they are often the trusts that are also delivering good care, because—to return to the comments of the hon. Member for Bristol South—if the care is right, the money flows from it. That is why Lord Carter’s review and a concentration on care quality will, we hope, produce the savings that we need, not just at this immediate moment to address provider deficits, but to achieve the £22 billion.

The hon. Member for Denton and Reddish also mentioned sales reps and procurement. I absolutely agree that the subject is covered in the report from Lord Carter. The numbers of product lines certainly should come down. I am not sure that the NHS, before having greater responsibility for purchasing, was any better at buying, but we need to be better at it. Procurement is a science. It is not one that I pretend to know a great deal about, but I know that in the end we will always end up in not quite the right place, because we might centralise too much, which takes away decision-making from the trust responsible. That is why we have to get the balance right.

On the cost of competition, the hon. Gentleman quoted a figure of £100 million. However, I understand that the costs of the reorganisation have been outweighed by the benefits, to the tune of about £1.5 billion annually. I think we all agree across the House on the producer-provider split. There will always be a degree of competition in the NHS; it is about getting the balance right between competition and collaboration.

In the last 30 seconds, let me touch on sub-acute services. The hon. Gentleman made his most pointed—and fair—remarks about the need to integrate social care with the NHS. The Government’s contention is that creating a new national structure for health and social care does not produce the end that we all want to see. That is why we want to see local solutions—we believe a good one is already emerging in Manchester—across the country, which will suit different areas according to their needs. In the end, we come back to money. We all know that money will be tight in local government. Our aim over the next few years is to ensure that as much of the resources that we can put into local government are going towards social care. That is the essence of the better care fund, which lies at the heart of what we are doing on integration over the next five years. I know the hon. Gentleman will want to comment on that as we proceed on those lines.

I thank all Members who have spoken in what has been an invigorating debate from which I have learnt a great deal. I again thank my hon. Friend the Member for Hendon for raising these important issues.

It was a pleasure to start the debate under the chairmanship of Mr Pritchard and, indeed, it is a pleasure to finish under you, Mr Gray.

The debate was fantastic, but not entirely what I expected. The NHS is often used as a political football. I thank the Members present for their contributions and for highlighting some issues for me to consider, as well as for the Department and the Minister to consider.

The personal NHS experience of the hon. Member for Bristol South (Karin Smyth) is welcome not only in the debate, but in the House as a whole, and I look forward to her contribution to other debates. I thank her for today’s contribution, which was important.

I was surprised at first by the hon. Member for Angus (Mike Weir), because the Carter review looked at England, and I wondered where the hon. Gentleman’s contributions would go, but I am pleased that both he and the hon. Member for Strangford (Jim Shannon) spoke about the devolved institutions and the lessons that can be learned throughout the United Kingdom from Lord Carter’s report. That is a great way for us to work as a one nation country.

I am grateful for the comments of the shadow Minister, who made some points about NHS procurement. Some issues about extraction from European Union procurement programmes still need to be resolved—I understand that the shadow Health Secretary, the right hon. Member for Leigh (Andy Burnham), says that that can happen, but Simon Stevens does not believe that is correct—so there are some good things for the Minister to go away and think about. I will certainly take them away too, and I am grateful for that.

In the short time I have available, I want to say a little about the response to the Carter review. There has been a positive response from the Royal College of Nursing, which not only acknowledged that nursing numbers have not been meeting demand, but stated:

“It is clear that there is waste in the NHS, which is holding it back from directing its resources to frontline patient care. Lord Carter’s review is a welcome illustration of how the NHS and individual hospitals could be much more effective in how they procure equipment, drugs, and above all staff.”

As the Minister said, we as parliamentarians therefore have a great opportunity to engage in the issue. As I said at the start of my speech, it came up at many hustings. It is often said that the Conservatives are not strong on the NHS, but I think we have a good story to tell. If we carry on in the same vein, and if the Minister carries on in the way he spoke today and in the recent debate in the main Chamber, that will please me and other colleagues.

I have been unfortunate enough in the past nine months to have need of the NHS, but I have been fortunate enough that it has been there. I am grateful. I have attended Moorfields, the BMI in east London and the Whittington with fairly serious issues. Indeed, my father-in-law had a hip operation on Friday, so I am grateful to the hospital in Swindon as well for making that happen. The care that he and I received has been second to none and I am grateful. I hope that it may continue to be such and that today’s debate will continue our efforts to make the NHS the best national health system in the world.

Question put and agreed to.


That this House has considered operational productivity in NHS providers.

Colin Worton

I beg to move,

That this House has considered the case of Colin Worton and compensation following an acquittal.

The case of Colin Worton is an indictment of the justice system and how it operated in Northern Ireland. I ask Members to cast their minds back 32 years, to when Northern Ireland was in the midst of the troubles. At that time, a Roman Catholic workman, Adrian Carroll, was murdered, gunned down in the streets of the city of Armagh. That was an injustice that has not been properly addressed. In fact, 32 years ago, a double injustice was done, when Colin Worton, a serving solider in the Ulster Defence Regiment, was arrested, held, questioned and subsequently charged. He was held behind bars for several years awaiting trial, where the case was thrown out because it was deemed by the judge that the statement he had made had come about under severe duress.

That injustice affected Colin Worton’s entire life and all his family. His father had already lost one son to terrorism, gunned down in the Kingsmill massacre. He then effectively lost his other son, Colin—a man who was serving Queen and country—along with Colin’s good character, through a smear and a charge that he was somehow a terrorist.

Colin Worton served in the Ulster Defence Regiment, as did I. He worked long hours, at unsociable times. Is it not despicably wrong that a man who gave so much for Queen and country and for his neighbours and his friends—indeed, to protect his enemies as well—is still waiting on justice today?

My hon. Friend’s comments echo and amplify the indictment of a system that has blinded itself. Justice has to be fair, but when it blinds itself so much to an injustice that it cannot find a mechanism or way to clear and compensate a man properly, something is fundamentally wrong with the system.

I congratulate my hon. Friend on obtaining this debate. As he knows, many of us in this House have been trying to get a debate on the issue for quite some time, so we are glad it is happening. There is something fundamentally wrong, as our hon. Friend the Member for Strangford (Jim Shannon) has said, when someone who has served his country has to fight to bring his case to this House to try to get justice, rather than getting it, as he should, through the normal system.

My hon. Friend makes an important point. I commend his actions. He has campaigned for years on this case and has tried to help Colin in the many different forums in which he has been a representative. He has also lobbied constantly and, more important, kept applying for a debate as well. It was really only the luck of the draw, so to speak, that my name came up. I am delighted that he has been so supportive of this case over the years.

As I said, Colin Worton never had his name cleared properly. I welcome the statement of the Northern Ireland Justice Minister, Minister Ford, of a couple of months ago that

“there is no stain on Colin Worton’s character”,

but unfortunately those words are not matched by actions. If there is no stain on the character of a soldier, why for the past 32 years has it been impossible for him to get back his job in the Ulster Defence Regiment? If there is no stain on his character and he can hold his head high, as he has been told by officialdom, why does he not have the simple right to have his job back, to serve his Province and his people?

I will tell the House why: because there is a stain, which has prevented him from going back to his job and from having a proper income-generating life. As a result, he has been forced to do menial jobs around the country, because people whisper behind their hands, “He’s the boy who was part of that murder team that killed an innocent man.” We need to nail that, and nail it loud and clear. We need to point out that if there is no stain on the character of Colin Worton then, given that he has not been able to have his job back for the past 32 years, he must now be properly compensated under existing mechanisms. I will come to those mechanism, because the Minister for Justice in Northern Ireland could use his powers in a discretionary way, and he should be encouraged by this House and this Government to do so. It is no way to treat a citizen of the United Kingdom and former soldier of Her Majesty’s forces. In essence, compensation should be paid to Colin Worton for his loss.

The effect of wrongful arrest and imprisonment—wrongful waste of life—on any person is devastating, and that situation is always wrong. But when a person sees three of his colleagues having their convictions overturned on appeal and being given substantial compensation—rightly so; those three were all also soldiers in Her Majesty’s forces, I should add—he must feel doubly indicted and abused. It seems he is not entitled to the same level of compensation or the same sense that not only has he got overturned something that was wrongly said about him, but the state that did that has been forced to pay for that injustice.

According to the available information, previous Secretaries of State and the Northern Ireland Justice Minister have indicated that, under section 133 of the Criminal Justice Act 1988, Mr Worton does not qualify for compensation. I believe that they are wrong in their interpretation of that section. I set that against the fact that we live in an era when the Northern Ireland Attorney General feels at liberty to recommend that there should be an amnesty system for terrorists to come forward to give evidence in historical cases without the risk of being prosecuted; it simply beggars belief that a man at the opposite end of the spectrum—a former soldier who has been told there is no stain on his character—is being punished for something he did not do in that same era. He is forced to live a life of little opportunity, with the stigma of a horrific murder latching itself to his hip despite his absolute innocence.

For Colin Worton to be told he falls outside the boundary of entitlement to compensation is wrong. The Northern Ireland Minister and the numerous Secretaries of State who come to Northern Ireland, should be encouraged to themselves encourage the devolution system to demonstrate the flexibility that it should have by addressing this particular injustice.

At Mr Worton’s initial trial, his so-called confession statement was deemed inadmissible as evidence because it had been extracted under extreme duress. Let me put that in the language of the street. Mr Worton had the crap kicked out of him until he said the right things. Once he had said them and had signed the right confession, he was going to be banged up in jail. That is what happened to three of his colleagues. Fifteen years later, those convictions were overturned and they were released. When Mr Worton’s case came to trial in 1986, the judge was so perplexed by what he saw that he immediately deemed that Mr Worton’s statement could not be used as evidence, and on that basis told Worton to leave the court room—he was a free man. That did nothing to compensate for the two and a half years he spent lingering in jail for the trial, and it did nothing to compensate him for the loss of his promising career in the services. It did nothing to compensate him for the now decades of financial loss and it certainly did not clear his name. When he left that courtroom, in the eyes of the general public, he got off. They thought, “He got off—he was lucky.”

That, unfortunately, has been the character of the case. There has been a very deliberate effort by many to continue to perpetuate the myth that these were lucky men. But no; these were innocent men, who were wrongly tried and wrongly convicted, and who eventually—thankfully—had their convictions overturned. There needs to be recognition of the serious nature of the case and of the fact that the overturning of the original trial of what became known as the UDR Four meant that convictions against soldiers in Northern Ireland for crimes halved. So few were ever convicted, and so few were ever involved in anything wrong, that this case was held up as an example of how soldiers had been involved in wrongdoing. When the case was thrown out, it halved the number of cases that could be pointed at to show that soldiers had done something wrong in Northern Ireland. That is why it is such an important example and such an important case, and why it has to be put right.

A false confession made under interrogation, of course, implies improper behaviour by the individuals who extracted it. There was therefore a “serious default”, or rather a lack of those words coming from the judge’s mouth. The judge should have recognised that that “serious default” was in place, and if he had recognised that and said so when he put Worton out of the trial, Worton would have been granted compensation. However, because of the lack of those two words, he did not get compensation under the scheme.

These are the words of the Justice Minister in Northern Ireland in a recent debate:

“The general principle behind any payment of compensation is to make reparation where the normal machinery of justice has demonstrably failed the accused person.”

In that debate in the Northern Ireland Assembly, 54 Assembly Members agreed that Worton should be compensated, whereas 27 Assembly Members did not. On that basis, there is a strong momentum to ensure that Mr Worton is properly compensated for this injustice. If he had been compensated in the 1980s when it happened, the matter would have gone away a long time ago.

It says something of the man himself that he has continued to campaign tirelessly, year in, year out, decade in, decade out, to clear his name, because he is so incensed by what has happened to him. His family are equally incensed, and rightly so. Mr Worton has, in my view, conducted this business well and in a dignified manner. He has never stopped in his mission to have his name properly cleared and to have compensation. This is a man whose brother was murdered by the Provisional IRA, and who served in the Ulster Defence Regiment to help protect the Province and its people he so dearly loved. This is a man who had every reason to hate the Irish Republican Army for what they did, yet he worked on behalf of this Government’s security forces to help bring peace to Northern Ireland.

Mr Worton’s father died having had one son murdered by terrorists and another one labelled a murdering terrorist. That injustice to his entire family must be properly addressed. That is why I am pleased that this matter has got the Floor of this House and pleased that it is recognised nationally that there is an issue which the devolved Administration in Northern Ireland must address expeditiously. It has been long enough in the making. They have time now in which they could address this case.

I am grateful to my hon. Friend for allowing me to intervene, as I know he is winding up. I congratulate him on securing the debate, on the eloquence and force with which he is putting the case, and on the work that he and others have done to get justice, not just for Colin Worton, but for the other members of the UDR Four. Does he agree that although the Minister may say, “This is a devolved matter; it is for the Minister of Justice, the Assembly and so on,” this case is to do with the past in Northern Ireland, which is the responsibility of the Government here, and they have a major role to play? It is not a question of saying, “It is a matter for Northern Ireland Ministers.” This is a matter that involves the legacy of the past, and therefore it falls to people here to address it as well.

I thank my right hon. Friend for making that point. He really gets to the crux of the matter: how we find the mechanics to solve this issue? How do we ultimately address it?

I hope that the Whips Office carries back to the Northern Ireland Office a very strong message. Heads have to be put together between the Northern Ireland Office and the Justice Ministry to find a way of resolving this legacy case once and for all. Resources are found for all sorts of things in Northern Ireland, and indeed, for all sorts of things across the United Kingdom. It would be very easy to solve this matter, and I hope that that message is carried back. My right hon. Friend has probably predicted the entirety of the speech of the Minister today. I understand why Ministers could be tied to such a degree, but there has to be some recognition that the devolved Administration have flexibility. They have the ability to find a mechanism—a special measure— through which they could address this case. I hope that they do. I hope that they are given the encouragement, and, if you like, the cover to allow them to act in this way, sure that what they are doing is right and what they are doing is proper.

Good afternoon, Mr Gray. It is, as always, a pleasure to serve under your chairmanship. I congratulate the hon. Member for North Antrim (Ian Paisley) on bringing this debate to the House. I am aware that he has championed Mr Worton’s case in the House on previous occasions, and he continues to do so. I very much recognise the challenges that Mr Worton has faced. He has suffered a great deal as a result of the terrible events of 8 November 1983, and no doubt has suffered a great deal as a result of the appalling loss of his brother, one of 10 Protestant workmen killed by the IRA at Kingsmill in 1976. Equally, our thoughts today are with the family of Adrian Carroll. Mr Carroll, a 24-year-old Catholic man, was murdered on 8 November 1983. He was shot outside his home in the city of Armagh as he returned from work. It is important, when we speak of these cases in the House and elsewhere, that we remember the pain and the ongoing needs of all those who have to live with the deadly legacy of Northern Ireland’s troubled past. The families who lost loved ones carry their burdens to this day, and those burdens do not get any easier.

On 21 June 2011, the Northern Ireland Justice Minister, David Ford, made a statement to the Stormont Assembly on Mr Worton’s case. Although I have no doubt that Mr Ford is better versed in the detail of the case than I am, the fact is clear that Mr Worton was acquitted of any involvement in Mr Carroll’s murder at the first instance. Unfortunately, the matter of Mr Worton’s clear acquittal is more straightforward than the issue of compensation. As the hon. Member for North Antrim made clear, Mr Worton has been campaigning for many years for compensation for unlawful detention, and his case has been considered by successive Secretaries of State and Ministers in the devolved Administration. I am aware that Mr Worton applied for compensation in 1992, but failed to qualify for the statutory scheme in operation at the time, because he was not convicted.

An application was also considered under the ex gratia compensation arrangements in place at the time. Those were set out in 1985 in a written House of Commons statement by the then Home Secretary. The Home Secretary’s statement provided that compensation could be paid to individuals who had spent time in custody following a wrongful conviction or charge where that had resulted from serious default on the part of a member of a police force or another public authority. The statement also confirmed that in exceptional circumstances—in particular, where facts emerged at trial or on appeal that completely exonerated the accused person—compensation could also be paid. That is opposed to having been acquitted because the prosecution had failed to prove guilt beyond reasonable doubt.

Successive Secretaries of State reviewed Mr Worton’s case for an ex gratia payment. They concluded that Mr Worton’s case did not meet the serious default or exceptional circumstances criteria. I am aware that the then Secretary of State’s decision was judicially reviewed, and in February 2010 a court upheld the decision of the Secretary of State to conclude that there was no serious default on the part of the police.

On devolution of policing and justice in 2010, responsibility for any ongoing consideration of Mr Worton’s application for compensation transferred to the devolved Administration and, in particular, to the Northern Ireland Department of Justice. At that time, Justice Minister David Ford advised that he would look again at Mr Worton’s case to consider whether an ex gratia award of compensation would be appropriate. I am aware that Minister Ford considered all available evidence, including official advice, and the outcome of the historical inquiry into Mr Carroll’s murder. Minister Ford subsequently met Mr Worton, on 17 April 2013, and confirmed that he was not entitled to compensation under the statutory scheme or the ex gratia scheme. It has been made clear to Mr Worton that consideration will be given to any new information that might affect his case.

I am grateful to the hon. Member for North Antrim for bringing forward this debate, and to colleagues from across the House for their thoughtful and considered comments. This is clearly a difficult case, and I am sure that the Northern Ireland Department of Justice, as the responsible office for consideration of cases such as this, will note with great care the comments made today. I simply conclude as I started, by remembering all the families who lost loved ones as a result of Northern Ireland’s troubled past.

Question put and agreed to.

Sitting suspended.

Tyne and Wear Metro

Order. Before we start, I think it is reasonable, despite my natural inclinations, to say that gentlemen may, if they wish, remove their jackets—if they have not already done so.

I beg to move,

That this House has considered the performance of the Tyne and Wear Metro.

It is a pleasure to serve under your chairmanship, Mr Gray. I secured the debate because my constituents are quickly losing patience with the Metro service, which is unreliable and overdue for investment. Barely a week goes by without me being contacted by people who are fed up with delayed or cancelled services making them late for work, preventing them from getting their kids to school, or keeping them from important appointments. A quick glance at Metro’s Twitter feed shows why. On most days, some sort of delay or cancellation is reported, not to mention the numerous other faults that disrupt passengers’ journeys, such as broken ticket machines—that happened again today—and information boards that give out misleading or incorrect information. Last winter, the service was so poor that only 64.5% of trains arrived on time, which means that more than one in three trains was late.

These problems occur so frequently that commuters have created a Facebook group called “Sort out the Metro”, which attracted hundreds of members in only a couple of weeks. Nearly 3,000 people have signed a petition calling for the Department for Transport to begin an independent review of our Metro services. These are not just annoyances; people rely on public transport to get them to where they need to be, and there are real consequences when the network fails them. One woman from my constituency wrote to me to explain the effect that delayed services have on her family. She explained that her husband uses the Metro to travel to his job in Gateshead, but failed trains mean that he can never guarantee that he will arrive on time. When he is three minutes late for work, he is docked 15 minutes’ wages. When he is 15 minutes late, he loses half an hour’s pay. Those may seem like relatively small sums of money individually, but when multiple journeys are delayed each week, the amounts soon add up.

The problems do not end there for my constituent. She explained that she works evening shifts, so if her husband’s train home is delayed, there is no one to take care of their young child. Either she has to be late for work, or she has to find a last-minute babysitter. Public transport is supposed to make people’s lives more convenient, but for her family it is doing just the opposite.

I congratulate my hon. Friend on securing this debate and on the excellent points that she is making about the importance of the Tyne and Wear Metro. I am probably showing my age by saying that I remember the Tyne and Wear Metro launching. I remember how proud we were that it was the first light rail system in the country to be entirely disabled-accessible. Looking back, can we not see that the current problems are testament to a failure of investment, which we need right now in the Tyne and Wear Metro?

My hon. Friend makes an excellent point, which I will come to later. When the investment is there and our Metro is working properly, it is brilliant and it serves our area well. At the moment, however, the lack of investment really shows, and it has an impact on all our constituents.

I congratulate my hon. Friend on securing this timely debate. No doubt the Minister, in responding to the debate, will point to the current significant investment programme in the Metro, but that investment is in infrastructure, ticketing and barriers, not in the rail cars, which are the most vital component. They are 40 years old and deeply in need of replacement to alleviate problems such as the regular electricity fires on the service.

That is a point that I will make later in my speech. The Metro cars are grossly outdated, and they cause the bulk of the delays in the system. The constituent I mentioned is not the only person who feels that they have to organise their family’s life around the unreliable service. One young man wrote to me to say that he actively avoided taking the Metro to college, even though it was theoretically the most convenient route, because he simply could not rely on the service. He said that some days he found it easier to stay with his grandparents in another area, because they live closer to his college, rather than relying on the Metro to get him to class on time.

We need to think about the economic impact of an unreliable service. A single person being half an hour late for work may have a relatively small impact, but we should remember that when a fault occurs during peak time, hundreds of journeys are disrupted. Metro figures show that more than 50,000 minutes of delays occurred last year, which is more than 800 hours. That is a lot of working time wasted. When companies look for a place to locate their business, one of the top items on their checklist is the transport infrastructure. They want to know that there is a reliable transport network that will allow them to attract employees from as wide an area as possible. If we want our regional economy to do well, we need a transport system that is up to the job.

It is clear that the Metro is simply not coping at the moment, and most of the problems that commuters experience come from the fact that the network’s trains and infrastructure are on their last legs. The Metro is long overdue for an upgrade, and trains that were expected to retire from service in 2010 have been patched up and are now expected to carry passengers until 2025. Commuters and my hon. Friends know that that is not a real solution. Our oldest train cars have been in service for 40 years, and no amount of refurbishment or repair can disguise the fact that they are falling apart. Our fleet has been refurbished at a cost of £30 million, but that does not appear to have helped things. Power failures and door failures, which are the two biggest culprits in delays, are happening more frequently than they did only a year ago. The number of power failures has increased by 49% and the number of door failures by 29%. The number of passenger complaints is on the rise, and of 502 complaints reported in April, more than 300 related to train performance.

The trains are not the only problem for our passengers. Brand new ticket machines and barriers malfunction far too often, and the departure boards on station platforms often display incorrect information. That can be particularly irritating for my constituents because South Shields is at the end of the Metro line, so boards that display incorrect destinations can mislead passengers. Support for passengers whose trains are delayed is not good enough, and passengers whose journeys are disrupted are given little time to find alternative routes to their destinations. The “Sort out the Metro” group believes that as many as half of the disruptions are not reported on social media, which means that passengers who rely on such sources of information are left in the dark about delays.

My hon. Friend is making some excellent points, and the debate is much needed and valuable. Is she aware of a report by the Institute for Public Policy Research in 2014 which showed that Londoners receive £5,203 more per head in capital investment than do those in the north-east? London is the capital, so we would expect it to receive a little bit more, but does she think that £5,203 more per head is an acceptable amount?

I do not think that that is an acceptable amount at all. In fact, I think it is an insult to the people of the north-east that so little is spent on us per head, when it comes to transport.

Some of the problems are a matter for Metro’s management, and I have taken them up with Nexus and the North East combined authority. Nexus has, to its credit, made some changes to improve customer service, and earlier this month it announced £40 million of investment, which will include a new rail traffic management system. The North East combined authority has also taken the issue up, and it is clear that there is a willingness locally to improve the service. Fines have been imposed on the operator, DB Regio Tyne and Wear. It is important that the operator is continually held to account for poor service.

Many of the problems also stem from a lack of investment, so the Government have to answer questions. More than half of the problems result from mechanical failures, and it is an unavoidable fact that our trains are far too old and need to be replaced. They should have been replaced years ago, but now it looks as if passengers will be waiting another decade before that happens. Instead, tens of millions of pounds have been spent on trying to patch up the existing rolling stock—money that would have been better spent on a more permanent solution. In 2010, the previous Labour Government made an important commitment to invest nearly £400 million in our Metro. The incoming coalition considered scrapping that commitment, and our local authorities fought tooth and nail to protect it. The investment was essential, not least because the Metro continues, despite all the faults, to have growing passenger numbers each year. Last year, passenger growth was the fastest outside London.

If the Metro is to meet demand, it needs clarity about its future funding. Nexus is waiting for confirmation on £46 million of funding for the Metro service from 2016 onwards. Can the Minister give us any further information about the status of that funding? It is important that the money be smartly invested. Recent projects have shown that well targeted upgrades can have an impact. New technology for cleaning rails has reduced the number of incidents resulting from low rail adhesion. The announcement that the new traffic management system will be in place sooner than originally planned is also welcome news. However, as long as the issue of our trains goes unresolved, we will not see the dramatic service improvements that our passengers expect.

My hon. Friend makes an excellent point about the Metro system. In case the Minister thinks this is just a number of north-east MPs complaining about historical issues, I checked the Twitter feed before I came to this debate. Today we have had:

“No trains South Gosforth - Monkseaton due to signalling problems.”

Another Twitter message stated:

“Most Metro ticket machines are back up and running.”

That implies that the ticket machines had not been up and running. A third message said:

“Disruption cleared at 12:25.”

Another message said that a train had been withdrawn from stations between St James and South Gosforth. These ongoing problems occur daily.

I thank my observant hon. Friend. He is, of course, correct. Since I started this campaign and made it public that I had secured this debate, my office has received an influx of complaints from across our region about the poor performance of the Metro.

Our local councils and Nexus have shown a willingness to invest in our local transport. There is clearly local demand, but we need a similar commitment from central Government. Today I want to hear what plans the Minister has to support the purchase of new rolling stock for the Metro as quickly as possible. In a written answer to my hon. Friend the Member for Houghton and Sunderland South (Bridget Phillipson), the Department for Transport said that it has

“engaged in preliminary discussions…for the replacement of rolling stock”.

Can the Minister give us any more detail about those discussions? Bearing in mind the concerns that have been raised, will he look favourably on a request for funding for new Metro cars?

This debate is a chance for the Government to demonstrate that they are truly committed to investing in the north-east, and to delivering their promises to our region. Many of my constituents remain cynical about the Chancellor’s sudden conversion to the cause of investing in northern cities just a few months before the last general election. It is notable that a number of the transport infrastructure projects announced for our region in the pre-election Budget were in fact re-announcements, not new money. In any case, it remains unclear where the north-east fits into his northern powerhouse, if it fits at all.

As my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) has said, it remains the case that the Government spend £5,426 a year on transport for every person living in London, but for the north-east they spend just £223 per head a year. If the Government are serious about rebalancing the economy, investing in new trains for our Metro would be a good start.

Obviously we need to fix what we have before we go any further. Is my hon. Friend aware that, with a population of some 55,000 people, Washington is the largest conurbation in the area not to be covered by the Tyne and Wear Metro? As well as giving us the money we need to make the Metro fit for purpose, we also need to ensure that the Metro covers the whole of Tyne and Wear.

I could not agree more. Investment is needed so that we can roll out the Metro, because that would help our economy, although we need to fix the faults first. It is not right that a large part of our area is not accessible by the Metro.

I suspect that the Minister will try to sidestep my constituents’ complaints by saying that the running of the Metro is a devolved matter. It is right that regions and cities should have control over transport, and Opposition Members have been pushing for even greater devolution. Nexus and the North East combined authority have been holding DB Regio Tyne and Wear to account by imposing penalties where appropriate, but it would be wrong to say that all the issues we are seeing can be attributed to the operator. Even the best management cannot compensate for trains that have come to the end of their lifespan and can no longer be relied on. There is a clear need for investment.

My hon. Friend is making an excellent contribution. Although the Tyne and Wear Metro does not extend to Northumberland, I am sure the Minister will give a cast-iron guarantee that that is only a matter of time. Does my hon. Friend agree that, although the Tyne and Wear Metro has a fantastic workforce, from the drivers to the cleaners, the one problem it has is that workforce numbers have dropped from 315 to 281? Eighteen drivers have left over the past year, which is nearly double the average over the past three years. Does she agree if the Metro does not have the workforce or the staff, it is highly likely that its productivity will be reduced?

I agree with my hon. Friend. For the Metro to work, it needs to have the staff and structure. I have already spoken to Nexus about staffing and the lack of staff available on the platform to advise passengers when there have been problems. There is clearly a need for investment. The Metro will not serve our area without that investment. I hope the Minister will recognise that today and tell us more about what the Government can do to bring that investment forward.

As ever, it is a pleasure to serve under your chairmanship, Mr Gray. I congratulate my hon. Friend the Member for South Shields (Mrs Lewell-Buck), my constituency neighbour, on securing this important debate, which centres on the performance of the Tyne and Wear Metro service, but I will also address the service’s future, to which she alluded.

In the past nine months for which figures are available, 42,749 excess minutes were recorded, which is more than double the Metro’s target. Causes include power failures, leaves on the line and train malfunctions. The majority of complaints received were due to train service performance. I live near a Metro station, so my family and I understand the Metro’s benefits all too well. The Metro is and has been a great service, and I remember when it first started. [Interruption.] We are all showing our age this afternoon.

The Metro has not been reliable over the past few years. If I turn up in the morning to catch the Metro to Newcastle to get a train down here—when I am not getting a Sunderland train—a delay can make the difference between catching my train and not catching my train. The Metro runs to the airport, so it has to be reliable. People have to be at the airport a certain amount of time in advance, and people have complained to me that they have missed flights because of problems with the Metro. Part of the issue is that there are not many public transport alternatives. It is not like London, where if the buses go off, the tube is there; or if the tube goes off, there are lots of buses. In the north-east, people who live within travelling distance of the Tyne and Wear Metro rely on that service and, historically, it was very reliable. The benefits of living near the Metro are great, but the problem is that it needs to be reliable.

People are not just being penalised for losing minutes at work; they can lose their job if they are consistently late for work. Employers are not interested in why people are late for work, but in whether they are there on time to do the job they are paid to do, and I totally understand that. It is a very serious problem. Of the 502 complaints in April and May this year, most were to do with train service performance. It is a real issue across the piece.

My hon. Friend makes a very important point about the impact of train delays. Does she agree that productivity is one of the key challenges that we face, as the acting leader of the Labour party, our right hon. and learned Friend the Member for Camberwell and Peckham (Ms Harman), said this morning? We are 30% behind other countries when it comes to productivity. Excellent transport links are important for productivity, but my hon. Friend has given various examples that show how it is being undermined by bad transport.

I thank my hon. Friend for that intervention. It is absolutely true that productivity is essential. Economically, the north-east is one of the most productive regions in the country. We are still the only region that has a positive balance of trade. We export enormously, which is something to be proud of, but people have to get to their jobs to be able to create that productivity.

It is clear that Nexus will have to procure a new fleet of trains to meet identified customer demand. The number of people travelling on public transport goes up all the time. From an environmental point of view, that is important. As has been said, the fleet started carrying passengers in 1980. The refurbishment going on at the moment will take it to around 2025, but further refurbishment is not cost-effective. The trains are cranky and noisy, and there is a limit to what can be done with old stock. By the middle of the next decade, the trains will represent 50-year-old technology, with all the problems that go with that, including low levels of reliability, poor energy efficiency and poor compliance with accessibility legislation. When they were introduced, they were trailblazing, but they are now old hat. As someone over 50, I understand the problems that getting older creates: you are not quite as good as you were a few years ago. New trains are critical. They will improve reliability and punctuality for the more than 38 million passengers who use the service every year.

I want to move on to the disparity in funding between the regions. According to recent research undertaken by the Equality Trust, if we combine bus and rail, the average amount of money in Government subsidy spent on transport for each household in the north-east is £139 a year. For those in the south-east it is £204. The figures speak for themselves. If the northern powerhouse is to amount to anything more than a vanity project for the Chancellor, he needs to put his money where his mouth is, and he needs to use the Budget next week to direct extra money into public transport in our region. A new fleet is central to securing a better, more punctual and energy-efficient Metro service. Given the costs involved, Government financing will be crucial. These things inevitably take time, so I urge the Minister to begin talks now to ensure that passengers in Sunderland, who rely on the Metro to go to work, attend hospital appointments and visit family and friends, get the service they need and deserve.

It is a pleasure to serve under your chairmanship, Mr Gray. I, too, congratulate my hon. Friend the Member for South Shields (Mrs Lewell-Buck) on securing this important debate.

The Tyne and Wear Metro is a critical part of the north-east’s transport infrastructure. For decades it has provided high levels of service, punctuality and customer satisfaction, running millions of journeys every year to ensure that the people of the north-east could get around quickly and efficiently. I am concerned to hear so many of the points raised by my hon. Friends today regarding the drop in operating performance. Valid concerns have been raised. Journeys are being affected by the age and need for upkeep of the rolling stock in use. Punctuality performance during the period of DB Regio’s operation has declined significantly: it is on average 8% lower than this time last year. Many travellers have also complained that when things go wrong, there is no information about what is happening and few viable alternative means of completing their journey.

I hope that as a result of today’s debate progress can be made to ensure that the Metro provides a reliable and affordable service. However, the Government have a role to play in ensuring that the Metro can meet its targets. One way to ensure that Nexus meets the plans it published last year in its “Metro Strategy 2030” document is for the Government to provide the funding necessary to secure a new fleet. This would reduce the number of technical issues that have arisen as a result of the 40-year-old rolling stock. We need upgrades to be carried out.

We heard from my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) about the need to extend the Metro to Washington. That is certainly something that my constituents would support. The re-opening of the Leamside line would benefit many people across Sunderland. Another proposed extension is the new line that would run from Doxford International business park in my constituency. This would transform transport links in my area, giving local people rapid access to other parts of the city and the wider region, and it would allow local businesses to grow and create jobs through improved transport links.

The people in Houghton and Sunderland South deserve to see real improvements. The north-east continues to get a raw deal on public transport investment compared with other parts of the country. In London, when things go wrong, commuters have a wealth of options available, but when we have a problem on one part of the network in Tyne and Wear, there is a knock-on effect. In the north-east, when there is a problem with the Metro or when local buses do not run, passengers can be left stranded.

If the Government are serious about creating a so-called northern powerhouse in the north-east to drive economic growth, they must match their rhetoric with action and invest to create a truly integrated transport network. Joining up the Metro, local buses and other transport options will give passengers genuine choice as to how they travel, and options when things go wrong. It will also help commuters get to work, improve transport links for businesses and spur job creation.

My hon. Friend makes very important points about increased investment, the extension of the Tyne and Wear Metro and integrated transport. This morning I headed off to an event outside Westminster. I used the new Tottenham Court Road station, which is part of the Crossrail investment. It is a beautiful station; I think it is excellent. Crossrail represents billions of pounds of investment in London. Does my hon. Friend agree that the north-east needs a suitably ambitious investment programme for its transport infrastructure?

Of course our capital city needs investment in the rail network to ensure it can function properly, so that we can attract jobs and investment, but so does the north-east. Unfortunately, in recent weeks we have had further confirmation that the Government remain lacking in commitment when it comes to investment in transport infrastructure in the north. In my constituency, we do not benefit at all from the Tyne and Wear Metro. Many people use it, but we do not have direct links within the constituency, and for many of my constituents, the only option is bus travel. That is why I have campaigned so much to support what the combined authority has done on introducing a quality contract scheme.

If businesses are to continue to invest in the region and jobs are to be created, we need a more integrated network. We need a joined-up network so that people can be confident of getting to work on time, and so that businesses know that they can invest in an area with excellent transport links. The north-east has many excellent road networks and good links in many respects, but we are let down by public transport. The proposed Metro extension to Doxford is critical, and I hope to see the extension proposals in “Metro Strategy 2030” become a reality.

I look forward to the Minister’s response. I want to hear him outline the work that he will do, through the Department, to make sure that the Metro receives the investment it needs in the short term, and how he will work with Nexus and the combined authority to deliver the long-term investment in transport infrastructure that the north-east needs, particularly the investment needed over the next 20 to 30 years to extend the Metro and offer better transport options for the region to support the businesses, job creation and growth that we all want to see.

It is always a pleasure to serve under your chairmanship, Mr Gray. I congratulate my hon. Friend the Member for South Shields (Mrs Lewell-Buck) on securing this important debate, and on setting out so clearly how the Metro service affects the lives of her constituents and the wider area. She has made a powerful case for investment in the north-east’s local transport infrastructure. I also welcome the Under-Secretary of State for Transport, the hon. Member for Harrogate and Knaresborough (Andrew Jones), to his place. I am sure that this will be the first of many Westminster Hall debates on light rail that he will respond to, and I wish him well in his new post.

We heard important speeches from my hon. Friends the Members for Sunderland Central (Julie Elliott) and for Houghton and Sunderland South (Bridget Phillipson), and many valuable contributions from other hon. Friends who represent Tyne and Wear constituencies. As my hon. Friend the Member for Sunderland Central said, reliable services are vital to people in her area—not only those working locally, but those connecting to inter-city rail services and flights from the airport. My hon. Friend the Member for Houghton and Sunderland South spelled out the important role that modern rolling stock can play in ensuring a punctual service, and how an expanded and integrated network could benefit businesses in her constituency. It is clear that the Tyne and Wear Metro plays a crucial role in supporting the local economy, and my hon. Friends are rightly ambitious for their region.

The existence of the Metro is a testament to the planners who, 40 years ago, had the foresight to take the run-down Tyneside Electrics network, which was ironically converted to diesel under British Rail, and transform it into the first modern light rail service in the country. It is fair to say that while the Tyne and Wear Metro owes more to conventional rail lines than most light rail networks, it pioneered the conversion of disused or underused rail lines, a practice that has been integral to the success of the Manchester Metrolink, the docklands light railway, and—I hope that I do not have to declare an interest here, Mr Gray—the Nottingham express transit system. I am sure that everyone in this House welcomes the investment in those systems in recent years.

The 2002 extension to Sunderland increased the size of the Metro network by around a third, and a £580 million funding package was awarded under the last Labour Government, with £350 million earmarked for investment and £230 million reserved for meeting running costs. It is a cause for concern that, as has been set out today, there are ongoing challenges to do with performance and the quality of services for passengers. It is certainly worrying that while tram and light rail use continues to grow in London, ridership has fallen on most systems since 2009-10, and the Tyne and Wear Metro is no exception. The network carried 40.8 million passengers five years ago, but that figure fell to 38.1 million in 2014-15, despite the fact that people who live within the Nexus passenger transport executive boundaries are more disposed to travel by light rail than those in any other area.

Of course, that decline might have something to do with worsening punctuality. As the Under-Secretary of State for Transport, the hon. Member for Devizes (Claire Perry), said in a recent written answer to my hon. Friend the Member for South Shields, punctuality declined from 87% in 2010-11 to just 80% in 2014-15. Although the Metro is not included in Passenger Transport’s recent passenger satisfaction surveys, according to information collected as a condition of the operator’s concession agreement, passenger satisfaction is also below target, and of course that was borne out in my hon. Friends’ comments today. Passengers deserve better, and I look forward to hearing the Minister’s response to the points ably put my hon. Friend the Member for South Shields and our colleagues.

The Metro network’s ageing rolling stock undoubtedly plays a part in those reduced passenger satisfaction ratings, and as my hon. Friends have said, it also impacts on the Metro’s operating performance. As was said, the Metro’s vehicles date from the 1970s and the early 1980s; they are as old as the system itself, and Nexus regards their replacement as “essential”. When the Minister responds to the debate, will he say what progress has been made in the Department’s discussions with Nexus on this point, and what options are available to the Department to support the procurement of new vehicles?

In addition to answering my hon. Friends’ questions, I would be grateful if the Minister could say a few words about the potential for integrating Metro and bus services. My hon. Friend the Member for Houghton and Sunderland South raised that point, and she has been a powerful advocate for the importance of integrated transport, and particularly the importance of improving bus services in the Tyne and Wear area.

During the 1970s and through to the mid-1980s, Tyne and Wear was well known—both locally, and in public transport enthusiasts’ circles—for its highly integrated ticketing system. Sadly, those arrangements were mostly lost following the deregulation of bus services from 1986 onwards. Does the Minister agree that local authorities should have the power to integrate timetables and ticketing over different modes to improve services for passengers, however that integration is delivered, and that tendering for bus services is an important tool that should be available to local authorities and passenger transport executives? In addition, does he agree that more co-ordinated bus and metro services might increase passenger satisfaction on both modes of transport? Finally, can he explain why, according to reports, there will be a disparity in the forthcoming buses Bill between the powers given to areas that have metro mayors and those that do not, and will he say when that Bill will be published?

This has been a valuable debate. My hon. Friend the Member for South Shields has made a number of important points on behalf of passengers in her constituency, and they have been taken up by hon. Friends from across the wider Tyne and Wear area. I look forward to hearing the Minister’s response to all the questions that have been put; I hope that he will address them in full.

Thank you very much, Mr Gray, for calling me to speak. It is a pleasure to serve under your chairmanship for what I think is the first time in my new role.

I congratulate the hon. Member for South Shields (Mrs Lewell-Buck) on securing the debate and on highlighting the importance of the Metro system to her area, as well as the problems with its services that local people are experiencing. Those problems came across strongly in the remarks by her colleagues from across the area, and I know that Nexus is also listening to this debate.

The Government recognise the important role that the Tyne and Wear Metro has played in the life of the north-east. I too remember it arriving; I suspect that those of us of a certain age—our early fifties—all remember it. It was exciting—an indication of confidence and a little bit of pride. Apart from the transport infrastructure benefits it provided, the Metro was a sign of resurgence and growth, and it has played an important role in the north-east. Light rail and local transport play an important role in the whole area.

Local transport is important, but the problem in my constituency, which is in the south-east of Northumberland, is that the Metro does not go anywhere near it, which presents a problem of connectivity for anyone seeking employment and so on in the big cities. Will the Minister agree to support the reintroduction of the Ashington, Blyth and Tyne line, which would eventually link up with the Metro, hopefully at Regent Centre, and give greater connectivity and more opportunities to people in my constituency?

I cannot make pledges off the cuff, as I think the hon. Gentleman knows, but do I think that rail investment drives economic growth? Do I think that we are struggling with our capacity? Our rail network is a victim of its success. There are as many passengers using our network now as there were in the late 1920s, but the network is only a fraction of the size it was then. During the last 20 years, passenger journeys have gone up from 750 million per year to more than 1.6 billion per year. That is the driver of some of the congestion and pressures that we now see—it is coping with success. Also, part of the challenge is the long-term historical underinvestment in our railways, which has taken place under Governments of both colours over many years, and we are now playing catch-up with our infrastructure. So can I back the hon. Gentleman’s campaign immediately? I cannot make that pledge and I think he knows that—I can tell from his little smile just now that he probably knows that. But on the general principle of whether we can do more to invest, I say yes—but goodness, this Government are doing that already.

Let me go back to Metro as it stands. I recognise that other Members have talked about the capacity to extend Metro and I can see much appeal in that. I think it was the hon. Member for Washington and Sunderland West (Mrs Hodgson) who made the point that the constant desire to see Metro extended to new destinations just underlines how important it is in the area and how popular it is with passengers. I hope the potential for new extensions will grow. The extensions to the light rail services in Manchester and Nottingham have been very positive developments, and I hope that the North East combined authority considers such an extension as part of its transport plan. I would support such a proposal.

Metro is an important and formidable asset for the area. It copes magnificently with certain big events in the area, such as carrying 100,000 people for the Great North Run. Metro is a success story. Notwithstanding the operational problems detailed by hon. Members, this is the busiest light rail network outside London, and the fastest growing. Passenger journey numbers have increased by 2 million in the past year, and there are now more than 38 million in total. The revenues of Nexus, which owns and manages Metro, have grown by 4.4% and it now funds its day-to-day operation entirely from fares revenue and central Government metropolitan rail grant, without having to ask the local authorities for funding, as in the past. The Government have supported Nexus in its 11-year £350 million capital investment programme. As the hon. Member for South Shields highlighted, the programme—essentially one of asset renewal—is still running. It is delivering significant benefits now and will continue to do so over the next few years.

I take a keen interest in the performance of all rail services in the country, but the performance of Metro is a devolved matter. Nexus and its operating concessionaire provide regular updates at meetings of the North East combined authority, where its performance has been scrutinised. I understand that Nexus’s performance will be on the agenda at an authority meeting next week, on 9 July, and local councillors can directly question the senior management team from Nexus and the operator.

I have had a brief conversation with Nexus and undertaken to visit it in the next few weeks. It accepts that the day-to-day performance of Metro does not match the standards it sets for itself and which passengers expect. The main reasons for poor performance are clearly the train fleet’s reliability and the availability of train drivers. Nexus, the public body owning the network, has instigated a performance improvement plan, working closely with its concessionaire to identify the most common and recurring causes of faults in the trains and the actions needed to address them. As a result, the most common problem—door faults—have come down by one third since April, and train power faults have been reduced by a half compared with the previous quarter.

The operator has accelerated its recruitment and training process for drivers, which the hon. Member for Wansbeck (Ian Lavery) mentioned. The company has suffered from the impact of an ageing workforce: many drivers who started with Metro in the early 1980s are now reaching retirement age. The operator is taking on 24 new drivers this year, and two thirds have already completed training or are about to do so. As a result, train cancellations due to no driver being available have been reduced and will continue to fall. There is also recognition that communications with customers need to improve, particularly when Metro is not running to timetable. The operator is committed to new training for its front-line staff and Nexus is to invest more than £20 million in new radio and train management systems as part of its investment in Metro, supporting better communication right through the system. Although there is further to go, Metro is heading in the right direction, and we want to be in a position to support it.

The Government are committed to the long-term investment plan, launched by the previous Labour Government, which will continue until 2021. In the last financial year, under that plan, we invested £30.9 million in securing Metro for some decades to come, and we are looking to invest a similar amount in this financial year. The real value of that investment is in giving Nexus the strength and security to plan projects over a number of years, in the same way that the Government structures investment in national rail infrastructure. One problem in our rail sector has been a stop-start—frequently stop—approach to investment over many years, which has meant that we do not have some of the skills or continuity of supply in industry to deliver our aspirations and expectations. That is part of the long-term failure to invest in transport that I mentioned earlier. This investment has focused on the key engineering assets on which Metro and its passengers rely, including new track, replacement of cable routes and renewal of lifts and escalators at stations. This investment has already improved the service for passengers by reducing faults.

Long-term planning and security of investment has helped Nexus to drive down projects’ overheads by a quarter, releasing a further £20 million that will be invested where it is needed in new assets for Metro. The investment has allowed Nexus to invest in people as well as infrastructure—for example, it has taken on 30 new apprentices in the last three years. Those young people can look forward to rewarding careers in engineering, thanks to that investment.

Government investment has also gone towards refurbishment of stations and trains. We have talked quite a bit about rolling stock, which I will come to in a moment. The investment has been focused on raising accessibility to modern standards as part of a commitment to providing a railway open to all. The refurbished trains provide more space for passengers, while refurbished stations offer tactile surfaces, double handrails, better lighting and proper bench seats to cater for the needs of all.

Alongside this programme, Nexus has, with the support of the Department for Transport, invested in smartcard travel. The smartcard is the reason Nexus has invited me to visit and see its operation. It is already used by more than 100,000 local people on the system. High-quality cycle storage at stations—another part of the integration that colleagues have talked about—which goes right across the system, is funded through the local sustainable transport fund.

It might help if I highlight the impact of ongoing investment. That is not to say that there have not been operational difficulties, because there clearly have been, and Nexus know it, but work is under-way to get this right. Nexus is trying to do a good job.

Metro is owned and run locally, but the Department works with it and in support of it. The Department is now working with Nexus and NECA to understand what future investment is required, to ensure that it continues to play a vital role in making the north-east economy work. Our discussions on replacement of rolling stock are at the very earliest stages. Colleagues have asked if I can make a commitment on rolling stock. I cannot make that commitment today, but I recognise that 40-year-old rolling stock—by the way, that is not unusual in our rail infrastructure—is coming to the end of its life and we are looking towards a new train fleet. The refurbishment will see the fleet through for a period, but it will not make it fit for decades into the future. Future rail fleets will certainly be required.

I welcome the Minister’s discussions with Nexus and the combined authority about investment in rolling stock. During those discussions, will he undertake to discuss the long-term investment that will be needed in the Metro network if there is to be expansion? That will require significant Government investment. I appreciate that this is a long-term strategy, but there are proposals in place that would bring significant benefits to the region. I know he cannot commit today to any particular schemes, but will he discuss that and bear in mind the economic benefits that those proposals could bring?