House of Commons
Tuesday 11 October 2016
The House met at half-past Eleven o’clock
[Mr Speaker in the Chair]
Oral Answers to Questions
The Secretary of State was asked—
GP Interventions: Physical Activity
The National Institute for Health and Care Excellence recommends that exercise referral schemes should be provided for people at increased risk of ill health, and it is right that such schemes are developed on a local basis to meet the needs of the population. Our NHS five year forward view strategy prioritises prevention, and the GP physical activity clinical champion programme has taught more than 4,500 healthcare professionals to provide advice on physical activity in routine clinical consultations.
The hon. Lady is absolutely right to raise this question. Inactivity costs England an estimated £7.4 billion a year, and regular physical activity reduces the risk of developing many health conditions by between 20% and 40%. People who exercise regularly can reduce their risk of developing certain kinds of cancer. We are particularly pleased that, in addition to the GP physical activity clinical champion programme, Public Health England has secured funding from Sport England to pilot an education cascade model involving midwives, physiotherapists and mental health nurses and, with the support of the Burdett Trust for Nursing, will soon be launching a pilot involving 21 clinical nurse champion programmes to embed this knowledge in practising nurses. It will, however, be up to local areas to ensure that they make the best of these programmes by targeting them at their local area.
The hon. Gentleman raises an important issue relating to drug and alcohol misuse. We have prioritised this question as one of the local statutory requirements. We have given £16 billion to local health authorities for public health delivery, and we will expect them to prioritise this issue.
Lack of physical activity contributes to obesity. With today’s Health questions falling on World Obesity Day, as I am sure the Minister is aware, it is vital that we recommit our efforts to reversing rising obesity levels in the UK. An opportune moment would have been the childhood obesity strategy—sorry, the plan—that was published over the summer, but sadly it did not go far enough. Therefore, will the Minister commit today to ensuring that the plan is fully realised as a preventive strategy to change behaviours and help to make the next generation healthier than the last?
I congratulate the hon. Lady on her appointment. I am particularly pleased to see her in her place. She has played an important role in the all-party parliamentary group on breast cancer. We are very proud of the childhood obesity plan. It is based on the best available evidence, and it will make a real difference to obesity rates in this country. The Government are also consulting on the soft drinks industry levy, and we have launched a broad sugar reduction strategy. She is absolutely right to say that we must now work hard to ensure that we deliver on that with the NHS, local authorities and other partners as we move into the delivery phase of the plan. We are proud that it is a world-leading plan.
Health and Social Care: Plymouth
Plymouth has gone further and faster in integrating health and social care than many parts of the country have done. The integrated fund that it has set up covers housing and leisure as well as health and care. I would be delighted to visit Plymouth and to learn more about how the fund is working in practice.
As my hon. Friend points out, Plymouth has taken innovative steps to try to address some of the funding inequalities at play within the Northern, Eastern and Western Devon clinical commissioning group. However, between the calculated spend and the actual spend, there is a funding shortfall of £30 million. Will he agree to work with local MPs, stakeholders and those involved in the wider Devon sustainability and transformation plan to develop a written agreement to address these inequalities?
My hon. Friend refers to the time lag that can exist between target and actual funding. When I visit, I will be delighted to meet stakeholders not only to understand the allocation issues to which he refers but to congratulate the health and social care leadership on the progress they have made with their fund and on the above-average satisfaction ratings that have been achieved in Plymouth.
Yes, I am happy to meet in that context. The right hon. Gentleman is right that the Success regime is about a transfer of resources from the community hospitals to care at home and domiciliary care. That is not necessarily the wrong thing to do, but it must be done right, and I am happy to meet.
I welcome greater integration, but the Minister will be aware that there are grave concerns about the effect of cuts to social care on the NHS. More and more patients are spending greater time in more expensive settings in hospital when they could be better looked after in their own homes or in the community, but cuts to social care make that impossible. Will the Minister set out what appraisal the Government are making of the effect and the damage to the NHS of cuts to social care?
My hon. Friend is right: social care funding is tight. It is also true to say that those parts of the country that do the best in this regard—there are some that do considerably better than others—have integrated social care and health most effectively. On the budget itself, there is some disparity among different local authorities. About a quarter of local authorities have increased their adult social care budget by 5% or more this year.
Alcohol Consumption Guidelines
The scientific evidence for the UK chief medical officer’s low-risk alcohol guidelines is available on the gov.uk website. The guidelines were published in August, following testing through public consultation to ensure that the advice is as clear and usable as possible. We received 1,019 responses to the consultation.
For many people, drinking alcohol is part of their normal social lives, and we are perfectly clear that these guidelines are advisory. They are in place to help people make informed decisions about how they drink and decide whether they want to take fewer risks with their drinking. They are not designed to label everyone who drinks as a problem drinker or to prevent everyone who wants to drink from drinking, but I point out to the hon. Gentleman that Rochdale has more than double the number of admissions to hospital where alcohol is a factor than the best authorities in England.
Following on from that answer, will the Minister reassure the House that public health guidance given to consumers of alcohol is realistic and will not undermine responsible drinking campaigns, penalise responsible drinkers or damage the vital role that pubs play in our communities?
Campaigners on alcohol abuse have acknowledged the importance of the pub, which is a controlled sociable environment in which to enjoy a drink compared with the unrestricted supermarkets. Will the Minister have a word with her colleagues in the Department for Communities and Local Government who continue to preside over a system in which profitable wanted pubs are demolished and in which supermarkets are built on the site against the wishes of local communities?
The hon. Gentleman plays a very important role as chair of the all-party save the pub group and has been a dogged campaigner for the pub. We are very clear that social drinking is not the target of these low-risk guidelines. I am happy to meet and discuss this issue with my DCLG colleagues.
Sadly, very few people are aware of the link between alcohol consumption and obesity and of the long-term impacts of life-limiting diseases—not just cirrhosis. To ensure that the impact of obesity is integral to the alcohol consumption guidelines, will the Minister, on World Obesity Day, put tackling both adult and childhood obesity even higher up the Department’s agenda?
The hon. Lady is right to raise the hidden risks of alcohol consumption, which is exactly why a widespread analysis of the evidence was conducted through this guideline exercise. She is right to say that obesity should be a top priority for the Government. We will analyse her question and look into it.
PFI Health Projects
Between 1997 and 2010, 103 NHS hospital PFI schemes reached financial close, creating liabilities for the NHS of £77 billion. Three legacy PFI schemes have been signed since 2010 on stricter terms, with liabilities of £1.7 billion, and one scheme has been signed under the new PF2 model, worth £340 million. In nearly all cases, except for a few of the early schemes, ownership of the hospital reverts to the NHS at the end of the PFI contract. But even in those schemes, the NHS always has the first option on whether to end or continue with the contract.
The hon. Gentleman has a consistent track record in opposing PFI, even when the vast majority of the schemes were put under contract by the Government of which he was a member—so I will not take any lectures from him about how to deal with PFI. We will continue to use the new stricter terms as and when appropriate.
The National Audit Office concluded that the PFI contract for the Norfolk and Norwich hospital was a bad deal for the taxpayer and for the NHS, yet last year Octagon Healthcare made a record profit as the Norfolk and Norwich’s finances sank ever further into the red. Will the Minister consider making a formal approach to Octagon Healthcare to ask it to forgo part of its profit to help confront the enormous financial black hole that the trust faces?
We have provided access for seven of the worst affected trusts with obligations under PFI to a support fund of some £1.5 billion to help them with those obligations. I am not sure whether Norfolk is one of them; I suspect that it is not. I would be happy to talk to the right hon. Gentleman about this, but rather than raising his hopes inappropriately I have to say to him that many of the schemes are too costly to divert resource to pay them off completely.
Clinical Commissioning Groups: “Five Year Forward View”
The “Five Year Forward View” will be delivered through sustainability and transformation plans which are currently being developed by clinical commissioning groups in collaboration with local authorities and providers. NHS England expects that all STPs will be published, although in some areas discussions are already taking place.
I am led to understand that in Wycombe we should expect no dramatic changes and possibly no publication of a strategic plan. Does my hon. Friend agree that public confidence would be much enhanced by the clear articulation in public of a strategy for meeting the “Five Year Forward View”?
I agree with my hon. Friend, and I will try to give a clear answer. NHS England is determined that all 44 areas will publish their plans shortly. For those that have not already done so, publication will take place after the formal checkpoint review at the end of October. Areas are working to different timescales, but the plans will all be published by the end of November. For the avoidance of doubt, that includes the STP for Buckinghamshire, Oxfordshire and Berkshire West.
The NHS “Five Year Forward View” called for a radical upgrade in prevention and public health. How does the Minister square that with the Government’s subsequent cuts to public health, including £200 million in-year cuts and further cuts expected by 2020?
Wantage community hospital in my constituency has recently closed because of the threat of Legionnaires’ disease, and it will not reopen until we have finally concluded consultation on the sustainability and transformation plan—if it reopens at all. This consultation has been delayed, and that naturally worries my constituents. Will the Minister join me in urging Oxfordshire to get on with consulting on this very important plan, so that we can have a reasonable discussion?
May I congratulate the Minister on his appointment to the Front Bench, as well as the Under-Secretary of State for Health, the hon. Member for Oxford West and Abingdon (Nicola Blackwood), on hers? I am sure that they will do a terrific job in their posts.
As a type 2 diabetic, I am very concerned about the fact that local clinical commissioning groups are just not providing information on preventive work against diabetes. Will the hon. Gentleman confirm that diabetes will be referred to once these plans have been published?
I will confirm that. There is a national diabetes plan, as the right hon. Gentleman will be aware. Diabetes is one of a number of long-term conditions in which these plans are charged to deliver improvements, and it would not be acceptable for a plan to be signed off or completed unless progress on diabetes had been made.
When the Minister looks at new treatment options in the forward view, will he consider the example of Velindre NHS Trust in south-east Wales, which treats 1.5 million cancer patients every year and is now using reflexology, reiki healing, aromatherapy, and breathing and relaxation techniques to alleviate anxiety, pain, side effects and symptoms? If that was more widely spread over the health service in England, cost savings and patient satisfaction would increase.
Central to the aim of the five year forward plan for the NHS is a sustainable health service in which all patients receive the right care at the right time in the right place. With that in mind, can the Minister tell me what action he is taking to address the problem of delayed hospital discharges, which have risen by 20% so far this year? That amounts to an additional 926 people every day condemned to stay in hospital longer than is medically necessary.
First, may I welcome the hon. Lady to her post and wish her luck in the new job? There has been an increase in delayed discharges in England over the past year. Only a part of that increase is due to difficulties in the integration between social care and the NHS—a large part of it comes from within the NHS itself—but it is not uniform across local authorities. Indeed, many local authorities are improving in this regard. What is very clear is that those making the most progress the most quickly are those that have gone furthest in integrating social care and healthcare.
The Department of Health has commissioned three separate reviews on the diagnosis, treatment and transmission of Lyme disease. The work will be carried out by the epicentre of University College and be clinically driven and evidence-based, and it will be published in late 2017.
Although I am delighted that the Government are looking into this serious and important disease, as the reviews progress thousands of people contract Lyme disease each year, particularly in areas such as Wiltshire, and they can receive inadequate treatment, so will the Minister look into speeding up these reviews?
It is fair challenge that this work is high priority, and we need to go as fast as possible, but we are working with research teams. The work will be trial-based and needs to be as definitive as possible. In the meantime, early diagnosis is the key way to make progress. Public Health England continues to work with GPs and the public on it.
My mother recently died of motor neurone disease. In some areas of my constituency, there are 13 sufferers per 10,000 people, whereas the UK average is two per 100,000. Will the Minister please agree to meet me and representatives of the Motor Neurone Disease Association to discuss how the UK Government could lend their weight to combating this awful and debilitating disease?
Bearing in mind that cases of Lyme disease have quadrupled in the past 12 years, and that some of those cases have been in my constituency of Strangford in Northern Ireland, what has been done with the devolved Assemblies in the United Kingdom of Great Britain and Northern Ireland to ensure that a UK-wide strategy is put in place to address this trend and to provide effective diagnosis and treatment?
The principal thing that we need to do with Lyme disease is to make progress on diagnosis, treatment and transmission through a definitive approach. When the results of the study that I mentioned are published, of course they will be available across all parts of the United Kingdom.
I agree with my hon. Friend that this is an important area. In his report earlier this year, Lord Carter identified potential annual savings of £700 million from reducing the variation in procurement performance between providers. We have announced a first tranche of 12 standardised products for all NHS providers to use; this will boost procurement volumes and bring about economies of scale, securing lower prices. These initial products, including commodity items such as gloves and needles, cover £100 million of trust spending. We expect this to result in savings of up to 25%.
Innovative private sector suppliers have successfully partnered with the NHS since its inception, and it is quite right to say that for that relationship to be sustainable, those suppliers must make a profit. However, does the Minister agree that rogue companies that exploit the NHS’s lack of commercial expertise could be named and shamed, because they are making a lot of money at taxpayers’ expense?
We believe that the right approach to securing procurement savings is to take advantage of the immense amount of data available across the NHS. That is why we have set up the purchasing price index benchmarking tool. Data on more than £8 billion of expenditure, covering over 30 million separate procurement transactions, has been collated and will be analysed. We will use that information judiciously to save the taxpayer money. We think that that is the right way to start, rather than naming and shaming.
I urge the Minister, when thinking about national procurement and national commissioning, to look at the national strategies that can underpin them—for example, at why we need to renew the national stroke strategy. Some 100,000 people a year suffer a stroke, and nearly 1 million people in this country have had a stroke. They care very much about rehabilitation and other services.
I am grateful to you, Mr Speaker, for drawing the hon. Gentleman’s attention to the fact that the topic is procurement. The hon. Gentleman is right to highlight the fact that we have looked at an acute heart treatment strategy. We are creating centres of excellence across the country to ensure that if people suffer from an acute heart incident or a stroke, they are treated by the specialists who will give them the best prospects for recovery.
Hospitals in Special Measures
In the last four years, 29 trusts have been put into special measures; that is more than one in 10 of all NHS trusts. Of those, 12 have now come out, having demonstrated sustainable improvements in safety and quality of care. There are nearly 1,300 more doctors and 4,200 nurses working in trusts that have been put into special measures.
The Secretary of State will be aware because he visited it last year, that the Queen Elizabeth hospital in my constituency has come out of special measures. It has made excellent progress, not least by introducing Saturday lists for in-patients and putting in place numerous measures to transform the out-patients department. Will he join me in paying tribute to all staff of the hospital, particularly the chief executive, Dorothy Hosein, and the chairman, Edward Libbey, for the excellent progress that they have made?
I am very happy to do that, and I very much enjoyed my visit to the QE with my hon. Friend a couple of years ago. This is a very good example of how trusts can be transformed when they go into special measures. Since coming out of special measures, the QE has opened a state-of-the-art laparoscopic theatre, got a dedicated breast unit, and expanded its A&E. It has got 72 more nurses over the past few years. It is a good example to many other trusts in special measures, and it shows that that really can be a turning point, bringing about benefits for patients and staff.
The problem is that many trusts are still in a financial mess and have a deficit. If hospitals and the wider health service are to solve that, they need more funding, and councils, too, need funding for care. What is the Secretary of State doing to fight for more funding for his Department to ensure that we deal with those problems properly?
The hon. Gentleman will have noticed that in last year’s spending review the NHS got the biggest funding increase of any Government Department. We have committed to the NHS’s own plan, which asks for £10 billion more a year during the course of this Parliament in real terms. However, I do not disagree that there are still very real financial pressures in the NHS and particularly in the social care system. The trusts that are delivering the highest standards of care are those with the lowest deficits. Delivering unsafe care is one of the most expensive things people can do, which is why this is an important agenda.
The Secretary of State will know that in my own area of Calderdale and Huddersfield there is a dreadful situation for the trust that has been caused by the behaviour of the clinical commissioning group and the way in which it procures. He has received a large petition from thousands of people in the Huddersfield area about the closure of the A&E. Will he look at that seriously and intervene, because the competence of local CCGs is not up to the mark?
I am well aware of that issue and have received a number of representations from hon. Members on both sides of the House. There is a mechanism by which these issues end up on my desk—they have to be referred by a local council’s overview and scrutiny committee and then I get an independent recommendation—but I will look at this carefully if that process is followed.
To cope with rapid population increases in my constituency, Basingstoke has advanced plans to build a critical treatment hospital and cancer centre, with the support of more than three quarters of the population. Does my right hon. Friend expect sustainability and transformation plans to provide clear, timely direction on plans for this new model of care in the community?
I can absolutely reassure my right hon. Friend on that. One of the main purposes of STPs is to make sure that we deliver our cancer plan, which will introduce a maximum four-week wait between GP referral and ultimate diagnosis. If we get it right, that might result in around 30,000 lives a year being saved, so this is a big priority for every STP.
NHS Staff Recruitment and Retention
I join the Secretary of State in welcoming the dedication and commitment of everyone who works in the NHS. We are taking active steps to encourage more people to become doctors, nurses and support staff. Only last week, my right hon. Friend announced a commitment to recruit an additional 25% of doctors to train in the NHS, which is 1,500 more doctors on top of the 6,000 currently trained every year.
Net temporary and agency staff expenditure has risen by 40% since 2013. It accounted for 8% of total staff expenditure in 2015-16, which equates to £4.13 billion. Does the Minister agree that rising agency costs point to a recruitment crisis, and will he make a statement to the House outlining his plans to address that crisis?
We recognise, absolutely, that bills for agency staff have become unsustainable, which is why we have taken deliberate action, including by introducing price caps on hourly rates last November, which has had a significant impact on reducing agency costs. In the year to date, agency costs are some £550 million less than they were last year.
I can reassure my hon. Friend that there is considerable excess demand from UK-based students to train to become a clinician in this country—only half of those who apply to train in medical school are accepted at present—so we are confident that there will be plenty of take-up for those extra places. With regard to clinical placements, we are in discussions with universities, colleges and teaching hospitals to ensure that there are adequate numbers of places.
I welcome the 25% expansion in medical student places, but I reject tying that to the elimination of 25% of overseas doctors who currently work in our NHS. With 10% of posts unfilled and ever-rising patient demand, the Secretary of State must know that we will always need international graduates in the future. Does he not recognise that he is creating unrealistic expectations and conflict with this idea of a British-only medical service?
I am grateful to the hon. Lady for giving me the opportunity to set the record straight and stop this scaremongering, which is undoubtedly unsettling many of the very valuable doctors, nurses and other foreign nationals who are currently providing vital services to the NHS. Last week’s announcement was about adding more doctors to be trained who are UK-based. We are not changing any of the present arrangements for international students being trained here, or doctors and nurses working here.
Staff shortages this summer led United Lincolnshire Hospitals NHS Trust to introduce a temporary closure of Grantham A&E, causing huge concern to my constituents. Will the Secretary of State agree to meet me and Jody Clark, the founder of a local campaign group, to discuss how we can resolve this unacceptable situation?
I am well aware, from representations made by my hon. Friend and other neighbouring MPs, of the concerns that that has caused locally. The Secretary of State has already indicated to me that he does intend to meet my hon. Friend and campaigners in due course.
The Minister says that no rhetoric or scaremongering was used last week. Can he explain to the House what the Prime Minister meant when she said:
“there will be staff here from overseas in the interim period until the further numbers of British doctors are trained and come on board in terms of being able to work in our hospitals”?
What did that mean? What should we expect next—ambulances plastered with “Go home” slogans?
That is exactly the kind of ill-judged remark I have been talking about, and I am surprised that the hon. Gentleman has used it in his first appearance in his new post. By the way, I congratulate him on that new post, but I very much hope that he will use more measured language in the future, rather than spreading that kind of inappropriate rumour. The interim period referred to is the period during which doctors will be trained. We will not get new doctors coming in under the increased allocation until 2023, and during that time we will clearly need to use all measures to ensure that we fill the spaces that I acknowledge we have across several of our hospitals.
I appreciate the Minister’s warm welcome, and I can tell him that I am very much looking forward to shadowing the Secretary of State, but his comments on ill-judged remarks should be directed at the Prime Minister, not me. We have seen 8,000 fewer nurses, student nurse bursaries are set to be cut, there is a reliance on agency staff and a failure to train enough doctors, and now, after six years in office, the Government are talking about self-sufficiency. Given the concerns that these plans do not go far enough, will the Minister tell us what steps he will take to ensure that no staff from the EU lose their jobs, and will the NHS still be able to recruit from the EU if necessary post Brexit?
Health Ministers have been very clear about reassuring all the 53,000 EU citizens working in our NHS that their roles are secure. Regarding clinicians, I remind the hon. Gentleman that, although we have some vacancy rates, which are acknowledged, we now have 7,800 more consultants employed in the NHS than in May 2010, 8,500 more doctors than in May 2010, and over 10,500 more nurses working on our wards. We have gone through a very consistent policy of recruiting more people to work in the NHS under this Government.
The independent cancer taskforce highlighted the report “Saving lives, averting costs”, which identified cost savings resulting from earlier diagnosis, in particular for colon, rectal and ovary cancers. We have committed to a further £300 million for earlier diagnosis, one major product of which will be the 28-day diagnosis standard to which the Secretary of State referred earlier.
In welcoming the Minister to his post, may I highlight evidence to show that early diagnosis, in addition to making for better survival rates, offers substantial cost savings? Colon cancer costs £3,000 per patient per year to treat at stage 1, compared with over £12,000 if it is diagnosed and treated at stage 4. We have a shortage of health economists in the NHS, so will the Minister go further and actually commission a study to look at this issue on behalf of the taxpayer, because it requires further detail?
We agree that early diagnosis saves lives and can lead to cost savings. Just as an example, we know that GP referrals are up by 91% since 2010—an additional 800,000 people are getting early diagnosis—and we are beginning to see the results of that coming through in the one-year survival figures. On my hon. Friend’s specific point about further study, Public Health England and Macmillan have commissioned recent studies on modelling, one part of which will be on the cost impact of earlier diagnosis, and we look forward to seeing the results of those studies.
GPs play a central role in the early diagnosis of cancer. In the 1990s, Sunderland was one of the most under-resourced areas in England in terms of the GP workforce, and we now face a similar and growing problem, even though action was taken then. Will the Minister set out how he intends to make sure not only that we train more family doctors, but that they are encouraged to work in areas where there is an acute shortage?
We are training 3,250 extra GPs every year, and we have a target of 5,000 additional doctors working in general practice by 2020. However, as well as new GPs, we must do much better with retention. That means keeping the GP population that we have, and there are a number of steps that the Government are taking to do that. On the specific point about Sunderland, there is a bursary scheme that is aimed at attracting GPs to areas where they may not necessarily have wished to work previously.
NHS Efficiency Savings
In 2010 a target was set by NHS leaders to make £20 billion of efficiency savings by 2015 in order to make more funds available for treating patients and to allow the NHS to respond to changing demand and new technology. Under my right hon. Friend’s inspirational leadership as a Health Minister, the NHS broadly delivered on this original challenge, reporting savings of £19.4 billion over this period. All these savings have been reinvested into front-line NHS services.
As Members would imagine, I warmly welcome that answer from the Minister. Would he confirm that those savings were achieved through greater efficiency and effectiveness in the delivery of care and by cutting waste in the NHS that occurred between 2002 and 2007? Can he confirm that the benefit of that achievement to the NHS is that not a single penny of those savings goes to the Treasury, but is reinvested in the NHS and front-line services?
My right hon. Friend managed to include several questions in his impressive supplementary. I can confirm that much of the waste that took place in the years he cited—2002 to 2007—related to projects of the previous Labour Government that they themselves then cancelled, such as the IT project. I can also confirm that savings generated in the NHS are kept in the NHS. Lord Carter, whose report I referred to earlier, has identified £5 billion of efficiency savings, which we hope to deliver during this Parliament.
There is a distinction to be drawn between realistic efficiency targets and systematic underfunding. Only last month, Simon Stevens told the Public Accounts Committee that for three of the next five years
“we did not get what we originally asked for”.
Chris Hopson, chief executive of NHS Providers, also said last month that
“we’ve got a huge gap coming… it’s the chairs and chief executives on the front line…who are saying they cannot make this add up any longer.”
On funding, the Government keep saying that the NHS is getting all that it has asked for; those actually running the NHS say something quite different. Who is right?
Tragically, suicide is now the biggest single cause of death in men under 50. There are 13 suicides every day, of which three quarters are men. I am currently reviewing our suicide strategy to make sure we leave no stone unturned in trying to reduce the totally unacceptable level of these tragedies.
Yesterday marked the launch of the mental health awareness and suicide prevention campaign called “It takes balls to talk” across Coventry and Warwickshire. The campaign is a public information programme targeted at male-dominated sporting venues, which aims to direct men to help and support when they need it to promote positive mental health and reduce the incidence of male suicide. With suicide being the single most common cause of death in men under 45, will the Secretary of State take the opportunity to welcome and support this important new campaign?
I am happy to do just that. I would like to thank the hon. Lady for bringing up this very important and difficult issue. We are making progress in reducing suicide rates, but we can do an awful lot better. The thing that troubles me most is that nearly three quarters of people who kill themselves have had no contact with specialist NHS mental health services in the previous year, even though in many cases we actually know who they are because, sadly, most of them have tried before. I am very happy to commend the “It takes balls to talk” campaign. She may want to put the campaign in touch with the national sport mental health charter, which is another scheme designed to use sport to try to boost the psychological wellbeing of men.
A recent survey showed that one in four members of the emergency services experienced mental health problems, and that a number of them experienced suicidal thoughts. What is the Secretary of State doing to protect our vital paramedics and other ambulance staff, and to ensure that they get the support they need in dealing with absolutely appalling situations?
Again, I thank the hon. Lady for raising that. She will be pleased to know that the NHS has introduced a scheme, backed with funding, to encourage NHS trusts to look after the mental wellbeing of their own staff. I particularly want to pay tribute to the courage of people who work in the air ambulance service, because they see—day in, day out—some of the most difficult and distressing cases. They have to cope with the pressure of that when they take it home every day, and we all salute them.
Elderly Patients (Care Support)
Every patient discharged from hospital into a care home should have a care plan or discharge assessment. This should include a clear assessment of their needs, covering transport, carers, GP notification, medication and, where necessary, clothing requirements.
I have been approached by a number of constituents concerned about cases of elderly and vulnerable people who have been discharged from hospital straight into care homes, often without any basic personal effects or clothing because their family cannot or are not willing to supply them. Does the Minister recognise this, and what can the Government do to tackle it?
As I said earlier, there is a national process in the form of the care plan. Where the family is not able to or will not provide support, typically the voluntary sector is asked to do so. If that does not work, local authorities can increase the personal expenses allowance to provide clothing. I am interested to hear about the cases that my hon. Friend mentions in his constituency, and I am very happy to talk to him to understand better why the process has failed there.
Last week, I announced plans to make the NHS self-sufficient in the supply of newly qualified doctors by the end of the next Parliament. We recognise the brilliant work that is done by the many outstanding overseas doctors who work in the NHS and have made it clear that, whether or not they are from the EU, we wish that work to continue post-Brexit. However, as the fifth largest economy in the world, Britain should be training all the doctors it needs. While there will always be beneficial exchanges of doctors and researchers between countries, we have a global obligation to train enough doctors for our own needs, otherwise the inevitable consequence will be to denude poorer countries of doctors whose skills are desperately needed.
Thornbury health centre is crying out for redevelopment to cater for the growing local population. Will my right hon. Friend meet me, representatives of the health centre and NHS Property Services to see how we can take a co-ordinated approach that will move the health centre forward?
I can do better than that, because I have said that I am prepared to go to the health centre. I remember a very good visit to Thornbury community hospital during the general election campaign. I understand what those at the health centre are trying to do and they are absolutely right to be thinking about how they can improve out-of-hospital services.
Will the Secretary of State look into the creation of a sideways move for a chief executive of a trust that was criticised for failing to investigate patient deaths? Six weeks after the special recruitment exercise by Southern Health, Katrina Percy has resigned from her advisory role, with a substantial 12-month salary payoff that has been signed off by the Department of Health and the Treasury. The campaign group, Justice for LB, has called that “utterly disgraceful” and I agree. Will the Secretary of State investigate?
I agree with the hon. Lady that the way this case was handled was by no means satisfactory. The truth is that it took some time to establish precisely what had gone wrong at Southern Health. As this House knows, because we made a statement at the time—I think it was an urgent question, actually—there was a failure to investigate unexplained deaths. I do not think the NHS handled the matter as well as it should, but we now have much more transparency and we do not have a situation where people go on and get other jobs in the NHS, which happened so often in the past.
My hon. Friend is right to highlight the fact that the London ambulance service is in special measures and has been for some time. I visited it this summer and am pleased to confirm that some £63 million of additional funding has been provided to the ambulance service since April 2015. The service is starting to make significant inroads in increasing the number of paramedics who are available on call, with some 250 more being added over the last couple of years.
It is clearly unacceptable if the situation that the hon. Lady sets out is the case. I am happy to meet her and work with her to take the action that is needed to make things better.
I am very happy to do that. My hon. Friend is right to highlight the fact that the provision of mental health services to children is one of the biggest weak spots in NHS provision today. It is an area that we are putting a big focus on. I would be happy to talk to her about the situation in her constituency.
I have made it clear that we should all be working together to defeat cancer. We know that the best way of doing so is early diagnosis. We have made a lot of progress on that in England over the past few years but have a lot further to go. We are of course willing to talk to the devolved Administration about what they can learn from us—and perhaps vice versa.
This is a very difficult area, but decisions on priority are clinically driven and must continue to be based on peer-reviewed data. The most recent review determined that less than one third of second transplants would result in survival after five years; that is why they were not funded. There will, however, be a further review next April, and to the extent that the data have changed there will be a new evaluation at that time.
The Conservative candidate in the Witney by-election will be saying very clearly that because of the extra funding from this Government we are aiming to have 5,000 more doctors working in general practice by the end of this Parliament, something that would not have been possible with the increase of less than half that amount promised by the Labour party.
I am grateful to my hon. Friend for raising baby loss awareness week. I am sure that, along with other hon. Members, she will be participating in the Backbench Business debate on that later this week. In February the independent maternity review, Better Births, made a number of recommendations, including on neonatal critical care. We are studying those recommendations and are due to report initial findings from our work in December.
I listened very closely to the Secretary of State’s comments earlier on mental health. On 9 December he stood at that Dispatch Box and said that
“CCGs are committed to increasing the proportion of their funding that goes into mental health.”—[Official Report, 9 December 2015; Vol. 603, c. 1012.]
However, my research shows that 57% of clinical commissioning groups are reducing the proportion they spend on mental health—yet another broken promise. When will we have real equality from this Government for mental health?
I will tell the hon. Lady what this Government have done. We have legislated for parity of esteem for mental health. We are treating 1,400 more people every single day for mental health conditions compared with six years ago. We have a new plan that will see 1 million more people treated every year by 2020, including a transformation of child and adolescent mental health services. That is possible because we are putting into the NHS extra money that her party refused to commit to.
My hon. Friend is absolutely right. I find it extraordinary that the Labour party said that our plan to train more doctors was “nonsense”. We currently have 800 doctors in the NHS from Sri Lanka, 600 from Nigeria, 400 from Sudan and 200 from Myanmar. They are doing a brilliant job and I want them to continue doing that job, but we have to ask ourselves whether it is ethical for us to continue to recruit doctors from much poorer countries that really need their skills.
I was alarmed to read at the weekend that NHS chiefs are warning that hospitals in England are on the brink of collapse. Is it the Government’s intention to cut the public supply of healthcare in order to create demand for a private healthcare system, or will they give the NHS the additional funds it needs?
Let me remind the hon. Lady that the party that introduced the most outsourcing to the private sector was her Labour Government under the previous Health Secretary, Alan Milburn. Our view is that we should be completely neutral as to whether local doctors decide to commission their care from the public sector or private sector. We want the best care for patients.
I welcomed last week’s NHS Improvement report which states that there are now sufficient staff for Chorley and South Ribble hospital’s A&E department to reopen, but I am dismayed that the trust is delaying the reopening until January next year. Will the Minister reassure me that he will work with me and other stakeholders to oblige the trust to open as soon as possible?
My hon. Friend has been a doughty champion of Chorley, in combination with another Member of the House and local campaigners, who visited the Houses of Parliament yesterday to meet local MPs. While welcoming the reopening of the A&E from January, I am happy to continue to work with my hon. Friend to see whether it can be brought forward.
I heard the Minister’s response earlier. He was of course right that sustainability and transformation plans are led locally, but he failed to acknowledge that the Government have given a mandate to make cuts attached to STPs. Without consultation, my local hospital has been downgraded. What on earth will the Secretary of State say to my constituents who may lose loved ones because they have had to travel miles further to another hospital?
If I may, I will give a quote:
“To reshape services over the next 10 years, the NHS will need the freedom to collaborate, integrate and merge across organisational divides.”
That comes from the 2015 Labour manifesto. The STP process is designed to bring about better care and health, and better productivity. We should be critical friends of the process because we all want a better national health service.
Local health commissioners have concluded that Telford’s brand new women and children’s centre, which serves some of the most deprived populations in the country, should be closed and moved to a more affluent area where health is better than the national average. The commissioning process has lost the confidence of local people. Will the Secretary of State intervene and ensure that local health commissioners fulfil their legal duty to reduce health inequalities?
I thank my hon. Friend for standing up for her constituents—it is absolutely right that she should do so. She would agree that that has to be a local matter led by commissioners locally, but she can be reassured that we are always watching what is happening to ensure that people follow due process, and that the results of any changes proposed benefit patients as intended. I will therefore watch very carefully what is happening in Telford and in Shropshire more broadly.
About half a dozen times in the last hour, the Secretary of State has bragged about the extra money he is putting in to the national health service, so why is Bolsover hospital, like many others that have been referred to in the past half hour, due to close? Why are neighbouring hospitals in countless constituencies in Derbyshire closing? Why does he not use some of that money to save the Derbyshire hospitals?
The extra money we are putting in to the NHS is going to better cancer care, better mental health care and better GP provision—it is going to all the things that Members on both sides of the House know matter. It will also mean that we can support our hospitals better. With our ageing population, we will continue to have great demand for hospital care, but the best way to relieve pressure on those hospitals is to invest in better out-of-hospital care, which has not been done for many years.
Kettering general hospital is treating a record number of patients with increasingly world-class treatments, yet despite being located in an area of rapid population growth, due to an historic anomaly, the funding for the local clinical commissioning groups is among the worst in the country in relative terms. What can Her Majesty’s Government do to correct that?
I am happy to look at that particular funding issue for my hon. Friend. I know that Kettering hospital is under a great deal of pressure. The one thing that it could do to relieve its financial pressures is to look at the number of agency and locum staff that it employs. As with many hospitals, there are big savings to be made in that respect in ways that improve rather than decrease the quality of clinical care.
The Secretary of State will be aware that the Public Accounts Committee has questioned both the Department of Health and NHS England on the parlous state of NHS accounts this year, following the comments by the Comptroller and Auditor General. It is clear that STPs are the only plan on the table. Will the Secretary of State make clear his support to the NHS to deliver the STPs in the teeth of opposition from his own Back Benchers? If he will not, what is plan B?
I do not recognise the picture the hon. Lady paints about opposition to STPs. We need to ensure we have good plans that will deliver better care for NHS patients by bringing together and integrating the health and social care system, and improving the quality of out-of-hospital plans. While we are in a period where those plans have not been published there will obviously be a degree of uncertainty, which we will do everything we can to alleviate, but she is right to say that these plans are very important for the future of the NHS. The process has our full support.
The Secretary of State will be aware of the concern in my constituency about the future of Paignton hospital, which prompted hundreds to turn up to a recent meeting. Does he agree with me that it is vital the clinical commissioning group, in publishing its plans, does not just publish what it will remove but the details of what it will replace them with?
Considerable efforts are going into sorting out some of the historical challenges in the provision of both acute and community care in Devon. I hosted a meeting for a number of colleagues who are concerned about this and I am happy to continue to engage with colleagues across the county.
Two years ago, Nottingham University Hospitals NHS trust privatised support services, including cleaning, handing them over to Carillion in an effort to save money. Since then there have been shortages of equipment, shortages of staff and an appalling decline in standards of cleanliness. Will the Secretary of State condemn Carillion for putting patients at risk? When will he ensure that hospital services in Nottingham are properly funded?
The decision on whether to outsource services must be a matter for local hospitals. I know that that hospital has been struggling with its deficit. I have been to visit the hospital myself and I know it has been trying very hard to improve clinical care. If the contract is not working and the quality is not right, I would expect the hospital to change it, but it must be its decision.
Point of Order
On a point of order, Mr Speaker. It is rather frustrating to hear Ministers and some Back Benchers continually referring to the Government having invested, or intending to invest, £10 billion into our NHS over the course of this Parliament. You may be aware, Mr Speaker, that I sit on the Health Committee. I would like to read you the following extract from a report:
“Last year’s Spending Review announced that the NHS would receive an additional £8.4 billion above inflation by 2020-21. But whilst previous spending reviews define health spending as the whole of the Department of Health's budget, the 2015 Spending Review defines it in terms of NHS England’s budget, which excludes, for example, spending on public health”—
I am extremely grateful to the hon. Lady. She is nothing if not persistent and she has put that thought on the record. I say to her in all courtesy, however, that she is not the first person to do this—I probably did it myself in the very distant past—and I do not suppose she will be the last. It is a very interesting point, but it is a continuation of debate. There is no matter for the Chair here. For that reason, and that reason alone, I must ask her to desist at this stage, but I have a feeling she will find ingenious ways of returning to her point on other occasions.
Perhaps we can leave it there, because we are short of time and I want to proceed. Unless there are further points of order—I am not exactly looking for them—then we will come on to the ten-minute rule motion. I call Conor McGinn.
Unlawful Killing (Recovery of Remains)
Motion for leave to bring in a Bill (Standing Order No. 23)
I beg to move,
That leave be given to bring in a Bill to establish a presumption against eligibility for parole in cases where a person, convicted of unlawfully killing another person, has not provided relevant knowledge in their possession for the purposes of facilitating the location and recovery of the remains of the victim; to create a separate offence of withholding such information; to make provision about the available sentences for such an offence; and for connected purposes.
For a parent to suffer the anguish of losing a child is beyond words, but the horror of having such a loved one murdered is surely too awful even to contemplate, so it is harder still, if even possible, to imagine the pain of being denied the chance to hold a proper funeral and lay that loved one to rest. My constituent Marie McCourt does not need to imagine it, because for 28 years she has been forced to endure what she describes as the special kind of torture of knowing she could die without ever discovering where her daughter’s body is or being able to lay her daughter to rest with the dignity she deserves.
Marie’s daughter Helen was murdered at the age of just 22 by Ian Simms in February 1988, as she travelled home from work in the village of Billinge in my constituency. In a landmark conviction, he was found guilty of murder based on overwhelming DNA evidence, even though Helen’s body was not found. For almost three decades, Marie has been tormented because he refuses to reveal what happened to her daughter’s body. Despite this brutal act of callousness and lack of remorse, he could soon be released from jail. This is not the justice that Marie and her family deserve. Killers who inflict this kind of suffering on their victims’ families should not be released on parole. That goes to the heart of the Bill I am bringing forward today.
Before I continue, I want to say something about Marie. She had Helen taken from her in the cruellest circumstances, only to be denied the sacred right to bury her daughter. Few could have found the strength to carry on, let alone mount such a formidable campaign to have the law changed so that others do not suffer in the way she has suffered. Her quiet dignity and powerful determination are an example to us all.
Our campaign for Helen’s law, led by Marie, calls on the Government to introduce a “no body, no parole” policy for murderers. The online petition has already attracted the support of over 340,000 signatures, and in February I was honoured to accompany Marie to No. 10 Downing Street to present the petition. The Government responded to the overwhelming public support for the campaign by asking the Parole Board to review the guidelines around convicted murderers. We await the outcome of that review, which is at least welcome progress, but as Marie has so eloquently and repeatedly said, this campaign is not just about her or Helen; it is about ensuring that others who find themselves in such horrific circumstances do not have such added pain visited on them.
Just yesterday, the Home Office revealed to me that since 2007 alone there have been 30 murders in England and Wales where no body has been recovered, but as it currently stands the English legal system does not require a convicted murderer, at the end of their determined tariff, to admit guilt or reveal the location of a victim’s remains before being released. Marie believes that if parole is granted to Helen’s killer, her hopes of finding her daughter will never be realised. As I have said, she is also determined that no other family should have to live that ordeal.
My Bill seeks to acknowledge, and in some cases mitigate, the pain and distress caused to the families of missing murder victims. There are three main elements to it: first, denying parole to murderers for as long as they refuse to disclose the whereabouts of their victim’s remains; secondly, passing a full-life tariff, denying parole or release, until the murderer discloses the location and enables the recovery of their victim’s remains; and thirdly, applying the rarely used common-law offences in murder trials without a body of preventing the burial of a corpse and conspiracy to prevent the burial of a corpse, disposing of a corpse or obstructing a coroner. In essence, the proposals are simple: if a convicted killer refuses to give information to reveal the location of a victim’s body, they should not be considered eligible for parole and they should stay in prison. The proposals would effectively mean a whole-life tariff for murderers who refuse to disclose the location of their victims and enable their remains to be recovered to give families a chance to pay their last respects.
Let me be clear: the modern system of parole is widely understood to involve a prisoner earning their conditional release through good behaviour. I believe in and support the rehabilitative purpose of our penal system, but while the current tariff system for the most serious crimes reflects the consensus that the majority will at some point be able to rejoin society, one is bound to ask in what sense a murderer who is content to torment the family of their victims in such a way could ever have earnt their freedom.
In recent years, Parliament and the legal profession have begun to take the rights of victims more seriously, and I believe that this Bill would be a further step towards ensuring that victims are at the heart of our criminal justice system—where they should always be.
Let me make it clear that the proposals in the Bill would not affect any individual’s fundamental right to maintain their innocence. The law changes I propose would not impinge in any way on the rights of convicted killers to retain full access and full recourse to the appeals process. It is worth noting, however, that in the case of Helen McCourt’s killer, his guilt has only been further confirmed at every single appeals stage because of enhanced DNA evidence against him.
Let me also say that my Bill will have no impact on the work of the Independent Commission for the Location of Victims’ Remains in respect of those referred to as “the disappeared”; nor would it impact on arrangements set out in relation to sentencing for offences committed during the troubles or indeed any future arrangements on addressing the legacy of the past in Northern Ireland. I want to acknowledge, however, that the pain and anguish felt by the families of the disappeared are the same as for any family who has lost a loved one in such awful circumstances.
We are not alone in this country in seeking to find a workable legal solution. In Australia, “no body, no parole” laws have already been passed at state level and are being examined at federal level. Quite simply, the introduction of Helen’s law is the only chance that the McCourts and other families like them have of securing some peace and the justice they deserve.
I want to acknowledge some of the families who are visiting Parliament today to attend this debate. Sheila Dolton and her daughter Nina are here. Their son and brother, Jonathan, was murdered in 2004. The family has continually written to his killer, begging for information about the son’s body, but has received no reply. Sam Gillingham was just 16 when her mum, Carole Packman, disappeared from the family home in Bournemouth in 1985, while Tracy Richardson’s mum, Michelle Gunshon, vanished in December 2004 while working at the NEC in Birmingham. Sadly, this Bill comes too late for Winnie Johnson who went to her grave never knowing where Moors murderers Ian Brady and Myra Hindley buried her 12-year-old son, Keith Bennett. But there is still time for Marie McCourt and other grieving mothers such as Joan Morson and Jean Taylor who also saw their children’s killers go to jail without revealing where their victims’ bodies lay. Denying a final resting place is perhaps the last heinous act by killers who have no place in a civilised society. The agony and torment caused to those who cannot lay a murdered loved one to rest is incalculable.
The families of victims quite rightly expect the law to act in their favour, instead of seeing the justice system rewarding with parole killers who decide to remain silent. For those who have had to face the loss of a loved one at the hands of a callous murderer, there is nothing we can do to make up for their loss, but if there is a way to help them receive the justice they deserve, we must take it. If there is a way to compel those who have committed the most awful crimes to assist in this task, we must do it. Most importantly of all, if there is a way to ensure that no family has to endure the suffering that Marie McCourt and so many others have, we—in this of all places—have a duty to act.
Question put and agreed to.
That Conor McGinn, Tom Tugendhat, Mr George Howarth, Siobhain McDonagh, Tom Elliott, Vernon Coaker, Marie Rimmer, Nusrat Ghani, Sir Jeffrey M. Donaldson, Carol Monaghan, Diana Johnson and Mr Alan Campbell present the Bill.
Conor McGinn accordingly presented the Bill.
Bill read the First time; to be read a Second time on Friday 3 February 2017, and to be printed (Bill 73).
Aleppo and Syria
I beg to move,
That this House has considered the unfolding humanitarian catastrophe in Aleppo and more widely across Syria.
Thank you, Mr Speaker, for granting this emergency debate on the unfolding humanitarian catastrophe in Aleppo and more widely across Syria. Although it was I who moved the motion applying for the debate under Standing Order No. 24, it has the strong support of the all-party parliamentary group for Friends of Syria, particularly my co-chairman, the hon. Member for Wirral South (Alison McGovern), the hon. Member for Barrow and Furness (John Woodcock), and my hon. Friend the Member for Beckenham (Bob Stewart). I am most grateful to them for the work that they do in the all-party group.
I am particularly pleased to see that the Foreign Secretary is present. The whole House will be grateful for the importance that he attaches to the debate. He has written and spoken about Syria, and I know that it is a subject on which he feels strongly. We are very pleased that the House is to hear from him this afternoon on what I think will be his first debate as Foreign Secretary
Yesterday, Mr Speaker, you had a choice between a Standing Order No. 24 application for a debate on Brexit and another for a debate on Syria. Everyone in the House will know that you made the right decision, and you explained your reasons, but I now submit that the effects of the crisis in Syria on our children and our grandchildren will be every bit as great as the effects of Brexit. Today’s debate will be watched by many people: civil society across much of the world will take an interest in the tone and the view that the House of Commons adopts this afternoon, and that is a very good thing.
At about 10 o’clock this morning there was a series of further air raids on civilian areas in Aleppo, and there are already reports of yet further casualties, maimings and deaths. As we look back at the Syrian crisis over recent years, we see that, at every turn, progress towards a solution has, alas, eluded us. First, at a relatively early stage, there was the plan put forward by Kofi Annan, the former United Nations Secretary-General, who stated specifically that as Assad was part of the problem he would by definition be part of the solution. Kofi Annan believed that Assad should be part of the negotiations, but that was vetoed by the Americans, and indeed—alas—by the British Government. Now, many years later, we understand how important it is that Assad should at least be present at the initial negotiations. He is not going to be beaten militarily, in my view, and it is clearly right for him to be there for the early part of the negotiations, as the Syrian opposition accept. However, more time has been lost.
Secondly, there was Obama’s failure to stand by the red lines that he had clearly asserted on the use of chemical weapons. That was a disastrous decision, and one from which we will suffer in the future.
Thirdly, there was the failure to provide safe havens. Much of civil society believed in the importance of providing refuge for the—now—more than 5 million Syrian men, women and children who are on the move in Syria, having been driven out of their homes. Those safe havens could, with political will, have been set up in both Idlib, which is in the north of Syria, and Daraa, which is near the Jordanian border in the south. We could, as many people have advocated, have set up no-bombing zones, but we have not done so. Today, 5 million people in Syria and 6 million outside are on the move, often unprotected, unfed and unhoused. That is the reality: nearly half the country’s population of 22 million are on the move, either inside Syria or beyond its borders.
My right hon. Friend is making a powerful case. Does he agree that, militarily, there is no reason why we could not enforce a no-fly zone when so many people are being affected? The helicopters that are dropping barrel bombs could easily be brought down by rockets based in Turkey or Lebanon, or, indeed, by our own type 45s in the Mediterranean.
My hon. Friend knows far more about such military matters than I do. That is my understanding of the position: that a no-fly zone—and I will say more about this later—is perfectly feasible. It is a question of whether the international community has the political will to face down the Russians and the Syrian helicopters by setting one up.
Fourthly, there was the failure to secure unfettered access for the United Nations. It is unprecedented in recent years for those bent solely on looking after their fellow citizens to be unable to gain unfettered access to very dangerous zones. This gives me an opportunity to pay tribute to the extraordinary bravery of those who work in the humanitarian world, doing nothing other than try to assist their fellow human beings and bring them sustenance, help, medicine and support.
I shall come to that point as well, but let me say now that the whole purpose of the efforts of the International Syria Support Group—and those of other elements, under Staffan de Mistura—is to answer the question that my right hon. Friend has so eloquently posed.
The fifth failure lies in the surrounding countries, particularly Jordan, Lebanon and Turkey. Although they have acted heroically in dealing with the extraordinary number of people who have fled across the borders, often under gunfire, there has been a lack of support from the international community for countries whose populations have ballooned, given that one in three of the people in Jordan and Lebanon has fled from Syria. Britain has undoubtedly done her stuff. I am pleased to see that the Secretary of State for International Development is present; she can be extremely proud of the Department that she has inherited for the outstanding work that Britain has done in helping refugees in the surrounding countries—more, I might add, than has been done by the whole of the rest of the European Union.
My hon. Friend has made his point with great eloquence.
We are not using the opportunity—if I may put it in that way—to provide an education for the children in the camps, given that they at least constitute a captive audience. Every child in a camp in one of the surrounding countries should be receiving an education. There should be education and training, and, indeed, there should be opportunities for the countries that are receiving all the refugees to have free access to the European Union for their goods and services. That is not happening. Moreover, because some countries have failed to pay their dues to the United Nations in some of the camps, the children and adults there are receiving only half the rations that they should be receiving, and they are down to starvation rations at that.
I recently received a parliamentary answer from the Minister of State, Department for International Development, the hon. Member for Penrith and The Border (Rory Stewart), on the subject of air drops. He stated:
“The use of air drops to deliver aid is high risk and should only be considered as a last resort when all other means have failed”.
Does my right hon. Friend agree that it would seem that “all other means” have indeed failed?
Not in respect of the camp. On the basis of my knowledge of these matters, I think that my hon. Friend the Minister of State was right to say that air drops should be used only as a last resort, but clearly they should be used if we reach that point.
The sixth and final barrier to progress has, of course, been the reception of refugees in Europe, where there has not been proper processing. Many of these people have cast themselves into the hands of the modern-day equivalent of the slave trader in the hope of reaching a more prosperous and safer shore. I think that Europe as a whole—which, admittedly, has its inward-facing problems—has failed to address this problem adequately, and to show proper solidarity with Greece and Italy as they tackle a very severe problem.
There are only two ways in which this can end: a military victory by one side or the other, or through negotiation. I submit that there is no way in which a military victory will be secured by any side in Syria. We must therefore hope that the fighting stops as soon as possible in order to create the space in which negotiations for the future can take place. We have all seen the heroic work that has been done by Staffan de Mistura, and the backing provided to him and the International Syria Support Group is essential. I will say more about that in a moment. To bring about a cessation in fighting we need the influence of the United Nations, of the great powers and of the countries in the region who have influence over some of the protagonists, in particular Iran and the Saudis. Where a country is able to exercise influence to stop the fighting and create the space for politicians to engage, in Geneva and elsewhere, it is absolutely essential that it should do so.
I commend my right hon. Friend for securing this debate. Does he agree that the Russian military has a deep history with the Syrian military, and that it is in Russia’s gift to deliver a peace process? When we visited Russia as part of the Foreign Affairs Committee, the Russian politicians kept reminding us they wanted to be taken seriously by the whole world and that they were a serious power. In order to be taken seriously, however, they really should be following the rule of law and international law. They should not be aiding and abetting war criminals such as Assad.
My hon. Friend makes an extremely good point.
The extraordinary misfortune of timing that I mentioned is being exacerbated by international attention being elsewhere. In Europe, Brexit, the issues with the euro, Greece, the German banks and the focus on migration have all meant that the focus has been on the symptoms rather than the causes of this conflict. In the United States, politicians have turned in on themselves as the election approaches, and Obama has underwritten an isolationist approach. However, there are people such as Senator Lindsey Graham and Secretary Kerry who are seized of the importance of this moment in tackling what Russia is doing. Then of course there is Russia, to which my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi) has alluded. It is behaving like a rogue elephant, shredding international humanitarian law and abusing its veto powers in the UN Security Council. It is using the veto to protect itself from its own war crimes.
The right hon. Gentleman is making an incredibly compelling case. The situation in Aleppo is beyond appalling. Does he agree that our own Government should follow the example of the French in supporting a referral of Russia to the International Criminal Court? Also, I completely understand the case that he is making for a no-fly zone, but does he recognise the risks involved in establishing such a zone? How would he best protect against the risk of an expansion of the mission if it were not initially successful?
I shall come on to the hon. Lady’s second point in a moment. On her first point, I agree with her. The UN Secretary general called for such a referral only yesterday.
The attack on the convoy marked a new low, with 18 humanitarian workers killed, food and medicines destroyed and warehouses and medical facilities seriously damaged. We should be clear about what is happening in Aleppo. The Russians are not attacking military formations. They are not engaging with militias and fighters. They are attacking hospitals and a terrified population, which is now down from 2 million to under 250,000. People are hiding in the cellars and the rubble that is Aleppo today. Last week, the M10 underground hospital was attacked by bunker-busting bombs to break through its roof and by cluster bombs aimed specifically at harming and injuring individual people. The location of that hospital was known to every combatant. There is no doubt that attacking that hospital was an international war crime.
My right hon. Friend is making an incredibly strong case. When it comes to Russia, are we not living in some kind of parallel universe? On the one hand, we see the Russians dropping bunker bombs on hospitals. On the other, we are allowing them to come and trade in our country as though nothing was going on. Do we not need a general review of our relationship with Russia?
I join my right hon. Friend in supporting no-bombing zones, as well as aid drops in memory of our former colleague and my Yorkshire neighbour, Jo Cox. On the issue of no-fly zones, I served in the Royal Air Force on the no-fly zone over northern Iraq. Does he agree that one message we could send out from this House today would be that, using our E-3 Sentry AWACS reconnaissance aircraft, any war crimes perpetrated by air forces would be identified and logged, and that the perpetrators would feel the full force of the law as a result?
The right hon. Gentleman mentioned Guernica. In the 1930s, there was united condemnation of what the Nazis and their air force were doing in Spain in support of the fascist regime. Is it not time that we had a united, unambiguous, explicit, direct condemnation of what Putin is doing in support of Assad in Aleppo at this moment, not just from the Government but from the Opposition Benches unanimously?
I congratulate the right hon. Gentleman on securing this debate. His comparison with the actions of the Nazi regime and the League of Nations is very powerful. Is this not a warning to the United Nations that unless it fulfils its duties and faces up to the atrocities that Russia is perpetrating, it might well go the same way as the League of Nations did?
That is the very point I was making.
We should single Russia out as a pariah. Like any bully, the Kremlin craves relevance, and it is winning as long as no one stands up to it. Russia must be confronted for its attacks on innocent civilians, both diplomatically and using hard power including sanctions and economic measures. We must seek to build support for multilateral military action to discharge our responsibility to protect. This is not about attacking Russia. It is about defending innocent civilians. It is about basic humanitarian decency and protection from the kind of barbarism and tyranny we hoped we had consigned to the last century.
I completely concur with the right hon. Gentleman’s words about Russia and the atrocities that it is committing against the people of Syria, but should we not also look at this in the context of Russia’s previous actions in Ukraine and Crimea? Ought we not to remember that Russia as a state is increasingly out of control? It is not playing by the rules, and we absolutely have to confront its behaviour internationally.
The hon. Lady makes an extremely powerful point. We cannot do this alone. We must use Britain’s outstanding connections, not least through our diplomatic reach, our membership of NATO, our relationship with America and our centrality in the European firmament—Brexit notwithstanding.
I am most grateful to the right hon. Gentleman, not only for securing this debate but for allowing so many interventions. Would it not be appropriate for the Government to bring forward a debate asking this House to put forward its views on Russia’s behaviour not only in Aleppo but in previous situations? We need the Government to lead on such a debate, so that the House can send out the very clear message that we are watching what Russia is doing and will not forget what it is doing, and that, when it comes to it, we will see those responsible answering for their war crimes.
I think the hon. Gentleman would agree that, by having this three-hour debate today, we are moving some way in that direction.
I have a number of specific questions for the Foreign Secretary to address when he answers this debate. First, he has said that the UK is taking the lead on sanctions on Russia. Will he tell the House what steps the Foreign Office has taken towards increasing bilateral or EU sanctions on Russia itself? Secondly, there are plans for a new addition to the Nord Stream gas pipeline running from Russia to western Europe—Nord Stream 2—allowing Russia to bypass transit countries and, therefore, transit costs in eastern Europe. Will the Foreign Office be working with our east European allies to block the new pipeline?
I presume that we are talking about the gas pipeline that runs from Kurdistan through Turkey and the Black sea and bypasses Ukraine and the eastern provinces. The signing of that deal was agreed yesterday between Erdogan and Putin. A relationship seems to be building up between those two. Does the right hon. Gentleman have any view on that, because that movement of Turkey towards Russia is concerning?
The Foreign Secretary has recently been in Turkey. I am sure that the House will be interested in his comments.
My third question for the Foreign Secretary is, what work has been done to catalogue and record human rights abuses—both individual and collective—in Syria? Will he update the House on the work of the Foreign Office, which was started and commissioned by the National Security Council in 2011, to collect evidence that can be used in the future to hold human rights abusers to account no matter how long it takes?
Fourthly, what steps has the Foreign Secretary taken with his colleagues in the Ministry of Defence to explore the feasibility of imposing and enforcing a no-fly zone over specific areas in Syria? Does he agree that, with the use of naval and air assets in the eastern Mediterranean, it is entirely possible both to monitor and enforce a no-fly zone with our allies? What steps will he take to make it clear to the international community that a no-fly zone is a matter of will and not of practicality?
I have operated under a no-fly zone. It is practical and it can work, but it is quite difficult at a low level. That requires us to have seriously good surveillance over the target areas. If we have that, we can deal with it. We cannot have just a no-fly zone; we need good surveillance as well.
As one of the four Opposition Members who did not oppose military action on that fateful day in August 2013, I fully support any measure to impose a no-fly zone. I assure the Government that, if they were to bring forward such a proposal, I will vote with them, and I guess quite a lot of my colleagues will do so as well.
That is extremely welcome news both inside the House and outside.
I have one final point on the no-fly zone. Will my right hon. Friend make a specific point of meeting the former Prime Minister John Major to explore his experiences in imposing a no-fly zone and a safe haven in northern Iraq during the 1990s?
I thank my right hon. Friend for giving way and I congratulate him on securing this debate. Given the discussion that there is over a no-fly zone, does he share my concern that Russia has moved very advanced surface-to-air missile systems into Syria when clearly Daesh or the al-Nusra front do not have a fast-jet capability. At whom might those missiles be targeted?
My hon. Friend makes a good point, but those S-300 missiles do not affect the viability of imposing a no-fly zone.
My final question for the Foreign Secretary is, what steps are he and his Department taking to support and enhance the work of the International Syria Support Group? Staffan de Mistura has said that the suspension of bilateral negotiations between the two chairs, US and Russia, “should not and will not” affect the existence of the group. What steps is Britain taking to provide financial, diplomatic and political support to the International Syria Support Group? This group includes all of the five permanent members, Italy, Turkey, Japan, Iran, and the key Arab countries. It represents the UN, the EU and the Arab League. It needs to be greatly expanded. There should be an office, for example, working with and adjacent to the Geneva talks. It should carry out work on the key ingredients for a peace whenever that may come, and we should give very strong support to it.
May I add a question to the ones that the right hon. Gentleman has posed to the Foreign Secretary? He has spoken very powerfully. Members of the House have described Russia as a pariah. He has compared it with the Nazi regime of the 1930s. Is it not utterly ludicrous that, in two years’ time, the greatest sporting spectacle on earth—the World cup—will be held in Russia, but not a single country is pulling out of it? If we are really serious about sending a message to Putin that is heard on the ground, should we not be questioning whether the World cup should take place in Russia?
The hon. Gentleman makes an extremely good point. I hope that when he is considering sanctions, both economic and otherwise, the Foreign Secretary will have a view on that.
The international community faces a choice. Are we so cowed and so poleaxed by recent history in Iraq and Afghanistan that we are incapable now of taking action? Was all the international handwringing after Rwanda, Bosnia and Srebrenica when we said “never again” just hot air? Is all the work on the responsibility to protect—RtoP—which was unanimously adopted by the United Nations Security Council and agreed by the entire international community just so many words? Let us at least be clear here among ourselves. We have a choice: we can turn away from the misery and suffering of children and humanity in Aleppo; we can once again, on our watch, appease today’s international law breaker, Russia, and continue to find eloquent excuses for inaction; or we can be seen to take a lead to explore the situation energetically and with determination with our allies in NATO, Europe, America, and the United Nations and refuse to take no for an answer. We can look at every possible way of ending this barbarism and this tyranny, which is threatening the international rules-based system, destroying international order and engulfing the Syrian people.
May I start by welcoming the right hon. Member for Witham (Priti Patel) to her new position? I also welcome to his post the right hon. Member for Uxbridge and South Ruislip (Boris Johnson), whom I have not seen in this place until today. I hope that they will both find their new roles fulfilling.
I pay tribute to the right hon. Member for Sutton Coldfield (Mr Mitchell) for securing this debate, and for the eloquent and passionate way in which he has spoken up for the people of Aleppo. He spoke up for them throughout his time as International Development Secretary. He stood on the side of the poor and oppressed throughout the world, and he has done so again today. He also understood how much the commitment to spend 0.7% of national income on helping those most in need mattered, which is something from which his successors could learn. He agrees with me that Britain’s work in international development reveals the better part of ourselves and is something about which we should be inordinately proud.
The situation for innocent civilians in Aleppo is truly a hell on earth. They are trapped, impoverished and desperately in need of food, clean water and medical care. That would be bad in any circumstances, but they are also living in daily fear of death coming from the skies—from airstrikes in the east of Aleppo and from mortar bombs in the west. The scale of suffering is beyond our comprehension. We should be in no doubt that the parties responsible for that—whether it is the Russian forces and the Assad regime on one side, or the jihadists of Jabhat Fateh al-Sham, otherwise known as the al-Nusra Front or al-Qaeda—stand equally condemned in the eyes of public opinion and are equally guilty of crimes against humanity. In time, there must be a reckoning for those crimes. That is why we support the efforts of France to enforce a tougher approach at the Security Council to the violations of international humanitarian law. Will the Foreign Secretary be supporting the French Government in those efforts?
Equally, the effort to hold the Russian forces and others to account for their actions, and the anger that people rightly feel here, must not prevent us, difficult as it is, from seeking to work with the Russian Government to restore the Kerry-Lavrov peace process. That means securing and maintaining a ceasefire, isolating the jihadi extremists, opening safe—
Absolutely there is not a ceasefire now; that is what I am moving on to. Of course there is no ceasefire, and there needs to be an initiative. In the end, we all know that we can move forward only by way of negotiations, and that no negotiations will happen without a ceasefire.
Can my hon. Friend present us with the evidence that she clearly has that it is realistic to believe that the Russians will seriously engage in further ceasefire negotiations? Does she think for a minute that they will stop bombing Aleppo while they are doing that?
I have thought about this a great deal and spoken to a number of experts about it, and I have some suggestions that I wish to make to the House and to put before the Secretary of State. We want to be helpful. If she will give me a moment, I will explain.
I am not a pacifist, personally. I believe in using military force when it can be effective, if we can achieve the ends that we have identified, and if we know what we want to achieve. I believe that in a multi-layered, multifaceted civil war such as that in Syria, the last thing that we need is more parties bombing. We need a ceasefire and for people to draw back.
Yes, I agree, but let us be strong about this and let us put forward a plan that might work. If the hon. Gentleman will give me a moment, I will explain what I am suggesting.
I was recommending that, despite the difficulties and the anger that many parties feel, we work with the Russian Government to restore the Kerry-Lavrov peace process. That means securing and maintaining a ceasefire, isolating the jihadis and opening safe channels for humanitarian aid—we should make that the basis to negotiate a lasting peace. Looking at the situation today, we accept that that could not look further away or seem more difficult, but we need to have that goal in mind. It is the only conceivable solution and the only way to bring relief to the people of Aleppo, so how do we do it?
I apologise to my right hon. Friend. I thought that that was exactly what I said. For the avoidance of any doubt—obviously, it is now in Hansard—of course the actions of the Russians can well be seen as war crimes. A number of war crimes have been committed during this terrible war, and as I said at the outset, there are the war crimes of Assad and Russia, and the war crimes of the jihadis. In time, we will expect those war crimes to come before the international courts, and those people should and must be held to account. It was for that reason—perhaps my right hon. Friend did not hear me—that I urged the Government to support French efforts to ensure that more initiatives are taken to bring the parties to international justice.
Mr Speaker, many people are getting impatient that I have not yet put forward my plan, so perhaps I will not take any more interventions at the moment so that I can actually do that.
What is the only conceivable way of bringing relief to the people of Aleppo? I believe that it will require strong statesmanship on all sides and not more brinkmanship. We need to talk to experts in the field. Their concern is not just how we stop the conflict as it stands, but how we avoid it escalating further. Yesterday, one expert said to me:
“On the ground, we are just one bad decision away…from Russian and American forces ending up in armed conflict.”
Facing that chilling prospect, we must all work for the alternative, and we need to start by looking carefully at the plan put forward by the UN Syria envoy Staffan de Mistura. The right hon. Member for Sutton Coldfield has already referred to it, and I respectfully agree with him. Staffan de Mistura has bravely promised that if the jihadi forces of Jabhat Fateh al-Sham agree to leave the city of Aleppo, he will personally escort them from the siege to Idlib, or wherever they wish to go. Such a move would isolate the jihadi fighters from the moderate rebels inside Aleppo and remove from the Russians and the Syrian forces their current pretext for the bombardment of east Aleppo. That process could—I stress it only could—provide the basis to restore talks on a ceasefire and on opening up the humanitarian channels that we all wish to see.
There is a precedent for such a step in the way the Jabhat fighters were escorted out of Homs and other towns in Syria. While we must treat the Russian assurances with caution, it is an approach that Sergei Lavrov has said they are ready to support and can persuade the Assad regime to agree to, so will the Government lend their support to the plan put forward by the United Nations? The Government have yet to respond to the initiative at all. I believe that it is a serious initiative with some prospect of hope in it, and that it should not be ignored. Will they persuade their French and US counterparts to do likewise and seek to use this pragmatic proposal as the basis to restart talks?
While we are rightly focused on Syria today, we know that many other countries in the world will listen to what we say about Syria, look at the values that we claim to uphold and ask whether we are true to those values when it comes to other countries and conflicts. Today we will hear Members from all parties rightly condemn Russia and Assad for the airstrikes against civilian targets. We will hear calls for independent UN investigations into breaches of international humanitarian law. We will hear calls to take further action against Russia to oblige it to cease the bombardment. While that is all correct, if we say those things about Russia and Aleppo, we must be prepared for what is said about Saudi Arabia and Yemen. We cannot condemn one and continue selling arms to the other. We cannot call for investigations into one and say that we are happy for the other to investigate themselves. We cannot pour scorn on the assurances of one that they have not hit civilian targets while blithely accepting the assurances of the other. Most of all, we cannot cry for the people of Aleppo and the suffering that they face while turning a blind eye to the 1 million children in Yemen facing starvation today. So I ask the Foreign Secretary to tell the House how the actions that the Government propose in Syria compare with the actions that they are taking in Yemen.
The suffering of Aleppo has gone on for too long. Every day that it continues, we must redouble our efforts to end it. We suggest a four-point plan to the Government. We suggest that we begin with more statesmanship and less brinkmanship. Secondly, we must adopt the UN plan to escort the jihadis from Aleppo. Thirdly, the Kerry-Lavrov plan needs to be revived and we must work together towards a lasting peace. Fourthly, we must de-escalate overseas military involvement in the conflict from all 14 other nations involved, including ourselves. That is how we will create safe corridors for aid, stop the destruction of Aleppo by Christmas and end the suffering of its people.