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Commons Chamber

Volume 598: debated on Tuesday 7 July 2015

House of Commons

Tuesday 7 July 2015

The House met at half-past Eleven o’clock


[Mr Speaker in the Chair]

Oral Answers to Questions


The Secretary of State was asked—

Hospital Acute Services

1. What assessment he has made of the effectiveness of recent reviews of acute services in hospitals. (900776)

The configuration of front-line health services is a matter for the local NHS. It is for NHS commissioners and providers to work together with local authorities, patients and the public to shape their local NHS in such a way as to improve the quality, safety and sustainability of healthcare services.

The review of acute services in Worcestershire has taken nearly two years longer than anticipated, and that has had subsequent negative implications for the health economy in Worcestershire. It is absolutely right that trusts carry out proper reviews from time to time, but has the system been written in such a way that it creates imbalances that prevent a conclusion from being reached? What steps is my hon. Friend taking to bring in practical measures to expedite the conclusion of such reviews?

I agree that the process in Worcestershire has taken too long. I am glad that the West Midlands Clinical Senate has made recommendations that are being looked at by commissioners at the moment. I have encouraged commissioners to come to as quick a resolution as possible—I hope within the next few months.

Will the Minister conduct a review of car parking charges? Patients in Dudley are absolutely furious after the people running Russells Hall hospital put up prices by as much as 50% for a short stay. Will he get together with NHS civil servants and the people running the hospitals to sort this out?

Thank you Mr Speaker—helpful as ever.

The hon. Gentleman is entirely right that those who seek to access acute services on a regular basis require special treatment. That is why we issued guidance in the previous Parliament. I very much hope that his local hospitals will be looking at that with due care and attention.

Kettering general hospital is looking to develop a £30 million urgent care hub—one of the first of its type in the country—to replace and enhance the accident and emergency department, which is under growing strain. This project enjoyed the support of the previous Government. Will my hon. Friend agree to meet me and the two other MPs from north Northamptonshire to make sure that it remains on track?

I very much look forward to meeting my hon. Friend and his colleagues, and I have already committed to doing so. I hope that the lead he has taken with his colleagues in forging a cross-party consensus will be copied across the House.

Each week, 1,000 diabetics suffer hypoglycaemic attacks, which require urgent medical treatment and access to acute services. Does the Minister agree that better management of diabetes services by GPs will lessen the pressure on our A&E services?

I do agree with the right hon. Gentleman, who is an expert in this field. We have a diabetes and obesity strategy coming later in the year. The Under-Secretary, my hon. Friend the Member for Battersea (Jane Ellison), who is responsible for public health, will be leading that effort.

GP Appointments

2. What recent estimate he has made of the proportion of patients who waited for at least one week for a GP appointment in the past 12 months. (900777)

While we do not record the proportion of patients waiting a week for their GP appointment, the latest GP patient survey results show that 85% of patients reported that they were able to get an appointment to see or speak to someone, and only a very small percentage ended up not speaking to or seeing someone.

Unfortunately, many of my constituents would not recognise the picture that the Secretary of State seeks to paint. The British Medical Association recently said that waits of one to two weeks were becoming the norm for patients. Why is it becoming harder, on his watch, to get a GP appointment?

If I may gently say so, the under-investment in general practice has been going on for decades, according to the BMA and the Royal College of GPs. We have announced that we are putting that right with our plans to recruit 5,000 more GPs during this Parliament. That is the biggest increase in the number of GPs in the history of the NHS, with £1 billion going to upgrade GP and primary care premises, and 18 million people by the end of this financial year benefiting from evening and weekend appointments. That is a big, positive change, and I hope the hon. Lady would welcome it.

Has my right hon. Friend had a chance to read the report by the Professional Standards Authority for Health and Social Care, which says that pressure would be taken off doctors and nurses if greater use were made of the 63,000 practitioners that it regulates on 17 separate registers covering 25 occupations? Will he look at the report and write to me?

I am very happy to do that. My hon. Friend is right to point out that the solution to the problem is not just about expanding the number of appointments offered by GPs, although we are doing that; it is also about looking at the very important role that pharmacists and other allied health professionals have to play in out-of-hospital care.

The Secretary of State mentions recruiting 5,000 extra GPs, but I note in a recent speech that that was downgraded from a guarantee to a maximum. With 10% of trainee posts unfilled and the BMA’s recent survey suggesting that a third of GPs will leave in the next five years, is that not going to be difficult? Has the Secretary of State had any consultation with the BMA and the royal college to ask why they are leaving?

It will be difficult. The commitment has never been downgraded: we always said that we needed about 10,000 more primary care staff, about half of whom we expected to be GPs. We have had extensive discussions about the issues surrounding general practice, such as burn-out, the contractual conditions and bureaucracy. We are looking at all of those things. The commitment is to increase the number of GPs by about 5,000 during the course of the Parliament, and that is a very important part of our plan to renew NHS care arrangements.

I assume the Secretary of State is aware that two of the pilot sites for the seven-day, 8 till 8 working—one in north Yorkshire and the other in County Durham—have abandoned the project owing to poor uptake by patients, with only 50% of appointments used on a Saturday and only 12% on a Sunday. Given that they found that it had a detrimental effect on recruiting cover for out-of-hours GP urgent services, does not he feel that this needs a rethink and that consultation with the profession and looking at cover would be of most benefit?

The hon. Lady is presenting only a partial picture. In Slough there are about 900 more appointments every week as a result of the initiative for evening and weekend appointments. Birmingham has dramatically reduced the number of no-shows and Watford has reduced A&E attendance measurably. Some really exciting things have happened, but of course we will continue to consult the profession to make sure that the programme works.

Radical and innovative steps were taken in Plymouth this April to integrate not only front-line health and social care services in the city, but all the council and clinical commissioning group resources into a single fund. Will my right hon. Friend describe how the success regime in the Plymouth and Devon area will build on those achievements?

Absolutely; I had the pleasure and privilege of visiting Plymouth during the election campaign to see some of the radical changes being offered in community care. There is huge enthusiasm for transforming the situation in Devon. It is a very challenged economy, but by bringing together the health and social care system and by putting more resources into primary and out-of-hospital care we will be able to give a better service to my hon. Friend’s constituents, which I know he will welcome.

Ten years ago, this great city lived through one of the darkest days in its history. Our thoughts today are with all those who were affected and we pay tribute to the heroic staff of London’s NHS, who did so much to help them.

The latest GP patient survey is important for the simple reason that it covers the first full year of the Government’s GP access challenge fund. The results do not make good reading for the Secretary of State. The percentage of patients dissatisfied with their surgery’s opening hours has increased and patients found it harder to get appointments last year than the year before. Will the Secretary of State admit that his policies are simply not working and that GP services are getting worse on his watch?

First, I echo the right hon. Gentleman’s comments about the extraordinary bravery of the emergency services, particularly the London Ambulance Service, in response to the terrible tragedy of 7/7.

I do not accept the picture the right hon. Gentleman paints of general practice. The Prime Minister’s challenge fund has been extremely successful: by the end of this year, 18 million people will be benefiting from the opportunity to have evening, weekend and Skype appointments with their GP. We have also announced the biggest increase in the number of GPs in the history of the NHS. The Labour party left us with a GP contract that ripped the heart out of general practice by removing responsibility for evening and weekend care and by getting rid of personal responsibility by GPs for their patients. The right hon. Gentleman should show a little contrition and modesty about Labour’s mistakes.

People who have been ringing surgeries this morning unable to get appointments will not be convinced by what they have just heard. The truth is that the disarray in the Secretary of State’s primary care policy goes much deeper. Not only has he made it harder for people to get a convenient appointment, but he now wants to charge people who miss the appointments they are able to get. We all want to reduce waste, but there are many reasons why people do not turn up, including family emergencies. That is presumably why No. 10 slapped him down. He will have worried people, so for the avoidance of doubt, will he today confirm that he will not return to that idea in this Parliament?

There are no plans to charge people who have missed appointments. That is precisely the sort of scaremongering that the British public rejected at the last election. The right hon. Gentleman put the NHS on the ballot paper, and the country voted Conservative; he might want to think about the lessons from that. Missed appointments cost the NHS £1 billion a year. We want that money to be spent on doctors and nurses. Labour spent billions on wasted IT contracts and the private finance initiative, and did not spend enough on front-line staff. We are putting that right.

Muscle-wasting Conditions

3. What steps he is taking to ensure that clinical commissioning groups routinely fund cough-assist machines for people with muscle-wasting conditions when a clinical need has been identified. (900778)

Muscle-wasting conditions associated with neurodegenerative disorders affect about 60,000 people in England at the moment. The Government are supporting research through the National Institute for Health Research, totalling £39 million. NHS England, CCGs and Muscular Dystrophy UK have come together and are jointly working on the “Bridging the Gap” report to improve neuromuscular disease, and the Department of Health is supporting this work with funding of £600,000. Decisions on the funding of cough-assist machines are rightly the responsibility of CCGs on a case-by-case basis.

As revealed in Muscular Dystrophy UK’s “Right to breathe” report published in February 2015, in some areas of the country patients have access to cough-assist machines which the local clinical commissioning group will not fund in other areas, despite a clinical need being clearly identified. These machines can help to prevent potentially fatal respiratory problems and to reduce costs and lengthy, unplanned hospital visits. A cough-assist machine costs £4,500, whereas a long stay in an intensive care unit can cost more than £13,000. [Interruption.] Will the Minister meet me and representatives of Muscular Dystrophy UK to discuss how better consistency in provision of vital respiratory equipment—

My answer of a few moments ago stands. Decisions on the commissioning of those machines are taken on a case-by-case basis locally. The National Institute for Health and Care Excellence has set out in guidance that cough-assist machines may be appropriate for some patients, but not in every area.

Eye Surgery

4. For what reasons his Department categorises corrective refractive eye surgery for medical purposes as cosmetic surgery. (900779)

The Department does not categorise refractive laser eye surgery for medical purposes as cosmetic surgery. Laser eye surgery is regulated through providers registered with the Care Quality Commission. Doctors carrying out the surgery must be registered with the General Medical Council and, like all doctors, they must recognise and work within their competence.

My constituent Mr Shabir Ahmed, whom I have visited, was repeatedly recommended, by the optician he went to for his NHS eye test, to have an eye operation involving complex refractive laser surgery. Over two years, the optician called him every month, bringing the price down until it was half what it was originally. It did not work out: the surgery led to a significant deterioration in his eyesight, and the company denies all responsibility and liability. It seems to me—

Mr Speaker, please bear with me for two sentences. Surgery as complex as that needs the same kind of regulation as if it were in hospital.

There are two parts to my hon. Friend’s question. The first is about the high-pressure tactics employed by providers. They will be covered by the new regulations brought in on 1 April by my right hon. Friend the Member for Bromsgrove (Sajid Javid), who is now the Secretary of State for Business, Innovation and Skills, by which we have given powers to the Information Commissioner. I suggest that my hon. Friend refers his question to our right hon. Friend. On the second point about failed procedures, refractive eye surgery operators are governed by the same regulators as hospitals, and achieve exactly the end that my hon. Friend wishes.

The regulatory procedures are not working. Ten years ago, our late colleague Frank Cook introduced a ten-minute rule Bill calling for regulatory reform, and I reintroduced that Bill three years ago. The Keogh report called for regulatory reform two and a half years ago, and nothing has happened. People are losing their eyesight as a result of some of the companies operating in this field. Will the Minister meet me and the hon. Member for Watford (Richard Harrington) to talk about progress in this field?

I am afraid that the hon. Gentleman is not right. Progress has been made. Ten years ago, that might not have been the case, but the Care Quality Commission was strengthened under the previous Government and it is regulating refractive eye surgery. Moreover, the doctors who perform those operations are regulated by the General Medical Council, and the Royal College of Ophthalmologists is bringing forward a certification scheme because of the moves that were taken by the last Government.

Hospitals in Special Measures

The 21 hospitals that have been put into special measures under the new inspection regime have recruited 458 more doctors and 1,012 more nurses, and all of them have made good progress, including the Medway and Burton hospitals.

I thank the Secretary of State for the support that he has given Medway Maritime hospital. Will he welcome the appointment of a chief quality officer at Medway hospital? It is one of only two trusts to have done that, and it is helping to improve safety and bring Medway out of special measures. Will he join me in paying tribute to the brilliant staff at Medway hospital, who are working day and night to turn things around?

I do pay tribute to them, and I welcome Dr Trisha Bain to that post. Ten years ago, that hospital had one of the worst mortality rates in the country. Since then, it has recruited nearly 100 more doctors and 83 more nurses, and has teamed up with Guy’s and St Thomas’. There is a culture of transparency and honesty about failings and a rigorous focus on improvement that were not there before. I hope that the whole House will welcome that change in culture.

My local hospital, Queen’s hospital in Burton, has worked closely with Monitor to improve while it has been in special measures. Does the Secretary of State agree that, although spending four nights in ward 7 was not the best way for me to start the general election campaign, all the staff should be congratulated on the way they have approached the need to improve?

I am sorry that my hon. Friend had to go to hospital at the start of the election campaign, but I congratulate her on being probably the only Member of the House to have launched their campaign from an NHS hospital ward. I trust that all the nurses voted for her as a result.

Inexplicably, the trust that my hon. Friend talked about was made a foundation trust in 2008, despite a number of problems that were not recognised. Since then, it has made dramatic improvements in its care, with more doctors and more nurses. I am delighted that it is on track to deliver better care.

How many of the hospitals in special measures have implemented recommendation 13 of the final Francis report on fundamental standards?

I would expect that all trusts have done so. If they have not, they will not come out of special measures. That is the benefit of a rigorous, independent inspection regime. Seven trusts have come out of special measures. I hope that the others will come out in due course, but that is not a decision for me; rightly, it is a decision for the chief inspector of hospitals.

The NHS in my constituency has moved beyond special measures into the success regime. Will the Secretary of State consider innovative models of care, because my constituency is very different from others and the trust will not achieve success without looking at how it can deliver safety in different ways?

The hon. Lady is absolutely right. The big change that we need in the NHS is to move away from the dependence on hospital care as the only way to deliver safe, effective care. That is why we put £200 million into the vanguard programme last year, which is looking at such models. I hope that the success regime will hasten the innovation in her area.

20. Now that the Mid Staffs trust board has been dissolved, will my right hon. Friend advise me on which is the appropriate body to deal with historic complaints against the previous trust, not only to provide answers for patients and family members, but to ensure that lessons are learned to improve patient safety? (900795)

In the first instance, patients who are concerned about safety should contact the trust concerned, even though it is a different trust legally from the one that was there before. The CQC is there to ensure that any lessons about the safety of care are disseminated throughout the NHS. That is an important part of the transparency culture that we are introducing.

Mental Health Services

6. What progress the Government have made on achieving parity of esteem for physical and mental health services. (900781)

7. What progress the Government have made on achieving parity of esteem for physical and mental health services. (900782)

15. What progress the Government have made on achieving parity of esteem for physical and mental health services. (900790)

The Government take mental health as seriously as physical health. We have introduced legislation to ensure parity of esteem, and with additional investment and the first access and waiting standards for mental health, we will hold to account and work with the NHS to achieve that aim.

There is understandable scepticism across the mental health sector about whether real-terms funding for mental health services has increased over recent years. In the interests of transparency, will the Minister commit to report on the levels of funding for mental health services that are provided nationally and to clinical commissioning groups, so that my constituents can have confidence that the Government are serious about achieving that parity of esteem?

I am happy to do that. There was an increase of £302 million in mental health spending in 2014-15, and there is an injunction on CCGs to ensure that a proportionate amount of any additional money they receive goes to mental health services. That is as transparent as it has ever been, and we will ensure that that standard is maintained.

Mental health budget cuts have hit us hard locally. I hope that the Minister will join me in paying tribute to the work of the Anthony Seddon Fund, which has raised thousands of pounds for mental health and wellbeing projects in Tameside and Failsworth? Will he promise real parity of esteem and pledge to increase mental health spending, not to cut it?

I refer the hon. Lady to the answer I gave to the hon. Member for Greenwich and Woolwich (Matthew Pennycook). Mental health funding is increasing, and parity of esteem is demonstrated by having access targets and targets for waiting times for the first time. Those measures could have been introduced by a previous Government but they were not, and the demonstration of parity of esteem shown by that legislation and by the increase in investment should help to reassure the hon. Lady’s constituents. I pay tribute to those who work in a voluntary capacity to assist those with mental health issues.

In the previous Parliament the Education Select Committee said that child and adolescent mental health services were not fit for purpose, and it called them a “national scandal”. The situation is getting worse, with children and families left for up to five months without appointments. What is the Minister doing to deal with that national scandal?

The way that children and young persons’ mental health services have been handled over a lengthy period has been extremely poor, and many MPs have similar concerns on behalf of their constituents. That is why one of my major priorities for this Parliament is to build on the good work of the previous coalition Government, with £1.25 billion to be spent on transforming care services for children and young persons—a commitment that I think the Labour party would struggle to match.

Despite the excellent work done over the past two decades, does my right hon. Friend agree that the challenge facing us all—not only in government but among members of the public—is to end the disgraceful stigma that is associated with mental ill health, and break down the barriers of prejudice so that people suffering from mental ill health are treated in the same way as those suffering from a physical infirmity?

My right hon. Friend is correct. The damage that has been done over many years by not regarding mental ill health as seriously as it should be regarded, and by not having that parity of esteem, has been immense. The campaigns that have been launched against stigma, often fronted by brave people—including some in this House—have done much to correct that, but he is correct to say that the campaign against stigmatisation must continue.

The first NHS point of contact for many people with mental health issues is often their GP. Does my right hon. Friend agree that it remains vital that GPs and primary care staff have proper understanding and training in mental health care, and more broadly that such training forms a greater part of medical qualification and training?

Last Wednesday I spoke to 2,500 psychiatrists—if colleagues think that this audience is scary they should try speaking in front of them. The chairman of the Royal College of Psychiatrists said that there had been an increase in the uptake of the psychiatry training given to doctors before they enter general practice, which was leading to a greater interest in mental health issues. I entirely agree with my hon. Friend: it is important that such training exists because that first point of contact with GPs is crucial.

To build on that greater awareness and understanding of mental health among general practitioners, will the Minister look at ways in which we can rebalance mental health care away from an overreliance on acute care towards greater and more consistent primary care?

Yes, and the adaptation of new and innovative therapies will also assist. Ensuring that GPs are aware of the increased access to psychological talking therapies is making a huge difference. Initial reactions to that programme indicate that, since 2008, nearly 3 million people have had access, 1.7 million have completed their treatment, and 1 million have recovered. Increased awareness of that in primary care will be very important.

Last month’s Care Quality Commission report revealed serious shortcomings in emergency mental health care, including that too many people do not have access to urgent help around the clock. The lead mental health inspector said that those findings must act as a wake-up call. How is the Minister ensuring that people in a mental health emergency get the same support that we would expect them to get in a physical health emergency?

The extremely important report to which the hon. Lady refers was commissioned by the Government. It described the crisis care concordat, which is at the heart of dealing with mental health crises, as a “remarkable initiative”. It states:

“An extraordinary range of public services and other bodies have acknowledged their responsibilities”.

For me, it serves as a baseline for what we should do. The word “efficiency” is pointed out, not least in respect of A&E treatment of those with mental health crises. I regard it as a very good base on which to work and to gauge the success of what we do to deal with mental health crisis care over the next few years. I commend the crisis care concordat—it is in operation all over the country—as a first step towards ensuring that the sort of treatment we want in mental health crises becomes the norm.

NHS Efficiency Savings

8. Whether he expects that the efficiency savings identified in NHS England’s most recent “Five Year Forward View” will entail a reduction in staff numbers. (900783)

The “Five Year Forward View” is about meeting increasing demand through new models of care, not cutting staff numbers. In fact, we are planning an additional 10,000 staff in primary and community settings, including around 5,000 doctors.

The Secretary of State will be aware that Sir Robert Francis specifically recommended that the National Institute for Health and Care Excellence provide guidance on safe staffing levels because it is independent and can establish guidance based on the needs of patients. The Government’s decision to suspend that work and transfer responsibility to NHS England has been met with criticism from patients’ groups right across the NHS. Will the Secretary of State please explain why he thinks NHS England is better placed than NICE to carry out that vital work?

The important thing is that that work happens. NICE did a very good job in delivering safe staffing guidance for acute wards. It is important to recognise that that guidance was interpreted as being about simply getting numbers into wards, but the amount of time that doctors and nurses have with patients is as important. The work will continue and we are proud of the fact that we are dealing with the issue of badly staffed wards. We will continue to make progress.

In trying to reduce waste as part of the drive for efficiency savings identified in the “Five Year Forward View”, the Secretary of State spoke recently about the possibility of putting a price label on high-value items in prescriptions alongside a label saying that they are paid for by the taxpayer. Will he reassure the House that such a measure would be carefully piloted and evaluated first, so that we can avoid any unintended consequences for those who might consider discontinuing very important medication?

We will look at all the evidence. The evidence we have seen from other countries is very encouraging. Apart from ensuring that NHS patients and the public understand the cost of NHS care, one of the main reasons why we want to do that is to improve adherence to drug regimes by making people understand just how expensive the drugs are that they have been prescribed. We will of course look at all the international evidence.

16. NHS England consulted in the last Parliament not just once but twice on downgrading the economic deprivation part of the funding formula, which would have had the effect of taking some £230 million per year out of the primary care budget for the north-east and Cumbria. Will the Secretary of State give the House a commitment—we got one from the Minister in the last Parliament—that he will not downgrade the economic deprivation part of the funding formula? (900791)

I give an absolute commitment that economic deprivation will be a very important part of the funding formula, but the right hon. Gentleman will appreciate that things such as the number of older people in a particular area is as important in determining levels of funding. We are committed to reducing health inequalities, but that also means making sure that similar levels of care are available in similar parts of the country. That has not always been the case.

Does my right hon. Friend agree that the efficiency savings our Government are introducing have led to the lower waiting lists and the better access to cancer drugs for patients in England that are the envy of my patients in Wales? What can I tell them about how we can get greater access and better standards in Wales while the NHS in Wales is run by Labour?

My hon. Friend can tell them that when Labour Members opposed the Health and Social Care Act 2012, we were doing the right thing for patients, with 18,000 fewer managers, 9,000 more doctors and 8,500 more nurses, whereas the Labour party was posturing. We can see the results of that posturing in Wales, where more people wait for A&E, more people wait for their cancer operation, and 10 times more people are waiting for any kind of operation.

The Secretary of State talks about having similar levels of care, but we do not have similar levels of safe staffing around the country. Peter Carter has said about the decision on NICE:

“If staffing levels are not based on evidence there is a danger they will be based on cost.”

Is my hon. Friend the Member for Wirral West (Margaret Greenwood) not right? NHS England should reverse that decision and let the independent body be the judge of safe staffing levels.

I gently say to the hon. Lady that we will not take any lessons in safe staffing from the party that left us with the tragedy of Mid Staffs. We have recruited 8,000 more nurses into our hospitals because we have learned the lessons of the Francis report. The important lesson in the report is that it is not simply about the number of nurses; it is about the culture in hospitals and making sure that nurses are supported to give the best care. We want to learn those lessons as well.

In reference to the “Five Year Forward View”, the Secretary of State talked about new modes of working. A very simple thing that could be done is for women’s smear test results to refer to the fact that it is not a test for ovarian cancer, and to then list the symptoms of that cancer. That would not cost any money, but it would save lives.

I am very happy to look into that. The general direction of travel my hon. Friend is talking about is right. We need to empower patients. We need patients to become expert patients, so that they take responsibility for their own healthcare. That means giving them much more information to help them to make the right decisions.

The Secretary of State is trying to avoid the question asked by my hon. Friend the Member for Wirral West (Margaret Greenwood). It was a key recommendation of the Francis review into Mid Staffs that safe staffing guidelines should be drawn up independently from Government and NHS managers to make sure people are confident that they are based on what is best for patients, not budgets. Why has he gone against Francis? What was wrong with what NICE was doing? He has published no new criteria for NHS England and no process or timetable for action. Will he now commit to doing that, so that patients, staff and Members of this House can be confident that this is not just a cover for cuts?

We will not take any lessons from the Labour party about what needs to be learned from Mid Staffs. Labour Members should be ashamed of the state of hospital care they left behind. There are 8,000 more nurses in our hospitals as a result of the changes that this Government have made. They should welcome that, not criticise it.

District General Hospitals

9. What recent discussions he has had with NHS England on the future of district general hospitals; and if he will make a statement. (900784)

The NHS was launched in a district general hospital. The continuing commitment of NHS England to DGHs is shown in their serial mentions in the “Five Year Forward View”. I recommend that the hon. Lady reads that to see the future for district general hospitals and the important role they will play.

I am grateful to the Minister for that answer, but it ignores the reality on the ground. In opposition, the Prime Minister promised a bare-knuckle fight to save district general hospitals. Since he came to power, Warrington has lost its vascular services and some of its spinal services, maternity services are under review, and a £15 million deficit threatens the future of the trust. Did that bare-knuckle fighter get knocked out, or did he not even bother to enter the ring?

I gently remind the hon. Lady that the difference is that changes to services provided at hospitals are now made on the recommendation of clinicians, rather than of bureaucrats and Ministers, as it was under the previous Government, in which she served. In respect of her own hospital, the number of diagnostic tests for cancer are up by 22,000 since 2010, the number of MRI scans by 6,000, the number of CT scans by 7,000 and the number of operations by 1,800. That is a record of which to be proud.

Wycombe hospital could benefit from one of the excellent models in the “Five Year Forward View”. Will my hon. Friend make sure these excellent proposals are carried through with energy and alacrity?

The strength of the NHS forward view is that it is a creation of the NHS itself, and we, as the only party to back it in full with cash, will give it the kind of support it needs to make sure it is delivered.

How many maternity wards or emergency surgery departments currently located in district general hospitals will close as a result of the Government’s seven-day NHS plans?

It is telling that the hon. Lady wishes to talk about wards rather than outcomes. Over the last five years, we have seen a significant increase in the number of patients treated in emergency wards, and we will continue to see an increase, and the difference is that they will operate seven days a week, rather than just five days a week, as is currently the case for many services across the NHS.

A&E: Dorset

11. Whether his Department has discussed with the Dorset clinical commissioning group the provision of accident and emergency services in Dorset; and if he will make a statement. (900786)

I understand that Dorset CCG is reviewing the provision of healthcare across the county under its clinical services review, and that includes emergency services. Obviously, any changes to services must be clinically led, in the best interests of patients and, certainly for acute services, in line with the principles of the Keogh review.

In that case, will my hon. Friend assure me that the Government do not support the CCG’s bizarre proposal to close 450 beds at the Royal Bournemouth hospital and force 40,000 in-patients each year to go to Poole general hospital?

I understand that the process is not even halfway through—the CCG’s plans are about to enter the consultation phase—and I would expect my hon. Friend, along with other Dorset MPs, to be engaged with that. I would be disappointed if they felt that they had not been so engaged. However, the House might be interested to know about just one of the proposed improvements. There is currently no 24/7 consultant cover anywhere in Dorset, and the proposed improvement plan aims to correct that.

NHS Funding

12. What changes in funding he plans to make to address the NHS funding shortfall forecast in NHS England’s most recent “Five Year Forward View”. (900787)

We have committed to providing additional funding to the NHS of at least £8 billion by 2020-21, over and above inflation. This is in line with the funding identified in the NHS England “Five Year Forward View” and in addition to the £2 billion extra for NHS front-line services this year.

With trust deficits reaching £822 million at the end of the last financial year, commissioners, chief executives and NHS professionals are saying that it is impossible to achieve £22 billion of efficiency savings without cutting services, staff numbers or staff pay or even stripping out the market. Which will the Secretary of State choose?

Of course, it will be very challenging to find those savings, but I gently remind the hon. Lady that Labour’s manifesto at the last election promised £5 billion a year less for the NHS than we promised, and that was because of our confidence in a strong economy, which is what the NHS needs.

The five-year forward plan will need to deal with the outstanding issue of the contaminated blood scandal, as a result of which one of my constituents suffered devastating consequences, including having to take the terrible decision to terminate their unborn child. When might we expect a statement and final resolution on this matter?

I thank my hon. Friend for raising this issue. It was a terrible tragedy—I had constituents who died—and I can confirm that we will be meeting the commitments made by the Prime Minister to bring forward a solution very shortly.

The House will have seen that the pitch is being carefully rolled by the Secretary of State today for future service closures around the country. Last week, a former care Minister was reported as saying that the £22 billion of efficiency savings the Government had signed up to were “virtually impossible” to achieve and that everyone knew it. Given that he is one of the few people to have seen the detail of the efficiency savings, this does not fill anybody with confidence. Will the Secretary of State now commit to publishing the details of the efficiency savings so that Members, the public at large, patient groups and medical professionals can have a proper and open debate about what it means?

We will of course publish how we are going to make these efficiency savings. We have already started with a crackdown on agency spend and a crackdown on consultancy spend, and with the work that Lord Carter, a Labour peer, has done to improve hospital procurement and rostering.

Let me gently say to the hon. Gentleman, however, that he went into the election promising £2.5 billion more for the NHS—£5.5 billion less than we did—and most of that was from the mansion tax that Labour now says was a bad idea. So there would have been nearly £8 billion more of efficiency savings under Labour’s plans than under this Government’s plans, and he should recognise the progress we are making.

Pregnant Women: Alcohol Consumption

13. What recent assessment he has made of the implications for his policies of guidance from the chief medical officer on the consumption of alcohol by pregnant women. (900788)

We know that too many women may be unaware of the health risks from drinking during pregnancy. The chief medical officer’s review of the alcohol guidelines—the hon. Gentleman knows, because we have spoken about it—includes consideration of the Government’s advice on drinking during pregnancy. The UK chief medical officers are meeting to discuss this in September, and we expect to consult on the new guidance in the autumn.

I thank the Minister for her answer and remind Members that 7,000 children are damaged every year from irreversible brain damage as a result of alcohol consumed by their mothers during pregnancy. I urge the Minister please to clear up the confusion in the advice available to pregnant women at the moment, which on the one hand says, “Do not drink at all”; and on the other hand says, “If you do drink, have only one or two units”.

The message is actually very clear, as we have labelling on over 90% of bottles. As the hon. Gentleman knows from the debates we have had on the subject, it is a difficult area and there is no consistent evidence of adverse effects from low to moderate pre-natal alcohol consumption. I have talked this through with the chief medical officer: we have to get the balance right between warning women and responding to the important stats the hon. Gentleman has mentioned, without causing unnecessary worry for the around 50% of women who do not plan their pregnancy and might have drunk alcohol before they realised they were pregnant.

Mental Health: Children and Young People

14. What steps the Government are taking to improve support for children and young people with mental health problems. (900789)

Improving children’s mental health services is one of my highest priorities. We want to achieve this by integrating mental health services for children and young people through a major transformation programme backed by additional funding; by expanding the children and young people’s access to psychological therapies; and by working with the Department for Education to develop single points of contact for mental health in schools.

I pay tribute to the West Sussex youth cabinet that is looking into the issue of mental health provision for young people. Why does the Minister believe this area has been chronically underfunded for so long, and will he give me an assurance that this will not be the case in the future?

I agree with my hon. Friend when he commends the involvement of young people in discussing their services. Only last week, the Under-Secretary of State for Education, my hon. Friend the Member for East Surrey (Mr Gyimah) and I attended a youth select committee organised by the British Youth Council to do something very similar.

There are two reasons why I think these services have not been so good in the past. First, there is the difficulty of collecting information and data; and, secondly, there is the complexity of financing for services. I hope that we will address both of those, and we will ensure that people know about this so that things do not slide back by being more transparent about both.

Topical Questions

The Government’s priority for the NHS this Parliament is to put Mid Staffs behind us by transforming the NHS into the safest healthcare system in the world, and in particular, through seven-day hospital care so that we end the tragedy of up to 6,000 lives lost because people do not have access to consultants or diagnostics at weekends. It means recognition that safer care costs less, not more, which is why we are cracking down on expensive agency staff who cannot give the continuity of care that is best for patients.

Almost two years ago, Lewisham took the Secretary of State to court over the closure of Lewisham A&E and maternity services—and won. In the light of the new report, “Our Healthier South East London”, can the Secretary of State promise me that any further shake-up of the NHS in south-east London will not involve the closure of services at Lewisham Hospital?

What I can assure the hon. Lady is that we inherited deep-seated problems in the old South London Healthcare Trust and we have dealt with them. We have more doctors and nurses looking after her constituents, and care is getting better as a result of the difficult decisions we have taken.

T2. Part of my constituency is served by Eastbourne District General Hospital, which is run by East Sussex Healthcare NHS Trust. The trust was recently deemed “inadequate” by the Care Quality Commission. Residents are obviously concerned, and both East Sussex County Council and Polegate Town Council have gone on record as saying that they have lost confidence in the hospital’s management. Will the Minister look into the matter urgently, in order to reassure my constituents? (900767)

My hon. Friend has been an extremely active champion of healthcare services for her local community, and I congratulate her on continuing to raise this matter. The CQC is due to publish the findings of its latest inspection of the NHS trust shortly, and we expect the trust to work closely with the regulators to deal with the concern that has been expressed. I know that there is concern locally, and I believe that Polegate Town Council will be discussing the matter soon.

We have heard a number of fair questions from Opposition Members, and, I am afraid, nothing but woeful and inadequate answers from Ministers so far. Let me try again by asking the Secretary of State about GPs. As we have already heard, before the election he promised that there would be an additional 5,000 GPs by 2020. However, now that the election is over, he says that that promise requires “some flexibility”, and he was similarly evasive in an earlier answer. Given that there is, in the words of the Government’s own taskforce, a “GP work force crisis”, will the Secretary of State now clear things up? By 2020, will there be 5,000 extra GPs—on today’s figures—as he promised, or is this yet another example of the Conservatives not being straight with people on the NHS?

I think that those were woeful and inadequate questions. What I said after the election was exactly the same as what I said before the election, which was that a number—[Interruption.] Yes, we will have about 5,000 more GPs by the end of the Parliament, which is just what I said before the election. I said that a total of 10,000 more people would be working in primary care. I also said before the election that the woeful problems in general practice would be dealt with only if we unpicked the terrible mistakes made by Labour in the GP contract. That is why this year we are bringing back named GPs for every single NHS patient.

T4. Does the Secretary of State accept the verdict of the Competition Commission, which decided recently that it would be against the interests of patients for Royal Bournemouth General Hospital and Poole Hospital to merge? The clinical commissioning group has responded by saying that one of the hospitals will have to give up all its services. (900769)

I think that we must respect the independent view of the Competition and Markets Authority, but I also think that there are lessons to be learned by the NHS more generally from the way in which that process was conducted. There will have to be changes on the ground if we are to give patients the care that they need in the very constrained financial circumstances in which we operate.

T3. In March this year I had a very useful meeting involving Devonshire Green & Hanover Medical Centres in my constituency and the then Under-Secretary of State, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), who recognised the threat posed to practices that serve patients with complex, demanding, and therefore costly needs by the withdrawal of the minimum practice income guarantee. The hon. Gentleman promised to follow up that meeting, but since then we have heard nothing. Will the Secretary of State guarantee that no practice will close as a result of the withdrawal of MPIG, and what will he do to ensure that that is the case? (900768)

The withdrawal of the minimum practice income guarantee was announced in 2013 because it was unfair. In fact, more practices will benefit from its removal than will lose from it. As for those that will lose, NHS England is already in contact with people about transitional care support. The practices that the hon. Gentleman mentioned have received some of that support, and I understand that the conversations are continuing.

T5. Following my fourth Adjournment debate on the future of Public Health England at Porton Down two weeks ago, I remain concerned about value for money for the taxpayer. Will the Minister confirm that she has assessed the full value of the life sciences work at Porton Down to the United Kingdom economy, and that she remains committed to maximising the site’s potential regardless of the outcome? (900770)

I congratulate my hon. Friend on securing so many Adjournment debates. Our most recent debate took place only a couple of weeks ago. He is right to continue to remind us of the contribution that the Porton Down site makes to the UK economy. I can assure him that the outline business case has been and is being scrutinised by Ministers, and that that includes an economic assessment. However, as I have said on previous occasions when we have debated the matter, Public Health England will remain committed to the site even if research staff are relocated.

T6. What concrete steps is the Secretary of State taking to increase the number of GPs and ensure my constituents can be seen by one when they need to be? (900771)

As has been discussed extensively during this Question Time, the Secretary of State has announced a programme that will include increasing the numbers training to be GPs, improving not only the recruitment but the retention of GPs, and work to make general practice more attractive to those who are worried about that. With all these measures, we will do our best to boost the position of general practice within an expanded primary care system in future, and I hope we can meet the concerns of the hon. Gentleman and his constituents.

T7. This is a request really: will the Secretary of State please meet me and GPs from the surgery in Cambourne—which we could call a new town—who are significantly underfunded? The funding model does not work for them; they are at breaking point, and they need your help. (900772)

I can confirm that the Minister for Community and Social Care will be delighted to meet my hon. Friend. NHS England is looking into how the fair funding formula works between different clinical commissioning groups, which is the reason for the uncertainty, and I, too, would be happy to meet my hon. Friend and confirm the process.

T8. Millions of people are worried about the privatisation of our national health service, so it is a real concern that the health sector remains part of the negotiations on the Transatlantic Trade and Investment Partnership. Tomorrow the European Parliament votes on TTIP, but the European Commission has already said it will not remove health from those negotiations, so can the Government confirm that they will defend the NHS and support the removal of health and other public services from future TTIP negotiations? (900773)

Really, the Labour party has got to stop this scaremongering that it did so much of, and to so little effect, at the election. Privatisation is not happening, but I will tell the hon. Gentleman what is happening: at his hospital, 85 more doctors in the last five years, 185 more nurses, 7,700 more operations, 20,000 more people being seen within four hours at A&E—progress in the NHS with a strong economy.

T10. The disparity in health funding allocations due to the imbalance in the system which favours deprivation over age has yet again been highlighted, this time by the British Medical Association’s annual meeting a couple of weeks ago. Having met the Secretary of State in the last Parliament, I know he is looking to address that. Will he update me and the House on this issue? (900775)

Yes, age and rurality come up quite regularly in discussions about funding for the contract. It can plainly be seen that there might be an increase in costs for rural areas, but it has been difficult for those involved in contract negotiations to pin it down to specific evidence. I assure my hon. Friend, however, that both age and rurality issues will remain very important for those deciding on the future contract and he can be sure that they will be taken into account.

T9. Given the proven link between poverty in childhood and ill health in adulthood, what advice has the Secretary of State given the Chancellor about not driving more children into poverty and ill health through cuts to tax credits? (900774)

We take the issue of childhood health extremely seriously. We want every child to have the best start in life. That is why, for example, we are bringing record numbers of health visitors into the health service and why health is now part of the troubled families programme. In my area of responsibility, public health, it is why we have taken measures on matters such as smoking that particularly affect children in deprived communities.

On adolescent mental care, capacity in my constituency can require lengthy in-patient care to be undertaken from Roehampton in south London. A constituent of mine makes regular visits to her young daughter making work impractical, but is unable to qualify for travel assistance as she is deemed physically able to work and does not qualify for benefits. As transport reimbursement is normally available only to those eligible for out-of-work benefits, will my right hon. Friend consider recommending widening the parameters to include those who have to travel outside their area?

I will look at the issue my hon. Friend raises. Clearly, in the first place, we want to make sure that more beds are available more locally, so that the issue does not arise. Greater concentration is being given not only to that, but to the level of care that can be provided before in-patient treatment is considered. I will take the point he makes about benefits and raise it with the relevant Department.

A recent study suggests that the NHS is starting diabetics on insulin much later than in other countries. What will the Department do to address that issue?

I thank the hon. Gentleman for his interest in this important subject. As he knows, we are looking at care right across the diabetes pathway, with a view to building on the first ever at-scale national diabetes prevention programme. I will take up the issue he raises and look at it in the context of all the other aspects of diabetes care we are examining.

Last week, Reeth medical centre in my constituency received an “outstanding” Care Quality Commission rating. Will my right hon. Friend join me in congratulating it and recognise that small practices in rural areas are still an important part of our healthcare system?

I am always ready and very willing to congratulate rural practices and general practices anywhere on the work done by our family doctors and those in primary care. It is so important and it is nice that they get a big boost and a thank you every now and again, which they do not get nearly often enough. My dad would be really pleased, thank you.

A large number of my constituents have advised me that they are unable to obtain a dental appointment and inquiries reveal that not a single dental practice in my constituency is accepting new NHS patients. Will the Minister meet me as soon as possible with a view to resolving that unacceptable situation?

I will indeed meet the hon. Lady. Access to NHS dental practices has been improving, but I am aware that there are some difficulties in some areas. The best thing we can do is meet and talk about it, and see what I can do.

In the last Parliament we made great strides using transparency to drive improvement in the quality of patient care. Does my right hon. Friend agree that we can and should go further, particularly on the transparency of performance in primary and community care?

My hon. Friend is absolutely right and has great experience in this area. We are now having a lot of transparency at an institutional level, but individual doctors and nurses in primary and secondary care are still finding it too hard to speak out if they have concerns. Getting that culture right has to be a big priority for this Parliament.

Thank you, Mr Speaker. On 22 June, the Life Sciences Minister said in a written answer:

“The decision on the interim funding of Vimizim…will be made by NHS England by the end of June 2015.”

The families involved, and also families affected by Duchenne muscular dystrophy and tuberous sclerosis, were then told that there would be a decision on 30 June and 1 July—

Order. The hon. Gentleman will resume his seat. It is a discourtesy to the House to be long-winded, especially when exhorted not to be. The hon. Gentleman has got—[Interruption.] Order. Do not argue the toss with the Chair, Mr Mulholland. Don’t shake your head, mate. I am telling you what the position is: you were too long. [Interruption.] Leave, that is fine—we can manage without you. [Interruption.] You were too long and you need to learn. That is the end of it. I call Mr Peter Bone.

They cause a lot of grief to many people, which is why we have issued new guidance that tells people to take particular trouble for people who have to visit hospitals on a regular basis.

Will the Secretary of State outline when compensation will be made available to those who were infected by contaminated blood products in the 1970s and 1980s?

The hon. Lady is right to draw attention to this tragedy, and we will be bringing our plans forward to the House shortly.

When will the Secretary of State be making a full statement in response to the Penrose inquiry into those affected by contaminated blood?

Only last week, I met the autism board in the Department of Health. There is a widespread piece of work being done to improve access to services involving those with autism. Just last week, I went to see Linden House, which is run by the National Autistic Society. The matter is very high on our agenda, and the hon. Gentleman was right to raise it.

Order. May I say thank you to colleagues? I am sorry but demand always exceeds supply—as it does in the health service—[Interruption.] Under any Government.

For the avoidance of doubt, I hope that colleagues will understand that I appreciate—I have been on those Benches—that all Members’ questions are important. Of course Members feel very strongly about them. I am sympathetic to that and I respect that, but people cannot simply take the attitude, “My question is important and therefore I can be much longer” because that is not fair on other Members. I am simply trying to be fair to all Members.

Bill Presented

Health Services Commissioning (Equality and Accountability) Bill

Presentation and First Reading (Standing Order No. 57)

Rehman Chishti, supported by Tom Brake, Yasmin Qureshi and Jeremy Lefroy, presented a Bill to make provision to reduce inequalities in the commissioning of health services for people with mental illness and learning disabilities; to require commissioners of health services for people with mental illness and learning disabilities to make an annual report to the Secretary of State on the equality of service provision to, and the health outcomes for, such people and of their qualitative experience of health care services; and for connected purposes.

Bill read the First time; to be read a Second time on Friday 11 September, and to be printed (Bill 49).

Football Governance (Supporters’ Participation)

Motion for leave to bring in a Bill (Standing Order No. 23)

I beg to move,

That leave be given to bring in a Bill to require football clubs to offer for sale to their supporters a specified percentage of shares in the club upon a change of ownership; to require that a minimum number of places on the club’s board be set aside for election by a qualifying supporters’ organisation; to define what constitutes a qualifying supporters’ organisation; and for connected purposes.

With my Bill today, I intend to begin the process of giving football fans their voice. From the very top of the game at FIFA and UEFA down to club boardrooms, fans have little representation. It is a sad fact that as football has become more and more of a global business, fans’ influence on their clubs and the governance of the game has become less and less. Many have talked about empowering fans, but when I have asked how that can be done, no one has had the answers. What do they mean when they say that they want to empower fans, to give them representation on club boards, or to give them the power to buy shares? I undertook to find out what was possible and whether that would fit with what the fans are asking for and meet EU competition rules.

I held a consultation with fans up and down the country, and I am grateful to the Football Supporters Federation and Supporters Direct for their help in communicating with fans’ groups. A total of 95 representatives of fans’ groups responded to my survey. One hundred per cent. responded positively to the question, “Should fans have more influence over the way their club is run?” Around 85% agreed that fans should be represented on club boards, and 97% said that supporters’ organisations were not given significant recognition by those involved in the governance of the game.

In July 2011, in its report on football governance, under the section headed, “A way forward for supporter ownership”, the Culture, Media and Sport Committee recommended that Ministers looked at two areas, the second of which was

“measures that increase the opportunity for supporters trusts to achieve a share in their clubs, whether on a minority or majority basis.”

In response, the Government said, in paragraph 40, that they urge

“the football authorities to consider ways to actively encourage and incentivise methods of including supporter representatives on the Boards of clubs.”

Under paragraph 67, they said:

“The Government is fully committed to ensuring that the changes put forward by the football authorities make a lasting and substantive difference. If that does not happen the Government will introduce a legal requirement on the Football Association to implement the appropriate governance clauses by the swiftest possible means. To do that the Government will seek to secure, using all available channels, appropriate legislation as soon as Parliamentary time allows. There is a strong case for such legislative proposals to be formally considered in pre-legislative scrutiny.”

On the issue of fan ownership, in the same response to the Select Committee, the Government said:

“The Government will consider bringing together an informal expert group to report on the degree to which there are other issues that create genuine barriers and to provide recommendations for practical action.”

That was in October 2011 and it was not until October 2014, six months before the general election, that the Government set up the expert working group. I am certain that the Government will say in response to my Bill that we should wait for the working group’s recommendations, but it took three years for the Government to set up the group and they did so knowing that there was no chance that they would have to respond to its conclusions before the general election. Until I am convinced that the Government intend to act, I shall proceed with my Bill.

The Bill seeks to do three things. The first is to give fans the power to buy up to 10% of shares that are offered for sale when there is a change of ownership, which is recognised as being when 30% of the shares are up for sale. The fans’ right to buy will not stop any transaction being completed and anyone purchasing shares will know that fans have the right to buy up to 10% of the shares purchased for up to 240 days after the transaction is completed. These will be bought at the average price paid by the buyer for the relevant securities in the year preceding the change of control. This automatic option will be capped once the fans have acquired 10% of club shares, but that would not prevent fans from buying more shares if they wanted.

In addition, fans will be given the right to elect and remove two representatives on the boards of clubs or 25% of the board membership, whichever is the greater number. Fan reps will have to undergo training to understand the sensitivities of their role as board members.

Finally, in order to take up these powers, a club’s fans must organise themselves into a single representative body. I would suggest the model of an industrial and provident society, but I appreciate that fans will want to be consulted on the best way forward. I will undertake to do that. There is no escaping the fact that there will be a requirement on fans to act collectively to set up a single democratic and accountable body for the election and scrutiny of board representatives and the management of shares. The Bill will set out what constitutes a viable fan body for this purpose.

We have talked around this issue for too long. Some have said that the people in the fan groups are not representative of ordinary fans, but they are the ones who helped me to consult the members of the fan trusts and fan clubs. They are the ones represented on the Government’s expert working group, whom the FA consult and who step in when an irresponsible owner has destroyed their club. We need only to think of Hereford, which has been resurrected by fans, of Portsmouth and Swansea, and the remarkable story of AFC Wimbledon. They all have one thing in common: football fans have had to step in and save their local club when the owners have destroyed it. As football fans, our passion for our clubs is lifelong. We do not change our clubs like we change the supermarket in which we shop.

We have seen how the game has become increasingly remote from the people who make it what it is today. Football fans create the atmosphere in the grounds and make our leagues so exciting to watch, which in turn makes money from the sale of the TV rights, yet on issues such as ticket prices, club names, sponsorship deals, stadium naming rights, club colours and moving clubs, they are too often an afterthought.

Our football clubs are not simply businesses. They exist because generation after generation of people from the communities in which they are situated have sustained their clubs through thick and thin. I do not present the Bill as a solution to all the problems, but giving fans a voice is a stepping stone to more accountability in the game. Fans are not the solution to every problem, but they can and will be the eyes and ears of an early warning system for emerging problems.

Today we take a step towards putting fans on club boards, but in time it will be the FA board and the boards of UEFA and FIFA. It is time to trust the people who make the game special—the fans, who will be there long after the owners have moved on.

Question put and agreed to.


That Clive Efford, Mr Gordon Marsden, Ian Lavery, Barbara Keeley, Daniel Zeichner, Matthew Pennycook, Jenny Chapman, Bill Esterson, Vicky Foxcroft, Anna Turley, Andy Slaughter and Jim Shannon present the Bill.

Clive Efford accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 4 December and to be printed (Bill 50).

English Votes on English Laws

Emergency debate (Standing Order No. 24)

I beg to move,

That this House has considered the means by which the Government seeks to deliver the objectives outlined by the Leader of the House in his Statement on English Votes on English Laws.

I am exceptionally grateful to you, Mr Speaker, and to hon. Members throughout the House for the support that they have given me in bringing this matter to the Floor of the House today. It is a matter that is genuinely urgent, given the timescale that has been presented to the House by the Government, although it need not necessarily have been so. The urgency is of the Government’s own making. The matter had been under consideration already and would benefit from further mature consideration.

I would have liked to put in to speak in this debate, but I have to return at 2 o’clock to Committee to consider the Education and Adoption Bill, which I believe I would be barred from participating in under the terms of the Government’s proposals. Does not the depth of the proposals mean that we should have proper, thorough parliamentary scrutiny of these matters, rather than the proposals being railroaded through in this unconstitutional manner?

I am not entirely sure whether the hon. Gentleman is right that he would be barred from that, certainly at this point, but I can see that that is the logic of where we eventually go, although I suspect that logic might be resisted by the Government and Opposition Whips Offices because I know from my own experience that getting people to serve on such Committees is not always easy. It will be interesting to see what influence the Government business managers bring to bear on that in the fullness of time.

Is there not a further reason why we would charge the Government with haste on this issue? Many of us on the Opposition Benches—a growing number, I hope—think the impact of the Scottish referendum will be to move this House to an English Parliament, with Parliaments in Scotland, Wales and Northern Ireland. That ought to be at least part of the discussion, rather than being excluded from the discussion, as the Government have done.

Rather than saying that that should be part of the discussion, I think it comes to the very heart of the discussion. I fully accept that the devolution process that was started in 1999 has created within the United Kingdom a number of anomalies. I entirely understand the concerns felt by right hon. and hon. Members representing constituencies in England, in particular. In order to address these anomalies, we need mature considered measures, instead of replacing the existing anomalies with further anomalies, as I very much fear the Government are about to do.

Surely it is true to say that discussions about future devolutionary change can go on. What is proposed is a change in the Standing Orders simply to give a veto to the representatives of the people affected. That does not lead to an English Parliament or to English initiative; it finally brings a little justice into the system. It is based on what we had in our manifesto, and it should be proceeded with quickly.

I am grateful to the hon. Gentleman for that intervention. Indeed, I suspect that I am more grateful than his colleagues on the Treasury Bench are, because he has nailed one point very early on: this does constitute a veto. As a federalist, I have no problem with vetoes, but if they are to be part of our parliamentary procedure we have to be prepared to have them going in different directions. The veto now being anticipated for English Members of Parliament would not be available to Scottish Members of Parliament, because they are governed by the Sewell convention and legislative consent measures. That is only the subject of a convention; it is not a veto. That is what I mean when I say that the Government, by bringing their proposal forward in this manner, risk creating further anomalies. The anomaly is one not of detail, but of fundamental constitutional principle. Were the House to bring together its collective mind, I do not doubt that we could eventually find a solution. Perhaps we would reach a compromise that was a little messy, but it is something we could reach. However, we are not going to reach that in the one day that will be offered to us to debate the changes to the Standing Orders.

Is the right hon. Gentleman not ignoring history? Scotland has had special arrangements in this House since the Victorian period. From 1948 Bills could be dealt with by the Scottish Grand Committee, and that was expanded in the 1990s, as he knows very well, and eventually Scotland ended up with its own Parliament. He cannot stop some change on the basis that it is not the final change.

I am by no means resistant to some change, and I will return to that point shortly. The hon. and learned Gentleman will be aware that the Scottish Grand Committee could debate Bills, but it could not vote on or amend them. That is how Grand Committees work. They are a perfectly sensible mechanism by which debate can be conducted by those who have the most direct interest, although they are perhaps a little redundant in this age of devolution, but they are by no means an attack on the fundamental principle that once we leave the Committee Rooms and enter this Chamber we are all equal and have the same right to participate in votes.

Does the right hon. Gentleman not accept that the biggest danger facing the Union is not Scottish nationalism, but English nationalism? If we fail to deal with English votes on English laws in a timely manner, as set out in our manifesto, which the people voted for, English nationalism will see off our Union.

I absolutely agree 100% with the hon. Gentleman. The threat comes from English nationalism. However—it pains me to say this—that English nationalism is to be found on the Treasury Bench. The Leader of the House, when he came to the Dispatch Box last week, took great pains to say that he was speaking as a Conservative and Unionist. I hate to say it, but he has brought forward something that no Unionist should. It is perfectly understandable for people in England to identify a national interest in response to a mood of Scottish nationalism forming north of the border, but the answer is not to meet it with more nationalism. The answer, I suggest, is a proper federal structure across the whole United Kingdom.

Mr Speaker, as an historian, you will know that the history of these islands is one of constitutional abnormalities. We are a nonsense, but somehow it works. It works because in this Chamber we are all equal, no matter where in the United Kingdom we come from. Therefore, to destroy that is nonsense.

This is where I will try to make some progress. I have been generous in taking interventions so far.

As I said yesterday, I want today’s debate to focus on the means by which the Government are seeking to achieve English votes for English laws, rather than the principle of English votes for English laws itself. As I have said, I am not without sympathy for the principle. I think that ultimately the solution will be for the people of England to decide what they want their constitutional future to be. Are they to have an English Parliament? If so, they should have an English Parliament, and this is the United Kingdom Parliament. Are they to have a network of regional Assemblies or something of that sort? That is a decision for the people of England, not something that we should seek to shoehorn into our Standing Orders.

My concern about what is proposed is that it is the most modest of proposals. It does not deal with the over-centralisation of power in Whitehall that blights people in England. It does not deal with the lack of proportionality. It does not deal with the fact that there is only one UK Independence party MP for 4 million votes. Those issues are also a democratic affront that require urgent consideration by those on the Treasury Bench, yet they do not seem to be attended to by the determination to introduce changes to the Standing Orders before the House rises for the summer recess.

What does the right hon. Gentleman say to my constituents who see the inherent unfairness of a situation in which he can vote on education matters affecting my constituency but I cannot vote on education matters affecting his? My constituents might quite rightly accuse him of wanting to have his porridge and eat it, and that is unfair to England.

Hopefully that is the last time I take an intervention intended for a local press release. Had the hon. Gentleman been listening, he would have heard me say a number of times already that I completely understand that point and am sympathetic to it. It is an issue that needs to be resolved by the people of England and for the people of England, but not by trashing the Union and the United Kingdom Parliament, of which we are all Members. I do not know what the ultimate solution will be, but I wish the people of England every bit as much joy in that debate as we in Scotland have had over the past 50 years. It is a debate that they must now have if we are to remain part of this family of nations.

Does the right hon. Gentleman agree that the Government, by ignoring Sir William McKay’s advice and proposing to give some MPs a veto, are creating a two-tier system of MPs and attempting to create a new Parliament by the backdoor?

I am afraid that is exactly what is happening. The Government are trying to create an English Parliament within the United Kingdom Parliament, instead of doing the long and difficult thing that we had to do in Scotland, Wales and Northern Ireland. It is a real threat to the United Kingdom if MPs from England regard this place as an English Parliament, rather than a United Kingdom Parliament. That used to be what it meant to be a Unionist. That is why I lay the charge at those on the Treasury Bench that they risk losing the right to call themselves Unionists.

I am going to make some progress, because the range of voices heard in this debate should be as wide as possible and I want to allow as many Members as possible to make speeches.

The Government brought forward a number of supporting papers with the Leader of the House’s statement last week. They are helpful, in as much as they give some detail on the proposals, but they give no indication of what they are seeking to achieve and where this will ultimately take us. The question of the double majority was raised earlier by the hon. Member for Beverley and Holderness (Graham Stuart). It does constitute a veto. If we are to have a double majority, that means, in effect, that we will have two tiers of MP. We cannot have a double majority without having two tiers of MP; it is illogical nonsense to insist otherwise. Once we have crossed that threshold—crossed the constitutional Rubicon—we have to wonder where it will ultimately take us.

Is it not the case that we already have a two-tier system of MPs in Parliament—[Hon. Members: “Hear, hear!”]—in that some Members who represent Northern Ireland constituencies refuse to take their seats and yet are paid allowances by this Government?

I do not think that is quite the kind of two-tier system that Conservative Members were cheering. The right hon. Gentleman is correct in his analysis. An appropriate change could be made to Standing Orders for that, because it is perfectly—

Forgive me—I really do need to make some progress, or nobody else is going to get to speak.

That would be an appropriate use of the way in which the Chamber responds to issues through Standing Orders. Matters of constitutional change, by convention—and rightly so—are taken on the Floor of this House at all stages, and likewise in the other place. They are given the fullest consideration because it is understood that they become exposed only with proper debate and scrutiny.

One of the novel aspects of the proposal that the Leader of the House laid before the House last week is the extension of these matters to Finance Bills. That opens up a whole range of questions that were not answered by him at the Dispatch Box or by the papers that he placed in the Vote Office. Finance Bills are, and have been for a long time, treated differently by this House. The fact that they are considered only by this House and not by the other place is the obvious difference, but there are also differences in the way in which they are introduced and considered in a mix of time spent here on the Floor of the House and in the Committee Room upstairs.

Are not Finance Bills a classic example of the way in which our unwritten constitution has developed? We trust Governments to be careful with it and to nurture it, whereas in this process we see a Government lighting the blue touch paper on the Union and not being careful with our unwritten constitution. Should not this House say, “Take care, take time, reflect”?

That is exactly what I hope this debate will achieve, because I know that the concerns about the constitutionality and the process of this are shared by right hon. and hon. Members on both sides of the House.

I am exceedingly grateful. The problem with the proposition that the right hon. Gentleman is putting forward is that it ignores the fact that there are already two classes of functions that were passed by the United Kingdom Parliament, which created not two tiers of membership in this House but two functions as between the Scottish Parliament, with its devolved functions, and those in the United Kingdom, which have been left swinging in the wind. Does he not accept that?

I do, but the hon. Gentleman must surely accept that what is being proposed through changing Standing Orders is not an appropriate way of addressing it. As I have already said times without number, I fully accept that several anomalies have been created by devolution, starting in 1999, but the answer to that is not to trash our own procedures in this House.

No; let me make a bit of progress because I want to stay on the question of Finance Bills.

Even with the measure of devolution of some taxes—I stress “some”—I would suggest that the setting of the Government budget as a whole is, again, treated differently from the passing of legislation in individual policy areas. Will the Leader of the House explain how his proposed new system is going to work for the consideration of estimates? For example, will estimates debates continue to be a vehicle for Select Committees, and how will that work when Select Committees draw their members from England, Wales and Northern Ireland, which will be the case in this Parliament, as we can see from the Order Papers for today and and tomorrow?

This goes to the point that the hon. Member for Cardiff West (Kevin Brennan) made about serving on Committees. I do not doubt that the Committee concerned, with good will, and perhaps even a measure of discussion among the usual channels, could deal with this, but the anomaly has been created and as yet the Government have no answer to it. Where is this going to take us in future? How are Members of Parliament from areas of the country that exercise devolved powers going to interact with Select Committees? If the principle of veto is to be accepted, and if members of the Health Committee or the Education Committee, for example, are to be drawn only from England and Wales, I very much look forward to seeing how the Government are going to set up the Scottish Affairs and Northern Ireland Affairs Committees—good luck to them on that one.

If the principle of the veto is to work, it has to work both ways. For the Scottish Parliament, that means the end of the Sewel convention and the end of the conventional sense—the classic sense—of parliamentary sovereignty as it has been understood in this Chamber in the past, because if we give a veto to the Scottish Parliament on legislative consent motions, then that is the end of Dicey’s classic definition of sovereignty. I am not too unhappy about that—I am quite relaxed about it—but if the House is to undertake something of this sort, surely it requires more than the debate that we are being offered.

I think that the right hon. Gentleman misses the key point about this being done through Standing Orders, which is that Standing Orders can be suspended by the House in a specific instance or permanently, and that therefore the sovereignty of this House remains unaffected.

No. If we are to take this to its logical conclusion—that is to say, to give a veto to the Scottish Parliament on areas that would currently be dealt with by the Sewel convention—then that will not be reclaimed by Standing Orders; it is the end of the supreme sovereignty of this House. That is why we need a sensible, more reasoned debate for which Standing Orders will always be inadequate.

No, I am sorry—I have been generous with my time.

The logic is that we should be considering this, if it is to be considered at all, by virtue of primary legislation. I know that that brings concerns particularly to those on the Treasury Bench, and that the Leader of the House will say that it raises questions of justiciability and reviewability of decisions that would ultimately have to be taken by you, Mr Speaker.

I am grateful. Is there not a clear distinction between two things? The first is whether this should be introduced by means of Standing Orders, and the second is what procedure, or method of reflection, the House may go through in deciding how and whether to adopt it, and under what circumstances. I thought that the right hon. Gentleman was drawing the House’s attention to the latter point and the apparent lack of a timetable for proper consultation on this issue.

The two propositions are not mutually exclusive. There are elements that could be capable of remedy through Standing Orders if we were to have a proper debate. The Government’s proposal goes too far, too fast. In principle, other changes may be possible, as we discussed in government before the general election. I do not completely exclude the possibility of proceeding in that way, but going as far as the Government want to us to go, and within their timescale, brings with it an attendant level of risk that I would consider to be irresponsible in these circumstances.

The last Government discussed whether the proposal could be addressed in a single Bill. If there is a will in the House to consider how it could be done, that would be a much more sensible way of doing it. The Government are saying that we should do it for a year and that it should then be reviewed by the Procedure Committee. I hold that Committee in very high esteem, but the only thing that would happen under that process is an examination of how the system had worked. It would not put a dangerous genie back in the bottle after it had been let out. I think we all know that that is the political reality.

Personally, I am quite relaxed about the use of primary legislation and the justiciability of decisions then made by Mr Speaker. I do not think that anybody in this House should be making any decision that would not stand up to judicial scrutiny. However, if that is to be the block, let us have a proper debate, because it must be possible to use primary legislation to deal with that very point. Surely it is necessary to have a proper description of the boundaries of judicial review and any proscriptions. Frankly, this House has never undertaken such an exercise. Judicial review as a body of law has been allowed to grow like Topsy, led by the judiciary itself.

I am aware that I have already taken up quite a lot of time, albeit with interventions.

Does not the presence of so many Tory Members—they are considerably greater in number today than they have been for sittings on the Scotland Bill—and the amount of animated interventions they are making indicate the need for a very full and proper debate?

I believe so. It also highlights the need for a debate that goes well beyond the walls of this Chamber. The debate needs to be conducted throughout the country and to take in not just the political parties, but the Churches, the trade unions and civic England in the widest possible sense.

No, I will not give way.

That was how we built the consensus in Scotland that then led to the creation of a Scottish Parliament. Ultimately, that is what the people of England are going to have to do. They are not entitled to use the United Kingdom Parliament as a proxy for an English Parliament.

That brings me to my final point. In Scotland last year we went through a painful process that ultimately led to the people of Scotland deciding to remain part of this United Kingdom. We did it on the basis that we are all equal participants in this Union. I made those arguments in good faith and I believed at the time that the Conservatives did so, too. It is difficult for them to sustain that proposition if they insist on proceeding in this way.

I am pleased to have a further opportunity to set out the Government’s plans for strengthening the Union by providing fairness for England.

At the centre of the plans I announced last Thursday is the concept of fairness for all four countries of our United Kingdom. Fairness requires that further devolution of powers to Scotland and Wales be accompanied by a louder voice for England at Westminster on English matters. If we are devolving tax rates to other countries of the United Kingdom—the House is currently legislating to do so—it is only fair that Members of Parliament in those constituencies affected by that change have the decisive say over any tax rates that apply in their constituencies. If Members of the Scottish Parliament are in future to decide a Scottish rate of income tax, is it actually unfair that English Members of Parliament, or English and Welsh MPs, or English, Welsh and Northern Irish MPs, have the decisive say over tax rates that affect their constituencies?

Will the Leader of the House tell us, then, whether it is now Government policy to end the Sewel convention on legislative consent motions and to give the Scottish Parliament a veto when it does not consent?

Not at this moment, no. We have an established method of using legislative consent motions. It is not unreasonable that we should use that same device in this House when an English-only matter affects English-only constituencies. Why does the right hon. Gentleman think that he should resist the idea of a legislative consent motion approved by English Members of Parliament on matters that affect only their constituencies?

May I take the Leader of the House back to January 2004, when Tony Blair’s Government were proposing top-up fees for English students? At the time, I was lobbied by the then Conservative Opposition and by Labour rebels, who told me that the Scottish National party should vote against that proposal on the basis that top-up fees for English students would have a knock-on effect on Scotland through the Barnett formula. Why has the Conservative party changed its mind? If these proposals go through, would I be in a position to exercise a vote on such a measure in the future?

Let me take that example and the question raised by the right hon. Member for Orkney and Shetland (Mr Carmichael) about estimates. It is not our intention that estimates be voted on by individual groups of Members. They are, and will continue to be, a matter for the United Kingdom Parliament. On the question of tuition fees, what the right hon. Member for Gordon (Alex Salmond) must understand is that one of the things that was not understood by those in England who were affected by that change—which, if I recall correctly, was carried by a majority of five—is that, although English MPs voted against it, it was only as a result of the votes of Scottish MPs that it was carried, but it did not apply to students in Scotland. That is a very simple example. If a measure is to be applied to a group of people in England and not in Scotland, is it really unreasonable to suggest that English Members of Parliament should have the decisive say over that change?

Is the Leader of the House not acting a bit like a male rights activist who thinks that when females get extra rights there is a zero-sum game that takes rights away from him? If Wales passes a law to give more education rights, that has no impact on England, but if a health law is passed in England it has a Barnett consequential for Wales. There is an asymmetry and it is wrong for the right hon. Gentleman to plod forward and demand these rights when this is not a zero-sum game.

That was a very strange analogy. I remind the hon. Gentleman that he can vote on education in my constituency but not in his own constituency. Surely, if anything creates an anomaly, it is that.

Could my right hon. Friend tell me how it can possibly be right that I as a Welsh MP should be able to tell his constituents how to run their education and health service, or even why I should want to spend my time doing so? We have a Welsh Assembly and a Scottish Parliament, so is it not absolutely right that English constituents should have exactly the same right to self-determination?

My hon. Friend is absolutely right. We have all lived with this situation for 20 years. The difference now is that we are legislating again: first for Scotland, to give significantly more powers to the Scottish Parliament, and later in this Session we shall legislate for Wales, to give significant additional powers to the Welsh Assembly. It is surely therefore right that, as part of our desire to protect our Union, we make sure that any resentment in England about the fact that those powers are not replicated there is addressed to the maximum degree.

Last night we discussed Scottish laws and whether they and Scottish powers should preside at Westminster or Holyrood. Ninety five per cent. of Scottish MPs in the House of Commons, as well as the Scottish Government and the Scottish Parliament, want those powers to be moved to Scotland, but 500 Labour and Tory MPs who are not from Scotland walked through the Lobby and applied a veto. Why does Scotland not have a veto when the Leader of the House wants an English veto?

There are two parts to the answer. The first is that in the referendum last year the Scottish people voted to protect the Union. At the same time, we offered them a raft of additional powers for the Scottish Parliament that will enable it to take a far broader range of decisions than it could in the past. That is the difference. If we are to make that change, we must in my view address the issues raised by constituents in England who ask, “What about us?”

Does the Leader of the House not understand from this very intense debate that what he is doing is ill-prepared? If we had proper legislation, we could have pre-legislative scrutiny, consult the public and get academic experts in, but he is denying the House a full look at all the implications.