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Commons Chamber

Volume 611: debated on Monday 23 May 2016

House of Commons

Monday 23 May 2016

The House met at half-past Two o’clock


[Mr Speaker in the Chair]

Dietary Advice and Childhood Obesity Strategy

(Urgent Question): To ask the Secretary of State for Health to provide an answer to the urgent question of which I have given him notice.

I thank the right hon. Gentleman for the question. The Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), is principally responsible for this issue, but as she is on Government business in Geneva—a cruel twist of fate— I am pleased to respond to his question.

Tackling the unacceptable level of childhood obesity in this country is a major priority for all of us in this House and for the Government. We know that obese children are much more likely to become obese adults. In adulthood, obesity is a leading cause of serious diseases, such as type 2 diabetes, heart disease and some cancers. Tackling obesity and improving diet, especially in children, is therefore one of our major priorities and an issue that we made a commitment to tackle in our manifesto.

Evidence shows that obesity is a complex issue to which there is no single solution. Tackling childhood obesity requires a full package of bold measures and collective action by Government, businesses, health professionals and individuals. Our comprehensive childhood obesity strategy, which is being launched this summer, will be a key step forward in helping our children to live healthier lives. It will look at the range of factors that contributes to a child becoming overweight and obese, and it will also set out what more can be done by all. Our cross-Government approach, led by the Department of Health, is based on the latest scientific evidence from Public Health England and the Scientific Advisory Committee on Nutrition.

As for the views expressed today by the National Obesity Forum on how to prevent obesity and type 2 diabetes, Public Health England has described them as irresponsible, as they do not reflect the totality of the evidence base. By contrast, Public Health England’s dietary advice is based on advice from independent experts on the Scientific Advisory Committee on Nutrition, which, in turn, is based on all available evidence. SACN conducts full-scale consultations on draft reports and goes to great lengths to ensure no bias. International health organisations agree that too much saturated fat raises cholesterol, increasing the risk of heart disease, and that obesity is caused by consistently consuming too many calories.

Order. It should now have become clear, but for the avoidance of doubt, in particular for the benefit of those attending our proceedings who are not within the Chamber, that these matters should be self-contained and readily intelligible. The request from the right hon. Member for Leicester East (Keith Vaz) was to the Minister to provide a statement on dietary advice and the childhood obesity strategy. All is now magnificently clear.

May I thank you, Mr Speaker, for granting this urgent debate and the Minister for his answer to the question?

The National Obesity Forum’s report published today has led to a public outcry and confusion. Indeed, the conclusions of this report contradict much of the health and lifestyle advice issued by the Government and the NHS over the past decade. Ordinary people are now caught in a whirlwind of conflicting advice at a time when they desperately need clarity, consistency and straight talk. Quite simply, they do not know where to turn. The Royal College of Physicians, the Faculty of Public Health and the British Heart Foundation have all raised concerns about this report. Some have claimed that local authorities, schools and the NHS are receiving guidance from organisations whose funding and motivations are not known. I welcome the use by the Minister of the word “irresponsible” in respect of this report.

The critical issue, however, is the delayed publication of the childhood obesity strategy. We were first told that this would be published in December 2015. We were then told that it would be February 2016. It is now expected at the end of the summer. No doubt you will confirm, Mr Speaker, that there is no clear indication from the Government as to when the end of the summer will be. Amid the delays, other voices are filling the vacuum. Clearly, a strategy is required on what steps are needed to prevent and tackle the growing levels of obesity, which, at current rates, are expected to reach 60% of the adult population by 2025. We need a definitive date for the publication of the strategy. Will the Minister give us a date today? In the Queen’s Speech last week, the introduction of a sugar tax was confirmed, which I warmly welcome. That could prevent 2.7 million people from being obese, by 2025.

Finally, obesity is a leading cause of type 2 diabetes, as the Minister has said. Just as the rates of obesity are set to increase, the number of people with diabetes is expected to rise to 5 million by 2025. As a type 2 diabetic and chair of the all-party group for diabetes, I live with how stark the situation is. Sadly, today’s information tsunami has demonstrated a lack of leadership in public health. Although the Public Health Minister should be commended for all the work she has done, the Government must go further. Failure to act now will jeopardise the future of our nation’s health and the solvency of our national health service.

I thank the right hon. Gentleman for taking the opportunity of the report’s publication to give the Government the chance to respond and, hopefully, to put in the public realm a degree of concern about the report to back up the comments that he has made. I can do no better at this stage than quote what the chief knowledge officer of Public Health England, Professor John Newton, said today:

“Suggesting people should eat more fat, cut out carbs and ignore calories conflicts with the broad evidence base and internationally agreed interpretations of it.”

He continued:

“This opinion paper from the National Obesity Forum and Public Health Collaboration is not a systematic review of all the relevant evidence. It does not include an assessment of the methodological quality of the studies and should not be confused with the comprehensive reviews of the evidence that are produced by our process. For example, this paper highlights one trial suggesting high dairy intake reduced the risk of obesity, while ignoring a systematic review and meta-analysis of 29 trials which concluded that increasing dairy did not reduce the risk of weight gain.”

I am pleased that the right hon. Gentleman has given us the opportunity to agree with him and others who have said the report is irresponsible.

To respond to the right hon. Gentleman’s questions for the Government, it is clear that the childhood obesity strategy will be much welcomed, but it has to be soundly based. Much though I would like to give a date, I have to say that its launch will indeed be “in the summer”, and the summer is in parliamentary terms a flexible period. In saying that, I do not in any way minimise its importance.

The presence of my hon. Friend the Minister for Children and Families demonstrates that this is a cross-Government strategy. We know it will be scrutinised by many different parties, so it has to be right to give the guidance the right hon. Gentleman talks about. One can look at any national newspaper—one in particular—any day of the week and read conflicting advice on what is good and what is bad. Whereas that might be a source of amusement to the news programmes, for parents looking for what is right for their children, it is vital that they have advice they can trust. That is why the childhood obesity strategy, much commented on in this place, is so important.

The right hon. Gentleman is an important voice in dealing with diabetes. “Healthier You”, the national diabetes prevention programme based on international evidence, will start this year in 27 areas covering approximately 45% of the population and making up to 10,000 places available to people at high risk of developing diabetes, and will roll out to the whole country by 2020. The right hon. Gentleman is right to emphasise the importance of diabetes. I hope he acknowledges that that is recognised by the Government.

Does my right hon. Friend not agree that instead of all this complex and conflicting nanny state advice, it would be far better simply to advise children to move about more and eat less?

I am delighted to welcome the question from my hon. Friend the Member for Bury North—may God bless all who live there. I had a small bet with the Secretary of State on how long it would be before the words “nanny state” were uttered, and I was not disappointed.

My hon. Friend is right to ask the question, and we still want to encourage children to move more and eat less—there is nothing contradictory about that. However, a Government who take children’s health seriously, whether in relation to dentistry, deprivation and the environment, or indeed their physical health, weight and wellbeing, are as entitled to comment on this issue as anyone else. The childhood obesity strategy will not contradict efforts to encourage physical activity, but it will, I hope, have elements that my hon. Friend and everyone in his constituency welcomes.

Obesity, and in particular childhood obesity, is one of the biggest public health challenges facing our country. Today’s report not only questions official Government advice, but says that it may have had disastrous consequences. Whether that is right or wrong is a matter for debate.

Let me start by asking the Minister about today’s report. It makes a number of recommendations, but perhaps the most controversial has been the call to stop recommending the avoidance of foods with a high saturated fat content. I am pleased that the Minister has reaffirmed that he has no plans to review the Government’s official advice in the light of that call, and has also reaffirmed that the evidence on the current dietary advice remains valid, but does he share the views of experts, including the British Heart Foundation, who have today stressed the importance of official guidance being informed by robust evidence, free from interference by industry?

On the childhood obesity strategy, as my right hon. Friend the Member for Leicester East (Keith Vaz) said, in September we were told that it would be published before Christmas. Then at Christmas we were told that it would be published in the new year. In the new year we were told that it would be published in the spring, and now we are told that it will not be published until the summer, so can the Minister explain this delay? May we now have a cast-iron guarantee that the strategy will be published before the House rises for the summer recess, so that Members will have the chance to question Ministers on the contents of that strategy?

We welcome the recent announcement of a sugar levy, but does the Minister agree that alongside action on cost, we need action on advertising and labelling? Perhaps the real cause of rising childhood obesity has been not the Government’s dietary guidance, but their failure to take tough action on the marketing and packaging of unhealthy products. Will the Minister confirm that the strategy will contain comprehensive and co-ordinated action to tackle this growing public health challenge? Some of the best advances in public health have come about because past Ministers have shown leadership and vision, so may I say politely to this Minister: “Enough of the delay. It is now time to act”?

I am sure the Under-Secretary, my hon. Friend the Member for Battersea, will be able to pick up a number of issues that the hon. Gentleman has raised, but let me respond to some.

First, in relation to the report, as I emphasised by quoting the remarks from Public Health England, any advice that goes into the public domain which is to have credibility and upon which people should want to rely must be fully evidence based and as thoroughly researched as possible. If there is any doubt about that—if the evidence appears to be scant—it is right that such advice should be dismissed as irresponsible. We should continue to urge people to look at far more in-depth studies and internationally accepted views on health, diet and wellbeing. I made that point and I am pleased that the hon. Gentleman agrees.

In relation to the Government’s activity, the childhood obesity strategy will come forward in due course, but it cannot be said that nothing has been done in the meantime. The sugary drinks tax has been taken forward, and I can assure the hon. Gentleman that advertising, labelling and promotion definitely come into the strategy and will be looked at. Having spoken to my right hon. Friend the Secretary of State for Health, I am sure that the intention is to get the report out at a time when the House will be able to consider it. There is little likelihood of the House not having an opportunity to discuss and debate such an important matter, but it is important to get the report right. It is important that it meet exactly the challenges that the hon. Gentleman made from across the Dispatch Box. If it is not seen to be thorough, well researched and well evidenced, it will fall foul of the concerns raised by the irresponsible report today. I am grateful for his support. The outcome is something we all want to see, and I can assure him that my hon. Friend the Minister will be studying his remarks carefully.

In the hope that the Minister has doubled up his bets with the Secretary of State, may I join my hon. Friend the Member for Bury North (Mr Nuttall) in urging him to curb the Department of Health’s natural nanny state instincts when it comes to a childhood obesity strategy? If the sugar tax is part of that childhood obesity strategy, can he explain why the tax is being directed at a certain number of products, when other products with far more sugar in them will not be covered by the tax? Will he abandon this policy and encourage the Chancellor to abandon it before it becomes the new pasty tax policy?

Tempting though it is to use my temporary position for a whole range of announcements in relation to this area, I think that would be unwise. I can inform my hon. Friend that I have him on an accumulator with my hon. Friend the Member for Bury North (Mr Nuttall); I am not saying who is the final part of it. No, the Government will stick to their declared policy in relation to sugary drinks. Perhaps my hon. Friend might welcome the fact that all the money from that is going into physical activity through sports in schools, which I know he is really keen on as well. Perhaps that mitigates any concern he might have.

We have heard about the evidence base and the importance of looking at that evidence as we move the strategy forward. May I ask, as I did when this was last debated on 21 January, that the childhood obesity strategy look at the evidence that breastfeeding can contribute to reducing childhood obesity? The evidence is there, and it makes a significant contribution, so will the Minister ensure that it gets prominence in the report when it comes to be published?

Yes, I am very conscious of the issues surrounding this. The hon. Lady already has a meeting with the Under-Secretary, my hon. Friend the Member for Battersea, when these issues can be taken further.

I welcome the Government’s words on the national child obesity strategy and the necessity of making sure that it is authoritative when it is published. However, in the light of today’s unhelpful reports, is not the real point that it is absolutely critical that that strategy deals with many of the myths out there and is truly authoritative and conclusive in the advice that it relays?

My hon. Friend is absolutely right—that is important. The strategy has been awaited, and if it is to do the job we all want it to do, it should deal with the myths and concerns that have been raised, and do so in a proper evidential manner.

May I join in a partial, and rather surprising, alliance with the hon. Member for Shipley (Philip Davies) in questioning the sense in taxing just one particular type of product? Would not the Government instead—this is where I part company with him—consider taxing sugar as an ingredient to create an incentive for reformulation of products to reduce sugar content across the board, rather than just picking on one type of product?

I thank the right hon. Gentleman. He was not on my accumulator, so it has gone down. What he is calling for is exactly what the strategy does. It is designed to be quite wide and to take into account the possibility of other action in other places. He is absolutely correct about that.

Far from raising the nanny state, I welcome the Government’s proposals regarding sugar. There is a difficult issue not only about childhood obesity but about dentistry and the shocking evidence showing that young children today are having to go through procedures that should not be necessary. Will the Minister reissue that guidance and warning to all parents? I have a son who is 19; I know many people will be shocked to hear that. When he was 16, he had not had a fizzy pop; by the age of 18, after he had had fizzy pop from 16 to 18, he had 12 fillings. Will the Minister reiterate the dangers of fizzy pop?

Now we are back on home territory, as I am the Minister responsible for dentistry and can thoroughly concur with what the hon. Lady has said, while sharing the House’s astonishment at her news. The issue of dental clearances and young children’s teeth is a scandal. I will be speaking about this because on Friday I am going to a British Dental Association conference in Manchester and it will form part of my speech. The question is how to reach the parents and carers who have charge of their children to make sure they have access to the sort of treatments that are available, and how we work through schools, and through dentistry itself, to try to make more provision available for those who can be reached so that we deal with this terrible problem. There are some good experiments going on, not least in Nottingham; I think that the hon. Member for Nottingham North (Mr Allen) is partly responsible for those. The hon. Lady is right: dental issues are a serious matter to be dealt with in the overall health strategy.

May I first declare that I am a believer in the nanny state? It was the nanny state that stopped children being sent down mines and up chimneys, and much more besides. May I applaud my right hon. Friend the Member for Leicester East (Keith Vaz) for raising this very important issue? Last week when I had a peanut butter sandwich, it tasted rather sweet, so I checked the jar and found it had sugar in it. May I suggest to the Minister that we go well beyond a sugar tax and have some means of stopping sugar being put wrongly into foodstuffs?

We now have a sugar app, which means that the next time the hon. Gentleman goes down to the supermarket and wants to check how much sugar there is in a product, he can use the app by placing a device against the barcode. My family have used it and they have found, to their astonishment, how much sugar is contained in products that they never expected to contain it. This is not only about making sure that there is a reduction in sugar content where that is possible and appropriate, but about alerting consumers to the amount of sugar, which is really important. I shall ensure that the Under-Secretary, my hon. Friend the Member for Battersea, gives him details about the app he can use.

I know the Minister is a very reasonable man, so will he explain to my constituents how it can be reasonable for the public health budget in Hull to be cut by £1.56 million in-year? That means a reduction of £300,000 in the obesity strategy, and local authorities of course lead on obesity public health issues, do they not?

They do. I just have to tell the hon. Lady that all parts of Government are making the sorts of efficiencies they need to make in relation to such matters, and that can be no different for her area.

Prior to the reported publication date in the summer, will the Minister make sure that he discusses the co-ordination of the strategy very carefully with the Welsh Assembly? In border areas such as mine—advertising crosses the border and labelling crosses the border—people from my constituency who buy sugary drinks in Chester will find that their resources are put into sport in England, but not necessarily in Wales. It is important to consult the Assembly.

In accordance with the last answer I made to the last question when I was last at the Dispatch Box, the answer is yes.

Order. We now come to an urgent question to be asked by Mr Bernard Jenkin. Not here. Where is the fella?

I find it very hard to believe that the hon. Gentleman is in Brussels. [Interruption.] Order. Given that I have granted the hon. Gentleman’s application for an urgent question, it is a considerable discourtesy for him not to be here at once. He should have been in the Chamber. This must not happen again. The hon. Gentleman is a very serious and conscientious parliamentarian. If you put a question in, man—be here. Let us hear it. I am sorry to be annoyed, but I am annoyed, because the House’s interests are involved. This is not just about the hon. Gentleman; it is about all the other Members who have bothered to be here on time and about the interests of the House. The Minister was here well in time, which is good, and the shadow Minister has toddled in—the hon. Member for Wolverhampton South West (Rob Marris) beetled into the Chamber just in time. Let us hear from the hon. Member for Harwich and North Essex (Mr Jenkin).

UK Economy: Post-Referendum Assessment

(Urgent Question:) To ask the Chancellor of the Exchequer to set out his latest assessment of the UK economy following the result of the EU referendum, which he has published today; and if he will make a statement.

Last month, the Treasury published a detailed report on the long-term impact of EU membership on our economy. Today, the Treasury has published a full assessment of the immediate impact of leaving the EU. It provides yet further evidence to support the Government’s firm belief that it is in Britain’s best interest to remain in the European Union. The analysis makes it clear that a vote to leave would cause a profound economic shock, creating instability and uncertainty that would only be compounded by the complex and interdependent negotiations that would follow. The central conclusion of the analysis is that the effect of this profound shock would be to push the UK into recession and lead to a sharp rise in unemployment.

Two scenarios have been modelled to provide analysis of the adverse impact on the economy: a shock, and a severe shock. In the shock scenario, a vote to leave would result in a year-long recession, a spike in inflation and a rise in unemployment. After two years, our economy would be about 3.6% smaller than if we remain a member. The value of the pound would fall by about 12%, house prices would sink by about 10% and unemployment would rise by about half a million, affecting people in all regions of the United Kingdom.

Under the severe shock scenario, the effects would be even starker, with GDP 6% lower than it would otherwise be, a fall of 15% in the value of sterling and unemployment up by more than 800,000. If negotiations with the EU were to take longer than two years to conclude, or if the outcome were to be less favourable than expected, the UK economy could be subject to further instability, which would depress UK economic prospects further. That would undermine the hard work of the British people in forging an economic recovery since the crash of 2008.

As I set out at the start, today’s paper forms part of the case that the Government are making that Britain will be stronger, safer and better off if we stay in the European Union. It is based on serious, evidence-based analysis, and I commend it to the House.

Order. In fairness to the hon. Member for Harwich and North Essex (Mr Jenkin), he is at least here, which is more than can be said for the Chancellor of the Exchequer, to whom the question was directed. It appears that, as has happened on many occasions, the Chancellor has chosen to uncork the Gauke. We will now hear from Mr Bernard Jenkin.

I reflect on the fact that obesity was rather less of a crisis for the House this afternoon than I imagined it would be, Mr Speaker.

May I first say to the Minister that we all know that these forecasts are just rubbish being produced by a Government who are now obsessed with producing propaganda to try to get their way in the vote rather than enlightening the public? Has this report been signed off by the same Professor Sir Charles Bean who has previously said that models of economic shocks are based on “gross simplifications”? Will the Minister confirm that the so-called shock scenario suggests nothing more serious than that the economy will remain the same size as it was just last year? Does that not demonstrate how Ministers have become preoccupied with dishonestly talking down Britain’s economic prospects, which is highly irresponsible?

Why do the Government not agree with the chair of the remain campaign, Lord Rose? He has been reassuring in saying:

“Nothing is going to happen if we come out of Europe in the first five years…There will be absolutely no change.”

What about my right hon. Friend the Business Secretary? He said in February last year:

“As I’ve said before, a vote to leave the EU is not something I’m afraid of. I’d embrace the opportunities such a move would create and I have no doubt that, after leaving, Britain would be able to secure trade agreements not just with the EU, but with many others too”.

What does the Minister say in response to his Conservative predecessor, my noble Friend Lord Lamont? He said this morning:

“A lot of the Government’s so-called forecast depends on business confidence, which the Government is doing its best to undermine. Economists are no better than anyone else in predicting shifts in confidence…We have nothing to fear but fear itself—which the Government is doing its best to stir up.”

The Government say that wages will fall, so why did Lord Rose tell the Treasury Committee that wages would rise if we left the EU? Is this report produced by the same Treasury that failed to foresee the banking crisis and the great recession that followed?

Why do none of the Government’s post-referendum economic assessments look at the risks of remaining in the EU? Given that in 2014 the UK contributed £10 billion net to support other, failing EU economies rather than our voters’ own priorities, what effect will the continuing collapse of the eurozone economies have on the EU budget as a whole, and particularly on the UK’s net contribution?

Does not the Government’s entire campaign reinforce the unfortunate impression that today’s political leaders will say anything they think will help them get what they want, whether it is true or not? Does the Minister not realise that my right hon. Friends the Chancellor and the Prime Minister are contributing to cynicism about politics and a sense that voters should not trust their rulers but should make their own choice and judgment, which is why they will vote leave on 23 June?

The economy is a key issue in the debate and in the choice that the British people will make on 23 June. Today’s analysis is an attempt to assist the British people in making an informed decision, based on the likely consequences of the United Kingdom leaving the European Union. Indeed, many supporters of the leave campaign have been prepared to acknowledge that leaving the EU would at the very least have a short-term impact on our economy and create a shock.

As my hon. Friend said, the analysis produced by the Treasury has been signed off by Sir Charles Bean, the former Deputy Governor of the Bank of England and a distinguished macroeconomist. He said that

“this comprehensive analysis by HM Treasury, which employs best-practice techniques, provides reasonable estimates of the likely size of the short-term impact of a vote to leave on the UK economy.”

It is not only the UK Government who are highlighting the risks of leaving the European Union; the International Monetary Fund, the OECD, the leadership of pretty much every ally we have, business groups, and many respected independent economists have all made it clear that this country would lose out from leaving the EU. However one looks at this debate, we cannot get away from that central fact.

Unusually, perhaps, I find myself agreeing with a great deal of what the Minister has said. The hon. Member for Harwich and North Essex (Mr Jenkin) tried to rubbish the report and referred to trade agreements. If we were to leave the European Union, we would have to negotiate in very short order trade relationships with the rest of the world, including more than 50 other countries. Rome was not built in a day, and there would be huge uncertainty. As he will know—and as I know from having been in business—one key concern of business is always uncertainty.

At the moment, our economy is in great shape in terms of jobs, but on almost any other indicator—productivity, balance of payments, the housing crisis, investment in infrastructure, and the national debt, which has risen by two-thirds in the past six years—the economy already has red lights flashing, as almost every economist has said. Were we to leave the European Union, that would become considerably worse. I welcome the fact that the Prime Minister and the Chancellor of the Exchequer now recognise that the large majority of the problems we faced in 2008 and onwards were caused not by a Labour Government, but by a world recession. We now need not a Tory Brexit, but an economy that is strong and will remain stronger if we stay in the European Union, but that still needs considerable changes, particularly in investment in infrastructure and skills. Our security, both economic and military, will be strengthened if we remain within the European Union. We should build on a strong economy by investing, not by leaving the European Union.

The hon. Gentleman’s point about uncertainty is right, and there is clearly uncertainty in the economy at the moment as a consequence of the referendum on Brexit. It is absolutely right that we have that referendum, but such uncertainty can resolve itself quickly on 23 June if there is a remain vote. If there is a leave vote, we clearly face at least two years of uncertainty, and quite possibly longer.

On the state of the economy—this is perhaps where the hon. Gentleman and I may differ—we have taken steps to address the long-term challenges faced by the economy, but there is no doubt that the past few years have been difficult for the British economy. We are now one of the fastest-growing major economies in the world, and our progress over the past six years would be put at risk were we to vote to leave the European Union.

I am sorry that my hon. Friend has had to come to the House to defend this disreputable, shabby and misleading report. The last Treasury report set out three scenarios, including membership of the European economic area. Why was that left out of this report, and was the permanent secretary in agreement with that major departure from normal procedure?

As I understand it, the leave campaign have made it clear that they would not want to go down the Norway route and be members of the EEA, because that would require continued contributions to the EU budget, continued compliance with EU regulations, and continuing to be signed up to free movement of labour. Given that the leave campaign is now focused almost exclusively on immigration, it would be strange to suggest that one option to take would be one that has been dismissed by the campaign to leave the European Union.

Here we go again. The Government seem determined to recycle “Project Fear”, based on Treasury projections invented on the back of its now famous neo-classical fag packet. If all the Government have to offer is fear, they do the cause of the EU no favours. There are many positive reasons for staying in the EU. Why is there no analysis of the emerging trading opportunities for business; why is there no analysis of the value of appropriate immigration to the labour market; and why is there not more respect for those of us who want to make a positive case for the EU?

I must admit that I am slightly confused by that contribution—my understanding was that the position of the Scottish National party was to favour remaining part of the European Union.

If the hon. Gentleman wants a positive case, let us put it this way: according to the shock scenario we have set out, in two years’ time, the UK economy will be 3.6% bigger if we stay in the EU than it will be if we leave. He criticises and wants to re-fight the Scottish independence referendum. May I just remind him—I suspect it will not be for the last time—that the Unionists won that referendum?

Why does the forecast leave out the very beneficial impact of spending another £10 billion, which we would get back in contributions, on our own priorities, jobs and services, which would boost the economy by 0.6%? Why does it leave out the impact of the lower interest rates and the big injection of liquidity that the Bank of England says it will grant the economy around the time of the vote?

First, the report is for the next two years. As my right hon. Friend will be aware, even if we vote to the leave the European Union, we will continue to be members of it for those two years as we negotiate our departure. During that two-year period, we would continue to make contributions to the EU budget. May I also point out what the International Monetary Fund has said? It said that, essentially, if the economy shrinks by 1% or more, any fiscal gain from ceasing to make contributions to the EU will be wiped out by lower tax receipts and greater costs. Indeed, under the central scenario set out in the report, the public finances will be £24 billion worse off as a consequence of our leaving the EU.

On interest rates, the assumption in the report is for no changes to fiscal or monetary policy. I point out to my right hon. Friend that one of the predictions in the report is that we would see the pound falling in value and inflation increasing. The Monetary Policy Committee has made it clear that it would have a difficult trade-off to try to get the economy going at a time when there would clearly be a slowdown. At the same time, the pound would be falling and inflation would be rising. In those circumstances, the safest thing to do is to make no assumptions on what monetary policy would be.

Has any assessment been made of the impact if we leave the EU on 23 June on companies such as Siemens, which invest in new industries in this country such as renewables?

The hon. Lady’s point is particularly significant because of the long-term impacts. It is very clear to any of us who engage with those who invest in the UK—businesses that make decisions on where to locate investment—that access to the single market is an important attribute for the UK. It is clear within the report that business investment would fall significantly in both the short and long term as a consequence of leaving the EU.

Leaving aside the Treasury’s notorious incompetence at forecasting, does my hon. Friend—for whom I have a lot of time, normally—not agree that this document really does plumb new depths in “Project Fear”? The Government are trying to scare the public witless. If the consequences are so dire, why on earth did the Prime Minister say on record that Britain could prosper perfectly well outside the EU? Why do the Government, through this report, say:

“as our economy transitions to a worse trading arrangement with the EU.”?

Does my hon. Friend not accept that that is utterly dishonest? The Europeans export £72 billion more to us than we export to them, so it will be in their interests to do a deal with us. And we will have a Government far more capable of negotiating than the present Government have been able to do.

First of all, may I say that I have an awful lot of time for my hon. Friend normally, but that I disagree with the points he makes? On trading arrangements, it is impossible to see how we could negotiate a trading arrangement as strong as the one we have at the moment. Access to the single market and its benefits, particularly in the context of non-tariff barriers, is very important. We would undoubtedly be a less open economy as a consequence of leaving the EU.

On the report and trying to scare people, it is worth pointing out the Treasury’s assumptions and what the Treasury is not suggesting is underlying what will happen. We are not putting forward a view that there will be an immediate financial crisis—for example, a current account crisis. We are saying that we can reach a deal within two years, which, I have to say, is ambitious. We are not saying, under the shock scenario, that there would be any economic contagion as a consequence of the UK leaving the European Union. If we wanted to put a much more dramatic, scary report together, there are a number of things we could have included in the report, but simply did not. This was a cautious, careful, small “c” conservative report, which, as I say, has been signed off by perhaps the leading authority in this area in this country.

Isn’t the premise that the Treasury spokesman is trying to convince people of the one that the economy under this Government is doing exceptionally well? In reality, of the many people who have a job, several million are on zero-hours contracts and do not know which way to turn. A hell of a lot of people are now borrowing money on loans they cannot afford and many people are going to food banks to make ends meet each week. The whole idea the Treasury announcement is trying to convey is that everything in the garden is lovely but that that will all be thrown away if we do something else. The truth is that it is based on a phony premise.

The hon. Gentleman and I differ in our assessment of the state of the UK economy, but whether he takes his view or I take mine, in neither case would our economy and our constituents benefit from pursuing a policy that would increase unemployment by 500,000 and see average wages fall by nearly £800. I hope he considers the impact that leaving the European Union would have on his constituents.

A 3.6% higher GDP, lower unemployment, lower inflation and a better exchange rate—surely these are things to celebrate? May we have the argument made that these are good things that will happen if we remain in the EU, rather than the other way around?

My hon. Friend makes a good point. Let me put it this way: the UK benefits from being an open trading nation. Membership of the single market helps us to pursue the approach of having an open trading economy. That is a very positive thing, one I hope the British people will ensure we continue to have.

Is the Minister as concerned as I am that the leave campaign dismisses as a conspiracy the views of the Treasury, the International Monetary Fund, the World Bank, the OECD, the CBI, the Bank of England, the Office for Budget Responsibility and the London School of Economics? Does he hope that in June people will vote with their hearts and their heads to stay in the EU, which, with NATO, has provided peace and prosperity for the longest period since antiquity, according to the outgoing London Mayor?

Actually, I think I have seen it—the right hon. Gentleman reminds me.

There is an overwhelming consensus on the economic benefits of membership of the EU, and I hope that the British people, when they make their assessment, be it with their hearts or their heads, carefully consider the economic consequences of their decision. It is a very important decision that will have an impact not just for a year or two—the focus of this report—but for many years ahead.

Is not the simple fact that countries trade with one another to increase their mutual prosperity and that trade with our principal trading partners is easier as a member of the EU?

Yes, that is absolutely right. Access to the single market reduces trade barriers to a level simply impossible to find outside the single market.

The institutions and individuals forecasting economic doom if we leave the EU have got it wrong time and again in the past and seem likely to do so again. The exchange rate mechanism debacle, driven by the whole Europhile spectrum; the prediction that the skies would fall in if we did not join the euro; and the complete failure to foresee the 2008 crisis coming down the road—all this shows just how hopeless they are. Does the Minister accept that a plausible opposite case—that we would be better off outside the EU—can easily be made? If not, I will happily provide him with one.

I look forward to hearing that plausible case when it is made. I look forward to an analysis, supported by leading economists, making that case, but we have not heard it yet. The hon. Gentleman and I agree about our membership of the euro—we always have done—but if we were to single out two politicians in this country perhaps more responsible than anyone else for keeping us outside the euro, I would highlight, from my party, William Hague and, from his party, Gordon Brown, both of whom believe we should remain in the EU.

“Project Fear” has reached new lows. Following the predictions of world war, we now have a forecast of recession equal to that of the great depression should we leave. Does the Minister accept that the Treasury got it absolutely wrong when it forecast an economic shock if we left the ERM and that the Treasury, the OECD, the IMF and even the Bank of England did not see the last recession coming?

The Treasury—indeed, some of the same civil servants—was involved in making the assessment of the five economic tests that kept us out of the euro. I suggest that my hon. Friend looks carefully at the report. We do not make any claims of the sort he suggests—about it being the greatest depression since the great depression of 1929—but suggest that the “shock” scenario involves the economy shrinking by 3.6% compared with the base, which is the forecast for the next few years. This is actually a very measured, conservative assessment of the impact, but none the less there would be an impact and it would result in 500,000 more people being unemployed than need be the case.

When does the Minister think that those advocating leaving the EU will level with the British public and provide their own economic assessment? Half of them think we can leave the EU and stay in the single market and the other half say, “Oh no, we won’t be part of the single market at all.” Is it not useful, therefore, that today’s analysis gives a snapshot of what a “severe shock” would look like if we were still in the single market? Will he also say a bit more about the “severe shock” analysis—falling back on the WTO membership rules—and how it could lead to 800,000 more people becoming unemployed?

The hon. Gentleman is right that under the more severe shock scenario, unemployment would increase by 800,000 and GDP would be 6% lower than it would otherwise have been. These are significant numbers. They are not equivalent to the great depression, but they are still significant numbers that would have a significant effect on his and my constituents. The hon. Gentleman raises an important point, and I hope we will get greater clarity about exactly what leaving the EU would involve. It seems to me that there is a clear trade-off: the closer a country is to membership of the EU, as for example with the European economic area model, the more it will continue to have the attributes of EU membership; the further away it is, it may have that greater freedom and flexibility, but it will clearly face a much bigger economic shock.

Inward investment is crucial to this analysis, and my constituency attracts it from China, Australia and the United States as well as from Japan. One crucial factor that has led me to believe that we are stronger in is the fact that all those countries and their businesses want to see us as part of Europe. Indeed, some of those inward investments are European headquarters. What estimate has the Treasury made of the potential relief rally in investment in this country, as and when we choose to stay in?

That is an important point. Anyone who has met international investors who are considering where to locate their European headquarters, for example, will be aware that they value and support membership of the European Union. Without that, it would clearly be harder to attract some of that inward investment. My hon. Friend also raises an important point about whether we would see a recovery. Evidence suggests that there has been a slowing down of investment due to the uncertainty about our relationship with the EU, but that—the Bank of England has supported this view, if not the IMF—there is likely to be a reasonably quick recovery if we vote to remain on 23 June, and we would see the investment coming back without a long-term detrimental impact.

The north-east is a manufacturing region, and recent analysis suggests that manufacturing is already in recession. Does the Treasury analysis go into the detail of distinctive regional impacts on areas such as the north-east of the shock or severe shock scenarios if we leave the EU? It used to be said that if America sneezes, Britain catches cold, but when Britain catches cold, regions such as the north-east get pneumonia.

The hon. Gentleman raises an important point. The increase in unemployment would affect every region of the UK, and the north-east of England would not be immune to that. Indeed, as an important exporting region, it might be particularly vulnerable. The Treasury assessment suggests that there would be something like 20,000 more unemployed people in the north-east of England as a consequence of leaving the EU.

When the Chancellor set up the Office for Budget Responsibility, he said that

“the public and the markets have completely lost confidence in government economic forecasts.”

He went on to say:

“Again and again, the temptation to fiddle the figures, to nudge up a growth forecast here or reduce a borrowing number there to make the numbers add up has proved too great… But I am the first Chancellor to remove the temptation to fiddle the figures by giving up control over the economic and fiscal forecast.”

Why does the Minister now disagree with the Chancellor, and why does the Chancellor now disagree with himself?

The remit of the Office for Budget Responsibility is set out in legislation, and it can set out forecasts only in accordance with Government policy. Today’s report, however, as I said earlier, has been signed off by Sir Charles Bean, who said that

“this comprehensive analysis by HM Treasury, which employs best-practice techniques, provides reasonable estimates of the likely size of the short-term impact of a vote to leave on the UK economy.”

We have third parties endorsing the analysis, having worked through the details.

Is it not the truth that this report simply echoes the concerns about the adverse impact of Brexit that have already been expressed by businesses in all our constituencies up and down the land? They include the ceramics industry in my area, representing manufacturing, and in recent days our biggest local private sector employer, Bet365, representing international services. Yesterday, The Sunday Times set out in detail the fundamental concerns of London’s vitally important financial and professional services industries. Does the Minister agree, therefore, that all the evidence not only suggests, but shows, that there is absolutely no economic rationale for the United Kingdom’s leaving the European Union?

The hon. Gentleman has made a good point. The analysis that we have set out in our document is consistent with what businesses up and down the country are telling us: every business survey has indicated that they are in favour of our remaining part of the European Union. It is also consistent, as we have heard, with the view of the likes of the International Monetary Fund, the OECD and the Bank of England, all of which have highlighted the risks of our leaving the EU.

Given that the independent think-tank Open Europe, which is not taking sides in the referendum debate, has said that it is a mistake to think that short-term forecasts are inevitably more accurate than long-term forecasts, can the Minister tell us, in percentage terms, what the chances are of these forecasts actually being true?

Of course I hope that none of them turns out to be true, because I hope that the hypothesis of our leaving the European Union is not realised.

It is not just the Government who are warning of the economic risks of Brexit, along with the OECD, the IMF, the World Bank, and every other mainstream economic voice in this debate. The former Mayor of London’s former economic adviser himself warned of an economic shock in the wake of Brexit. Does the Minister agree, however, that it is not Project Fear that the other side are complaining about, but Project Fact? Does he agree that the leave campaign argument would be a great deal stronger if those campaigners had produced a single shred of credible evidence to demonstrate that Britain would be better off out, when the mainstream economic opinion in this country and around the world is that our economy is stronger through our remaining in the European Union?

The hon. Gentleman is absolutely right: mainstream opinion does support the United Kingdom’s being part of the European Union. I should be fascinated to read a report similar to ours arguing the other case. We produced our long-term report last month, and I look forward to receiving a proper, detailed response to it. I think that the reason no analysis of that kind has yet been produced is that there is insufficient support for such a view, and I hope that that will become more and more apparent over the next month.

Each year we have a Budget statement and an autumn statement in which the Chancellor corrects the forecasts in the previous statement. Will the Minister assure us that, after we vote for Brexit, the Chancellor will come to the House regularly to correct the forecasts contained in this document?

This scenario has been set out by means of perfectly normal, widely used techniques, and signed off by the leading economist in the field. We have made a number of assumptions that have been cautious, and have in no way sought to exaggerate the risks. I have to say to my hon. Friend that there is a real risk to the UK economy. This is not fearmongering, or scaremongering; it is simply setting out what the risks are to the British people—matters of which the British people should be aware when they vote on 23 June.

Much as I am enjoying the Punch and Judy show in the Conservative party, may I remind the Minister that if both leave and remain continue to run negative campaigns, the most negative campaign will win? At a time when we should be engaging with the electorate of the United Kingdom, they will be turning off in their droves, and that does not serve democracy well.

What we are doing is making clear what the risks to the British people would be were we to leave the European Union. All I would say to SNP Members is that if they have a positive contribution to help the remain case, let them make it, rather than lecturing others on how to put across important factors that will, I hope, sway the British people. The British public are seeking information on the consequences of leaving the European Union, and the Government have a duty to provide that information.

It is right that we should deal with scare stories as quickly as possible, and I think that the Minister has done a very good job in that regard. Will he comment on the remarks made by the Minister for Employment in Leicester last Thursday, when she parked a very big red bus in front of the biggest temple in my constituency and announced that if we stayed in the European Union all the curry houses in Leicester would have to close down because the EU was responsible for a crisis in chefs? Will he confirm that the issuing of visas is actually a matter for the UK Government and has nothing to do with the EU? Will he also confirm that if the British people vote to stay in the EU, we will still be able to eat curry in Leicester, but if they vote to go out, Leicester City will still play in the European Champions League?

I shall try not to be drawn too much on the subjects of curry or Leicester City, although I of course congratulate Leicester City and look forward to their season, and possibly more, in the Champions League. Immigration policy for those outside the European Union is clearly a matter for this Government and for this House, and that will continue to be the case, whatever the result on 23 June.

Airbus, which employs 7,000 people across north Wales and north-west England and many thousands more elsewhere in the United Kingdom, has, with the full support of the trade unions, written to every employee of Airbus to explain to them why they should vote yes in the forthcoming referendum. Will the Minister confirm that the short-term and long-term risks outlined in today’s report are the very reason that companies such as Airbus have come off the fence to strongly support a yes vote on 23 June?

The right hon. Gentleman makes a good point. Businesses are perfectly entitled to write to their employees when they see a risk to the business that they undertake, and those consequences should be made very clear. It is striking how the concerns of individual businesses, big and small, about the consequences of leaving the European Union are consistent with some of the concerns that we have set out in the Treasury document—namely, that the UK would be poorer outside the European Union and that we are stronger, safer and better off within it.

Debate on the Address

[3rd Day]

Debate resumed (Order, 19 May).

Question again proposed,

That an humble Address be presented to Her Majesty, as follows:

Most Gracious Sovereign,

We, Your Majesty's most dutiful and loyal subjects, the Commons of the United Kingdom of Great Britain and Northern Ireland in Parliament assembled, beg leave to offer our humble thanks to Your Majesty for the Gracious Speech which Your Majesty has addressed to both Houses of Parliament.

Defending Public Services

Today’s debate, chosen by the Opposition, is about defending public services, so I want to start by stating very simply that this Government do not believe in private wealth and public squalor; quite the opposite—we believe in prosperity with a purpose, and building high quality public services is perhaps the most important purpose of all. But there is a difference between the two sides of the House. Indeed, there is more than one difference. One is that we on this side are prepared to take the difficult decisions necessary to build the strong economy that will, in the end, fund those public services. A second difference is that we go further and say that securing funding from a strong economy is not enough, and that the battle for higher standards is as important as the battle for resources. Without high standards, we let down not just the taxpayers who fund our public services but the vulnerable citizens who depend on them.

So yes, we are proud to have protected schools funding since 2010, but we are even prouder that 1.4 million more children are in good or outstanding schools. Yes, we are proud to meet our 2% of GDP defence spending pledge, but we are even prouder of the professionalism of our armed forces operating in the Mediterranean today to help to find the wreckage of the tragically lost Egyptian airliner. Yes, we are proud to have protected science and research funding, but we are even prouder that this country continues to win more Nobel prizes than any other, apart from the United States. Yes, we are proud that, since 2010 and despite the deficit, we increased NHS funding by more than was promised by the Opposition at both elections. We are even prouder that failing hospitals are being turned around, that MRSA rates have halved and that cancer survival rates have never been higher.

With that, let me turn to the NHS and say up front that nowhere is the importance of the two challenges of proper funding and high standards more stark. I pay tribute to the 1.3 million staff who work in the NHS. Whatever they have thought over the years about the politicians running their service, their dedication to patients, their hard work, night and day, and their commitment to the values that the NHS stands for make up the invisible glue that has always held it together, whatever the challenge. I know that I speak for the whole House when I thank them for their service.

Let us look at what staff have achieved over the past six years. Compared with 2010, we treat 100 more people for cancer every single day. We treat 1,400 more mental health patients, 2,500 more people are seen within four hours in A&E departments, and we do 4,500 more operations. At the same time as all of that, hospital harm has fallen by a third and patients say that they have never been treated with more dignity and respect. In the wake of the tragedy of Mid Staffs, we should recognise the huge efforts of staff at the 27 trusts that have since been placed into special measures. Eleven have now come out, three of which are now officially rated as good. Neither Stafford nor Morecambe Bay nor Basildon—three of the hospitals of greatest concern—are now in special measures thanks to excellent local leadership and superb commitment from staff.

However, all NHS staff want to know about the funding of their service. The NHS’s own plan, published in October 2014, asked for a front-loaded £8 billion increase in funding not just to keep services running, but to transform them for the future. The then shadow Health Secretary, the right hon. Member for Leigh (Andy Burnham), said that the Conservative promise to deliver that funding was a cheque that would bounce, but we delivered that promise to the British people in last autumn’s spending review, and the increase was not £8 billion, but £10 billion. It was not back-loaded, as many had feared, but front-loaded with £6 billion of the £10 billion being delivered this year.

On the Secretary of State’s point about what the NHS asked for, is it not right that the forward view set out three different efficiency savings scenarios? It was not a case of the NHS asking for £8 billion. Does he really believe that the £8 billion— £10 billion including last year’s increase—will be sufficient to meet the NHS’s demands?

The right hon. Gentleman will have heard Simon Stevens being asked that question on “The Andrew Marr Show” yesterday. He was clear that £8 billion was the minimum of additional funding that he thought the NHS needed. In fact, we supplied £10 billion, which came with some important annual efficiency saving requirements. Indeed, for that £8 billion, the NHS recognises that £22 billion of annual efficiency savings are required by 2020, because even though funding is going up, demand for NHS services is increasing even faster. I will come on to talk about how we are going to make those efficiency savings. Some in this House have observed that without £70 billion of PFI debt, without £6 billion lost in an IT procurement fiasco, and without serious mistakes in the GP and consultant contracts a decade ago, the efficiency ask might have been smaller.

We all hear what the Secretary of State is saying: it is always somebody else’s fault. However, the fact of the matter is that I have been told by senior health professionals at the highest level—I do not watch “The Andrew Marr Show” often—that only two of this country’s health trusts are not in debt. Is that right?

That is not true, but we do all accept that there is financial pressure throughout the system. The question that is always ducked by Labour Members is how much greater that financial pressure would have been under Labour’s plans, which involved giving the NHS £5.5 billion less every year than was promised by the Government. I just point out that when Labour Members condemn the £22 billion of efficiency savings as “politically motivated”, as the shadow Health Secretary did in March, they cannot have it both ways. Her manifesto offered the NHS £5.5 billion less every year compared with what this Government put forward—

The hon. Lady shakes her head, but let us consider what the King’s Fund said in the run-up to the election:

“Labour’s funding commitment falls short of the £8 billion a year called for in the NHS five year forward view.”

It was there in black and white: Labour was committing to a £2.5 billion increase in the NHS budget, not the £8 billion that this Government committed to. The hon. Lady cannot have it both ways. If this figure was £5.5 billion, the efficiency savings needed would be not £22 billion, but £27.5 billion, which is a 25% increase. That would be the equivalent of laying off 56,000 doctors, losing 129,000 nurses or closing down about 15 entire hospitals.

I welcome the Secretary of State’s policy that foreign visitors should be asked to pay for non-urgent treatment that they get when they are here and that European visitors should have to recoup this through their national systems. Why do we need extra legislation, and how much money does he think we can get from that?

We need extra legislation to expedite the process. I point out to my right hon. Friend that that is another policy which has been opposed by the Labour party. All the time it says we should be doing more to get a grip on NHS finances and yet it opposes every policy we put forward in order to do precisely that. The answer to his question is that the issue with the NHS is primarily that we are not very good at collecting the money to which we are entitled from other European countries, because we are not very good at measuring when European citizens are using the NHS. This legislation will help us to put those measurement systems in place so that we can get back what we hope will be about half a billion pounds a year by the end of this Parliament.

We will no doubt hear later this afternoon the charge that the Government have lost control of NHS finances, but we strongly reject that charge. The House may want to ask about the credibility of that accusation from a party that is at the same time proposing a funding cut for the NHS and criticising the difficult decisions we need to take to sort out NHS finances.

Two months into this financial year, can the Secretary of State say whether or not the Department of Health broke its budget for last year?

We will find out those figures when the full audit is complete. I just say to the hon. Gentleman that efficiency savings are never easy, but a party with the true interests of NHS patients at heart should support those efficiency savings, because every pound saved by avoiding waste is one we can spend improving patient care.

Let me therefore outline to the House what we are doing to deliver those efficiencies, as well as to support NHS trusts to return to financial balance. First, we are taking tough measures to reduce the cost of agency staff, including putting caps on total agency spend and limits on the rates paid to those working for agencies. So far, that has saved £290 million, with the market rate for agency nurses down 10% since October and with two thirds of trusts saying that they have benefited. Our plan is to reduce agency spend by £1.2 billion during this financial year. Secondly, we are introducing centralised procurement under the Carter reforms. Already 92 trusts are sharing, for the first time, information on the top 100 products they purchase in real time, and we expect savings of more than £700 million a year during this Parliament as a result. Thirdly, given that the pay bill is about two thirds of a typical hospital’s costs base, we are supporting trusts to improve on the gross inefficiency of the largely paper-based rostering systems used at present. This should also significantly increase flexibility and the work-life balance for staff, as we announced last week. Finally, and perhaps most critically, we will reduce demand for hospital services by a dramatic transformation of out-of-hospital care, as outlined in the five-year forward view. If we meet our ambitions, we will reduce demand by more than £4 billion a year through prevention, improved GP provision, mental health access and integrated health and social care.

For as long as I can remember, unfortunately, discussions about the NHS have always been reduced to simplistic arguments about whether enough money is being spent on it, and whether efficiency is being improved enough. I think that the Government, in the present financial circumstances, have increased spending and pursued efficiency at least as effectively as any of their predecessors.

Does my right hon. Friend agree that the real issues that we ought to be considering are the rapid rise in, and the changing nature of, demand on this important service? Will he have time to consider things such as moving to a seven-day service; ending the curious divisions between the hospital service, GPs, community care and local council social services; providing for an ageing population with chronic conditions; and, at the same time, giving extra emphasis to mental health and all the things that have been neglected in the past? All these exchanges such as, “You should be spending more,” and “You are cutting, and we would spend more” are the sterile nonsense pursued by every Opposition that I can recall when they cannot think of anything positive to say.

My right hon. and learned Friend speaks with great wisdom, as he did during the junior doctors’ strike. Perhaps that is based on his experience of featuring in a BMA poster, which was put up across the country, as someone who ignored medical advice, because he smoked his cigar.

My right hon. and learned Friend is absolutely right. The crucial issue for the future of the NHS is the simple statistic that by the end of this Parliament we will have 1 million more over-70s to look after in England, and their needs are very different from those of the population whom we had to look after 20, 30 or 40 years ago. In particular, their need to be looked after well at home, before they need expensive hospital treatment, is a transformation. That is why a core part of what we are doing is to transform the services offered in mental health and in general practice, which I will come on to a bit later.

While the Secretary of State is talking about transformation, let me say that I agree with the right hon. and learned Member for Rushcliffe (Mr Clarke) that we have to start focusing on quality. In the east midlands, for example, the ambulance service has just been judged by the Care Quality Commission to be inadequate when it comes to patient safety. Things are in a real state of difficulty in our NHS. Ambulance services need improvement; what is he going to do about it?

I absolutely agree with the hon. Gentleman. In fact, I wanted to come on to talk about that perceived tension between money and the quality of care. Until three years ago, we did not have an independent inspection regime to go around ambulance services and tell the service, the public, constituents and Members of Parliament how good the quality of care is in each area. The first step is to have that inspection regime so that we know the truth, and then things start to happen, as is beginning to be the case in ambulance services across the country.

The big point—this is precisely what I wanted to move on to—is the worry, which is shared by many people, that an efficiency ask of this scale might impact on patient care. They should listen to the chief inspector of hospitals, Professor Sir Mike Richards, who points out that financial rigour is one of the routes to excellent quality, and that there is a positive correlation between hospitals offering the best care and those with the lowest deficits. In other words, it is not a choice between good care and good finances; we need both.

Before my right hon. Friend moves on, I want to draw him back to the question of charging international visitors for the use of the NHS. The Government now charges non-EU citizens £200 per person as part of their visa application. Will he tell the House why he has chosen the figure of £200, which seems extremely low? An equivalent private healthcare policy for a year would be £800, £900 or £1,000, and an equivalent level of travel insurance for the same period would be £400 or £500. Is there not an opportunity to tier this and perhaps charge people more as they get older and become more likely to rely on the NHS?

I recognise why my hon. Friend has asked that question. We do think very hard about the level at which we set that charge, which was introduced for the first time only a couple of years ago. The reason that it is set that low—I recognise that it is quite a low charge—is that a large number of people paying it are students who tend to have low health needs and be low users of the NHS. We want to ensure that we do not create an inadvertent disincentive for people coming to the UK when they can, at the same time, choose to do their studies in Australia and America. However, it is something that we keep constantly under review.

My right hon. Friend will of course be aware that there is a differential charge for students—some £150 a year rather than £200. Will he go away and consider whether there is a possibility of charging high earners who come to this country more than a couple of hundred pounds a year, because the charge does seem so low? Will he also specifically look at whether there is a possibility of charging people who are older more, as they are much more likely to rely on the NHS?

Let me repeat that we do keep this matter constantly under review. The important thing is that, for the first time, we are charging people who come to the UK on a long-term basis for their use of NHS resources. That is something that did not happen before.

Let me return to the crucial issue of this link between the quality of care and good finances. Why is it that it is so important not to see this as an artificial choice between good care and good finances? Very simply, it is because poor care is about the most expensive thing that a hospital can do. A fall in a hospital will cost the NHS about £1,200, as the patient typically stays for three days longer. A bed sore adds about £2,500 to NHS costs, with a patient staying, on average, 12 days longer. Avoidable mistakes and poor care cost the NHS more than £2 billion a year. We should listen to inspiring leaders such as Dr Gary Kaplan of Virginia Mason hospital in Seattle, which is one of the safest and most efficient hospitals in the world. He said:

“The path to safer care is the same one as the path to lower costs.”

That brings me on to the second way that this Government are fiercely defending our public services, which is our restless determination to raise standards so that people on lower incomes can be confident of the same high quality provision as the wealthiest. To their credit, the last Labour Government succeeded in bringing down NHS waiting times. I hope that that decade is remembered as one when access to NHS services improved. However, because of poor care identified in many hospitals post Mid Staffs, we should surely resolve that this decade must become the one in which we transform the safety and quality of care. Mid Staffs was the lowest point in the history of the NHS, so we must make it a turning point, or a moment that we resolve to offer not just good access to care, but care itself that is the safest and the highest quality available. The record of the past three years shows that we can do just that.

The King’s Fund has given credit to the Government for their focus on safety and quality of care. Patient campaigners have said that the NHS is getting safer and the main indicators of hospital mortality and harm are going in the right direction. However, there is much more to do, so what are our plans? First, we must deliver a seven-day NHS. It should never be the case that mortality rates are higher for people admitted at weekends than for people admitted in the week. Last week’s junior doctor contract agreement was a big step forward, but we also need to reform the consultants’ contracts, improve the availability of weekend diagnostic services and increase the number of weekend consultant-led procedures.

Secondly, a seven-day NHS also means a transformation of out-of-hospital services, especially access to an integrated health and social care system that needs to operate over busy weekends as well as during the week. It also means more GP appointments at convenient times, which is why we want everyone to be able to see a GP in the evening or at weekends. We are backing general practice with a £2.4 billion increase in its budget.

One group of people who particularly need integrated care are those who are addicted, as their life chances are most blighted. They need to be able to make a full recovery. Will the Secretary of State tell us what has been done to support that full recovery? Like me, is he looking forward to hearing the Minister for Culture and the Digital Economy, my hon. Friend the Member for Wantage (Mr Vaizey), conclude the debate, as we will perhaps hear how blighted communities are impacted by high-stakes fixed odds betting terminals? I would like to hear what is being done by the Government on that, as we need to act now to show that we have an all-round approach to improving life chances.

It is a pleasure to sit on the Treasury Bench with my hon. Friend the Minister for Culture and the Digital Economy for the first time in several years. I will leave him to respond to that point, but I will make a broader point in response to the question from my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) which is that the change we need to make in the NHS is to prevention rather than cure. If we can stop people becoming addicted in the first place, whether to drugs, alcohol or gambling, we will reduce costs for the NHS in the long term. That is the purpose of many of our plans.

Thirdly, a seven-day NHS requires a big improvement in access to 24/7 mental health crisis care, so that whenever a problem arises we are there promptly for some of our most vulnerable people. We will deliver that alongside our broader plans to enable 1 million more people with mental health problems to access support each year by 2020.

May I commend the Government for accepting the majority of the recommendations from the independent mental health taskforce and allocating £1 billion to implement them? The Secretary of State has been talking about system change within the NHS. To deliver on the taskforce’s recommendations, we need system change to make sure that we have the sort of mental health services that the people of this country deserve.

My hon. Friend speaks with great knowledge and as chairman of the all-party group on mental health. He is absolutely right to say that we need system change. The system change we need is to stop putting mental health in a silo, but instead to understand that it needs to be part of the whole picture of treatment when a person is in hospital or with their GP; it needs to be integrated with people’s physical health needs. We need to look at the whole person. We will not get all the way there in this Parliament, but I think the taskforce gives us a good and healthy ambition for this Parliament and I am confident we will realise it.

I am pleased to hear the Secretary of State acknowledge the importance of quality of care in mental health as well, but of course there are also problems in areas such as learning disability, where there are some highly vulnerable individuals. After the shocking Southern Health exposé, does he really not think that the leadership of that organisation, which presided over some dreadful events and so many unexpected deaths not being investigated, need to be held accountable and to move on?

As the right hon. Gentleman knows, the chair of that organisation has stepped down, but he is absolutely right about accountability. Accountability needs to be about not just individual organisations within the NHS, but the people commissioning mental health care and care for people with learning disabilities. That is why, from July, we will for the first time be publishing Ofsted ratings on the quality of mental health provision and of provision for people with learning disabilities by clinical commissioning groups, so that we can see where the weak areas are and sort them out.

I conclude on quality by saying that important though a seven-day NHS is, we need to go further if we really are to make NHS care the safest and highest quality in the world. According to the respected Hogan and Black analysis, we have 150 avoidable deaths in our NHS every week. That is 3.6% of all hospital deaths with a 50% or more chance that that death could have been avoided. In the United States, Johns Hopkins University said earlier this month that medical error was the third biggest killer after cancer and heart disease, causing 250,000 deaths in the United States alone every year. That is why this year England will become the first country in the world to lead a transparency revolution in which every major hospital will publish its own estimate of its avoidable deaths and its own plans to reduce them. This year, we will focus particularly on reducing maternal deaths, stillbirths and neonatal death and harm, with plans I hope to outline soon to the House.

If we are to do that, perhaps most difficult of all will be transforming a blame culture found in too many parts of the NHS that still makes it far too hard for doctors and nurses to speak openly about medical error. Among other measures, we have set up a new healthcare safety investigation branch to conduct no-blame investigations when we have tragedies. It is modelled on the highly successful air accidents investigation branch. As in the airline industry, our model for reducing avoidable death must be transparency, openness and a learning culture that supports rather than blames front-line professionals, who in the vast majority of cases are only trying to do their best. Part of that new culture of responsibility and accountability must be a return to proper continuity of care, which is why this Government have brought back named GPs for every patient, which had been abolished in 2004, and are introducing lead consultants for people who go to hospital with complex conditions.

In conclusion, for this Government defending the NHS involves higher standards of care, wise use of resources and secure funding from a strong economy. Because the challenges we face in England are the same as in Wales, Scotland and Northern Ireland— indeed, the same as in developed countries all over the world—we should exercise caution in politicising those pressures, or we simply invite scrutiny of the relative performance of the NHS in different parts of the UK, which often shows that those who complain loudest about NHS performance in England are themselves responsible for even worse performance elsewhere.

What this Government want is simple: a safer seven-day service, backed by funding from a strong economy. Already we have delivered more doctors, more nurses, more operations and better care than ever before in NHS history.

I am about to conclude, so I shall finish, if I may.

But with that achievement comes a renewed ambition that our NHS should continue to blaze a trail across the world for the quality and safety of its care, and that is how this Government will continue to defend our biggest and most cherished public service.

I start by thanking the Health Secretary for joining us today. I know that he does not always choose to respond to me when I bring matters to this Chamber, so I am grateful to him for being here. I am conscious that, if the Cabinet deckchairs shift around after the referendum, this may be our last parliamentary exchange. If that turns out to be the case, let me put on record my best wishes for whatever he goes on to do, but may I gently suggest that a future career in resolving employment disputes may not be for him?

The topic of this debate is defending public services, and as the House would expect, I shall focus my remarks on what is happening to our health and care service. Listening to the Health Secretary today, one could be forgiven for thinking that all is well. One would have no idea that hospital finances are at breaking point, waiting lists are approaching a record high, and the NHS is facing a workforce crisis with endemic understaffing and broken morale. Put together, the triple whammy of challenges on the finances, quality of care and the workforce put the NHS in a very precarious position. Let me take each of those challenges in turn.

First, on the finances, the right hon. and learned Member for Rushcliffe (Mr Clarke) called it sterile nonsense, but it is fundamental to whether hospitals and GPs can continue to deliver the care needed for our ageing and growing population. One of the Health Secretary’s favourite soundbites recently has been to claim that the Government are giving the NHS the sixth biggest funding increase in its history. Indeed, he has made that claim six times in this Chamber over recent months, so I was surprised that it did not feature in his speech today. However, I think I may have an explanation for that omission. Last week the King’s Fund and the Health Foundation, two well-respected independent think-tanks, looked into his claim. I have a copy of their analysis, which states:

“We’re afraid to say, although perhaps not surprised . . . that we have a very different figure.”

They go on to say that, rather than being the sixth largest funding increase in NHS history,

“we find that . . . this year it is in fact the 28th largest funding increase since 1975”.

I completely defend the methodology that we used to come up with our figure, but does the hon. Lady not see the irony? She is criticising a £3.8 billion increase in NHS funding this year, when Labour’s own plans at the election last year were for a £2.5 billion increase—£1.3 billion less than this Government have delivered.

I am grateful to the Secretary of State for that intervention. He might want to rake over the last general election but he clearly does not want to talk about the crisis in NHS finances today, with a £2.45 billion deficit among hospitals at the end of this year, cuts to public health spending, and £4.5 billion coming out of the adult social care budget over the past five years. I am quite happy to debate NHS finances with him. The truth is that the NHS is getting a smaller increase this year than it got in every single year of the previous Labour Government.

The King’s Fund and the Health Foundation concluded:

“Getting public spending figures right is important, otherwise they can mislead and detract from the real issues. The fact is that the NHS is halfway through its most austere decade ever, with all NHS services facing huge pressures.”

May I recommend that the hon. Lady read a recently published book by Tom Bower which shows the utter failure of the Blair Government, who pumped billions of pounds into the NHS over a period of years but had no control over it and made no attempt to increase productivity, so that from 1998 performance flatlined for six years, and the then Health Secretary was forced to bring back health policies that they had abandoned in ’97?

I am grateful for the reading advice from the right hon. Gentleman, but I simply say this: I am very happy to defend the record of the previous Labour Government, who trebled the NHS budget and had the highest-ever public satisfaction ratings and the lowest-ever waiting lists.

We should be crystal clear about the crisis that we face today. The decade from 2010 to 2020 is set to be marked by the biggest sustained funding squeeze on the NHS ever. As a percentage of GDP, spending on health is set to fall from 6.3% in 2009-10 to just 5.4% by the end of the decade.

People who are listening to this debate will want some clarification. Is the hon. Lady denying the fact that if Labour were in government it would not have increased NHS spending in the way that this Government have done? I think she needs to be clear on that point.

We were very clear at the last election that we would have had an emergency Budget to put every penny that the NHS needs into its funding.

I was talking about the reduction of NHS spending as a proportion of GDP. In terms of real funding, the House of Commons Library has shown that, if spending as a percentage of GDP had been maintained at Labour levels, by 2020, £20 billion more would be being spent on the NHS each year. That demonstrates the scale of underfunding that we have already seen and just how tough the coming years are going to be. That is not to mention the deep cuts to adult social care, which have piled the pressure on to hospitals, and the £22 billion-worth of so-called efficiency savings that this Government have signed up to. I have yet to meet anyone who works in the NHS who thinks that efficiencies on this scale are possible without harming patient care.

I do not disagree with the hon. Lady that there are big pressures on the horizon, but can she say how much, beyond Simon Stevens’ predicted costs, her party is now pledged to spend on the national health service, because so far all we have heard is prevarication?

I am not going to be drawn into giving figures here at the Dispatch Box today. Yesterday the Life Sciences Minister was tweeting that we need a big public debate about funding of the NHS.

Three days ago, the scale of this crisis was laid bare. NHS Improvement, the body responsible for overseeing hospitals, published figures showing that NHS trusts ended 2015-16 with a record £2.45 billion deficit—I repeat, £2.45 billion. To give hon. Members some context, that is treble the deficit from last year. What is the key cause? It is the spiralling agency spend because of staff shortages. When this Government talk about more money going in, let us remember that, before that money gets to the frontline, the bulk of it will be spent on paying off the bills from last year.

Will the hon. Lady give us an idea of how much extra money and how many more personnel she thinks we need to deal with current levels of migration?

I am grateful to the right hon. Gentleman for that intervention. I actually think that the health service benefits more from migrants than the amount migrants cost it.

I want to tell all Conservative Members that Labour Members are not going to take any lessons about NHS spending from the party that has created the biggest black hole in NHS finances in history. It has got so bad that the Health Secretary cannot even guarantee his Department will not blow its budget. It is chaos: Ministers blame hospital bosses, hospital bosses blame Ministers and all the while patients are paying the price.

Faced with this crisis, we might have thought that the NHS would get more than a passing reference in the Queen’s Speech, but that was not the case. What is the Government’s answer when it comes to the NHS? Fear not: they will introduce a Bill to crack down on health tourism. With all the problems the NHS is facing, this Government want to focus Parliament’s time on debating a Bill that risks turning NHS staff into border guards.

Let me be clear: if such measures are about getting the taxpayer a better deal and ensuring fairness in the system, we will not oppose them. However, I must ask, given everything that is happening in the NHS right now, whether Ministers’ No. 1 priority is really to introduce legislation to charge migrants and their children for going to A&E. If so, my fear is that we will see the kind of dog-whistle politics that was so rejected by the people of London earlier this month, and which I hope will be rejected again on 23 June. The truth is that the cash crisis in the NHS is not the fault of migrants; it is the fault of Ministers.

I genuinely believe and have no doubt that the hon. Lady is committed to the NHS and I share her desire for a wider public debate, but does she agree that, to have a meaningful debate and to add value to her critique, she needs to set out what she sees as the financial requirements of the NHS, otherwise such a debate will not be very helpful?

I am grateful to the hon. Gentleman for his intervention, but he will just have to watch this space.

As I was saying, the truth is that the cash crisis in the NHS is the fault not of migrants, but of Ministers. Cuts to nurse training places during the last Parliament have created workforce shortages and led to a reliance on expensive agency staff. Cuts to social care have left older people without the help and support they need to remain independent at home, putting huge pressure on NHS services. The underfunding of GPs has left too many people unable to get timely appointments, which means they are often left with nowhere to turn but A&E. The financial crisis is a massive headache for NHS accountants, but we all know it can mean life or death for patients. Waiting time targets, which exist to ensure swift access to care, have been missed so often that failure has become the norm.

The hon. Lady is making a very political attack. In that context, would she care to explain why the performance for accident and emergency admission is far worse in Labour-run Wales than it is in England?

I would have thought better of the hon. Gentleman, but it is clear Conservative Members want to talk about anything other than their record in England. A&E performance is currently the worst since records began, taking us back to the bad old days of the 1980s, when patients were left waiting on trolleys in hospital corridors. The figures speak for themselves.

May I ask the hon. Lady to consider again what my hon. Friend the Member for Cheltenham (Alex Chalk) said? If A&E performance is the fault of Conservative politicians in England, is it not also the fault of Labour politicians in Wales, where it is 11% worse?

From memory, I seem to think the budget going to the NHS in Wales has been cut in Westminster.

Let us have a look at the figures. In March 2011—[Interruption.] The Health Secretary would do well to listen to these figures, because I am about to tell him the record of his term in office. In March 2011, 8,602 patients waited more than four hours on trolleys because no beds were available. Four years later, the figure was up sixfold, to 53,641. In March 2011, just one patient had to wait longer than 12 hours on a trolley. Four years later, 350 patients suffered that experience. The NHS waiting list now stands at almost 3.7 million people—the equivalent of one in every 15 people in England. Only 67% of ambulance call-outs to the most serious life-threatening cases are being responded to within eight minutes.

I could reel off more statistics, but I will instead read a letter that I received the other week:

“Dear Ms Alexander,

I recently had the misfortune of using the A&E at my local hospital in Margate. My wife feels that I was lucky to escape with my life.

My experience has convinced me that our health service has never been more under threat than since Mrs Thatcher.

The fact that I was sent home after 4 hours without seeing a doctor and returned by emergency ambulance with a now perforated appendix I blame mostly on the conflict between the Health Secretary and the Junior Doctors. Had this been resolved he would have been able to concentrate on the woeful lack of resources our NHS faces.”

Take the experience—[Interruption.] The Parliamentary Private Secretary to the Health Secretary says, “Show us the letter”. I have it here, and I got the permission of the individual who wrote to me before referring to it.

Let me refer to another example—the experience of Mr Steven Blanchard at the Swindon Great Western hospital last November. He said in an open letter to the Swindon Advertiser:

“We arrived at 6.40pm and were asked to sit with about 15 others in the unit. It became apparent this was a place of great suffering and misery…Firstly, there was a lady who was doubled up in pain who had been promised painkillers three hours before and I witnessed her mother go again and again to reception until she was begging for pain relief for her near hysterical daughter.”

Another old lady

“who had been left on her own by her son…was sat picking at a cannula in her arm trying to pull it out…A very frail and sick old man was sat in a wheelchair and he had been in the unit since 8am. He kept saying over and over ‘a cup of tea would be nice’…then I watched as urine trailed from him and fell on to the floor beneath the chair…At 10.30pm he was taken to a ward after 14 hours.”

Mr Blanchard said that he and his partner were finally seen at 1.20 am, and stated:

“Never before have I seen people crying out of desperation…I don’t know what is to blame or whether it’s lack of money or lack of staff but this place was what I can only describe as ‘hell on earth’.”

That is what is happening in our NHS in 2016, and such stories are becoming more common. Ministers may not like to hear it, but they need to start taking responsibility.

There are always pressures in the giant national health service as demand grows and expectations rise, and there always will be. The hon. Lady could have made this speech as an Opposition spokesman 10, 20, 30 or 40 years ago. After 20 minutes, she has not yet suggested a solitary policy proposal as an alternative to the Secretary of State’s, and she has not said whether she agrees with him about seven-day working and all the rest of it. She is describing sad incidents in which things have obviously not been ideal or as they should be, but does she have anything to suggest by way of policy that may contribute to helping the NHS in future?

Having had these exchanges over the Dispatch Box for the past nine months, it strikes me that the reality of what people are experiencing in hospitals is sometimes missing from these debates, and that is why I thought it important to quote from those letters.

On workforce challenges, nothing sums up this Government’s failure on the NHS more than the way that they have treated NHS staff. We have had pay freezes, cuts to training places, and the first all-out doctors strike in 40 years—a strike that the Health Secretary did not even try to prevent; in fact he provoked it. He has spoken about seven-day services, but he said little about how he proposes to improve weekend care without the extra resources and staff that the NHS will need. We can only assume that his plan is to spread existing resources more thinly, asking staff to do even more and putting patients at risk during the week.

The Health Secretary also failed to say what experts think about his approach. For example, Professor Sir Bruce Keogh said that the NHS was making good progress towards improving weekend care, but that that became “derailed” when the Health Secretary started linking seven-day services to junior doctors. Fiona Godlee, editor of The British Medical Journal, said that, by picking a fight with doctors, the Health Secretary has set back NHS England’s established programme of work on improving services at weekends. Not only does he have no plan to deliver a seven-day NHS, but he has ripped up the plan that was already in place to improve weekend care. You couldn’t make it up, Mr Speaker.

The Health Secretary often reads out his usual list of stats on staff numbers, but to know what is really happening we must look beyond the spin. A recent survey of nurses by Unison found that almost two-thirds believe that staffing levels have got worse in the past year, and 63% said that they felt there were inadequate numbers of staff on the wards to ensure safe and dignified care—that figure was up from 45% the year before. Whether GPs, nurses or midwives, numbers of staff have not kept pace with demand.

Analysis by the House of Commons Library shows that, in the Labour Government’s last year in office, there were 70 GPs per 100,000 of the population, but that figure has now fallen to just 66. In Labour’s last year, there were 679 nurses per 100,000 of the population, but there are now just 665. No wonder that doctors and nurses feel pushed to breaking point. If we do not look after the workforce, patients will suffer. There was nothing in the Queen’s Speech to help the workforce—no U-turn on scrapping NHS bursaries, no plan to train the staff the NHS so desperately needs, and no plan to improve working conditions.

My hon. Friend’s point about the workforce is important. Does she share my concern about those attacks on doctors and nurses, and the undermining of numbers? If we break the doctors we will in turn break the NHS, and it is a lot easier to get public support to privatise a broken NHS, than an NHS that is well, healthy and working as it should.

My hon. Friend makes a good point, and motivated staff are essential to providing high-quality care.

Under the last Labour Government, new medical schools were set up—including Hull York medical school—to train the additional doctors that we knew the NHS needed. The Queen’s Speech is a missed opportunity because there is no announcement about increasing capacity in those new medical schools that Labour brought in.

My hon. Friend is, as always, entirely right.

The Government have run out of answers and they have run out of people to blame. Whichever way we look at it—funding, quality of care or staffing—theirs is a record of failure. That will be the Health Secretary’s legacy. He rightly said “Never again” to Mid Staffs, but his time in office has been marked by tragedy and failure at Southern Health. He talks about patient safety, but his actions have made the NHS less safe.

The Government have failed patients and staff. They have proved the old saying true: we simply cannot trust the Tories with the NHS.

I welcome the legislative programme that the Government have set out in the Queen’s Speech, particularly on improving life chances for disadvantaged people, which is in the very best traditions of one nation Conservatives.

In opening the debate, my right hon. Friend the Secretary of State demonstrated his strategic vision and his clear personal commitment to improving life chances through the NHS. We owe him a debt of gratitude for the work he is doing in that respect, and for his work on ensuring that the NHS is fit for the future. There has been a great deal of discussion about NHS budgets—perhaps there was a lack of clarity from the Labour Front Benchers on their budgets—but, as my right hon. and learned Friend the Member for Rushcliffe (Mr Clarke) said, we need to talk not only about the budget, but how we use that money. That is the point I will focus on in my contribution.

In this Session, whether through legislation or other ministerial action, we need to ensure that we have a nimble, agile and responsive NHS for the future. We need public services that respond to people’s needs as they change. People’s lives are changing: we are living and working longer, and we have growing communities with more housing. The NHS, not simply Ministers, needs to respond to those changes to reflect our changing community needs.

The NHS cannot afford to lag behind its users—its patients—in its thinking. That is why I believe that, more than ever, the Government need in this Session to ensure that there is more devolution to local government to join together NHS spending and social care spending, which will help to make sure that our money goes further in future.

Sir Bruce Keogh, medical director of the NHS, has set out a compelling vision for the NHS in this changed world. People with non-life threatening needs should have access to care as close to home as possible, and people with life-threatening conditions should be treated in centres with the very best 24/7 consultant-led care. That is safer and better for patients.

Like many constituencies throughout the south-east, my community has grown not only in recent years, but throughout the recession. We need the Secretary of State to press for a nimble NHS that can respond to the changes in our community, and hopefully plan for the future. We need clinical commissioning groups to work to ensure that new doctors’ surgeries are delivered where there are new houses, and that hospitals deliver the very best every day of the week.

In my constituency, we are truly fortunate to have clinicians who are already ahead of that thinking. The Hampshire Hospitals NHS Foundation Trust already has fully funded plans, a site with planning permission and support across the community to establish a 24/7 critical treatment hospital, bringing together emergency care for the sickest patients in one site, leaving those requiring walk-in A&E, planned surgery and out-patient care to our local hospitals in Andover, Winchester and Basingstoke.

That approach has been developed by clinicians to keep services safe and sustainable, and I urge the Secretary of State to ensure that we listen to clinicians carefully. They often see the needs of the NHS changing before others do, and we need to ensure that those changes are put in place. The NHS investigation unit is looking at how we deal with delays at A&E, because the changes proposed by clinicians have not been brought forward in a timely manner. We are now awaiting a new models of care programme, and sustainability and transformation plan. In the meantime, my constituents regularly face more than four-hour waits in A&E, which I hope will come to an end when the long-awaited centralised critical treatment hospital is brought to fruition—after four years of planning and discussion.

Within the NHS programme for the future, we need to find ways to respond to the needs of other groups of people. The first Women and Equalities Committee report brought the needs of transgender people to the fore. It was clear from the evidence we received that access to primary and specialist care for this group of people was far from routine and, in some cases, quite shocking—another example of the need for the NHS to respond carefully to the needs of communities. I do not underestimate the challenges GPs face in our communities, but we need to ensure that they are tasked with, and deliver on, treatment and care plans for every group of people and do not leave minority groups out.

We live in a country with a proud tradition of fairness and some of the most comprehensive legislation in the world to protect disadvantaged people—the theme of the Queen’s Speech. Too often, however, legislation does not create the change in the delivery of public services that we in this House would perhaps like to see. I hope the Government will use every Bill in this parliamentary Session to challenge themselves on whether there is more that can be done to support disadvantaged people: whether, in the modern transport Bill, the Government could consider how disabled and older people can benefit from important developments in transportation; whether, in the local growth and jobs Bill, the Government could look more closely at the three quarters of pregnant women and new mums who suffer negative or discriminatory experiences at work, and bring forward measures to help to address this problem more speedily to unlock this important pool of labour for the future; and whether, in the education for all Bill, the Ministers responsible could look carefully at the House of Lords Select Committee paper on the achievements of disabled children in schools. Despite a great deal of work in recent years, we still need to be better at unlocking the educational achievement of disabled children. At the moment just 18% of children with special educational needs achieve good development, compared with 65% without.

The prison reform Bill will of course be pivotal in supporting disadvantaged people. I am sure there will be a great deal of debate on that today, but I would like very briefly to touch on the importance, in relation to the Bill of Rights, of the need to ensure that we really do tackle the disadvantage that people face. I refer again to the need to address the rights of transgender and non-gendered people. They suffer great disadvantage in our society. If we are to have a Bill of Rights, we need to tackle this issue head on.

Before I close, I want to touch on something very close to my heart from when I was a Minister: superfast broadband. I was delighted to see the Government propose a Bill to ensure that superfast broadband is seen as the essential utility that it is. I am sure the Health Secretary will have responded to this with great joy too, given his previous role as Culture Secretary.

The experience of my local authority means that I will be looking very carefully at the detail of the Bill. My local authority in Basingstoke has long seen superfast broadband as essential infrastructure, but when trying to make it happen, in terms of planning conditions for building, it has been blocked pretty firmly by the local planning inspector. Basingstoke and Deane Borough Council and Hampshire County Council have looked long and hard at how they might make progress on this. I am sure they will welcome, as I do, the measures in the Queen’s Speech. Indeed, they have asked the Government for superfast broadband to be a material planning consideration. I hope the Minister will clarify that superfast broadband will be a material planning consideration and indicate when that will come into force. My local community, like those of many other Members, has seen a rapid increase in the rate of house building, and we need to know when this might come into play.

Coventry has also experienced problems with BT’s delivery of broadband. That is one of the big problems. I know that Ministers have been looking at this, but we need urgent action. BT is a big problem in this regard.

The hon. Gentleman makes a point that many Members have made, but I am making a very different point—about ensuring that local authorities can make superfast broadband an essential prerequisite for new house building. No one can build a house in this country without water, electricity and the many other utilities we have come to rely on. Superfast broadband has fast become a basic utility of life, and that is how it needs to be viewed; I am sure that other Members will mention the performance of those who put the service into place.

The Government have a powerful opportunity to continue on their mission to improve life chances for disadvantaged people, not only in the obvious Bills, such as the one on prison reform, but in every single Bill on their agenda. I urge Ministers to consider carefully how they can bring that into play. While we might have some of the best equalities legislation in the world, when it comes to putting it into practice, we sometimes fall short. We need to admit that and up our game.

It is a pleasure to follow the right hon. Member for Basingstoke (Mrs Miller).

I hope the House will forgive me if I reflect on an historic event that took place in Scotland this weekend. For the first time in 114 years, the Scottish cup returned to Leith, in Edinburgh, when Hibernian won the cup final. For many years those of us who are fans of Hibernian have been used to taunts that the last time the cup came back to Easter Road, Buffalo Bill was in town and Queen Victoria was on the throne. At least those taunts are over. The hurt of losing 10 cup finals—of traipsing to Hampden to face defeat after defeat—is over. A fine game, between two teams entertaining the fans, took place in Scotland on Saturday, and I am delighted that the people of Edinburgh and Leith can celebrate a cup victory at long last.

There is little to be welcomed in the Queen’s Speech. It was a missed opportunity for progressive action on pensions, social security and the economy. The UK Government are caught in a civil war over Europe and have delivered a Queen’s Speech with a poverty of ambition. The Tory party is at war with itself and failing miserably in its war on poverty, which the Prime Minister talked about at the conference last year. We are seeing not a war on poverty but a war in the Conservative party.

One could perhaps compare the Conservative party’s disagreement over Europe to two men fighting over one woman. Is it possible that after such a catastrophe everyone can come back together as friends?

I am saddened at the depths to which the hon. Gentleman stoops. I am delighted to have friends and colleagues representing my party here and in government in Edinburgh, and they will continue to have our full support.

The Queen’s Speech demonstrates that the Tories are a threat to high-quality, well-funded public services. Having listened to the Leader of the Opposition last week on the Queen’s Speech, we are none the wiser as to what the Labour party is offering. We could have asked him, of course, had he been taking interventions, rather than forcing us to sit and listen to a monologue that lost the attention of his own party, never mind that of the House.

Some measures are to be welcomed, such as the likely delivery of the universal service obligation on broadband, as mentioned by the right hon. Member for Basingstoke, but the Queen’s Speech delivers nothing on pension reform for the WASPI women, on tax simplification or on social security, and no major action on the economy to boost exports and productivity.

The Conservatives have orchestrated some truly devastating cuts that have destroyed the safety net that social security should provide. We see through their rhetoric on life chances. The scrapping of legal commitments to tackle child poverty, the four-year freeze on working-age benefits, including child tax credit, working tax credit and jobseeker’s allowance, will see families losing up to 12% of the real value of their benefits and tax credits by 2020. We have seen the butchering of the very aspect of universal credit that might have created work incentives and the hammering of low-paid workers, to name just a few of the regressive cuts that will decrease the life chances of children across these islands.

Why do the SNP Government not put up taxes in Scotland if they feel that they need to spend more money?

One of the things we want to do in Scotland is to deliver economic prosperity and a fairer society. We want to invest in our economy in order to grow the economy. Let me remind the right hon. Gentleman that we fought the general election in Scotland on a progressive manifesto that would have seen us investing over the lifetime of this Parliament, throughout the UK, £140 billion by increasing Government spending by 0.5%—investing in innovation and in our productive potential with a view to delivering confidence and growth in the economy. This was a sensible programme that would still have seen both the debt and the deficit reduced. It was a sensible way of dealing with the problems we face both in Scotland and in the rest of the UK.

It does not matter how many times the Government use the soundbite of “life chances” because in reality the so-called assault on poverty is a crusade to refine what poverty is and a shift towards blaming individuals rather than the Government, so that their austerity agenda can continue to attack the most disadvantaged in our society.

Does my hon. Friend agree that all the rhetoric about the life chances strategy is incompatible with the austerity agenda that is all about balancing the books on the backs of the poor?

My hon. Friend is correct: we need to invest in our children and in our productive potential, giving life chances through opportunities, which are badly missing from this Government’s approach.

Imran Hussain, the director of policy for the Child Poverty Action Group, said:

“There is a disconnect between what the government is doing and saying. You can’t spread life chances when child poverty is expected to rise steeply.”

He said that there was

“very little evidence about poverty being caused by addictions or family breakdown”.

Recent Office for National Statistics figures show the true scale of poverty in the UK, with almost a third of the population experiencing poverty at least once between 2011 and 2014. The Institute for Fiscal Studies analysis of February 2016 found that absolute child poverty is expected to increase from 15.1% in 2015-16 to 18.3% in 2020-21. We do not want lectures from the Conservatives on improving life chances; all the evidence shows that exactly the opposite is happening.

What would it take for the Conservatives to wake up to the reality that increased child poverty is a direct consequence of their austerity agenda? Their attempt to disguise cuts with this life chances agenda is transparent. If the Government want to lift children out of poverty and give them an equal start in life, they must reverse their punitive cuts and be more ambitious about tackling in-work poverty.

The hon. Gentleman is making a powerful case against austerity, with which I agree, but the SNP Holyrood Administration in Edinburgh is forcing £130 million of cuts on Glasgow City Council, which covers one of the poorest areas in the country. How does that measure up with what he has been saying?

One of the things we have done since being in government in Edinburgh since 2007 is to protect local government. What we face is the consequence of the cuts that have come from Westminster. I am delighted that an SNP Government have, through the council tax freeze, saved individuals in a typical band D house £1,500—protecting the individuals, while at the same time protecting the budgets of councils. That is what the SNP Government have done in Edinburgh.

In Scotland, the SNP Government have protected public services, despite the cuts to the Scottish budget. With cuts to Scottish public services handed down from the Chancellor of the Exchequer, lacking in compassion and empathy, the poorest and the weakest in our society are paying the price for Tory austerity.

The SNP has put forward a credible, progressive alternative to the Queen’s Speech, proving once again that it is the only real opposition to the Government in the House of Commons. [Interruption.] In our dreams? Well, let us see what the Labour party is offering. We got nothing from the Leader of the Opposition last week, and we certainly got nothing from the Labour Front Bench. It is little wonder that Labour has fallen in the polls, and fallen to become the third party in Scotland. That is the reality: no hope, no vision, and no agenda from today’s Labour party.

Although the debate could be characterised as focusing specifically on defending public services, to my mind, and those of my colleagues, it should be seen in a much wider context. The SNP has published its own Queen’s Speech, which offers hope to the people of Scotland. It says that we should aspire to do better, and that we need to create the circumstances that will allow us to deliver sustainable economic growth, thus enhancing life chances for all, while at the same time recognising the necessity of investing in and enhancing our vital public services.

Our manifesto, like our Queen’s Speech, recognised the necessity of driving down debt and the deficit, but we would not do that on the backs of the poor and at the cost of our public services. We recognise not only that austerity is a political choice, but that its implementation is, in itself, holding back not just growth in the economy, but the potential of so many people throughout the United Kingdom. Cuts in public services withdraw spending from the economy, and that undermines our moral responsibility to deliver public services that support people and give them opportunities to return to work, as well as the vital support network that allows communities to function effectively.

The attacks on services for the disabled, women and young people are a result of the Government’s programme, which holds people back from making a full contribution to society. What we in the SNP have, by contrast, is a strategy that will enhance life chances for people in Scotland and throughout the United Kingdom. It is a progressive agenda, which recognises the responsibility of Governments to show leadership in creating the architecture that will deliver sustainable economic growth. That means investing for growth, delivering stronger public services, driving up tax receipts, and cutting the deficit. Our strategy is an appropriate response to the circumstances in which we find ourselves, but it also acknowledges the circumstances in which many Governments in the western world find themselves.

We in the SNP are ambitious for Scotland. That can, perhaps, best be evidenced by the programme of Nicola Sturgeon’s Government. That programme will tackle the attainment gap, while also focusing clearly on using what powers we have to influence innovation, recognising that there is a twin track: tackling attainment must go hand in hand with improving skills, enhancing capability, and creating competitive opportunities in the global marketplace.

We have focused specifically on export capabilities in key sectors. The manufacture of food and drink continues to be our top export sector, accounting for £4.8 billion in revenues. The value of our food and beverage exports, excluding whisky, rose from £755 million in 2013 to £815 million in 2014, an increase of 8%. In 2014, Scotch whisky exports reached £3.95 billion, accounting for 21% of the food and drink exports of the whole United Kingdom. Scotland has shown the way in increasing its export capability, and driving investment and jobs into our economy. That plays to our key strengths, and our reputation as a provider of high-quality food and drink. It is also based on segments of the market that offer long-term growth opportunities.

We need to tackle the relative decline of manufacturing in our overall economy that hampers our ability to meet the challenge of delivering prosperity. Growth sectors in the economy, such as biotechnology, can deliver opportunities for jobs and growth. We need a strategy which focuses on manufacturing growth that outstrips the service sector in terms of value added to our economy. That is not to downplay the desire to achieve growth in services, but to recognise that we have an imbalance in our economy that hampers our ability to maximise opportunities for all our people.

We cannot decouple a debate about defending public services from the wider economic agenda, because they are so completely intertwined. We need a well educated, healthy population who can rely not only on our education and health services but on our ability to deliver effective childcare, for example. When Conservative Members talk about small government, they reject the vital role of the state in providing much of the support that allows all of us to achieve our potential.

This Queen’s Speech is a missed opportunity to deliver a programme that could offer so much more to those who aspire to a healthier, wealthier and fairer society. We need to tackle inequality, to improve living standards for ordinary workers, to create a fairer society and to strike an effective balance between prosperity and investment in the public services that underpin a successful society. Today, we are moving away from that.

There is an increasing disparity between executive pay and rates of pay in the mainstream, leading to increased calls for action by shareholders and ultimately to stronger action if moderation cannot be achieved. With wage growth outpacing productivity growth, there are legitimate concerns about the sustainability of real wage growth and, as a consequence, taxation receipts and the ability of the Government to meet their targets, with all that that would entail for the public finances and, no doubt, for investment in our public services.

In short, to secure our public services, we need to tackle the shortcomings of the Government’s economic strategy. Of course we would invest for growth and create opportunities for investment by the private and public sectors, resulting in greater confidence and growth outcomes. Confidence and growth, on the back of modest investment in our public sector, would see the debt and deficit come down, by contrast with policies driven by this Government’s ideological desire to achieve a budget surplus at any cost. The logic behind that desire to achieve a budget surplus almost irrespective of economic circumstances beggars belief. If the Chancellor misses his growth forecasts, as has been the case on numerous occasions, his office can make the strategy work only through tax rises or, more predictably, cuts to public spending.

The trouble with this strategy is that we are now six years into it and it is not working. The squeeze on public spending is hurting and damaging services. Those of us who are old enough to remember the Thatcher Government elected in 1979 will recall the line from the Government that “if it’s not hurting, it’s not working”. Patently, it is hurting and it is not working—[Interruption.] It might have been John Major, but it is the same old Tories. The strategy is harming the life chances of people in Scotland and the rest of the UK.

Let me return to the Queen’s Speech and the future of the NHS. We strongly disagree with the UK Government’s moves to charge visitors to this country to use the NHS. NHS Scotland will not charge overseas visitors if they need to visit A&E or a casualty department if it involves a sexually transmitted disease or HIV or if they are sectioned under the Mental Health Act. That is the right thing for anyone to do in a civilised society.

Does the hon. Gentleman not understand that the Government are not proposing to charge for emergency treatment in A&E? Surely it is right, however, that if someone comes here and has elective surgery, they should pay the bill and get the money back from their own country.

In many cases, we are talking about the Government wanting to charge people who have come here to work and who are already paying their taxes. What a disgraceful way for any Government to behave! That measure is the latest indication that the Tories represent a real and present danger to the NHS.

The Conservatives have mismanaged the junior doctors’ contracts in England and shamefully filibustered the recent debate on a Bill introduced by the hon. Member for Brighton, Pavilion (Caroline Lucas) that would have restated the principle of the NHS being public and free. In the Scottish election, the Scottish Tory leader, Ruth Davidson, stood on a platform of reintroducing prescription charges. Such a measure would be a regressive tax on the ill. It is estimated that the SNP’s abolition of prescription charges has benefited around 600,000 adults living in families with an annual income of less than £16,000.

In England, the Health Secretary—who is no longer in his place—seems to favour confrontation with the health service, but we in Scotland favour a more consensual approach that delivers results. The SNP Scottish Government have delivered record funding for Scotland’s NHS despite Westminster cutting the Scottish budget. They will ensure that the NHS revenue budget rises by £500 million more than inflation by the end of this Parliament, meaning that it will have increased by some £2 billion in total. Health spending in Scotland is already at a record level of £12.4 billion. Under the SNP, the number of employees in the Scottish NHS is at a record high—up by nearly 9% since 2006.

Patient satisfaction with the NHS in Scotland is high, with 86% of people being fairly or very satisfied with local health services, which is up five percentage points under the SNP. That is the result of a popular SNP Government working together with our health professionals to deliver results. Unlike the UK Government, the SNP values and respects the work of all our medical professionals. Were we to move towards a new contract for junior doctors in Scotland, it would only ever be done on the basis of an agreed negotiated settlement. Thank goodness that we are still wedded to the principles of Beveridge in Scotland and will protect the ethos of the health service as a public asset for the common good.

Turning to further and higher education, one of our driving principles is that access should be based on ability, not ability to pay. Tuition fees of £9,000 and potentially more remain a heavy burden on the working families and students of England, and the UK Government must rule out the Higher Education and Research Bill raising the cap. The SNP has guaranteed free university education for all in Scotland, but Ruth Davidson and the Tories would have tuition fees north of the border if they ever got near Bute House.

Will the hon. Gentleman confirm that the SNP secured free higher education by butchering the further education budget, affecting some of the poorest in the community and those who need FE’s assistance most?

No, I will not, because that is not true. Full-time places at Scottish colleges have increased, and I will return to that point.

Ruth Davidson would want to introduce tuition fees in Scotland by the back door. Down here, the Tories are all for front-door fees. In Scotland, the Tories are all about back-door fees. The doors are locked to many who want to participate in education unless they can pay the price. Front door or back door, with the Tories there is always a price to pay. Young people from the most deprived areas in Scotland are now more likely to participate in higher education by the age of 30 since the SNP came to power—up from 35% of young people in 2007-08 to 41% in 2014-15—which is the result of the SNP’s successful education programme. The number of qualifiers from the most deprived areas increased by over 2,300 from 8,035 in 2007-08 to 10,395 in 2014-15.

Overall, since the SNP came to power in Scotland, the number of Scottish-domiciled, first-degree students going to university has risen by 11%. Last year saw a record number of Scots accepted to universities across the UK. That is a record to be proud of. Rather than carping from the sidelines, the Labour party should perhaps get behind what the SNP has delivered in Scotland for the people of our country.

The Scottish Funding Council has invested more than £76 million in additional widening access and articulation places over the past three years and continues to fund a wide range of other initiatives to support access. We will ensure that those who have a care experience and who meet minimum entry requirements will be guaranteed the offer of a university place and a non-repayable bursary of £7,625. In Scotland, we recognise that access based on ability, investing in our human capital, is the right thing to do. That is a non-negotiable principle. It is price worth paying for our children and our future. As my right hon. Friend the Member for Gordon (Alex Salmond) said some time ago:

“The rocks will melt with the sun before”

the SNP imposes tuition fees on Scotland’s students.

There is little good news for young people. Whether someone is young and looking to start a journey towards eventual retirement or is nearing retirement, there is much to fear from this Government. Given the injustices for many women, the UK residents living in many overseas countries suffering from frozen pensions, or the constant tinkering with pensions that undermines saving, there is little for which to commend this Government. The Government are playing a risky game on pensions; the new lifetime ISA muddies the waters in an already complex area. ISA savings from taxed income undercut the pension saving from pre-tax income—in other words, the Chancellor has found a convenient tool to increase tax receipts today, but that is not necessarily good news for individual savers. According to the Association of British Insurers, presented with a choice, no employee will be better off saving into a lifetime ISA than a workplace pension because of the loss of employer contributions. ABI calculations indicate that the long-term cost of forgoing employer contributions would be substantial—for a basic-rate taxpayer, the impact would be savings of roughly one third less by the age of 60.

The hon. Gentleman is making an important point, but does he not accept that one benefit of people saving for their retirement through an ISA is that it gives considerably more flexibility? As we go on our life journey, there are often times when we may want to draw down some of that money—for example, for a deposit to buy a house. Does he not see this as being about consumer choice? There is probably room for both of these things, although it is extremely important that we protect the existing pensions system as well.

This is a vastly important issue, and I genuinely want to work with the Government on it. All of us in this place have a collective responsibility to get pensions right. I will accept that there is a shared concern across the House, with a recognition that pension saving is not at a sustainable level in this country. My problem with the lifetime ISA proposal is that it undermines what should be the best route for all, which should be saving through the new auto-enrolment, with the incentives that are there. Of course, that will be discussed when the plans are presented to Parliament, but I say to the Government that they should be very careful with what they are doing, because we all share the ambition to get this right. I make the offer to the Government that we are prepared to work together to make sure that we get the best mechanisms to increase pension savings in this country.

Pension saving is at a crisis point, and no amount of regulation will right that problem—[Interruption.] I can hear some guffawing; I will try to wrap up my remarks, but I have been very generous in taking interventions from across the Floor. We need a fundamental overhaul of the pensions system. The Tories need to be more ambitious on pension reform and find real solutions that incentivise pension saving. The SNP has long called for the establishment of an independent pension commission to look holistically at pension reform, focusing on existing inequalities and paving the way forward for a fair, universal pensions system.

We must also prioritise fraud and scam prevention. Kate Smith, head of pensions at Aegon UK, commented that fraud and scams that pensioners are vulnerable to should really have been tackled in the pensions Bill. She said:

“I’m extremely disappointed that the government has failed to use the Queens Speech as an opportunity to tackle the ever-growing threat of pensions fraud via legalisation.

We still need to look at ways for the industry, regulators and pension industry to work together to raise the profile of pensions fraud to stamp it out and protect savers.”

I am going to wrap up my remarks, Madam Deputy Speaker, but let me just say that nearly 1 million people aged over 75 live in poverty and need more help from the Government, according to a report by City University London and Independent Age. It also suggests that the income of those aged over 75 is, on average, £3,000 a year less than that of younger pensioners. Those figures suggest the vital need for a sustainable income in retirement to be available for our older generation, and the Government must do more now to address that. There is so much that needs to be addressed to give confidence to savers and pensioners.

Our alternative Queen’s Speech proposed a universal pensions Bill to support a more progressive pensions system. Such a Bill would establish an independent pensions commission to investigate the inequalities in current and future proposed pension policies; fund transitional arrangements for WASPI women affected by the rapid pace of increases in the state pension age; and allow for further development of access to automatic enrolment and further options to incentivise pension saving. The complexity of the pension system is a real turn-off for savers, preventing them from shopping around or making sound savings choices. Just last week, the Bank of England’s chief economist, Andy Haldane, said that the British pension system was so complicated that even he failed to understand it, and he warned of the damaging consequences that that presents for consumers as they approach retirement. Conversations with countless experts and independent financial advisers have confirmed for me only one thing: they have no clue either.

That comment about having no clue could equally be made about the Government in the Queen’s Speech. We have outlined an SNP alternative, delivering a message of hope and vision for the people of Scotland. It is not too late for the Tories to open their ears and, indeed, their minds to a different direction. If the Government seriously want to increase the life chances of our children, they must return to the drawing board on social security cuts and admit that they have got it wrong, as they have done on the economy. Instead of the promised assault on poverty, we have been left with a Government plan that has a poverty of ambition. There is a different way, and I appeal to the Government to make the right political choice and abandon austerity.

The Queen’s Speech contains an important measure, the Bill of Rights, but we are told that we need to wait and get it correct. I have no problem with that. If there is to be a Bill of Rights, it needs to reflect the liberties and freedoms that have been hard won over many centuries by people and Parliaments in our country.

I welcome the principle behind the Bill of Rights—the simple principle that our ancient and modern liberties should rest on the decisions of this Parliament, to be upheld by MPs, as custodians of those liberties, or to be amended and improved as the British people see fit and as they express their will through general elections. It is extremely difficult to root our liberties and freedoms in inflexible international treaties, or to rely on the judgments of far-away foreign judges, who may not understand the mood, the temper, the history or the culture of our country, rooted in liberty and rooted in a titanic struggle to establish parliamentary control.

There is one obvious omission in the Queen’s Speech, for the reason that we do not yet know the will of the British people on the fundamental issue that overhangs the debates that we will have today and over the next few weeks. Do the British people wish to take back control? Do they wish this Parliament to find within itself the wit, the wisdom and the skill to wrestle back control of our laws, our taxes and our decision-making powers so that we can be freer, more prosperous, more independent and more democratic; or do they not wish us to do that? I earnestly hope that they will want to be on the side of freedom and liberty.

At the moment, we are but a puppet Parliament—a Parliament that struts upon the stage and pretends to be in charge and in control, but is not in charge or in control. Let us take the mighty issue of paying for our public services, which is at the heart of this debate. I am on the side of prosperity, not austerity. I think that we do need to spend more on health and education, and I welcome the extra money that the Government have managed to find. But how much easier it would be if the £7 billion of revenue that we collected from big businesses in the last Parliament but had to give back to those companies, because the European Court of Justice said that we were not allowed to raise it, were available for our public services. [Interruption.] How much easier and better it would be to banish austerity—and the chuntering of some Opposition Members, who rightly do not like austerity—if we had back the £10 billion of net contributions that we make to the EU every year, which we cannot spend on our own priorities because it is spent elsewhere.

I want us to take back control of our money so that we can banish austerity. I want us to take back control of that money so that we have it for our priorities of health and education. While we are taking back control, as a free people, we should empower people in an elected Assembly to decide how to raise revenue and which taxes to impose. I want us to restore that power on behalf of the British people. I would like us to abolish the tampon tax. I would like us to say to the European Court of Justice, “We do not accept your verdict that we have to put up taxes on green products to 20% from 5%.” However, that is its judgment, and that is what this Parliament will have to do after the referendum should we decide to stay in and not to leave.

The Government say that they have made progress in their renegotiation, that there will be some relaxation of the requirements, and that we will get a little bit more power back over the imposition of VAT. However, I have now read the document issued by the European Union after those negotiations and I am afraid to tell the House that that document makes absolutely no mention whatsoever of any deal or settlement between the United Kingdom Government and the European Union. It makes no mention of our need to abolish the tampon tax, and it makes no mention of our wish to keep our green taxes down at the 5% level because we want to encourage people to have more draught excluders and insulation so that they can keep warm in the winter at lower cost. It is not an unreasonable request, so why is there nothing in the European Union document on that reform that makes it clear that we could do that? There are only two things in that document: one is more centralisation of our future VAT system so that it can collect more and ensure that we are collecting all that it wishes; and the other is some general statement that perhaps at some point in the future, if the European Parliament and all the member states so agree, there could conceivably be some greater flexibility, but it is extremely unlikely.

The sadness of the document is that it shows that there is no political agreement whatsoever in the European Union to give back to us the right to impose the taxes that people should pay and that they might accept. There is absolutely no right for this Parliament to do what it clearly wishes to do by overwhelming majority on the issue of the tampon tax and the green tax.

We see before us the parting of the ways with those who believe that it is fine to belong to a subsidiary Parliament that pretends to be able to make choices on the part of the British people, but that has to give away a lot of its money to the European Union, has to accept a series of judgments on things such as trade union law, which it does not like, and has to accept that we are no longer free to make the laws that we need to make to reflect the will of the British people.

Is there nowhere in this Parliament on the Front Benches where we can find the Hampdens, the Miltons and the Cromwells not guilty of our country’s blood, who will rise up and say, “Surely now is the time to take back control, to make sure that we can choose our own laws, to make sure that we can impose our own taxes, to make sure that we can redress the wrongs before we ask people to pay those taxes, to go back to the fundamentals of United Kingdom democracy fought for over many centuries, and to go back to the foundations of democracy as so brilliantly chronicled in the founding documentation of the United States of America”? We can only say that we have a proper Parliament and not a puppet Parliament if we do those things. More Members need to urge their constituents that now is the time and now is the moment to seize control and to banish the puppet Parliament.

It is always a pleasure to follow the right hon. Member for Wokingham (John Redwood). He speaks with huge passion about these matters, and of course he has always been consistent in his opposition to being a member of the European Union. He also speaks eloquently about why he feels the way that he does.

The European debate—I say this as a former Minister for Europe—has dominated the Government’s agenda to such an extent that this Queen’s Speech is a shadow of what it should be. There is no great ideological commitment in it, so it is difficult to attack too much of it. It is important that, when we get past 23 June, we can then settle down to an intelligent legislative programme that is not dominated by people banging on about Europe —I include myself in that. Although crime has gone down in England and Wales, blue-on-blue crime has increased as far as the EU debate is concerned.

As I mentioned earlier, last Thursday the Minister for Employment was in my constituency with a very big red bus parked outside the biggest temple telling everyone that if we remained in the European Union, there would be a curry crisis and people would not be able to eat curry any more. It is important that we get the European debate into perspective.

As a fellow east midlands MP, you would expect me to say this, Madam Deputy Speaker, but I was surprised that there was no mention in the Gracious Speech of Leicester City winning the Premier league, but perhaps that will come next year.

I agree with the Government’s proposals regarding the revolution in the Ministry of Justice and our prisons. I and members of the Select Committee on Home Affairs have been very concerned about, for example, the number of people who go into prison with no interest in drugs and come out addicted to drugs. We are concerned that our prison system is not doing what it was intended to do: to punish, but also to rehabilitate. Although we expected the right hon. and learned Member for Rushcliffe (Mr Clarke), when he was Lord Chancellor, to talk about changing the way we look at prisons, we did not expect this from the current Lord Chancellor, and we are delighted that he has embraced the reform agenda. Ensuring that when people go to prison they are first punished, then rehabilitated and they do not pick up bad habits, so that when they come out of prison they do not reoffend and go back again, is one of the big issues that has confronted this Parliament for all the 29 years that I and the right hon. Member for Wokingham have been Members of it. How do we break the cycle?

I remember on a visit to a prison in the south of England speaking to a young man who was there because he had committed murder. He told me that his father had had a life sentence and he had a life sentence; he just hoped that his young son, who was then a year old, would not end up in prison. How do we break the cycle? I think we should work with the Government to make sure that our prison system does what it is intended to do.

The second issue I am interested in and concerned about is extremism. Although the Government are proposing legislation on extremism, I do not think they have gone far enough on the counter-narrative. The Select Committee is about to conclude its year-long inquiry into counter-terrorism. I am concerned, as is the rest of the House, about the number of young British citizens who decide to give up their life in this country and go and fight abroad. The current figure for those who have done so is 800, and 400 have returned so far. I cannot understand why we are not doing enough while they are still here to prevent them from going in the first place. Also, although there are programmes to detoxify those who return to this country, there is always the risk that having gone abroad to fight, whether in Syria or elsewhere, on their return they will retain the poison that was drilled into them abroad. It is important that we treat the counter-narrative seriously. We need to support our police and intelligence services in working out who is going, and work with families so that we can try to persuade people not to go.

Does the right hon. Gentleman agree that our prisons are a breeding ground for extremism and radicalisation, and that until we address that the flow of new extremists will continue?

The right hon. Gentleman is absolutely right. It is not just about preventing people without a drugs habit going to prison and coming out with one. We have been sending people to places like Belmarsh, which has been described as a place where jihadists seem to be able to influence young people. Knowing his great passion for mental health issues, the right hon. Gentleman reminds me that Simon Cole, the chief constable of Leicestershire, who is the lead on counter-terrorism in the Prevent programme, has talked about the number of jihadists who have mental health problems. These are all issues that we need to confront. We cannot necessarily do it by legislation, but we need to make sure that we have the framework in legislation to provide the resources, the time and the effort to work with people.

My final point concerns the sugar tax. I was delighted when the Chancellor of the Exchequer introduced it. We should acknowledge the fact that today is his 45th birthday. I hope he is having a sugarless cake because, as we know, a spoonful of sugar may help the medicine go down, but it is also one of the steps on the way to diabetes. As someone who suffers from type 2 diabetes and chairs the all-party parliamentary diabetes group, I believe the proposed sugar tax will send a clear message out to the retail companies. However, the manufacturers of drinks such as Coca Cola and Red Bull do not have to wait until the sugar tax comes into effect; they can start promoting sugarless drinks now.

I got into a lot of trouble because I did not want the Coca Cola van to come to Leicester at Christmas. I was accused by some people of robbing them of their Christmas. They had decided that the Coca Cola van was so strongly associated with the Christmas spirit—forget about Christianity, the birth of Christ and so on; it was the Coca Cola van that gave them Christmas—that I was severely criticised. I will make a deal with Coca Cola from the Floor of this House: if the company sends its van to promote non-sugar drinks, I will be happy to welcome it, but promoting a drink containing seven to 10 teaspoons of sugar, cannot be good for the health of our nation.

The right hon. Gentleman should recognise that since 2010 sales of diet drinks have increased by 33%, and in 2014 the crossover point was reached—more people purchased diet drinks than regular drinks.

That is a good statistic, for which I thank the hon. Gentleman. The change has come about only because of pressure from parliamentarians and from others outside Parliament, particularly clinicians, who have argued strongly that unless something is done, the health of the nation will be affected. That is why I tabled my urgent question on the obesity strategy. Unless we continue to put pressure on the manufacturers and the retailers, nothing will change.

Although we will have a sugar tax, it is still up to the supermarkets to ensure that they promote sugarless drinks. At Waitrose in Wolverhampton, which is not that far away from your constituency, Madam Deputy Speaker, there is a kiosk right in the middle of the store displaying only no-sugar products. The drinks with sugar content are put elsewhere. That is what the retailers have to do. The introduction of the sugar tax will encourage retailers and manufacturers to change their ways.

Finally, this is a hospitals and health debate—at least, it was opened by the Health Secretary. I shall not mention video games this time; I leave that to the Minister for Culture and the Digital Economy. I am very concerned about proposals from the local health authority to close the Leicester General Hospital. The possibility of reconfiguration is being considered. I have had had discussions with the chair and the chief executive of the hospital trust. I know that we have on the hospital site a world-class diabetes centre run by Professor Melanie Davies as well as Professor Kamlesh Khunti. We need to look very carefully at any plans that will diminish the services available to local people.

The general hospital site has been used by local people for years and years as a hospital site. We were promised a new hospital, accommodation for nurses and all kinds of things in the 29 years that I have represented that city. None of those promises have been realised. Although we in the community and I as the local Member of Parliament are prepared to enter into dialogue with the local health authority over its proposals, if the authority thinks it can close the hospital and give us nothing in return, there will be a bare-knuckle fight to try to preserve those services. I am not attached to the buildings—buildings are just a means of delivering services—but I am attached to the services. It is really important that we ensure that our health services remain the best in the world. I take the Secretary of State at face value: he wants our NHS to be the best in the world, and so do we. In order to achieve that, we need to make sure that it is properly resourced, keeps up with the developments in our population, and provides the expertise that is necessary for the NHS staff, to whom we pay tribute, to do their work so that it retains the best the world has to offer.

It is a great pleasure to follow the right hon. Member for Leicester East (Keith Vaz), who, as always, spoke very thoughtfully on a range of subjects, and with great passion in favour of curry and against sugar. However, I was rather surprised that he implicitly endorsed the fundamentally racist immigration policy we currently have in this country whereby any number of white Europeans can come and settle here, with or without jobs, whereas a curry chef from Bangladesh related to people in this country, with an offer of a job, cannot. That is implicit, inevitable and unavoidable for as long as we remain members of the European Union, and that is why so many members of the ethnic minority community in my seat and elsewhere will be voting to leave on 23 June.

I hope, Madam Deputy Speaker, that it is in order for me to speak to the amendment in the names of 54 right hon. and hon. Members, including me, which says that we

“respectfully regret that a Bill to protect the National Health Service from the Transatlantic Trade and Investment Partnership was not included in the Gracious Speech.”

I believe in free trade—I always have and always will. I think I am the only surviving Member of this House who has negotiated a trade treaty—the Uruguay round in the 1990s when I was Secretary of State for Trade and Industry. Therefore, when the Transatlantic Trade and Investment Partnership treaty was presented, my instinct was to support it, but the more closely I looked at it, the more parts of it came to worry me. TTIP is not primarily about free trade. The average tariff imposed by the United States of America on goods from the European Union is 2.5%, and that of the European Union on goods from America somewhat higher. Getting rid of them would be worth while, but it is not a big deal.

However, other aspects of the treaty are worrying. My main concerns relate to the investor-state dispute settlement system. That creates a system of tribunals—special courts—in which foreign multinationals can sue Governments, including the British Government, but the British Government cannot sue them, nor can British companies use those courts should they wish to.

These companies can sue the British Government if they feel that Government policies are harming their investments. For example, US companies could sue a British Government who wanted to take back into the public sector privately provided services in the NHS or education, or to open fewer such services to private provision. The British and EU Governments have denied that such suing is possible, but a cogent counsel’s opinion argues that, because these tribunals can award unlimited fines, and have different evidence criteria from British courts, they could, at the very least, exert “a chilling effect” on Government decision making.

Up until now, most of the concern about this has been expressed by people who have opposition in principle to any private provision in the health service. I do not have opposition in principle, although I have always believed that the scope for it is limited in practice.

I found an example in my own constituency that illustrates the problem that could arise if TTIP were in force. A surgicentre, privately owned, set up by Tony Blair and working alongside the NHS Lister hospital in Stevenage, which serves my constituents, ran into terrible problems. The whole system under which surgicentres were set up was daft; it did not work. So I lobbied against it, as did my right hon. and hon. Friends from Stevenage and north Herts—all of us Conservatives. We lobbied that it should be brought back into the NHS, and we were successful.

However, had TTIP been in force and the company fallen into the hands of an American health company—most private hospitals in this country are now American-owned—the company could have sued the local NHS for taking back that service. At the very least, it might have won massive damages. It might even have been able to prevent that from happening entirely. Even if it had lost, the case would have cost the local health service a massive sum, because the average cost of these cases is $8 million. It seems to me that Members should be very cautious about signing up to a treaty that might have such a consequence.

These tribunals were originally invented to encourage investment by American and other companies in developing countries that had poor systems of government. Their courts were, frankly, unreliable and sometimes corrupt, so a parallel system of courts was set up with the agreement of the local Government. Such Governments were prepared to suffer the indignity of having courts that could overrule their own judiciary and laws in return for encouraging investors to invest in their country, in the knowledge that, should those investors be expropriated, either directly or as the result of Government policies, they could get fair compensation. That was fine, but such courts are not necessary to encourage investment in the UK. America invests more in the UK than in any other country in the world. American companies, like those of many other countries, choose to have cases heard in British courts because they trust our courts system. We do not need a parallel system of courts to encourage and promote investment in this country.

The Government say, “This is impossible. It won’t happen.” If it is impossible, does it really matter if they make such an assurance doubly sure by exempting the NHS from TITP, as amendment (c) suggests, just as the French have exempted their motion picture industry and artistic endeavours from the scope of the treaty? The very fact that the Government are not willing to do so, or have not been so up till now, raises some doubts, at least in my mind, about how secure we will be.

However, the Government have now accepted the amendment, although it is true that they did not have much choice, given the wide support for it in the House. That means the Government are now committed to bringing forward a Bill, and it is very important that they do so speedily, so that we can see whether it will achieve what we want to achieve and so that Members with wider concerns than mine—indeed, I have some further concerns about whether environment or health standards should be taken entirely out of the purview of Parliaments in the ways envisaged—can amend and adapt the Bill accordingly. If the Government do not bring in such a Bill or delay it until after the referendum, we will realise that something fishy is afoot.

Is the TTIP draft treaty not just another example of what I was trying to say, which is that more and more things are no longer under the control of British law makers and electors, but under the control of unelected people in Brussels, and that such things are not amendable once they have been agreed?

My right hon. Friend is absolutely right. If we let TTIP through, it will be a further transfer of law-making power away from this country to international bureaucrats and multinational companies.

There is a referendum dimension to the TTIP treaty issue. First, the only absolutely certain way of preventing it is of course not to be part of it—by leaving the EU on 23 June. We might be able to exempt ourselves or to prevent the treaty from going ahead if we remain in, but that is far from certain. Secondly, as my right hon. Friend has said, there is a certain similarity between such courts of a supranational nature—run by bureaucrats to enforce laws negotiated by bureaucrats, which have never been endorsed by this House and are not open to rejection by it—and it is natural that those courts should sympathise with each other and carry the treaty forward. If we were outside, we could negotiate our own deal with the United States, which I hope would not need any such system of courts. Why should America need such courts to invest in this country or for us to invest in the United States? That deal would require a stripped-down and far simpler Bill, and it would be far quicker and easier to negotiate.

Some people have said, “But President Obama has said we won’t be allowed to negotiate a deal and we’ll have to go to the back of the queue”, but the House of Commons Library has revealed that there is no queue. After the negotiation of TTIP, there are no countries with outstanding negotiations with the US. Not only was President Obama trying to bully us, but he was doing it on the basis of a bluff. We will be not at the end of the queue but at the front of it, and we will no doubt be able to negotiate with his successor.

I hope that hon. Members will consider the EU dimensions of TTIP seriously. I accept that people who are very optimistic about what we can achieve within the EU, and about what the EU might be able to achieve in negotiating TTIP with the Americans, might want to take the risk. It is not a risk that I want to take. It is not a risk that those who give high priority to the NHS, or those who are worried about environmental standards, health protection standards and potential threats to our education and other public services, will want to take. In the light of the topic of today’s debate, I hope that we will give priority to protecting public services rather than going along with something that none of us has ever seen—we are not allowed to see it, and it is being negotiated in secret—and that has aspects that most of us ought to find offensive to the House and dangerous to the people of this country.

Thank you, Madam Deputy Speaker, for allowing me to deliver my maiden speech today.

In keeping with the tradition of the House, I would like to take a few moments to pay tribute to my predecessor as Member of Parliament for Sheffield, Brightside and Hillsborough, Harry Harpham. I am doubly proud to say that not only was he a dedicated and conscientious Labour MP, but, as many colleagues will know, he was also my husband. He served in this House for less than a year before his death, but in that time he made his mark. He spoke powerfully against the Chancellor’s cuts to tax credits, knowing the suffering they would cause the people he represented, and, as a lifelong trade unionist, he made an eloquent speech in defence of workplace rights when they were threatened by the Trade Union Bill.

I would also like to pay tribute to Lord Blunkett, who, as colleagues will know, stood down as the MP for Sheffield, Brightside and Hillsborough at the general election last year. David has been a tireless champion of Sheffield since he was elected to the council at the age of 22. He led the city through the turbulent years of the 1980s before becoming an MP in 1987, and his drive and tenacity soon propelled him to the Front Bench. There simply is not time for me to list all his successes as Education Secretary and later Home Secretary, but fortunately anyone who is familiar with the last 25 years of British politics will know that his achievements speak for themselves.

My constituency sits in the north-east of Sheffield, perched above the city centre on one side and the Don valley on the other, where once upon a time we could find the steelworks that were the foundation of our economy. It was my constituents and their forebears, including my father, who worked in them, forging not just steel but their own fame and reputation and that of the city along the way.

But times have changed, and after the pain and upheavals of the 1980s, we find that these days working lives are not dominated by a single industry. Having said that, nearly 20% of my constituents work in health and social services, so it is with good reason that I say we are a community that cares for one another. We are a diverse constituency, with people and communities from across Europe and beyond, both recently arrived and long-standing. Sheffield has sometimes been called the biggest village in Britain thanks to the friendly, open nature of its people. We were the first city to join the gateway protection programme back in 2004, through which we have provided a place of safety for 1,000 refugees. Plans are well under way to welcome a further 225 fleeing the conflict in Syria over the next three years.

Sheffield became a city of sanctuary in 2007, with more than 70 local organisations working to bring asylum seekers and refugees together with local people to celebrate the strength that we all gain through our diversity. I am proud to represent a constituency and city that are so welcoming and tolerant.

What maiden speech would be complete without singing the praises of the local football team? This Saturday, Sheffield Wednesday will be battling Hull City at Wembley for a place in the premiership. If—or should I say when?—Wednesday win, they will be back in the top flight of English football for the first time in 16 years, which is exactly where they belong. I am a proud Wednesdayite, and while I may not have much in common with the players, I like to think that we are all coming down to London to put Sheffield firmly on the map, and I wish them all the best for the weekend.

Like anywhere, we face our fair share of challenges. The rate of unemployment in Brightside and Hillsborough is more than double the national average, and we are ranked 9th in the country for the number of households with dependent children where no adult is in employment. More than a third of children in my constituency are classed as living in poverty. Seven food banks now serve my constituency, and it goes without saying that I have nothing but praise for those who give up their time to collect, sort and distribute the donations that people in the area willingly give to help those who find themselves backed into a corner. The fact that people have to rely on food parcels at all in 2016 speaks volumes about the Government’s determination to tackle inequality, particularly when a third of those who rely on them are children.

Perhaps the most troubling aspect of the growth in food-bank use is the way that it is now taken as read that people will have to rely on them. They have become accepted as part of the landscape, and arouse little comment. It is frankly disgraceful that we have reached the point where those in most need can no longer rely on the state to help them through hard times, and that is a damning stain on the Government’s record.

Ironically, Harry chose to make his maiden speech during a debate on productivity and the Government’s skills agenda. He said that the jobs being created in Sheffield were often low-skilled, low-paid, zero-hours contract work. He was right, and I find it sad that a year on, the Government have still not grasped the need to provide proper skills training, so that my constituents can find worthwhile, meaningful work.

One of the most pressing concerns for my constituents is the availability of housing, and I was deeply disappointed by the Housing and Planning Act 2016, which will do nothing to help people in Sheffield to keep a roof over their heads. Nearly 40% of my constituents live in council or housing association homes, and the introduction of fixed-term tenancies, alongside the hated bedroom tax, will cause them more needless worry and upheaval. For the Government, it seems that social housing is now a temporary benefit that people are to be chivvied out of, rather than a home to settle down in and to build a life.

I am glad to make my maiden speech during today’s debate on public services, because after a lifetime of working in them I feel somewhat qualified to speak up in their defence. I started my first job as an assistant at Firth Park library aged 16, and since then I have worked across library services, further education, and the NHS. I know from long personal experience how important each and every one of our public services are, and that they are often a lifeline for ordinary working people. They protect and empower those who would otherwise be unable to fend for themselves, and they are the living expression of the belief that everyone, whatever the circumstances of their wealth or health, should be able to live dignified, fulfilling lives.

Over the last six years, those services have borne the brunt of an ideologically imposed austerity that has left them withering on the vine. Men and women working across the public sector are being asked to do more with less and less. Morale is at rock bottom across the board: teachers, doctors, police officers, nurses, firefighters, social workers, prison and probation officers—the list goes on. They have all dedicated their working lives to public service, and all see on a daily basis their ability to serve being undermined by this Government.

I make no apology for saying that I am Sheffield born and bred. I grew up there, have spent my whole life working there, and raised a family there. We may sometimes be blunt, but it always comes from the heart, and it is in that spirit that I intend to work for the people of Sheffield, Brightside and Hillsborough. No one would have chosen the circumstances that led me to this Chamber, but nevertheless here I am. I am deeply humbled by the trust that my constituents have placed in me, and I pledge to repay that trust by fighting for their interests and making sure that their voices are heard loud and clear here in Parliament.

I congratulate the hon. Member for Sheffield, Brightside and Hillsborough (Gill Furniss) on her maiden speech. It always takes courage for an hon. Member to make a maiden speech in this daunting Chamber, but it must especially have been so when she paid tribute to her predecessor—her late husband—whose untimely death robbed this Chamber of a promising new Member who spoke with equal passion for his constituents in her city of birth, Sheffield. She will clearly be a great champion for her constituents, and will speak with the bluntness that she declared. I am sure she will be a much respected Member.

I did not intend to address the issue of the European Union, but will respond to the points made by my right hon. Friends the Members for Hitchin and Harpenden (Mr Lilley) and for Wokingham (John Redwood), to whom I listened with great interest. I listened with care to the concerns of my right hon. Friend the Member for Hitchin and Harpenden about the Transatlantic Trade and Investment Partnership. It is surprising that those who have been campaigning to leave the EU, and who for so long have criticised the EU for not completing enough trade deals despite the fact that the EU has more trade deals than any other country—it has far more than the United States—find themselves in the position of criticising trade deals. In my judgment, the benefits of TTIP include a £10 billion a year trade boost to our economy, which would enable us to invest more in public services.

First, may I clarify to my right hon. Friend that I have long campaigned against TTIP? Secondly, Switzerland has more deals than the EU, including deals with China, Australia and India. The only countries with which the EU has deals that China does not are very minor states.

My point is that the EU has trade deals with more than 50 other countries, whereas the US has only 14. I thought the narrative was that we want the EU to have more trade deals.

The issue is this: any modern international trade deal will involve some kind of binding arbitration mechanism. My right hon. Friend is clear that he opposes the Canadian free trade deal, but that has been championed by my hon. Friend the Member for Uxbridge and South Ruislip (Boris Johnson), who leads the leave campaign, as a model that our country should adopt if we leave the EU. It is also true that the Trans-Pacific Partnership, the North American Free Trade Agreement and even the World Trade Organisation all involve some kind of arbitration panel that takes decisions out of the hands of elected Chambers. If we are to take the position that any trade deal of that kind should be resisted if decisions can no longer be taken by elected Members, none will be acceptable. We would then be in the position of trading without any such arrangements, at potentially enormous cost to our country.

My right hon. Friend the Member for Wokingham spoke with characteristic passion about parliamentary democracy and described this place as a puppet Parliament. I note that none of the Bills in the Gracious Speech that are of interest to me and my constituents are restricted or affected by our membership of the EU. That goes to a central point: we can vote on and discuss much of our legislation and domestic affairs without the encumbrance of the EU. I therefore find it difficult to accept that the 650 Members of the House of Commons are puppets, and that our views and votes on those matters are entirely irrelevant simply because of our membership of the EU. That strikes me as an exaggeration, legitimate though the concern about parliamentary sovereignty might be.

I welcome the proposed prisons and courts reform Bill, having been the author of “Prisons with a Purpose” before the 2010 general election. The document urged the rehabilitation revolution and a transformation of the way in which we run our prisons. The radical reforms proposed by the Government are welcome in respect of reducing reoffending.

A number of measures are of special interest to my constituency of Arundel and South Downs in West Sussex. The neighbourhood planning and infrastructure Bill will address a problem that I spoke about in the House recently. The welcome reform of neighbourhood planning introduced under the Localism Act 2011 empowers local communities to make plans that benefit their local area, but they must not be undermined by speculative developments that call into question the legitimacy of plans that have been voted on democratically in referendums. It would be very welcome if the neighbourhood planning and infrastructure Bill addressed those problems and prevented those speculative development applications. We should remind ourselves that neighbourhood plans have had the effect of producing more and not less housing than was originally intended. Therefore, the proposal will not reduce house building, but will properly empower local communities.

The digital economy Bill is welcome—I am delighted to see my hon. Friend the Minister for Culture and the Digital Economy on the Front Bench. He will know of the concern that many in rural areas have to close the emerging digital divide. We want to ensure that the Government’s welcome proposal to extend superfast broadband throughout the country reaches those in hard-to-find rural areas—they, too, are entitled to fast broadband speeds. That is important for rural employment, but it is also important on the ground of fairness. It will take new means, and I hope the Bill sets out measures that will future-proof broadband provision to ensure that the speeds obtained in those areas meet tomorrow’s as well as today’s needs. Many areas in my constituency currently cannot get broadband at all.

I welcome the education for all Bill and its promise to meet the Conservative party manifesto commitment to a fair funding formula for our schools. West Sussex schools are unfairly disadvantaged in that respect.

I also welcome the modern transport Bill. I should like to refer to two crucial infrastructure issues that affect my constituency. First, on the A27 upgrade, I am delighted that the Government have announced that that major route will be upgraded to include the Arundel bypass and that funding has been provided. I hope the plans continue to timetable, so that work on the bypass begins by the end of the Parliament, as has been set out.

Secondly, the rail service to my constituency is a concern to a large number of hon. Members on both sides of the House. The performance of the Govia Thameslink Railway franchise has simply been unacceptable over the past year, hugely inconveniencing passengers. It must be said that 60% of the delays are the responsibility of Network Rail and result from infrastructure failure. It should also be acknowledged that the Government are embarking on major infrastructure investment, including the £6 billion London Bridge upgrade, which will improve services. Nevertheless, GTR is not meeting the self-set targets in its performance improvement plan. Those targets were low in ambition, but the company is falling below its original performance thresholds set one year ago to improve performance for customers. That failure is exacerbated by the entirely misconceived industrial action of the RMT on driver control of doors. It cannot be a safety issue when drivers rather than guards already control the doors on 40% of Southern services. Industrial action has exacerbated existing problems with the service, meaning a very serious level of disruption for passengers over the past few weeks. This is now causing real anger among my commuting constituents and many others in the area covered by the franchise.

First, there is no justification for the industrial action and it should not continue, and nor should the unofficial industrial action caused by drivers and guards who seem to be suffering from an unusual level of sickness. Secondly, the management of the GTR franchise must recognise that, while the proposed measures to reform how it runs the trains may be justified, its management of the franchise as a whole has been absolutely lamentable. It has brought the Government’s rail policy into disrepute. It is essential that the company and Network Rail are held to account for their poor performance and that they meet their own self-set performance improvement standards.

Does my right hon. Friend think that the licence to operate this service should be taken away and a new supplier found to ensure it is delivered properly and in line with what he would expect?

My hon. Friend raises a fair point. The ultimate sanction available to the Government for the failure of a franchise to perform effectively is to withdraw it. Indeed, that has been suggested by the Prime Minister. The franchise has only just been awarded. One problem is that the company failed to plan for enough drivers, so for the past year there has been a driver shortage. There has literally been an inadequate number of drivers available for the trains and there is a very long training period. The company assures the Government that it can improve its performance. The Government are reluctant to withdraw the franchise and find themselves in the position of running the railway, but unless the position improves more radical measures will have to be taken to deal with the underperformance of this service. Frankly, it has been simply appalling. It is unacceptable for the rail-travelling public in this area. It is time that both Network Rail and Southern recognise that it is no longer acceptable to deliver a low-standard performance of this kind.

It is a great privilege to be called to speak in this debate at this particular juncture. You will know, Mr Deputy Speaker, that sometimes Mr Speaker teases me a little about my long service in the House. I, in turn, accuse him of being slightly ageist. Well, I have to say that of all the maiden speeches I have heard, the speech delivered to the House by my hon. Friend the Member for Sheffield, Brightside and Hillsborough (Gill Furniss) was one of the best. It was delivered with passion, knowledge, experience and wisdom. She will be a first-class Member of Parliament representing her constituents, because she knows her community. She has lived and worked in her community. We are all proud of her, and Harry would be proud of her, too. I look forward to her brilliant career. [Hon. Members: “Hear, hear.”]

Some of us will have been a little hurt by the remarks of the right hon. Member for Wokingham (John Redwood), who was very keen to tell us that he is passionate about freedom and liberty. I do not mind him using his speech to say how passionately he is against the European Union, but to seem to suggest that we who oppose that view and who believe our liberties work better as members of the EU do not care about freedom and liberty is a little hurtful. As I said to the Prime Minister on an earlier occasion, I was born the day before the worst day of the blitz. German bombers bombed the street in which I was born. Seventy years of peace and prosperity can be too easily taken for granted.

When looking at a Queen’s Speech, it is important to track what has been left out or forgotten. There are some high-flown ideas at the beginning of the speech:

“My Government will use the opportunity of a strengthening economy to deliver security for working people, to increase life chances for the most disadvantaged and to strengthen national defences.

My Ministers will continue to bring the public finances under control so that Britain lives within its means, and to move to a higher wage and lower welfare economy where work is rewarded.”

The Secretary of State for Health, at the beginning of his speech, said that he did not believe in private wealth and public squalor. I do not believe that he believes that and I do not believe that the Government believe that. What they do believe is in some ways more insidious: private sector good, public sector bad. That is the message I get all the time from Government Members. Those of us who have worked in education, health, welfare, transport or housing know that lurching towards the private sector for an answer is not always the right or most efficient way. I feel embarrassed to hurt the feelings of those sitting on the Government Front Bench, but I mention in passing the botched rail privatisation that nobody wanted and which was executed badly. We now spend more money on trains, which are normally run by foreign-owned companies, than any other country in Europe—and to provide what? A very poor service.

We have heard a very large number of long speeches about health. I represent the constituency of Huddersfield. It looks as though we are going to lose our hospital and A&E not because anything is wrong with it—it used to be very high performing and financially sound—but because it has to absorb a weaker health trust next door, the Calderdale and Huddersfield NHS Foundation Trust, and because we are imprisoned by a PFI contract that we cannot deny or modify. That is a real threat.

The elephant in the room is that the health service is struggling to make ends meet. It is underperforming not because we do not have amazing and dedicated staff, but because we do not have enough of them. We do not have enough doctors, nurses, A&E specialists or people supporting doctors. The fact is that the NHS needs more resources and investment. I will say this a number of times in my speech: it also needs more imagination to deal with new demands. Yes we have an ageing population and need to deliver healthcare in a different way, but that needs leadership and imagination that does not exist at the current time.

Members on all sides complain about the health service lacking resources, but they go through the Lobby to vote for High Speed 2. On the latest figures, HS2 will be three times more expensive than it was predicted to be: £138 billion and rising. The Cabinet Secretary has now been drafted in to look at this, because even the revised costs are out of control. It seems strange to be ploughing money into HS2 when, according to the Queen’s Speech, we will very soon end up with driverless cars. We will have the ability to dial a number and have a pod arrive outside our house and take us anywhere in the country. I predict that by the time we have completed HS2, in 2033, it will be redundant, because driverless cars and the new generation of transport will have wiped out the need, just as the invention of the railways did away with the effectiveness of, and the investment in, canals.

As you would expect, Mr Deputy Speaker, I want to home in on education and skills, on which subject the Queen’s Speech gives me great cause for concern. First, enforced academisation will diminish local education authorities’ role in education and so take away a great deal of wisdom and resource that we have relied on for many years. I can see academisation being a very disabling influence on the whole of our education system. In one small paragraph, the Queen’s Speech also makes reference to new private universities. The Government are persistent in their ideology—ideology with a little i not a big I. In almost everything they touch, we see not big, bold privatisation but back-door privatisation. Academisation will lead to a greater role for the private sector. The changes to the BBC, under the new BBC charter, will mean much more privatisation by the back door. The same will happen with private universities. Will they train doctors, engineers and those in the high sciences? No, they will go for the low-hanging fruit—for legal degrees and accountancy—that cross-subsidises the difficult stuff in our universities.

I want to end on two little things. The Queen’s Speech referred to the northern powerhouse, but we see no resources or the knowledge to take us forward on that course. Lastly, I want to say something about defence—something the House would not expect from me. Today, we could get the whole of our defence forces—100,000 men and women—into Wembley stadium. If anybody wants to read the truth about our lack of preparation for defending this country, they should read Max Hastings in The Sunday Times this Sunday. We are struggling to maintain a credible force for the defence of our country and the maintenance of our liberties. At this time, the EU is a bedrock of our freedoms.

It is a pleasure to follow the hon. Member for Huddersfield (Mr Sheerman). Having listened carefully to his remarks, I would take issue with his assertion that many on the Government Benches are fully committed to the notion that private sector is always good and public sector is always bad. That is not my approach. I wanted to speak in this the third day of the debate on the Queen’s Speech because I think that the delivery of quality public services is critical to what we deliver to our constituents, and it is really important that we have an open mind about how we deliver those services effectively. The biggest employer in my constituency, Salisbury hospital, is from the public sector. It has just gone through the rigours of a Care Quality Commission inspection, and I am grateful to Professor Sir Michael Richards for his constructive observations around that and the way to move forward.

I welcome the many Bills in the Queen’s Speech that seek to address the biggest issues facing our nation, both now and under all Governments: how we create the conditions where the most vulnerable can be helped on to a better pathway. I was genuinely shocked and saddened when listening to the response from the Leader of the Opposition last week, when he said:

“Apparently, it is all about instability, addiction and debt—all things that can be blamed on individuals about whom Governments like to moralise… Poverty and inequality are collective failures of our society as a whole, not individual failures.”—[Official Report, 18 May 2016; Vol. 611, c. 16.]

I agree that it is a failure of society as a whole that people in our communities must endure complex, ongoing problems, but it is not about labelling society collectively or people individually as failures, and it certainly is not about moralising; it is about a credible analysis of the diversity of individuals’ problems, recognising that it is incumbent on Government to deliver a customisation, adaptation and reformulation of public service delivery if they are sustainably to meet the needs of our communities. It is naive to say that a financial measure of poverty, by itself, is likely to provoke a meaningful recognition of the complexity of poverty.

I want to make some observations about several of the proposed Bills, but three themes will emerge as I contemplate them. The first is about the need to innovate in public service delivery and the second is about the need to integrate. Going back to my opening remark, it is not about public versus private; it is about recognising that sometimes we need to innovate and integrate good public services, bringing in new ideas and providers able to improve how we have done things to date. The third important element is about timeframes. I vividly remember, in my six years’ service as a magistrate, seeing individuals come back again and again before the court for crimes related to the same underlying problems—typically addictions—in their lives. On average, it takes people seven attempts at rehabilitation to overcome some of those addictions. There is no one template for delivering those sorts of services. That is why we need to be careful, when we frame the legislation, to put in place reasonable measures of what success looks like and to show an understanding of the complexity of the lives of the people we are trying to help.

My enthusiasm for the children and social work Bill is infused with a strong conviction that the Government are absolutely right to look at looked-after children and care leavers, who experience some of the worst outcomes, in terms of life trajectory, of any in our society. It is important, however, that innovation is examined. In local authorities near me and across the country, we are beginning to look at schemes, such as those run by Safe Families for Children, where trustworthy families are engaged to look after children when underlying issues need to be dealt with in families. I recognise that the pathway to securing the engagement of safe families for children obviously necessitates more work in order to complete the process of safeguarding, but this is an example of where innovation and integration with existing public sector provision—in this case, within local authorities —can deliver enhanced outcomes.

On all the Bills, we need to look at how health, education and social services can work better together, so that the payback is significant. I remember, three or four years ago, being asked to visit a residential centre in Devon, with the Amber Foundation, which was working with young adults leaving the criminal justice system and in grave danger of not finding their way—often they were without family support and, being low-skilled, finding it difficult to get into employment, and typically they had been engaged in the criminal justice system previously. I hope that when we come to consider the proposed legislation, we will find room to enfranchise groups such as the Amber Foundation into the delivery of services. It is through commitment over time that those individuals are able to find a sustainable trajectory into independent living. We need to be honest and real about the challenges that those individuals face. I welcome the overdue reform of adoption. I have seen too many cases in which the evaluation stresses reasons why not, while in the meantime too much time passes and the individuals are left behind.

I welcome the education for all Bill, and there is particular enthusiasm in my constituency for the fair funding formula. Wiltshire is the third worst funded local authority, and that has a significant impact on the ability of schools to plan their budgets going forward. It is critical at the moment in the formation of a multi-academy trust, because trying to anticipate what the uplift will be is significant in giving assurance to governors as they come together.

When we look at options facing young people at 18-plus, it is important to be clear about the integration of the great macro-policy goal of having 3 million new apprenticeships with enabling children from difficult backgrounds to get on to a pathway that will deliver the skills and employment opportunities that they crave.

The prisons and courts reform Bill is also very welcome. The emphasis on rehabilitation to reduce reoffending is wholly necessary. Importantly, it will introduce new boards with external experts and emphasise prisoner education and the necessity to have a pathway to employment.

Finally, there is the digital economy Bill, and this is a massive issue for rural Wiltshire. I have campaigned on it for many years. We must have a reliable plan for the last 5% in particular. The universal service obligation must have meaning and teeth in ways that my constituents and those across rural England can fully understand.

I finish where I started. I have no ideological objection to the integration of innovative ways of delivering public services. I hope that this Government will continue to have ambition and will measure their success in a way that allows further developments to take place so that we can meaningfully address the conditions of the poorest in our society with solutions that give them dignity and the justice that they deserve.

We can all recognise that this Queen’s Speech contains a thin raft of legislation and that it is perhaps a Queen’s Speech in hiding for obvious reasons. It is certainly one that misses out many things that people might have thought would be included. It may not contain some terribly bad things, but we can ask a central question about it, following on from the thoughtful contribution by the hon. Member for Salisbury (John Glen). It is not just a question of changing services and ensuring we get the best out of them, because we need to think about who actually achieves the things set out in the Bills.

We should ask ourselves whether it is good enough to pass legislation and then say, “Get on with it; it is down to you. We have done our bit on the legislation, and it is your job now.” Here lies an increasingly central flaw in the roster of Bills presented for our inspection. They certainly do not come with any “how to do it” impact assessment. It is important to recognise that we can have good public services only if we have good public servants carrying them out. When it comes to many of the measures in the Queen’s Speech, one cannot say, “That is a good thing.” One should increasingly say exactly how to make it more than just a good thing, so that it actually becomes a good thing achieved.

The title of today’s debate is “Defending Public Services”, but there seems to be a disjunction between what a service can do and what is coming its way as a result of this and other recent Queen’s Speeches. We discuss this one against a background of a crisis in funding for the NHS. We know that the NHS simply cannot do what is required of it as a public service with its existing funding. Deficits are rising for hospital trusts, and it is not sufficient to answer, as the Prime Minister did in his opening speech, that it is necessary to do “more with less”. The people who are doing more with less are the public servants who have to carry out the services.

Statistics show the number of doctors per 100,000 head of the population between 2009 and 2015. There were 70 per 100,000 in 2009 and 65.5 in 2015. The same figures for nurses are 680 in 2009 and 664 today. That shows exactly what is happening. Public servants are doing more with less and continuing to have more and more piled on them with less and less resource—until, I suspect, the service starts to break down.

Social care is the other part of the health service revolution that we have debated today, but £1 billion has been taken out of social care budgets in the past year alone, with £4.5 billion taken out over the last five years. Local government is generally responsible for social care and social services, but councils have lost something like 79% of their direct funding between 2010 and 2020, with a further £3 billion of cuts announced in last year’s autumn statement.

The most deprived areas of the country, those with the most pressing concerns on social care and the most disadvantaged seem to suffer the worst cuts. How can it be that nine out of 10 of the most deprived areas are seeing cuts above the national average? We face a Queen’s Speech, on the other hand, that places substantial new requirements on those desperately stretched services in the areas of the country that need them the most. In my authority, by no means one of the most deprived parts of the country, £72 million has been cut from the budget since 2010, and there is expected to be a further £90 million a year by 2020.

The services that we seek to defend are, frankly, in a position of near starvation as they seek to provide us with the cover and the response to statutory responsibilities that we require. For example, the Queen’s Speech contains a requirement for further responsibilities to be put on local government and social care departments under the Children and Social Work Bill. This is what the Prime Minister said:

“So, in this Queen’s Speech we are saying to care leavers: you will get guaranteed entitlements to local services, funding for apprenticeships and a personal mentor up to the age of 25. All this will be included in our care leavers covenant, so that our most disadvantaged young people get the opportunities they deserve.”—[Official Report, 18 May 2016; Vol. 611, c. 26.]

Who could disagree with that? On the other hand, who could disagree with the people who are going to do those things?

I declare an interest in that my daughter is a social worker. I am very proud of her hard work in becoming a social worker in the first place and her dedication in carrying out her duties and responsibilities. I see her on a daily basis, so I can see the effect as her case load gets stretched and the authority has to cut corners increasingly just to keep the service going. These new requirements are going to be a huge strain on her; she will be one of the many people who will have to carry out this new piece of legislation as part of her local authority responsibilities. I know, by the way, who will get the blame if services fail because departments cannot stretch themselves far enough to take on those new responsibilities. It will not be the Government who presided over that near-starvation, but the poor social services departments that were worked into the ground while they were just trying to cope.

The Prime Minister spoke of the services that local authorities would provide, but they are decreasingly in a position to do so. New responsibilities are coming their way, not just for social care but for planning, as a result of the neighbourhood planning and infrastructure Bill, and for buses, as a result of the bus services Bill. Moreover, authorities apparently have an interesting future in connection with the devolution of business rates. It is being suggested that the local growth and jobs Bill will enable them to retain 100% of business rates, and who would disagree with that? I have championed the idea for many years. However, when it comes to who will implement the retention, there is as yet no indication of how business rate devolution will be married up with local equity. It appears that the authorities with the highest business rate bases will do much better than those in the most deprived areas which have much lower bases, and whose public servants will suffer as a result.

It has been announced that combined authorities will be handed powers from above, but they will be left with the same responsibilities and the same costs. How will they be funded? An authority that takes on devolved powers in south Hampshire, for example, will do so through a levy from a pooled business rate, which means that other authorities will have less money with which to support their already stretched services. I suspect that “more out of less” will not redound to the benefit of the public servants who are working in those authorities.

This is the central problem for our services. We can talk all we like about the sunny uplands, and about what shiny new words in shiny new pieces of legislation mean for people, but if those words are not followed by a commitment to make the services that will deliver on the promises work, they are hollow promises, and that, I think, is what this Queen’s Speech suffers from.

Like me, Mr Deputy Speaker, you will know that Lancashire has some of the finest public services in our country. I represent the police force and the health service in my constituency with the greatest pride here in Parliament, and rely on them when I am at home in Lancashire.

However, proud as I am of our public services in the north-west and Lancashire in particular, we need to show that our businesses and our economy will improve in order to support them. This Queen’s Speech—a one nation speech—did not give preference to the private sector over the public sector, but set out a programme in which both could succeed, and in which, specifically, the northern powerhouse, which was mentioned by the hon. Member for Huddersfield (Mr Sheerman), could play a central role.

Many years ago, my home city of Liverpool contributed more to the Exchequer than the City of London. In 1889, when our great county council—Lancashire county council—was formed, our first civic leaders, some of whom had been Cabinet Ministers, resigned as Members of Parliament to lead it. Was that because, at the time, it was said that the empire’s bread hung by Lancashire’s thread? Well, it may have been, but I believe that the real reason was that those MPs—including former Cabinet Ministers—knew that more power resided in our great northern cities, and in our town halls, than at Westminster and in Whitehall.

Of course, all that changed during the first and second world wars. As we waged total war in this country, it became necessary to concentrate power in London. We saw the nationalisation of our industries, and we saw many decisions taken away from our great regional local authorities. Just as the power came to London, wealth and skills moved away from the north of England to the south. The Queen’s Speech, and its commitment to the northern powerhouse, means that some of that money and power will be removed from London and returned to the north. London has had it for far too long, and we want it back.

This scheme did not drop out of thin air. My right hon. Friend the Chancellor of the Exchequer first advocated the idea of a northern powerhouse in June 2014, at the Museum of Science and Industry. It could not have happened in a better place than Manchester, close to our Free Trade Hall. With your indulgence, Mr Deputy Speaker, I want to reflect a little on the progress that we have made in the last 23 months.

During debates in the House, Members often ask why so much money is spent on London’s infrastructure. Why has London been given Crossrail 1, and why is it to be given Crossrail 2? Well, one reason is that Transport for London unifies all the London boroughs so that they can work on infrastructure projects throughout this great capital. For far too long, our local authorities in the north of England have been in competition with each other when it comes to rail and road infrastructure projects, rather than working together to ensure that we have a plan in the north to enable our cities to grow. That is why I am so pleased that we now have Transport for the North fighting for our cities and towns throughout the region.

It is so important for the north of England to become super-connected. What do I mean by “the north of England”? Well, within 40 miles of Manchester we have Leeds, Liverpool, Lancashire, Cheshire, Yorkshire, and the city of Sheffield. That belt of counties, towns and cities encompasses 10 million people. One powerful urban conglomeration could become one powerful, super-connected economic unit, which would not compete with London, and would certainly not pull London down, but would create growth and wealth throughout the north of England so that we could compete not just with the south, but with other cities across the globe. If the north were an independent economy, it would be the ninth largest economy in the European Union, and—much as it pains me, as a Lancastrian, to say this—if Yorkshire were its own country, it would have created more jobs in the last five years than the whole of France.

Of course the northern powerhouse is hugely important, but we are also very excited about the digital economy Bill. The commitment to super-connect every house with a universal broadband connection is important to our rural communities throughout the north-west of England. It is a glue that can bind towns and villages into the northern powerhouse project, and Lancashire can play its part.

We have three world-class universities; Uclan—the University of Central Lancashire—Lancaster, and, of course, Edge Hill. However, I must make an appeal to Lancashire county council. If we are to have a powerful, knowledge-based economy in which we all become wealthier and more successful, the council must not cut our library services. If we want young people throughout Lancashire to be able to study in peace, and to look things up on the internet in, for instance, Bacup, Whitworth and Crawshawbooth libraries, we must be far-sighted. We cannot focus on short-term cost savings. I accept that budgets are under great pressure, but we must have a long-term plan, and that will not be served by robbing our young people of their libraries.

In the last 23 months, we have also seen development to help the northern powerhouse to grow throughout Lancashire. The Heysham link road is nearing completion, and a close partnership with Peel Ports in both Liverpool and Heysham is enabling us to create a global gateway through the sea for the north-west’s industry. That, of course, includes the aerospace industry. We are very lucky in Lancashire—our aerospace industry is globally pre-eminent—but we must ensure that, through the northern powerhouse project, we can build on the success of that existing industry. In my own constituency, companies such as J. and J. Ormerod plc, Linemark, WEC Engineering and of course the world-famous Crown Paints are already making the northern powerhouse a reality.

I have a simple ambition, and I hope that it will be reflected in the Queen’s Speech. It is to drive the northern economy ahead and to narrow the north-south divide. In a one nation speech, we in the north of England must show that we do not want to drag down London or the south; rather, we want to create a more prosperous north of England to rival and succeed the south as we build our economy. Those who talk the northern powerhouse down—as the Leader of the Opposition did in his response to the Queen’s Speech—are making a mistake. Perhaps the ambition of Members from across the House who represent the north of England is not understood in Islington or other parts of London. People who say that the northern powerhouse is dead just because one infrastructure project has been delayed or because one business has closed do not understand the scale of our ambition. I caution those Labour Members who are hanging on in the south of England— one of whom we have just heard from—against talking down the north, because to do so would be a terrible mistake. I know that the hon. Member for Southampton, Test (Dr Whitehead) did not do that; it was the Leader of the Opposition who talked it down in his response to the Queen’s Speech.

I have some small suggestions for the Government. First, we have handed over an unprecedented amount of power to our cities through city deals in Preston, Leeds, Liverpool and Manchester. There was some criticism when civil servants from the northern powerhouse were brought to London. Let us reverse that by creating a northern powerhouse board made up of civic leaders based in the north of England. Secondly, people in the business world want clear guidance about how they can be involved in this project. It excites businesses across the north of England like no other Government initiative, and we have to get the information out there. Finally, I hope that the Government will keep in mind our creative industries in the north-west. Those industries are supremely successful at competing on a global scale, and the northern powerhouse must drive that forward and celebrate those industries.

I was hoping for a lot more from this Queen’s Speech. I hoped that there would be something to address the ever-growing housing crisis in this country. I also hoped that there would be something on the environment or on the long-awaited and much promised Bill on wild animals in circuses. But mainly, I hoped that there would be some hope for my region and my constituency. Yet again, however, we heard only scant warm words with the brief mention of the northern powerhouse—the Chancellor’s pet project—which does not even seem to reach the north-east.

I do not think the Chancellor heeded my words on the lack of measures for the north-east in his ultra-shambolic Budget back in April, when I warned him that, despite his ambition to be king of the north, he needed to recognise that there was a lot more of the north beyond Manchester before he got to the wall. Mercifully, his time as Chancellor is almost up. Who knows where he will be when winter comes, post-referendum: in No. 10 or in the wilderness on the Back Benches? His legacy for the north-east is, sadly, only more pain and hurt.

Today’s debate is all about our public services, and I want to highlight the damage that is being inflicted on them by this Conservative Government, who are continuing to starve them of proper investment while forcing through damaging and unnecessary legislation. The Tories are now trying to dismantle and ruin two of our country’s greatest and most precious institutions: the NHS and the BBC. These are two public services that we probably all use almost every day and both are central to our national way of life. This Government are hellbent on completely changing the culture and ethos of the two institutions. They have already started the process, but we must not let them complete it.

Since the Conservatives came into office in 2010, the NHS has faced crisis after crisis, all of which could have been avoided if it had been given proper investment and support. Instead, we saw an unnecessary top-down reorganisation of the NHS that disjointed funding streams and placed unnecessary burdens on services through cuts that have been detrimental to our constituents’ experiences of using the NHS. This abysmal mismanagement of the NHS by the Health Secretary and his equally appalling predecessor is compounded by the fact that 3.7 million people are currently on waiting lists, by the understaffing of our hospitals and by patients’ struggles to see their GP. The mismanagement has been acutely felt in the north-east, with the prime example being the underperformance of the North East Ambulance Service NHS Trust. That was the subject of a Westminster Hall debate about two weeks ago in which I and a dozen other north-east colleagues raised our numerous concerns. I hope that the Government have listened to those concerns and will act as soon as possible.

Instead of addressing the issues that the NHS is facing on a day-to-day basis, the Health Secretary took it upon himself to enter into a protracted fight with our junior doctors. They do an amazing job of treating patients in difficult circumstances, yet he has battled with them remorselessly over their pay and conditions. It is welcome that a deal has now been struck between the Department of Health and the junior doctors after everyone was at last brought back around the negotiating table. However, this all could have been avoided, including the recent strike action, if only the Health Secretary had meaningfully listened to the junior doctors’ concerns about the impact the proposed changes to their contracts would have on the NHS.

The Health Secretary must rethink his entire strategy for the national health service and ensure that it does what it was created to do. I want to quote from the leaflet that every home received when the NHS was launched in 1948:

“It will provide you with all medical, dental and nursing care. Everyone—rich or poor, man, woman or child—can use it or any part of it.”

It was Nye Bevan who said:

“Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community”.

We should have seen something like that in this Queen’s Speech. But wait—no, that only happens in a Labour Queen’s Speech. That is how we got our NHS in the first place.

The BBC is another of our treasured public services that the Government are trying to undermine. The Culture Secretary is using tactics that can only be described as bullying and intimidation to make the BBC accept a new charter—which is in no one’s interests other than those of commercial media moguls—and he has shown his true colours by going on record as saying that the disappearance of the BBC is a “tempting prospect”. Those are the words of the man who is supposed to be in charge of nurturing and championing British culture and talent.

The Government’s proposals aim to hobble the BBC, and they will put its position as an independent public broadcaster in jeopardy by introducing Government appointees to oversee the organisation. That is a clear attack on the BBC’s independence and its ability to hold the Government to account. Putting Government-approved people on the board would threaten the very existence of the BBC as we know it. Peter Kosminsky, the director of “Wolf Hall” and winner of the BAFTA Best Drama award, has said that

“the BBC’s main job is to speak truth to power—to report to the British public without fear or favour, no matter how unpalatable that might be to those in government.”

Those words remind us of exactly why the Government must maintain the integrity that the BBC has come to be respected for, not just in the UK but right across the world.

The BBC is not only one of our main sources of news and information; it also acts as a beacon for British culture and talent and is a true cornerstone of UK plc. From giving that much needed break to up-and-coming artists on BBC radio stations to the many TV programmes that showcase the greatest aspects of British life—commercially successful shows such as “Strictly Come Dancing” and “The Great British Bake-Off”, informative and incredible documentaries such as “South Pacific”, “Frozen Planet” and the many other David Attenborough documentaries that have taken us into some of the most remote and exotic places in the world—the BBC is the very best of British in everything it does, and we get to enjoy all that for the remarkably good-value price of just 40p a day while sitting in the comfort of our own home. However, the Culture Secretary has persistently put the future of commercial BBC programming in jeopardy by saying that the BBC should focus on broadcasting for the public good. He clearly forgets that all shows broadcast by the BBC, whether commercial or informative, are for the public good. The two cannot be separated because commercially successful programmes help to fund world-class documentaries that are viewed across the globe. My Opposition colleagues and I will do everything in our power to ensure that one of our most treasured institutions is protected, continues to drive creativity in the 21st century, and is accessible to all.

Going back to Peter Kosminsky, he also said in his acceptance speech at the BAFTAs:

“It’s not their BBC, it’s your BBC.”

Never have truer words been said about our BBC. We need to defend it at all costs from the damage that this Government wish to inflict upon it. Our NHS and BBC make us proud to be British. When it comes to damaging those two precious public services, the Government will not get an easy ride either from Opposition Members or from the wider public watching today.

Does the hon. Lady agree that the BBC is uniquely able to tackle difficult issues such as controlling abuse? She may have been following the recent story in “The Archers” relating to Helen Titchener, which showcases the BBC at its best. If the hon. Lady goes on to the “Free Helen Titchener” JustGiving page, she will see that the BBC has been involved in helping to raise £130,000 to support women’s refuges across the country.

I am so pleased that I allowed that intervention, because it was excellent. I thank the hon. Gentleman for that, and I do agree with him.

The NHS and the BBC are cherished institutions, providing an essential public good. They are the very best of British. The proposals are a damning indictment of this Government’s attitude towards our country and those two great institutions, of which I believe the whole country is immensely proud. That is why we cannot allow them to be dismantled or diminished in stature or performance. On the day that the NHS was founded, Nye Bevan said:

“The NHS will last as long as there are folk left with the faith to fight for it.”

His words apply equally to the BBC in this context, as much as he intended them for the NHS. We need to have faith now, and we need to fight for both of them before it is too late. Otherwise, the NHS and the BBC, which our grandparents’ generation so proudly created, will no longer be there for our grandchildren, who will never forgive us.

It is a pleasure to follow the hon. Member for Washington and Sunderland West (Mrs Hodgson). I also place on the record my appreciation of the memorable maiden speech of the hon. Member for Sheffield, Brightside and Hillsborough (Gill Furniss). The connection between those two hon. Members is that I look forward to visiting their football teams next season and not having to suffer attending St James’ Park.

The Queen’s Speech contained some 21 Bills. I do not intend to refer to all of them in the time available to me, but I want to mention some and to express my views about some that appear to be missing. It is almost de rigueur to discuss the EU referendum in our speeches, and I look forward to the Government needing to bring forward legislation to disentangle us from the European Union once we, the British people, have set ourselves on to the path of freedom and democracy.

As for today’s debate, I particularly want to talk about the national health service and not only some of the key issues contained in the Queen’s Speech, but some things that do not require legislation. The Bill to ensure that people who do not pay taxes in this country have to pay their way when using the NHS should be welcomed across the House. We all recognise that the NHS requires additional funding and needs resources, but it is a national health service that the people who live, work and play in this country rely on for their health; it is not an international health service to treat the rest of the world. I hope that that Bill will receive support right across the House, including from the Opposition.

I congratulate the Health Secretary on achieving an end to the negotiations with junior doctors that paves the way for a proper seven-day NHS. I went looking around my constituency at the weekend on behalf of constituents who want a weekend GP service, but no GP surgeries were open at all. That is the reality. GPs widely advertise as being open Monday to Friday, but no GP service is available in my constituency on a Saturday or a Sunday. If someone is ill or needs medical treatment, there is no choice but to attend A&E, leading to increased pressure on the emergency services. Equally, it is important that the Health Secretary negotiates terms with GPs that ensure that a service is available for people needing routine medical procedures at the times of day and on the days of the week when people want the service to be provided and not just when it is convenient for GPs.

The NHS’s cumbersome investment decision-making process must also be disentangled. The Royal National Orthopaedic hospital, which I am proud to champion, has been making a case for its rebuilding for some 30 years. Six years ago, we received confirmation from the coalition Government that money was available to do exactly that. However, despite draft outline business case after draft outline business case and so on, we are still waiting, six years on, for the business case to be signed off. It is ridiculous in this day and age that our NHS is spending more money on management consultants to make decisions than on consultants to deliver medical treatment. I hope that our health team can resolve the problem without the need for legislation by ensuring that we cut through red tape and enable decisions to be made—a business-like approach to running the NHS without introducing any form of privatisation whatsoever.

I warmly welcome the proposed sugar tax, because it is a great means of driving behaviour. For most people, the sugar content of many drinks is masked, which is clearly unhealthy for people of all ages, young people in particular. The change is a sign of the way things are going. Something that seemed to pass without too much celebration last week was that we finally got clearance to introduce standardised packaging of tobacco products when the court case brought by the tobacco companies collapsed in the High Court. That is good news. I was also pleased by Axa’s decision to remove the £1.7 billion of its policyholders’ money that was invested in the tobacco industry. It quite rightly said that investing in tobacco products was destroying its customers’ health and it then had to pay out on insurance claims to support those customers. That shows the way things are going. I hope that the Chancellor will consider not only the sugar tax, but a levy on tobacco companies through increasing the cost of a packet of 20 and then ensuring that all the money raised goes directly to funding local health initiatives to stop people smoking and to prevent them from starting.

I also welcome the digital economy Bill. For the unaware, I had the honour of working for BT for 19 years before being elected to this House. Back then, I promoted the idea of BT having a universal service obligation to provide superfast broadband. In fact, broadband full stop would be a start, and speed could be increased thereafter. My constituency is on the edge of London, yet it has a series of housing estates, built more than 20 years ago, in which it is impossible to get broadband—that is outrageous. We have people who work in the City of London, in very responsible jobs, who would like to work from home but are unable to do so because BT fails to provide broadband of a reasonable speed. In this day and age, it is outrageous that they should be deprived of that fundamental service, on which we all rely. As we ask more and more people to work from home, so that they do not congest the roads and do not have to travel to an office to do their work, they should have the facilities to be able to work from home, if they so wish. I look forward to that becoming more and more a focus of attention for the Government.

I also welcome the neighbourhood planning Bill. As hon. Members on both sides of the House have said, we need to build more houses in this country for people to live in. I strongly supported the Bill that became the Housing and Planning Act 2016, which creates the environment in which houses can be built. The neighbourhood planning Bill clears up the issue and prevents the process whereby plans are clogged up and development is prevented from taking place. We should set out our plan, and I support the Government’s plan to generate more and more housing for younger people to be able to purchase and so get their foot on the ladder of property ownership.

One of the most fundamental local services is refuse collection. Although localism is welcome, it cannot be appropriate that, right across London, and probably across the country, people who move, probably every six months, because of private rental arrangements suddenly find that the refuse collection systems and the colours of the bins are totally different depending on the borough. They are therefore totally confused as to what should happen. As a fundamental service to people, we should seek to ensure that we have a sensible waste-collection service in this country; we should sort out who pays for it and how it is collected. At the moment, it is one area where local decisions can be made but clearly there are vast differences in the quality of services being provided.

I am also pleased that the education Bill will be coming forward, and I am glad that the Government have wisely dropped their decision to force schools to become academies. I welcome academies being created, but forcing schools to do that would be the wrong thing to do. Finally, I will just mention the counter-extremism and safeguarding Bill, in the short time I have left. I have—

A theme has been emerging during the debate; it is the apparent “lack” or “poverty” of ambition in Her Majesty’s Gracious Speech. That theme has come from speakers on both sides of the House. When the hon. Member for Harrow East (Bob Blackman) was talking rubbish—or was it refuse collection? [Interruption.] I knew he would not mind that. However, there was still the criticism, “Here’s all the things I would have liked to have seen in the Gracious Speech.” We have heard very little about what is actually in it. If this Queen’s Speech and agenda are regarded as largely harmless or tame, it still is not the job of the Opposition to roll over in the face of that. I encourage them robustly to test each of the measures thoroughly, no matter how harmless they may appear, and to improve upon them, if that is possible.

With that in mind, I wish to focus my comments on the following promise:

“Legislation will be introduced to establish a soft drinks industry levy to help tackle childhood obesity.”

The Minister for Community and Social Care, who was before the House earlier today, promised that there would be a full package of measures to address childhood obesity, but we have seen that that package is in fact a single action: putting in place a new tax. I commend the Government for wishing to tackle childhood obesity, but I have yet to be convinced that a tax or levy on soft drinks will achieve that. If taxation was indeed the way to tackle bulging waistlines, Her Majesty’s Government would have found the holy grail, but it is important that the Opposition test this measure before blindly following it, saying, “It sounds good. It looks good. It seems to be a positive measure. Let’s support them in it.”

The over-taxation of products does not lead to reduced consumption, as we have seen with cigarettes and alcohol; consumption does not drop dramatically, although it might be controlled, and the root cause is not addressed. When taxation has been introduced at the highest levels possible, we have seen crime associated with those products increase. Let us just say that I am sceptical about a levy on sugar. It is one of those policies that sounds good and catches the headline, but it has no sound evidential base. Public Health England and the McKinsey Global Institute, in 2014 reports and studies, state that portion size, the reformulation of products, exercise, education on nutritional values and parental control have a greater impact on obesity than any taxation policy. The one country where this policy has been introduced is Mexico, where it has not worked at all. For children, the actions of their parents probably do more to improve their lifestyle than a tax on their parents’ weekly shopping cart. This sugar tax is a stealth tax dressed up as a health measure, and the Government should not be pursuing it.

The target of the tax is the soft drinks companies, but they are already taking steps to follow the evidence, through the reformulation of some of their drinks. In fact, soft drinks are the only food and drink category where sugar intake is falling year on year, and that has been the case since 2012. I therefore have a number of questions and I hope the Government will attempt to address them, either this evening or when they try to introduce this measure later in the year. Did they formulate their tax plan on 2012 evidence or on evidence since then? Do they intend to direct this tax at other higher sugar content products, in order for us to see what the Minister said earlier about the full package of measures? Where, therefore, is the real ambition of this policy?

Why have the soft drinks companies been singled out, when the evidence shows that they are already reducing sugar content in their drinks? Soft drinks are not even in the top 10 for calories contributing to the UK diet. Other products—for example, confectionary—are far higher up that list in terms of sugar content. Soft drinks form the only category of food and drink where the amount of sugar in take-home products is being reduced, and that has been the case since 2012. That fact is backed up by the 2014 Department for Environment, Food and Rural Affairs food survey—a Government survey—which showed that the switch to a diet drink from a regular sugar content drink has now taken place and that more of those drinks are now being drunk. If the Government intend to tax something, why put a levy on something that is already reducing the sugar content? They make all these promises about how they are going to spend the money, but that money is going to run out. They may promise that the money they raise will go on schools, but the figures that I have before me show that the commitment of £285 million to fund extended school days will cover only 25% of our secondary schools. If the Government pursue this tax, in five, 10 or 15 years from now, they will cover even fewer schools, so why pursue the tax at that level? The Office for Budget Responsibility predicts that the levy will raise less money year on year, but the Government have yet to set out how they will meet their commitment if that prediction is borne out.

I have tabled a number of written questions on this matter, and I have had some answers back from the Chancellor. Some of my questions were also to the Department of Health. No cost has been given for the policing or implementation of the levy. We have been promised a wide consultation, but we have had little apart from a sugary and sweet soundbite. The Opposition should challenge this a lot harder, because there is not the evidence to put it in place.

There are 21 Bills in the Queen’s Speech, and I could talk quite a lot about most of them, but I want to focus predominantly on the digital economy Bill. The announcement of that Bill will resonate in my constituency, because it creates the right for every household to have access to a high-speed broadband facility. I represent a very rural area, where people will be watching this with interest.

We use the phrase “a digital economy”. It is a nice slogan and a nice catchphrase, but in a world that is more reliant on the internet and mobile communication—as I look around the Chamber, I see that many colleagues have their iPads and their mobiles with them, and we are all using the internet—I argue that there is no other form of economy. Without the internet, we will struggle, and it is the rural economy in the High Peak that I am concerned about.

When we came into office six years ago, only 45% of the country had access to superfast broadband. To date, we have provided superfast broadband to 90% of the UK—an extra 4 million homes and businesses. By the end of next year, we will have reached 95%. That is the result of a huge investment by the Government, local councils, devolved Administrations and BT, which totals some £1.7 billion. That is no mean achievement. However, we cannot stop there; we need to continue working to connect significantly rural areas such as the High Peak. The progress made since 2010 is welcome, but the rurality of the High Peak makes it crucial that we continue to drive this forward. We cannot rest on our laurels thinking, “Aren’t we clever?” and congratulating ourselves on a job well done.

There are many advantages to living and working in the countryside, and particularly in the High Peak. We have fabulous countryside, outdoor pursuits, clear air and breathtaking scenery. The a