House of Commons
Wednesday 4 May 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—
1. How many countries have had aid suspended for corruption or failure to implement good governance under the terms of the Cotonou agreement in the last five years. 
Six countries have faced action: Guinea-Bissau, Zimbabwe, Fiji, Madagascar, Guinea and Burundi.
Does UK overseas aid still include revenue support, and does the Secretary of State not agree that such direct Government-to-Government aid often inhibits good governance? Far from encouraging democracy, it actually encourages kleptocracy.
The hon. Gentleman will be pleased to hear that we have curbed general budget support, which has been reduced by nearly 90% since 2010. There is now one remaining programme of general budget support, which will finish shortly.
I disagree that it is wrong to work with Governments. In the end, one way in which we can tackle corruption is by strengthening public finance management and tax revenue authorities. We need to find a balance and provide earmarked support that actually achieves an impact.
Every year, the Palestinian Authority gives £84 million to convicted terrorists serving time in Israeli jails, out of a general fund to which this country contributes part of its £72 million a year in aid to the Palestinians. Is that not corrupt practice? How is it an example of good governance? Will the Secretary of State consider following Canada’s example and ensuring that our aid goes to specific projects in the Palestinian territories?
My hon. Friend will be aware that the trust fund that we are part of is broadly supported by the international community. It is yet to become clear whether the new Canadian Government will change the country’s approach and go back to working in the same way as countries such as the UK. I should also point out that that support sits alongside direct support on the ground, and I can assure the House that no UK aid funding goes to the Palestine Liberation Organisation.
Will the Secretary of State recognise the important role that faith communities and civil society organisations play in holding Governments to account in developing countries? Will she assure the House that the Department for International Development remains committed to supporting civil society, capacity-building programmes and good governance programmes to help promote stability and tackle corruption?
I can give the hon. Gentleman that assurance. Our work with civil society is not only important for the impact that it can have in driving accountability on the ground, as he mentions, but is one way in which we can tackle corruption. It is also vital in changing attitudes towards women and girls, a matter that I care about and that we must make progress on.
Projects for Young People
2. What support her Department provides for projects which involve working with young people in the developing world. 
With Africa experiencing unprecedented growth in its young population, DFID has prioritised job creation for young people. That is good not only for young Africans but for Britain, because in the end we are tackling a root cause of migration.
Will my right hon. Friend outline what the impact might be on the number of Syrians trying to reach Europe if aid spending in Jordan, Lebanon, Turkey and other neighbouring countries hosting Syrian refugees were cut?
My hon. Friend raises a pertinent question. If the refugee camps that we support in countries around Syria were not funded and were closed, do we think the people there would stay in Syria? They would not; they would almost certainly look to come to Europe. The irony is that parties such as the UK Independence party that want to cut back on aid have, in effect, a pro-migration policy.
Today the Select Committee on International Development publishes its report on the crisis in Yemen, and one issue that we highlight is the impact on children and young people, including the fact that 47% of school-age children are not at school. Will the Secretary of State inform the House of what plans the Government have to use the forthcoming world humanitarian summit in Istanbul to focus on education in emergencies such as the situation in Yemen?
The crises in Syria and Yemen shine a spotlight on an issue that I feel has been missed out of humanitarian responses for too long—the fact that 37 million children around the world are out of school purely because they are in areas affected by either emergencies or conflict. The UK has led the way, with the “No Lost Generation” initiative, in working with countries to get children back into school. We would like to do the same in Yemen, but as the hon. Gentleman will know, the situation in that country makes it extremely difficult to get even the most basic humanitarian support flowing.
DFID funds the International Citizen Service, which helps young people from Britain to help their counterparts in developing countries. Will the Secretary of State join me in encouraging more young people from Havant and across Britain to get involved?
My hon. Friend has asked a really sensible question. More than 20,000 young people have now benefited from the International Citizen Service. It gives them a fantastic experience at a really important stage in their lives. In our manifesto we committed to tripling the numbers of young people able to benefit from it.
Do the Government recognise the important role that young people play in combating global poverty? Will the Secretary of State welcome the commitment in the Scottish National party manifesto to continue funding Scotland’s development education centres, and will she set out the steps that the UK Government are taking to promote global citizenship across the country?
We recognise the Scottish Government’s work in Malawi, which is also very much the focus of UK work. On young people’s role, from my perspective, it is not simply that young people can be, and are, advocates for development but that they are many of the people on the ground delivering. If we look at the response to Ebola in Sierra Leone, young people in communities did the work to help those communities understand how to stay safe.
For young people in countries most affected by the trauma of war and displacement there can be as few as one psychiatrist or mental health worker per 2 million people. How will the Secretary of State ensure that the Department has adequate resources to fulfil its commitment to young people’s mental health, as set out in the disability framework?
We have brought in the disability framework over the past couple of years because we felt that we had not focused on that area in development in the way that we should have. Children’s mental health is incredibly important. We have put in more money through great agencies such as UNICEF to fund psychosocial support. One of the biggest problems we face is making sure that we have Arabic speakers with the right kinds of skills in the right quantity to deal with the scale of the challenge.
Tax Avoidance and Financial Transparency
3. What recent assessment she has made of the effect of tax avoidance in developing countries involving institutions based in the Crown dependencies and British overseas territories on the economies of those developing countries. 
5. What recent assessment she has made of the effect of low levels of financial transparency in the Crown dependencies and British overseas territories on the economies of developing countries. 
Through our presidency of the G8 in 2013 and through the G20 we have led on assisting developing countries in strengthening their tax regimes, and tackling avoidance and evasion. UK overseas territories have agreed to furnish our tax and law enforcement agencies with company beneficial ownership information.
I thank the Minister for that answer, but the world’s poorest countries are deprived of some $1 trillion every year because of money laundering and tax avoidance. Will he call on the British overseas territories to establish a public register of beneficial ownership ahead of next week’s anti-corruption summit in London?
We are light years ahead of where we were, and indeed of any ambition expressed by previous Administrations. Full automatic exchange of taxpayer account information will be available from September this year, and company beneficial ownership information will be available to our tax authorities by June next year.
I acknowledge the progress made by previous Governments and this one on this issue, but is it not time, in advance of the anti-corruption summit, to require overseas territories and Crown dependencies to provide public registers of beneficial ownership?
We have advanced a huge amount by agreement and leadership, not by having recourse to compulsion. The overseas territories are now well in advance of many of our major trading partners. It is better to proceed by agreement. Much of the information will be available through the initiative for automatic exchange of beneficial ownership registers, to which 33 countries have now signed up.
Does my right hon. Friend agree that we need to look very carefully at the purpose of this? Its purpose is not simply to deal with excessive avoidance and evasion schemes—they often mask deeply corrupt and criminal activities. What has been achieved is the ability for our law enforcement agencies to get in there and get that information, without tipping off the criminals we are seeking.
I pay tribute to the National Crime Agency, and the unit within it paid for by DFID, for tracing that international corruption. My right hon. Friend is right. Huge amounts of revenue are being denied to the poorest countries in the world, and we have to do something about that.
The questions asked by the hon. Ladies are entirely legitimate, and the Minister has replied well. The added liquidity that comes as a result of moneys coming in—often from parts of the developing world—to places such as the overseas territories and the Crown dependencies can lead to a range of project finance initiatives that benefit many people in the developing world. It is not as straightforward as suggesting that moneys in tax havens do not have a longer-term benefit, particularly in those parts of the world that the Department holds close to its heart.
My right hon. Friend is right. The common reporting standard is vital, together with the automatic exchange of taxpayer account information. Precisely because of that, we have a pilot running in Ghana to draw developing countries into that arrangement.
The Minister will be aware that tax avoidance in developing countries costs them three times what they get in aid. Why will the Department not put pressure on Government colleagues to insist that offshore centres such as the British Virgin Islands and the Cayman Islands set up registers of beneficial ownership that are open to the public?
We are vastly in advance of the situation left by previous Administrations, and we are advancing by agreement. That information will be available if countries sign up to the initiative for the automatic exchange of beneficial ownership registers, and next month the United Kingdom will be the first country to publish that information.
Another way that the UK can increase transparency and help to lead the world towards more open communication and higher revenues for developing countries is to support strongly the extractive industries transparency initiative. The previous Government signed us up to that, after too many years in which we had stood aside from it. Will the Minister confirm that we will be leading other parts of the British overseas territories, and signing up to the EITI?
Those territories certainly have extractives, and we are pushing that agenda. I regularly meet representatives of the extractives industry to drive forward this initiative.
Access to Energy: Africa
4. What steps her Department is taking to improve access to energy for the poorest people in Africa. 
Some 600 million people in sub-Saharan Africa still do not have access to the electricity that we all take for granted, and progress towards the global goal of universal access by 2030 is too slow. We launched the Energy Africa campaign to accelerate the expansion of the household solar market and make it work for the poorest people in the world.
Does the Minister agree that solar power can make a real difference to economic development in places such as the Sahel? What is DFID doing to assist the roll-out of off-grid solar power for countries coming out of conflict, such as South Sudan and Somalia?
My hon. Friend has a profound understanding of the region, and I assure him that Somalia is one of the first countries to have signed an agreement with us on the Energy Africa campaign. I hope that many others will follow.
In many African countries oil is still king, and with that comes a lot of corruption that prevents benefits from going to the poorest people in those countries. What is DFID doing to eliminate corruption, which undermines the projects, such as Energy Africa, that the Minister is talking about?
The hon. Gentleman makes an extremely important point. DFID has an extensive range of programmes to combat the culture of corruption, particularly in oil-producing states such as Nigeria, and an anti-corruption summit will soon be convened in London to address those specific issues.
13. Will the Minister update the House on what role Britain can play in encouraging the private sector to invest in energy infrastructure in Africa? 
My hon. Friend makes an important point, and the whole thrust of the Energy Africa campaign is about accelerating a market. It is not about dumping a huge amount of public money on the table or a traditional aid programme; it is about accelerating a market in which we fully expect British entrepreneurs and investors to play a leading role.
A fundamental prerequisite to accessing energy in the poorest nations in Africa is access to clean water. What assistance do the Government give to the many charitable institutions that have proven that clean water can be delivered to millions of people in a cost-effective way?
The hon. Gentleman makes an important point about the need to retain ambition in making it easier to access water, and I am delighted that the UK continues to play a leading role in fulfilling our manifesto commitment of connecting another 60 million people to water during this Parliament. As he rightly points out, non-governmental organisations are an important part of delivering on that commitment.
Fraud and Corruption
6. What steps her Department is taking to tackle fraud and corruption in developing countries. 
Corruption is bad for development, it is bad for poor people and it is bad for business. All our country programmes have anti-corruption strategies. DFID funds units in the National Crime Agency that are dedicated to investigating the money laundering and bribery that affects developing countries.
Corruption is also bad for taxpayers who have a natural concern if they see too much of their money going into the hands of corrupt Governments and other organisations, particularly in Africa. What are peer-to-peer lending and giving doing to tackle this issue?
As my hon. Friend says, platforms are now emerging that allow charitable donations to be sent directly from an individual in the UK to, for example, a remote village in Uganda or an entrepreneur in Kenya seeking to raise money from the UK public directly. Strong regulation is key. DFID is now actively working with the industry to see how this approach can be made better.
Does the Secretary of State agree that one of the best ways we can help developing countries to tackle fraud is to make sure there is no fraud and corruption in the UK? Will she look at whether the murderers of Mr Magnitsky have hidden away something like $20 million or $30 million in the UK? Is that something she would like to investigate?
I am sure I will look further at the case the right hon. Gentleman mentions, but DFID funds and helped to establish the international corruption unit that is now part of the National Crime Agency. It is there specifically to ensure we are able to investigate cases of corruption and fraud that affect the UK system, as well as developing countries.
That was very, very dedicated of the Secretary of State. It was, if I may say so, an elastic—one might almost say a liberal and possibly a democratic—interpretation of the question on the Order Paper.
9. One of the best ways to reassure our constituents that our money is spent wisely is to release as much data as possible about where it goes. Sunlight is the best disinfectant, so can the Secretary of State reassure me that we will go further and release even more data than we already have to reassure our constituents? 
I assure my hon. Friend that we will continue to be a leader in global aid transparency. Taxpayers can already see on the web the Department’s projects in every country. Indeed, last month the Department was again rated as “very good” in Publish What You Fund’s aid transparency index.
14. Somalia was recently judged to be the most corrupt country in the world by the independent watchdog Transparency International, yet in 2014 it received £124 million in aid. Does the Secretary of State believe that the entirety of that sum went towards helping the country’s poorest and most needy? 
I do. In fact, DFID has a series of controls to manage the inherent risks not just in Somalia but in many of the other countries where we work. We make extensive use of third-party monitoring so we can verify independently that every pound is spent effectively.
7. What assessment she has made of the effectiveness of her Department’s spending in the Palestinian territories in achieving its aims. 
We are strengthening Palestinian institutions and supporting economic development. Last year, we supported 60,000 children in school and created thousands of jobs. Results are monitored quarterly.
Just 0.2%—2 pence in every £10—of the £72 million the Department spends in the Palestinian territories goes to co-existence projects bringing Palestinians and Israelis together through the Conflict, Security and Stability fund. Why will the Department not support Middle East Entrepreneurs of Tomorrow—MEET—which does brilliant work with Israeli and Palestinian students, or, for example, Save a Child’s Heart? Co-existence and humanitarian work are the two pillars on which peace and a two-state solution will be built.
We spent £349 million between 2011 and 2015, and last year we spent £72 million. There is, of course, a difficulty when managing any number of very small projects and initiatives. However, I appreciate the importance the hon. Gentleman draws to this particular need, and I am happy to accommodate him and discuss it with him.
May I urge my right hon. Friend to not just maintain our spending on the Palestinian Authority but even increase it? Do we not have an obligation to make a stand against the moral outrage of the continuing annexation, by the Israelis, of Palestinian land?
The main effort of our interventions in the Palestinian territories remains to deliver an independent and stable Palestinian state. I cannot give any indication of finance now; an announcement will be made in due course.
T1. If she will make a statement on her departmental responsibilities. 
Three weeks ago at the World Bank spring meetings in Washington, we discussed the central role that development plays in tackling the root causes of migration, terrorism and conflict. I should inform the House that no representative I met thought it would be a good idea for the UK to leave Europe. Last week in Kenya, I saw at first hand how our support for refugees and for creating livelihoods for young people is not only the right thing to do for them, but firmly in our national interest, allowing people to stay in their home region.
On my recent visit to India, I saw the fantastic work being done by the World Health Organisation, UNICEF and others to vaccinate children against polio, which has now been eradicated in India. What is the Government’s assessment of the shortfalls of the global vaccine action plan as set out in the 2015 assessment of the strategic advisory group?
We have seen the group’s report, and we think it addresses some key issues and is realistic. It is also worth pointing out that the number of cases of polio in the world this year is down to a handful. We are within touching distance of seeing this terrible disease eradicated from our planet for the first time in history.
Last month, I visited Somaliland in the horn of Africa to see for myself some of the effects of the drought that has swept southern and eastern Africa and some of the 36 million people facing hunger. I met desperate people who need food, water and shelter. What steps is the Secretary of State taking to ensure that this drought does not become a famine?
The hon. Lady raises an important issue, which underlines the fragility of many countries in Africa which, while on the path to development, face challenges such as El Niño. Specifically in Somalia, we have made additional funding available to tackle this humanitarian crisis to try to do precisely what the hon. Lady suggests, which is so important.
T2. Does my right hon. Friend agree with VSO that the generous amount of money that the British people give in overseas aid has transformed the lives of children throughout the world as well as, in particular, in developing countries? 
Yes, I do. We have supported 11 million children into school over the last five years and distributed 47 million bed nets, which has seen malaria deaths fall by two thirds over the last 15 years. We are helping 60 million people to get access to better water and sanitation. VSO, of course, is delivering a fantastic project for the International Citizen Service, too.
T3. People are fleeing war zones in developing countries across the globe. Will the Government now heed Lord Dubs and Sir Erich Reich, two prominent Kindertransport children, and think again about providing sanctuary for unaccompanied child refugees from Syria? 
The hon. Lady will be aware of all the work that DFID has done in Syria and in the region, and it has been particularly focused on supporting children affected by that crisis. We should be proud of the fact that no member state has done more financially to support refugees arriving in Europe. As she will be aware, we are looking at how to continue to work harder on ensuring that we support children who are in Europe and unaccompanied.
T5. Does my right hon. Friend agree that her commendable efforts to improve sexual equality across the world would be made easier if organisations such as the Blackburn Muslim Association were not putting out information to people that women should not be allowed to travel more than 48 miles without a male chaperone? 
I am grateful for my hon. Friend’s question. I had a look at its website last night and, frankly, the view expressed on it is disgraceful and unacceptable. It has no place in Britain, and it is contrary to our British values. I think the Blackburn Muslim Association should very clearly and publicly withdraw those comments.
T4. The Secretary of State may be aware of the brutal murder of LGBT activist Xulhaz Mannanw in Bangladesh last month. He was hacked to death by Islamist activists. Is she aware that Amnesty International says that his was just one of four such murders last month? Will she tell me what we are doing to help the Government of Bangladesh to offer more protection to the LGBT community there? 
The right hon. Gentleman has been as concerned as I have been about some of the terrible murders that have taken place in Bangladesh. It is important that we continue to work with the Bangladeshi Government to ensure that there is freedom of speech combined with the rule of law, and that the perpetrators of the murders are brought to justice.
T6. Does my right hon. Friend agree that our GDP would fall by more than 0.7% if we withdrew our investment from various stability projects around the world? 
Absolutely. We know that conflict costs tens of billions of pounds of global GDP every year. We also know that simply enabling women to be more economically empowered would add tens of billions to global GDP every year, so what we are doing is not just good for the poorest people on our planet; it is in our national interest as well.
The Prime Minister was asked—
Q1. If he will list his official engagements for Wednesday 4 May. 
I know that the whole House will wish to join me in congratulating Leicester City on winning the premier league title. Having been 5,000:1 outsiders at the start of the season, they have shown superb ability, incredible resilience and a great team ethic.
This morning I had meetings with ministerial colleagues and others. In addition to my duties in the House, I shall have further such meetings later today.
May I begin by associating myself with the Prime Minister’s comments about Leicester City? That result is something on which he and I can agree.
On Monday, the Foreign Secretary said:
“There is a need for a new initiative in the Syria dialogue to keep it alive.”
Will the Prime Minister withdraw his airstrikes, which have done nothing to bring about peace, and will he redouble his efforts to secure a political resolution to the war through a new dialogue, as recommended by his own Foreign Secretary?
I think that we should do both. I think that we should continue to hit Daesh terrorists because they threaten our country, but at the same time do everything that we can to support dialogue between the opposition and the Syrian regime, which is what the progress has been about. We will continue to take both those steps.
Q2. My right hon. Friend will be aware that 33 Conservative candidates will stand in the Lincoln city elections tomorrow, along with our county’s police and crime commissioner candidate—and Labour will lose some seats! All of us in Lincoln are aware of the need for tolerance and the stamping out of racism and anti-Semitism, especially in view of my Labour predecessor’s current role on the Board of Deputies. Will my right hon. Friend join me, and all our Conservative colleagues, in condemning the actions and propaganda of Hezbollah and Hamas? 
I certainly wish my hon. Friend’s candidates well. If people want to have well-run services at a good cost and keep taxes down, it is right for them to vote Conservative throughout the country.
My hon. Friend’s point about Hamas is important. We should be clear about who they are. They are a terrorist group who believe in killing Jews, and that is why whatever the Leader of the Opposition says about combating anti-Semitism in the Labour party will mean nothing until he withdraws the remark that they were his friends. He needs to do that, and he should do it today.
I join the Prime Minister in congratulating Leicester City on their amazing achievement. I hope that what he has said is not an indication that he is going to support another football team, rather than sticking with the two that he has already.
Later today, commemorations begin for Holocaust Memorial Day in Israel. I hope that it is agreed in all parts of the House that we should send our best wishes to those who are commemorating the occasion, and also send a very clear statement that anti-Semitism has no place in our society whatsoever and we all have a duty to oppose it.
Tomorrow people will go to the polls to vote in council elections in England. Nine of the 10 most deprived councils are set to see cuts higher than the national average, and eight face cuts more than three times the national average. That means less money for youth services, for adult social care, and for those in the areas with the greatest need. The Prime Minister used to say, “We are all in it together.” What happened to that?
First, I join the right hon. Gentleman in saying that we should always support Holocaust Memorial Day, whether here in the UK, where we have a number of commemorations, or in Israel. But I am going to press him on this point, because he said:
“it will be my pleasure and my honour to host an event in parliament where our friends from Hezbollah will be speaking… I’ve also invited friends from Hamas to come and speak as well.”
Hamas and Hezbollah believe in killing Jews, not just in Israel but around the world. Will he take this opportunity? If he wants to clear up the problem of anti-Semitism in the Labour party, now is a good time to start: withdraw the remark that they are your friends.
I have made it very clear that Labour is an anti-racist party and that there is no place for anti-Semitism within it. We have suspended any members who have undertaken any anti-Semitic activities or work or made such statements, and have established an inquiry led by Shami Chakrabarti. The point the Prime Minister makes relates to a discussion I was hosting to try to promote a peace process. It was not an approval of those organisations. I absolutely do not approve of those organisations.
The reality is that vulnerable people are being abandoned in this country. The Prime Minister has said that social care and support for the elderly were a priority for him. If that is the case, why has he cut £4.5 billion since 2010 from the adult social care budget, leaving 300,000 older people without the care and support they need to live in dignity?
First, we are putting more money into social care and allowing councils to raise council tax to put that money in.
I am afraid the right hon. Gentleman will have to do this one more time. He referred to Hamas and Hezbollah as his friends. He needs to withdraw that remark. Let me give him another chance: are they your friends or are they not? Those organisations, in their constitutions, believe in persecuting and killing Jews. They are anti-Semitic and racist organisations, and he must stand up and say they are not his friends.
Obviously, anyone who commits racist attacks or who is anti-Semitic is not a friend of mine. I am very clear about that. I invite the Prime Minister to think for a moment about the conduct of his party and his candidate in the London mayoral elections and their systematic smearing of my right hon. Friend the Member for Tooting (Sadiq Khan), our candidate for Mayor. I wish him well, and I invite the Prime Minister to undertake to ensure that the Conservative party in London desists from its present activities in smearing my friend.
Last week, the Joseph Rowntree Foundation’s “Destitution” report found that 1.25 million people in Britain were unable to afford the essentials needed to eat and stay warm, clean and dry. The number of people using food banks rose again last year. The Prime Minister usually lectures us about a stronger economy. When will that stronger economy mean that fewer people need to use food banks?
What the stronger economy means is that there are over 2 million more people in work than when I became Prime Minister, and that someone can now earn £11,000 before paying tax; and we have introduced a national living wage—something never done in 13 years of a Labour Government.
I completely reject the right hon. Gentleman’s comments about Labour’s candidate for the London mayoralty. As I have said before at the Dispatch Box, we are not responsible for everything someone says when they share a platform with us, and we cannot control everyone who appears in a picture, but there is a pattern of behaviour with the right hon. Member for Tooting (Sadiq Khan). He shared a platform with Sajil Shahid, the man who trained the ringleader of the 7/7 attacks and accused the United States of bringing 9/11 on itself. He shared a platform with an extremist who called for Jews to be drowned in the ocean. When this was put to the right hon. Member for Tooting, he described it as mere “flowery” language. If the leader of the Opposition wants to know why he has a problem with anti-Semitism, let me tell him: it is because his candidates share platform after platform with extremists and anti-Semites and then excuse their words. One more time: say you withdraw the remark about Hamas and Hezbollah being your friends.
Last week, the Prime Minister tried, as he often does, to smear my right hon. Friend the Member for Tooting for his association with Sulaiman Ghani. It turns out that Mr Ghani is actually an active Conservative supporter who has shared platforms with the hon. Member for Richmond Park (Zac Goldsmith). The Prime Minister should also reflect on the words of Lord Lansley some years ago when he said that racism was “endemic” within his party. We have set up a commission of inquiry; I suggest that the Prime Minister might think about doing the same thing.
Lord Kerslake, the former Government housing chief, has said that the Housing and Planning Bill
“effectively removes the security that people need”,
and that it is “fundamentally wrong”. Homelessness is up by a third since the right hon. Gentleman became Prime Minister, and it is rising again this year. A voter, Malcolm, wrote to me this week to say that he and his family will lose their home if the Government’s Housing Bill goes through. Why can the Prime Minister not follow the example set by the Welsh Labour Government by placing a legal duty and responsibility on councils to help people during a housing crisis? Why cannot he do that?
I will tell the right hon. Gentleman what this Government have done, not in Wales where Labour is in control but here in England: we have built twice as much council housing in the last six years as Labour did in the previous 13.
But I am not going to let the issue about the right hon. Member for Tooting rest. The Leader of the Opposition raised the case of Sulaiman Ghani, whom the right hon. Member for Tooting shared a platform with nine times. This is a man who says that it is wrong to stop people going to fight in—[Interruption.] No, as long as it takes. Do you want to know the views of a person that your leader has just quoted? He has described women as—[Interruption.] The hon. Member for Islington South and Finsbury (Emily Thornberry) might be interested in this. He described women as “subservient” to men. He said that homosexuality was an “unnatural” act. He stood on a platform with people who wanted an Islamic state. That is why the Leader of the Opposition’s attempts to deal with anti-Semitism are utterly condemned to failure. He will not even condemn people who sit on platforms with people like that.
I did point out to the Prime Minister—I was trying to help him—that the gentleman concerned is actually a Conservative. Maybe he would care to think about that. He might also consider that Shazia Awan, a former Conservative parliamentary candidate, has said this of the Tory mayoral campaign:
“I’ll be voting Labour. A lifelong Tory voter and ex-candidate, I’m ashamed at the repulsive campaign of hate”.
Homelessness has been reduced by 67% in Wales since the new regulations came in. Why can the Prime Minister not do the same in this country? Inequality is getting worse. Education ought to be a route out of poverty, but new figures show that the number of people participating in a level 2 adult education course in the first half of this year fell by a fifth compared with last year. How can we tackle inequality when the Prime Minister and his Government are taking away the opportunities for people to find a pathway out of poverty?
The right hon. Gentleman talks about inequality, but inequality has gone down under this Government. There are 764,000 fewer workless households and 449,000 fewer children living in workless households. Why? Because we have a growing economy, a living wage, more jobs and people paying less tax. That is what is happening under this Government. Once again I say to him that we are investing in schools to give people opportunities and in schemes to allow people to own homes to give them opportunities. He opposes all those things because the truth is this: he may be a friend of the terrorist group Hamas but he is an enemy of aspiration.
Politics is about choices. The Prime Minister cut—[Interruption.]
Order. Let me gently say to the assiduous but slightly over-enthusiastic Government Whip, the hon. Member for Hexham (Guy Opperman), that his role is to be seen and not heard—no further noise, please, from the hon. Gentleman today or from the sidekick to his right. A cabal of Whips will not shout people down in this Chamber. Be quiet or leave; it is very simple.
The Prime Minister’s Government cut income tax for the richest, cut capital gains tax, and cut corporation tax again and again. At every turn, they make the wrong choices. Tomorrow, people can make their own choices about the crisis of social care, the housing crisis in this country, the unprecedented cuts to local councils in the areas of greatest need, and the cuts to further education, taking opportunities away from young people. The choices have been made. The Government cut taxes for the rich; we want proper taxation to ensure that there are decent services for the rest.
The right hon. Gentleman is right that tomorrow is about choices. People can choose a party that is on the side of security for hard-working people and that wants to ensure that there are more jobs, better pay, lower taxes, good schools for their children, and a seven-day NHS that is there for them when they need it. Their other choice is to back a party that puts extremists over working people and that is utterly incapable of providing the leadership that their local council or our country needs.
Q5. Does my right hon. Friend agree that in order to create a northern powerhouse that can produce innovation and prosperity, investment is needed in vital transport links in our northern cities? Of particular concern to my constituents is the junction of the A34 and the A560 at Gatley. Will the Prime Minister and his Ministers meet me to discuss how we can keep traffic moving into and out of the great city of Manchester and alleviate congestion in my constituency of Cheadle? 
My hon. Friend is absolutely right to raise this issue. We established Transport for the North to look exactly at schemes such as the one that she proposes, so that we can speak with one voice. We are also investing £13 billion in transport across the north over this Parliament. Planning for the next road investment strategy for after 2020 is also now under way, so it is absolutely the right time for her to make that point.
Last week, the Prime Minister took issue when I mentioned unaccompanied Syrian refugee children in Europe and the Kindertransport of the 1930s. Since then, he has been written to by Sir Erich Reich, the chairman of the Association of Jewish Refugees’ Kindertransport special interest group, who said:
“The echoes of the past haunt many of my fellow Kinder and I whose fate similarly rested with members of the British parliament. I feel it is incumbent on us to once again demonstrate our compassion and human-kindness to provide sanctuary to those in need.”
Why has it taken so long, and the threat of a parliamentary defeat, for the Prime Minister to begin changing his mind?
First, let me pay tribute to the gentleman mentioned by the right hon. Gentleman. Let us be clear that no country has done more than Britain to help when it comes to Syrian refugees. No country has raised more money, and only the United States has spent more money. I want us to proceed with as much support from across the House as we can. I think it is right to stick to the principle that we should not be encouraging people to make this dangerous journey. I think it is right to stick to the idea that we keep investing in the refugee camps and in neighbouring countries. I also think it is right not to take part in the EU relocation and resettlement schemes, which have been, in my view, a failure.
We are already taking child migrants in Europe with a direct family connection to the UK, and we will speed that up. I am also talking to Save the Children to see what more we can do, particularly with children who came here before the EU-Turkey deal was signed, because I say again that I do not want us to take steps that will encourage people to make this dangerous journey. Otherwise, our actions, however well-meaning they will be, could result in more people dying, rather than more people getting a good life.
Last week, I accused the Prime Minister of walking by on the other side when he stoutly defended his then policy, opposing further help for unaccompanied refugee children in Europe. If what we are hearing now is the beginnings of a U-turn, I very much welcome it, as I am sure do Members from all parts of the House. May I encourage him to think more about what can be done, given that the Kindertransport helped 10,000 children from Europe? Finally, may I ask him to take the opportunity to thank Lord Alf Dubs and all campaigners who have worked so hard for the UK to live up to the example and the spirit of the Kindertransport?
I certainly think that all those people deserve recognition for the work they have done to put this issue so squarely on the agenda, but let me say again that I reject the comparison with the Kindertransport. I do so for this reason: I would argue that what we are doing primarily—taking children from the region, taking vulnerable people from the camps, going to the neighbouring countries and taking people into our country, housing them, clothing them, feeding them and making sure they can have a good life here—is like the Kindertransport.
I think that to say that the Kindertransport is like taking children today from France, Germany or Italy—safe countries that are democracies—is an insult to those countries. But, as I have said, because of the steps we are taking, it will not be necessary to send the Dubs amendment back to the other place; the amendment does not now mention a number of people. We are going to go around the local authorities and see what more we can do, but let us stick to the principle that we should not be taking new arrivals to Europe.
Q7. The Department of Health is looking to introduce a cell-free DNA test for pregnant women in order to reduce the number of miscarriages, but this will have the unintended consequence of increasing the number of abortions for those with Down’s syndrome. I know that nobody in this House cares more about the protection and safety of those with special needs, so will the Prime Minister meet me and representatives of the East Lancashire Down’s Syndrome Support Group so that we can look at ways of protecting those with Down’s syndrome and ensuring that they will not be simply screened out? 
My hon. Friend raises a very important issue. A local group of Down’s syndrome parents came to my constituency surgery on Friday and made all these arguments to me. As a constituency MP, I am taking this up with the Department of Health to make sure that all the right processes are followed. There are moral and ethical issues that need to be considered in these cases, but on the other hand we also have to respect the view that women want to have screening and testing about the health of their children, and we should be in favour of maximum transparency, on the basis that this is optional rather than mandatory, but it is part of routine care. So the Health Secretary is going to have to find a way through this, but, above all, we must make sure we go about it in the right way.
Q4. Nifco UK manufactures components for Ford and Nissan cars and employs hundreds of people, including many from my constituency. I am sure the Prime Minister knows of the need for us all to get behind our manufacturing industry, but does he agree with Nifco’s managing director, Mike Matthews, that it would be “business suicide” for the UK to leave the European Union? 
I think we should listen to all the business voices, particularly those in manufacturing, so many of whom say that we are better off in a reformed European Union. We get an enormous amount of investment, particularly from Japanese motor industries. I will be welcoming the Japanese Prime Minister here to the UK tomorrow, when I am sure this will be on the agenda.
Peace in Europe: Assessment of EU’s Contribution
Q12. What recent assessment he has made of the extent of the contribution of the EU to the maintenance of peace in Europe. 
NATO is the cornerstone of Britain’s defence, but our place in the EU is, in my view, a vital part of protecting our national security. I would argue that it helps in two ways: first, by ensuring that issues are settled by dialogue; and secondly, by helping to provide assistance in particular circumstances—for example, the Balkans.
I entirely agree with the Prime Minister’s remarks about NATO, but does he accept that although dictatorships often attack democracies or other dictatorships, democracies seldom, if ever, go to war with each other? If an aim of the EU is, as we are constantly told, to prevent conflict between its own members, as in world war one and world war two, is it not heading in precisely the wrong direction by trying to create an unelected, supranational Government of Europe that is accountable to nobody?
My right hon. Friend has long-standing and passionate views on this issue. Let me make a couple of points in response. First, we should not forget that, until very recently, some countries now in the European Union were not democracies, but forms of dictatorship. Secondly, those countries that have worked towards membership of the EU have had to put in place all sorts of democratic and other norms to help them on their way. Finally, we have had an unparalleled period of peace and prosperity in Europe. My argument is that whether we attribute all of that to NATO or some of that to the EU, why would we want to put it at risk?
Q6. The findings of the NHS England report on the sudden closure of Bootham Park mental health hospital in York have confirmed that the relationships between the NHS bodies, as defined under the Health and Social Care Act 2012, are dysfunctional and have failed patient safety. A Healthwatch report showed that harm has occurred because life has been lost. Will the Prime Minister now accept that, because of the serious risk that has been created, the 2012 Act has to change in line with NHS England’s recommendations? 
I will look very carefully at what the hon. Lady has said. My understanding is that she called for action on an outdated and dangerous facility back in July last year, and that is exactly what happened. I am pleased that action was taken. Bootham Park was not fit for purpose. The Care Quality Commission identified serious and life-threatening issues on patient safety, which were not put right. As a result, there was a decision to close and then subsequently reopen the facility after changes. Of course there will be incidences of poor practice; what matters is whether we intervene fast enough and put them right. In this case, I will look again at what she says, but it does look as if action was taken.
The Christian Yazidi and Shi’a children in Syria are suffering from genocide carried out by Daesh, and we should recognise it as such. May I urge the Prime Minister to do more to replicate the Kindertransport of the 1930s? That is what we are doing in taking children directly from the camps in Syria. If we were to take 16-year-olds from a safe environment in Europe, we would simply be causing more misery and encouraging the people traffickers.
My hon. Friend has asked me two questions. One is whether there is more we can do to label what has happened as genocide. That has always been done under a legal definition, but there is a very strong case here for saying that it is genocide, and I hope that it will be portrayed and spoken of as such.
On the issue of the Kindertransport, I agree with my hon. Friend. We have an enormous amount of which we can be proud—the money that we have put into the camps, and the fact that we raised more in London on one day than any humanitarian conference has ever raised in the history of the world. We have a very strong record. We will do more for children who were already registered in Europe before the EU-Turkey deal, but the principle that we should try to cling to is that we should not do anything that encourages people to make the perilous journey. That has been the cornerstone of our policy and it should remain the case.
Q8. For the benefit of the House and for 10 and 11-year-olds up and down the country, will the Prime Minister explain what the past progressive tense is? Will he differentiate between a subordinating conjunctive and a co-ordinating conjunctive? Finally, will he set out his definition of a modal verb? 
The whole point of these changes is to make sure that our children are better educated than we are. That is why I am absolutely delighted that my three children at state schools are going off to do these tests.
Three years ago—[Interruption.]
Order. I want to hear Mr Vickers’s inquiry.
Three years ago, five members of the Cockburn family from County Durham were killed in a tragic accident on the A18 in my constituency. At the recently concluded inquest, the coroner said that he had no confidence that the proposed work by the highway authority would remedy the situation. Obviously the council wants to do all it can, and has committed to carry out the work in full. However, resources are very limited. Will my right hon. Friend give serious consideration to an application from the council for additional resources to avoid a future tragedy?
I will certainly have a very close look at the issue that my hon. Friend raises. I know the A18 and its importance for his constituency, and I will look at what the Highways Agency has made available and at whether there is real evidence that more could be done to make the road safe.
Q9. Eritrea was described as the North Korea of Africa at the recent inaugural all-party group meeting, which heard reports of Government-enforced indefinite conscription. The UK FCO advises against travel to areas within 25 km of the Ethiopian border. Will the Prime Minister personally and urgently review Home Office guidance that says that it is safe to transport asylum seekers back to Eritrea? 
I will certainly consider what the hon. Gentleman says. We know that Eritrea is a deeply undemocratic and autocratic country that has done appalling things to its people and that is one reason why so many of those seeking to cross the Mediterranean, normally through the Libyan route, have come from that country. When I had the opportunity to meet the Eritrean leadership, as I did at the conference in Valletta in Malta, I made those points very strongly.
Four years ago, I asked my right hon. Friend on behalf of my mother, Maud, whether the EU referendum vote could be brought forward because of her age. She was then 100. She now wishes to know whether she needs to set a world record for longevity before the Chilcot report is published.
I think that I can reassure Maud that this summer she will have a double opportunity to deal with these things, with a referendum on 23 June and the Chilcot report, which, I am sure, will come not too much longer after that.
I rather imagine that she will then want a Backbench Business Committee debate on the matter.
Q10. Tata Steel has indicated that it wishes to complete the sale of its UK assets by the middle of June and that it wants a preferred bidder in place by the end of this month. Does the Prime Minister really think that that is a realistic timeframe and that there will be a credible process of due diligence? What steps is the Prime Minister taking to ensure that Tata Steel delivers on its promise to be a responsible seller? 
The hon. Gentleman is absolutely right about this. The positive news is that the deadline yesterday was met by a number of serious inquiries of interest into buying all of Tata, and that is good news. Obviously, we now need to work intensively with Tata and those buyers to get that list down to those who seriously intend to bid for the business. The hon. Gentleman is right that it is a very short timetable. He asks what we are doing, and what we are doing is talking intensively with Tata to ensure that it does everything it can to make sure that this is a serious sales process.
The Prime Minister just made a very important announcement about refugee children, but obviously time is of the essence because of the peculiar vulnerability of children without the guidance and protection of their families. Will the Prime Minister indicate to the House how quickly he expects to have those arrangements in place?
I am grateful to my right hon. Friend, who has spoken powerfully and passionately about this issue. I do not see any reason why there needs to be a long delay. We need to carry out conversations with local councils, because many of them, particularly in the south of England, are already under pressure owing to the number of child refugees who have already come. We need to carry out those conversations, but hopefully we can then make progress during this year.
Q11. Documents leaked earlier this week appear to confirm what most have feared: that the Transatlantic Trade and Investment Partnership makes unacceptable concessions in respect of public health and safety regulations, opening the doors for US investors to sue for loss of profits. Will the Prime Minister recognise the concern raised by the French President and tell this House what protections his Government are seeking for the national health service and public services? 
This is the reddest of red herrings, I have to say. The health service is completely protected under this agreement, as it is under others. There are all sorts of reasons why people might be against free trade and wanting to see an expansion of trade, investment and jobs, but I think people ought to be honest about it and say that they do not want to see those things happen, rather than finding total red herrings to get in the way of something that could add tens of billion pounds to our economy and bring jobs and investment to our country—[Interruption.]
Calm yourself, Mr Campbell. You are supposed to be a senior statesman in the House. Calm down. Take up yoga, as I have told you before.
Looe Lifeboats in my constituency celebrates its 150th anniversary this year. Will my right hon. Friend join me in congratulating and thanking not only the Looe lifeboat men, but all the lifeboat men who keep us safe at sea?
I am very happy to do that in conjunction with my hon. Friend. Lifeboat men are incredibly brave people. Having met some of them, particularly during the flood episodes that we have had in recent years, I know the immense professionalism and dedication that they bring to the task, and they put their lives at risk all the time to save others. They really are the bravest of the brave.
Q13. What assessment he has made of the effect on the performance of Government of the introduction of five-year fixed-term Parliaments; and if he will make a statement. 
What matters is what works and allows the Government to make long-term decisions in the long-term interests of the country. In my view, five-year fixed-term Parliaments are an important part of that.
Will the Prime Minister ensure that his Government’s performance includes the long-overdue creation of a centre of evidence on sexual abuse of children—something that I first raised in Prime Minister’s questions with Margaret Thatcher in 1989? We can deal with the awful consequences of child sex abuse for victims and perpetrators, but we must also use early intervention expertise to stop it happening in the first place. Will the Prime Minister back the excellent work of Ministers and Members from all parties and get this much-needed What Works centre up and running without delay, within the five-year term of this Government?
I am glad the hon. Gentleman rescued his own question with those last words. We are grateful to him, constitutionally at least.
I am sorry that it has taken so long for a question in 1989 to get an answer, but I can tell the hon. Gentleman that setting up a centre of expertise on sexual abuse is exactly what the Home Office is doing. It will play a significant role in identifying and sharing high-quality evidence on what works to prevent and deal with sexual abuse and exploitation. Alongside this, the Department for Education’s existing What Works centre will ensure that social workers across the country are able to learn from the best examples. It is a good example of Government reform, which I know the hon. Gentleman supports.
The Prime Minister and we on the Government Benches can be very proud of the fact that in recent years we have reduced both relative poverty and income inequality. We are a one nation party or we are nothing. Does the Prime Minister agree with Lord Rose, the leader of the Remain campaign, that if we were to leave the EU and exercise greater control over immigration for the sake of public services, wages would rise even faster?
If we were to leave the EU, I think we would see an impact on our economy that would be largely negative. That is not just my view; that is the view now of the Bank of England, the International Monetary Fund, the OECD and a growing number of international bodies. I would say to anybody who wants to make that choice that obviously it is a choice for the British people to make, but we have to be clear about the economic consequences.
Q14. In 1972, my constituent Susan Lee, aged just 19, having been married for nine months, and six months pregnant with their first child, received a knock on the door to say that her husband Private James Lee had been killed in action in Northern Ireland. When Susan, now Rimmer, married and found love again, she lost all compensation for her and her daughter Donna-Marie, and she still has no compensation for having made that huge sacrifice. That is a disgraceful way to treat those who have lost loved ones who were serving our country. Will the Prime Minister meet me and Mrs Rimmer to discuss this case and the injustice that still faces several hundred more widows in this country? 
I will make sure that Susan Rimmer gets the meeting and the attention that she deserves. I know that the Minister with responsibility for defence personnel and veterans, my hon. Friend the Member for Milton Keynes North (Mark Lancaster), met the War Widows Association earlier this year so that it could put forward its case. Of course, it was this Government who made a historic change so that war widows who remarried, from 1 April 2015, would retain their war widow’s pension. That was a change long asked for and only delivered under this Government. We will continue to look at this issue, but at present we are of the view—this is the long-standing policy of successive Governments—that we should not make these changes and apply them retrospectively.
Yesterday the Foreign Affairs Committee started our inquiry on Anglo-Russian relations. This afternoon I have a Westminster Hall debate on Anglo-Russian relations. Despite all the tensions between our two countries, will the Prime Minister give us an assurance that he will redouble his efforts to try to lower tensions with that fellow permanent member of the UN Security Council?
Of course we want to keep tensions low, and of course we want to have good relations, but we cannot ignore the fact that Russian-backed and directed separatists have effectively tried to redraw the boundaries of Europe. When we consider how dangerous such exercises have been in the past, we have to take them extremely seriously in the present.
May I thank the Prime Minister for joining Leicestershire MPs and the rest of the planet in congratulating Leicester City football club on their brilliant and historic success in the premier league? During this amazing season, local Leicester hero, Gary Lineker, thought the idea of Leicester winning the league was so far-fetched that he said he would present “Match of the Day” in his underwear if they won. Does the Prime Minister, as an Aston Villa supporter—my commiserations to him on their season—agree that, in politics as well as in football, when people make a promise, they should keep it?
I absolutely agree. I have been watching everything Gary Lineker has said since, and he is not quite answering the question—something that, of course, no one ever gets away with in this House. I welcome what the right hon. Gentleman has said; obviously, I hope it is just the start of him joining the blue team.
Dublin System: Asylum
(Urgent Question): To ask the Secretary of State for the Home Department if she will make a statement on reforms to the Dublin agreement and the effects on asylum.
This morning the European Commission published its proposals for reform of the Dublin protocol and emergency relocation in response to the migration crisis in the Mediterranean. The proposals were first announced under the EU-Turkey deal, and agreement is critical to finding a solution for Europe’s asylum systems ahead of the summer. The Government will now scrutinise the proposals carefully.
As the House will be aware, the UK has an opt-in to any EU proposals on justice and home affairs issues. It is not bound to sign up to the proposals the Commission has published today; we will have three months to consider whether to do so. The proposals will be laid before Parliament, and an explanatory memorandum will be provided. Scrutiny Committees in both Houses will look at the issue in detail, and Parliament will be able to consider the proposals in the usual way.
The Government strongly support the principles behind the Dublin regulation. We believe that an asylum claim made in the EU should be dealt with by the member state most responsible for the applicant’s presence in the EU. This provides certainty for the applicant and protects other member states’ asylum systems from abuse. But our starting position is clear: we will not opt into any legislative proposal that replaces the existing Dublin principles with a redistribution mechanism, and we do not support relocation. Those in need of protection should claim asylum in the first safe country they reach. We support the existing Dublin regulations and the principles underpinning them.
In this context, it is worth noting that the Commission has been very clear today that, should we not opt into the revised Dublin regulations, the existing regulations will continue to apply between the UK and other member states, and this is at least partly a direct result of the Government’s engagement with the Commission and other member states. As such, there is no risk that we would lose our existing powers to return people to other EU member states—powers that we have used nearly 12,000 times since 2005.
Where an individual is the responsibility of another EU member state under EU law, the Government seek to return them under the Dublin regulations—and we will continue to do so. We have been engaged in regular constructive conversations with our European counterparts and the European Commission, and will participate fully in the negotiations on this draft proposal at European level. I commend this statement to the House.
I thank the Minister for his statement, although I am somewhat concerned that it will be three months before we know what this will look like in reality, given that we have a very important referendum coming up in that time.
The Minister said in February that the Dublin agreement
“should be upheld, not undermined.”—[Official Report, 29 February 2016; Vol. 606, c. 689.]
In theory, the Dublin asylum regulations ensure that EU countries can deport refugees to their first port of entry, as he just re-confirmed. The Secretary of State recently restated her view
“that amending the Dublin regulation is unnecessary and risks undermining a vital tool in managing asylum claims within the EU.”—[Official Report, 2 December 2015; Vol. 603, c. 21WS.]
However, the EU Commission is pressing ahead with reforms despite her views, and despite many European countries expressing their extreme disquiet. Under the existing rules, Britain ostensibly, as the Minister said, has the right to deport asylum seekers to their first port of entry. However, in practice that means—he gave a figure—that only 1% of asylum seekers from the UK each year have been relocated to the first port of entry, according to Eurostat. Does he accept that this very low figure of only 1% for relocations is accurate? If so, will he explain why the UK is performing so badly under the current regulations?
In practice, the Dublin agreement is very far from perfect, and the EU is desperate to find ways of evening out the strains from the large numbers of asylum seekers, as well as of not rocking the British boat before our referendum. Even the European Commission has acknowledged that the current Dublin system does not work. Germany has all but abandoned it, and Greece has apparently not abided by it since 2011. The Commission has stated:
“Even where Member States accept transfer requests, only about a quarter of such cases result in effective transfers, and, after completion of a transfer, there are frequent cases of secondary movements back to the transferring Member State”.
Does the Minister accept that even with relocations as low as 1%, we are often obliged to re-admit individuals under the secondary transfer process? Does he have figures for the House on how many are relocated back to the United Kingdom? Given the low numbers sent back to the first port of entry under this system, and the fact that many of them return, does he still believe that this is a good deal for Britain? Despite the haggling and horse-trading going on behind closed doors as we speak, has the Secretary of State secured a permanent and favourable opt-out from any form of quota sharing—an opt-out that cannot be overruled at any point in future by other member countries? It is important to know that at this moment.
These proposals are part of a package to try to manage the surge in migrants and refugees flooding into Europe. The Commission is in the process of proposing measures revising the terms of the Dublin regulation—namely, imposing a financial penalty of €250,000 for every refugee not taken by a country if another member state experiences a sudden influx. How will this new quota/penalty system proposal sit with the current Dublin III proposal that the Minister says he wishes to stay within? Has he secured a permanent and favourable opt-out from any form of penalty payment that might be negotiated in future for non-acceptance of quotas—one that could not be overruled at any point in future by other member countries?
Order. Before the Minister responds, two points should be made. First, I say in all courtesy and gently to the hon. Lady that she modestly exceeded her time allocation, but I am sure that that was inadvertent and will not be repeated on subsequent occasions.
Secondly, equally courteously and gently, I say to the Minister, with reference to his final sentence commending his statement to the House, that he did not make a statement to the House. The Government could perfectly well have volunteered a statement to the House, but the reason the right hon. Gentleman is in the Chamber is that I required a Minister to attend the Chamber to answer the urgent question—capital U, capital Q—from the hon. Lady. It may seem a fine distinction to those attending our proceedings, but it is quite an important one. The right hon. Gentleman is here involuntarily and not voluntarily. I hope the position is now clear.
No, he does not need to be deported—we want him to answer the question.
Thank you, Mr Speaker. I am always the servant of the House in this regard.
My hon. Friend the Member for St Albans (Mrs Main) has raised various points. The UK has a very clear opt-in arrangement in relation to justice and home affairs matters and we retain firm control over the ability to decide which matters to opt into, as I explained clearly in my opening comments.
The existing Dublin regulations provide a significant benefit. As I have said, we have used the process to remove nearly 12,000 people from the UK to other EU member states over the past 10 years.
My hon. Friend asked whether we may subsequently be bound by, or be required to be participants in, the new arrangements. I point her to a specific statement in the European Commission’s press release:
“The UK and Ireland are not required but instead determine themselves the extent to which they want to participate in these measures, in accordance with the relevant Protocols attached to the Treaties. If they do not opt in, the current rules as they operate today will continue to apply to them, in line with the Treaties.”
That provides the important clarification and certainty sought by my hon. Friend. Clearly, that provides protection in relation to whether or not we decide to opt into certain matters, including the quota penalty, to which she referred.
Let us be clear from the start: through our opt-out on home affairs and justice, Britain would not be required to take part in any asylum relocation system, nor would we be required to pay any financial levy to avoid it. Let us also be clear, however, that we have a keen national interest and a moral responsibility to ensure that effective systems are in place to tackle the worst humanitarian crisis in Europe in a decade. A humanitarian crisis on this scale clearly needs a concerted EU-wide response.
It is clear that the Dublin arrangements are not working on the ground. They are not able to cope with the numbers or process the claims. For those precise reasons, Labour has been calling for many months for a reconsideration of how the Dublin arrangements work in practice. The Government, as ever, have been slow and reluctant to act, as characterised by the Minister’s involuntary appearance here today.
Labour is also clear that the key Dublin principles preventing first country states from refusing to process asylum seekers and allowing return to first country are important. We welcome the Government’s update on that, but what reform proposals have they made to the Commission?
There is also the wider and key question of unaccompanied children in Europe. Today the chair of the Association of Jewish Refugees called on the Prime Minister to do more to help what he called “the most vulnerable victims” of the Syrian conflict. We cannot continue to sit on our hands or to be subject to the repugnant rhetoric that these children in Europe are safe—they are not. There is a groundswell of support. When will the Government finally listen? If there is to be a U-turn, the sooner it happens, the better.
The hon. and learned Gentleman clearly did not hear what the Prime Minister said at Prime Minister’s Question Time just a few moments ago. He said that we are in discussions with Save the Children and the United Nations High Commissioner for Refugees about what further assistance can be provided to those who had already registered in Europe before the EU-Turkey deal came into force. He also mentioned the discussions that we will have with local authorities.
I reject entirely the hon. and learned Gentleman’s claim that the Government have been slow to act on the Dublin regulations. We have sent experts to France and other European countries to support that process, to enable its practical implementation on the ground, and to ensure that it bears fruit and speeds up.
The hon. and learned Gentleman highlighted issues relating to the Dublin regulations. The Government believe that the long-standing principles at the heart of the Dublin system are the right ones, and it would be a major error to tear them up and replace them with something completely different. Dublin may not be operating as it should be, but that does not meant that its principles are fundamentally flawed. That is the approach that this Government will take to further negotiation.
Right hon. and hon. Members will not have seen the proposals in detail, because they have only just been published. It is right, therefore, that we reflect on them in detail and continue our discussions in order to ensure a reformed Dublin system that benefits the UK, while acknowledging the protections we have to maintain the existing Dublin arrangements.
I congratulate my hon. Friend the Member for St Albans (Mrs Main) not only on securing the urgent question, but on the manner in which she conducted her analysis. She was, of course, completely right. The European Scrutiny Committee is looking at this very matter and we will be talking about it this afternoon. Would the Minister be good enough to give us an assurance that, if we so decide, which I feel we will, that there should be a debate on the Floor of the House, he would encourage that with the Whips? Will he also make sure that the matter is not left hanging around for as long as three months? We need urgent answers to these questions.
The three-month period is the time the UK has to consider whether to opt into measures at the outset. As my hon. Friend will know, that is one of our protections in our relationship with the EU with regard to justice and home affairs matters. The Commission has published its papers this morning and I am sure that they will be scrutinised in detail by the European Scrutiny Committee. The Government will provide information and support that process in order to ensure that the measure is properly scrutinised by the House. There is no delay on the Government’s part: the three-month period is our safeguard in deciding whether to opt in, and it certainly does not defer scrutiny.
The Dublin rules were not fit for purpose, even before the current crisis in Europe developed, and that crisis has pushed the system way beyond breaking point. Even a child would understand that front-line countries such as Greece and Italy cannot be expected to deal alone with all the asylum seekers who arrive there. The proposed system of financial penalties would be an improvement, but it is a distant second best to the proper sharing of responsibility throughout the European Union. If the United Kingdom is not prepared to sign up to the new EU asylum system, exactly what steps will the Government take in order for the UK to do its bit for those already in Europe, particularly the child refugees?
When I was in Calais with other Scottish National party MPs at Easter, we met many refugees with family in the UK, and we met men who had acted as interpreters for the UK armed forces, including men who had been at Camp Bastion at the same time as Prince Harry and when the Prime Minister visited. The Government keep assuring us that they are taking action to speed up the processing of take charge requests, once they receive them. Will the Minister now provide us with the figures on processing times that we have repeatedly asked for, so that we can have some evidence that those take charge requests are being dealt with more speedily?
More fundamentally, there is a real problem with the French side of things being handled slowly and the fact that many of the refugees in Calais and Dunkirk are afraid to claim asylum in France because of the very bad experiences they have had there already, including being tear-gassed by French authorities. Will the British Government consider providing a route to bypass the French system and allow direct claims to the UK based on family ties?
The relevant requests under the existing Dublin arrangements are being processed in a matter of weeks, as I have indicated to the hon. and learned Lady on previous occasions. Direct contact between officials on both sides means that they are able to make speedy decisions and ensure that those who have links to the UK can be reunited. The Government believe in that principle very strongly. We are also providing additional funding to and investment in other parts of Europe, and that work is absolutely intended to support that principle.
The hon. and learned Lady mentioned the French Government’s actions. They have engaged a specific non-governmental organisation, France Terre d’Asile, to identify people in the camps and ensure that they are protected speedily. We support that work and we will continue to support the French Government and play our part in ensuring that those who have a connection to the UK are established, identified and come to the UK quickly.
Does the Minister agree that the migrant crisis that we face is our part of a crisis that affects every European Union member state and requires a European Union solution? It is a complete absurdity, first promulgated by the UK Independence party, that if we left the EU these people would somehow no longer be a problem for us.
As the Government have played a full part in the limited progress so far on closing the outer border of Europe and making arrangements with Turkey for the return of asylum seekers, does the Minister accept that although we are legally quite entitled to insist on the Dublin convention, and of course must exercise our opt-out when it is in our interests, we must have regard to the problems of Greece, Italy and other countries? Those countries have not encouraged these vast numbers of people to come to them, and we will need the co-operation of their Governments if we are eventually to restore order in every member state, including the United Kingdom.
My right hon. and learned Friend is absolutely right that this is an EU-wide problem which we will need to continue to address at that level, and that it is clearly not the case that the UK leaving the EU in the referendum would suddenly make the migration crisis go away.
My right hon. and learned Friend mentions Greece and Italy, and he will equally know that the EU-Turkey deal is intended to support efforts on the frontline. From next week we will be sending out about 75 experts to support front-line activity in Greece.
I think that in his heart, the Minister probably accepts everything that the hon. Member for St Albans (Mrs Main) said today, including that the Dublin agreement is in crisis not because of the United Kingdom but because other EU countries are flouting the way it operates. The Home Affairs Committee saw that for itself when it visited Greece and Italy. Other partners need to fulfil their obligations under Dublin and deal with matters in their countries so that people do not end up coming to Calais seeking to come over to the United Kingdom. To do that, they need just 10% of the money that has gone to Turkey. The EU-Turkey deal was the most generous in history, but Greece and Italy are the countries that need our support.
The right hon. Gentleman will know about the practical support that we are providing through the European Asylum Support Office to front-line states that have seen significant numbers of people arriving on their shores. We have provided £70 million of funding for the Europe-wide response, which is a significant contribution to the activities needed to support vulnerable migrants. He is right that we need to continue the work with Greece and Italy, which is precisely what the Government will do, as we recognise the pressures that those Governments are under.
The EU documents about the EU-Turkey agreement, including the creation of a visa-free area for most of the EU and Turkey, make it clear that strengthening the Turkish frontier with Syria, Iraq and Iran must be part of the revised asylum and migration policy. Quite remarkably, and rather strangely, the documents say that the EU will help build walls, fences and ditches along what is an extremely long border. Can the Minister tell us how many miles of those impediments to migration the EU has in mind, and what the costs might be?
The clear focus is on seeing that refugees do not make the journey across the Mediterranean sea to the shores of Europe, which is consistent with the approach that the Government have taken. It is why we have pledged £2.3 billion to tackling the humanitarian crisis, which is giving people a sense of hope and opportunity through work and education. That is the right approach to show people why they should not be making the journey, and the EU-Turkey deal supports that.
I know that the Minister is proud of his opt-in, but in reply to the right hon. and learned Member for Rushcliffe (Mr Clarke) he seemed to agree in principle that the refugee crisis is a European crisis that requires collective action. If we had the Brokenshire regulations instead of the Dublin regulations, what exactly would they be?
I am grateful to the right hon. Gentleman for framing the question in that way. It underlines the need for each EU member state to play a part, which is precisely what the UK Government are doing. We are providing expert support, funding and a significant contribution to resettlement through the vulnerable persons resettlement scheme and the new children at risk resettlement scheme. The basic principles of Dublin are right and need to be upheld, but the question is how we can improve the practical aspects of it.
If the Dublin convention is to work optimally, it requires the collection of biometric data from migrants. Perfectly understandably, the more savvy migrant declines to co-operate with that process, probably with the connivance of Italian and Greek officials. What can be done to strengthen that part of the Dublin arrangements?
It is about practical implementation, and that is why I made the point about the 75 experts we are sending out to Greece. Other European countries are doing the same, to see that the practical measure of taking fingerprints is upheld at the frontline. I think that practical support will make the difference.
Does the Minister accept that the Dublin regulation should put a floor on what we do, not a ceiling? With that in mind, will he look again at the treatment of those who claim asylum having previously helped our armed forces in Afghanistan as interpreters? If they had treated us as we now treat them, the lives of many of our servicemen would have been put at risk or lost.
I will look carefully at what the right hon. Gentleman says about how those who have supported the British armed forces in Afghanistan are analysed and treated in our asylum system. Many right hon. and hon. Members have raised that issue, and I can assure him that I am giving it close attention.
Does the Minister agree that EU reform in this area should take into account a member state’s efforts to resettle refugees from third countries outside the EU and to fund those countries? With the UK having delivered more than £1 billion of aid to try to prevent perilous journeys at sea, it would be right for the EU to endorse our approach if reduced migration is the aim.
My hon. Friend is absolutely right about the steps that the Government have taken through the vulnerable persons resettlement scheme. Our focus remains on providing safe routes for the most vulnerable in the region. The UK has made an important contribution, which plays a part in the overall work across the EU of providing stability and preventing people from making the journey.
The Minister will know that there is a huge amount of concern about the issue in this country, and especially about unaccompanied children in the camps in Calais. It is welcome to hear that the Government now agree with Alf Dubs, but given what the Minister has said today and the problems that we have seen to date with people claiming asylum through the current Dublin arrangements, will he give us some numbers? How many young people does he think the UK will now be able to offer sanctuary to as a result of the decision that the Government have made today?
The Prime Minister said earlier that we will discuss the matter with local authorities, and we will also continue discussions with the United Nations High Commissioner for Refugees, Save the Children and others. It is right that we assess the issue carefully in that way and come to the right conclusion.
Does my right hon. Friend agree that the UK has the double protection of being outside the automatic opt-in and outside Schengen, so that when asylum seekers choose not to claim asylum at the first port of call, they cannot travel across Europe and come to the UK through a no-border zone?
We have the best of both worlds in being outside the borderless area of Schengen, which gives us the protection of being able to uphold our own border and carry out the necessary checks, and having legal rights through the opt-ins and the enhanced mechanisms that the Prime Minister achieved through his renegotiation, which will add to that protection.
It would be helpful if the Minister made it clear, given that the Government are now going to accept the Dubs amendment, that many of the justice and home affairs opt-outs are designed, as he has just said, to control Britain’s borders. He will be aware of the very good journalism by Ben Riley-Smith of The Telegraph showing that the Semaphore system, which controls those coming into the country, went down for several days last summer, leading to the Minister and the Home Secretary being roused from their beds. Yesterday, his permanent secretary admitted that that had happened many times but would not say when and for how long. Do we not deserve that information? Will the Minister publish it?
We provide clear assurance and protections for the UK border. We take a multi-layered approach. We ensure that the primary control points have 100% checks for scheduled arrivals, which the last Labour Government did not do. This Government will continue to maintain that focus on our border and security.
My right hon. Friend will know from the conference on the migrant crisis at which both he and I spoke last week of the anger and despair of the Hungarian Government at what is now being proposed by the European Union. Will he explain what our Government are doing to criticise, or to try to take enforcement action against, Germany for its unilateral rejection of the current regulations?
As I have indicated to the House, the Government have opt-outs and opt-ins for certain measures. There are aspects of Schengen that we are not party to, and we will not be party to the Schengen area. It is for those member states bound by those regulations to enforce compliance, with the Commission. That is rightly a matter for them and not for the UK.
I hope that the Minister will find a way to provide more support for unaccompanied children. Compassion demands it. Will he outline how the UK front-line support that is going to be provided to Greece and Italy will help to ensure that unaccompanied children already in the European Union do not go missing?
The right hon. Gentleman raises an important point about issues such as trafficking and exploitation. Kevin Hyland, the independent anti-slavery commissioner, will be travelling out to Greece and Italy shortly. The experts we are sending out will include people with knowledge and understanding of those issues in relation to children, so as to seek to provide greater assurance on the very matter he raised.
Through their recent renegotiation the Government have demonstrated that an axiom of our EU membership is our common European citizenship, which implies the common treatment of people right across the EU. Will the Minister not concede that if the public vote to remain in the EU, he will not long be able to resist pressure in the Council of Ministers to concede our opt-out and to join the arrangements, whatever those are, in a process of bargaining away to achieve whatever happen to be the objectives of the Government of the day?
I do not concede that. The UK has very clear legal protections; indeed the way in which we opted out of a number of pre-existing justice and home affairs measures shows the clear approach of this Government in upholding what is in the UK’s best interests. I have been very explicit this afternoon in highlighting that we judge that being part of the relocation mechanism is not in the interests of the UK.
Given that the Minister has said that the asylum regime may well change after the EU referendum, will he concede that there is no status quo on the ballot paper for the referendum, just as those who voted to stay in the Common Market in 1975 did not get the status quo? Given that Opposition parties seem to be working on the basis that other EU countries are incapable of providing decent and humane refuge to asylum seekers, does he agree that we should not want to be part of a political union that cannot treat asylum seekers properly and with decency?
On the status quo, the Commission has said explicitly that we can continue to uphold and operate the existing Dublin arrangements if we decide not to opt in to the new measures published today. That assurance is important. Clearly, we will continue to work to support other EU partners, to ensure that those who claim asylum on their shores are able to do so effectively. Our expert support is precisely in tune with that.
Part of the plan announced today is a proposal that European countries that refuse to give shelter to refugees could be forced to pay into the coffers of countries that do take them. We have the temporary opt-out on this at present, but will the Minister state that that opt-out is absolutely guaranteed and is one that we will not consider reneging on? Will he also publish the legal advice he has been given on the legal basis for that proposal?
I say to my hon. Friend that I am not referring to some temporary opt-out. Our ability to opt-in to measures on justice and home affairs matters is one of the basic principles of the treaty. I know he understands and recognises that. It is the basis upon which I have made my points to the House this afternoon.
The Minister has been involved on the issue of human trafficking for many years and so knows about the problem. One problem with continental Europe is its open borders. Whatever the other advantages of those open borders, they are a human trafficker’s charter. It seems to me that the new proposals will add to that problem. We want more checking, to stop the evil crime of trafficking.
I pay tribute to the work of my hon. Friend, who has done so much to highlight the issue and has assisted in the reforms that have taken place. We need to step up our response to organised immigration crime, which is why we have established the taskforce and will continue to work with European partners to highlight these important issues and see that children are protected and do not fall into the hands of traffickers. I hope that the work on the frontline and the further inputs from Kevin Hyland will assist us not just as a country but in supporting other member EU states.
I have to notify the House, in accordance with the Royal Assent Act 1967, that the Queen has signified her Royal Assent to the following Acts:
Enterprise Act 2016
Northern Ireland (Stormont Agreement and Implementation Plan) Act 2016
Bank of England and Financial Services Act 2016
Trade Union Act 2016
Transport for London Act 2016.
Town and Country Planning (Electricity Generating Consent)
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 disclosure, consideration and approval of proposals for onshore electricity power stations of 50MW or less; to require the application of Engineering Construction Industry (NAECI) terms and conditions in certain circumstances; to require sector-specific collective national workforce agreements in other circumstances; and for connected purposes.
Any solid biomass or combined heat and power plant producing 50 MW or below—indeed, any power project producing 50 MW or below—does not come under the terms of national planning consent. Ostensibly that sounds fine, as it supposedly gives more control to local people about developments in their locality. Projects with a generating capacity of 50 MW and less are considered under the Town and Country Planning Act 1990 and can therefore be dealt with by local authorities.
That is where, for workers in the construction industry, the problems begin. Civil engineering and engineering construction are lifestyle choices that demand commitment, loyalty and hard graft. Workers more often than not work long hours under arduous and sometimes dangerous conditions to produce the end-product. However, all those great virtues count for nothing when the dice are loaded. From Teesside to south Yorkshire, from Scotland to Wales, there has been a recent epidemic of deliberate subterfuge to avoid and evade the industry standard for terms and conditions for construction workers in the power generation sector.
Locally, I and fellow Teesside Labour MPs, such as my hon. Friends the Members for Redcar (Anna Turley), for Hartlepool (Mr Wright), for Stockton North (Alex Cunningham) and for Middlesbrough (Andy McDonald), have been trying to unravel a complex knot of potential exploitation and undercutting. We have been working alongside the GMB and Unite the union at both regional and national level.
The sleight of hand employed and the deliberate use of opaque contractual arrangements via umbrella companies, which has seen workers paying their own national insurance twice, are known universally. Put together with potential undercutting and exploitation of migrant workers, they only frustrate an area and its people, who have seen massive privation in the light of closures at SSI Steel, Caparo Hartlepool, Air Products and Boulby potash mine, to mention just a few of the sites undergoing closure or job losses. That frustration has culminated in a year-long escalation of unrest in the construction industry fraternity, with mass protests outside the Wilton International site about the fact that the Wilton 11 energy from waste plant is being built on Teesside with a predominantly non-UK labour force.
Any MP considering the upcoming construction of energy from waste, biomass, or combined heat and power plant, must be aware that any individual project in or near their constituency that is under 50 MW will have achieved planning consent from a local authority. That consent will almost certainly not carry the necessary requirements of collective agreements, such as NAECI terms and conditions for workers in the construction of the project, which would also instil a level playing field for all at the tendering stages of the project.
Until now, the assumption has been that NAECI terms would carry over, but sadly that has not been the case. Owing to unscrupulous practices by certain construction companies, the lack of a voice in this growing market of power generation has led many who have been shut out of employment to take on board tactics that are born out of pure frustration and can develop into demonstrable anger. On 1 March and 7 April 2015, large numbers of construction workers took part in co-ordinated protests outside new biomass power stations in Rotherham, south Yorkshire, Port Talbot and Dunbar, and with the support of GMB, Unite and UCATT trade union members, they blockaded and disrupted work on those sites.
As a comparator for the injustice and undercutting of those unscrupulous construction companies, the rate under the national industry agreement should be between £16 and £64 an hour, depending on the skill of the role. However, the largely migrant workforce on those projects is being paid just €9 to €13 an hour—approximately between £7 and £10. With current levels of unemployment above the national average in the industry, it is no wonder that those workers are angry at the exploitation of migrant labour at the expense of local employment.
How can developers and employers get away with this race to the bottom? In Rotherham, for example, the local council gave planning consent in 2011, but sites producing under 50 MW have no legal provision for adherence to collective agreements.
The venture capitalists Brite Partnerships bought the site and then sold it on at a big profit to a Danish company, Copenhagen Infrastructure Partners. CI then contracted Babcock & Wilcox Vølund and Interserve to design, construct and operate the plant. In talks at its Birmingham office with GMB and Unite, BWV refused to allow the project to be included under the terms of the “blue book” NAECI national agreement. Subsequently, BWV sub-contracted the construction of the boiler to a Croatian firm called Ðuro Ðakovic TEP, which tendered to a lowest bid based on Croatian economic wage levels.
Ðuro Ðakovic TEP has form—very bad form. It is the same company that GMB and Unite caught underpaying its largely migrant workforce last year on the Ferrybridge Multifuels power station in Yorkshire. Because that job came under the NAECI independent audit facility, the unions were able to force the company to repay every euro that it owed its workers. However—sadly—the unions discovered only later from a worker via email, that when those workers got back to Croatia, the money was retaken from their wages under duress. Because the Rotherham biomass project and similar new waste-to-energy plants are not covered by collective agreements, and because they are under 50 MW, the employer can pay below the rate, and legally get away with it.
Well-meaning legislation from the European Union to try to combat such malpractice does not go far enough. Currently, it only gives workers who have been posted to work temporarily in another EU country the protection of the host country’s minimum standards, namely the minimum wage, not the industry rate such as NAECI. That is not the EU’s fault; it is our fault for not protecting the pay, terms and conditions of all workers at the trade union NAECI national agreed rate.
Without blanket collective bargaining for all workers, firms will use caveats to exploit them. Support of collective bargaining and of collectively bargained nationally achieved terms is the only solution to prevent the exploitation of immigrant labour, and a real tangible means by which we as a nation can prevent the deliberate social discord that is created among our own communities by effectively excluding workers in our towns from seeking and achieving meaningful employment.
We can achieve such collective bargaining, and also help local authorities that are under severe financial and logistical pressure, by ensuring at the start of the planning process—whether a power generation site is above or below 50 MW—that collective agreements such as NAECI “blue book” terms, and nationally agreed minimum terms, are adhered to by any company that is constructing on British soil. That must be clearly written within the contract.
Question put and agreed to.
That Tom Blenkinsop, Kevin Barron, Sarah Champion, John Healey, Andy McDonald, Anna Turley, Alex Cunningham and Mr Iain Wright present the Bill.
Tom Blenkinsop accordingly presented the Bill.
Bill read the First to be; to be read a Second time on Friday 13 May, and to be printed (Bill 173).
On a point of order, Mr Speaker. Have you received immediate notification of a statement by the Secretary of State for Energy and Climate Change on the admission by the chairman of Arriva in France that 400 dossiers relating to parts of reactors meeting required standards have been falsified, and on the extent to which those falsifications were present in the generic design assessment process for the operation of Arriva reactors in the UK?
I have received no indication that the Secretary of State for Energy and Climate Change has any plans to make a statement to the House on that extremely important matter. The hon. Gentleman may be dissatisfied by that news. If he is, he has manifold ways in which to pursue the matter through the use of the Order Paper and the facility of this Chamber. Knowing his experience and dexterity, I feel sure that he will use all the instruments available to him.
[Un-allotted Half Day]
[Relevant document: e-petition, entitled Keep the NHS Bursary (113491).]
I beg to move,
That this House recognises the contribution of student nurses, midwives, allied health professionals and other healthcare staff; has serious concerns about the potential impact of removing NHS bursaries on the recruitment and retention of staff; and calls on the Government to drop their plans to remove NHS bursaries and instead to consult on how they can best fund and support the future healthcare workforce.
I have been told that the Under-Secretary of State for Health, the hon. Member for Ipswich (Ben Gummer), will be opening this debate for the Government. Given that the Health Secretary is sitting next to him, may I ask the Minister why we will not be hearing from his boss today? If he would like to give a genuine reason I would be happy to take an intervention, but if not I will take it that the Health Secretary simply does not want to defend his policy to the House. [Interruption.]
Order. There is a certain amount of chirruping from the Treasury Bench and elsewhere on this matter, and I simply make two points. It is entirely for the Government to decide which Minister to field, but I say gently to the Secretary of State, and to the Deputy Leader of the House, that to sit on the Bench rather than to participate while these matters are debated, is one thing—particularly in the case of the Secretary of State—but to sit there fiddling ostentatiously with an electronic device defies the established convention of the House that such devices should be used without impairing parliamentary decorum. They are impairing parliamentary decorum, and in very simple terms the Secretary of State and the Deputy Leader of the House are being rank discourteous to the shadow Secretary of State and to the House. It is a point so blindingly obvious that only an extraordinarily clever and sophisticated person could fail to grasp it.
Thank you, Mr Speaker. This is not the first time that the Health Secretary has chosen not to respond to debates that I have secured or questions that I have put. [Interruption.]
Order. I say to the Deputy Leader of the House: put the device away. If you do not want to put it away, get out of the Chamber. It is rude for the—[Interruption.] Order! I am not inviting a response from the hon. Lady. [Interruption.] Order! I am simply telling her that it is discourteous to behave like that—a point that most people would readily understand.
Thank you, Mr Speaker. I will leave my comments on that matter there.
In the past few months, Ministers and I have had a number of exchanges across the Dispatch Box about the unnecessary and dangerous fight the Government are picking with junior doctors. You might think that having totally alienated one section of the NHS workforce, Ministers would think twice about doing it again, but you would be wrong. Not content with junior doctors, the Government are now targeting the next generation of nurses, midwives and other allied health professionals: podiatrists, physiotherapists, radiographers and many more. Instead of investing in healthcare students, and instead of valuing them and protecting their bursaries, which help with living costs and cover all their tuition fees, the Government are asking them to pay for the privilege of training to work in the NHS: scrap the bursary, ask tomorrow’s NHS workforce to rack up enormous debts, and claim that this is the answer to current staff shortages.
The hon. Lady is making a spending commitment. Why then, only a few months ago, did she stand on a manifesto that opposed the Government’s £10 billion investment in the NHS?
The Labour party has always made it clear that it would have given the NHS every penny it needs.
Given the approach to healthcare students I have outlined, most people would think the Government had taken leave of their senses. They would be right.
My constituents in Hull are baffled by the Government’s approach. At a time when our local hospitals have to recruit nurses from Spain and other European countries, stopping bursaries that enable more people to get training seems absolutely ridiculous.
I absolutely agree with my hon. Friend. Indeed, the bursary acts as an incentive to get those students into training and into the NHS.
A few weeks ago, the Government launched their consultation on the technical detail of the changes—not the principle, just the detail. In his foreword, the Under-Secretary of State for Health, the hon. Member for Ipswich, claimed that the proposals were
“good for students, good for patients and good for the NHS.”
The opposite is the case.
Before I set out why the plans are so bad, it is important to remind ourselves of why our country has a nursing shortage in the first place. Shortly after the 2010 election, the coalition Government cut the number of nurse training commissions in an attempt to make short-term savings. The cuts saw nurse training places reduced from more than 20,000 a year to just 17,000, the lowest level since the 1990s. As a result, we trained 8,000 fewer nurses in the previous Parliament than we would have done had we maintained commissions at 2010 levels. At the time, experts such as the Royal College of Nursing warned that the cuts would cause
“serious issues in undersupply for years to come.”
It was right, but it was ignored by Ministers who were too focused on the short term and no doubt too distracted by their plans to launch a massive reorganisation of the NHS.
Our health service is now suffering the consequences of those decisions. New analysis by the House of Commons Library released today shows that the number of nurses per head of population fell from 6,786 per million people in 2009 to 6,645 per million people in 2015. A Unison survey published just last week found that more than two-thirds of respondents felt that staffing levels had got worse in the past year, with a further 63% saying they felt there were inadequate numbers of staff on the wards to ensure safe, dignified and compassionate care. Because of these shortages, hospitals are forced to recruit from overseas or spend vast amounts on expensive agency staff.
In the years 2014 to 2015, the NHS spent £3.3 billion on agency staff. Does the short-sighted step of removing the bursary mean that beleaguered trusts may actually be more reliant on agency staff?
My hon. Friend is completely right to point out that the problem of staff shortages leads to more agency staff having to be used, and that creates an enormous black hole in hospital finances. My fear is that the proposals will put off the next generation of nurses.
It now appears that the Government are making some of the same mistakes all over again. A report sneaked out on the day the House rose for the Easter recess revealed that the Government had commissioned only one-tenth of the extra nurse training places that experts said were needed this year. The report, from the Migration Advisory Committee, states:
“We were told that HEE—
Health Education England—
“has acknowledged that, on the basis of workforce modelling alone, they would have liked to commission an additional 3,000 places in 2016-2017. Funding constraints meant that they had only commissioned an additional 331 places; one tenth of what was actually needed”.
Does the hon. Lady not agree that by changing the way we run the NHS, especially in relation to bursaries and opening it up to more competition, we will get more nurses coming into the NHS, thus plugging the gap she describes?
I do not agree with the hon. Gentleman, and later in my speech I shall explain why in some detail.
I would like to return to the Migration Advisory Committee report, because it does not make happy reading for Ministers. It goes on to say:
“It seems self-evident to us that the reduction in the number of commissioned training places between 2010 and 2013 across England, Scotland, Wales and Northern Ireland, was a significant contributing factor towards the current national shortage of nurses.”
Finally, there is the crucial sentence that sums up why we are experiencing across-the-board nursing shortages:
“Almost all of these issues relate to, and are caused by, a desire to save money. But this is a choice, not a fixed fact. The Government could invest more resource if it wanted to.”
Those are the words of the Migration Advisory Committee. Hospitals are short of nurses; mental health services are short of nurses—so, too, are care homes, hospices and primary care. We therefore have a big problem. No one in this House disputes that, but no one in this House should be under any illusion as to the cause. The question, when faced with this problem, is this: what is the right thing to do? How best can the Government work with experts to ensure that we are training enough staff and supporting those staff so that they stay motivated and stay working in the NHS?
Of course we all agree that there is a significant shortage of nurses, and the hon. Lady is absolutely right to ask what should be done. Does she therefore support the Government’s concept of associate nurses, which I believe will make a huge difference in places like my constituency where we need new nurses of this kind to increase the numbers of home-trained nursing staff?
I am grateful to the hon. Gentleman for his intervention. The key question we need answered with regard to nursing associates is whether the Government intend them to replace registered nurses. If that is the case, I fear the proposals would be bad for patient care.
Madam Deputy Speaker, you might think a sensible approach to trying to resolve this problem would be to sit down with the Royal College of Nursing, other trade unions, universities and healthcare providers to work out a way forward. But no, this Government seem incapable of that. Instead, in just two lines in the Chancellor’s autumn statement, they announced that they would be scrapping NHS bursaries and asking student nurses to pay tuition fees. The Minister will argue that this will allow universities to train more students, but his problem is this.
Does my hon. Friend agree that the Government should listen to the Royal College, which said that these proposals were “high risk”, potentially
“deterring prospective students from entering the nursing profession”,
and that they risked “worsening the nursing shortage”?
I entirely agree with my hon. Friend. I think the Government’s problem is this: they have failed to back up their claim with any evidence and they are now faced with a breadth of opposition to this proposal, not just from Members but from the Royal College of Nursing, the Royal College of Midwives and Unison, while organisations such as MillionPlus, the association for modern universities, are also questioning the assumptions on which the Government base this policy.
Does my hon. Friend agree with my constituent Zoe, who is training to be a nurse and is particularly concerned about mature students? She feels that about 50% of their time is spent in unpaid clinical placements in hospitals in the community, so they do not have the opportunity to do part-time work to support themselves as many others do. Will they not be disproportionately affected?
I agree with my hon. Friend, and I shall make some remarks on that precise point later.
The Opposition’s purpose in calling today’s debate is that we hope the House can rally round what many would view as a straightforward and reasonable proposal— that the Government drop these plans and instead consult on how properly to fund and support the future healthcare workforce.
Let me set out why these plans are bad for students, bad for patients and bad for the NHS. The Government claim that these plans will leave healthcare students 25% better off. What they will not say is that, according to their own consultation, in order to be 25% better off, a student will have to take out a maximum maintenance and tuition fee loan for three years and would graduate with debts of between £48,000 and £59,000.
Many Members will know that I had a son born at 23 weeks’ gestation who spent six months in intensive care with a neonatal nurse, Nicola Probert, who sadly died not long after my son came out of hospital. I am frightened, as many people watching this debate will be, that people like Nicola will no longer go into the profession because of the astronomical debts that they will have to take on. Does my hon. Friend agree that this is a regressive step, and that the Government should think again about it?
I completely agree with my hon. Friend. It seems that the Government’s argument is that students will be better off because they can borrow more. The simple truth is that loan repayments will hit nurses’ take-home pay—there are no two ways about it. The current starting salary for a nurse is £21,692—just above the student loan repayment threshold which, of course, has been frozen. This means that nurses will start paying off their loans as soon as they graduate. According to Unison, based on current salary levels nurses will be faced with an average pay cut of over £900 a year to meet their debt repayments. How can that possibly be justified? Even worse, the average age of a student nurse is 28, so the current 30-year repayment period means that many nurses will be paying off loans to within years of retirement. We Labour Members say it is wrong to burden the next generation of NHS staff with a lifetime of debt and wrong to expect tomorrow’s nurses to pay the price for this Government’s mis- management of the NHS.
Does the Minister not understand that student nurses, midwives and other allied health professionals are different from other students? Can he not see that it is dangerous to assume that just because application rates remain stable after the trebling of tuition fees in the last Parliament, the same will happen with his proposals? Assuming healthcare students will respond in the same way as other students to a tuition fees hike is one hell of an assumption and one hell of a risk.
Courses for nursing, midwifery and other allied health professions are substantially different from most other arts and science degrees. Courses are more onerous—there are fewer holidays, longer days and longer term times—while students are also required to spend about half their time in clinical practice. This means 2,300 hours in the case of a student nurse, including night and weekend shifts as a normal part of their studies.
Will the hon. Lady give way?
I have already given way to the hon. Gentleman, and I want to make some progress.
These changes will effectively charge students for working in the NHS. Of course, longer term times and clinical placements also make it harder for these students to get a part-time job to supplement their income in the way many other students do. It is not just the course that makes healthcare students unique; they are much more likely to be women, much more likely to be mature students, much more likely to have children and more likely to be from BME backgrounds.
Many nursing students have already completed one degree and turn to nursing in their late 20s or early 30s—indeed, the average age of a student nurse is 28. When I think of my own friends who are nurses and midwives, I find that three out of four took the decision to re-train, having done a different first degree.
The Minister probably moves in different circles from me, but I can tell him that if he wants a dose of reality, my friends would, I am sure, be more than happy to oblige. I understand that he may not have experienced the conversations that I had in my working-class family about the pluses and minuses of racking up debts to get a degree, but I can tell him that for many nurses, under his proposals, that consideration will be all too real. Does he not realise that for the one in five healthcare students with children, the fear of debt is greater than it is for carefree, privately educated history students bound for Cambridge? My concern about these proposals is that we ultimately end up with those best placed to pay becoming nurses and midwives rather than those best placed to care. That brings me on to why these proposals are bad for patients.
I think we are all agreed on the need for more nurses; the question is how we fund them. Will the hon. Lady tell us how much money she would take away from front-line NHS care in order to fund the expansion of nursing places that the country needs?
We set out at the last election our clearly costed plans for how to recruit additional nurses, doctors and care staff to the NHS.
The NHS should have a workforce that reflects the population it serves—just as this place should, too. The mental health sector in particular relies on mature students and the additional life experience they bring to what is a very demanding environment.
A few months ago, I met Marina, a young woman who has not had an easy life, but who is now on a mission to become a mental health nurse. When Marina says that she thinks some of the people best placed to care for others are those who have experienced hardships themselves, I think she has a point; and when she says she would not have been able to start her training without the bursary, I believe her. Why is the Minister so convinced that the NHS can do without people like Marina in the future? Why does he think they should pay to train, and why will he not consider other options for increasing student numbers?
The quality of training that student nurses, midwives and other allied health professionals receive will also depend on the quality of their clinical placements. Government Ministers claim these changes could deliver up to 10,000 extra places over the course of this Parliament, so can they set out what capacity hospitals and other providers have to accommodate these extra students, and confirm whether Health Education England has sufficient funds set aside to fund these placements? Will the Minister be clear about how this 10,000 figure was arrived at? Is it the Government’s assessment of what the system needs, what Health Education England can afford to fund or simply a big-sounding number plucked out of the air at random?
An extra 10,000 compared with when? What is the baseline year on which we should judge the Minister’s policy? I have asked him that three times in written parliamentary questions, and each time I have not received an answer. Does he not understand that if his Department cannot even answer a simple question relating to one of its key claims about the policy, that does not exactly inspire confidence? There are so many questions that the Minister needs to answer that it is impossible to do all of them justice in a single speech.
As has been indicated, it is agreed that we need to expand the number of places. Thanks to this Government, however, an extra £10 billion has been put into GP services, acute services, cancer treatment and hospital care. Which of those services would the hon. Lady cut to fund the alternative bursary scheme that she has in mind?
The hon. Gentleman does not seem to realise that that money is plugging a very big black hole in NHS finances. I am sure that when the Minister responds to my speech, he will note that many people who apply to study for nursing and other healthcare degrees are turned away, but what proportion of those unsuccessful applicants actually meet the entry criteria? How can he be sure that his new system will deliver the required numbers of different types of nurses and other healthcare professionals in the right geographical areas? What guarantees has he given to higher education institutions that the new arrangements will fully cover the costs of delivering degrees, and what assessment has he made of the amount of un-repaid student debt that will accumulate, given that, over a lifetime, some nurses will not earn enough to repay the totality of their loans plus interest?
The proposal to scrap NHS bursaries is a massive gamble at a time when the NHS needs certainty. Put simply, it will shift the costs of training nurses, midwives and other allied health professionals from the state to the individual. If we are all happy to enjoy the benefits of the NHS, why should we not all contribute to the training of those who work in it?
I was the first member of my family to go to university. My tuition fees were paid in full, and I received a full maintenance grant. What really worries me is that people like me, and people like my friends, will be put off what could be a fulfilling and important career. We should be doing all we can to inspire today’s schoolchildren to become the nurses and healthcare professionals of the future, but, sadly, the Government are making a very good job of doing the very opposite. If Ministers want to continue to import staff from overseas, they are going the right way about it. We owe a debt of gratitude to those staff, but we want home-grown staff too.
Finally, let me return to the Government’s consultation paper. One section is entitled
“Nursing, midwifery and allied health professional students deserve the same opportunities as other students”.
Labour Members say, “No, they deserve better.” Those people should be treated differently from other students, because they are the people who will look after us when we are older, care for our relatives when they are sick and staff the NHS when this shambolic Government are long gone.
The Government should drop these proposals and think again. I commend the motion to the House.
It is a great pleasure to respond to the motion, not least because I think that this is potentially one of the most exciting things that we will do in the NHS in the next five years to increase opportunity and quality, and the presence of nursing staff on wards. We will be able to do that because of the reform that has helped so many other students throughout the country in the last five years.
The hon. Member for Lewisham East (Heidi Alexander) entered the House at the same time as I did. In November 2010, we sat on opposite sides of the House and contributed to a debate; many of us expressed anxiety about the outcome, not least because of the enormous pressures that we were experiencing from our constituents. Members who have been here for many years will know that that was the first occasion on which a riot taking place outside the House could be heard from the Chamber. The rioters were complaining that we were going to destroy people’s ability to go to university. We were going to make it impossible for people from disadvantaged backgrounds to go there, and we were going to set back years of progress in the closing of the inequality gap in this country.
Members on both sides of the House who spoke in that debate felt very passionately about the issue. We believed that it could be resolved by different means, but over the last five years we have been able to see the effect—and, as posited by the hon. Member for Lewisham East, the evidence—of the changes that were made. That evidence is quite clear. This year, 394,380 people were given university places in this country, 35,000 more than were given places in 2010, the year of the debate. If those 35,000 were to make up a single university, it would be the fourth largest in the country: one university, the fourth largest in one year, following the expansion of opportunity that resulted from the reforms that the House passed in 2010.
The hon. Lady made the most important point, however, when she asked how the reforms extended opportunity to the people who most needed to go to university. I regret the tone that she adopted in that portion of her speech; it was, I am afraid, beneath her. It was indeed wrong that when I was at university my fees were paid for in part by nurses paying tax on low wages. That was wrong, and we accepted that it was wrong. We also accepted that the system was not helping the people who most needed to go to university in order to escape their backgrounds.
The result that we should be looking for now is the number of people from disadvantaged backgrounds who have been helped to get into university in the last five years, and I can tell the hon. Lady that it has increased by 10,150. That is a massive increase. Had someone said back in 2010 that that would be possible, I doubt whether anyone would have given 5,000:1 odds on it, but I can also tell the hon. Lady that 10,150 is the number of people at the University of Leicester. That is the number of people whom we have brought into the university sector as a result of the changes that we have made. We have the equivalent of one more university, full of people from disadvantaged backgrounds, as a result of the reforms that we enacted in 2010.
I know that the hon. Lady’s motivations back then were entirely honest and commendable. I also know that many Conservative Members felt likewise. But we have to accept when we get things wrong, and it is in that regard, I am afraid, that the hon. Lady, rather than us, is failing to learn from history. During the 2010 debate, in an intervention on one of my hon. Friends, she said that the proposed changes would force on students a “huge debt”, and that
“the huge debt that they could now face will act as a greater disincentive to go to university than it will for students from more affluent backgrounds”.—[Official Report, 9 December 2010; Vol. 520, c. 579.]
The hon. Lady has made exactly the same point in today’s debate. She was wrong then, and I humbly suggest that she is wrong on this occasion. She should listen very carefully to the evidence that has been presented, not by me but by so many institutions, about the progress that has been made in reducing inequalities, and the reasons why we need to press ahead. In this instance, for one reason alone—and I will come on to others—we need to bring about the reforms to nursing bursaries.
Does the Minister not accept, though, that healthcare students have very different characteristics from other students, and that their behaviour will not necessarily be same as that of students affected by the reforms in the last Parliament?
I accept that there are differences—I will come to them in a second—but implied in the hon. Lady’s point is an acceptance that she was wrong in 2010, and she should therefore be more measured in her proposals, or lack of them.
It has not all been plain sailing since the reforms, not least as regards the impact on applications from mature students, who make up a significant proportion of the nursing cohort. Does the Minister not accept that there is no proposal in the consultation on how to mitigate the risk to good recruits from mature student backgrounds, who make up a significant proportion of the nursing workforce?
I am afraid that the hon. Gentleman is wrong on both points: more mature students are applying now than in 2010; and there are specific recommendations in the consultation to deal with mature students.
Does this not demonstrate the Minister’s point? We have a choice: we either inspire people to aspire and give them the opportunity to enter the NHS by talking it up, or we take the opposite view, talk the NHS down by being negative, and put people off.
I do believe that. The Opposition were wrong back in 2010, and had we followed their advice, fewer people from disadvantaged backgrounds—precisely the people Labour was elected to represent and support—would be going to university. As a result of our taking forward brave proposals, in the teeth of much opposition, we have done more for the prospects of people from disadvantaged backgrounds than any Government dealing with this matter since higher education was reformed after the second world war.
I come now, I am afraid, to the motion tabled by the hon. Member for Lewisham East. It implicitly accepts that we have made progress. The fact that it is so anaemic in offering an alternative makes it clear that there is no alternative suggestion that she thinks would achieve the aims that she and I want: an increase in the number of students going into nursing and training, and of those coming from a diverse background. It also implies that she accepts, like me, that workforce planning over the last 10, 15, 20, 30 or 40 years has failed. I can say that, whereas she is not willing to, because everything we are doing now to correct workforce numbers—for example, the 5,000 additional GPs my right hon. Friend the Health Secretary fought the last election campaign on and will be delivering in the next few years—is the result of poor commissioning decisions made not under the coalition Government, or even in the latter years of the Labour Government, but under Governments 20 and 30 years ago.
The failure to predict the number of GPs needed, and the number and types of other professionals needed, lands us perpetually in this perverse situation where we are not accepting British students on to training courses at British universities and, as a result, are not creating the numbers of domestically trained nurses we need. In response to the inadequacies in care uncovered as a result of the Mid Staffordshire NHS Foundation Trust scandal and the failure of the Labour Government to provide the number of nurses needed in hospitals across the country, we are having to import nurses from abroad and to fill nurse places with expensive agency posts. That is something we are putting right now.
One of the main pieces of feedback I have had from Salisbury NHS Foundation Trust is its frustration at the reliance on agency nurses, so I welcome the Government’s moves, because they will open up supply and reduce that reliance and the significant additional costs we have seen over the last few years.
It is precisely to help my hon. Friend’s hospital that we are introducing these reforms.
The Minister said there was no alternative to these proposals. Which of the royal colleges did he consult before coming to that decision?
Contrary to what the hon. Member for Lewisham East said, I did consult the royal colleges. I have spoken at length with the Royal College of Nursing and with Unison. As I would expect, we differ on key parts—though not every part—of the plan, but the royal college’s initial response accepted that the premise on which we were proceeding was, in significant part, correct. In the consultation, I want to find areas we can agree on and improve the proposals we have put before the public. We were open about the consultation and offered the full 12 weeks—many people said we would not do so, but we did—precisely so that we could listen to the concerns, proposals and exciting challenges from people across the sectors, and thereby improve the proposals we have put before the NHS.
The motion suggests a series of things, but not a proposal from the Opposition to do anything different. They are not offering the NHS any new money—they offered £4.5 billion less than we did at the last election—so I can only presume that the money would have to be found from cuts elsewhere in the service. The hon. Lady will have no credibility unless she tells the House that she will pay for the 10,000 additional training places out of taxpayers’ money, rather than by finding an alternative funding mechanism. I will not offer the House a series of suggestions that might or might not be better, or merely criticise proposals, rather than offering constructive improvements.
Whenever I make suggestions, they’re just ignored.
The hon. Lady is welcome to contribute to the consultation. She is doing so now, although sadly we heard no solutions or alternative proposals. I intend to set out not suggestions, but a clear announcement of our plans, the reasons for them, and how we will enact them over the year to come.
The Opposition have proffered many solutions to the Government. Just last week, we suggested a cross-party solution to the doctors crisis, but it was thrown back in our Front-Bench team’s face. Here is another solution: will the Minister speak to colleagues in the Department for Business, Innovation and Skills to see whether the apprenticeship levy, which the Government are taking from all large employers, could be spent on subsidising nurses to tackle the funding challenges?
The hon. Member for Ilford North (Wes Streeting), who has concerns about the proposals, has discussed the matter with me several times and offered some useful suggestions about the detail. I have accepted his points and incorporated them into our thinking. I am very willing to listen to people from across the House when they come with helpful suggestions, and I am sure that the Minister for Skills, my hon. Friend the Member for Grantham and Stamford (Nick Boles), would be interested in the hon. Gentleman’s contribution about the apprenticeship levy. The way not to do it, however, is to come to the House with a series of criticisms but not one suggestion, nor any money to provide for the increased number of training places in the plan.
We should make these changes not only for reasons of social equity, though that is the foremost reason; not only to produce 10,000 additional training places in our university system; and not only because we have a broken planning system, which otherwise would remain broken—even people as intelligent as the hon. Member for Lewisham East cannot predict how many nurses, doctors and allied health professionals we will need in 20 or 30 years, or the skills they will need. Even were it not for all those things, it would still be important to do this, because of the changes it will make to the quality of training we can provide to nursing graduates. Across the rest of undergraduate training, universities have been released to innovate and improve their courses. Satisfaction levels have gone up and drop-out rates have fallen; consequently, people are getting a better experience.
We have not, however, been able to spread those advantages to nurses, who, I am afraid, remain trapped in a system that is prescriptive and does not take account of the skills that they and their future employers will need. By releasing universities from their straitjacket, we can make significant improvements to the quality of the training they provide.
That’s just an assertion.
It is an assertion that is backed up by the evidence of the past five years, and which has received the recommendation of Professor Dame Jessica Corner, the chancellor of the Council of Deans of Health. I can tell the hon. Member for Lewisham East, in answer to her barracking, that Professor Dame Jessica Corner said:
“We recognise that this has been a difficult decision for the government but are pleased that the government has found a way forward. Carefully implemented, this should allow universities in partnership with the NHS to increase the number of training places and also improve day to day financial support for students while they are studying. The plan means that students will have access to more day to day maintenance support through the loans system and recognises that these disciplines are higher cost, science-based subjects.”
Likewise, Universities UK has said:
“We support increasing health professional student numbers and will work with Government and the NHS to secure the sustainable funding system”
that the Government have provided. It is particularly pleased about the impact that this will have on placement training. These are the people who are providing training in our NHS, and they support our proposals because they will release the same kind of innovation that we have seen elsewhere in the university sector.
I want to reinforce a point that the Minister has made. I think—he will know this—the evidence shows that far more people from deprived backgrounds have gone to university since the changes we made five years ago, at a time when Opposition Members were saying that they would have precisely the opposite effect. So the evidence is even more conclusive than my hon. Friend suggests. Can he confirm that the maintenance grants will go up by about 25%, which will help in regard to the specific point being made by Universities UK and the other lady?
I thank my hon. Friend for that intervention. It brings me neatly on to my next point, which is that the great virtue of these reforms to student finance is that we will be able to increase student finance support—maintenance support—by 25%.
The hon. Member for Lewisham East made some clear and sensible points. She suggested that training as a student nurse was different from being a history undergraduate, because student nurses have less time to take on a second job. There is therefore even more reason to provide better maintenance support for them. However, she has not come to tell the House that she will provide 25% additional maintenance support for students who do not have time to do a second job. She has not made that commitment, yet she has criticised our efforts to increase maintenance support by 25% precisely to help those people who would not otherwise be able to take time out to take on a university course. She cannot have it both ways. She cannot criticise us for the reforms we are undertaking while at the same time saying that students need greater support. It is precisely through these reforms that we are producing the support that so many students require.
The Minister talks about maintenance support, but can he clarify that that support will no longer be in the form of a grant, and will now be in the form of a loan? Does he acknowledge that that will land students in even more debt when they finally qualify?
By reforming the system so that this becomes a loan rather than a grant, we are able to produce 25% extra support for these students while they are training, much as with the rest of the student population.
The results relating to newly qualified nurses are not as the hon. Member for Lewisham East suggests. She should be very clear in the way she addresses this question, because all of us, whatever our views on this subject, have a duty to inform the public properly. It would be remiss of all of us, even those who disagree with the policy as she does, to mislead potential students into thinking that they will have to pay more than they would otherwise. She said that students would have to pay hundreds of pounds more in repayments once they had qualified. That is just not the case. We anticipate that a newly qualified nurse will pay roughly £90 a year more; that will be about the same as they are currently paying, because of the way in which student payment finance is gradated. The impact on newly qualified nurses will therefore not be anywhere near the impact that she has suggested. She should be very careful about how she addresses her points; otherwise, people could receive an impression about these loans that is not actually a fact.
What calculation has the Minister made of how much of the loan will not be paid back over a period of time? Can we have that information in the public domain as well?
The economic impact assessment is part of the consultation, and the hon. Gentleman should consult that. It will obviously depend on the way in which the student workforce develops over the next 20 or 30 years, but this has been fully costed within the Treasury’s assumptions, and we anticipate that people working beneath the current limits will not be paying back more than they are doing at the moment. That is in the nature of the way in which student finance repayments are calculated. These measures will not land newly qualified nurses with new payments that they might otherwise not have expected.
The Minister has urged me to be careful with my words, which I was, and I recognise that he is being careful with his, too. He is talking about newly qualified nurses. Can he confirm what the average repayment would be for the average nurse?
We do not currently have a figure for the average nurse, as the hon. Lady puts it. I cannot project where a nurse’s career path will take them 50 years into the future, for precisely the reasons that we have been discussing. The actual repayments—[Interruption.] I will come to the hon. Member for Kingston upon Hull North (Diana Johnson) in a second. The actual repayments are clearly listed in the consultation document. They are clear about the amount that will be paid back over and above what existing students would be expected to pay.
The only way in which we will be able to square the circle that the hon. Member for Kingston upon Hull North mentioned is by reforming student finance. Rather than shouting from a sedentary position, she might like to know that, contrary to her suggestion that many people in her constituency were none the wiser about this reform, I talked about the reforms to nurses in her constituency a few months ago. I also talked to them about the introduction of apprenticeships and of nursing associate grades, all of which are part of the reforms that I am outlining, and they were very excited about the changes that we are making to the nursing profession. All of this is possible only within a budget that is being carefully controlled, and in which priorities are placed on where the money is spent.
I am sorry; perhaps I should not have been shouting at the Minister from a sedentary position, but I am surprised that he has come to this House and been unable to answer a basic question about the amount of money that will be lost through the scheme that he wants to introduce. Surely he ought to have those facts at his fingertips when he is standing at the Dispatch Box.
I do have those facts at my fingertips. A newly qualified nurse will not be paying any more than he or she is paying under the current system. For those on higher pay rates, the figures are in the consultation document, and if the hon. Lady is not willing to go and look at that herself, I will write to her with the details for her ease and comfort. Opposition Members, rather than picking at points because they refuse to face the fact that they have to fund their commitments with additional money, should listen carefully to the entirety of the reforms that we are proposing.
I will make some progress now, if the hon. Lady does not mind.
We are introducing a new nursing associate grade. This will present an extraordinary opportunity to eradicate one of the great unfairnesses in the NHS, which is that there are brilliant people working as healthcare assistants who are unable to become registered nurses because they were let down by the schools they went to. I am afraid that this is a consequence of the failure of school reform under the previous Government. Under previous Governments, people were failed to the extent that they have not been given the opportunities that they deserve.
We are going to reverse that situation by providing an apprenticeship ladder to a nursing associate role, and from there to a registered nursing position. A degree apprenticeship will be available to those who are able and competent to reach that grade. That will provide a route of opportunity that was not available under the previous Labour Government. It is being brought in by this Conservative Government—a one nation party for all.
By bringing in these reforms, creating a nursing associate role and creating 100,000 apprentices in the NHS, many of whom will be healthcare assistants working their way towards a nursing associate position and from there to a registered nursing grade, we will give people multiple opportunities to become nurses. That will include those who are already in the service and who want to earn while they are learning. It will take them between four and a half and six years to get to a registered nursing position from a healthcare assistant role. It will also include those who are able to take time out and do a degree to become a registered nurse, for whom we will provide additional support in the form of increased maintenance grants. Opposition Members are shaking their heads, but at what, I do not know. Are they shaking their heads at the 100,000 NHS apprentices that we are creating? Are they shaking their heads at the nursing associate roles? Are they shaking their heads at the increased maintenance support? None of those issues was addressed in the speech of the hon. Member for Lewisham East.
Will the Minister give way?
I hope that my hon. Friend will not mind if I just conclude my remarks, because I know that Members from across the House want to contribute to the debate.
In my remaining minutes, I want to state why the reform is important not only for the individuals who want to become nurses, and not just for social equality and opportunity, but for the NHS. The NHS is unable to innovate like other parts of our public sector and our private sector because of the long lead times for training people. We do not have the instruments within the NHS to reflect the dramatic changes in demography and technology that change the NHS not year by year, but month by month. The great benefit of bringing in apprenticeship routes and nursing associate roles, of diversifying the skill mix and of creating quicker, more numerous routes into the nursing profession is that we can create a more diverse, flexible and agile trained workforce.
All that will be possible as a result of the changes, of which this bursary reform is part. None of it would have been possible with the reduction in funding promised by the Labour party, or a failure to wish reform upon the system. That is why I hope the House will reject the motion, which is full of suggestions and implications rather than firm plans. It says nothing about the future of the people on whom the NHS depends, and does nothing to suggest how we will increase numbers, provide additional maintenance support or, most importantly, provide opportunities for those who have not yet had any. We will do that by reforming the system, just as we did in 2010. We will ensure that we do not listen to the well-intentioned but erroneous voices of the Labour party. Had we listened to them back in 2010, tens of thousands of people would have been denied an opportunity. We are determined not to do that. We will be the party of opportunity, presenting it to people who want to be nurses or hold any other position in the NHS. This NHS will be truly national only if it provides opportunity to the many, not the few.
I must declare an interest due to my work in the NHS and having had the privilege of a grant when training to be a doctor.
The NHS is one of our most esteemed public services, but there is a long-standing shortage of qualified healthcare professionals. While the current bursary system for nursing and allied healthcare students in England may not be without issue, the UK Government’s proposed changes are concerning, as is the manner in which they have been presented, with detailed consideration of the impact somewhat lacking.
As we have heard, the UK Government have proposed changes to the current NHS bursary system. Instead, healthcare students will be required to pay tuition fees and will be subject to the same standard loans-based system to which other students in England are subjected. The UK Government have indicated that they expect the reforms to create up to 10,000 additional nursing and health professional training places over the course of the current parliament. However, that appears to be narrow-sighted. The proposed move to a system that relies on students funding themselves by taking on significant debts has raised substantial concerns among unions, professional bodies and students. One of the key fears is that such a move could be a barrier that deters prospective students from entering the profession. I stand here as the first doctor in my family, and I have to say that I would not have considered applying if it had meant racking up debt. I am particularly concerned about access to doctorate courses and postgraduate requirements. Will we create an elite workforce based not on ability, but on means?
Unison estimates that a student undertaking a three-year, 30-week course outside London under the new scheme will graduate with a debt of at least £51,600, plus interest and any overdraft and commercial debt.
The hon. Lady’s achievement as the first doctor in her family is to be applauded by us all, but does she recognise that there are many people who do not think that university is for them? The two-year apprenticeship course offered by the new nursing associate route will provide them with a real opportunity to get into the NHS and maybe to go on to become a full nurse later on.
I want to see a widening of access to training schemes in the NHS, and I would hope that that would be properly funded and that we do not rely on NHS staff doing other jobs while dealing with the stress of training. We should invest in and fund them properly, letting them know that NHS staff are invaluable.
For many, loans may be higher due to the additional costs of longer courses or of courses within London. As I said, I am particularly concerned about postgraduate courses and doctorate trainees, who may not be able to afford further loans that will add to their debt. It is likely that debt could be considerably higher for the majority of healthcare students. It is naive to think that larger loans will not be a psychological deterrent, especially to those from poorer or non-university backgrounds or to mature students and career changers, who may have additional financial responsibilities or debts from first degrees or family life.
The demographic of students on nursing, midwifery and allied health professions courses tends to be different from other student populations, as we have heard. They are more likely to be women, from black and minority ethnic backgrounds, parents or mature students. It is therefore likely, and a real concern, that abolishing bursaries will reduce diversity, foster inequalities and discourage potentially high-quality applicants.
The hon. Lady is making an important point. Returning to something the Minister said, the frustration for me is that I was a Unison rep in homecare before coming to this place, and we were able to give unqualified women access to a foundation degree when they were healthcare assistants. They could then do a vocational degree and get into hospitals in much the same way as what the Minister claims is not currently available. It is important that that route remains open and that its users, mature students in particular, do not get disadvantaged because of the thousands of pounds-worth of debt that they would take on at the end.
The hon. Lady makes her own point. It is important that people from all backgrounds are encouraged to enter our NHS. The UK has a diverse society and we must ensure that our healthcare staffing system reflects that and supports those from all backgrounds to enter it.
It is not enough just to increase numbers by creating an open market for training. In order to ensure a quality service, it is crucial that student placements are well planned, well supervised and well distributed between the various areas within the service, so much consultation is required. In response to the Government’s proposals, a former chief executive of the Royal College of Nursing commented:
“The last thing we need are disincentives to recruitment. We should be doing everything possible to attract applicants, as the country needs more nurses now than at any other time in its history.”
The hon. Lady is making many valid points. If someone lives in Wales and wants to study at an English university, it is proposed that the bursary will be stopped. If someone lives in England, Scotland or Northern Ireland and wants to study nursing, midwifery or an allied health profession at a Welsh university, the Labour Welsh Government will pay the bursary. Taking that to its logical conclusion, the numbers will decrease in England and increase in Wales, Scotland and Northern Ireland. Of most concern is the fact that the UK Government did not commit to undertake an impact assessment of cross-border applications before proceeding with the changes. Does the hon. Lady think that they should have?
Once again, the hon. Lady makes her point very well. I believe we need to staff the NHS well right across the UK. Impact assessments may require consideration down the line if there is a shortage in England as a result of this policy. I hope that answers her question.
In Scotland, the SNP Government recognise the value of investing in our NHS, providing a support package that is hugely generous in comparison with that in England. The nursing and midwifery student bursary in Scotland provides all eligible students with a non-income-assessed and non-repayable personal allowance of £6,578 per year, excluding additional allowances. That can be topped up by a range of income-assessed allowances, and it comes in the context of there being no tuition fees. Therefore, there are other examples of ways to make progress in this policy area.
Under the SNP Government, NHS staff numbers have increased by more than 10,000, and the party is committed to supporting the development of a quality health service that will meet the needs of the Scottish people, not just now, but in the future. Workforce projections show that more than 1,000 extra NHS staff are expected to be recruited across Scotland this year. There has been an 8.4% increase in NHS staffing, to a record high. There are more qualified nurses and midwives per 1,000 of population in Scotland than there are in England and Wales. In the past year, Scotland has seen the total number of nursing and midwifery staff increase by more than 500 whole-time equivalents, with boards projecting an increase of more than 600 whole-time equivalents in this financial year. The number of doctors has increased by 26.7% or by 2,560 whole-time equivalents, and the number of consultants is now at a record high, having increased by 40.3%. Every newly qualified nurse is guaranteed one year of employment once they complete their studies—that commitment is not offered anywhere else in the UK. Our health Minister, Shona Robison, has also confirmed that the nursing and midwifery student bursary and allowance will be protected at existing levels in 2016-17. A review of the scheme is due to report in June 2016.
The NHS is a crucial public service, and the UK Government cannot continue to railroad their way through it. They are making significant changes and although reform may be needed to address current issues within the service, such decisions should not be made hastily and without full consideration of their impact and of potential workable alternatives. We have heard about some workable alternatives today. I therefore urge the Minister to commit to having a comprehensive consultation on the full proposals, to determine the best way to support and invest in this service and its students. This is a vital workforce, whom we depend on in our times of crisis. It is only right therefore that they should be able to depend on us during their training and when they hope to help the NHS in the future.
Several hon. Members rose—
Order. Before I call the first Back-Bench speaker, I should say that we are going to have a time limit of seven minutes to start with. The debate finishes at 4.27 pm and a large number of people wish to speak.
Let me start by congratulating the shadow Health Secretary on calling this important debate. First and foremost, it matters because of the impact on patients of a nursing workforce shortfall. When the Health Committee’s recent primary care inquiry took evidence, Professor Ian Cumming estimated that shortfall to be between 15,000 and 20,000 nurses. This is not just about the overall shortfall; it is also about shortfalls geographically and in certain key areas, particularly primary care, community care and mental health. We therefore need to look at the big picture.
The workforce shortfall adds costs. We know that the agency staffing bill was about £3.3 billion in the last year and that three quarters of trusts are still breaching the agency price caps, although we are making some progress on that, with the relevant figures being £303 million in October last year and £287 million in February this year. These resources should be spent elsewhere, on patient care. There is an over-dependence on nurses who are trained overseas. They are a very valued part of our workforce but they are often being recruited from countries that can ill afford to lose them. We will need to train more nurses—that is the prime consideration of this debate, along with how we achieve that.
I congratulate the Minister on the proposals to open up many more places to nursing students, but we should consider some unintended consequences and I wish to touch on those further in this debate. We must do this without disadvantaging or cutting off our current core nursing workforce. It is absolutely right that we pay particular attention to the impact on mature students, because we have heard the data on that: 23% of all nursing applicants are over 30; more than half are over 21; and, as the hon. Member for Lewisham East (Heidi Alexander) said, the average age is 28. The question is whether this core mature nursing workforce are going to be deterred from applying.
We have already seen an example of innovation, with the University of Bolton partnering the Lancashire Teaching Hospitals NHS Foundation Trust to start offering places where students apply through the UCAS route. They introduced 25 places in the first pilot, with the first intake being in February last year, and there were 650 applicants for those places, even though they knew that they would have to access loans. There has been a very successful second round, with an increase to 75 places this year, and so the assumption that people will simply not apply for these courses just is not correct. We need to bear it in mind that we cannot necessarily extrapolate from there to a wider increase in numbers, but I ask the Minister whether there is any room, as we start to roll this out, to retain some bursaries for our very valued core mature nursing workforce for at least the first few years, until we know what the impact is. Will he address that in his summing up? Is there any role for a period of transition? It is important that we bear in mind the potential for unintended consequences.
Two thirds of those who apply for nursing places are unsuccessful, and it is unreasonable not to increase the opportunity for those students. I very much welcome the Minister’s plan to roll out other opportunities to enter the nursing workforce. We know from the Cavendish review that one reason we lose so many from our core healthcare assistant workforce is because there are no continuing professional development opportunities for them. Very many of those people, whom we know to be fantastic at their job, are not able to progress in the way that we should be allowing them to do. The key focus for us in this House should be: what is best for patients? What is best for patients is for us to train up a more diverse workforce, through many routes. There is a case for saying, “Let’s not completely abolish bursaries in the first round. We could phase things in more slowly.”
Another opportunity we could look at to try to attract people into nursing is through recognising that the clinical component is very high in the nursing course, at about 50%. Is there any way we could recognise that with a limited grants system for those who would otherwise be deterred? Perhaps at the end of a nursing course we could recognise mature students, particularly those who have taken on a second degree. Is there a way we could allow an extra payment to go to those nurses, particularly those who are going to go on to train in specialties where there is a shortage, linked with a period of NHS service. I know that we are using such an approach in general practice to try to attract people into shortage specialties. Would the Minister also consider that in responding to the legitimate concerns about the impact on the mature nursing workforce?
In summary, there are things we are doing where we are making progress, but there are things we can recognise as being unintended consequences. I hope the Minister will also look at some of the other recommendations from the recent Health Committee inquiry on primary care and say, “What can we do, as we increase the number of these courses, to increase the exposure to shortage specialties within the training period?” Too many of our healthcare workforce are staying within acute care and we know that if they have increased exposure to primary care during their training, they are more likely to want to go into those specialities.
Finally, as we increase these other opportunities for nursing and physician associates, may I ask the Minister please to touch on registration? We have heard evidence that, sometimes, not being registered can deter people from taking on physician associates. Allowing those associates to be registered is a recognition of their skills. These should be professional qualifications, and I hope that he will refer to that in his summing up.
It is a great pleasure to follow the hon. Member for Totnes (Dr Wollaston), as I have a lot of respect for her. Indeed, she commands respect across the House, and it is important that we listen to her views. It is also important that we listen to the views of others, including those of her colleague the hon. Member for Lewes (Maria Caulfield), who said:
“Speaking as a nurse, I would struggle to undertake my nurse training given the proposed changes to the bursary scheme.”—[Official Report, 5 January 2016; Vol. 604, c. 15.]
Clearly, the changes have not been thought through.
As a south Manchester MP, I am very proud to represent a large number of Manchester University students, including many of our nurses and midwives of the future. Indeed, the School of Nursing, Midwifery and Social Work at the university was the first institution in England to offer a nursing course, and it remains one of the top 10 universities in the world to study that same degree today. For the 2,000 students currently studying there, as well as for those weighing up their future with healthcare education in mind, the proposals on student bursaries will do nothing to instil any confidence that the Government understand the perspective of student nurses or potential student nurses.
I want to use my brief remarks to raise two main points. The first is the disappointing lack of consultation with organisations such as the Royal College of Nursing, and the second is the effect that this policy will have on potential students and patient care. Ensuring that access to these professions remains fair, that their funding is sustainable and that the Government consult experts from the sector are vital factors in securing the interests and the confidence of future healthcare professionals. Those roles are the lifeblood of our national health service, and we all have a stake in their future.
One big concern that we have consistently raised is the Government’s reluctance to engage with stakeholders. We have heard from charities, representative organisations, and think-tanks that the evidence base for these proposals is at best uncertain, and at worst non-existent. The very real fear is that the proposals will reduce the numbers of people entering nursing studies. Even the 12-week consultation that the Minister was lauding earlier takes the form of a technical questionnaire on the implementation of the proposals rather than a real consultation on the substantive policy.
On consultation with stakeholders and so on, does the hon. Gentleman agree that when a hospital such as the Gloucestershire Royal shows strong support for the concept of nursing associates and wants to run a pilot project for them, we have to assume that it sees real value in those associates in terms of providing good nursing for its patients and my constituents, and that that must be as telling as anything in a formal consultation?
I thank the hon. Gentleman for his intervention. Parliamentary questions have shown that the Department of Health failed to consult the Royal College of Midwives, the Royal College of Nursing and Unison before the policy was announced in the autumn statement last year. It is not just the Labour party that is worried about this, but the Royal College of Midwives, the Royal College of Nursing, the College of Podiatry, the Royal College of Speech and Language Therapists and the NHS Pay Review Body, as well as Members across the House. It is little surprise, then, that the result fails to understand the unique characteristics of the sector and the hard-working professionals that work in it. This is a process that has been driven by short-term financial savings at the cost of tackling the big questions of how we adequately fund our NHS for the decades to come.
What about the effect of this policy on the nurses and midwives of the future? At the centre of any policy on healthcare education must be the students themselves. In this case, they are diverse: older than most—the average age is 28—and overwhelmingly female. There are greater numbers from black and minority ethnic backgrounds. We should not forget that completing a degree necessitates 2,300 hours of clinical practice over three years. Any legislation that we need to design to encourage students in the future and to guarantee high-quality care for patients must recognise those types of people. They are people like Katie, a nurse in my constituency, who wrote to me about her concerns about the prospect of debt. She said:
“It is particularly worrying for mature students, many of whom have dependants, and it could deter them from joining the profession altogether. I can relate to this as three of my close colleagues are mature students and have stated on multiple occasions that, without the bursary, nursing school would not have been an option. Student nurses are not like other students: 50% of their time is spent on unpaid clinical placements in hospitals and in the community and there are simply not the same opportunities for part-time work as other students. I could not have completed this course without the bursary. Studying nursing requires participation in extra-curricular activities. This is in line with a recent national initiative: revalidation…Therefore, finding time for part-time work becomes very difficult, and many of my friends have been turned away from part-time jobs as our weekly schedules, working shifts and time for completing university work are often sporadic. The bursary covers my rent and without that I would not be able to support myself and nor would my family.”
We need to take such views on board when looking at a new policy.
Research from the House of Commons has shown that of the net savings made to the Treasury through measures taken by this Government since 2010, 86% will have come from women. Does my hon. Friend agree that these proposals are no different from those we have seen in the junior doctors’ contract dispute, and that they will adversely affect women rather than men?
My hon. Friend makes a very important point. It is important to remember that, and to think about how the prospect of paying off more than £100,000 worth of debt affects the calculation of a mature student looking to study a second time to become a mental health nurse. It is important to think about how a lone parent, who is hoping to become a midwife, might feel the pressure of £59,000 of repayments when considering the future of their family—that is the latest estimate of debt from the Royal College of Midwives.
It is important to wonder how a nursing student, taking part in a 48-week extended course, is expected to find part-time work to make their studies viable. Not only is the Government’s evidence base desperately weak, but research by the Higher Education Funding Council for England tells us that poorer students, lone parents and BME students—the demographics of many of the people attracted to nursing—are disproportionately dissuaded from applying to university by the prospect of large debts.
The policy fails on two fronts. The refusal to engage with experts in the field has led to a misguided policy that makes healthcare education the privilege of those who can afford decades of debt. It fails to ensure fair and equal access to healthcare education. Secondly, there is a real danger that this policy will fail to achieve its own aim of attracting future students. Everyone in health who knows about these issues will acknowledge the shortages of nurses, midwives and other health professionals, but moving the burden of payment to students is widely seen as a mistake. Deterring potential candidates by promising a lifetime of repayments immediately on graduation cannot be the answer.
I conclude by joining the calls of the Royal College of Midwives and the Royal College of Nursing for the Government to rethink the proposals and to scrap the NHS bursary. We need a thorough and inclusive consultation process so that those with experience of the system are able to contribute properly. I ask Ministers to ensure that future students at Manchester University’s School of Nursing, Midwifery and Social Work are not forced to bear the burden of a Government unwilling to listen. The Royal College of Nursing has said that the Government have not thought hard enough about the risks. Now is the time to do so.
It is an absolute pleasure to follow the hon. Member for Manchester, Withington (Jeff Smith), and I congratulate the shadow Health Secretary on securing this debate as it highlights the current pressures that we are facing in the NHS. We start with 20,000 nurses and we lose 3,000 a year. Perhaps that is where the Migration Advisory Committee report gets its figures from when it says that we need to plug a gap of 3,000 places. The Government say that we need 10,000 new nurses a year. In stark terms, those figures show that there is a loss percentage, so perhaps we can work out how many people drop out and what it costs, and use that money in the NHS by putting it back into an apprenticeship scheme such as that proposed by the Government. It seems that the magic figure of 3,000 plays into the Government’s thinking about creating 10,000 new nurses.
The Opposition say that we lost 2,400 nurses under the previous Government, whereas the previous Government said that we have 3,000 more. Which is correct? The truth is that both are: it depends when we take the measurement. If we measure from election to election—that is, from May 2010 to May 2014—we find that the Prime Minister was correct to say that we have 3,000 new nurses. We also take into consideration health visitors and midwives, and physiotherapists to an extent. The Opposition say there was a drop of 2,400 between September 2010 and September 2014. Believe it or not, recruitment and loss are seasonal.
We have to be grown up and address these concerns. How do we do that? The answer is, quite simply, through reform. We must open up instead of having the fixed bursaries whereby we attract in the region of 20,000 nurses a year but lose 3,000 a year. I say this with all due respect to the Opposition, but under the previous Government the Opposition said that reforming education would deter people from all backgrounds—I would not say “disadvantaged” backgrounds—from going to university. I did not go to university, but my son is at university and is the first member of my family ever to go to university. That is an aspiration, and an accolade. Here we are, five years down the line, with 10,150 new places since 2010 for students going to university. We must open up that philosophy for the NHS.
What is the difference between a student nurse starting on £21,000 or thereabouts a year and a junior doctor starting on £26,000? Nurses are as valued as doctors in the NHS; I certainly feel that. Why do some have bursaries, even though we are not attracting the numbers, and why do some not have them? My own trust, which is in difficulty at the moment but has already overcome many difficulties and is out of administration—it should be praised for that—has been abroad recruiting nurses, but we could get the nurses by taking away the bursary scheme and opening it up to academia, trying to get more people in from inside the system through apprenticeships. That could plug the gap and allow us to have home-grown skills and jobs here.
Reform will plug the gap and solve the skill shortage. It will also be fair in bringing nurses into line with doctors in the profession. Mature students who want to go into the vocation of nursing and be correctly accredited through the academic route will see that as a good starting place for a career that starts at £21,000. In all honesty, the career path does not end at £21,000; it goes up the pay scale, as it does for doctors.
In conclusion, I thank all colleagues for this measured debate. This is a subject that we need to address on both sides of the House.
I thank the shadow Health Secretary and the shadow Health team for securing this important debate this afternoon, which effectively gives us the opportunity to debate early-day motion 1081, which is set to become the most popular early-day motion in this Session of Parliament. It has been signed by Members from across the House, including Government Members, because of the concerns that people have bravely shown about the potential consequences of the Government’s proposed decision on the NHS bursary.
As I have argued before in Adjournment debates on the Floor of the House and in Westminster Hall, what we are debating this afternoon is the biggest shake-up in the funding of nursing, midwifery and allied health subjects since 1968. It was announced, without adequate evidence and planning, as part of the Chancellor’s Budget rather than being a carefully thought-through policy proposal; that is why the Government are consulting people only through a technical consultation rather than through a consultation of all stakeholders on the principle of the policy, as they ought to have done.
Although I and others will refer to “student nurses and midwives” as shorthand, it is important to acknowledge, as my hon. Friend the shadow Health Secretary did, that this will affect students of all sorts of subjects and vital workers being trained in a range of aspects of the NHS—physiotherapists, occupational therapists, chiropodists, dieticians, podiatrists, radiographers, paramedics, prosthetists and others. That is why more than 100 right hon. and hon. Members signed the early-day motion and thousands of members of the public have spoken out through the online petition.
At present, nursing, midwifery and allied health subjects are not subject to tuition fees and students on these courses receive a non-means-tested grant of up to £1,000 a year as well as a means-tested bursary of up to £3,191 a year. That recognises that students of these subjects have to work considerably long hours during their courses—not just in the libraries and lecture theatres like most students, but on clinical practice as part of a full 24-hour care cycle. Indeed, it is estimated that student nurses work at least 2,300 hours across the course of their degree. I am not sure that many of us with degrees in this House could claim to have put in so many hours when we were at university. We should recognise the effort that such students need to make to secure their qualifications.
Those who work outside course hours to fund their degrees can end up working up to 60 hours, and we should not expect them to do so: it can have a deleterious impact not just on their academic studies but on their approach to clinical practice. Under the Government’s proposals, the changes will mean that students of these subjects will be charged tuition fees in excess of £9,000 a year and, as a result, will be burdened with £51,600 of debt. They will begin paying that back as soon as they graduate, which means that nurses will take on average a pay cut of £900 a year.
As if that were not unacceptable enough on its own, will the Minister explain when he winds up how it can possibly be fair that under the proposed approach there is no recognition in the student support system of the unique demands placed on these students? The NHS bursary, as it exists, alongside the tuition fee remissions that these students effectively receive, at least recognise that for many of the students it is difficult, if not impossible, to take on the sorts of part-time work that I did when I was studying, either during my A-levels at McDonald’s or during university at the now-defunct Comet. For those students, it is simply not possible to fund their degrees in that way.
The student support system should recognise that it is more expensive to study these subjects and that the opportunities to earn extra income on top of taking the courses are not as readily available as they are for other students. It is a real mistake for the Government not to recognise that in their plan.
Does the hon. Gentleman also accept that there is a serious problem with hardship on the existing bursaries, particularly given that the amount of the bursary drops in the final year?
I am grateful for that intervention. I shall come on to thank some of the people who have been in touch, but I will never forget the very first conversation I had with a student nurse in my constituency who sat with me in the Members’ area of Portcullis House and cried because under the existing system she struggled to meet the costs of training to be a nurse, even with the NHS bursary currently provided.
I want the student support system to be more generous for these students because other students like my constituent have dreamed of being a student nurse. It is not right that financial support, or the lack of it, should be a barrier to their taking on this valuable vocation, which does so much for so many.
The Government’s policy is riddled with risk. Earlier the Minister challenged my assertions on mature student numbers. It is a fact that in the wake of the introduction of the coalition’s reforms to higher education, there was a fall in part-time and mature student numbers. The Minister claimed that there were record numbers of mature applicants to higher education; I can only assume that he was referring to last year’s figures. We should not identify a trend from one year’s figures, not least because UCAS figures for the 2016 application cycle published on 4 February 2016 show an increase in 18-year-old applicants, but a fall in most other older age group categories. I am more than happy to look at the data and conduct an evidence-based debate, but let us have an evidence-based debate and not take one year’s worth of figures and claim that there is some sort of trend.
The figures that the hon. Gentleman cites are welcome, but they are different from those of the shadow Health Secretary.
No, I do not disagree at all with the figures cited by my hon. Friend the shadow Health Secretary. This is the problem with lies, damned lies and statistics, as Disraeli once said. We need to look at all the data in the round before we identify trends. The Minister singled out one year’s worth of application data to identify a trend.
It is also entirely possible that numbers relating to nursing, midwifery and allied health subjects account for a significant proportion of applicants to higher education and mature applicants to higher education. The Minister was talking about general applications for all subjects. We should probably ask the Library to do some work so that we can get to the bottom of the claims and counterclaims. None the less, most people involved in the higher education debate acknowledge that there are still serious challenges in access to higher education for part-time and mature applicants in the light of the coalition’s reforms. That is one of the reasons why the Government ought to tread carefully in this area.
Against this backdrop, there is a shortage of nurses. In 2011 and 2012 the number of training places was cut to the lowest level since the 1990s. Unison, the trade union of which I am proud to be a member, conducted a survey which found that two thirds of nurses believe that staffing levels were worse now than they were previously, and 63% feel that the numbers are inadequate to provide a safe degree of support on wards. That reflects feedback that I have had from NHS staff in my constituency, and it is something that the Government should take very seriously.
Since I first raised the issue in an Adjournment debate in the House, I have been privileged to meet so many nurses, midwives, other professionals and students of allied health subjects. I am particularly grateful for the campaigning that Danielle Tiplady and Kat Barber have undertaken, not least in meeting the Minister. I thank Unison, the Royal College of Nursing, the Royal College of Midwives, the Royal College of Speech and Language Therapists, and the National Union of Students. I take this opportunity to pay particular tribute to the outgoing president, Megan Dunn, for the effective way in which she has represented students during her term in office.
The reforms reflect a big risk to nursing numbers. At the very least the Minister should commit this afternoon to a further full debate on the Floor of the House and a vote of both this House and the other place before such a radical change as the Government propose is made to the funding of these crucial subjects. There is considerable concern and the Minister should not downplay the issue. I hope he will at least commit to a full vote in the House before the change goes ahead.
It is a pleasure to follow on from the hon. Member for Ilford North (Wes Streeting), who made a thoughtful speech and highlighted an important point about the different study load of those training to be nurses, compared with some of us when we were at university. I do not think that that invalidates the Government’s proposals, but it is an important point to take into account.
Like the hon. Gentleman, I congratulate the Opposition spokesman on calling the debate, which has been an important one, and I congratulate the Minister on a characteristically thoughtful, reasonable and lucid response to it. I cannot help observing that the debate demonstrates the value of having people in this House who come from genuine professions, rather than having reached here purely as a result of being political professionals. There has been considerable input from those who have studied, worked or been in the national health service.
Although it is an Opposition debate, there are some points that we can all agree on. First, we should agree that we need to recruit, train and retain enough nurses to staff our health service to meet the needs of the British people. Secondly, we can agree that it is wrong—morally wrong—to rely on recruiting nurses from poor countries, who have had to bear the cost of their training, to meet our failure to train enough nurses ourselves. Thirdly, we should not be turning away British people who want to train as nurses when we need more nurses. Surely all of us can agree on those three points. We can debate how best we finance the recruitment, retention and motivation of sufficient nurses in this country, but we should all agree that that is the objective.
My initial interest in this topic came a couple of decades ago and resulted from my first career as a development economist working in Africa and Asia. I discovered while I was in the House that we were denuding Africa of nurses. We had recruited more than one in eight of all the nurses in sub-Saharan Africa and brought them to this country. That could not be right. I lobbied against it and the then Prime Minister promised that there would be no active recruitment from Africa, but seven years later I discovered that we had recruited another 60,000 nurses. We were continuing to recruit at several thousand a year, but we were promised that that would cease.
What I blame myself for is that it took me so long to realise that the problem did not lie so much in recruiting from Africa and other poor parts of the world as in our failure in this country to train enough nurses of our own. I did not ask why we were not doing so until I was talking to people in my local NHS, who told me that they were recruiting abroad, mainly in southern Europe but also in Asia, and they were doing so despite the fact that they would have preferred to recruit and employ nurses from the University of Hertfordshire, whom they described as excellent, well trained and in every way desirable. I asked why they did not recruit more, but they said that they could not recruit enough. Even if they recruited the next several years’ worth of output, that would not meet the needs of Hertfordshire’s health service, which is why they were recruiting abroad.
Does the right hon. Gentleman agree that it is ironic that through our international aid programmes we are assisting developing countries to pay for trainee placements in clinical establishments such as hospitals abroad, yet we do not afford the same rights to our NHS trainees here?
It is certainly bizarre that we pay African countries to train nurses and promptly recruit them to come here, so we are getting them cheaply trained abroad. I do not mind particularly the manner in which their training is financed.
The problem faced by my local NHS was that it could not get enough nurses from the University of Hertfordshire. I spoke to the University of Hertfordshire, which said that there was no lack of applicants—it turned away three quarters of applicants to its highly regarded nursing courses—but it was not allowed to expand. It had taken me decades in this House to realise that we had a system that limited the number of people we were recruiting. I duly lobbied the Government, and it may be because of my lobbying that we now have this proposal for bursaries, though I suspect the Government reached the decision on their own evidence.
The sad truth is that successive Ministers of all parties—we should recognise that—have bucked the question of how we train enough people in this country. Ministers tend to have a time horizon of roughly the time it takes to train a nurse, so why put up with diverting resources into training when the output of extra nurses will come after they have ceased to be Health Ministers? I am glad that this Secretary of State for Health and his fellow Ministers have addressed the question. However, we should recognise that it is symptomatic of a wider problem across British business in both the private and the public sector that we have a culture that does not put enough emphasis on training. It is particularly bizarre that we allow unlimited numbers of people in universities to study art history and media studies—very valuable subjects—but restrict the numbers who can train to be nurses, when we know we have a crying and desperate need for more.
I am agnostic about the best way to finance the training of more nursing recruits. Clearly, if nurses bear the extra cost, that will have to be reflected in some way in their remuneration. The Minister told us that they will actually be no worse off, so I suppose the assumption is that they will not have to repay much of their loans. It is a somewhat artificial feature of the public finance rules, but it is a feature of them, that perhaps the only way of not borrowing the money from the public ourselves is for the nurses to borrow it and for us then to write off their loans. However, whatever the financial system—the end of bursaries and their replacement with loans is probably the only option—we have to pay nurses enough in the long run to recruit, retain and motivate them.
There is one other issue we should look at before we close the debate. There are 200,000 trained nurses who maintain themselves on the register at their own expense, but who are not currently working in the NHS or elsewhere—they may be taking time off to raise a family, and they may be thinking about coming back some time. We must be much more flexible and creative about providing patterns of work that meet the family needs of those trained, valuable, caring and experienced people if we are to bring them back into the health service. That, too, will help to meet the needs of the health service, as the Government are trying to, sensibly and wisely, in the measures they have brought before us to replace bursaries with loans.
I am grateful for the opportunity to contribute to today’s important debate. This is the second time I have raised concerns about the Government’s plans to scrap NHS bursaries in favour of a loans-based system for nursing, midwifery and allied health profession students, and it follows my contribution to a Westminster Hall debate on the same subject in January. I do not propose to reiterate in their entirety the arguments I put forward; instead, I intend to make just a few brief observations on the Government’s proposals, which have been roundly condemned by students, trade unions and professional bodies alike. They have been described by one of those bodies—the Royal College of Nursing—as “high risk”. The proposals are high risk because they take a significant gamble with the future sustainability of the NHS workforce. There are several reasons for that.
First, the proposals have the potential to deter many committed and talented prospective students from pursuing nursing, midwifery and allied health profession degrees altogether. That is due primarily to concerns over the huge level of debt associated with the change to a loans-based system. That is particularly true for more debt-averse mature students, who may have young families, caring responsibilities and a mortgage to pay, and for those for whom healthcare is a second degree.
There is a considerable problem with recruitment and retention of staff in the NHS, and the Government’s plans are likely to exacerbate that problem, so impacting adversely on the future security of the NHS workforce. This is at a time when we have an ageing and increasing population, which will require more, not fewer, front-line healthcare professionals.
Secondly, the proposals do not take into consideration the fact that nursing, midwifery and allied health profession courses are very different from most arts and science degrees. These courses are much longer, with shorter holidays, and they offer fewer opportunities for students to supplement their incomes, as people are required to spend a significant amount of time working with patients in clinical practice, with a requirement to work irregular and long evening and weekend shifts as standard. Effectively, the Government’s proposals will mean that these students—the individuals who keep our wards running and who are involved in life-and-death decisions on a daily basis—are forced to pay for the privilege of undertaking often physically and emotionally demanding work in the NHS.
Thirdly, the proposals seek to replace the bursary system, which has, for some considerable time now, fostered strong and enduring links between healthcare students and the NHS right from the start of their course. The Government propose severing that link, which risks reducing students’ loyalty to, and the attractiveness of, the NHS as a potential employer.
Those are just a few of the reasons why the Government’s plans are so high risk. There are, of course, many more, some of which have been eloquently articulated by others in the House today. I conclude by urging Ministers to drop their proposals and instead work with trade unions, professional bodies and, most importantly, the dedicated individuals who work in the NHS—the nurses, midwives, physiotherapists, speech and language therapists, occupational therapists, dieticians, radiographers, chiropodists and podiatrists—to find a fairer, more sustainable and effective funding solution.
May I start by declaring my interest as a member of a healthcare profession allied to nursing?
Two thirds of those who apply for nursing school places are rejected and have to look at other trades or professions—that is tens of thousands of people every year. Despite the comments of some hon. Members, those are good, high-quality applicants. I took the trouble of looking at the entry requirements of the three universities that accept adult candidates on to general nursing degree courses in the south-west—Bournemouth University, the University of the West of England and Plymouth University. The typical offer is 300 UCAS points—three Bs at A-level—so there is not a shortage of applicants who are academically well-qualified and, indeed, qualified in every way. Lots of young men and women who wish to study nursing and to be nurses are being turned away.
That is a double tragedy because we have a gross shortage of nurses in this country, and nothing I have heard from the Opposition gives me any confidence that they have any plan as to how we are to satisfy the two imperatives of allowing those who want to study nursing to do so and of plugging the shortage in our national health service. At the moment, I am afraid, we are able to deal with that issue only because nurses from overseas are prepared to come here—nurses, very often, from countries that can scarcely do without them.
Historically, student nurses have been an intrinsic part of the NHS workforce. My hon. Friend the Member for Totnes (Dr Wollaston) will remember, as do I, that they were essential to the working of hospital wards, and one or two of the good points made by Opposition Members revolve around that issue. The question is whether, in this day and age, we are still heavily reliant on that workforce for the proper functioning of hospital wards. If we are, there is a good case to be made for allowing for that in the bursary arrangements for student nurses, because it is simply not right to expect those people to do service work and not be compensated in some way for it. I hope very much that that strand of thought will be taken up as part of the consultation.
However, the fact remains that as part of Project 2000 in the 1990s, the nursing profession decided to move away from a hospital-based training structure to a structure based around universities—that was driven by the profession itself. The debate we are having today is part of that process—the process by which nurses become graduates, in exactly the same way as anyone else, including those who are preparing, for example, to teach in schools.
When we design the finances for student nurses, it is of course important that we understand the difference between a nursing degree course and a normal degree course, as it were. We must also accept that this is a graduate profession, and that it is not right to try—as I think the hon. Member for Lewisham East (Heidi Alexander), who speaks for the Opposition, did—to distinguish between graduates and to say that one graduate is more worthy than another. She may have in mind a view of a typical graduate, but those graduates are also potential teachers, engineers, biomedical scientists, and all the rest. We start down a very difficult path if we try to hold up one graduate as being superior morally, or in some other sense, to others. That is a very difficult thing to sustain.
I very much support the notion of a nursing associate. I am old enough to remember state-enrolled nurses. These were nurses who would not satisfy the entry criteria for a course leading to state registration but wanted to be members of a caring occupation. Naturally enough, nursing associates will not be SENs revisited, because we now live in a very different age, but there is surely a place within healthcare and our national health service for a group of people who may not want the academic rigour that goes with a nursing degree—or indeed be fitted for it, at their stage of life—but who nevertheless want to nurse, and to enter an intrinsically hands-on, caring occupation. The important difference, though—this is where SENs, I am afraid, suffered so badly all those years ago—is that there must be a sufficiently pervious system to allow nursing associates, if they want to and have the necessary skill sets, to enter a professional nursing stream. It was a tragedy that so many well-qualified SENs were unable to develop their careers in that way. I hope that as we design the future for nursing, we keep that very much in mind.
A few hon. Members have commented on workforce planning. Historically, the NHS has been absolutely abysmal in this regard, and we need to do much better in future. We need to avoid unintended consequences of the changes that we are making. We need to ensure that the £21,000 threshold that would apply for nursing graduates does not mean that people are inclined to avoid it by working part time where they might otherwise work more full-time hours. That would be a great disservice to the overall workforce.
The 10,000 new places created must not be denuded by our offering them to applicants from overseas, because that would not be in the interests of our national health service. We need to understand that nursing graduates may be tempted to migrate as a result of the introduction of these fees. I ask the Minister, in his consultation, to think of all the unintended consequences that may develop, given our general historical tradition in this country of doing health workforce planning so abysmally.
It is a pleasure to follow the thoughtful contribution by the hon. Member for South West Wiltshire (Dr Murrison), who draws attention to the whole issue of workforce planning, which is clearly very challenging for those who are doing it—or not doing it.
The recent inspection of North Lincolnshire and Goole Hospitals NHS Foundation Trust exposed issues of real concern about staffing levels at Scunthorpe general hospital. The challenge of attracting, securing and retaining sufficient nurses and other medical staff has been a constant theme in my conversations with the trust since 2010. In that respect, Scunthorpe hospital is no different from many others around the country. The more I have got involved, the more I have thought that locally designed solutions have a role to play. Having talked to Health Education England, it is disappointing that it cannot do more to support healthcare assistants, for instance, in growing into nurses on the local patch, because they are clearly a potential resource.
There are lots of issues about recruitment, training and retention, as the right hon. Member for Hitchin and Harpenden (Mr Lilley) said, and about how, if we lose 3,000 nurses a year, as the hon. Member for Morecambe and Lunesdale (David Morris) said, we try to keep them. That is a big issue, as well as how we recruit and retain them.
Just to clarify that, we are not losing 3,000 nurses a year—we are losing 3,000 applicants to be nurses a year.
I thank the hon. Gentleman, but many nurses are being lost to the system as well, as his comments clearly highlighted.
In Scunthorpe, as in other areas, we are having to recruit from Spain, Portugal and elsewhere in the world. Although that is helping and supporting us, it has impacts, as we have heard, on those areas of the globe from where those nurses are being recruited.
I would like to quote the words of a young student nurse—a constituent—because in some ways they capture the comments that people from around the country are making to us. Katie-May Taylor says:
“I’m a first year student nurse and when I start placement (for 3 months), I will just about be able to cover my travel on top of my rent and food. When you see the hours we have to complete and having a fraction of the summer holidays other students get, you have to understand why the proposed cuts to the bursary and overall funding to the NHS isn’t beneficial.
I appreciate that to other students, getting a monthly bursary must seem like a luxury, however every penny I get goes towards my rent—it’s not just pocket money.
We’re seeing reports that parents are already telling their children not to go into the nursing profession and future nurses are being scared out of applying for university. This is deeply saddening; it’s such a wonderful course to be a part of and our nurses are absolutely vital in the care of society’s health and the maintenance of OUR NHS.
If the bursary is scrapped, a lot of student nurses will end up working 70 plus hours a week (placement, study time, job/s). Is a student nurse working that many hours a week safe patient care?”
Those words capture very effectively the concerns that we have.
The Government are taking a huge gamble with the future of the NHS workforce and patient safety. There is already a shortage of nurses in the NHS, and scrapping bursaries risks making the recruitment and retention of staff even harder. Student nurses are not like other students: they are required to work in clinical practice throughout their degrees, and they deserve to be treated differently. The hon. Member for South West Wiltshire was right to say that it is worth looking at how much they are an intrinsic part of the NHS, and if they are, that must be recognised within the consultation so that they are given credit and remunerated effectively for it. My hon. Friend the Member for Ilford North (Wes Streeting) rightly emphasised the unique position of student nurses.
The longer courses and clinical placements make it harder for NHS students to get part-time jobs to supplement their income. NHS students are much more likely to be women, more likely to come from black and minority ethnic backgrounds, and more likely to be mature students. Many nursing students have already completed one degree and turned to nursing in their late 20s or early 30s. The average age of a student nurse is 28. Many student nurses have family or caring commitments. MillionPlus has pointed out that the changes to the higher education funding system in 2012 have been much less favourably received by mature students and part-time students. Those two groups make up a much greater proportion of the nursing, midwifery and allied health student body, so it is worth looking at that part of the evidence as well.
Analysis by London Economics estimates that the switch to loans will have a significant negative impact of minus 5% on participation, at least initially, especially if one bears in mind the composition of the student health cohort. The Government’s insistence that undergraduate and postgraduate loans will be repaid at the same time will require a repayment rate of 15% above the earnings threshold for those students accessing both undergraduate and postgraduate loans. That will be in addition to any tax, national insurance and pension contributions that will be due.
The savings to the taxpayer are questionable. The Minister was not clear about that when I pressed him on it during his opening remarks. The Department of Health estimate that taxpayers will be better off as a result of the switch is very much a short-term calculation. In fact, it is much less likely that these students will repay their loans as graduates in the 30-year repayment period than the general higher education cohort. Essentially this is a switch in responsibility for the funding of the education of the health workforce from the state to the workforce itself, and it is primarily designed to reduce the departmental budget of the Department of Health.
We need to know more about what estimate the Government have made of the percentage of second degree student loans that will be written off after a 30-year period. We need the Department of Health to provide an estimate of by how much the taxpayer will be better off. We need those figures.
All the key stakeholders have expressed concern, including the Royal College of Midwives, the Royal College of Nursing, the College of Podiatry and the Royal College of Speech and Language Therapists. Even the NHS Pay Review Body has said that
“the removal of the incentive of the bursary could have an unsettling effect on the number and quality of applications for nursing training places in the early years.”
Those who are closest to what is going on are all concerned.
The Minister for Community and Social Care is a very good and thoughtful Minister, and I am sure that he is concerned about the issue. I hope that he will listen to and engage with all those bodies, which know what they are talking about. They are not making it up—their concerns are real and genuine. The Royal College of Nursing is calling on the Government to work with all stakeholders to create a model of student funding that encourages people to join the profession and that recognises the unique aspects of nursing degree courses.
I hope that the Government will take this opportunity to engage with the strong initiative proposed by the shadow Health Secretary and work together to come up with a solution that will allow us not only to recruit professionals, but to retain them into the future. As the son of a nurse and the father of a speech and language therapist, I hope that the Government are listening.
Welcome to the Chair, Mr Deputy Speaker. I am glad that your first act has been to call me to speak.
It is a pleasure to follow the hon. Member for Scunthorpe (Nic Dakin), for whom I have a great deal of respect. He always speaks with credibility and from experience. I am more than happy to acknowledge that there are many colleagues in the House with more experience than I have of working in the NHS, particularly my hon. Friends the Members for South West Wiltshire (Dr Murrison) and for Totnes (Dr Wollaston). My experience is as a customer or as a relative of someone who has been treated in the health service. I have to say that, to date, my experience has been nothing but positive. The treatment that our NHS continues to deliver to our nation is the best in the world, and Government Members can be immensely proud of that.
One of the things that I find most frustrating about our debates on the health service is the fact that the Opposition seem to think that they have a monopoly on caring for the NHS. Nothing could be further from the truth. Conservative Members care deeply about our health service and we do everything we can to support it.
It is worth saying that every Labour party election leaflet since the second world war has said, “We’ve got 24 hours to save the NHS before the Tories come into government.” It repeats that message every time. If we look at the facts, however, we will see that the truth is that the Prime Minister was the only party leader to enter the 2010 general election saying that he would protect the NHS budget. Others did not. In 2015, the Prime Minister was the only party leader who committed to the extra £8 billion support funding for the NHS when other Opposition parties would not back that figure. Today that figure has increased: this party is now backing the NHS with an extra £10 billion. We are also delivering on the aspiration of people like me, who are either customers or relatives of people who use the NHS, to get a high-quality service seven days a week.
Whenever we debate this issue, the difference between the two parties is one of credibility. The only way we have been able to deliver the extra £10 billion of funding to the health service is by having a credible economic plan that stands up to scrutiny. The great British public understand that and what it means to have a credible plan that can be delivered in government.
As a number of colleagues have said, we agree on a lot of things. No one can deny that both the Government and the Opposition acknowledge that we need more nurses, but we differ on the credible plan to deliver them. Members on both sides of the Chamber have made speeches today acknowledging the need to deliver extra nurses, but it is only Government Members who have a credible plan to make it happen. We cannot just hope it happens, or state that it will happen, without saying where the extra money will come from. The consequence of that would be to withdraw cash from front-line services, such as existing doctors, nurses, operating theatres and wards, and put it into training.
If we want to increase the number of nurses coming into the NHS, we should not restrict the number who can be trained. It seems obvious that the way to raise the number of nurses is to lift the artificial cap on the number that we can train. I welcome the fact that the Government are considering and consulting on their options and looking to ensure that there is no artificial cap, so that we can train as many people as are inspired to go into the nursing profession.
I reiterate my admiration for those people. People leaving full-time education enter nursing not because they want to be rich but because they care and they see it as a vocation. We need to support people who have that calling and who aspire to look after those in society who find themselves ill and in need of support. We must find a system that allows them to aspire to that, whatever their background and wherever they come from. They must be able to go through their training and reach the point where they can follow their vocation.
The arguments that are being deployed against the Government’s suggestions appear similar to the ones that we heard about student loans. We were told that those from a deprived background or from more challenging areas would be put off and would not be able to find a way through the system. We need to reflect on the evidence, which shows that the opposite has happened—the number of people from challenging backgrounds going to university has gone up, even though we were told that they would not be able to go.
At the end of the process, we need an NHS that can adapt and change. There is enormous social pressure on it, and there is the challenge of getting a balance between adult social care and healthcare as society gets older. When cash is short, we must spend it on front-line services—on the doctors, nurses and drugs that can improve the lives of people who need the support of the NHS. I look forward to the consultation, and I know that the team in the Department of Health will look at the responses. I hope that we get to the right place, and that we have more nurses at the end of the process.
I am pleased to hear that the hon. Member for Sherwood (Mark Spencer) values the NHS so highly, but he might like to reflect on the fact that the coalition Government legislated to allow all NHS hospitals to make up to 49% of their money from private patients. Perhaps he will review his opinion of his party’s performance when he starts to see the number of private patients in his local hospital increase and the number of NHS patients decrease.
The Royal College of Nursing and the Royal College of Midwives are concerned that abolishing nurse bursaries and free tuition will break the historic link between the NHS and trainee nurses. I share their concern, and I believe that the Government’s proposal is part and parcel of wider changes that they are seeking to make to the culture of the NHS. They are turning the emphasis away from training people to be part of the NHS family, in which they can work with dedication throughout their working lives, towards training them to work in a fragmented health marketplace. If the plans go ahead, the nurses of the future may no longer feel the same obligation to work in the NHS and could be more inclined to work abroad or in private hospitals to pay off their debt. Who could blame them? They will feel that the Government have deserted them.
The Minister was unable to tell us what the average repayment would be, so I will let the union Unison give him the answer. It states that debt repayment will effectively mean a pay cut of more than £900 a year. The question arises of whether the changes will deter people from training to be nurses in the first place. The Royal College of Nursing and other bodies such as the Royal College of Midwives, the College of Podiatry and the Royal College of Speech and Language Therapists think that they will. The Government’s own consultation document estimates that a trainee nurse who takes out the maximum tuition and maintenance loans for three years will graduate with debts of between £47,712 and £59,106. Who would want to embark on a lifetime of caring for others with a debt of that size?
That brings us to the concern that the measures will lead to further shortages. We are all aware of the shortages in our hospitals. The coalition Government allowed the number of training places to fall from more than 20,000 to just 17,000 in 2011 and 2012, the lowest level since the 1990s. As a result, over 8,000 fewer nurses were trained in the 2010 to 2015 Parliament compared with 2010-11. Those cuts in training places have meant that nurse numbers have failed to keep pace with demand. According to calculations by the House of Commons Library, the number of nurses per 100,000 population has fallen from 679 in 2009 to 665.
There are real concerns that removing NHS bursaries will only make matters worse. As was mentioned by my hon. Friend the Member for Scunthorpe (Nic Dakin), the independent NHS Pay Review Body has said that
“the removal of the incentive of the bursary could have an unsettling effect on the number and quality of applications for nursing training places in the early years. In addition, the reduction of net pay in the early years, as nurses repay their loans, will make the employment package and medium to long term reward offer an important factor in attracting high calibre students who are choosing between courses and career options.”
The Secretary of State should definitely focus on that.
The Royal College of Nursing is also concerned that there is a risk that the changes could result in an uneven distribution of students across nursing specialties and geographically across the UK. Health Education England currently commissions student places for four branches of nursing: adult, children, learning disabilities and mental health. Without workplace planning by a central body, there could be insufficient numbers across the four branches, as some may be more popular than others. There has been no indication of whether there will be any control over which sectors nurses train for in future or whether that will simply be determined by—of course, under this Government—the market. That could leave some sectors with even greater shortages than at present.
Tuition is currently paid for by Health Education England. Under the current system, no students have to pay tuition fees and fees are not means-tested. Students also receive a non-means-tested grant of £1,000, or £1,000 pro rata for part-time students. Students also qualify for a maintenance grant or bursary, which is means-tested, as well as additional allowances when a term lasts longer than 30 weeks, and help with the costs of clinical placements. I believe that that is the appropriate way to deliver NHS nurse training. If we are to continue to have a state-run public NHS, free at the point of need, we must continue to provide bursaries for our NHS nurses. It is the very least that we owe them.
If we ask any patients about their e