House of Commons
Tuesday 9 February 2016
The House met at half-past Eleven o’clock
[Mr Speaker in the Chair]
Oral Answers to Questions
The Secretary of State was asked—
Public Health Grants
The local authority public health grant is ring-fenced and must be spent in line with published grant conditions set by the Government. Local authority chief executives and directors of public health are required to certify that grant spend is in line with these conditions. In addition, Public Health England further reviews spending information and local authority spend against the grant is subject to external audit.
In 2014-15, my city of Plymouth received £47 per head. Portsmouth, which is statistically healthier, received £77 and Kensington and Chelsea got £136. I absolutely understand that this is a legacy issue with the funding formula, and the Government are committed to dealing with it, but I cannot stress enough how important it is that we speed this up. How does the Department plan to achieve this? The current situation is grossly unfair to my constituents.
I applaud my hon. Friend for being a champion of public health in his community. We have had several conversations on this issue. As he says, there are historical differences, of which I am conscious, in the levels of local public health spending. They mostly arise from historical primary care trust spending priorities. We have made some progress in addressing the matter, but, as regards future allocations, we are considering a full range of factors, including the impact on inequalities and existing services. Those will be announced shortly. As I have told him before, the chief executive of Public Health England is happy to talk to him about the specific challenges facing his community, and that offer remains open.
The NHS “Five Year Forward View” states that
“the future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health.”
How will the in-year cuts this year and the future 4% real cuts in public health help to achieve that objective?
The challenge of being serious about prevention is one for the entire health and social care system. We acknowledge that, like many parts of government, public health grants have had to absorb some of the fiscal challenge. We are dealing with the problems we inherited at the beginning of the coalition Government. Despite that, local authorities will receive £16 billion in public health grants alone over the spending review period, but that is not the only way we invest in prevention. On my many visits, I have seen some of the great work being done to work with local authorities, and I am confident of the great things they can do with that money.
19. Given the report by the Crisp commission, released in the last few days, on mental health provision and treatments, can the Minister provide any assurance about the equitable treatment of physical and mental health to ensure an equal allocation of funds? (903552)
There is rightly a great deal of attention on this area—more tier 4 beds have been commissioned, for example—but I want to stress what is being done in my area of public health. Right at the heart of our new tobacco strategy, which we are beginning to work on, is a concern for the inequity facing people suffering from mental ill health in terms of smoking levels. I can reassure the hon. Lady that across the piece we are considering how we can do more for those who suffer with mental health problems.
Access to contraception is not only a fundamental right but a cost-effective public health intervention—every £1 spent on contraception saves the NHS £11—yet the Government are presiding over savage cuts to public health services. It is predicted that £40 million will be cut from sexual health services this financial year alone. Is that what the Minister means when she says the Government are serious about prevention? Why does she not finally admit that these cuts not only make no financial sense but could put the nation’s health at risk?
I reject that analysis. It is for local authorities to take decisions on local public health spending, but they are mandated by legislation to commission open-access sexual health services that meet the needs of their local population, and in fact there is a great deal of innovation around the country in how people are doing that. For example, in Leeds, they are redesigning services to enable people to access sexual health. [Interruption.] The shadow Minister laughs, but the question of how much they would have invested in the NHS goes unanswered by the Opposition—a question that was never answered at the general election. On prevention, as I have said, the public health grant is not everything. In the next financial year alone, for example, the Department will spend £320 million on vaccines. We have introduced two world firsts: the child flu programme and the meningitis B immunisation programme. Right across the piece, this Government are investing in prevention and in our NHS.
Hospital Trusts: Special Measures
Eleven out of 27 hospitals have now exited special measures, having demonstrated sustainable improvements in the quality of care. Overall, trusts put into special measures have recruited 1,389 more doctors and 4,402 more nurses, with one estimate saying this has reduced mortality rates by 450 lives a year.
Following the recent Care Quality Commission report on the Medway hospital, the staff and new chief executive are working hard to turn around long, historic and deep problems. What further support can the Secretary of State and the Government offer the hospital to help turn it around and get it out of special measures? I thank the Secretary of State and his Department for the support they have given to the hospital so far.
I thank my hon. Friend for his enormous support for that hospital, which has been through a very difficult patch. I had a long meeting with the chief inspector of hospitals about the Medway yesterday. My hon. Friend will be pleased to know that, over the past five years, we got 106 more doctors and 26 more nurses into the trust. We now have a link with Guy’s and St Thomas’s that is beginning to bear fruit. There is a lot more to do, but we are determined to ensure that we do not sweep these problems under the carpet and that we deal with them quickly and deliver safer care for my hon. Friend’s constituents.
My right hon. Friend will know of some of the terrible problems experienced in Shropshire with respect to clinical commissioning groups and the trust, particularly over the future fit programme and A&E services in the county. The Royal Shrewsbury hospital covers a huge area—not just Shropshire, but the whole of mid-Wales. Will my right hon. Friend give me an assurance that he will do everything possible to support me and the residents of Shrewsbury to guarantee that A&E services remain at the Royal Shrewsbury hospital?
First, I thank my hon. Friend for his campaigning on behalf of the Royal Shrewsbury; no one could do more than he has over many years. I encourage him to engage carefully with the future fit programme. In the end, it is incredibly important to get the right answer for patients. My hon. Friend has been supportive of the process, but like him, I would like to see it concluded sooner rather than later.
The advantage of the special measures programme is that we tend to make much faster progress in turning round hospitals in difficulty than used to happen in previous years. My hon. Friend will know that, in the past five years, his local trust gained nearly 50 more doctors and more than 100 more nurses. We are making progress, but we need to do it much faster. The hospital will have my full support in getting these problems dealt with quickly.
Walsall NHS trust has been placed into special measures, so what immediate action can the Secretary of State take to ensure that the Manor hospital can recruit the vital staff in paediatrics and A&E that it now needs—not agency staff, but long-term fully employed staff?
The hon. Lady is absolutely right that one thing that can tip hospitals into special measures is having too high a proportion of staff from agencies so that a trust cannot offer the continuity of care that other trusts can. There have been an extra 83 full-time doctors at Walsall Healthcare NHS Trust over the past five years, along with 422 full-time nurses. An improvement director started this week and we are looking to find a buddy hospital, which is what I think will help most. When it comes to turning hospitals round the fastest, we have found that having a partner hospital can have the biggest effect, as with Guy’s and St Thomas’s for the Medway.
Despite having a football team at the top of the premier league, the hospitals of Leicester are in need of urgent assistance. The worry for Leicester is that they will slip into special measures, particularly regarding A&E. What steps can the right hon. Gentleman take to ensure that our hospitals perform as well as Leicester City football club?
We want to them to be as outstanding as Leicester City football club, but we recognise that there is some way to go. There is pressure on A&E departments, as the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), has acknowledged in the House, and we are giving careful thought to what we can do to support them. Leicester will be one of the first trusts in the country to offer full seven-day services from March or April 2017 onwards, so important improvements are being made, but we will do all that we can to ensure that they happen quickly.
Calderdale and Huddersfield trust is not in special measures, but it is in trouble, and we are likely to lose our A&E service—in one of the biggest towns in Britain—if we follow the recommendations of the CCG. Does the Secretary of State agree that when hospitals and trusts get into trouble, it is usually because of poor management? What can we do to improve the management of hospitals, and, in particular, what can we do about people who, because they are GPs, think that they are managers?
The hon. Gentleman has made an important point. I think that there are some things that we just need to do differently. For instance, we should allow managers to remain in their posts for longer. If the average tenure of NHS chief executives is only about two years, their horizons will inevitably be very short-term, so we need to give them enough time to turn their organisations around. The chief executive of the latest trust to be given an “outstanding” measure, Frimley Park Hospital NHS Foundation Trust, has been there for 26 years, and I think there is a connection. We can ensure that managers have the necessary resources. I think we can also make sure that we identify their problems quickly, and give them support before those problems turn into a crisis.
Barking, Havering and Redbridge University Hospitals NHS Trust is working extremely hard to improve its services and has already achieved considerable success, but although there are 250 spare home beds in the London borough of Havering, there are still a great many frail elderly patients in hospital who are no longer clinically ill. Has any research been done on the reasons for delayed discharge, and to what extent does patient choice play a part in it?
Unfortunately, it sometimes plays a part, but the main way to tackle the problem is to establish better co-ordination between what local authorities do, what the CCGs do and what the trusts do. That applies not just to my hon. Friend’s local trust, but to trusts throughout the NHS. I do, however, commend her local trust. At its last inspection, the CQC found that it had made significant progress. It has more doctors, more nurses and, in my view, an excellent chief executive, and I am very confident about its future.
Sixteen trusts across the country are currently in special measures, nine out of 10 hospitals are failing to fulfil their own safe staffing plans and waiting time targets are being missed so often that failure is becoming the norm. Does the Secretary of State think that that might explain why, as we learned yesterday, a King’s Fund survey has found that dissatisfaction with the NHS increased by eight percentage points in 2015? That is the largest single-year increase since the surveys began in 1983.
The hon. Lady might want to look more closely at that King’s Fund report before turning it into a political football. According to page 6, satisfaction rates in Wales—run by her party—are six percentage points lower than those in England.
Let me tell the hon. Lady exactly what is happening with the special measures regime. We are being honest about the problems and sorting them out, rather than sweeping them under the carpet, which is what caused the problems that we experienced with Mid Staffs, Morecambe Bay and a range of other hospitals. At the same time, we are putting more money into the NHS and helping it to deal with its deficits, we are treating more people, and public confidence in the safety and dignity of the care that people are given is at record levels.
It is clear that the Secretary of State does not want to talk about his record in England. His own Back Benchers are queueing up to tell him about the problems in their NHS areas of Medway, Shropshire and Worcestershire, but he seems not to understand the extent of those problems.
Let us return to what the public think. Satisfaction with the NHS has fallen by five percentage points; dissatisfaction has risen by eight percentage points; satisfaction with GP services is at the lowest rate ever recorded; and satisfaction with A&E stands at just 53%. We know that the Secretary of State has lost the confidence of doctors, but is that not the clearest sign yet that he has lost the confidence of patients, too?
What my Back Benches are queueing up to say is, “Thank you for sorting out the problems that Labour swept under the carpet for years and years.” What did Professor Brian Jarman of Imperial College say about the Department of Health under the last Labour Government? He said that it was a “denial machine”, with all the problems in hospitals being swept under the carpet and not dealt with. What is happening under this Government? Every day, 100 more people are being treated for cancer, 2,000 more people are being seen within four hours at A&E departments and 4,400 more operations are being carried out. There are record numbers of doctors and nurses, and the NHS is safer than ever in its history. We are proud to be the party of the NHS.
The results of the last GP patient survey show that 91.9% of all patients get convenient appointments. Of the 8% who are unable to get an appointment or a convenient appointment, 4.2% indicated that they went to A&E.
The same survey indicates that one in four people are now waiting more than a week to see their GP, and a staggering 1 million people are heading off to A&E because they cannot get an appointment with their GP. It is a total meltdown. What is the Minister doing about it?
There are 40 million more appointments available for GPs than in the past. The Government have made a commitment to transform GP access, and £175 million has been invested to test improved and innovative access to GP services. There are 57 schemes involving 2,500 practices, and by March next year more than 18 million patients—a third of the population—will have benefited from improved access and transformed service at local level. That is what we are doing about it.[Official Report, 22 February 2016, Vol. 606, c. 2MC.]
The Minister will be aware that, despite great improvements in cancer care under this Government and the previous Government, one in five cancer patients—more than 20%—are first diagnosed as late as when they go to A&E. The Government rightly focus on one-year survival rates as a means of driving forward earlier diagnosis. Can he give me an assurance that that will remain a key focus?
My hon. Friend raises a serious issue. Pursuing the earliest diagnosis of cancer is very important to the Government; it is obviously also important to all patients. We are going to publish the statistics on early detection through the clinical commissioning groups to improve transparency still further, because as this Government have shown, transparency often drives improvement in performance.
24. Can the Minister tell me how the Government are urgently going to tackle safety of care at the North Middlesex hospital A&E department, following revelations last week that a patient died at the hospital in December 2015 after being forced to wait an unacceptable time in A&E? The department has also received a notification of risk. (903557)
The hon. Lady gives an example of why it is so important to continue to seek to improve the quality of care in A&E and why it is so important to keep transparency going. This is one of the reasons that we have a new inspection regime, which has been designed to highlight these things, but the introduction of 1,250 new doctors in accident and emergency departments over the past five years will also make a difference to the improvement in quality of care. However, she is right to highlight this matter. The NHS does not do everything right, but what is important is that we value what is done with the vast majority of stuff and that, when things do go wrong, we say so, we examine them and we learn lessons.
According to information that I have received, 16 of the 25 ambulances on duty in Leicestershire one evening before Christmas were queueing outside Leicester royal infirmary to discharge patients. I have written to my right hon. Friend the Secretary of State about this issue. Please will the Minister update me and the House on the steps he thinks we should be taking?
The issue with ambulances and with quality of care elsewhere is the variation in quality. It is so important to ensure that local leadership addresses those local problems, because they are handled very differently in different places. It is right for my hon. Friend to raise this matter, and I am sure he has raised it with his local ambulance trust, as well as the hospital, to see how there can be better facilitation of patients going in and being discharged so that ambulances need not queue.
The Health and Social Care Information Centre has shown that last year 124,000 patients waited more than 12 hours after arrival at accident and emergency, which compares with a figure of 1,700 in Scotland, and the number has doubled since 2013. The Royal College of Emergency Medicine has explained that these tend to be the sickest patients and that this delay is associated with increased mortality, so how do the Minister and the Secretary of State plan to improve that performance?
I have to tell the hon. Lady that patient satisfaction with A&E was rather lower in Scotland than it is in England, which indicates that we all have problems to deal with in this area. It is correct that we continue our progress both to increase resources throughout the health service and to A&E, and to improve transparency and people’s ability to see what is going on. Unacceptable waits are not part of what we all want to see from the NHS, which is why we are determined to drive them down. Patients in England will have the best information anywhere in the world about what is happening in their NHS, as we continue to drive efficiency and improvement.
Patients will not have the information about the four-hour waits, as that has not been published since November. The doctors required to look after these people are A&E specialists. There is already a major problem in retaining A&E trainees because they work a higher proportion of unsocial hours. These are exactly the hours that will be less rewarded in the new contract, so how does the Secretary of State plan to recruit and retain doctors in emergency medicine in the future?
There have been 500 more consultants in A&E medicine since 2010. The new contract is under negotiation at the moment and the majority of it has been agreed with junior doctors. It is designed to replace the failures in the old contract, which everyone knew needed to be corrected, and it provides the basis for the profession for the future to deal with some of the issues the hon. Lady mentions. All of us are concerned to ensure that the negotiations continue and that there should be no strike tomorrow, so that this pattern for the future, which is wanted by doctors and patients alike, as well as by the Government, gets a chance to work.
Independent Healthcare Commission: North-West London
It might assist the House if I were just to mention that this commission was commissioned by five Labour councils and was chaired by Michael Mansfield, QC. On the assessment of the commission’s findings, I can put it no better than the lead medical director for the “Shaping a Healthier Future” project, who said:
“The unanimous conclusion of the board’s clinicians was that the report offered no substantive evidence or credible alternative to consider that would lead to better outcomes for patients…above the existing plans in place”.
I concur with that judgment.
Last July, the Minister held a constructive meeting with west London MPs and agreed that information on the review of our hospital services would be shared. We understand that a plan B is being considered that will still move hospital services from Charing Cross and Ealing but, because of rising costs, will retain and mothball existing buildings rather than redeveloping the sites. Can we see the current plans?
The hon. Gentleman rightly says that we had a constructive meeting but, as with everything in this area, it is time to move on. There is a grave danger of him appearing to be like one of those soldiers discovered on a Pacific island after the second world war still fighting the old war. Part of the reason for cost escalation in NHS projects is the constant challenge and delay, and “Shaping a Healthier Future” has complete clinical consensus across north-west London. The clinicians say that this
“will save many lives each year”.
It is time to get on with this project.
The report heavily features Ealing hospital, where the radiographer Sharmila Chowdhury blew the whistle on consultants taking bungs—extra payments. She is now jobless and, as a widow with a mortgage, soon to be homeless. Will the Minister urgently look into her case, because despite a plethora of reports—this one and the Francis review—this Government do not seem to be doing anything for her?
I do not think that is fair. In fact, my right hon. Friend the Secretary of State of State has met the clinician in question, and the Francis review recommendations, as we have adopted them, make it quite clear that staff have a right to speak out. Of course we want everyone to speak out on behalf of patient safety.
Hospital Trusts: Deficits
Trusts reported a net deficit of £1.6 billion for the first half of this financial year, with 75% of trusts reporting a deficit, which is why, last week, we launched the Carter efficiency programme in which Lord Carter confirmed that hospitals can save £5 billion annually by making sensible improvements to procurement and staff rostering.
Almost every acute trust will be in deficit in the coming year, including Warrington and Halton Hospitals NHS Foundation Trust and Whiston and St Helens hospitals, which cover my constituency. The fact is that the Government have been slow in dealing with one of the causes of the deficit, which is the employment of great numbers of agency staff. They also want to cut the tariff, which is based on efficiency savings, leaving hospitals such as Whiston and St Helens, which are among the most efficient in the country, struggling to make greater efficiencies. Will the Secretary of State look at that matter again?
The hon. Gentleman should give a slightly more complete picture of what is happening in his hospitals. There are nearly 2,000 more operations every year, 7,000 more MRI scans, and 7,000 more CT scans than there were five years ago. When it comes to the issue of deficits, we are tackling the agency staff issue. That happened because trusts were responding to the Francis report into what happened in Mid Staffs. Rightly, they wanted to staff up quickly, but it needs to be done on a sustainable basis. I simply say to him that if we were putting £5.5 billion less into the NHS every year, as he stood for at the previous election, the problems would be a whole lot worse.
Does my right hon. Friend not agree that running costs in the NHS, which vary from £105 to £970 per square metre per year as highlighted by Lord Carter, are wholly unacceptable, and that the concept of a model hospital to bring the worst up to the standard of the best, which was also highlighted by Lord Carter, has great merit?
My hon. Friend knows about these things from his own clinical background, and he is absolutely right. We are now doing something—it is probably the most ambitious programme anywhere in the world—to identify the costs that hospitals are paying. From April, we will be collecting the costs for the 100 most used products in the NHS for every hospital. That information will be shared. We are the biggest purchaser of healthcare equipment in the world, so we should be paying the lowest prices.
Barts Health NHS Trust, the UK’s largest hospital trust, is set to run up a £135 million deficit this year. That would be by far the greatest ever overspend in the history of the NHS. When will the Minister accept the sheer scale of the austerity-driven crisis facing the NHS?
It is stretching things a bit to call that an austerity-driven problem when, next year, we are putting in the sixth biggest increase in funding for the NHS in its entire 70-year history. There are some severe problems at Barts, but we will tackle the deficit. We also need to ensure that we improve patient safety and patient care.
The staff of the University Hospitals of North Midlands to whom my right hon. Friend entrusted the care of County Hospital in Stafford and the Royal Stoke University Hospital have done a great job both in improving the quality of care and in bringing down the deficit. Will he ensure that a long-term approach is taken to the finances of that trust so that we do not make rapid decisions that could result in difficult situations in the future?
As ever, my hon. Friend speaks very wisely. When we are reducing these deficits and costs, the trick is to take a strategic approach and not to make short-term sacrifices that harm patients. That is why, at the weekend, we announced a £4.2 billion IT investment programme, which will mean that doctors and nurses spend less time filling out forms and more time with their patients.
By 2020, everyone will be able to get GP appointments at evenings and weekends. By March this year, a third of the country—18 million people—will have benefited from improved access to GP services.
There is a concerning recruitment issue for GPs in my constituency, Eastleigh, which has led to patients experiencing significant delays in getting non-urgent appointments. Will my right hon. Friend look into promoting more agile working structures for GPs, especially women? This was highlighted by my CCG on Friday as vital for recruiting and retaining the extra GPs we need.
I know that West Hampshire CCG is providing extra space and capacity to take on more trainees, and across the country we plan to have 5,000 more doctors working in general practice by the end of this Parliament. This will be the biggest increase in GPs in the history of the NHS. It builds on the extra 1,700 GPs we have working in the NHS since 2010. It does take too long to get to see a GP. We are committed to sorting that out, and the record investment in the NHS five year forward view will make that possible.
Wyken medical centre in my constituency is due to close in March. This will leave more than 2,000 of my constituents needing to find a new GP, at a time when it is practically impossible to get a prompt GP appointment, never mind register at a new GP surgery. Can the Secretary of State therefore assure me that he will co-ordinate with NHS England to ensure that it manages the situation appropriately and does all it can to assist each of my constituents affected, particularly the vulnerable and elderly, to get access to a new GP as soon as possible?
I am happy to do that. The hon. Lady is right to make those points. It is to care for the vulnerable people with long-term conditions that we need to see the biggest support given to GPs, because strengthening their ability to look after people proactively will mean that those people are kept out of hospital and kept healthier, and costs are kept down for the NHS.
In Rochester, we are facing the closure of two single-handed GP practices owing to a retirement and a suspension, with no long-term replacements, making it more difficult for our growing population to access these vital services. Will my right hon. Friend outline the steps he is taking to maintain appropriate access to local GPs?
I am absolutely prepared to do that and I have met a number of GPs in my hon. Friend’s area. We are reversing the historic underfunding for general practice, with an increase of more than 4% a year in funding for primary care and general practice for the rest of this Parliament. That will give hope to the profession, whose members are vital to the NHS.
Northern Ireland has the lowest number of GPs per capita across the United Kingdom. In order to access GPs, we need to have GPs. In the whole of the United Kingdom of Great Britain and Northern Ireland 25% of GPs are aged over 55, and that is going to get worse. What steps have been taken to train more GPs and to ensure that they stay in the NHS and do not go overseas, where there are better wages and conditions?
We have plans, as I mentioned, to have 5,000 more doctors working in general practice, and there is a big interviewing process. We need to increase the number of GPs going into general practice by 3,250 every year and I am happy to liaise with the Province to see how we can work together on these plans.
Care Outside Hospitals
I join you, Mr Speaker, in offering the Government’s congratulations to my hon. Friend the Member for Louth and Horncastle (Victoria Atkins) on her extraordinary success.
Tackling the long neglected integration of health and social care is a major priority for this Government. It is crucial to avoiding unnecessary hospital admissions, providing better care outcomes for the elderly and easing the pressure on our health economy from an ageing population. That is why we have set up the better care fund, providing funding of £3.9 billion—£5.3 billion if we include local funding; why my right hon. Friend the Chancellor has announced the social care precept, which will raise £2 billion; and why we have fully funded the NHS five year forward view integrated care pioneers and new models of care in 95 sites. That is more than Labour promised or ever did in its term of office.
Thank you for calling me, Mr. Speaker. I must mention the team ably led by the hon. Member for Ealing North (Stephen Pound) and of course the hon. Member for Heywood and Middleton (Liz McInnes).
In areas with a high proportion of older residents, home aids and adaptations can help people live longer in their homes, which benefits them and can also help to ease pressure on the NHS and social care services. What steps are the Government taking to boost such support?
My hon. Friend makes an excellent point. The disabled facilities grant is our primary mechanism for supporting the most vulnerable patients. It is currently £222 million, and I am delighted my right hon. Friend the Chancellor has announced it will increase to £500 million by 2019-20. That will fund 85,000 adaptations and help to prevent 8,500 unnecessary hospital admissions.
My hon. Friend makes an important point. It is right that the crisis resolution and home treatment teams were criticised in the recent CQC report for not providing adequate home treatment. That is why the Prime Minister announced in January that we are providing an extra £400 million in funding for those teams. It is also why, in the mandate, we recently required that NHS England not only agree but implement a plan to improve crisis treatment in all areas.
Does the Minister now accept that the Government’s decision to slash funding to local authorities was disastrous for adult social care, as the Government were warned at the time it would be? Does he also accept that the social care precept, which the Government are allowing councils to levy, will raise the most money in those councils with the highest council tax base, not necessarily in those with the greatest need?
I would be concerned if that were true. The point is that we are facing extraordinary, exploding demand in our system. At the risk of sounding like a Monty Python sketch, what have the Government done, apart from launching the £3.9 billion better care fund and a £2 billion social care precept; fully funding the NHS five year forward view, with a front load of £3.5 billion; driving health devolution; and providing £4 billion for health technology? We are funding the integration of health and care in a way the last Labour Government never did.
That is really not true. Ministers are presiding over the hollowing out of social care, because their funding falls far short of what is needed. Some £4.6 billion has already been cut from adult social care, and the funding gap is growing at £700 million a year. The social care precept the Minister has just been talking about will raise £400 million a year, and the better care fund does not start until next year, when it starts at £105 million. Simon Stevens has called this “unresolved business”. When will Ministers face up to the fact that the Government’s figures just do not add up?
I think that that question could be taken more seriously, first, if the Labour party had tackled this issue in office and, secondly, if it had any suggestions. Let me summarise the pressure the system is under. Over the next 10 years, there will be a 22% increase in over-65s, and the number of people aged over 75 will rise by 90% in the next 20 years. We face extraordinary challenges. That is why we have announced the better care fund increases, why we have launched the social care precept and why we are driving devolution powers for local areas, which allow local health and care leaders to integrate. If this was as easy as Labour Members say, perhaps they would have done these things during their term in office.
Hospital Treatment: Patient Choice
The NHS choice survey, which has been carried out in its current form for the past two years, shows that the proportion of patients who said that they recalled being offered a choice of hospital or clinic for their first appointment was at 40% in 2015, up from 38% in 2014.
What the Minister just left out from his answer is that the figure was 50% when Labour left power in 2010. How does he explain this worrying fall in the proportion of patients being given a choice on the Conservatives’ watch? Will he reaffirm that choice is a legal right under the NHS constitution? Will he acknowledge that the introduction of choice by the Labour Government has been a major driver in improving NHS performance across the piece?
The fact the right hon. Gentleman missed out was that that was a different survey, so the figures are not comparable. However, I agree that choice is important. We are still not doing enough, and we should do more. I would like to take this opportunity to congratulate the team at his local hospital, which has just been rated good by the CQC—the first hospital in the south-west to receive that rating.
Patients needing mental health services do not get to choose where they receive their care, as highlighted in the Commission on Acute Adult Psychiatric Care report, which was published today. The report says
“the whole system has suffered from a steady attrition in funding…in recent years.”
“poor quality of care, inadequate staffing and low morale.”
It describes the situation as “potentially dangerous”. Does the Minister now accept that the Government have let vulnerable people down? Will he implement the commission’s recommendations in full to put this serious situation right?
We have just received the report. It is a good report; we have taken note of it; and NHS England is already working on its recommendations. I remind the hon. Lady that this Government have put mental health on equal parity of esteem within the NHS constitution for the first time. [Interruption.] Opposition Front Benchers say that is meaningless, but why did they not do it when they were in office? We have done it for the first time and we are acting on it, not just in the constitution but in funding for the NHS, which is going up in real terms in the course of this spending review.
Cambridgeshire and Peterborough Clinical Commissioning Group
The CCG expects to publish its internal review by the end of February, and NHS England’s independent review is expected to be completed by the middle of the month. Monitor is assessing the project from the providers’ perspective and will share its findings with NHS England in due course.
The UnitingCare contract in Cambridgeshire was an attempt to join up unintegrated services. We now appear to be having a series of unintegrated reviews. What is actually needed is a single overarching review that looks at the roles of NHS England, Monitor, the strategic projects team, and, of course, Ministers. When are we going to get that review?
As I said, there are ongoing reviews concerning the precise responsibilities of each individual part. There is no doubt that this is a very serious matter—a serious failure—that raises series concerns. We want to know what went on as much as the hon. Gentleman does, so once the reviews have been completed and we have been briefed, I will be very happy to talk to him about their consequences.
It is my considerable honour, Mr Speaker, to respond to the hon. Gentleman in his victorious mode.
Community pharmacy is a vital part of the NHS and it plays a pivotal role in improving the public’s health in the community. We want a high-quality community pharmacy service that is properly integrated into primary care and public health. The proposed changes will help us, in conjunction with the pharmacy profession, to do just that.
I am very grateful to the Minister for that answer. There is always a place for him in our team next year, although we are running trials in the next few weeks.
Despite the generosity of the Minister’s response, does he not accept that community pharmacies are of great and growing importance to our constituents and provide an ever-increasing range of healthcare and advice in accessible high street locations? What message does he have for these dedicated professionals, who, frankly, now fear for the future due to the uncertainty arising from the announcement of a 6% cut in funding for the NHS pharmacy service?
I am grateful to the hon. Gentleman not only for his question but for the way he put it. The message is that community pharmacy does, and is doing, an extraordinary and important job, but it will change. In 2013, the Royal Pharmaceutical Society said in its publication, “Now or Never: Shaping pharmacy for the future”:
“The traditional model of community pharmacy will be challenged”
“economic austerity in the NHS , a crowded market of local pharmacies, increasing use of technicians and automated technology to undertake dispensing, and the use of online and e-prescribing”.
It pointed to the massive potential of community pharmacists to do more and sees pharmacy as ideally placed
“to play a crucial role in new models of…care.”
All that is to come. We are negotiating with the pharmaceutical profession. A consultation is going on. There is a great future for pharmacy, but, like so much else, it will be different.
The UK continues to play a global leadership role on antimicrobial resistance. We co-sponsored the World Health Organisation’s 2015 global action plan on AMR, created the Fleming fund to help poorer countries tackle drug resistance, and are promoting action through the G7. The O’Neill AMR review is galvanising global awareness.
Antibiotic resistance is one of the biggest global challenges for public health, making routine operations impossible within 10 or 15 years unless action is taken. I welcome the Government’s action on this. Antibiotic Research UK is the world’s first charitable organisation, set up in my constituency, to tackle this issue. Will the Minister look at how we might fund such organisations in the charitable sector?
I very much welcome the fact that my hon. Friend is becoming a real champion of this important international and national agenda. I am aware of the important work of the charity he mentions, and I believe it has already had some contact with the Department. I do not make the decisions on these sorts of funding issues, but I am happy to look at the issue he mentions and to meet him to discuss it.
UK health and medical research projects benefit hugely from European Union funding, with the UK at the top of the table for approved grants. That funding is vital if we are to tackle global health challenges such as resistance to antibiotics. Does the Minister accept that pulling Britain out of the EU may have a detrimental impact on the UK’s role as a world leader in health research and development?
GP Practices: Chelmsford
NHS England advises that in Chelmsford there is a GP to patient ratio of 1,927 patients per whole-time equivalent GP, which is slightly lower than that for the Mid Essex clinical commissioning group area. The Care Quality Commission has inspected eight of the 13 Chelmsford GP practices—seven were rated “good” overall and one, Sutherland Lodge, was rated “outstanding”.
I hope so. I appreciate my right hon. Friend’s visit to my office yesterday with members of that surgery and NHS representatives. The £1.4 million released from PMS in Essex will be reinvested in the CCG area, but it is important that there is an opportunity for all practices to bid for that money so that some of the work already done under PMS gets the chance, if it is vital and still needed, to continue, which certainly includes services that are rated “outstanding”.
Significant progress has been made in our negotiations with the British Medical Association on a new contract for junior doctors, but agreement has not been reached on the issue of Saturday pay, despite previous assurances from the BMA that it would negotiate on that point. So, regrettably, 2,884 operations have been cancelled ahead of tomorrow’s industrial action, which will affect all non-emergency services. I urge the BMA to put the interests of patients first and to reconsider its refusal to negotiate.
At Prime Minister’s questions in February 2014, I raised with the Prime Minister my very serious concerns about the dangerous bullying culture at Liverpool Community Health NHS Trust. I understand that the Capsticks inquiry into parts of that is now complete, so will the Secretary of State, in the spirit of honouring his stated commitment to openness and transparency, ensure that that report is made available, perhaps via the NHS Trust Development Authority, if necessary, to the public trust board on 23 February?
I will happily look into that matter. The Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), has held a round table on bullying and harassment. I thank the hon. Lady for raising the issue, because over the past decade—none of us should be proud of this—the number of NHS staff who say they are suffering from bullying and harassment has gone up from 14% to 22%. If we are going to deliver safer care, we have to make it easier for doctors and nurses on the frontline to speak out without worrying about being bullied or harassed.
T4. I am sure Ministers will join me in congratulating Number 18 surgery in Bath on being ranked in the top 10 GP practices in the country. Do they agree that patients having a choice of where they are treated will increase patient satisfaction in the NHS? (903563)
Yes, it certainly will. That is another reason why we hope to have 5,000 more doctors and 5,000 more allied health professionals working in general practice, to expand the primary care service by 2020.
Today’s The Independent reports that a potential deal on the junior doctor contract was put to the Government that would have resolved junior doctors’ concerns without costing any more money and potentially avoided tomorrow’s industrial action. A source close to the negotiations told the newspaper:
“The one person who would not agree was Jeremy Hunt. Even though the NHS Employers and DH teams thought this was a solution he said no”.
So let me ask the Health Secretary a very direct question: have the Government at any point rejected a cost-neutral proposal from the BMA on the junior doctor contract—yes or no?
The only reason we do not have a solution on the junior doctors is the BMA saying in December that it would negotiate on the one outstanding issue—pay on Saturdays—but last month refusing to negotiate. If the BMA is prepared to negotiate and be flexible on that, so are we. It is noticeable that despite 3,000 cancelled operations, no one in the Labour party is condemning the strikes.
T6. Will my right hon. Friend update us on the progress in decriminalising dispensing errors for pharmacists? (903565)
I am aware of my hon. Friend’s keen interest in the rebalancing programme of work, and particularly the work on dispensing errors. We are fully committed to making that change. There are a number of stages to amending primary legislation through a section 60 order. Given the timetable, it is likely that the order will be laid before the Westminster and Scottish Parliaments in the autumn.
T2. The Secretary of State will be aware that Maximus is recruiting junior doctors to perform work capability assessments in the Department for Work and Pensions. The company is offering £72,000 a year, which is up to twice the salary that junior doctors would get in the health service. Is he concerned that that will result in inexperienced medical staff making judgments that relate to people’s livelihoods? Is he not also concerned that it will result in a drain of staff resources out of the NHS and out of providing general healthcare for the public? (903560)
As a result of the changes the Government have made on welfare reform, we have 2 million more people in work and nearly 500,000 fewer children growing up in households where nobody works. Part of that is making important reforms, including having independent medical assessments of people who are in the benefit system. I think everyone should welcome that.
T8. Comparative research has shown that proton therapy is as effective as radiotherapy for certain cancers, but has fewer side effects. Do Her Majesty’s Government accept the use of comparative evidence in deciding the availability on the NHS of emerging treatments such as proton therapy? (903567)
I will reflect on the wider point my hon. Friend makes, but the House will be keen to know that we are investing in building two proton beam therapy facilities at the Christie in Manchester and University College London hospitals. Work has already started on that £250 million project, and the first facility is due to become operational in 2018.
The Government are taking the matter extremely seriously, and they have it under active review. Up-to-date medical guidance has been cascaded to the NHS in England. As the hon. Gentleman will know, the UK is at the forefront of some of the world’s response. We are a major funder of the World Health Organisation. We have got people on the ground helping in Brazil, in particular. I assure him that we are maintaining close links with the devolved Administrations at official level, and I am always happy to speak to colleagues. We take very seriously keeping those links live.
T9. Has the Secretary of State seen the comments of Professor Angus Dalgleish, who is widely reported in the papers today as suggesting that EU rules are forcing us to spend billions of pounds treating health tourists and preventing us from undertaking important clinical trials? Has the Secretary of State made any assessment of Professor Dalgleish’s comments? (903568)
The Government have made a huge and significant assessment of the cost of overseas people using the NHS, and we think that there are £500 million of recoverable costs that we do not currently recover. When it comes to the EU, the biggest problem that we have is that we are able to reclaim the costs of people temporarily visiting the UK, but we do not do so as much as we should because the systems in hospitals are not as efficient as they need to be. We are sorting that out.
T5. Despite the prevalence of pancakes in Parliament today, I am pleased to be asking a food-related question. A recent opinion poll performed by Diabetes UK showed that three quarters of British adults think food and drink manufacturers should reduce the amount of saturated fat, salt and sugar in their products. Does the Minister support introducing mandatory targets for industry to reformulate food and drink products to help people to eat more healthily, and will that form part of the Government’s childhood obesity strategy? (903564)
We made considerable progress in this area in the last Parliament, under the responsibility deal, but we have always said that there is more to do and the challenge to industry remains. We will say more about that when we publish the childhood obesity strategy in due course.
Midwife-led units, such as the brilliant Crowborough birthing centre in my constituency of Wealden, are key to the provision of high-quality, safe and compassionate maternity care. Last year, it scored 100% satisfaction on a friends and family survey. Will my hon. Friend outline the Government’s plans for midwife-led care, particularly given this weekend’s launch by The Sunday Times of the safer births campaign?
Midwife-led units have increased in number in the past few years, to the great advantage of women wanting a full range of choice when they give birth. That is why we are all looking forward to the publication of the Cumberlege review, which I hope will map out the future of maternity services and show what midwife-led units will do within maternity services in the NHS. I am very excited about that, and I know that my hon. Friend will be, too.
T7. Ministers will be aware of The Lancet series on breastfeeding and the open letter signed today by a range of organisations in the field calling for concerted action to promote, protect and support breastfeeding. Will the Minister meet me and these organisations to discuss the proposals further? (903566)
I am aware of The Lancet review, which makes some important points. We are not doing well enough yet in England, and it is of note that progress has been made in Scotland, Wales and Northern Ireland that we should be able to copy in England. I know that the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), who has responsibility for public health, will want to hold such a meeting to discuss that. We have made considerable progress, but there is still a differential between rich and poor that we need to fix.
I am pleased to support the National Society for the Prevention of Cruelty to Children’s “It’s Time” campaign, which is an initiative to ensure that children who have been the victims of abuse receive ongoing support. May I seek assurances from the Government that they will actively help with this initiative?
Yes, indeed. We strongly support the initiative. Our work to look after children who need extra care, particularly in relation to their health and emotional needs, has been helped by the transforming care package, which is going through local authorities at the moment. Their vulnerabilities are certainly a matter of great concern, and that will be followed up by the Government.
Over 1 million elderly people are able to maintain independence and remain in their own homes due to the attendance allowance. What discussions has the Minister had with his colleagues about ensuring, when the fund is transferred from the Department for Work and Pensions to the Department for Communities and Local Government, that the allowance will remain at the same level?
The consultation is ongoing between Departments. A unit has been set up by the Department of Health and the DWP to look at a range of issues that concern us both. The actual detail of the future attendance allowance has not been finalised yet, but it is a matter of concern and discussion between Departments.
In asking a question about mental health, may I remind the House that I am married to an NHS forensic psychiatrist, who is also registrar of the Royal College of Psychiatrists? Have the Government looked carefully at today’s report from the independent commission on improving mental health services, particularly its finding that provision nationally for the most severely ill acute patients is inadequate? Will the Government set out what measures they will take to make sure we really see progress on parity of esteem and on improving access to such severely ill patients?
I thank my hon. Friend for her question, and the Royal College of Psychiatrists for its work on Lord Nigel Crisp’s commission, which we have supported. The report and recommendations have only just come to us, but they certainly travel in the direction in which the Government are already going. We want to reduce out-of-area placements. The NHS is already committed to that, and is working on moving to a definitive target to reduce the number of them and, I hope, eventually to scrap them. I was up in Hull last week to look at problems in that particular area. The recommendations on waiting times are very important. As we all know, this area has been undervalued in the past. It is under greater scrutiny, and more investment and support are going in through the Government. Today’s report will help us in relation to that.
Leeds has a shortage of integrated care beds and pressure on acute services. Will the Secretary of State—[Interruption.] That was a comma, Mr Speaker. Will the Secretary of State please intervene, so that Leeds Teaching Hospitals NHS Trust can open wards at Wharfedale hospital, which it wants to do, while the clinical commissioning group provides the money?
By refusing to condemn the junior doctors strike, the hon. Member for Lewisham East (Heidi Alexander) has shown that she has little regard for patient safety. [Interruption.] Will my right hon. Friend repeat his condemnation of this strike, which will seriously endanger patient safety, and assure me that he will continue to press for the new contracts, which will guarantee safer patient care and a better contract for doctors?
I think my hon. Friend got a bit of a reaction with those comments. The Labour party is saying that if a negotiated settlement cannot be reached, we should not impose a new contract—in other words, we should give up on seven-day care for the most vulnerable patients. There was a time when the Labour party spoke up for vulnerable patients. Now it is clear that unions matter more than patients.
Negotiations are ongoing with the Pharmaceutical Services Negotiating Committee. The amounts that have been set out cover this financial year and the settlements are moved on from year to year, so the discussion is ongoing. The future for pharmacy is very good, although it will be different, as the profession has wanted for some time. Not only is there a great future for high-street shops in areas where we need them, but there will be an improvement in and enlargement of pharmacy services in healthcare settings, primary care settings and care homes around the country.
Points of Order
On a point of order, Mr Speaker. It has been brought to my attention that the use of vellum—the calfskin material on which Acts of Parliament are printed—is to be discontinued, with Parliament giving 30 days’ notice to cease to the printers. However, in response to a point of order made by the hon. Member for North Wiltshire (Mr Gray) on 26 October last year, you made it clear that a decision on this matter would have to be taken on the Floor of the House.
May I therefore seek your guidance on what should be done now in order that Members from across the House can register their opposition to the decision and make the case for the continued use of vellum, especially in the light of significant disputes over the so-called savings that have been cited by the Administration Committee and influenced its recommendation to end the centuries-old practice of using vellum to print this country’s legislation? Surely we think that the legislation that we make in this place—the mother of all Parliaments—is worthy of nothing less.
I am very grateful to the hon. Lady for her point of order and for her courtesy in giving me notice of it. She is, indeed, correct that when the matter was raised in October last year by the hon. Member for North Wiltshire (Mr Gray), I indicated that, as had been the case in 1999, the House would be asked to decide whether to agree to the recommendation of the Administration Committee that it should agree to the proposal of the House of Lords—indeed, the decision of the House of Lords—to replace vellum with archival paper. That was my understanding at that time, not least for the historical reason that I have just given. No such opportunity has, however, been offered to the House. That is why she is complaining. The provision of such an opportunity is not in my gift.
I should also say that the arrangements for printing Acts of Parliament and the associated expenditure are matters for the House of Lords, and not for this House, so its arrangements with the printers of Acts are not matters for the Chair.
As for seeking an opportunity to demonstrate the depth and breadth of support for the continued use of vellum, I am sure that the hon. Lady will have thought of tabling an early-day motion. I shall leave the matter there for now.
On a point of order, Mr Speaker. As you may recall, last week I asked the Minister of State for the Department for Business, Innovation and Skills a topical question. It was about facility time and check-off provisions contained in the Trade Union Bill, and whether they would be removed as they apply to Scotland and Wales. The Socialist Worker newspaper—you may have a subscription, Mr Speaker—and other media outlets have published a letter from the Minister of State to other Ministers, including the Prime Minister, which indicates that concessions will be made to devolved Administrations, effectively removing the Bill’s check-off and facility time arrangements. That letter was dated 26 January.
The information that I was given on 2 February and the letter of 26 January are contradictory to say the least. Can you indicate, Mr Speaker, whether the Minister of State has made a request to clarify those contradictory statements, and can you say what options are available to hon. Members who wish to seek clarity on that matter?
I am grateful to the hon. Gentleman for his point of order, but I have received no indication from any Minister from that Department about an intention to make a statement on the matter. I hope he will forgive me, but I do not recall off the top of my head which Minister responded to the question last week.
Yes, but there is usually more than one Minister of State. Name recognition is helpful, but in the absence of a declared name, I cannot recall which Minister answered. I hope I followed the drift of the hon. Gentleman’s attempted point of order, but I was not conscious that Ministers had a hotline to the Socialist Worker newspaper.
Not yet, says the leader of the Liberal Democrats from a sedentary position. I read the journal myself occasionally when I was a school student, but I readily concede that it has not passed my desk since. If there is confusion about the matter, it is best that that is dispelled. My advice to the hon. Member for Glasgow South West (Chris Stephens) in all seriousness is that he should wend his way to the Table Office and table a written question on the matter. If, when he receives a response, the fog has not lifted, I have a feeling that he will turn up at business questions on a Thursday to press for an early statement or debate on that matter. He is nothing if not dogged, and I feel sure that he will pursue his objective with the fixity of purpose that is required.
Further to that point of order, Mr Speaker. If I remember correctly, you said that in your youth you read the Socialist Worker. Would it be right to come to the conclusion that having read that revolutionary journal, you decided to become a Tory?
The hon. Gentleman may be correct in that surmise. A young lad at my secondary school was a devoted seller of that paper, and another young lad was also a devoted seller of the paper and has since become a distinguished academic, but as far as I know, he no longer adheres to the precepts of the Socialist Workers party. Did reading that paper make me a Tory? Probably. I am grateful to the hon. Gentleman, both for his point of order and for his sense of humour.
Blood Donor (Equality) Bill
Presentation and First Reading (Standing Order No. 57)
Tim Farron, supported by Michael Fabricant, presented a Bill to make provision about the conditions to be met by male blood donors, including removing the restrictions relating to blood donation from men who have sexual intercourse with men; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 11 March, and to be printed (Bill 130).
Ofsted Inspections (Schools’ Rights of Challenge)
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 establish the right of schools and academies to challenge the timing and format of school inspections; to appeal against the outcomes of such inspections; to make provision about increasing accountability and quality assurance within the school inspection system; and for connected purposes.
I apologise in advance, Mr Speaker, for my lacklustre demeanour. I recently had a bout of winter vomiting, and I am concerned that I have more to worry about than projecting my voice.
Her Majesty’s inspectorate of schools, as Ofsted used to be called, has a long and distinguished history stretching back to the days of Queen Victoria, when inspectors such as the great poet Matthew Arnold fought against the scourge of philistinism in British society—a term, incidentally, he invented. Historically, it has always been torn between its twin and not always compatible roles of supporting school improvement and ensuring that state-funded schools abide by whatever standards and rules are currently laid down by the Government of the day.
We are now witnessing an interesting period of Ofsted’s development. It is a huge multimillion pound organisation, with 1,000-plus permanent employees and a remit stretching not just over the entire school system but over nursery, pre-school, out-of-school provision and sundry aspects of childcare. The varying and occasional pronouncements and opinions of the head of Ofsted, whether delivered with the self-effacing modesty of Sir David Bell or the misguided arrogance of Chris Woodhead, are treated as though they are the ex cathedra announcements of a pope. Unlike other HMIs toiling away for the public good, the head of Ofsted is guaranteed celebrity status. For schools and providers, Ofsted is critical. Preparing for Ofsted—pleasing or pacifying Ofsted—is hugely important. It casts a long shadow over the entire school year. Its verdict can determine a school’s reputation, future funding, governance, the professional careers of its staff, ownership and very survival.
I do not, at this stage, want to minimise the very real role that HMIs have, and have had, in school improvement. However, we need to flag up that as a country we are almost unique in currently having such a heavy duty, high-stakes, expensive and unaccountable public body policing our schools. It is also worth pointing out that many of the countries we seek to emulate—in terms of pupil progress, whether in science, technology, engineering and maths, PISA ranking or whatever—lack such a cumbersome and encumbering apparatus.
The considerable amount spent by the Government on Ofsted is a mere fraction of the amount that schools spend in trying to ensure and protect themselves from a perverse or unfair judgment from Ofsted. Again, as a nation we are an outlier here. Unsurprisingly, good teachers and heads who fear an errant verdict are diverted or stressed. They leave the profession early, or, in the worst cases, pass up opportunities for promotion. We do not have a collegial, peer-reviewed model of school improvement. Instead, we have what can become, at worst, the teaching equivalent of the Spanish inquisition, where careers go up in flames at the mere whiff of educational heresy.
I recognise that inspection has a valuable role in education, but the way we currently do it in England, via the bloated bureaucratic beast that Ofsted has become, is clumsy, poor value for money and unaccountable. Critically, there is no independent appeal on matters of substance. The Bill seeks to give schools powers to contest an unfair judgment by appeal to independent regional panels. Where disagreements remain, it would give a school the right to table its response for inclusion in the final Ofsted report. Currently, even lodging a legitimate complaint is seen as futile and positively risky. Very few schools actually do it—it is about as good as arguing with traffic wardens or traffic cops. We need to change this top-down culture and address the imbalance of power. We need a cultural change.
It is not as though Ofsted has never been without flaws. In 2015, Ofsted dismissed 40% of its inspectors for reasons undisclosed. It is not as though it has never been arbitrary. The current head of Ofsted summarily announced recently that schools would be graded inadequate for allowing full veils—that was just his decision—and a nursery was downgraded from outstanding to inadequate simply for emailing a picture of a happy child to its parents.
Worse still, it is not as if judgments are wholly impartial or immune from political pressure—or the suspicion of that. I do not suggest that that is systematic, but it can happen. It is a known fact that the Government want all schools to become academies, and that the head of Ofsted worked for an academy chain. He sought to inspect academy chains but, to be fair, he has been blocked from doing so by the Government. The only antidote to the suspicion that free schools and academies get an easy ride is more transparency and the possibility of challenge, as there is not a straightforward read-across from the data collected to the verdict reached.
I have with me two Ofsted reports on two schools in Liverpool, both in tough, challenging areas, and both with similar scorecards—virtually identical in every respect. Notre Dame Catholic College is rated good by Ofsted. The Savio Salesian College in Bootle is said to require improvement. Oddly, the apparently inferior school has appreciably better results in English than the so-called good school, and its maths results, too, are better in places. Ironically, the head of Notre Dame has been invited to take over Salesian school based on the Ofsted judgment. To add to the irony, I taught in Savio Salesian High in the early ’70s under a saintly headmaster called Father Maurice Gordon, an Oxbridge graduate who, on stepping down as a successful head did not become a consultant—not even an Ofsted inspector—but timetabled himself to teach remedial maths to hard-to-reach pupils. He fostered a glorious sporting tradition, and numbered among his alumni Jamie Carragher and the deputy leader of the UK Independence party.
I know absolutely nothing of the college in its current incarnation, but my suspicion, based on the evidence provided on Ofsted’s website, is that Ofsted has little reason to be confident in its verdict, hence the need for the right to challenge. Ofsted verdicts shape the destiny of schools, and determine their structure, ownership and very survival. Not to have the right to challenge such a fallible system—it clearly is such a system—is not only demoralising but fundamentally unjust.
My enthusiasm is undiminished, Mr Speaker.
Question put and agreed to.
That John Pugh, Mr Clive Betts, Norman Lamb, Tom Brake, Kelvin Hopkins, Greg Mulholland, Mr Mark Williams, Steve McCabe and Fiona Bruce present the Bill.
John Pugh accordingly presented the Bill.
Bill read the First time; to be read a Second time on Friday 11 March 2016, and to be printed (Bill 131).
EU Referendum: Timing
I beg to move,
That this House notes and regrets that the Government appears set to rush to a referendum on the UK’s membership of the European Union in June 2016; believes that no case has been made for holding a referendum at such an early stage, and that further, any such needlessly premature date risks contaminating the result; believes that a subject as fundamental as EU membership should be decisively settled after a full and comprehensive debate; notes the recommendations of the Electoral Commission on best practice for referendums; further notes that there are elections happening in Northern Ireland, Scotland, Wales, London and some local authorities in May 2016 and that the First Ministers of each of the devolved administrations have all expressed opposition to a June referendum date; and urges the Government to set the date for the referendum having respect for the May elections as distinct electoral choices.
The referendum on EU membership is one of the biggest decisions that the people of this country will be asked to make in our lifetime. I, for one, am glad that we have been afforded the opportunity to have our say. The Democratic Unionist party campaigned long and hard, when the two major parties were against a referendum, for the people of the United Kingdom to have their say. I commend the Government very much for introducing legislation to allow the referendum to take place during this Parliament.
Today’s debate is about the timing of the referendum and the date on which the vote is held. Some Members who support our motion hold different views on EU membership and, indeed, on whether we should have a referendum at all. However, whatever side of the argument we are ultimately on, we agree that, when the referendum is finally held, there must be the fullest, most comprehensive debate possible, which does not overlap with, or otherwise become enmeshed in, the election campaigns in May for the Scottish Parliament, the Northern Ireland and Welsh Assemblies, and indeed for that matter, for the London Mayor, and other local elections.
I am grateful to the right hon. Gentleman for taking an early intervention. Does he take comfort from the fact that the view that he has just expressed has been endorsed by all the party leaders in the National Assembly for Wales—not just the First Minister but the Liberal Democrat leader, the Plaid Cymru leader, the Labour leader and, critically, the Conservative leader?
The hon. Gentleman makes an extremely important point, which I shall come to, about the cross-party nature of the sentiments behind the motion. It is not motivated by one side or the other on the EU referendum debate, or by a party political consideration, and it has the support of a diverse range of parties on both sides of the argument. The issue needs to be taken very seriously by the Government, and cannot be dismissed lightly or set aside easily, given the breadth of support that it attracts from all parties, including the major parties mentioned by the hon. Gentleman: the Conservative and Labour parties in Wales, and the Labour First Minister in Wales. It would be interesting to know the position of the main parties in Scotland.
Does the right hon. Gentleman agree that having elections to the devolved Administrations and the campaign for the European referendum running in parallel could obfuscate the issues and confuse them? Politicians in the devolved Administrations should concentrate on the principal issues of health and education, and working towards an evolving programme for government.
Again, that illustrates the point. The hon. Lady and I may have different views on EU membership and so on, but we agree on the need for a full and comprehensive debate that is not caught up in the election campaigns for the devolved Administrations. I will discuss that in more detail shortly. .
I commend the right hon. Gentleman and his party for the work that they have done to campaign for an EU referendum for many years, long before it was fashionable. Has he also taken into consideration the fact that there is a European Council meeting scheduled for 23 June—apparently, the Government’s favoured date for the EU referendum? Does he think it appropriate for a European Council meeting—and who knows what reports might come out from that meeting on the day—to be held on the same day as the EU referendum?
I wonder whether the right hon. Gentleman’s constituents will pay more attention to the European Council meeting on 23 June than the Northern Ireland fixture against Ukraine on 16 June. Perhaps his constituents have other things in their life, and Europe is not a constant feature in their psyche.
As my hon. Friend says, it is not an either/or. People are capable of watching the football, listening to the political debate and doing other things. If this is to be an issue, it will be because the Government have chosen to foist the EU referendum on us at the time of the Euro championships, which people will want to concentrate on. That is another good argument for having the debate later. Another good reason is that many fans from England, Wales and Northern Ireland—sadly not Scotland—will be travelling to France. We could avoid the extra cost of postal votes, proxy votes and the rest of it, if we had the vote on a different date.
Does the right hon. Gentleman agree that this is not about the voters in Northern Ireland, who are quite capable of concentrating on the European championships—we envy them for being in it—and politics but about the devolved Administrations, who, unlike the one closer to here, respect purdah? If the referendum is on 23 June, the three Administrations will be in purdah for 10 out of 13 weeks. I do not know whether Conservative Members have considered that.
The right hon. Gentleman, from his considerable experience, makes a very salient point.
This debate is not about the substance of the EU referendum argument or the deal that the Prime Minister has negotiated, so I will pass over the details of that deal—it is surprisingly easy to do so. Instead, I want both sides of the House to consider whether the result of the referendum will be morally binding or politically conclusive and whether we will settle the debate for a generation. We can do that, of course, but, on the Government’s current timetable, I fear we will not. This is needless folly, not least for the Conservative party, but there is time, even now, for it to reconsider—that would be in its long-term interests—and I believe it should.
To be clear, there is no suggestion that the public cannot choose or that a compressed electoral cycle would, as some have suggested, be too complex for the voters. Of course the people can choose and understand the issues. This is not about their choice, and still less is it about their ability to choose; it is about the Prime Minister’s desire that they choose in a particular way at a particular time in the rushed referendum that I fear he is set upon.
Why hold the referendum on 23 June? No Minister has made the case for an early referendum—quite the reverse; they have extolled and observed the virtues of Electoral Commission guidance and past polls at all levels, be they general elections, local elections, devolved elections and, yes, both the national referendum in the last Parliament on the alternative vote and the recent Scottish referendum. The House and public are entitled to ask, therefore, why they are seemingly intent on kicking over their own precedents. Why is this poll to be so very different from all that have gone before? What explains the rush and the panic?
The hon. Gentleman makes a good point. Despite the public’s ability to discern the different issues at stake in the different election questions, the media often fixate on one issue. They will undoubtedly concentrate heavily on the national question of the EU referendum while giving little coverage to the elections in the devolved regions. That is another good argument for why the two should not become enmeshed.
Is the right hon. Gentleman aware that in Sweden in 1994 two months elapsed between a general election and a referendum on membership of the EU; in Denmark, two months elapsed between the general election and the referendum on the treaty of Amsterdam; in Malta, one month elapsed between two such elections; and in Switzerland, 15 referendums were held in 1992 alone? Is he suggesting that these countries have abdicated their responsibility to the general public?
No, not at all. That is a rather strange argument to make. In Northern Ireland and elsewhere, European elections have been held on the same day as local and Assembly elections. So that is neither here nor there. We have already made the point that people are quite capable of separating out the issues. We are talking about the impact on the functioning of the devolved Administrations and the ability of political parties to campaign and work with others, if necessary, on those issues; about the purdah issue the right hon. Member for Gordon (Alex Salmond) rightly raised; and about the media’s concentration on EU issues to the exclusion of devolved issues. This debate is about those important issues, not the question the hon. and learned Lady raised.
On 3 February, the First Ministers of Northern Ireland, Scotland and Wales, along with the Deputy First Minister of Northern Ireland, wrote jointly to the Prime Minister to set out the case against a June referendum and to argue for the debate to be free from other campaigning distractions. That needs to be taken seriously and treated with the respect it deserves. We hear a lot about the respect agenda and taking on board the views of the devolved Administrations, and that now needs to be put into practice. This is an important moment in this Parliament. Will the Government respect the devolved Administrations?
I was interested to hear the right hon. Gentleman talk about listening to the views of the Electoral Commission. Last Thursday, in questions to the hon. Member for South West Devon (Mr Streeter), who was representing the commission, I asked if it had given a view yet on dates in June. It had—it had only ruled out the 2nd and the 9th. Does the right hon. Gentleman think that says something?
I will come to the Electoral Commission shortly.
The leaders of the Administrations in Scotland, Wales and Northern Ireland have very different views and come from very diverse backgrounds. We have the leader of the Scottish National party, the leader of the Labour party in Wales, the Democratic Unionist party leader and the Sinn Féin leader in Northern Ireland. That is a diverse group of politicians with very different backgrounds—to say the least—but they have come together not out of party political interest but in the interests of the peoples they represent in their respective countries. Whether on the “remain” or the “leave” side, they have set aside party political considerations in the common interest that the referendum should not happen in June. My colleague, Arlene Foster, Northern Ireland’s First Minister, has rightly observed that any premature European referendum campaign would inevitably become intertwined with the Stormont elections. How could it not?
I suspect that the right hon. Gentleman and I will both vote to leave. From a Eurosceptic English point of view—we are self-confident and we know our arguments—we say to the Prime Minister, “Bring it on—no delay, don’t look worried, bring it on!”. We can have a proper debate, and we can win this.
I respect the hon. Gentleman’s point of view. I understand where he, as an English Eurosceptic, is coming from. I hope he respects where we in Northern Ireland, Scotland and Wales on both sides of the argument are coming from. We will weigh the arguments and consider whether his view should be tempered by the contributions of colleagues from other parts of the UK, some of whom might share his views.
A phrase in the motion stands out as pretty strong stuff, and I would welcome the right hon. Gentleman’s explanation of it. It claims that the
“needlessly premature date risks contaminating the result”.
I thought we had already established across the House that the electorate can both walk and chew gum. I am not entirely sure how the result could be “contaminated”.
It is pretty obvious on an issue that the Conservative party has debated for many decades and the country raised many concerns about, that when the deal is finalised—the “t”s are crossed, the “i”s dotted and all the rest of it—we surely deserve more than a short 18, 17 or 16-week campaign for detailed consideration. If the Conservative party and others are really interested in putting the issue to bed once and for all, I think they will want the fullest and most comprehensive debate possible.
Does my right hon. Friend agree that a consensus seems to be emerging that this serious issue needs to be examined, debated, made subject to dialogue and voted on? We need to have this discussion and debate unencumbered by regional influences, London Mayoral elections and other issues that will undoubtedly feature in the media, sidelining the issues relating to a European referendum, which should take place at a time later than June this year.
I quite agree with my hon. Friend, who sets out the position very clearly.
Only last month, the Prime Minister himself was pretty unambiguous about this matter. He said:
“I’m not in a hurry. I can hold my referendum any time up until the end of 2017”,
“it is more important to get this right than to rush it.”
My fear is that he is rushing it and not getting it right.
As a Welsh Member of Parliament, I have some sympathy with the right hon. Gentleman’s argument on grounds of purdah and for other reasons, but will he help to clarify it by telling us on what date he thinks the referendum should be held? I am also concerned that the longer this is left, the more damaging it will be to the long-term economy of the United Kingdom.
The Government have set in legislation the end of 2017 as the backstop. I generally think that the longer the debate, the better, because it will give people the fullest and most comprehensive debate possible. Personally, I would be content to have the referendum in the autumn. We do not have to go to the end of 2017, but we should certainly go beyond June and not have it enmeshed with the other elections we have mentioned.
Many people are asking the question—it needs to be asked—of what the Prime Minister is afraid of in relation to the summer. What is it that he does not want to risk voters see happening over the course of the summer when they consider the issue of British membership of the EU? What mistakes does he anticipate our EU partners will make? What is he really worried about?
That brings me on to some of scare stories that are going around at the minute and, sadly, getting a lot of currency. Some are silly; some are implausible; some, of course, are simply knockabout stuff, without which politics would be infinitely duller and the papers would have less to write about. However, some are pernicious and should not be casually repeated.
In anticipation of our referendum deciding our membership of the EU on the grounds of what is or is not in our national interest, I entirely acknowledge the right of friendly foreign Governments to say how that might affect them. What I do not accept, and what I can hardly believe has happened from the mouths of serious figures who really should know better, is the sort of absurd nonsense that British exit from the EU could somehow in itself precipitate the rise of Irish republican terrorism again. It is hard to know what is worse about claims such as these—that they are criminally irresponsible, or logically fatuous. Brexit will neither cause republican terrorism, nor make any difference to it. Its cause, wrong and bad as it is, is Northern Ireland’s membership of the United Kingdom, democratically decided and settled—not the UK’s membership of the EU. Those who have claimed in recent weeks that terrorism would be encouraged or facilitated by a leave vote in the EU referendum are peddling scare stories of the very worst nature. I can only hope they are already ashamed of them, and will not repeat them again.
It is worth outlining that every single witness to the Northern Ireland Affairs Committee, which is looking into this issue, has underscored and reiterated what my right hon. Friend has just said—that there is no chance of terrorism being affected one way or the other by this debate.
My hon. Friend reinforces the point strongly. I look forward to reading the Select Committee’s report when it comes out. It will provide a very useful contribution to the debate in Northern Ireland and indeed more widely.
We have provided for a body to administer these things. The Electoral Commission is not wholly without fault or flaw, but it has been consistently clear on how this referendum should best be conducted. It has said that administrative necessity, the needs of the other elections in the first half of this year and fairness all combine to suggest that the referendum should not, in my view, be on 23 June. Of course, the Electoral Commission is not in charge of the process—the Government are. Indeed, they took to themselves additional powers to determine how this very referendum should be run.
It is interesting that the designation process for lead campaigners is still murky and uncertain, and I wonder who benefits from that. By way of contrast, long before the regulated campaign began in Scotland, both Yes Scotland and Better Together had been designated lead campaigners for their respective sides on the ballot paper. What is the point and what is the reason for the Government to flout for the very first time their own guidelines, as issued by the Electoral Commission? To do so is very telling—and not in a good way.
The Electoral Commission has said:
“We currently do not know when we will be able to run the process to appoint lead campaigners.”
It is now February, and the Government are planning to hold this referendum in June. Frankly, this is not fair play, but foolish game playing. Having taken to themselves the power to set both the date of the referendum and the date of designation for lead campaigners, this puts in front of the Government the temptation, in some people’s eyes, to rig the process. They would be very foolish to succumb to that temptation. Let me say to the Government that the Prime Minister and his successors will sorely regret any perceived fixing of this referendum. We have already debated some of the issues surrounding purdah and so forth, and I think the Government should learn from that debate, as well as from the 40 years of debate within the Conservative party on this issue.
On the advice of the Electoral Commission and the timing of designation, there is a growing concern that the designation process will finish up overlapping the referendum period. In a letter to me, the chair of the Electoral Commission, Jenny Watson noted that the commission had
“recommended that the statutory six week process for the designation of lead campaigners should take place shortly before, rather than during the first weeks of the referendum period. This ‘early’ designation would provide clarity earlier for voters and campaigners about the status of campaigners.”
Does the right hon. Gentleman agree that it would be unforgivable if the Government were to allow, by sleight of hand, what amounts, frankly, to corruption of the designation process?
I agree with the hon. Gentleman. The Government really need to get on with this and get the matter resolved. Frankly, it would be scandalous if matters were allowed to drift and to drag. Again, that would call into question the Government’s handling of the referendum and its fairness. It would give cause for people to question whether they have made the final decision on this matter. If the Government were wise, they would want to ensure that once the people had spoken on this matter in a referendum, everyone would accept—from whatever side and whatever the outcome—that the decision had been properly taken by this country under the proper rules and that everybody will respect it for the foreseeable future. To do otherwise is short-term opportunism.
In conclusion, we need to face up to this crucial issue of the timing of the referendum. We need to ensure that the Government respect the Electoral Commission and that they respect the devolved Administrations in Northern Ireland, Scotland and Wales. On an issue of such import, we must put the national interest above every other consideration. We must respect the rights of the people who go to the polls in May. We must allow for the fullest possible debate on the biggest decision to be made by this country for generations. For those reasons, I commend the motion to the House.
I am delighted to respond to this important debate, and I commend the long-standing support of the Democratic Unionist party for the principle of holding a referendum on the European Union. As was pointed out by the right hon. Member for Belfast North (Mr Dodds), its members were there earlier than many, and I think that their consistency and constancy in respect of that principle can serve as a model for others.
Before we get too far into the debate, let me say that I think it is important for us all to remember that any debate about the referendum date needs to be undertaken in the conditional mood. In other words—if I may make a statement of the blindingly obvious—the date has not yet been set. As the Prime Minister has consistently said, it is renegotiation and then referendum. As the renegotiation is not yet complete, there is, as yet, no referendum date.
Given the breadth of the range of interests among the parties in the devolved nations that are asking for the referendum not to be held in June, and given that no date has been set, why are the Government so reluctant to accede to the views of the right hon. Member for Belfast North (Mr Dodds)?
I am coming to that, but I think it would be, at the very least, disrespectful to the principle behind the European Union Referendum Act 2015, which requires the date of the referendum to be set through a debate in the House on a statutory instrument, under the affirmative resolution procedure, in due course. When that point comes, there will be plenty of opportunities to debate the issue. I think that it would be premature to start ruling too many dates in or out, although I will be specifying the dates that we have already ruled out.
I am grateful to my hon. Friend for giving way so early in his speech. I realise that we are not talking about a specific date proposed by the Government, but about the principle of opting for certain dates. Will my hon. Friend comment on the appropriateness of holding the referendum on the same date as a European Council meeting?
I know that my hon. Friend is an assiduous follower of matters European, but I suspect that he may be one of the very few people in the entire country who pay quite so much attention to the musings of the European Council. I think that the Council would be honoured to feel that its conclusions carried as much weight with anyone else as they clearly do with him. I shall address some of the broader issues underlying his question in a moment.
I said that the renegotiation was not yet complete and that, therefore, a date for the referendum had not yet been set because I suspected that certain Members might try—gently and kindly, I am sure—to tempt me to commit some hideous indiscretion by revealing a planned referendum date, whether in June or in any other month between now and the end of 2017. For the sake of our collective mental and emotional health, and to save us all an awful lot of time, I thought that I should take this opportunity to advise any amateur Kremlinologists who might be hoping to glean clues about the date of the referendum from close textual analysis of my remarks not to bother, because there are no clues.
I shall address those points in a moment. I am sure that the hon. Gentleman will pick me up if he feels that I have glossed over any of them inappropriately.
Let me repeat that there are no clues. Alan Greenspan, the famously gnomic and opaque former chairman of the United States Federal Reserve, once said:
“I guess I should warn you: if I turn out to be particularly clear, you’ve probably misunderstood what I've said.”
He went on to say:
“I know you think you understand what you thought I said but I’m not sure you realize that what you heard is not what I meant.”
In other words, clues are to be avoided.
However, even if we do not know the precise date on which the referendum will be held, we know several dates on which it will definitely not be held. It will not be held on 5 May this year or on 4 May 2017, because both those dates are expressly excluded in the primary legislation that we passed last year, and—as was recently promised by my right hon. Friend the Prime Minister—it will not be held within six weeks of 5 May this year. Although we do not yet know the exact date, those exclusions are important, because they create and guarantee enough time between the referendum and any other upcoming elections to ensure that the important issues that arise in each set of polls are debated fully and separately in each case.
The Referendum Act specifies a 10-week period between the Government’s publication of their response to the negotiations and the referendum date, presumably because both this House and the other place thought that people needed that period to digest the information. Would it not be wrong for three of those 10 weeks to fall right in the middle of an election campaign affecting over 20 million citizens who will be voting in the referendum a few weeks later?
I am coming to that point. I hope that I shall be able to respond to it adequately, but I am sure that the hon. Gentleman will come back to me if I do not.
It is important for those issues to be debated fully and separately, because, as we have just heard, 5 May this year will be a very busy time at the ballot boxes. I need mention only a few of the votes that will be held then: votes for the Mayor of London, for police and crime commissioners, and for devolved legislatures in Stormont, Cardiff and Edinburgh.
I am not arguing, as some do, that it is impossible to hold more than one election in the same place and on the same day. The fact that local council elections took place at the same time as the general election in many parts of the country last May without democracy collapsing in a heap shows that voters, and election administrators, are perfectly capable of handling such a situation comfortably. As we heard from my hon. Friend the Member for North Dorset (Simon Hoare), everyone is capable of walking and chewing gum at the same time, and I think that the right hon. Member for Belfast North made it clear that that was not the main source of his concern.
I accept what the Minister has said, but does he agree that this particular referendum will absorb the minds and hearts of people throughout the United Kingdom as no referendum has for 40 years, and must therefore be unencumbered by any other electoral considerations?
I agree with part of that. The important point is that the overlap needs to be dealt with extremely carefully. We must not attempt to run two polls at the same time, but an overlap is perfectly feasible provided that we accept a gap of a minimum of six weeks between them. I remind the House that six weeks is the full length of a general election campaign during which we decide who is to govern the country.
I am sorry to tell the Minister that after a six-week general election campaign my constituents are pretty cheesed off with politics. I think we need to understand that not everyone in the country is as excited about politics as we are in this place. A short campaign enables people to focus on the issues, and then to make a decision at the end of that short campaign.
Absolutely. Europe is one of those issues that may be extremely exciting for a small number of people—extremely exciting, perhaps, to a small number of people in this place and in the half-mile that surrounds us—but if we “bang on about Europe” for far too long, we shall run the countervailing risk of starting to turn people off the whole issue, important though it is. A decent period which, after all, we use to decide general elections is what the country and the electorate are used to. It allows plenty of time for a full and in-depth discussion of the issues that need to be covered, without necessarily boring everyone to tears and turning everyone off before they go to the ballot boxes. Of course I entirely accept that a gap will be necessary.
Given that Northern Ireland remains part of the United Kingdom and will continue to do so for a long time, I expect the Prime Minister of the United Kingdom to come to Northern Ireland and campaign for it to remain part of the European Union. It would be helpful if the Minister confirmed that the Prime Minister will indeed campaign in Northern Ireland, but will do so after the Northern Ireland Assembly elections and not before.
I thank the hon. Lady for giving me this opportunity to commit the Prime Minister’s forward diary in such a specific way, although I think it would be a career-limiting move were I to do so. I suspect that she will nevertheless make her point strongly, and my right hon. Friend will have an opportunity to respond to it specifically.
I am sure the Minister would agree that the decision on whether to remain in the European Union is at least as important as the decision that Scotland had to take on remaining in or leaving the United Kingdom. There were 540 days between the announcement of the Scottish referendum and the date of the poll. We are not necessarily suggesting that there should be that length of time before this referendum, but if the Minister is saying that there should be a free and open discussion, the period should surely be longer than six weeks.
This is where I would respectfully part company with the hon. Gentleman. While it would be stretching a point to argue that holding two polls in the same place a minimum of six weeks apart would be somehow disrespectful or that it would prejudice the result of either poll—