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Commons Chamber

Volume 607: debated on Tuesday 22 March 2016

House of Commons

Tuesday 22 March 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—

Cancer Survival Rates

Before I answer the questions, may I start by saying that I am sure the thoughts of the whole House are with the people of Brussels today after the shocking events that they have witnessed? As the Prime Minister made clear this morning, we will do all we can to support them.

Cancer survival rates are at a record high. We are on track to save an estimated 12,000 more lives a year for people diagnosed between 2011 and 2015, but we know that we need to strive to be better. The independent cancer taskforce report, “Achieving World-Class Cancer Outcomes”, which was published last summer, recommends improvements across the cancer pathway and sets a clear ambition for further improvement of survival rates.

I thank my hon. Friend for that answer, and I associate myself with her comments about the terrorist outrage in Brussels.

As my hon. Friend may be aware, the Rosemere cancer foundation has been fundraising for a new chemotherapy unit at Burnley general hospital, which will be a huge boost for cancer patients in my area. Because of the huge generosity of Pendle residents, Rosemere has already raised £90,000 towards its target of £100,000. Will she join me in congratulating Rosemere on its efforts and encouraging residents to help it to meet its full target?

Absolutely. It is a delight to associate myself with my hon. Friend’s support for that excellent local group. The Rosemere cancer foundation supports world-class cancer treatment throughout Lancashire and south Cumbria. Around 4,000 chemotherapy treatments are delivered each year at Burnley general hospital, and the new unit will be of real benefit to local cancer patients from my hon. Friend’s constituency—for which, as he knows, I have great affection—and from the surrounding area.

Is there anything further that my hon. Friend can do to incentivise NHS trusts to replace linear accelerators that are more than 10 years old, and thereby allow more patients to access cutting-edge radiotherapy techniques?

This, of course, is one of the areas covered by the cancer taskforce, and it is a very important matter. Cally Palmer, the NHS national cancer director and chief executive of the Royal Marsden, is leading on taskforce implementation. The replacement of LINACs is being taken into consideration in planning improvements across the pathway. That can only be done because we are putting into the NHS and into cancer treatment the money that we need to achieve those world-class outcomes.

Each year, 38,000 people in the UK are diagnosed with a blood cancer, but very few people are familiar with the term blood cancer. Patients have expressed concern about the fact that a lack of awareness has a significant impact on them throughout their patient journey, from causing confusion and uncertainty at diagnosis to making them unaware of the organisations that provide the support and care that they need. Will the Minister tell us what more the Government can do to tackle that lack of awareness in order to improve outcomes and survival rates for all patients affected by the 137 types of blood cancer?

The hon. Lady is absolutely right to draw the attention of the House to the challenge of joining up thinking across the cancer pathway. That is exactly the approach that Cally Palmer and the taskforce implementation team are looking at. I recently had a conversation with her and with NHS England representatives in which we talked about how we get that joined-up approach. That is at the heart of the taskforce’s recommendations, and we will be taking it forward for all the reasons that the hon. Lady has eloquently expressed.

Cancer Research UK has said that cancer waiting targets have been missed so many times that failure has become the norm. Does the Minister agree that failure to tackle that is undoing the good work of the last 15 years on survival rates?

These days, we are dealing with the fact that a hugely greater number of people are being diagnosed. The increase in the number of people being referred by GPs is extraordinary. For example, last year GPs referred nearly half a million more patients to see a cancer specialist. That is an increase of 51%. When it comes to waiting lists, of course we want to make sure that everyone is seen. The Government have committed more money to diagnostics, for example, but we expect the NHS to look urgently at any local dips in performance and to take action to make sure that all patients get access to treatment as quickly as possible.

Will the Minister join me in welcoming the Government announcement of funding for a new radiotherapy machine in Eastbourne district general hospital, which will improve cancer survival rates for patients from Seaford, Alfriston, Polegate and East Dean in my constituency?

Absolutely. My hon. Friend again highlights where we are investing, upgrading machines and putting in money, effort, people and resources to make sure that we can achieve world-class cancer outcomes. As I say, we are on course for record outcomes in terms of patients surviving 10 years beyond a diagnosis. However, we always want to do better, so I applaud the local efforts that she has highlighted.

I would like to reiterate what the Minister said. As I sure my hon. Friends would agree, our thoughts go out to everybody in Brussels at this time.

Will the Minister please inform the House of what consideration has been given to bringing the bowel cancer screening age into line with that in Scotland—at 50 rather than 60—following the recent Westminster Hall debate on this subject?

We had an excellent debate. An extraordinary number of colleagues turned up in Westminster Hall, a debate of just half an hour, demonstrating how many people are interested in this important subject. I outlined in my response to the debate the fact that we have the bowel scope screening programme and the bowel cancer programme in England, which complement each other. The result, particularly of bowel scope screening, is that we can actually make a huge impact on mortality rates for people who are caught. I went into that in more detail in my response to the debate, but that is the key to making sure we identify more people and stop them dying from this dreadful disease.

Deprivation of Liberty Safeguards

2. What recent representations he has received on the effect on health budgets of the administration of deprivation of liberty safeguards. (904251)

I have received a range of representations on the effect of the deprivation of liberty safeguards, including on the impact that the current system has on health and care budgets. The hon. Lady is a respected voice on the challenges that these safeguards pose, and I can reassure her and the House that there is ongoing work to address those challenges.

I thank the Minister for his reply. Deprivation of liberty assessments are costing Stockport Council £1.2 million this year, as a result of the Cheshire West judgment. Not one single penny of that is providing social care. This is clearly unsustainable at a time when social care budgets are under intense pressure. Something needs to be done now; we cannot wait for the Law Commission. Will the Minister consider, as a small step forward, scrapping costly automatic annual reassessments and the necessity to reassess every time an elderly person leaves a care home to go into hospital?

I will happily look at anything that might assist us. As the hon. Lady knows, we are caught in the process of trying to deal with a court judgment and the issues surrounding mental capacity in relation to deprivation of liberty safeguards, which are genuinely serious and cannot be easily changed at the stroke of a pen, as well as the extra costs that the problem has raised. We are now close to hearing the Law Commission’s post-consultation proposals. I understand that it will publish its latest analysis in mid-May and will have drafted detailed legislation by the end of December. I will look at any suggestion of hers that might ease the situation practically.

Will the Minister confirm that when the new legislation is finally introduced, it will be simpler to understand and result in fewer bereaved relatives facing distressing delays when a loved one dies in care?

My hon. Friend is absolutely right. What has caused the confusion has been a definition of loss of liberty and dying in state detention that bears no relation to anyone’s common-sense understanding of the situation. Whatever new legislation is proposed by the Law Commission, it must meet the test of being much simpler, but it must also meet the legislative test of meaning what it says so that it does not get disrupted in the courts again.

Hepatitis C

The UK Government take the issue of prevention, diagnosis and treatment of hepatitis very seriously. I can confirm that Public Health England and NHS England, together with key stakeholders, are continuing to develop a strategic approach to tackling hepatitis C, including plans which have now been published for treatment through operational delivery networks.

So far as I am aware, the Scottish Government provide treatment for all those with sensitive hepatitis C, including those infected with contaminated blood, and that transforms the lives of patients and reduces the risk of further infection in the population. Will the Minister commit to providing similar access to treatment in England?

The National Institute for Health and Care Excellence has provided guidance on the new drug, so the hon. Gentleman is right to highlight how effective the new treatments are compared with what was previously available. The NHS is in the process of rolling out its response. It has already treated a number of people, and there is a commitment to treat 10,000 people with those treatments in 2016-17. We are of course looking more widely at how we can tackle these issues, not least in the context of the tragedy of those infected with contaminated blood, which he has highlighted.

What discussions has the Minister had with her counterpart in Northern Ireland regarding the reduction and eventual eradication of hepatitis C? Does she agree that it is important to have a strategy that encompasses the whole United Kingdom of Great Britain and Northern Ireland?

Absolutely. The consideration of all aspects of how we eliminate hepatitis C over time is important, but we should not underestimate what a difficult job that is, largely because an awful lot of people are not aware that they have it—they are asymptomatic and therefore much of the burden of the disease is not visible to us. However, there is always more we can do, and we continue to make this issue a priority.

Junior Doctors Contract

4. Whether the terms and conditions of the junior doctors contract were finalised before he took the decision to introduce that contract. (904253)

May I start by echoing the thoughts of my the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), for the people of Brussels, with whom we stand shoulder to shoulder?

In my statement to the House on 11 February, I gave a broad outline of the new terms for doctors and dentists in training, which were recommended as fair and reasonable by Sir David Dalton. I am still reviewing the exact terms, alongside the equality impact assessment, and finalised terms will be published shortly.

When the Secretary of State declared that he was imposing the contract on junior doctors last month, he claimed the support of senior NHS leaders, many of whom subsequently denied supporting his position. Given that foundation trusts are free to offer their own terms, how does he envisage enforcing that contract?

We consulted widely with NHS leaders about the terms of the new contract, and they confirmed that it was fair and reasonable. Any decision to proceed with a new contract when it is not possible to have a negotiated settlement is inevitably controversial, but we wanted to ensure that independent people thought that the terms of the contract were fair. I think we have done that, and when junior doctors see their new contracts—as they will do shortly—they will realise that we were right to say that.

Underlying the dispute over the junior doctors contract is a long-standing problem of morale among junior doctors, and a failure to pay enough attention to their experiences in training. I welcome the Government’s decision to launch an independent review led by Professor Dame Sue Bailey, and I ask my right hon. Friend to update the House on the progress and timing of that review.

As ever, my hon. Friend speaks with great knowledge about NHS matters, and she is right to say that some of the underlying issues have nothing to do with contractual terms but are about very big changes in the way that training has happened over recent years, in particular the loss of the firm system and the sense of camaraderie that was part of the deal for junior doctors in training. We would like to see whether we can rectify some things that have gone in the wrong direction, but we have not yet had the co-operation of the British Medical Association for that independent review, which is led by the highly respected Professor Dame Sue Bailey. I hope that the BMA will co-operate with that, because it is a big opportunity to sort out some long-standing problems.

There are currently 4,500 gaps for trainees in the NHS. Junior doctors often have to cover those gaps, which can mean having to do extensive extra shifts, or even covering two roles at the same time. It looks as if that situation will get worse, because fewer than half of the most junior trainees have applied for ongoing training this year. Does the Secretary of State accept that that represents a serious threat to patient safety?

The purpose of the changes is to improve patient safety, and particularly to deal with the issue that we have higher mortality rates for people who are admitted to hospital at weekends than for those admitted during the week. Because of the confrontational approach taken by the BMA, it has been difficult to negotiate an agreement, but we are committed to doing the right thing. What is right for patients is also right for doctors. We have been talking about morale, and the biggest way to dent doctors’ morale is to prevent them from giving the care that they want to give patients, so we must sort that issue out.

I suggest that what is good for doctors is also good for patients, and if people are being texted four or five times a day and asked to do a second shift to cover for a junior and a senior post at the same time, that is not good for either. On 11 February the Secretary of State said that he was imposing the contract to bring stability to the NHS, but that has not exactly gone well. What is his plan to re-establish his relationship with junior doctors and get us back out of where we are now?

With the greatest respect, we are trying to solve a problem that in Scotland is being ducked. We want a seven-day NHS with mortality rates that are no higher at weekends. There is no plan in Scotland to deliver that across the whole NHS. Rather than sniping, the hon. Lady should recognise that, in the interests of patient safety, we need to take difficult decisions. In the end, doctors will see that it is the right thing for them, too.

First, on behalf of the Opposition, I associate ourselves with the comments made by Ministers about the tragic events in Brussels, and offer our condolences and solidarity to the people there.

Yesterday in Westminster Hall, there was a debate calling on the Health Secretary to resume meaningful contract negotiations with the BMA. The Health Secretary was not there—I do not know, but perhaps he was out buying a leaving present for the Chancellor—but if he had been, he would have heard his junior Minister confirm that, since the announced imposition, the Government have made no attempt to prevent further industrial action. They know more industrial action is coming. Do they not owe it to patients who would be inconvenienced by further strikes to get off their backsides and do something to prevent it?

The reason we made the decision to proceed with the new contracts is that we had independent advice that a negotiated settlement was not possible. On that basis, we decided that it was important to have certainty for the service by making clear what the new contract is. The contract that we decided on is one that strikes a mid-point between what the Government wanted and what the BMA asked for. It is a fair contract and a better contract for patients. The Labour party would support it if it was really on the side of patients.

Children and Young People’s Mental Health Services

5. What steps the Government is taking to improve support for children and young people with mental health problems. (904254)

The Government are committed to delivering the vision set out in “Future in mind” and are driving forward a major system-wide transformation programme, working alongside our partners in Government and arm’s length bodies to improve access to high-quality support across the country.

I thank my right hon. Friend for the steps he has set out. Will he join me in congratulating the charity YoungMinds on the important work it does in highlighting the mental health challenges young people face, not least from the so-called dark net and social media. Does he agree that we must ensure that the internet is a positive and not a negative force in tackling young people’s mental health challenges?

Yes, the work that YoungMinds and a range of other partners have done and continue to do to ensure that children and young people can access information safely is commendable. Children, young people and their parents have expressed the need to access both high-quality and reliable information and support online. That was reflected in the “Future in mind” report on children’s and young people’s mental health. We are investing with MindEd and a number of groups and organisations to work on apps for young people. It is important that they have access to safe material to exclude that which is rather darker.

The Minister will recognise that walk-in centres run by experienced GPs can offer important support to children with mental health problems, yet popular walk-in centres that were established by local GPs in my constituency are being put out to tender, putting at risk the leadership and involvement of those experienced GPs in the centres. Will the Minister give guidance to the NHS Procurement Authority that walk-in centres should be led by local GPs with experience of that area?

I will look at what the hon. Gentleman says. As he will appreciate, I am not responsible for individual commissioning decisions. The commissioners will have full regard to the needs of the local population when they are putting those services out. It is important that access is increasingly available at GP and primary level, as well as in other areas where the Government are investing further money. I will have a look at what he says.

20. Will the Minister inform the House of what dialogue is maintained between his Department and the Department for Education to ensure that those issues are picked up and that help is signposted as early as possible? (904271)

There is a growing relationship with the Department for Education—it is better than it has ever been. For the first time, there is a Minister responsible for mental health in the Department, and there is a schools champion for mental health, whom I met the other day at a conference in Cambridge. The Departments work closely together to deliver the vision set out in “Future in mind”. For example, there is a £1 million pilot project, working across 22 schools, to find the right people in schools to deal with mental health issues. There is much greater recognition that, the earlier we pick up these things, the better it is for youngsters and their future mental health.

Eating disorders among children and teenagers cause life-threatening health problems and even death. What steps is the Minister taking to enable early detection and intervention, which result in better prognoses and support closer to home?

There are two things that can help the hon. Lady. The first is the commitment to build £30 million a year into budgets over the next five years to support those with eating disorders, about which I spoke at a conference last week. The second is the earlier detection of eating disorders. We reckon that, by 2020, 95% of urgent eating disorder cases will be seen within a week, with routine cases seen within four weeks. There is recognition of the real danger now posed by eating disorders.

Earlier this month, school and college leaders reported a large rise in the number of students suffering from anxiety. Two thirds said that they struggle to get mental health services for their pupils, and of those who had referred a student to child and adolescent mental health services—CAMHS—most rated them as “poor” or “very poor”. Despite the Minister’s warm words, things are getting worse, not better. Will he confirm that every single penny promised to children’s mental health will reach those services and that none of this money will be used to plug the gap in hospital budgets?

Following long and frank conversations between me, the NHS and the Treasury, I can give the hon. Lady that assurance—every penny of the £1.4 billion pledged in the 2015 Budget for CAMHS and for eating disorders will be spent on children’s mental health by the end of this Parliament. It is not fair continually to say that nothing is going on. The first tranche of money—£173 million—is being spent: £75 million to the clinical commissioning groups; £30 million to tackle eating disorders; £28 million for the expansion of children’s IAPT—improving access to psychological therapies—services; £15 million for perinatal services; and £25 million to address other issues involving training. That is money already committed and it is being spent now. The problems that she mentions are a high priority and are being dealt with.

I listened carefully to the Minister, but by his own admission—in response to parliamentary questions—he is going to underspend this year by £77 million on his pledge to spend £250 million on CAMHS, and by £11 million on his £15 million pledge regarding perinatal mental health. He talks about the importance of intervening earlier. Does he agree with Labour that every child should receive personal, social, health and economic education so that young people are equipped with the resilience better to support their mental health?

We cannot have it both ways, it would seem. I have given a pledge, which the hon. Lady asked for in her first question, that the £1.4 billion committed to CAMHS will be spent by the end of this Parliament—and it will be. It is known that the first tranche has not been fully committed, but this is the first year and some money has to roll over. However, I have made absolutely sure that that money will be spent, including on perinatal services, which will reach a much better place than when we came into office, and that is very important. The work will be done. PSHE is not a matter for this Department, but I fully agree that it is important that children have such information. The pressure caused through social media, sexting and the like means that children these days need to have a very up-to-date, modern understanding of issues associated with personal health and social education, which I fully support.

May I gently point out to colleagues that, very useful and comprehensive though these exchanges have been, as usual at this stage we have got a lot to get through and we need to speed up a bit? There is a long waiting list of colleagues and we must get through that list.

100,000 Genomes Project

6. What progress the 100,000 Genomes Project has made on providing UK leadership for international developments in precision medicine. (904255)

Our groundbreaking 100,000 Genomes Project, which was announced by my right hon. Friend the Prime Minister as part of our 10-year life sciences strategy, represents the moonshot of medicine in making the UK the first nation on earth to sequence the entire genetic sequence of 100,000 genomes from NHS patients. Through our precision medicine strategy, the launch of 13 genomics medicine centres in the NHS, funding from Government and the precision medicine catapult, we are winning international plaudits and attracting inward investment, as a sign of our commitment to a 21st century NHS.

I recently visited the medical school in Nottingham where I saw the great work being carried out, including groundbreaking genomics work on identifying Alzheimer’s risk genes. What support is the Department providing to ensure that work is fully funded and expanded, so that the east midlands and the UK continue to be world leaders in the search for treatments and ultimately a cure for Alzheimer’s, based on our research?

I pay tribute to my hon. Friend, who had a distinguished career in the life science sector, including through setting up her own business. She is right to highlight the work at Nottingham University which, along with Leicester and Birmingham, represents something of an east midlands powerhouse. The Nottingham University Hospitals NHS Trust is part of the East of England NHS Genomic Medicine Centre, recruiting patients and becoming one of our hubs for NHS genomics medicine. In addition, we are actively supporting research into Alzheimer’s through our £1 billion a year National Institute for Health Research budget, the £150 million Dementia Research Institute and our dementia plan. I continue to lead conversations with dementia charities.

Mental Health Services

7. What progress the Government have made on achieving parity of esteem for physical and mental health services. (904256)

We remain committed to achieving parity of esteem between mental and physical health, and we are investing more than ever in mental health. We welcomed the publication of the Mental Health Taskforce report last month and will work to embed its recommendations in our policies.

Steph Cater, a 17-year-old at Pate’s Grammar School in my constituency, is concerned that mental health in-patient services are distributed unevenly, meaning that those needing treatment can end up being cared for hundreds of miles away from their families. What more can be done to ensure that those in crisis are treated closer to home?

A review of beds in 2014 partly redressed that uneven distribution. In my hon. Friend’s area, an analysis of the impact of the new beds shows that the average distance travelled to child and adolescent mental health services units in the south-west has improved from 114 miles in 2014 to 39.9 miles in 2016. It is not enough simply to provide more beds, however. We have to provide more community-based support and treatment—that is at the heart of “Future in mind”. The number of out-of-area treatments also has to be reduced.

I was delighted that Paul Farmer’s taskforce report endorsed the plan first proposed by the Secretary of State and myself in 2014 to have comprehensive maximum waiting times in mental health by 2020 so that people with mental ill health have exactly the same right to treatment on time as others. I was delighted that the Government endorsed the whole plan, but dismayed that Simon Stevens then confirmed that there was no money to implement it. How will the Minister ensure that the comprehensive waiting time standards are implemented by 2020?

If anything, questions are getting longer, not shorter. I say with great courtesy to the right hon. Gentleman, whom I hold in the highest esteem and whose track record is greatly respected across the House, that his question was far too long.

Two things: the first set of waiting time standards—the first ever by a Government—are already in place from April 2015, with 50% of people experiencing an episode of psychosis treated within two weeks and improved waiting times for talking therapies; and, secondly, we have to get the database right. The right hon. Gentleman will know that we are doing an extensive and much greater data trawl to find a base on which those waiting times can be set, but it remains our determination to get them introduced by 2020.

Future in Mind Strategy

8. What improvements have been made to child and adolescent mental health services since the publication of the Government’s strategy, “Future in mind”, in March 2015. (904257)

Progress has been made on many of the key ambitions set out in “Future in mind”. Of greatest significance is the development of local transformation plans that cover the full spectrum of children and young people’s mental health issues, from prevention to intervention for emerging or existing mental health problems, for every clinical commissioning group in the country.

This month, the Mental Health Network, representing NHS providers, said that very little, if any, of the money promised for child and adolescent mental health has yet materialised and that some services are experiencing cuts in-year. The Minister must accept, despite his assurances to my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger), that the Department’s efforts in getting this money out the door has been woeful. What will he change?

I do not necessarily, despite the energy of the hon. Member for Liverpool, Wavertree, accept everything that she says. I gave a list of where the money is being spent. However, I think I can help both the hon. Gentleman and the hon. Lady. Much more is being done to ensure that CCGs deliver what they need to deliver in relation to mental health. This year’s figures will show that, whereas there has been a 3.7% uplift for CCGs, there has been an uplift of 5.4% in mental health spending. With more transparency and more determination by the NHS on CCG spending, hopefully what people are saying and feeling will become less justified in the future.

Healthcare Spending

9. How much was spent on healthcare as a proportion of GDP in (a) 2009-10 and (b) 2014-15; and what estimate he has made of the amount that will be spent on healthcare as a proportion of GDP in 2020-21. (904258)

Because in 2010 the country faced a deficit that constituted 11% of GDP, all major political parties committed to plans that reduced Government spending, including on health, as a proportion of GDP. However, because of this Government’s commitment to the NHS, health spending as a proportion of Government spending will increase from 14.2% to 15.8% over the decade.

Former coalition Minister David Laws has recently written that under the previous Government the NHS chief executive told Ministers that the health service required an additional £30 billion, and that he was forced to cut that figure and squeeze it down to £15 billion, but was allocated only £8 billion by the Treasury. That was a savage cut of £22 billion to what the NHS really needed. Is that not the root cause of all the NHS’s problems, and does it not make utter nonsense of the Government’s claim to be protecting NHS funding?

What the hon. Gentleman describes as a “savage cut” was a real-terms increase of £10 billion a year, which was £5.5 billion more than his party proposed as part of the platform he stood on at the last election.

16. Does my right hon. Friend agree that as well as focusing on health inputs and how much we spend on the NHS, it is also important that we focus on health outcomes? (904266)

My hon. Friend is absolutely right, which is why I am so proud that under this Conservative Government we have put 27 hospitals into special measures, 11 of which have now come out of special measures. We are improving the standard and quality of care, and increasing the number of people being treated across the board. Outputs matters, and that is what this Conservative Government will deliver.

The Health Secretary may talk a good game on funding, but the reality in A&E departments and GP surgeries tells a very different story. The whole system is on its knees, and the revelations of the former Chief Secretary to the Treasury this weekend confirmed what everyone in the NHS already knew—making £22 billion of efficiency savings over the next four years is pure fantasy. In the interests of transparency, therefore, will he now publish the full analysis explaining how NHS England arrived at the figure of £22 billion?

Let us look at what the chief executive of NHS England, Simon Stevens, actually said, and not what he is alleged to have done, which he denies. He said that, when it came to the spending review, the Government had listened to and actively supported the NHS’s case for spending and that he could kick-start his plan for the NHS. But it is rather academic—is it not?—because Labour refused to fund his plan at all, which all goes to show, when it comes to the NHS, that Labour writes the speeches but Conservatives write the cheques.

I did not ask the Health Secretary what the chief executive of the NHS said. I asked the right hon. Gentleman to publish the analysis behind the £22 billion figure, but he will not do so because he knows that the only way to achieve these politically motivated efficiencies is by making cuts to staff and pay. The truth is that the NHS survives on the good will of its staff, yet he has pushed that good will to breaking point. How does he expect to improve current services, let alone deliver a seven-day NHS, with fewer staff and a demoralised workforce?

Under this Government, staff levels have actually risen: we have 11,000 more doctors and 12,000 more nurses. If the hon. Lady is worried about NHS funding, perhaps she might look in the mirror, because in 2010 her party wanted to cut funding to the NHS—in Wales, it actually did cut it—and in 2015 it wanted £5.5 billion less than the Conservatives. The NHS does not need Labour rhetoric; it needs more doctors and more nurses, which we can have only on the back of the strong economy that only the Conservatives can deliver.

NHS Staff Morale

The Department assesses staff morale in the NHS using engagement scores from the annual NHS staff survey. I am delighted to say that the engagement score currently runs at 3.78 out of 5, which is a rise from the position in 2012, when the survey began, when it was at 3.68.

On top of the junior doctors debacle, the staff survey shows that midwives are stressed, with 90% of them working extra shifts unnecessarily. I have raised before the case of the radiographer Sharmila Chowdhury, who was sacked for exposing bribes at Ealing hospital, but has yet to get a practical response, other than the words, “Francis review”, which has yet to be implemented. When will the Government get a grip on plummeting morale in the NHS?

The hon. Lady asked a number of questions. On the specific issue about this particular member of staff, I know that my right hon. Friend the Secretary of State has met her, and I would be happy to discuss this further. The hon. Lady is wrong about the Francis recommendations, which are being implemented in full. She should look at the balanced results from the staff survey, with more staff saying that their motivation at work is going up, with the number recommending their trust as a place of work and as a place to receive treatment going up, and with the number able to contribute to improvements at work also going up. There are issues in the staff survey that we would like to address—it is unfortunate to see reports of bullying and harassment going up—but we are addressing the problem through the staff partnership forum, which I chair. Overall, however, this is a balanced and positive return from the staff survey.

Will my hon. Friend confirm that, as well as the importance of staff morale, we should note that in hospitals where seven-day working has been implemented, patient morale is also improving considerably?

My hon. Friend is right, and the returns from the friends and family tests across the country show increasing patient satisfaction with the NHS.

22. How does the Minister think that staff morale is affected when people hear the Government’s constant refrain of “implementing seven-day working”, particularly among pathology staff and others who have for decades provided a 24/7 service? (904274)

Despite the best efforts of Labour Members, staff morale has gone up over the past few years. The situation is not helped when the nature of the junior doctors contract is misrepresented, as it continually is by Labour Members. If they were to give a fair account of the contract to their constituents, I am sure we would see further improvements in staff morale in years to come.

Staff morale at Uckfield community hospital is exceptionally high, partly owing to its receiving 100% in a recent friends and family survey. Will the Minister join me in congratulating all the nurses, volunteers and front-office staff in Uckfield community hospital?

I happily congratulate the staff at my hon. Friend’s local hospital. This shows where good constituency representation, reinforcing the efforts of local people working in local hospitals, can produce improvements in staff morale and therefore in the experience of patients, which is something from which Labour Members would do well to learn.

In a recent survey, 70% of GPs warned that their workloads were becoming unmanageable, and 55% said that the quality of the service they provided had deteriorated, with too few patients getting appointments, treatment and the range of services needed. We now hear reports of a large decrease in applications for GP training places, and this is one of the last cohorts to be fully trained by 2020. Unless the Minister takes urgent action to address these issues affecting GP morale, workload and recruitment, patient care will just get worse. What is he going to do about it?

The hon. Lady raises the issue of GPs. We are ensuring that there will be 5,000 additional GPs by the end of this Parliament, which addresses precisely the issues that she raises.

I do not know why the hon. Lady is shaking her head. She asked what I am doing, and 5,000 additional GPs will help to solve her problem. Secondly, we are putting a greater proportion of funding into general practice, by comparison with the proportion of the NHS budget as a whole, than any previous Government. Thirdly, we are increasing the number of GP training places. I am pleased to report that we are doing well in ensuring that more people in training positions are choosing to become general practitioners.

Hospitals in Special Measures

12. What progress his Department has made on improving the performance of hospitals in special measures. (904261)

Trusts put into special measures have recruited 1,363 more doctors and 4,190 more nurses, with one estimate saying that this has reduced mortality rates by up to 450 a year.

In the past six years, the North Cumbria University Hospitals NHS Trust has had four chief executives, an acquisition that is going nowhere and a so-called success regime that is reporting later than intended. There are clearly tough decisions to be made in the north Cumbria health economy, and the sooner they are made, the better. Will the Secretary of State undertake to ensure that the recommendations of the success regime are implemented in full and in a timely manner?

I thank my hon. Friend for his persistent campaigning on behalf of his local trust. He is right that there are big issues there. He is also right generally that the NHS has too rapid a turnover of chief executives. There is a new one, Stephen Eames, who is one of the top-rate NHS chief executives. The Care Quality Commission says that things are improving and mortality rates are going down. I will support my hon. Friend in every way I can to resolve the situation as quickly as possible.

As the Manor hospital is in special measures, Walsall mothers-to-be are being denied the right to choose to have their babies at that hospital. Will the Secretary of State confirm that there are safe staffing levels at the Manor and at other hospitals?

What I can tell the hon. Lady is that we have 83 more doctors and 426 more nurses at Walsall Healthcare NHS Trust than we did in May 2010. The trust has a quality improvement plan, and it has had an improvement director since February.

Mesothelioma Research

I thank the hon. Gentleman for raising this issue. Mesothelioma is a terrible disease from which more than 3,000 people die in this country every year. The Government are completely committed to supporting treatment, prevention and compensation. In the last three months my noble Friend Lord Prior has had a number of discussions with interested parties, and, as the hon. Gentleman will have noted, my right hon. Friend the Chancellor was able to announce £5 million of funding for a new mesothelioma research centre in last week’s Budget.

The British Lung Foundation has welcomed the £5 million that the Government have announced for a national mesothelioma centre, but when will those funds be released, and how will the Government ensure that funding for research is sustained in the years that follow?

We are engaged in active discussions with the various parties, including charities such as Cancer Research UK, and we have received some interesting submissions from some of the research institutes. Over the coming weeks, we will consider how best to put that £5 million from the Government to work in order to maximise inward investment and build UK leadership in this important centre.

Cough Assist Machines

14. What steps he is taking to ensure that people with muscle-wasting conditions who require a cough assist machine have access to such a machine, commissioned in the community by their clinical commissioning group. (904263)

NHS England is working with Muscular Dystrophy UK through the Bridging the Gap project, and looking at issues such as the provision of cough assist machines, which are a local matter for clinical commissioning groups. A number of CCGs now have commissioning policies for these devices, based on a policy developed by Walsall CCG and shared nationally as an example of good practice by Muscular Dystrophy UK.

Twenty-one-year-old Freddie Kemp, who had muscular dystrophy, sadly died of cardiac and respiratory complications. He had been refused a machine by his CCG. The Minister said that he was working with Muscular Dystrophy UK. Will he meet representatives of that organisation to discuss what can be done to persuade CCGs to prioritise the provision of these important machines?

I thank the hon. Lady for bringing the matter to the House’s attention. Of course I will meet any groups who are concerned with it. I understand that the clinical evidence is divided in respect of the efficacy of cough assist machines as opposed to manual massage, but Walsall CCG has sought to resolve that—successfully, I understand—and other CCGs might wish to adopt its template. However, I will of course discuss with the hon. Lady personally the issues that she has raised.

HIV Pre-exposure Prophylaxis

15. What the timetable is for the launch of the public consultation on HIV pre-exposure prophylaxis for adults at high risk of contracting HIV. (904264)

NHS England will invest £2 million over the next two years in order to run, together with Public Health England, early implementer test sites which will seek to answer the remaining questions about how PrEP could be commissioned in the most cost-effective and integrated way to reduce the incidence of HIV and sexually transmitted infections for those at the highest risk.

Yesterday NHS England scrapped plans to fund PrEP. Is there anything that the Minister can do to end this erratic and inconsistent decision making? Does she agree that yesterday’s decision to abandon the roll-out of a game-changing drug totally failed those who are at risk of contracting HIV?

NHS England’s senior specialised commissioning management team made that decision, and I think NHS England recognises that it could have been made earlier. However, it is also recognised that NHS England has already done valuable work. Some important lessons have been learned, and we do not want to lose that. We must now work with both NHS England and Public Health England to understand how we can continue to learn from, for example, the test sites.

I share some of the concerns expressed by the hon. Member for Hornsey and Wood Green (Catherine West) about the roll-out of PrEP, but it is only one tool in HIV prevention. Will my hon. Friend update the House on the progress of the HIV prevention innovation fund?

My hon. Friend is right to draw the House’s attention to the fact that PrEP is only one part of prevention, although obviously we understand its importance. He is also right to mention the innovation fund, which, of course, he championed. We have invested up to £500,000 in new and innovative ways to tackle HIV. Some excellent organisations have come forward with some very innovative approaches, and we have also established the first national HIV home sampling service.

Topical Questions

The latest performance figures show the challenges that the NHS faces in coping with extraordinary levels of demand. Despite these pressures, however, the Government are making good progress in our ambition that NHS care should be the safest and highest quality in the world. Figures from the Health Foundation show that the proportion of patients being harmed has fallen by more than a third in the past three years, that MRSA infections have nearly halved since 2010, and that C. diff infections fell by more than a third over the same period.

The “Five Year Forward View” said that the NHS would need between £8 billion and £21 billion extra from the Treasury by 2021. It got a commitment of £8 billion, which was opposed by the party opposite. Can the Secretary of State say when the Stevens plan will be formally reviewed, and where in the range between £8 billion and £21 billion he expects the real requirement will be found to lie?

We are actually putting in £10 billion of additional public money to support the NHS over the next few years. That means that we need to find between £20 billion and £22 billion of efficiency savings. We will be reviewing the progress of the plan as we go through it, but I want to reassure my hon. Friend that I meet the chief executive of NHS England to view the progress of the plan every week and that we are absolutely determined to ensure that we roll it out as quickly as possible.

T4. I would like to express my sadness at the news that two people in my constituency lost their lives in a house fire yesterday. My thoughts are with their family and friends at this extremely sad time. The coalition Government legislated for NHS hospitals to earn up to 49% of their money from private patients. Arrowe Park hospital in my constituency is highly valued by local people for the service that it delivers, so for the sake of clarity will the Minister tell us whether he sees an increase in the number of NHS beds being used for private patients and a decrease in the number being used for NHS patients as a sign of success or a sign of failure? (904243)

The matter of private beds is entirely for the trust to decide, but we are very clear that NHS patients should always come first.

T3. In the last decade, under the then Labour Government, Crawley hospital saw its accident and emergency and maternity units close. However, I am pleased to say that in recent years we have seen casualty services returning, as well as the introduction of a GP out-of-hours service and a greater number of beds. Will my right hon. Friend join me in congratulating the NHS staff in my constituency who are working so hard to deliver these new services? (904242)

I am absolutely delighted to join my hon. Friend in congratulating the staff in his constituency. A&E targets there have been met in the year to date: at the moment they are seeing 36,509 more people in under four hours every year compared with six years ago. The trust is meeting its 18-week target and its diagnostic waiting time target, so that is a very good performance.

T8. Scotland has consistently outperformed all other nations in the UK on A&E over the past year. With England’s performance dropping in every single month since weekly publication was abandoned last July, does the Secretary of State think it is time to return to more frequent analysis and to eliminate the obfuscation of the six-week delay in publication? (904247)

I am somewhat surprised at the complacency of the hon. Gentleman’s question after Audit Scotland identified in the autumn that performance against seven of the nine key targets for the Scottish NHS had deteriorated in the past three years, that spending since 2009 had fallen in Scotland while increasing in England, and that spending on private sector providers was increasing. The hon. Gentleman should think about that before he criticises what is happening in England.

T5. Successful cardiopulmonary resuscitation often involves people knowing where the nearest public access defibrillator is located. In my constituency, however, it is difficult to find out exactly where such defibrillators are located. Will the Minister ask the Department of Health to carry out a live mapping of public access defibrillators as well as ensuring that every workplace with a first aid point has a clear sign showing where the nearest defibrillator is located? (904244)

This work is already in hand through the British Heart Foundation. I should like to add that last week the Chancellor announced another £1 million to make public access defibrillators and CPR training more widely available in communities across England. Coupled with last year’s funding of £1 million, that means that there are now over 690 more publicly accessible defibrillators in communities across England. That mapping work is important, however, and my hon. Friend is right to raise it.

I believe that the Capsticks governance review, published today, will show that serious harm was caused to patients and staff, that there was a culture of bullying and harassment even after the Francis inquiry, and that Liverpool Community Health NHS Trust is the community equivalent of Mid Staffs. In the spirit of openness and transparency, will the Secretary of State instigate a public inquiry to establish the full extent of the harm caused to patients and staff?

May I commend the hon. Lady for the brave stance that she has taken on this difficult issue? I will certainly take her concerns seriously. I want to read the report now that it has been delivered, and will speak to her at the earliest possible opportunity to establish how the Government and local commissioners can take things forward. It is imperative that the NHS has the best possible culture for how staff are treated and heard. I hope she will look at the announcement made by my right hon. Friend the Secretary of State about ensuring that people have the freedom to speak up and safe spaces in which to blow the whistle.

T6. At Colchester general hospital, insurance premiums under the clinical negligence scheme for trusts have more than doubled to £11.2 million in four years. What steps is the Department taking to reduce that figure? (904245)

My hon. Friend points to variations across the service. Premiums sometimes go up and down in different trusts. We are examining the whole scheme at the moment, and I am happy to speak to him further about what we are doing.

Does the Secretary of State agree that this week’s public debate about breastfeeding has been destructive and condemnatory of women who suffer from post-natal depression and struggle to bond emotionally, never mind physically, with their children? Do we need to reframe the debate and reduce, rather than reinforce, the stigma for mothers who want to do the best by their children?

As my right hon. Friend the Minister for Community and Social Care, who is responsible for mental health, takes forward the increase in funding for perinatal mental health, he will want to work with me on breastfeeding rates and the relationship between breastfeeding and mental health that the hon. Gentleman correctly raises.

T7. Is my right hon. Friend aware of the agreement struck by President Obama and Prime Minister Modi of India to collaborate on the research and development of traditional medicines for preventive and palliative cancer care? Should we not be aiming for a similar agreement, bearing in mind antimicrobial resistance? (904246)

It is worth saying that the National Institute for Health and Care Excellence does not recommend homeopathy to treat any health condition. My hon. Friend mentioned antimicrobial resistance, and an increasing number of studies from around the world show that resistance to common treatments is growing, which serves to underline the importance of the responsible stewardship of all drugs and medicines and why the international efforts on AMR, in which the UK is at the forefront, are so important.

Given the latest, very worrying reports about goings on at the office of the Parliamentary and Health Service Ombudsman, does the Secretary of State still have confidence in the leadership of this vital regulator?

I have expressed my concerns on the behalf of patients about some of the things that have been happening, but I respect the fact that it is a matter for this House and its relevant Committee, not for the Government, to deal with. I do have concerns, and it is important that patients have confidence in the ombudsman, because it is a vital, independent avenue to challenge NHS trusts when things go wrong.

T9. Will my right hon. Friend join me in congratulating chief executive Glen Burley and the whole team at Warwick hospital on delivering the excellent new orthopaedic ward, which I was honoured to be invited to open? Will he tell the House what support the NHS is being given for similar state-of-the-art facilities across the country? (904248)

I am delighted to join my hon. Friend in that congratulation and to confirm the announcement in the autumn statement that the Government are committed to putting £4.8 billion of capital into the NHS every year through to 2021. That will include funding for proton beam therapy and for major new hospitals at Brighton and at Sandwell, in addition to our billion pounds a year for NHS research and our £700 million a year for medical research through the Medical Research Council.

The financial year ends next week. What does the Secretary of State expect the NHS provider budget deficit to be by then?

We know that the deficit will be bigger this year, and that there is extreme pressure. Part of the reason for that is that NHS trusts have rightly said that, in the wake of what happened at Mid Staffs, they want to ensure that their wards are properly staffed, but they have done that by using unsustainable agency staff. The most important thing that we need to do is to move to permanent full-time staff rather than agency staff who are too expensive and not good for care.

T10. A number of my constituents are unable to access an NHS dentist. May I ask the Minister to look at the availability of NHS dentists in my constituency and use his good offices to ensure that there is enough capacity for all of my constituents who want to use a good NHS dentist to be able to access one locally? (904249)

Overall access to NHS dentistry is good, but it does vary from area to area, and West Yorkshire, as the hon. Member for Dewsbury (Paula Sherriff) well knows, is one of the areas that worries us and that we are trying to do something about. Work is being undertaken in the West Yorkshire area to look at issues around NHS dentistry. I have met a number of hon. Members to discuss this matter. It has my attention, so I will be monitoring it closely, and my hon. Friend was right to raise it.

The King’s Fund analysis revealed that there will be not a £10 billion, but a £4.5 billion real-terms increase to the NHS. Will the Health Secretary apologise for misleading not just this House but the public as a whole?

Order. The hon. Lady must not accuse a Member of misleading the House. If she wishes to insert the word “inadvertently” she would spring back into order, which is where I am sure that she wishes to be. Do I take it that the word “inadvertently” has been inserted?

The hon. Lady may inadvertently have not been listening to my previous answers. Let us look at what Simon Stevens, the chief executive of the NHS, actually said about that spending settlement. He said that the Government had listened to and “actively supported” the NHS case for public spending.

Following the very welcome announcement of a graduated levy on sugar, sweet and drinks manufacturers, will the Minister please tell the House what discussions she is having with manufacturers to speed up the reformulation process and also to introduce a differential in price at the point of sale? Given the importance of childhood obesity, will the Department welcome the opportunity to take over the lead on this strategy so that we can make progress on this vital issue?

There are a number of invitations there, some of which I will resist. My hon. Friend is absolutely right to highlight the importance of this announcement. Obviously, it is the first step towards the Government’s comprehensive childhood obesity strategy, which we will be launching in the summer. The Chancellor of the Exchequer was absolutely right to go ahead with this and to move forward. The burden of childhood obesity, as she knows all too well, falls very, very heavily on poorer communities, and my right hon. Friend was absolutely right to champion that measure, because it will make the most difference in the poorest areas.

Families with boys with Duchenne muscular dystrophy are anxiously awaiting the NICE guidance to be published next week. Can I get an assurance from the Minister that, with this drug already being licensed and available in 18 countries, if NICE approves it, NHS England will bring the funding forward very quickly?

The hon. Gentleman is a doughty campaigner. Although he tempts me to pre-empt the decisions of NICE, I cannot, and it would not be appropriate for me to do so. I am afraid that we will just have to wait for its decisions, which are rightly taken on the best clinical evidence.

Hednesford is a dementia-friendly town, and I am pleased that my office team, who are based on Market Street in Hednesford, will be receiving dementia-friendly training next month. Does the Minister agree that we should be encouraging more towns to become dementia-friendly?

I absolutely recognise the excellent work that is happening in Hednesford, and in South Staffordshire, as a dementia-friendly community. I know that there are more than 2,000 dementia friends in Cannock Chase. Fantastic work is going on, and I thank my hon. Friend for her support.

When will we have a decision on the future of the human papilloma virus vaccination programme? Will it be clear, and is there due engagement with the devolved counterparts?

As the hon. Gentleman knows, two programmes are going on. There is a very large-scale piece of modelling work going on with regard to the HPV vaccination for boys, and that work, as I have previously told the House, will look to report in 2017. We already have guidance on HPV for men who have sex with men from the Joint Committee on Vaccination and Immunisation, and we are working through it in some detail to see how we can take it forward in practical terms.

Points of Order

On a point of order, Mr Speaker. Have there been any discussions between you and the Government about a possible statement on the terrible events unfolding in Brussels? Of course, we do not yet know the final facts, but a number of innocent people have been killed. We do not yet know whether there are any British victims, but there will be many families anxious to find news of relatives. I am sure that those on both sides of the House would welcome the opportunity to question the Prime Minister and the Home Secretary about the ongoing efforts of the police and security services here to protect the public in the UK from similar attacks.

I thank the right hon. Gentleman for his point of order and for the terms in which he put it to me. As Members present throughout Question Time will know, condolences have been expressed by Members on both sides of the House as regards the victims of this terrible outrage and their loved ones who will live with the consequences. The short answer to the right hon. Gentleman is that I have had no such discussions with any Minister to date. I think that it is a matter of public record that the Prime Minister has been chairing an important meeting of Cobra this morning and I think it will be accepted in all parts of the House, not least by the right hon. Gentleman, that the Prime Minister is punctilious in coming to the House to address these matters at such a point as he feels that he has the requisite level of information to impart to colleagues and is best placed to be informative and helpful. We should await the development of events, but the serious concern registered by the right hon. Gentleman will be keenly felt across the House. I thank him again for the terms in which he raised his point.

On a point of order, Mr Speaker. My thoughts are with the people of Brussels, as will be those of all Members of the House. I understand that Ministers will as a priority work with our colleagues in Brussels, putting security in this country first. I have been contacted by a number of my constituents who travelled to Brussels earlier today and who are trying to get home, as I am sure are many others. They have been told by the airline, Ryanair, that it will cost them £6,000 to be brought back to this country. Through you, Mr Speaker, may I ask Ministers to intervene and suggest to Ryanair and other carriers that all efforts are made to help those who want to come back to this country in a reasonable way?

I thank the hon. Gentleman for his attempted point of order. That is not a matter for the Chair, but, again, he has raised a question of real and immediate concern. That real and immediate concern will have been heard by those on the Treasury Bench and, knowing the hon. Gentleman’s ingenuity, I feel sure that if he does not receive some sort of contact or reassurance from an appropriate quarter, he will not rest in continuing to highlight his concern, and I thank him for doing so.

On a point of order, Mr Speaker. On Friday, the Government were taken to the Supreme Court by ClientEarth for failing to meet EU air quality standards which have resulted in 40,000 deaths a year at a cost of £20 billion a year. Are you aware of any statement that will be made by the Government on this important issue, particularly in the light of what is happening in the Budget? They have an opportunity to stop people dying and becoming disabled, rather than charging people for being disabled.

I confess that I have received no such indication. Once again, the hon. Gentleman has put his concerns on the record. They will have been heard and doubtless he will return to the matter if he does not receive the satisfaction he seeks.

On a point of order, Mr Speaker. May I seek your advice and guidance on a matter of principle for this House? Select Committees have the power through this House to send for persons, papers and records, to enable them to obtain oral and written evidence to allow them to undertake their work. In keeping with this long-established power, the Business, Innovation and Skills Committee, which I chair, has sought to take evidence from the owner of Sports Direct, Mr Mike Ashley, on the treatment of workers at his company. That was in response to reports that workers at Mr Ashley’s warehouse in Shirebrook were not being paid the minimum wage. I have received correspondence from workers at Sports Direct, who have told me of practices such as employees being made to clock out but having to continue to work so that wages were not over budget; of staff kept for an hour after their scheduled finish time without pay to tidy shops; and of workers finishing work at 5 am and being required back at work two hours later.

We on the Select Committee naturally and not unreasonably wish to question Mr Ashley on the review of working conditions at his company that he announced he would undertake personally. After his refusal to accept our initial invitation to attend on a mutually convenient date, last week the Committee formally ordered Mr Ashley to attend on 7 June. Yesterday he indicated to the press, although not to the Committee, that he has no current intention of attending the Committee. He referred to the order to attend as

“an abuse of the parliamentary process”

and described the Committee as “a joke”. I do not think that scrutinising reports of Victorian-type employment conditions in modern-day Britain is a joke.

Can you confirm, Mr Speaker, that the Committee has acted in accordance with the procedures of this House? Can you advise me what steps can now be taken to ensure that Mr Ashley complies with the very reasonable request, and then the formal order, of the BIS Committee?

I am grateful to the Chair of the Business, Innovation and Skills Committee for notice of his point of order. The House delegates to nearly all its Select Committees the power to send for persons, papers and records. Each Committee is free to decide whom to invite to give oral evidence, and if the invitation is refused, the Committee may decide to make an order for the attendance of a witness.

In response to the hon. Gentleman’s direct question, therefore, it appears to me that so far the proper procedures have been followed. As long as the Committee is acting within its terms of reference, the House expects witnesses to obey the Committee’s order to attend. If, after due consideration, the hon. Gentleman’s Committee wishes to take the matter further, the next step would be to make a special report to the House, setting out the facts. The hon. Gentleman may then wish to apply to me to consider the issue as a matter of privilege, and to ask me to give it priority in the House. Under procedures agreed to by the House in 1978 and set out on page 273 of “Erskine May”, this application should be made to me in writing, rather than as a point of order. I would then be happy to advise him on the options open to him.

Further to that point of order, Mr Speaker. This could be a long, drawn-out process, based on what Mike Ashley has been doing and saying over the years. He operates zero-hours contracts for many thousands of people. There are very few full-time people. He believes that as a billionaire he can do as he likes. I put it on the record for you, Mr Speaker: you had better act very firmly with the person concerned. There used to be a woman in the House working for the Serjeant at Arms called Mary Frampton. We will need one to deal with him.

We have such a person. I can say only that I shall always profit by the counsels of the hon. Gentleman.

I do not know that there is more to add, but I will give the hon. Gentleman the benefit of the doubt—he is a very experienced Member. I have tried to treat of this matter fairly and factually, but of course I will take a point of order from the hon. Gentleman if he persists.

The point of order I wish to raise with you, Mr Speaker, is simply this: in view of the obvious contempt that this person has shown for the House of Commons, would it not be appropriate for him to appear at the Bar of the House? [Hon. Members: “Hear, hear.”] There have been occasions in the past when that has occurred, and the House of Commons has shown that it will not tolerate such contempt. I put it to you that that could perhaps be considered as well.

I am very grateful to the hon. Gentleman for his point of order. I recognise that there are historical precedents, but it is only right for me to say that it is not for me to make any such decision. If we were to get to that point, and I am not suggesting that we shall do so—I am not seeking to anticipate events—that would be a matter for the House to decide, but I hope that I have dealt fairly, squarely and intelligibly with the important matter that the Chair of the Select Committee and others have raised.

Taxi and Private Hire Vehicle Operators (Regulation)

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 make provision about the skills and knowledge required of a person driving a taxi or private hire vehicle (TPHV) and related responsibilities of TPHV company operators and service providers; to require operators of TPHV companies and service providers to hold specified types and levels of insurance; to make provision about the tax liability of TPHV companies and service providers; and for connected purposes.

I am grateful for the opportunity to present the Bill, and I am delighted by the strength of support from right hon. and hon. Members on both sides of the House, which is reflected, I think, in the attendance today.

The Bill seeks to put fair competition and passenger safety at the heart of the taxi and private hire vehicle industry in London and across the country. The advent of new technology in the industry is revolutionising the way people navigate our great capital city; indeed, it is revolutionising transport in cities across the United Kingdom and the world. At its best, disruptive technology drives innovation and increases competition, with enormous benefits for businesses and consumers alike. However, as we have seen on the streets of London, it also brings significant challenges. The Bill seeks to address some of those challenges, which have been neglected for far too long.

The debate about the future of London’s taxi industry has been unfairly characterised as a debate between those who support competition and innovation on the one hand and those who want to cling to the past on the other. That is lazy analysis. It is true that London’s iconic black taxi trade is at risk; indeed, I would go as far as to say that the threat to it is existential—but the cabbies I represent are not afraid of change and innovation, they are not afraid of new technology and they are not afraid of competition. However, they are finding it increasingly hard to compete in a changing marketplace with both hands tied behind their backs. [Interruption.] It is great to see even the Chancellor taking an interest in their plight. [Hon. Members: “Taxi?”] The Chancellor may need a taxi.

I represent many black taxi drivers; indeed, Ilford North was once known as “Green Badge valley”, and it is still not unusual to see taxis parked on the driveways of Gants Hill, Clayhall, Barkingside and Woodford. I also represent hundreds of minicab drivers and drivers who work for new market entrants such as Uber. Like many Londoners, I use black taxis, particularly in central London. I also use minicabs and apps such as Uber locally. I welcome the choice and enjoy the benefits of competition, but I also recognise that the explosion in the number of private hire vehicles in London presents regulatory challenges and risks for passengers.

An investigation for LBC by Theo Usherwood exposed the ease with which individuals can access a private hire licence without adequate insurance. We know that a number of vehicles are already on the road without appropriate insurance. Last year, The Guardian was able to demonstrate how easy it was for an Uber driver to pick up a customer, having provided fake insurance paperwork via the company’s operating system. Some private hire vehicles are illegally plying for hire and touting, increasing the risk of passengers getting into cars driven by unlicensed and unknown drivers, with considerable risk to their safety. This is an illegal practice that the regulators ought to be acting a lot harder on. Guide Dogs UK found in a survey of assistance dog owners that 43.5% of respondents had been refused access to private hire vehicles, and it is all too common for lesbian, gay, bisexual and transgender passengers to experience discrimination.

Though I enjoy price competition as much as anyone else, is it really fair to expect cabbies to compete on fares while Transport for London continues to put up regulated fares for black taxis and apps such as Uber are able to drive their prices down, as profit-shifting allows them to avoid paying their fair share of taxes here in the UK? If we fail to act, London’s iconic black taxis will be driven off our streets. This is bad for competition, bad for passengers, and bad for London.

The Bill proposes action in three areas to improve passenger safety and make competition fairer so that our black taxi industry can continue to survive and thrive alongside minicabs and other private hire operators. First, on the issue of training, private hire vehicle drivers undertake only a rudimentary topographical test and in many cases do not undergo formal training. This sees many relying on sat-nav, which means that the risk of collision is increased owing to sharp braking or not focusing on the road ahead. The Bill proposes that in order to obtain a PHV—private hire vehicle—licence all drivers should complete an enhanced Driver and Vehicle Licensing Agency assessment, requiring additional skills such as how to drop off and pick up passengers and wheelchair exercises to learn how to support the disabled. PHV drivers should also undertake an assessment on the principle of plying for hire and touting regulations, so that there can be no excuses for breaching regulations. PHV drivers should be properly and fully trained and assessed in their obligations under the Equality Act 2010, so that protected groups such as LGBT people and disabled people can travel with confidence.

The second issue that the Bill seeks to address is insurance. The current system requires “hire and reward” insurance for all drivers where the responsibility for insurance rests with individual drivers. There is a higher cost for this insurance, which means that many private hire vehicle drivers can be tempted to opt for a cheaper form of insurance when accepted by a licensed operator. In order to resolve this issue, I propose moving to a system of operators’ insurance that places the responsibility on operators as a prerequisite for obtaining their licence. This will deliver three key benefits for passengers and the industry: guaranteeing that cars managed by the operator are insured so that customers have confidence that they are safe; reducing the cost of insurance through bulk purchasing, thereby delivering better value for money; and making the regulators’ task easier because checking a few thousand operators is easier than checking over 100,000 individual policies. Some companies, such as Addison Lee, already do this voluntarily, meaning that customers and businesses can book with the confidence that is sometimes lacking around private hire operators.

Finally, my Bill makes provision for the tax liabilities of taxi and private hire vehicle companies. It cannot be right that some companies in this industry are making huge profits but not paying their fair share of taxes. Lower fares are great, but some operators are frankly trying to drive their competition off the road through new apps by offering lower fares made possible by offshore tax arrangements, in effect robbing Peter to pay Paul. I pay particular tribute to my right hon. Friend the Member for Don Valley (Caroline Flint), who a week ago today brought forward her own ten-minute rule Bill on transparency for multinationals. Her proposals would be a refreshing step in the right direction.

This Bill would introduce a requirement for the Chancellor or the Financial Secretary to the Treasury to make an annual statement to this House on the progress of the OECD’s base erosion and profit-shifting project and the action that Her Majesty’s Government are taking to ensure that there is proper scrutiny in this area—though I hope that the Chancellor might be better at making progress there than on his own targets. It is a small measure, but it would indicate the view of this House that the Government need to do much more to tackle tax avoidance. These changes collectively would go some way towards levelling the playing field. TfL needs to go further than it currently proposes, and, in any event, these challenges also exist in towns and cities across our country.

Gwyneth Paltrow once said:

“Brits are far more intelligent and civilised than Americans. I love the fact that you can hail a taxi and just pick up your pram and put it in the back of the cab without having to collapse it.”

Perhaps more profoundly, Professor John O’Keefe, a Nobel prize-winning neuroscientist, said:

“Some of the best navigators in the world are London taxi cab drivers. They have to learn 25,000 streets and how to get from one to the other.”

I am sure that the whole House will agree that Brits are more intelligent and taxi cab drivers are the best navigators in the world. They are also small businessmen and women providing a world-famous service and struggling to make their families a good living. We owe them a chance to compete fairly, and we owe it to our great capital city to ensure that the iconic black taxi industry and the great iconic black taxi itself are not consigned to London’s history books. For these reasons, and so many more, I commend this Bill to the House.

Question put and agreed to.


That Wes Streeting, Lyn Brown, Neil Coyle, John Cryer, Clive Efford, Mr David Lammy, Kate Osamor, Joan Ryan, Mr Virendra Sharma, Mr Gareth Thomas and Mr Charles Walker present the Bill.

Wes Streeting accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 22 April and to be printed (Bill 154).

Ways and Means

Budget Resolutions and Economic Situation

Amendment of the Law

Debate resumed (Order, 21 March).

Question again proposed,


(1) It is expedient to amend the law with respect to the National Debt and the public revenue and to make further provision in connection with finance.

(2) This Resolution does not extend to the making of any amendment with respect to value added tax so as to provide—

(a) for zero-rating or exempting a supply, acquisition or importation;

(b) for refunding an amount of tax;

(c) for any relief, other than a relief that—

(i) so far as it is applicable to goods, applies to goods of every description, and

(ii) so far as it is applicable to services, applies to services of every description.

Before I call the Chancellor of the Exchequer, I should inform the House that I have selected amendments (b) and (a), so both can be debated together with the Budget motions today. With the leave of the House, I will call the shadow Chancellor to move amendment (b) after the Chancellor has opened the debate. At the end of the day’s debate, the Question will first be put on amendment (b). As long as time permits before 7 pm, I shall then call the hon. Member for Dewsbury (Paula Sherriff) to move amendment (a) formally, and the Question on that amendment will be put. The House will then proceed to decide on the Budget resolutions.

Let me start by offering all our condolences to the victims, and their families, of the attacks in Belgium. The full details of this morning’s horrific attacks are still emerging, but we know that at least 13 people died in the attack at Brussels airport and that there are reports of multiple dead at Maelbeek metro station. As details of these horrific events continue to unfold, my thoughts and prayers, and indeed those of right hon. and hon. Members in all parts of the House, are with those who have lost loved ones or have been injured.

Earlier this morning, the Prime Minister chaired a meeting of Cobra attended by the Home Secretary, myself and others. The police have confirmed that, on a precautionary basis, they are increasing the policing presence at key locations, including transport hubs, to protect the public and provide reassurance. In London, the Metropolitan police have deployed additional officers to patrol key locations and the transport network, and Border Force efforts have been intensified.

It is too soon yet to comment on the details of these attacks, which are still emerging, but the Government would reiterate that the UK threat level remains at “severe”, meaning that an attack is highly likely. We would urge the British people to remain vigilant, and the Home Secretary will keep the House updated. But let us be clear: terrorists seek to threaten our values and our way of life, and they will never succeed. It is a reminder of what a precious thing our democracy is, and this Budget debate is part of that democratic process.

This is the first time in 20 years that a Chancellor has spoken on the last day of the Budget debate, and I think it is fair to say that we have had a livelier debate about this Budget than about many. Let us be clear: the key principles behind this Budget are that if we are going to deliver a strong and compassionate society for the next generation, we have to live within our means, we have to back business to create jobs and we have to make sure work pays by putting more money into the pockets of working people. That is what we committed to in our manifesto. That is what the British people elected us to deliver. That is what this Budget does, and that is what we are going to vote on tonight.

I will give way in a moment, but let me straightaway address the resignation of my right hon. Friend the Member for Chingford and Woodford Green (Mr Duncan Smith). I am sorry that my right hon. Friend chose to leave the Government. Let me here, in this House, recognise his achievements in helping to make work pay, protecting the vulnerable and breaking the decades-old cycle of welfare dependency. Together, we had to confront a huge deficit and uncontrolled welfare spending. Of course, there is always robust discussion between the Treasury and the spending Departments when money needs to be saved. The decisions we make to keep our economy secure are always difficult, and where we do not get them right, I have always been prepared to listen and learn.

I am very proud that my right hon. Friend and I worked together longer than any two people who have done our jobs before us in any Government, and we have been part of the team that has reduced the number of people on out-of-work benefits to levels not seen for 40 years, reduced inequality, seen poverty fall, seen child poverty fall and seen pensioner poverty fall, and got a record number of people into work—a long-term economic plan and welfare reform delivering a fairer society for all.

I am grateful to the Chancellor for giving way. It is less than a week since he stood up to deliver the Budget and made that decision affecting disability independence payments—something that upset many hundreds of thousands of people across this country. He has made a welcome U-turn, but should not he now acknowledge that that decision was a mistake that he should say sorry for?

I am going to come on to speak about the disability benefits and our way forward, but I have made it very clear—I have just said it—that where we have made a mistake, where we have got things wrong, we listen and we learn. That is precisely what we have done. Where is the apology from the Labour party for the things that they got wrong? Why don’t they take a leaf out of that book? Why don’t they get up and apologise for the countless decisions that added to the deficit—that bankrupted our country?

The progress we have made on social justice did not happen by accident. It happened because we in this Government set out to turn our economy around, to control spending, to back business and, yes, to reform welfare.

I will give way in a moment to my former partner in the coalition Government that undertook many of these welfare reforms. The reform has meant difficult decisions to strengthen the incentives to find work and the sanctions for not doing so; to make sure that every hour extra that people work is rewarded, instead of seeing them trapped in dependency; and to cap benefit payments so that our welfare system is fair both to those who need it and to those who pay for it. It has not been easy, and it has often been opposed, but the truth is that many of the acts of progressive social change that we seek to achieve in government are difficult and they are opposed. In any democracy, you have to fight to make lasting improvements in society, and that is what we have done.

I thank the Chancellor for giving way, and I want to associate myself with the remarks that he made earlier about the appalling situation in Brussels.

Does the Chancellor agree with me that the one thing that is more dangerous for our economy than his remaining Chancellor is that we might leave the European Union; and does he agree that his being called out by his former colleague as acting not in the economic interests of the country, but in a short-term political way, introduces a risk that the referendum will be a referendum on him, not on the future of our role in Europe? Will he act in the national interest and resign?

May I remind Members that interventions should be brief? We want to hear from both Front Benchers, and I want to hear from dozens of Back Benchers. I repeat that interventions should be brief.

That was like one of those interminable interventions at ECOFIN. I happen to think that it is better to be in that council than not, but that is a debate for another day. We are talking here about the reforms we are making to welfare and to our economy.

I am grateful to the Chancellor for giving way. Is he aware that had he stuck with Labour’s plans for fuel duty, a litre of petrol would cost 18p more than it does? Has he assessed what impact that would have on the lowest-earning people in our society?

My hon. Friend is absolutely right. If we had stuck with the fuel duty escalator that we inherited from the last Government, it would have cost much more to fill up a car, which would have cost small businesses much more. We took action in this Budget to freeze fuel duty for the sixth year in a row, because we are on the side of working people.

To put this debate in context, would my right hon. Friend like to share with the House, in both financial and non-financial terms, how much help this Government have given to assist the sick and the disabled since May 2010?

I am coming on to talk about disability benefits, but my right hon. Friend is absolutely right to draw attention to the support we give—close to £50 billion—to disabled people. When we look just at the disability benefits, disability living allowance and personal independence payment, we see that that support has gone up from £13 billion when we came into office to £16 billion today, and it will go up to £18 billion in the future. As my excellent right hon. Friend for Preseli Pembrokeshire (Stephen Crabb), the new Welfare Secretary, made clear yesterday, we continue to give support to disabled people. I will come on to deal with that in detail.

The Chancellor boasted when he opened the debate that this was the first time a Chancellor had opened the final day of a Budget debate. He will know that that is because it is also the first time a Chancellor has had to drop the biggest revenue raiser in his Budget within two days of announcing it. The former Work and Pensions Secretary, who has just resigned and to whom the Chancellor paid great tribute, described the Budget as “deeply unfair” and “drifting” in a wrong direction that will divide the country, not unite it. He said all those words after the Chancellor announced that he was ditching the PIP cuts. Is the former Work and Pensions Secretary deluded?

I am glad that the right hon. Lady intervened, because I have done a little research and, frankly, I wish that when she was the Chief Secretary to the Treasury we had seen a few more revenue raisers in Budgets, such as savings in welfare and savings in public expenditure. During the period in which she was the Chief Secretary, the deficit went from £76 billion a year to £154 billion a year. The measures that my right hon. Friend and I have been taking over the last six years are to clear up the mess that she and her colleagues in government left.

Let me make a little more progress, and then I will come back. The proof that these difficult changes are worth while—

I will give way to the right hon. Lady. I have said that when we have made a mistake, we have listened and learned. When is she going to apologise and say that she made mistakes and her colleagues made mistakes during that period in government, which is what we have been clearing up for the last six years?

The Chancellor did not address the issue of the unfairness of his Budget, so will he address the issue of the revenue behind his Budget? He has abandoned £4.4 billion in revenue raisers from his Budget. Where is that money going to come from, or will he change the scorecard that he set out?

I will tell you what is unfair: to saddle the next generation with debts you have no way of paying off. That is what the right hon. Lady did. [Interruption.] That is what she did. I will come on specifically to disability benefits, but let me tell her about fairness and what we have done over the last six years. We have taken action that means 500,000 fewer children are growing up in workless households than when she was at the Treasury, 1 million fewer people are on out-of-work benefits and over 2 million more people are in work than when we came to office. That is the social justice record we on this side of the House are proud of.

I am also proud that the work continues, and in this Budget we are taking further steps to build a stronger society. There is money and reform to improve our nation’s schools. There is action to reduce sugar intake and give our children better healthcare. There is support for the savings of low-income families. There is more help and housing for homeless people. There are personal allowance increases that will lift another 1 million of the low-paid out of income tax altogether, and there is an increased minimum wage ahead of the introduction of the first ever national living wage in just two weeks’ time. Those are all in the Budget we will debate today—all the actions of a compassionate, one nation Conservative Government determined to deliver both social justice and economic security.

The new Secretary of State for Work and Pensions said yesterday, in his first statement, that the Government would not be making any further cuts to welfare during this Parliament, but later on he said that there were “no plans” to make further cuts to welfare during this Parliament. Will the Chancellor now confirm, for the sake of disabled people and others, that there will be no further cuts to the welfare budget in this Parliament?

Yesterday, my right hon. Friend the Secretary of State gave exactly the Government’s position, which is that,

“we have no further plans to make welfare savings beyond the very substantial savings legislated for by Parliament two weeks ago, which we will…now focus on implementing.”—[Official Report, 21 March 2016; Vol. 607, c. 1268.]

I will now address the specific issue of welfare savings and disability, but I should have thought that the hon. Lady, when she got to her feet, might have thanked the Government for delivering the flood defence schemes that she asked for for her city, and which were in the Budget statement a week ago.

Let me turn to the disability benefits. We are proud that this Government are providing more support to the most disabled people. It was very clear that while the reforms proposed to personal independence payments two weeks ago drew on the work of an independent review, they did not command support. We have listened, and they will not go ahead. Even if they had, this Government are spending more on disabled people than the previous Labour Government ever did.

People have asked what this means for future support for disabled people, for our welfare cap and for the numbers in the Budget. Let me directly address all three points.

Let me address these points, and then I am happy to take interventions.

First, over 3 million disabled people are now in work, which is 300,000 more than just a couple of years ago. We are also providing more support than ever before for the most disabled people. The budget has risen, will continue to rise and is much greater than the one we inherited. We are going to take our time, listen, consult widely and continue to build a system of disability support that works much better with our health and social services. As my right hon. Friend the Secretary of State said in his excellent statement yesterday, we will continue to support disabled people, and we will work with him to make sure that we do.

Does the Chancellor agree with me that we can be a compassionate Conservative Government only if we have a strong, stable economy, with a reduced deficit, to enable us to protect the most vulnerable in society?

Let me deal with the measures we are taking to control spending, and then I will take some interventions.

The welfare cap is the instrument we have introduced to set out, in a transparent way to Parliament, what we aim to spend on welfare. It is independently judged by the Office for Budget Responsibility every autumn, which is when we either have to comply with the cap or explain to Parliament and the country why we have not done so. I find it incredible to hear Labour Members protesting about the welfare cap. It never existed at all under a Labour Government: there was no cap, no control on the largest area of Government spending, no transparency, no independent forecast, and as a result, welfare costs soared by 60% and the country was brought to the brink of bankruptcy.

On Friday afternoon a couple, Mr and Mrs Ford, came to visit me at my surgery. Mr Ford, who is in a wheelchair, is unable to feed himself, dress himself or do anything for himself. They live on £559 a month in PIP, plus £63 per week in carer’s allowance. They still have a mortgage to pay. They have clocked up 80 years of national insurance contributions between them. They ask the simple question, “How are we meant to cope?” They were in a real state of distress. Will the Chancellor please now apologise to such people for the distress that he has caused?

I have already said that we are not going ahead with those changes. [Interruption.] I have addressed these issues. The truth is that that family and many more families are getting increased support under this Government. We would not be able to provide any of that support unless we had a strong economy and we controlled public spending, because the people who suffer most when the economy—[Interruption.]

Order. I apologise for having to interrupt the Chancellor. [Interruption.] Order. Members are yelling—in some cases, from sedentary positions—very noisily. If people put questions to the Chancellor, they must leave him to respond. The same will go for Government Back Benchers when they no doubt challenge Members speaking from the Opposition Benches. Let us try to restore some sort of order to this debate.

Will the Chancellor confirm to the House that this Government are spending £2 billion more on support for the disabled, that inequality is at its lowest rate for 25 years according to the Institute for Fiscal Studies and that there are 2 million more people in work thanks to this Government? Is that not what we are doing for the vulnerable?

My hon. Friend is absolutely right: more people in work, reduced inequality, reduced poverty, more disabled people in work and, by the way, we got in a freeze on beer duty as well.

Let me make a little progress, and then I will give way again.

Not proceeding with the PIP changes means that spending on disabled people will be just over £1 billion a year higher by the end of the decade than was set out in the Budget. This will be an important factor, but only one of many, that will affect the overall forecast for welfare that the OBR will make in the autumn—

Several hon. Members rose—