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Westminster Hall

Volume 619: debated on Wednesday 11 January 2017

Westminster Hall

Wednesday 11 January 2017

[Mr Adrian Bailey in the Chair]

Pharmacies and Integrated Healthcare: England

I beg to move,

That this House has considered pharmacies and integrated healthcare in England.

It is a delight to serve under your chairmanship, Mr Bailey. In the light of the extreme pressures on our health services, particularly in the winter months—much has been made of this recently in the media, although it is not dissimilar to many other years—with our over- burdened frontline services, clogged up A&E departments and congested GP services, I believe it is vital that we explore new models of delivering patient care, particularly an integrated model of patient care.

In 2016, there was an average of 2,500 more attendances at major A&Es a day compared with 2015, which is a 6% increase. People aged 80-plus have the highest rates of A&E attendance. As a country, compared with only a few decades ago, we are now fortunate enough to benefit from innovative drug treatments, greater survival rates from complex surgery, better nutrition and better education; but, as a population, many of our residents are living longer. For example, in my constituency of St Albans, the average life expectancy for a pensioner is over 89 years—it is nearly 89 and a half years. However, for far too many of our constituents, the latter part of their lives brings a prolonged period of frail health, with dementia and diabetes on the rise and an increased incidence of ill health linked to lifestyle choices such as lack of exercise, alcohol, obesity and smoking. That period at the end of our lives is often not characterised as a period of good health.

We need to come up with a seamless, flexible model that makes the best use of precious resources and benefits patients. It is therefore timely to explore in this debate the role that local pharmacies play in local health services and the potential role that they might play to ease the strain on more congested frontline services. I also want to make the Government aware of the continuing importance of pharmacies in communities and their potential to do so much more.

In an ever-changing world, we have a duty continuously to challenge the old models of health delivery systems. In October, the Government proposed to reallocate money to NHS frontline services. We all accept that the NHS is labouring under huge financial pressures, so any areas in which precious resources are dissipated due to inefficiencies or duplications ought to be considered. It is important to integrate community pharmacies into the NHS urgent care system and GP services. We need to promote a pharmacy-first culture for minor ailments to take pressure off frontline services.

Community pharmacies currently see some 1.6 million people a day in the UK. It is worth noting that the recent standard patient experience report for the East of England Ambulance Service NHS Trust in 2016 showed that 0% of respondents in my county of Hertfordshire had contacted a walk-in service, an out-of-hours GP service or a pharmacy service before contacting the ambulance service. I think we can agree that a lot more can be done to take the pressure off emergency frontline services.

Pharmacies are the most accessible health services in most communities: they are found on high streets, in supermarkets and in shopping centres. In St Albans, we have some great independent local pharmacists who want to get more involved and we even have the headquarters of the National Pharmacy Association, which supports independent pharmacies and helps them grow their businesses. We need to look at the current pharmacy model. In St Albans, patients can choose from five dispensing pharmacies within a half-mile area of the high street. Some pharmacies are just over the road from each other, and some have only yards between them. Given the Government’s financial support of £25,000 for those dispensing 2,500 prescriptions per annum, which comes directly out of our NHS budget, it is easy to see why we need to look at the model of provision and ask how we can get a better bang for the NHS buck.

I accept the Government’s assertion that a balance must be struck to ensure that pharmacies remain accessible but are not excessive in number and, importantly, that we have a range of offering. All the local pharmacies on the high street in St Albans are closed on Sunday, whereas the big supermarket pharmacies are open, in line with their shopping experience. It is worth noting that Sunday is the busiest day for most A&E services. However, a recent survey showed that 50% of people prefer, for a variety of reasons, not to use a pharmacy in a supermarket, particularly the retired, the elderly and other frequent pharmacy users. We therefore need to examine the model of opening hours, as well as location and the type of provision on offer. Given that many supermarkets are located outside the town centre, their pharmacies are not accessible to everyone, particularly the most vulnerable in society. Diversity and accessibility of provision are key to integrating pharmacy and health services.

Let us explore what pharmacies could do. Pharmacies should be capable of providing general health services. They could increasingly work beyond the traditional role and offer services to promote sexual health, increase physical wellbeing and give advice on flu immunisations and drug-harm prevention, for example. However, if we expect pharmacies to do more, we need the funding formula to reflect the quality of service they provide. That is what the pharmacies want. Local pharmacists in St Albans believe that they should be the first point of contact for advice on medicines, minor illnesses, healthy living and wellbeing. To facilitate that, the Quadrant pharmacy in St Albans has undertaken a major refit, with a brand new consulting room, and invested heavily in technology, including an expensive automated robot for dispensing medicine.

I visited the Quadrant—I am sure that many hon. Members made similar visits after the Government’s pronouncements in October—in November last year to discuss the opportunities and challenges facing small independent pharmacies. The pharmacy is a friendly, attractive place to pop into and is well regarded by local people. It has the potential to do so much more, but that extra service does not come without a cost. If people spend time talking to their local pharmacist, the pharmacy gains nothing if they then walk out of the door and go off to see their GP. It is important that we recognise the role pharmacies are being asked to play in giving advice, holding consultations and, potentially, dispensing services. There must be some reflection of the cost involved in the staff time that it takes to do those things.

Rachel Solanki, the director of the Quadrant pharmacy, told me:

“General Practice will need to continue to be the gate keeper of referral to secondary care.”

However, she helpfully suggested

“a whole raft of services and support for self-limiting and long-term conditions”,

such as dealing with uncomplicated urinary tract infections in women, impetigo and bacterial skin infections; managing non-complex patients with high blood pressure; performing healthy heart and cholesterol checks; and supporting patients diagnosed with diabetes. The list was quite exhaustive. She proposed that pharmacies could and should act as wellbeing hubs for the communities they serve. She went on to say:

“The community pharmacist, a highly-skilled and trained individual, is the most accessible healthcare professional and is available without an appointment. If a mechanism could be found to incentivise and remunerate, we are confident the mutual agendas would be achieved.”

That is her view, and that of many other local pharmacists. There is a mutual agenda for providing good healthcare for patients that could be achieved if pharmacies were brought into play.

The Government’s proposals in October last year were a step in the right direction, but we need more detail. I want to ask the Minister a series of questions, and hopefully he will be able to answer some of them. How can the Government make smaller and local pharmacies more attractive and accessible for everyone? How can the Government encourage GPs to offload services such as flu jabs on to pharmacies? In saying “offload”, I recognise that where there is a cost to the pharmacy and the GP is in receipt of payment for that flu jab service, that needs to be considered, but I would like to hear the Minister’s views on that. How can the Government promote the pharmacy as an alternative local health provider that can be trusted and deliver a quality service? This is not just about having a shop that you take your prescription to and maybe pick up a few aspirin; it is about the pharmacy being a health provider. How can the Government increase pharmacy capacity to provide a broader range of health services and ensure the correct remuneration for the service provided?

Responding to an oral question on 2 March 2016, the then Health Minister, Lord Prior, stated:

“The big driving force going through healthcare and community pharmacy today is one of integration, which means that community pharmacies must in future work more closely with their local hospitals and GPs.”—[Official Report, House of Lords, 2 March 2016; Vol. 769, c. 817.]

That is the point of today’s debate. The Government have pursued several polices that are intended to lead to better integration of community pharmacies, including the introduction of a pharmacy integration fund as part of the 2016-17 community pharmacy settlement.

Last month, Richard Murray of the King’s Fund published a paper looking into the role of community pharmacies in the NHS. In December 2016, the Minister described that review as

“an essential road map that sets out how we are going to move the community pharmacy network away from a remuneration model based just on dispensing and on to services as well.”—[Official Report, 20 December 2016; Vol. 618, c. 1301.]

When can we expect a response to that incisive review?

The NHS “Five Year Forward View”, which was published in 2014, recognised that GPs are “under severe strain”, and many of us will have met GPs locally who have restated that view to us. It also states that steps will be taken to:

“Build the public’s understanding that pharmacies and on-line resources can help them deal with coughs, colds and other minor ailments without the need for a GP appointment or A&E visit.”

I urge the Government to listen to pharmacists when considering how to take that integration forward, as we do not want to lose what is good in the system, especially where it works well for our local patients. For example, I know that the Government are piloting an urgent medicine supply service. Rachel Solanki, the director of the Quadrant pharmacy, tells me that in Hertfordshire there is a local scheme that is so well regarded that it has now been rolled out again. Her concern is that the proposed national service does not necessarily promote a pharmacy-first culture. The Minister may wish to clarify that that is not the case, but that was the view she expressed to me. She was worried that there might be a perverse incentive to encourage patients to phone NHS 111 in order to get a referral to the pharmacy service.

In an email Rachel wrote to me recently, her view was that the change could have the unintended consequence

“of actually increasing NHS 111 calls for emergency medicines when they should be directed to community pharmacies first. Our local service offers both the facility to help the patients get their medicine but, more importantly; also offers incentivisation of the community pharmacy to promote ordering medicines in a timely way to reduce medicines waste, and hopefully therefore preventing a further incident of need.”

She thinks it unlikely that the proposed 111 service will operate both the services that we have locally and the new model, and she worries about losing the existing local scheme. Will the Minister reassure me by saying whether schemes such as the one operating in my county of Hertfordshire could still operate in tandem, or will they be mutually exclusive?

My hon. Friend is making a very powerful speech. Does she agree that although we must encourage clinical commissioning groups to work closely with community pharmacies—she has highlighted some good examples of that—the practice is patchy across the country? There is reluctance in some areas for clinical commissioning groups to engage with their local pharmacies. We have had that problem in York, where the CCG has been very reluctant to talk to local pharmacies. Local MPs, across parties, have written to it and finally got it to engage but it has been very slow, and we have to speed that up. We have great examples in some parts of the country, but poor examples in others.

My hon. Friend is absolutely right and completely backs up the point I was making. There is evidence of good practice but other areas could do much better. Without bringing pharmacies to the table and into the ongoing dialogue about this issue, we risk not having the new model that we would all like to see—one that operates consistently wherever people go.

There must be a consistent model in the drop-in pharmacy service that we are envisaging. Of course, people often use pharmacies away from where they live, such as where they work or when they are on holiday or visiting friends. If the model is patchy, as my hon. Friend says, the system will not improve and we will end up with a situation like the one that is found in many holiday towns. A few years ago, the Select Committee on Communities and Local Government looked into the fact that many seaside and holiday towns have enormous pressures on their frontline services. If something goes wrong when people are on holiday, although what happens is not necessarily catastrophic, they all end up at the local A&E services in hospitals. That huge problem was recognised, I think, in the 2006 seaside towns report by the CLG Committee. This is all part of evening out the stresses and strains on the system, which for many seaside holiday and tourist destinations are often huge.

Does my hon. Friend agree that that was largely the point of the Murray review, which she alluded to earlier? Integration throughout the whole of the NHS is vital, so that everybody knows what everybody else is doing and so that there are seamless pathways that everybody knows how to follow. That will ultimately give us benefits not only in pharmacies, but right across the NHS.

Absolutely. Rachel Solanki and her colleagues are not necessarily critical of change—that is important. Pharmacies are nervous about some of the things that may be coming along, but they are not critical of change. Indeed, they would welcome a debate on the innovative services that other pharmacies are operating around the country. The fact that we do not all know about these services in other places shows that there is not an integrated approach. The services include anticoagulation monitoring in Knowsley; medicines optimisation work for respiratory diseases in South Central; sexual health screening, including for hepatitis, syphilis and HIV, on the Isle of Wight; oral contraceptive supply in Manchester and other contraceptive provision in Newcastle; alcohol screening and brief intervention on the Wirral; healthy lung screening in Essex; pneumococcal immunisation in Sheffield; a reablement service on the Isle of Wight; and phlebotomy services in Coventry and Manchester. That is a long, diverse list of services that are provided by pharmacies in those areas.

Will my hon. Friend recognise that some innovative things are taking place in the west country, especially in my constituency?

I am happy to acknowledge that some fabulous things are happening in the west country. That list was given to me. I make no excuse for the fact that I thought it seemed fairly long already, but I am certain that there are a lot more services that hon. Members do not realise are out there—perhaps even in pharmacies in their own constituency or the one next-door that they go shopping in or visit with their families. The fact that we do not know about them shows that there is no integration in the system. We should be aware of it if these services are being rolled out. Perhaps there should be a directory that we could consult to find out what is going on in certain areas.

That list shows hon. Members the exciting possibilities that could be open to pharmacies, including those in the west country that were just referred to, if we just gave them the chance to embrace them. Rachel, the director of the Quadrant pharmacy, ended her observations with a positive endorsement of the “Community Pharmacy Forward View”. She told me that it has

“been developed and signed up to by all national community pharmacy organisations about the types of services that either need to be commissioned at a national level or pressure put on Sustainable Transformation Plans (STP) leaders locally to commission a service package to patients”.

My hon. Friend the Member for York Outer (Julian Sturdy) said that there is reluctance in some areas to embrace this. We need a strong steer from the Government that this is where we are going and that they had better wise up, get around the table and come up with a suitable model.

My hon. Friend is making an excellent point and I congratulate her on securing this debate. I have discovered the same thing as my hon. Friend the Member for York Outer (Julian Sturdy) in Suffolk. It is about trying to get the CCG to talk to the pharmacists. The interest of the NHS is our interest—it is a national interest—and not that of acute hospitals, the primary care sector or any particular sector. The NHS must operate in the national interest, and if that means involving pharmacists much more heavily and that we have to be the ones pushing for innovation, it is our job to do that.

My hon. Friend is absolutely right. I shall conclude my remarks soon, because I know that other hon. Members want to take part in this debate. If there is resistance in the system, I ask the Minister to find out what can be done to sort that out. How aware is he of resistance in the system? How much input have pharmacies had into highlighting what they would be prepared to do and their concerns about the fact that they are sometimes not being listened to in this debate? There seems to be broad agreement in the NHS “Five Year Forward View”, the “Community Pharmacy Forward View” and at the King’s Fund that the integration of pharmacies into NHS healthcare is the direction of travel.

The hon. Lady is making a really interesting speech. I have had such a big postbag on this issue because of the threats to pharmacies in my constituency. The fact that local community pharmacies are facing cuts is threatening the level of healthcare that people receive, particularly elderly people who cannot drive, people with children who need to be able to pop in with them after school and people with mobility issues. The cuts imposed by the Government are threatening the quality of the service that is being delivered. They need to address that before they look at further integration.

I agree that there are concerns. As I mentioned earlier, there are five dispensing pharmacies within half a mile in St Albans. Some are literally over the road from each other, although I know that model is not repeated everywhere. None of them is open on a Sunday and the only pharmacy that is open is in a big out-of-town superstore. We need to look at a model that addresses their proximity to the populations that need to use them and the hours that people are looking for pharmacies to be open. It is no good if people can access the seven-day-a-week pharmacy service only by getting in their car and driving two or three miles out of town. It is all part of the same thing.

That is why I support the point made in the Government’s proposals in October about models such as the one in St Albans, although this is not the case everywhere, where there are the big boys and smaller independents all in the same area. If the hon. Lady were to walk into Boots in my constituency—I have nothing against Boots, which is one of the pharmacies on my high street, as on many others—she could pick up sandwiches for her lunch, as well as a variety of health and beauty products, perfumes and so on. It is a one-stop shop for many things, a bit like a supermarket.

My concern is that we must not lose community pharmacies such as the Quadrant, which is a single pharmacy in a small shopping precinct that many people walk to and use locally. We have to have a balance of availability and opening hours. If we are truly to embrace an integrated system, some pharmacies may need to consider their opening hours and sign up to being open when they would not normally be. They will have to be remunerated for that as well. We need to look at the whole model. I understand that there are concerns, but our current model cannot continue. I want integration, and I want more money and more services directed towards pharmacies to make them viable and to make them the first hub for the community.

There is broad agreement that the direction of travel we need is towards getting people to use the most accessible health provider, which is the local pharmacy. That would keep many smaller pharmacies going. They cannot compete with all the other offerings from supermarkets such as Sainsbury’s, which has a pharmacy in its out-of-town store in London Colney, so we need to ensure that they compete as health hubs.

I look forward to hearing what the Minister has to say about these issues. I am sure that many other Members will make contributions about their local models, because the provision and the pharmacies on offer vary throughout the country. I accept that, in areas such as mine, the current model cannot continue, particularly if it asks for NHS funding, but we must not throw out the baby with the bathwater. I ask the Minister to say what more the Government will do to ensure that pharmacies have a real role in the integrated health service.

May I say what a pleasure and a delight it is to serve under your chairmanship, Mr Bailey? I congratulate my hon. Friend the Member for St Albans (Mrs Main) on securing the debate. I should warn the House that I am the Government’s pharmacy champion. I have been following this issue quite closely for about the last 20 years —not that I have been in the House of Commons for the last 20 years, but I have followed it consistently since being involved in the community pharmacy group action campaign, which was to do with resale price maintenance on non-prescription medicines in the 1990s, when I was doing a commercial job. I became a vice-chairman of the all-party pharmacy group when I was elected to the House, so this is an issue I feel quite strongly about and have been very involved in.

To put things in context, Plymouth, Sutton and Devonport is, uniquely for a Conservative constituency, an inner-city seat. Indeed, I am one of very few Members of Parliament outside London to represent a totally inner-city seat. The only countryside I have in my constituency is the Ponderosa pony sanctuary, which is a rather muddy field. How we can integrate pharmacies is a really important issue. There is an 11-year life expectancy difference between the north-east of my patch—I could probably walk from one end to the other in a couple of hours or so—down to the south-west in Devonport, which is a very deprived community that has real issues with homelessness, drug taking and smoking. People certainly need to be referred to pharmacies for smoking cessation too.

There are several areas of the debate that I am particularly interested in exploring, and I hope the Minister will respond on them. The first is summary care records. A lot of pharmacies want to be able to access the care records for their patients. They also want to be able to populate those records, so that they can review the medicines given to patients. We need to make sure that happens throughout the whole of England. I was very concerned by something I discovered over the Christmas recess. I did not take masses of time off over Christmas, but I did speak to a number of GPs; needless to say, I also did a surgery, with one of my local GPs in the Devonport ward. He told me that GPs—and, I suspect, pharmacies too—cannot access the medical records at Derriford hospital, because it uses a completely different system from the GPs and the pharmacies. The Minister needs to look at that.

The second issue we should look at is using pharmacies much more for minor ailments—a point that my hon. Friend the Member for St Albans made very clearly—so that people are signposted to the pharmacy rather than necessarily going to the GP. I was watching breakfast television this morning while I was getting ready to come and speak in this debate—I think it was Sky television, so I should declare an interest, because my brother is the cricket correspondent for Sky television and I do not want to be accused of doing anything wrong. I was interested to hear the person reviewing the newspapers say that she was doing a programme tomorrow evening on Radio 4 at 9 o’clock—I am giving her a plug—on how, rather than having lots of patients come to see them, some GPs in Plymouth have ended up talking to patients on the phone. Patients do not necessarily always need physically to go to a GP to seek help, which is a useful way of taking some of the pressure off GPs.

I should also make a point about the decriminalisation of prescription errors. At the moment, GPs can get a slap on the wrist or be struck off, whereas pharmacists who fail to give prescriptions properly can face criminal charges. I had thought that the Government were very keen to address that. I was led to understand by the Minister that the matter might have been sorted out before Christmas, but that there were problems to do with the devolved Administrations needing to deal with it first. However, it seems very odd: here we are, at the beginning of the year, and we still have not dealt with it. I must warn my hon. Friend that I have tabled a parliamentary question about it.

My final point is that a great deal of pressure has been placed on the Government and the national health service, especially during the winter. There has been a great deal of discussion about how pharmacies need funding and so on, but in my opinion this is not just about money; it is about ensuring that we use the systems properly, so that we can deliver a better quality of care. We could get pharmacists to go into residential care homes for the elderly, too. It is not just about money; it is about the structure, too. We need to take that into account, because we need to ensure that budgets sweat.

It is a pleasure to serve under your chairmanship, Mr Bailey. I congratulate my hon. Friend the Member for St Albans (Mrs Main) on securing this debate on what I believe is a very important issue.

There is no doubt that our health service is currently under great pressure, as we have heard already. People are living longer and we are able to treat far more conditions than we could in the past, which adds to the demand on our health services. Although more money is always welcome, I am sure that many of us would agree that simply throwing more money at the health service is not the solution. We need to find better, smarter, more efficient and more effective ways of working to provide the healthcare that our growing population so desperately needs.

I have no doubt that pharmacies, particularly community pharmacies, can play an important role in finding better and smarter ways of providing healthcare to the people of this country. Community pharmacies continue to be an undervalued and underutilised section of our health service. As a country, we really need to embrace the role that community pharmacies can play in delivering health services. They have much more to offer than they are currently seen be to offering.

The Government have started to recognise that, with the current pilot scheme, started in 2015, to increase the presence of clinical pharmacists in general practice. That is clearly a step in the right direction, but I propose that we should also look the other way. We should not only look at integrating pharmacies into GPs’ surgeries; we should be looking to integrate GP services into our community pharmacies. It is quite clear that many of the routine services that people typically go to their local GP for could be provided by their local pharmacists in a much more cost-effective way.

I will give way to my hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) first.

I thank my hon. Friend for giving way. He makes a very powerful point. I have thought for some while that we should be trying to put GP surgeries into pharmacies, so that when someone goes to their GP and says, “I have got this ailment and I need some help,” he can say, “Don’t come and talk to me; go and talk to the pharmacist, because he or she can manage the thing properly.” To my mind, that seems a very clever way in which we could take some of the pressure off the finances of GPs, as they would not necessarily have their own lease, but could get the likes of Boots or others to provide facilities.

I thank my hon. Friend for that intervention and I agree with him. Clearly, part of the answer is getting GPs and pharmacies working much more closely together, and co-locating can often be one way to help with that.

My hon. Friend is making an excellent speech. Does he accept that the demand for prescribing pharmacies can be demonstrated by the recent proliferation of adverts we have seen on television for “pay to see your GP” services, which I was very surprised to see so many of on TV over Christmas? For £20, someone can pay to have a Skype consultation with a GP, who will then email or contact the local pharmacy to issue them with a prescription. An NHS that is free at the point of use should be absolutely fundamental to us in this country, but the fact that people are now paying to see GPs rather than waiting to see them shows that there is huge demand for people to have minor ailments prescribed for by a pharmacist.

I thank my hon. Friend for that intervention; he clearly watches far more TV than I do, because I was not aware of that. However, he makes the point well that there has been a huge increase in the demand being placed on our GP services, and people are therefore looking for other ways to meet that demand when it cannot be met in the usual ways.

I applaud and support the Government in their desire to create a truly seven-day-a-week health service. Part of the way to achieve that is by making far better use of our community pharmacies. Many are already open for longer hours than GP surgeries, typically on a Saturday, and my hon. Friend the Member for St Albans made the point that maybe some need to consider opening for longer still. That is something the Government could certainly help with. If we are to achieve a truly seven-day-a-week health service, we need to make more effective use of our pharmacy services.

The hon. Gentleman is making a strong case for the importance of community pharmacies. Pharmacies in my constituency of Wirral West that will be unable to receive money under the planning access scheme have written to me to say they are very concerned that they face closure. Does the hon. Gentleman agree that it would make sense for the Government to pull back from those cuts while they consider the whole issue of integrating services?

I thank the hon. Lady for that intervention, and in many ways I share her concerns. While I respect the desire of Department of Health’s to ensure that money is well spent and delivers value for money, there are cases of over-duplication, as we have already heard. Some changes need to be made to the funding models. I agree that we need to do all we can to protect our community pharmacies, particularly in more rural areas such as my constituency in Cornwall, where they play such a vital role for rural communities. I was pleased that the Department was able to do something to help—certainly many pharmacies in my area benefited from the changes to the funding—but I respect the fact that that may not have been the case in her constituency, and I will be urging the Minister to do all we can to ensure that these vital services in our rural areas are protected as much as possible.

With the right support, and indeed the right funding streams, our pharmacies could play a role that would take pressure off the parts of our health service that are clearly under severe pressure, in particular primary care and acute and urgent care. We are all aware of the pressure that our A&E departments are under at the moment. I believe that many times, when people go to A&E—perhaps because they cannot get to see their GP as quickly as they would like or feel they need to—they could actually get what they need from their local pharmacy.

Part of this is about increasing people’s awareness of what our pharmacies can offer. Part of the learning curve that I have been on since becoming an MP has involved going to see our local community pharmacies and getting a better understanding of exactly what services they provide, which I was not aware of before. More could be done to promote the role that pharmacies can play and the services that they can offer by making the public more aware of those services. That in itself would take pressure off our GPs.

I did not make this point in my speech, but my hon. Friend is almost making it for me—it is that our pharmacists are hugely qualified, but too often they are the most under-utilised highly qualified local health professional. It is nonsense that their expertise is not being used routinely, challenged or made available, because people do not seek to use it and are not even necessarily aware that it is there for them to utilise.

I thank my hon. Friend for making that point, which I completely agree with. There is much more we could do to increase the general public’s awareness of exactly how highly qualified our pharmacies’ staff are and of the excellent services that pharmacies can provide.

My hon. Friend the Member for Plymouth, Sutton and Devonport talked about the need to integrate IT systems better, which I believe is part of the solution we seek. My understanding is that community pharmacies can access summary care records, but on a read-only basis. Many pharmacists I talk to say that if they had read-write access to that information, so that they could input data about treatments they have given to patients, that would be better. For example, if they could take a patient’s blood pressure and input that reading into the patient’s care record, that would save the patient time as they would not then have to go their GP to have the same reading taken and put into their record. I urge the Government to consider carefully whether read-write access could be granted to pharmacies, because I believe it would save a huge amount of time and reduce what I believe is often duplication of work within our health system.

An interesting fact that I discovered in my discussions on this subject is that the average time that someone waits when they go to see their pharmacist—that is, the time between entering the pharmacy and actually getting to see the pharmacist—is eight minutes. Many people in this country would be absolutely delighted if they could see a health professional within eight minutes of asking to see one. I am sure that many hon. Members here today have in-boxes full of people’s complaints about how long it takes them to see their GP. If people were aware that if they went to see their local pharmacist they would only have to wait eight minutes on average to see a very well qualified health professional who has a good chance of providing them with what they are looking for, I believe they would be delighted. That is another example of how we can promote the work of pharmacists, which would provide a far better service to the people of this country and take pressure off the other parts of our health system.

I am grateful to the hon. Gentleman for giving way and I apologise, Mr Bailey, for missing the start of the debate.

The excellent pharmacies in my constituency do much of the fine work that the hon. Gentleman and other speakers have described, but it struck me as I was sitting here listening to him that he is making a very powerful case for investment in our pharmacies, rather than the cuts that the Government have proposed. Does he accept that point? Will he and his hon. Friends take this opportunity to call on the Health Secretary to think again about pharmacies and the important role they play and to see them as an investment, so that they can play their part, particularly in taking pressure off A&E?

Although I agree with some of what the hon. Gentleman says, I believe the funding model for pharmacies needs to be looked at because there is a great deal of duplication. The money spent could be better utilised, so the funding model needs to be reviewed. Some of the recent changes are a step in the right direction, but I will always make the case that, particularly in our rural communities, we need to be careful how those changes are applied so that our local pharmacies continue to be viable and able to provide the services that are needed.

My hon. Friend is making an excellent speech. I understand why Labour Members want to focus on the potential savings that once again the Government are having to make, but I point out that the two pharmacies that I visited in Clare and Hadleigh in my constituency accept the changes, provided they are balanced by their having a more positive role in the healthcare system and doing more for our communities. That is what they want.

I agree absolutely. This is not only about money; it is about reviewing the way we provide our healthcare services, embracing a greater role for our pharmacies, and understanding and promoting the role that they can play.

I want to pick up on the point about tourist areas made by my hon. Friend the Member for St Albans. I represent the constituency of St Austell and Newquay in mid-Cornwall, and tourism is the biggest part of our economy. Hundreds of thousands of tourists come every year, which puts a great deal of pressure on our A&E and local GPs, because if people fall ill on holiday, they try to get to see a GP.

I commend the work of one of my local pharmacists, Nick Kaye, in Newquay. The Secretary of State visited a couple of years ago and saw the excellent work that he does working closely with the local GP surgery to provide a frontline service particularly for tourists. By doing so, he takes pressure off the other parts of the health service. We could see more of that if we supported pharmacists and promoted the excellent work that they can do.

We have already touched on my final point. We cannot have a one-size-fits-all approach. The services provided in urban metropolitan areas are very different from those provided in more rural parts of the country. As we have heard, there might be multiple pharmacies in a town, all falling over one another to compete for business—so different from the many rural villages that have one local pharmacy, which is struggling to make ends meet and to provide an ongoing service to the community. Another fact I have learnt is that there is an oversupply of qualified pharmacists in many areas, whereas in Cornwall we have a shortage. We cannot get enough into Cornwall to meet demand, so we cannot have a one-size-fits-all solution. I encourage the Minister to look carefully at the specific needs of different parts of the country, particularly with regard to pharmacies, to make sure that funding streams meet need and that we can sustain the vital role that community pharmacies play in our rural towns and villages.

I am pleased to have been able to contribute to this important debate. As we continue down the path of integrating pharmacies into the health service, we must value and promote the role they play and make sure they are able to provide a service. They are part of the solution that we need to make sure our health service is fit for purpose.

It is a pleasure to serve under your chairmanship, Mr Bailey. I add my congratulations to my hon. Friend the Member for St Albans (Mrs Main) on securing not only a timely debate, given the current circumstances, but one that is important because we need to look at the whole system and integration, rather than at each specific service.

Interestingly, on 6 December, Lord Prior said:

“The Government recognise the vital importance of community pharmacy.”—[Official Report, House of Lords, 6 December 2016; Vol. 777, c. 593.]

It is from that positive stance that I wish to make my points. Pharmacists have been identified as one of the professions that are highly qualified and not in short supply. Some very advanced GPs are bringing pharmacists into their surgeries to help to alleviate some of the pressure. Some clever thinking is going on out there. I hope the Minister can tell us how we are capturing that innovative thinking and how it is being spread throughout the system.

The “Five Year Forward View” identified that the British public need to be made more aware of what pharmacies can do and how they can help people keep healthy. However, the Government need to give a steer and ensure that people with minor ailments understand that the pharmacist should be their first port of call.

When I visited my pharmacist there was concern about the 111 service, which was my hon. Friend the Member for St Albans mentioned. We need to keep an eye on that so that we do not unintentionally put pressure on different parts of the service. We need to look at it in the round and incorporate all key roles into pharmacies in order to provide additional services. I had my flu jab at a pharmacy this year, which is a useful use of resources within the system and within the community. We could make that more available and perhaps incentivise individual pharmacists to go out into care homes, which have a proliferation of need because of age and comorbidities, and give flu jabs and so on. Moving our workforce around, rather than driving ever-greater demand into smaller places such as hospitals, must be a consideration.

The Murray review, which has been mentioned, found that poor integration with other parts of the NHS was a significant barrier, and the Royal Pharmaceutical Society agreed. I like to think that the Government are taking a good look at what was said in the review and taking the issues on board.

I love the term “pharmacy-first culture”, which is a good motto for everybody to live by. I want to concentrate on my Bury St Edmunds constituency for a couple of minutes. We have 21 pharmacies and a cluster of Superdrug and Boots shops, which are volume providers that have other things such as make-up and lunches; they have optical services and Boots has audiology services. They provide everything needed from the cradle to the grave and they have considerably greater footfall than my excellent independent pharmacist, who puts more prescriptions through than any other pharmacist in the town. The 100-hours rule meant that I got local surgeries with pharmacies dispensing in them. We need to take a little bit of care, step back and get the right things in the right place. The last thing my local community wants is my independent pharmacy not being able to survive through these important transitions.

An ageing population is a challenge in rural areas such as Bury St Edmunds. Within the next decade, 40% of Suffolk’s population will be over 85. We know that that age group lives with comorbidities that need a degree of monitoring. That can be done most effectively in the pharmacy and in the GP’s surgery, but out of the big NHS pie the GPs get only about 8% and the acute sector gets about 92%. We need to show that we are spreading the money throughout the system, because a lot of the pressure will be coming down on the pharmacies, the GPs and the care sector.

Pharmacists are often not used to their full value. Delayed discharge from hospital often comes about because people do not get their meds, and pharmacies in some hospitals are not available throughout the weekends. There could be more joined-up thinking.

I do not think I disagree with anything the hon. Lady has said. She is making a very good case for the excellent practice in her constituency and for pharmacists more generally. Does she agree that the logic of her argument is that money is saved by investing in pharmacies? That is a strong argument. She is arguing that cuts should not be made and that the Government should invest in pharmacies to support the whole health system, which is what this debate is about.

I thank the hon. Gentleman for his intervention and agree with his final point. This is about the whole system and making efficiencies. We are talking about evolution. We are no longer looking at the service as it was perceived in 1948. There was a private element to it even back then, because that is what GPs wanted. We need a 2017 solution to the challenges of a larger population, an ageing population and so on. Pharmacists must play their part in that. They are really keen to step up and deliver more for the Government and more for the patients and people in their communities.

There are issues in the town, but there is an interesting rural situation, where there are rural payments for Elmswell and Thurston, but the GP surgery in Woolpit, which dispenses more scripts, does not get one. There seems to be a bit of discrepancy. I echo the point made by my hon. Friend the Member for St Austell and Newquay (Steve Double): looking at rural constituencies is a very different thing from looking at the whole ecosystem.

There is a Day Lewis pharmacy in my town. An exceptional local resident, Ernie Broom, is keen to note that that pharmacy, because of its location, cannot offer a lot of peripheral things. The local residents are largely mature or on lower incomes, which means that the pharmacy is vital to the community. We also have really poor bus services into town—it would take a young mum or an elderly person nearly an hour and a half to cross town. I want the Government to look at a weighting system, which takes into account what local pharmacies can deliver. They would get points for being in certain areas, or incentives for delivering more. I know that is something that is being looked at.

My questions are similar to those posed by my hon. Friend the Member for St Albans. What more can pharmacies be incentivised to do? How much more capacity can they provide? With people living longer and with comorbidities, how can we remunerate for services? How can we ensure that that is included as part of sustainable transformation plans? It is not something that should be added at the end as an afterthought, but is a hugely integral part of how we make our NHS better and more able to look after the health of us all.

It is a pleasure to serve under your chairmanship, Mr Bailey. I thank the hon. Member for St Albans (Mrs Main) for securing the debate. I found much that I agreed with in her contribution, and I echo her call for a pharmacy-first culture.

It is a pleasure to take part in the debate, although I must admit to feeling a bit of an observer, as the debate is about pharmacies and integrated healthcare in England. We have heard from a number of speakers about the different practices that affect their parts of England; I hope that my observations from Scotland may also be of interest to Members. I have commented in a few debates that there are often lessons that we can learn from one another and good practices that can be shared. This issue provides an excellent case in point.

Community pharmacies were developed in Scotland 10 years ago and are there for minor ailments, chronic medication and public health services. The Scottish Pharmacy Board has stated that more than one in 10 GP consultations and more than 1 in 20 accident and emergency attendances could be managed by community pharmacists using the minor ailments service; that represents huge potential for the future. Although we await the full evaluation of the minor ailment service later in the year, estimates suggest that as much as £110 million could be saved. Further expansion of the MAS is planned.

I do not often agree with what is said by Scottish National party Members, but I looked at the Scottish service, and one of the key things, which I think other hon. Members have raised, is the software functionality that in Scottish pharmacies are obliged to have. That is something we do not have in England—I do not know about Wales—and I wonder if the hon. Gentleman could let the Minister know about that. The ability to input into scripts and the remuneration that comes through that software functionality in Scotland is something that I found very interesting.

The hon. Lady has emphasised the point very well. There is a considerable degree of integration in the Scottish service. It has been around for 10 years and is a fairly mature service.

The Scottish Government work side by side with the medical professions in Scotland and recognise just how important community pharmacies are. They are interested in exploring new ways for pharmacies to offer primary care services to help deliver care across our communities. There are some 1,200 pharmacies throughout Scotland, providing a range of services on behalf of the NHS. As well as dispensing prescriptions, they offer four NHS pharmaceutical care services, which have been gradually introduced since 2006. These are the minor ailment service, which I have mentioned, the public health service, the acute medication service and the chronic medication service. Those new services involve pharmacists more in the community in the provision of direct, patient-centred care, with every community pharmacy in Scotland having patients registered for the minor ailment service by March 2015.

Patients register with a pharmacist in the same way as they register with a GP. The aim is for all people to be registered with their local pharmacist, wherever they consider that to be, by 2020, and for all our pharmacists to be independent prescribers by 2023. Approximately 18% of the population of Scotland are registered for the minor ailment service—a total of 913,483 people. More than 2.1 million items have been dispensed under the service, which is some 2.2% of all items dispensed by community pharmacies in Scotland. Almost 500,000 patients are registered under the chronic medication service.

It is important that retail and dispensing pharmacies in England be encouraged to go in a similar direction to Scotland, because that would bring great benefit for the NHS. In Scotland, we recognise just how important community pharmacies are. We are committed to supporting and developing local GP and primary care services and have recently announced a three-year, £85 million primary care fund to help develop new ways of delivering healthcare in the community, which will involve pharmacists delivering aspects of patient care.

Looking at pharmaceutical services across the two nations, one of the significant differences appears to be how the services have developed, partly as a result of the funding structures. In Scotland, pharmacists do not get a large payment merely for existing, such as the £25,000 in England. Instead, they receive a modest establishment payment of £1,730. However, payments are based on needs that reflect a population’s age, vulnerability and deprivation. That model will see funding in Scotland rise by approximately 1.2%, while it looks likely to decrease by around 4% in England.

Another difference is the almost random way in which pharmacies in England appear to have opened, as a result of anyone being allowed to do so if they open 100 hours a week. A concern must be that there could equally be unplanned random closures, if they are allowed to shut down simply because they can no longer afford to survive. In Scotland we have a system of controlled entry for those who want to open a community pharmacy. Need must be demonstrated and applications approved by health boards. Consequently, we find community pharmacies in areas of deprivation, serving those most in need. Often health boards refuse applications because demand is already met.

Pharmacists are located throughout communities in Scotland, from rural areas to deprived inner-city areas, providing pharmaceutical care on behalf of NHS Scotland. The Scottish Government policy remains that, wherever possible, people across Scotland should have local access to NHS pharmaceutical care. There is much in the Scottish model that is working well and may provide a useful example for study on this side of the border. It is imperative that this successful model of community pharmacies across Scotland should not be put under threat by UK Government health budget cuts, which would impact on the Scottish Barnett formula.

It is a pleasure to serve under your chairmanship, Mr Bailey. I thank the hon. Member for St Albans (Mrs Main) for securing this debate on a very important subject. It is pleasing to hear so much agreement around the room; I hope that the Minister is listening. I agree with most of what hon. Members have said.

This subject is very dear to my heart. My husband is a community pharmacist, and I worked with him for 24 years in our own community pharmacy in my constituency of Burnley; I have to add that we no longer have any financial interest in community pharmacy, but what I retain is a very deep understanding of the value of community pharmacy to patients, the community and the wider NHS, so I appreciate the hon. Member for St Albans securing this important debate.

I cannot think of a better way to demonstrate the value of community pharmacies than to talk about my experience. Coopers chemist in Burnley—a deprived constituency in many ways, where life expectancy is closer to 80 than 90—serves a community along with four other pharmacies in very close proximity, all of which are really busy and serve a big demand. On a typical day, we dealt with 600 prescriptions and 100 minor ailments, and ran many other services—forgive me if I forget some, because there were so many—including medication use reviews designed to maximise our use of medication, make sure patients understood it, encourage compliance and save money on wastage; smoking cessation programmes; dietary advice; emergency hormonal contraception; methadone programmes; and support for diabetics and asthmatics. It was an ever-increasing list. Those are the kinds of services that are at risk if the Government pursue their plans.

I appreciate the value of community pharmacies. I am also a former private business owner. Let us not forget that that is what community pharmacies are; they are not provided for and paid for by the NHS.

That is a very good example of how the private sector, working in the national health service, can deliver good-quality services.

I do not disagree with the hon. Gentleman’s point.

It is important that we recognise that community pharmacies provide their own premises and train their own staff. As a former business person, I totally get the point about value for money, but this is not just about money; it is about the efficient use of money. We all understand the pressures that our NHS face, and we have to look at that. There are a lot of myths floating around, so it is important that we clarify that.

There has been a lot of talk about the clusters. Again, because pharmacies are private businesses, they respond to demand in the community.

The hon. Lady brings her expertise to the debate. Does she agree that we need more innovative approaches? The Grove surgery in Solihull has a symbiotic relationship with its local GP services, but in parts of the UK we seem to have run into the sand. We need greater public awareness and encouragement to take such innovative approaches forward.

I will come on to that very point in a moment.

To return to value for money, it is important that the Government take a responsible attitude and review funding for pharmacies, and I think that professional community pharmacists across the country accept that. Much has been made of the clusters. Pharmacies are independent businesses that arise and stay in business where there is demand. I do not know whether this is widely understood—hon. Members will have to forgive me if they already know this—but the global sum allocated to pharmacies is what pharmacies cost the Government. The Government know what community pharmacies are going to cost. If a new one opens, it does not cost the Government any more; it just means that the same amount of money is shared out more thinly. That is a bit of a red herring. We can be sure that if there is no demand for the services that a pharmacy provides, it will close.

Much has been made of the £25,000 payment, but that does not cover the cost of putting a van on the road and paying for a driver to deliver and administer a prescription delivery service. Those services are absolutely invaluable to communities with many elderly people. I had a conversation with practice managers and general practitioners in my constituency recently, and they were absolutely horrified because they use that service—there is a lot of repeat ordering—and if it were lost, they could not cope.

The Government are suggesting that in-surgery pharmacists are a substitute, but that is another red herring. I welcome the use of well-qualified pharmacists in GP surgeries, but that is a totally separate issue. It is like comparing hospital doctors with GPs. Community pharmacists are at the heart of the community and are accessible for many hours. The hon. Member for St Austell and Newquay (Steve Double) made the point very well earlier when he said that eight minutes is the average wait to see a qualified professional who can help with most things. We have got to embrace that and use what is already there.

I have had conversations with the National Pharmacy Association and the Royal Pharmaceutical Society, and just last night the chair of the English Pharmacy Board said, “We want to work with the Government. We want to sit down and look at how we can do more.” There is the idea that integration is a new thing waiting to happen, but we were proud as community pharmacists to be at the heart of the primary care team, working with GP surgeries, hospital discharge teams, community nurses and district nurses. They often came to us. GPs came and went—that is even more the case now, given the problems with retention in GP practices—so we provided the only continuity in healthcare for many chronically ill people. Particularly for the elderly, that was a vital part of the service, and we were really proud to provide it.

Many community pharmacies are proactive. When this business of moving towards a clinical approach was suggested, community pharmacies accepted it without it needing to be mandated. We invested in a purpose-built consulting room to provide a more clinical environment. That is the way forward, and most community pharmacies accept that.

What is the alternative to what the Government are proposing? For a start, we need a proper assessment of what the cuts will mean. There has been no impact assessment of which pharmacies will close. I agree with the hon. Member for Bury St Edmunds (Jo Churchill) that it will not be the multiples that will close; it will be the independent pharmacies that rely on the £25,000 to provide their core services. That is an absolute fact. Not a single pharmacy in my constituency qualifies for access payments, and only three in the entire city of London do. I can say with absolute confidence that in my constituency it will not be Boots that closes or cuts its hours; because of the volume of business, it has other ways of covering its overheads.

I ask the Government not to throw money willy-nilly at pharmacies, but to look at their value and assess the impact of the cuts. If they think that the best way forward is for some pharmacies to close, they must ensure that the right ones close. We must do what the professional organisations are asking for and come to the table. Pharmacies are begging to take on extended roles. There is so much good will there. The minor ailment scheme, which we were privileged to provide, is an important service. Busy families who have children with minor ailments do not have time to be at the GP surgery. GPs accept that, without that service, they could not manage. We all know that GPs work hard and are overstretched. This is not about criticising the work they do; it is about supporting them, saving the NHS money and taking off pressure.

I ask the Minister not to reconsider the funding, but to look at the way he works with pharmacies in the NHS. I ask him to look at their role, as many Conservative Members have said, and at how they can work with the Government to support other areas of the NHS, thereby saving money. Let us avoid a knee-jerk reaction with no proper assessment of the impact. Let us deliver a better integrated service. The way to do that is not to make blind cuts with no proper assessment.

It is a pleasure to serve under your chairmanship, Mr Bailey. I congratulate my hon. Friend the Member for St Albans (Mrs Main) on leading the charge on what we all agree is an important subject. We have heard some very useful speeches, although I would make the point in passing that the subject is apparently so important to the Opposition that there have been no speeches from their Back Benchers on any aspect of the reforms during the last hour and a half.

My hon. Friend used an important word in introducing the debate: integration. I will talk about that, because if we are to fulfil the potential of the sector, which we need to do, it needs to be integrated. We have heard other important words too. We have heard about “pharmacy first” and also the phrase “wellbeing hub”, which I think sums up where we want to be in time. I will try to address many of the points made in all parts of the Chamber, but I will also set out what the Government are planning. When we boil it down, however, there is a huge amount of agreement about where we need to get to and the direction of travel. We also heard about Scotland, which is not perfect—the Murray review made some points about IT integration in Scotland, which is not yet working as well as it might—but as I have said in the past, I think we have things to learn from Scotland.

Everyone in the Chamber, Government or Opposition, can agree on three things. First, we need to move funding and the profession from a model based principally on dispensing to one based much more on services. Of course it is true that, to an extent, we are already going in that direction, but the funding model is not facilitating that, and it needs to. The Government must address that and take it forward.

Secondly, we all agree that services are a good thing per se, but that they are better if integrated with the primary care pathway much more than has been the case historically, and that is about working much more closely with GPs. I do not agree that employing more clinical pharmacists in GP practices is a “red herring”; it is part of how we bring the professions together, although I accept historically there have been difficulties doing that.

The third thing we all agree on—this must apply to the Opposition as well—is that we need to get value for money for the £2.8 billion that we spend on dispensing around £8 billion-worth of drugs. It is right to look at doing that as efficiently and effectively as possible. For example, the existing funding model encourages clusters to develop. I note that the establishment payment in Scotland is £1,700 per annum—I think I heard that right—while ours is £25,000, which has encouraged clustering, so that NHS money is not being spent on frontline services.

It is worth reminding the House that none of the efficiency changes that we announced before Christmas represents a cut of money going back to Treasury; the money is being reallocated to other areas of the NHS. The impact analysis talks in some detail about how money can potentially be spent more efficiently. In parallel with that, we need to make progress on services. I completely agree with that, and I will talk about the pharmacy integration fund and the Murray report, an important piece of work which my hon. Friend the Member for St Albans talked about and which will inform our policy.

We all agree not only on those three things, but on others. For example, there is a big benefit in diverting activity away from GPs. Various reports have been produced by the sector itself, and the Government accept that up to 30% or 40% of GP appointments could possibly be handled by pharmacists. That is a massive number. If we can achieve that, it will be of great benefit to us all. More can be done in pharmacies, such as medicine reviews and medicine optimisation, let alone how they can help us with the public health agenda, which we have not covered in particular today. A lot could be done with smoking cessation, obesity and sexual health programmes.

The Minister is contradicting himself. Pharmacists are already planning to reduce the hours that they are available to provide these services—the very services that he tells us he values and wants to see more of. Does he accept that if he persists with the cuts, there will be less of them? Some pharmacies will close, while others will reduce services, and are already planning to cut opening hours and reduce staff.

What we are not reducing is the amount of money available for services, as opposed to dispensing. Some pharmacies use part of their dispensing money to provide services on a discretionary and ad hoc basis, but I make this point again: overpaying for dispensing is not a good vehicle for getting more and better services.

I want to talk about some of what is already happening. We have heard about flu jabs this morning—I, too, had a flu jab at a pharmacy—and at the end of last year, we had had more flu jabs in pharmacies by October than we had in all of the previous year. The money available for that and similar service-based allocations has not been affected by the changes we announced. The community pharmacy sector has received £10 million for flu jabs up to the end of October. We want to see more of that happening, and that direction of travel is important.

A number of hon. Members made the point, which I agree with, that the public need to understand that pharmacies represent an important first port of call—it should not always be GPs. The Government can do more to make that clear. When I was preparing for this debate last night, I saw a television advert from NHS England for its “Stay well this winter” campaign. The campaign is running TV and newspaper adverts, and its theme is for people to visit their pharmacy as soon as they feel unwell. The people running the campaign have told us they think the advertising campaign has generated about 1.2 million additional pharmacy visits that would not have happened otherwise. That was a good challenge and we need to do more of that.

We also need to go further with services. There are two approaches. I recommend that anyone interested in this subject—as everyone present clearly is—reads the Murray review, which was produced by the King’s Fund. NHS England commissioned the review to inform it and us on how to spend the integration fund, the budget available to drive services more deeply into the system. I will talk about some aspects of that and about some announcements that I made in October as part of the package we are discussing.

One of the announcements was about urgent or repeat prescriptions. At the moment, NHS 111 gets about 200,000 phone calls a year asking for a further prescription, and those callers are told to see an out-of-hours GP to issue a prescription, which in due course goes to the pharmacy. We are changing that so that people will be directed to a pharmacy immediately. That is a stream of revenue for the pharmacy, which will provide both a consultation, for which it will be paid, and then the drug or prescription, as necessary.

My hon. Friend the Member for St Albans asked whether that scheme would somehow affect a good local scheme in her area. There is no reason why that should be the case. The new scheme is supplementary to anything that might have been commissioned already. It sounds as if her scheme was commissioned by the CCG, and that is good, although it takes us to the fact that things are patchy—different CCGs do different things in different areas, which I will come to. However, that is an example of where we need to be.

Another example is the minor ailments scheme. As I have said, 30% to 40% of GP appointments could be dealt with in pharmacies. Parts of England already have minor ailments schemes, but the service is very patchy and it need not be. It is true that different CCGs and indeed different GPs have different attitudes to such schemes, but NHS England has made a commitment that by March 2018 it will have encouraged all CCGs to be commissioning minor ailment schemes in pharmacies across their patch.

Is the Minister aware that in Devon about £5 million a year is apparently being wasted on unused medicines? Something needs to happen with that to ensure that the NHS has enough money with which to do things.

If I may answer the previous intervention, I will certainly give way again. I have talked about medicine optimisation and pharmacies doing reviews, in particular in people’s homes, for example, and they are part of that solution. Pharmacists in GP surgeries are part of the solution too, and a way of achieving that—as I said earlier, I do not agree that that is an irrelevancy.

I thank the Minister for giving way. A highly trained pharmacist, who often has a trusted relationship with his patients in the community, is better placed than any other health professional to lead on saving money on wasted drugs. Patients quite often say in a close conversation when they collect their prescription, “Actually, I’ve not been taking that,” but they quite often do not say that to their GP. The pharmacist will then take it upon themselves to say either, “Actually, do you realise you should be taking this?” or, “Let’s speak to your GP and, effectively, avoid waste.” The pharmacist is best placed to do that.

I completely agree. Pharmacists have a big role to play in saving money, and medicines optimisation is very important in that. NHS England has established an integration fund, which will provide £42 million—a significant amount, even in the context of the rebalancing that has occurred—of seed money between now and the end of the next financial year to address just those sorts of things and take that work further.

The Murray review, which was commissioned by Dr Ridge, the chief pharmaceutical officer at NHS England, and published in December, sets out in some detail what we believe the direction of travel should be. Someone asked earlier when the Government will respond to that review. I expect NHS England to respond this month—if I may put that on the record in that way. NHS England will respond, not me, but there is not a lot in the review that is controversial. There are a lot of very good points, many of them about IT integration and the care record. I agree completely that some of the progress we need to make with services involves the ability to both read and write to the summary care record. That will be part of where we have to get to. Frankly, technology is an area in which the NHS could improve. That is true in Scotland—it is true everywhere. I will not spend a lot of time talking about what we need to do, but we could facilitate an awful lot of progress on integration between pharmacy and primary care, and primary care and secondary care, if we had stronger technological and IT solutions.

Colleagues have talked about the need to have more pharmacy involvement in medicines optimisation, and care homes are part of that. Pharmacists could do an awful lot with a more structured approach to care homes. One strand of work that has come out of the integration fund is a care homes taskforce, which is chaired jointly by the Royal Pharmaceutical Society and NHS England and is setting out a direction of travel for doing the sorts of things we have talked about, such as medicines optimisation, in a more structured way in care homes right across the country. There are more than 50,000 qualified pharmacists across our country. There are also 23,000 qualified pharmacy technicians, who are part of this too. The pharmacist profession is not as short as some, and it can and needs to do more to make progress in this area.

One part of the Government’s approach to this whole area that has been mentioned and I do not think enough is made of is the GP forward view. Everyone understands how much pressure GPs are under. There are something like 400 clinical pharmacists working in GP practices. We have committed and budgeted £112 million to increase that to 2,000 clinical pharmacists, many of them dispensing pharmacists. Parts of the community pharmacy network, which we have heard a little about, regard that as potentially in conflict with what they do. I think that is wrong. It is not in conflict; it is a way of breaking down the barriers that I accept there have occasionally been between CCGs and GPs and the pharmacy profession. Those are not in anyone’s interests, and we need to get over them.

The only concern I have about too much of a drift towards putting pharmacists in GP surgeries is that GP surgeries have limited opening hours. Many pharmacies have a drop-in service. My hon. Friend the Member for St Austell and Newquay (Steve Double) mentioned the average waiting time of eight minutes. Having a link between booking a GP appointment and going to the pharmacy would start to bring people back into GP services rather than keeping them outside those services. That is the only concern I have about that matter.

That is of course a valid concern. We are trying to make progress on having GP services open for much longer than they have been historically, including weekend opening. Several colleagues have made the point—the Murray review also addressed this—that there is occasionally a barrier between the attitudes of some GPs and what can be done by pharmacists. That is true. We must be conscious that it behoves us to try to encourage the breaking down of that barrier, and misplaced professional pride must not prevent us from doing things to the best extent. Putting some pharmacists in GP practices—particularly with new models of working in which more disciplines tend to work together and a GP does not just work on his own—is an important part of that.

There is a barrier, but again, those services are used in different ways. My independent community pharmacist in Bury St Edmunds dispenses around 18,000 or 19,000 prescriptions in the town and provides all these ancillary services. He also has a dispensing practice in a GP surgery, which he is looking to automate, to make it more streamlined and cost-effective. Those services are two slightly different things, and I would worry if there were too much of an idea that they service the same thing.

They are different, but my point was somewhat different: optimising the use of the pharmacist profession could facilitate the breaking down of barriers and some of the care home activities that have to happen.

I will leave a couple of minutes for my hon. Friend the Member for St Albans to respond, so I will not talk in detail about the value for money aspect, other than to repeat the point—Opposition Members made a couple of interventions about this—that overpaying for a dispensing service is not the way to facilitate a much more clinically-based and service-based approach. The way to facilitate that is to get the appropriate remuneration models and revenue streams in place, and that is what we are determined to do. In the end, that is what we expect to be judged on, and I hope that we will be judged on it. With that, I will let my hon. Friend summarise.

This has been an excellent debate. I echo the Minister’s sadness about the fact that the two Opposition Members who made interventions did not stay for the whole debate. Unfortunately, some did not even arrive for the beginning of the debate, let alone stay for it all. That is disappointing, because this issue has filled my postbag and this debate is timely. There has been a lot of news about whether the NHS is under massive strain now more than ever. The reality is that we need a new model of working. Many hon. Members have put forward positive suggestions and have obviously been engaging with their local pharmacists. I am pleased that so many Government Members have made that effort and are so knowledgeable about their pharmacies.

The very fact that many private independent pharmacies like Quadrant have put money into their businesses—the hon. Member for Burnley (Julie Cooper), who leads for the Opposition, stressed her role in that—shows that there is a private model that can work with the NHS. It shows that those two models can be mutually beneficial and can learn from and give to each other. I am delighted that the Minister said that the emergency prescription system would not necessarily rule out the excellent system that Quadrant pharmacy operates, and I am delighted that we will soon hear the response to the Murray review, which contains many positive aspects about the way forward for pharmacies.

I am glad that there is so much consensus that keeping the model in which small, private independent pharmacies support the public NHS is an excellent way forward, and long may it reign. I am just concerned that we must ensure that small independent pharmacies in rural areas like the one that my hon. Friend the Member for Bury St Edmunds (Jo Churchill) represents are supported, perhaps with a weighting system. It is hard for them to compete with the big boys on the high street and the concessions in out-of-town supermarkets with parking and Sunday opening. I am glad that the Minister has been so frank with us, I am glad that there is so much consensus, and I am really looking forward to a great future for the NHS.

Motion lapsed (Standing Order No. 10(6)).

Asylum Seekers: Right to Work

Before I call Alison Thewliss to move the motion, I have had a request from Stuart McDonald to participate in the debate. May I confirm that both the mover of the motion and the Minister are happy for him to do so?

I beg to move,

That this House has considered asylum seekers and the right to work.

It is a pleasure to see you in the Chair, Mr Bailey. I have taken an interest in the rights of asylum seekers for some years now. One of the very first events I attended as a councillor in Glasgow in 2007 was the opening of Refugee Week, the inspirational and ever-growing festival co-ordinated by the Scottish Refugee Council. That was the first time I heard directly the testimonies, experiences and views of those who had fled violence and persecution. They told their stories through music and dance as well as in words, because the trauma they were expressing was often beyond description.

The right to seek asylum is set out in the universal declaration on human rights, and it is one of the most important obligations in international law. However, it has become clear to me over the past few years that sadly in the UK we are not fulfilling our duties to asylum seekers. We often keep them in a situation of destitution and danger, with little acknowledgement of the difficulties that led them to flee. Worse still, we are devaluing these precious human beings. Asylum seekers have skills they could bring and talents they could share. These are people who have overcome everything and lost so much. The very least we should do as a nation is give them a means of living in dignity, and I believe, as I will lay out, that there are circumstances in which they should have the right to work. That is consistent with the position that the Scottish National party took, along with Labour Members, in proposing amendments to the Immigration Act 2016 to enable asylum seekers to work if they had been waiting more than six months for a decision. The UK Government sadly rejected the amendments.

With no permission to work, asylum seekers survive—it is barely survival in many cases—on £5 a day. That affects more than 8,000 asylum seekers in the UK. The right to work was withdrawn by the Labour Government in 2002. At present, asylum seekers can work only if they have been waiting for a decision for longer than one year and they have skills relevant to the occupations on the shortage occupation list, which covers only jobs that few or no UK nationals are able to perform. Those are often very specific jobs, such as various types of scientists and engineers, as well as trades such as professional dancer or musician, which require specific qualifications and experience, as well as an employer who is willing to take a person on when they do not know how long they may be in the UK.

I congratulate the hon. Lady on securing this important debate. I know she does a great deal of work in this area. I want to focus briefly on volunteering. In Solihull, many volunteers provide an outstanding service to our communities. Solihull Welcome, for example, supports new asylum seekers with great information, food and clothes. Does she agree that to integrate asylum seekers further into society, we must promote voluntary work?

I agree, and I congratulate the organisation in Solihull on doing that. However, I have found in some of my casework that there are barriers even to volunteering. The Home Office has held that against one of my constituents, whom I had intended to mention later, who was volunteering for the British Red Cross. When he applied for naturalisation as a British citizen, that was held against him as a means of demonstrating bad character. It is bizarre, but his volunteering and his good work in an attempt to integrate into the community in Glasgow was held against him.

It can also be difficult for asylum seekers to prove that they have professional qualifications and so should have access to the shortage occupation list. Depending on the circumstances in which they fled, they may not have documentation, and it may cost to transfer or update their qualifications. That approach prohibits asylum seekers from offering their skills while they are still waiting on decisions. Many asylum seekers have been waiting for longer than six months. The latest figures that I can find suggest that more than 20% of asylum seekers wait longer than six months to have a decision made. During that time, they cannot bring in any money, and they find it difficult to support their family.

The recent working paper, “Restricting the economic rights of asylum seekers: cost implications,” published by Dr Lucy Mayblin and Poppy James at the University of Warwick, outlines the significant savings there would be to the public purse should asylum seekers be given the right to work. There would be a benefit to the UK if they were allowed to do so. Dr Mayblin’s research indicates that significant savings could be made on asylum support payments—both section 95 and section 4 —if asylum seekers were given the right to work. If just 25% of all asylum seekers currently receiving asylum support participated in the labour market, that would reduce the overall asylum support bill, both in cash and for accommodation, under sections 94 and 4, excluding staffing and admin costs, from more than £173.5 million to just over £130 million. That would save about—I rounded the figures up, because some of them are lengthy—£43 million in asylum support payments, without making asylum seekers destitute. If 25% of all asylum seekers were able to obtain employment, section 95 payments would decrease from about £63 million to £47 million, and section 4 cash payments would decrease from more than £9 million to just less than £7 million, based on 2014-15 figures.

Even with increases in the asylum support rate to 70% of the jobseeker’s allowance rate, if we enabled 25% labour market participation, savings could be made to the asylum support bill. Estimates suggest that the total asylum support bill—again in cash and for accommodation, under sections 94 and 4, and excluding staffing and admin costs—could decrease from £173.5 million to £152 million, a saving of about £21 million. The Government are always looking to make savings, so I offer helpful suggestions for where those might be made.

Those figures, however, represent more than just money. Case studies available on a host of websites, such as that of the Scottish Refugee Council and the Regional Refugee Forum North East, speak of dignity, and of the impact on family life of not being able to work. I quote from one of the testimonies on the RRF website:

“It’s a degrading situation. You feel useless in a place that sings democracy. Not being able to work is degrading to me. It is something that has been taken away from me, something that I believe is a right that nobody should lose. It’s depressing because my background is feeding my own family. We have very strong family values. I have a big duty of care that has been stripped away. And not being able to do that for myself I feel a failure in life. I feel very much a failure in life. The kids, I would have loved to do anything that the children would ask me for. But this position is a crippled life.

As a volunteer with the refugee service and as a leader for my own community, which is the Zimbabwean Community in the North East, I have witnessed people who are so depressed, who I can say they are now mentally disturbed, people who had skills but cannot use them anymore. It’s like somebody taking a certain measure of power away from you. If you lose that something, it won’t just go, it will go with a part of yourself that makes the You inside you.”

That is a powerful statement. There is appalling waste of human potential during that time; people can wait for years without working and contributing as they would dearly like to do.

I congratulate my hon. Friend on obtaining the debate. Is there not another problem, in that the shortage occupation list does not recognise degrees from countries such as Iraq, Syria and Afghanistan, which many asylum seekers have come from? The Government should have a look at that situation so that they can allow asylum seekers to work.

I agree. There are many ways in which verification becomes quite difficult when countries have been in a state of chaos.

I have one of the largest immigration case loads in Scotland in my constituency of Glasgow Central, and I regularly have asylum seekers at my surgery who are in dire straits as a direct result of Home Office policy. One constituent who came to me had fled political persecution in Sri Lanka in 2013. On claiming asylum in 2014, she was detained in Dungavel detention centre, where she was sexually assaulted by another detainee. She is now destitute and relies on charities for support. That bright young woman could be using the qualifications in business, which she gained, as it happens, from a UK further education college, to get a job and support herself. Instead, she has been so emotionally ground down by her experience of the system that she is deeply fearful for the future. Her heartbreaking case is part of a pattern of behaviour by the Home Office that in many cases treats those fleeing persecution with contempt.

The hon. Lady is making a good and important speech. There are far too many asylum seekers in Rochdale—more than 1,000—which is unfair in terms of how they are shared out across the country, but I completely agree with the point that she makes about work. Does she agree that if more were allowed to work, it would help with community cohesion in places such as Rochdale?

I agree. People often do not understand that asylum seekers are not allowed to work. Media perceptions can be hugely damaging, including, as I mentioned earlier, to asylum seekers’ mental health. Many are keen to contribute but also scared, as I described in the example of my constituent whose volunteering was held against him. That puts fear into organisations that might take volunteers: they do not want to be caught out by the Home Office and get into trouble. Some of them employ people via the visa process. However, volunteers also do not want to come forward; they say, “If it is going to count against me, I am not going to volunteer. I am not going to help with interpreting.” If an organisation such as the Red Cross is seen as giving someone a bad character, that is difficult, and it definitely puts people off.

Another of my constituents has endeavoured to learn English to a high standard, and has taken up volunteering, supporting elderly people at a community centre. She has a clear aptitude for community work, but is unable to develop it because of the ban on work for asylum seekers. My constituent has two children, who go to a local school, but she is held back. She would love to do that work but cannot.

I am lucky to have the organisation Radiant and Brighter, founded by Pheona and Micheal Matovu, in my constituency. They came from Uganda to the UK and were unable to work for years, because of immigration controls. They were a couple with a family, used to working for a living, and found it very hard to be dependent on help from churches, family and friends. Pheona once told me how determined the two of them were not to let their children know they did not have a job, even when they were not permitted to work. Their experiences led them to find others in similar situations, and to discover the support that some asylum seekers and refugees required to transfer the skills they brought from their home countries and take up UK opportunities when they could. Radiant and Brighter provides practical day-to-day support and assistance, including personal coaching, advice on legal and financial matters and help with CVs—something that people might not be familiar with in their own countries—and job applications.

Crucially, Radiant and Brighter recognises the skills, talents and potential of asylum seekers and refugees beyond the narrow bounds of the shortage occupation list, appreciating the fact that asylum seekers can be a bonus to the UK, not a burden; the Minister would do well to speak to Pheona and Micheal and see for herself the work that they do in Glasgow to integrate and support asylum seekers. They have a good model for allowing people to make the jump to being productive members of Scottish and British society, as they want to be, and for supporting them in that.

Allowing asylum seekers to work would enable them to integrate better into society, develop their English and make friends in what can be a lonely environment—and a strange one, depending on where they have come from. Many are professionals, with skills that they would love to put to use and which would benefit our economy. By making a modest change to the immigration rules, so that they are similar to those of other European countries, and by relaxing the restrictions on working, we can give asylum seekers back a sense of dignity and self-confidence, while saving money for the public purse in the long run.

My hon. Friend the Member for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald) is sponsoring an exhibition by the Joint Council for the Welfare of Immigrants in the Upper Waiting Hall this week. That organisation has campaigned for fair asylum and immigration law since 1967. I urge the Minister and other hon. Members to see the exhibition, if they have not already. It clearly demonstrates the contribution of people who have sought asylum in the UK over the years. Examples include the co-founder of Marks & Spencer, Michael Marks. There is nothing more British than Marks & Spencer. Michael Marks was born in 1859 in Slonim in what is now Belarus, which was then part of the Russian empire, and fled to England in 1882. It cannot be argued that he did not make a lasting contribution to the UK.

The children’s author and illustrator Judith Kerr fled Germany with her family in 1933 aged nine, just days before the Nazi party came to power. It cannot be argued that she is not a beloved part of British society. The supermodel, designer and refugee campaigner Alek Wek was born in 1977 in what is now South Sudan. The singer and actress Rita Ora arrived in the UK in 1991 aboard the last plane to accept Kosovan refugees. There are so many people who have come to our shores seeking safety. We should take pride in that and treat them with the dignity and respect they so greatly deserve. I appeal to the Minister to see the human potential in those whom we have made a commitment to protect.

It is a pleasure to serve under your chairmanship, Mr Bailey. I congratulate my hon. Friend the Member for Glasgow Central (Alison Thewliss) on bringing this important debate to the Chamber and on her fantastic speech, and I thank you, Mr Bailey, my hon. Friend and the Minister for allowing me to make a short speech. I was keen to take up the opportunity, because the matter is important to the Scottish National party. We have campaigned for change for a long time, and that is why we divided the House on the issue during the ping-pong stage of the Immigration Act 2016.

The Government’s position is to deny asylum seekers the right to work. The idea that after one year, an asylum seeker can apply for a shortage occupation job is just a small footnote, for a series of reasons, including the one pointed out by my hon. Friend the Member for Glasgow South West (Chris Stephens). It would be interesting if the Government would tell us how many asylum seekers have enjoyed that right. I understand that they have previously failed to answer written questions on that point.

Sadly, and typically for UK Government policy on asylum and migration issues in general, the position has little to do with principle and nothing to do with evidence, but everything to do with political posturing. Excluding people from the right to work is a lose-lose situation. It is bad for the individual, for the family, for the UK citizens who could benefit from the people in question using their skills, for community cohesion, as the hon. Member for Rochdale (Simon Danczuk) pointed out, and for the public purse, as my hon. Friend the Member for Glasgow Central pointed out.

We are warned by the Government of the danger of creating a pull factor, but are we really to believe that people will decide to up sticks and come to the UK on the off-chance of claiming asylum, becoming one of the minority of people who must wait longer than six months—outside the Government target—and then having the possibility of working? If so, where is the evidence for that? There is no evidence for it. Also, why do those asylum seekers not go to other European countries where there is such a right to work, and a more generous one? Yet again, we are the EU outlier. The whole proposition is nonsense, and I think that the Government know that.

Another argument that the Government sometimes use is that there would be a danger of asylum seekers deliberately frustrating the process, so that their claims would take longer than six months. However, that argument does not stack up. The Government have the power to refuse asylum claims on the basis of non-compliance. The argument does not make any sense.

We are dealing with human beings who have asked for international protection. That is an important right, whatever the outcome of the claim. Whether or not the claims are found to be sound in law, the applicants deserve dignity and fair treatment, so we ask the Government to think again.

It is a pleasure to serve under your chairmanship, Mr Bailey. I thank the hon. Member for Glasgow Central (Alison Thewliss) for raising such an important issue, and I commend her passionate speech. She is clearly pursuing the issue in the House with great vigour and determination. I also thank the hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald) for his speech. I am sure to have said the name of his constituency wrongly, so I apologise. I noted also the remarks of the hon. Member for Rochdale (Simon Danczuk). It is disappointing that the shadow Minister did not bother to come to the debate. I see that the hon. Gentleman agrees with me that that is a sad reflection.

It is right to say that, as a general rule, we do not believe it is appropriate to allow asylum seekers to work in the UK. However, we will grant an asylum seeker permission to work in one of the jobs on the shortage occupation list if their claim has not been decided after 12 months, through no fault of their own. We believe that that is fair and reasonable; it protects the resident labour market and ensures that access to jobs is prioritised for British citizens and those with leave to remain, including refugees.

The immigration rules for non-EEA nationals wishing to work in the UK are designed to meet our needs for skilled labour and to benefit our economy. That approach would be undermined if non-EEA nationals could bypass the rules by lodging unfounded asylum claims. It is an unfortunate reality that some individuals make such claims in an attempt to stay in the UK. It is reasonable to assume that some do that because of the benefits—real or perceived—that they think they will gain.

I will not; I have been generous in allowing the hon. Gentleman to make his speech. So that I have the opportunity to answer the serious points that have been raised, I will need to make my whole speech. If he feels that I do not address his concerns, I ask him to write to me.

Allowing asylum seekers earlier access to work risks undermining our asylum system by encouraging unfounded claims from those seeking employment opportunities for which they would not otherwise be eligible. We also must not create further incentives for asylum seekers to risk their lives attempting to travel here illegally. We instead want to encourage genuine refugees to claim asylum in the first safe country they reach.

I know there are those who say, as has been said today, that there is little evidence of a pull factor. I do not agree. We have seen the effect that policies in Europe have had in driving migrant behaviour. In 2015, following a shift in policy, Germany saw its asylum intake increase by 155%. More than 20% of those claims were from countries in the Balkans, which, mercifully and thankfully, have not seen conflict for more than 20 years.

There has been much debate, as has been referred to, about past delays in decision making by the Home Office, but that has been brought under control. In most cases, asylum seekers receive a decision within six months. While they are awaiting that decision, asylum seekers, who would otherwise be destitute, are entitled to free, furnished accommodation that is safe and of a good standard. In preparation for the debate, I met a Home Office official who personally inspects that accommodation in the constituency of the hon. Member for Glasgow Central and was assured of its quality and safety.

A cash allowance is given to asylum seekers to cover essential living needs. It is worth noting that in October, the High Court agreed that the methodology used by the Home Office for assessing the adequacy of payment rates is rational and lawful. The judgment also rightly rejected the argument that the rate should be the same or similar to that paid to benefit recipients by the Department for Work and Pensions. I do not accept that we are in some way treating people in an appalling or degrading way by providing that accommodation.

I will not, because I want to address the points that the hon. Lady has raised.

It is worth noting that we encourage asylum seekers to undertake volunteering activities, so that they can benefit the community. That supports integration if they are granted protection, and addresses some of the self-esteem and respect issues that the hon. Lady rightly referred to. Opportunities will be provided in communities for people who are used to being providers for their families or community leaders in the countries from which they fled.

I was pleased to hear the intervention from my hon. Friend the Member for Solihull (Julian Knight), who made an excellent point about the role the voluntary sector is playing in his community in supporting asylum seekers. For clarity, it is important to understand that those volunteering activities must not amount to unpaid work or job substitution. The Home Office recently published revised guidance to help clarify that issue, in case there is any uncertainty.

The current policy strikes the right balance. It is fair and reasonable towards genuine asylum seekers, it is consistent with our international obligations, and it takes into account the rights and needs of asylum seekers and our whole society.

Question put and agreed to.

Sitting suspended.

Access to Justice

[Geraint Davies in the Chair]

I beg to move,

That this House has considered access to justice.

It is a pleasure to appear in front of you, Mr Davies. I thank all those who sent in briefings and background information, which have been most helpful. I especially thank the law firm where I was a partner for several years, Thompsons. In fact, two other Members who are Thompsons alumni are with us today. Thompsons supported my campaign for re-election 18 months ago financially. I also thank the Law Society of England and Wales, of which I have been a member for three decades or more, and the Association of British Insurers.

Access to justice is a pillar of the welfare state. To me, it is no coincidence that in 1948, the legal aid system in England and Wales was introduced—the same year as the introduction of national insurance and the national health service. It is one leg of a three-legged stool called the welfare state. This afternoon, I will not have time to cover as much information and as many matters as I would like. I hope to run around the block on the small claims limit for personal injuries, soft tissue injuries and whiplash claims, and to touch on employment tribunal fees, legal aid deserts and court closures.

I will start with the small claims limit. In recent years, other jurisdictions with similar systems to ours have looked at raising their small claims limit. In Scotland, the small claims limit was raised in 2007, but all personal injury claims were specifically excluded from that, as colleagues from the Scottish National party who are here today will know. They were excluded principally on the grounds of complexity, because of the need for those claiming for a personal injury to instruct solicitors to obtain expert medical evidence and, quite often, other expert evidence—for example, from an engineer.

When the Scottish system was reformed in 2014, personal injury was still treated differently. In 2014, a new procedure was introduced in Scotland called, simply, the simple procedure, to replace small claims and summary causes for cases with a value of less than £5,000. However, most personal injury claims, while proceeding under simple procedure, have special rules. Employers’ liability claims, where someone is injured at work, are entirely excluded from simple procedure.

Whether to raise the small claims limit has been looked at repeatedly in England and Wales. For example, in 2009 Lord Justice Jackson recommended in his report that the limit be retained at £1,000 for small claims relating to personal injury, with a fast-track system. Looking back on that in 2016, he said:

“The fixed costs regime for fast track personal injury cases is working reasonably well.”

I appreciate that people could say he is biased: he suggested one course of action, which was followed, and then seven years later said it was working well.

However, in July 2016, less than a year ago, Lord Justice Briggs in the final report of his civil courts structure review concluded that

“a fixed or budgeted recoverable costs regime, backed by Qualified One-way Costs Shifting…plus uplifted damages has, in the sphere of personal injury (including clinical negligence) litigation been a powerful promoter of access to justice, in an area where the playing field is at first sight sharply tilted against the individual claimant, facing a sophisticated insurance company as the real (even if not nominal) defendant.”

That sets the scene, because there is an asymmetry between many victims who are claiming that they were injured as a result of someone else’s negligence and the effective body against whom they are claiming. For example, following a car accident between two individual drivers, the victim will be claiming against the other driver. That is often an individual, but behind that driver sits the insurance company, which will run the claim and has to do so under the compulsory policy of insurance that all drivers have to take out.

My hon. Friend is doing a great service to the House of Commons by bringing this issue before it. He is beginning to make the case that access to justice is fundamental to the welfare state. In one sense, he underestimates its importance. Does he agree that it is fundamental to democracy? A democracy relies on freedom of speech, freedom of the press, the right to vote and access to justice. If there is not the money for access to justice, we do not have the rule of law.

I entirely agree. It is little use having rights if one cannot afford to enforce them. That entrenches inequality.

The consultation came out under the rubric of whiplash. I have to say to the Minister that the consultation somewhat sneakily was announced on 17 November and closed on 6 January. That is a short consultation period over Christmas, which is not helpful.

The Government’s own figures on the whiplash proposals, which may well be a gross underestimate, suggest that if implemented, they will see the NHS lose at least £9 million a year and the Treasury lose £135 million a year. But here is the stinger: insurance companies will get at least £200 million more per year. That is likely to be an underestimate. That figure is due to a methodology that is biased towards insurance companies and has been severely questioned by the Association of Personal Injury Lawyers, of which I think I used to be a member.

The methodology for who gains and who loses under the proposals counts as a gain the extra moneys that insurance companies will get but does not take into account the loss to solicitors. We can all weep crocodile tears about solicitors, but when talking about commercial arrangements, if we are looking at them dispassionately, we have to weigh in the balance where one commercial sector gains and another loses.

Will the hon. Gentleman join me in welcoming the UK’s largest insurance company’s commitment to pass on in full any savings realised to consumers? That means, I hope, that the transfer of value, if it occurs, is from the personal injury law community to everyday consumers.

I will get on to that. It is interesting and a great declaration, but of course other changes in the past five years or so have led to an increase in insurance company savings of £8 billion in claims costs. That has not been passed on in terms of reduced premiums, which have continued to go up, so I will believe it when I see it. The Government’s own calculations suggest that at least 90% of the money has to be passed through—the term for returning money to policy holders—for there to be any benefit at all.

As the hon. Gentleman will know, the small claims limit is being put up in all the other jurisdictions, apart from this one, to £10,000. Is it really right that motorists should each pay £40 a year extra, simply so that the sort of solicitors firms he referred to can continue to do work on these very small claims?

The limit has not gone up in Scotland for personal injury claims. I will get on to the figure of £40 a year and whether it is accurate or not.

So much of this information comes from the insurance companies, which are making huge profits. Premiums have gone up 17.2% in the past year, which I regard as unacceptable. I asked the Association of British Insurers about that on 3 January, and it kindly replied a week later. I am not a statistician, but I have knocked around statistics a lot, and its approach is strange, to say the least. It says:

“Given there is no objective medical evidence for whiplash type injuries, with diagnosis often being made on the basis of the claimant’s word, the ability to prove beyond all reasonable doubt that the claimant has not sustained an injury is both incredibly challenging and expensive.”

That is typically misleading of the Association of British Insurers. The Minister will know, as a distinguished lawyer, that if the insurers refuse to pay out on a claim and the policy holder says the insurers are wrong, the policy holder makes a claim in the civil courts against his insurers, where the test is not about proving something beyond reasonable doubt, but based on the balance of probabilities, which is a much easier test to pass. So that is a straw man, but it is true in terms of criminal actions.

The ABI also states that

“actual criminal convictions clearly only represent the tip of the iceberg, and are not in any way a true reflection of the level of fraud that insurers and wider society face on a daily basis… While some of those cases may have an innocent explanation, many more cases of successful fraud go undetected, especially for whiplash.”

The ABI is assuming what it is trying to prove. It is assuming that there is fraud, but it admits that if there are such cases, they are going undetected. We do not know whether there are undetected cases of fraud or there never was a case of fraud. If it assumes what it is trying to prove, I certainly hope my insurance premiums are not set by insurance company actuaries who take such an approach.

That is all very well and good, but the hon. Gentleman must know that the number of road claims has gone up from 460,000 in 2005-06 to 770,000 in 2015-16, and that 90% of them are for whiplash at a time when our roads are getting safer and our cars have seen huge road safety improvements in their manufacture. How can this be?

It cannot be because the Minister has the figures wrong. The Government’s compensation recovery unit indeed talks of 771,000 claims in round terms, of which 441,000 are for whiplash. That figure has come down by 7% since 2011-12. The overall figure is already coming down, so it is not going in the direction the Minister thinks it is and perhaps he will rethink the proposals.

The ABI says that its statistics

“are therefore intended to provide an indication of the volume and value of fraud detected by the industry. These statistics do not include claims which involve exaggerated personal injury, particularly for whiplash, where the claim has been paid.”

However, it also says that insurers pay out on 99% of claims, so apparently we are talking about the 1% and that is what all these assumptions are based on. That is not a good basis for creating public policy.

Does the hon. Gentleman agree that the qualified, one-way costs-shifting arrangements that were introduced three or four years ago, whereby the defendant bears their own costs, even if they are successful, creates a perverse incentive for insurance companies to settle claims even when they have a very good prospect of defending them?

That regime was introduced as part of other changes which have led to £8 billion more for the insurance companies. One must look at the matter in the round.

The ABI says:

“Previous reforms aimed at tackling the compensation culture have not had the desired effect because claims frequency has not been addressed. As such, the removal of general damages for minor soft tissue injuries is by far the most effective way to address claims frequency.”

What sort of minor injuries are we talking about? The Law Society helpfully provided me with some examples from a public briefing:

“A fractured rib (up to £3,300)”—

that is well below the £5,000—

“Food poisoning symptoms continuing for weeks (up to £3,300)”—

No, I will not. The Law Society continued:

“Neck injuries lasting”

for up to

“12 months (Maximum £3,630)… Back injury lasting up to 3 months (up to £2,050)… Minor wrist fracture (£3,960 maximum)”.

I would venture that such injuries would not seem minor to most of our constituents. Most of them would not say a broken wrist was minor. [Interruption.] Well, they certainly would not in a Labour constituency; perhaps they would in Conservative constituencies. [Interruption.] The Minister is chuntering, “It’s not whiplash”; part of the problem is that the proposals in the consultation paper do not cover just whiplash, with which, I have said, there is not a problem. They cover all personal injuries, including accidents at work. Someone who breaks their wrist at work would not be able to instruct a solicitor, but they would almost certainly have to get a medical report and so on. I just do not think that these are what most of my constituents would call minor soft tissue injuries.

That is one reason why the Law Society has come out against the proposals, saying that:

“the government does not appear to have a robust evidential basis for undertaking the reform”.

So, too, has Cycling UK—it used to be the CTC or the Cyclists’ Tourist Club—which says:

“This change doesn’t target whiplash claims or claimants: it impacts most on those who end up in casualty with broken limbs due to the negligence of others.”

It talks about

“A reform which denies”

the injured

“justice, and sends a message to motorised road users that vulnerable road users’ injuries are a trifling matter”.

The Government have said in their propaganda that most road users have legal expenses insurance as part of their car insurance policy—I do not—so they will be able to get legal representation under that policy. That may be true for many if not most car drivers, but most of us cyclists do not have such insurance, nor do most pedestrians. That is why Cycling UK and its partners—RoadPeace, a national charity for victims, and Living Streets, a national charity for everyday walking—have come out against these changes.

No, I will not. I have already given way to the hon. Gentleman. I was going to talk about employment tribunal fees, but I have taken up quite some time, and some of my colleagues wish to talk about that. Of course, employment tribunal fees have dissuaded huge numbers of people from bringing employment claims. If the Government really think that 67% of previous claims were frivolous—that is how much the figure has dropped by—they are living in a different world from me. Again, the Law Society, which of course has a vested interest, is against those fees. It said:

“In our members’ experience the remission system”—

for remission of fees for those who cannot afford to pay tribunal fees—

“is confusing, uses complicated language, and is hard to navigate”,

and that is for Law Society members, who are solicitors, let alone the lay person who may have just lost their job and perforce be broke. Only 21% of claimants—far fewer than the Ministry of Justice predicted—have benefited from any fee remission at all. Early conciliation was put forward as another approach, but ACAS says that 70% of claimants who entered into early conciliation did not reach a formal settlement.

I congratulate my hon. Friend on bringing forward this debate. There is another dimension to tribunals and legal aid in general. Many people come to us, although we are not allowed to give legal advice, because they cannot afford to pay for it. Secondly, citizens advice bureaux and bodies such as the Coventry Law Centre are overloaded with work, because the Government have cut the grants to those organisations, and as a result, they have had to reduce staff. There is an endless vicious circle when people try to get justice in this country.

My hon. Friend is quite right. It is a matter of playing catch-up following the changes to legal aid. There are now legal aid deserts. Recent figures from the Legal Aid Agency show that large areas of England and Wales have little or no provision for legal aid services for housing. That is rather ironic on a day when the Homelessness Reduction Bill, introduced by the hon. Member for Harrow East (Bob Blackman), is being debated. In the south-west, over half of areas have only one provider of legal aid for housing advice. In Wales, half of areas have only one provider. In the west midlands, where my hon. Friend the Member for Coventry South (Mr Cunningham), who just intervened, and I come from, over half of areas have one or no provider. Shropshire, which is not far from my constituency, has no provider. When there is one provider, families on low incomes often cannot afford to travel to see them.

My hon. Friend the Member for Coventry South adverted to the fact that we have a catch-up system, because there are cuts in the number of courts. In Shropshire, people cannot get to Shrewsbury Crown court for a hearing at 9.30 in the morning by public transport from Ludlow, another major population centre. Cases are collapsing as a result; witnesses will not travel, and people are pleading guilty because they do not want to take even more time off work. That is not justice.

Solicitors in Coventry and Warwickshire are looking at the possibility of getting local law students at the University of Warwick to assist with some cases.

Indeed—that is, when they can get to a court, because there are plans to close 86 courts and tribunal centres and to cut Ministry of Justice staff by between 5,000 and 6,000. That has led to the courts getting clogged up with litigants in person who cannot afford to pay for legal representation. Judges, quite properly, try to assist litigants in person and to be flexible, so cases take longer. The Government end up with a false saving, because we spend more on the remaining courts to deal with litigants in person, and we have a worse justice system with less access to justice.

Is that not particularly acute in family law cases, and difficult cases relating to children and finance, when litigants in person appear before district judges, who have problems resolving the cases?

My hon. Friend is entirely right and anticipates what I am going to say. There is, as he will know as a distinguished lawyer, an exceptional case fund, which was established to help people such as survivors of domestic violence to get free legal assistance. The Independent, which admittedly is a newspaper and not the Ministry of Justice, reported in 2015 that from April to December 2013 there were 617 applications to the exceptional case fund—that will be for all of England and Wales—and eight were successful. In the three-month period from April to June 2015, five out of 125 applications were successful. The people applying are some of the most disadvantaged in society and face some of the most grievous personal circumstances.

Legal aid has been eroded particularly, perhaps, for victims of domestic abuse, and many now have to present their cases in the family court. Regardless of recently announced Government proposals in relation to abuse of process, surely domestic abuse victims must have their own lawyers in family courts to avoid abuse by proxy.

I will reply to the hon. Lady first. I agree entirely with her. I will give way to the right hon. and learned Gentleman, as the Minister, but I will just say that the Ministry of Justice anticipated between 5,000 and 7,000 applications annually. The actual figures are far lower than that. One reason—perhaps the Minister, when he intervenes, can promise to do something about this—is that, understandably, many solicitors are unwilling to make applications to the ECF because it is so bureaucratic, even though this Government say that they do not like bureaucracy; it takes between six and 10 hours just to make the application. The cuts have had far-reaching negative implications for children and vulnerable young people as well.

I was just going to ask whether the hon. Gentleman agrees that domestic violence cases are within scope, and that a victim would have legal aid in the way that I outline. As for the exceptional cases fund, which the hon. Gentleman has challenged me to say something about, 1,200 cases a year is the current rate, and 53% are being granted; that is the latest.

That is helpful, but it kind of makes my point for me. The right hon. and learned Gentleman’s own Ministry—before he was there, I have to say—anticipated between 5,000 and 6,000 such applications. A 53% success rate seems to me, on the face of it, to mean very stringent criteria, given how long a solicitor will spend preparing the application—and they will not get paid for that preparation, which suggests that the solicitor making the application on behalf of the vulnerable individual thinks that there is a very good chance of success. But what do they find? It is about half.

In time-honoured tradition, I will ask the Minister some questions, which I hope he will be able to answer. I did give him some notice of them, but only at noon today, so although he is a hard-working Minister, he may not have had the chance to get on top of them all. On small claims, does the Minister accept that there will not be a level playing field if the proposed changes are introduced, because they will remove funding currently available for injured people to instruct lawyers, leaving them having to act as litigants in person on personal injury small claims?

Does the Minister seriously contend that there is a fraud crisis in relation to workplace injury claims, which the proposed changes would cover, and if he does, which he may, what independent evidence, not from the insurance industry, does he have of such a crisis?

The impact assessment for the proposals says that there will be a cost to the NHS of at least £13 million a year and to the Treasury of at least £135 million a year, and an increase in insurance company profits of £200 million a year. Does the Minister accept that that means that the Treasury will lose out while the insurance industry gains? If he does not accept that, perhaps he could explain why.

Can the Minister say by what date the Department will publish its review of the impact of employment tribunal fees, and what data the Department has on how such fees have affected the use of alternative dispute resolution services? What steps will the Government take to try to ensure that all children and vulnerable young people can get legal aid? The Minister has already mentioned some changes in that regard. Following on from that, will he give a commitment to review the exceptional cases funding system to make it much more accessible, and if he will not, can he explain why not?

Order. I think that we have five Back-Bench speakers, as well as the Front Benchers, so I will impose an immediate time limit of six minutes on speeches.

It is a pleasure to serve under your chairmanship, Mr Davies, particularly given your previous association with Croydon.

I would like to talk specifically about the Government’s consultation on whiplash claims, and the reason for that is an experience that I had two or three years ago. After a very minor road traffic accident in which no one was injured, I was bombarded with phone calls to my personal mobile every week for about a year from a claims management company. It explicitly asked me to pretend to have an injury that did not exist in order to claim compensation.

I have no issue with the more general points that the hon. Member for Wolverhampton South West (Rob Marris) makes about access to justice and the court system. I am talking specifically about whiplash. It is as a result of practices such as the one that I have described that this country has more than two times more whiplash claims than the rest of Europe, and the total number of claims for soft tissue injuries— whiplash and neck and back—has been static, at about 800,000, for the last few years.

One reason for that is the perverse incentives in the system. As I mentioned in an intervention, under qualified one-way costs shifting, when a claim is made, even if the defendant—the insurance company—is successful in defending the claim, it must bear its own costs, which are quite often up to £10,000, so it is easier for the insurance company to stump up £3,000 in insurance and pay some costs to the prosecuting or claiming solicitors firms—some of those costs go to the claims management company—than to dispute the claim. That is why claims here have grown to proportions that are vastly higher than obtain in the rest of Europe and why, as my right hon. and learned Friend the Minister said, at a time when accidents have declined by 30%, claims have gone up by 50%.

In The Sunday Times a year or so ago, there was a shocking report about a company called Complete Claim Solutions—one of the most notorious CMCs, which makes 7 million outbound cold calls a year. Its trainers were covertly recorded by The Sunday Times encouraging or telling—instructing—its staff to get the public basically to lie and make fraudulent claims. I have myself been on the receiving end of those phone calls.

On the point made by the hon. Member for Wolverhampton South West about broken bones, I have looked at the consultation document, and it specifically refers to soft tissue claims. I fully accept that where a cyclist or motorist has broken a rib, wrist or leg, their claim is perfectly valid and verifiable and should be allowed to proceed. We are talking about soft tissue injuries, where there is no objective medical evidence other than the claimant’s own claim. Those claims add, I believe, about £40 to everyone’s motor insurance policy, but more worryingly in my view, they are morally corrosive because large numbers of the public are being incited to commit fraud. That is a bad thing for the fabric of our society.

The Government’s press release announcing the consultation on 17 November said that measures include

“raising the limit for cases in the small claims court for all personal injury claims from £1,000 to £5,000”.

It said nothing about soft tissue injuries.

Well, certainly the consultation document refers on its front page to soft tissue injuries. I am sure that the Minister will consider how that might apply to broken bones, but the title of the consultation refers to soft tissue injuries only.

In my response to the Ministry of Justice consultation, I made a number of proposals, several of which I would like to elaborate on here. I believe that there should be a blanket ban on outbound cold calls in relation to soft tissue injuries. There should be a ban on pre-medical offers. Insurance companies should be required to conduct face-to-face medical examinations, and those examinations should produce independently verifiable evidence. That should be more than just someone saying, “My neck hurts.” The injury should be capable of verification by a third party, so in the case of a broken bone, that would clearly involve an X-ray.

I believe that there should be a ban on general damages for minor soft tissue injuries—not broken bones, but minor soft tissue injuries, where there is no evidence of the kind to which I have just referred. For those injuries, I fully support a threshold of £5,000.

There should also be a duty on claims management companies and solicitors to explain explicitly to prospective claimants that fabricating evidence is an unlawful act. They currently do the reverse; they actually encourage false claims. The Ministry should look again at qualified one-way costs shifting, because it creates a very perverse incentive for insurance companies to settle even when they could win a case in court.

On the point raised by the hon. Member for Wolverhampton South West about where the money ends up, I think that the saving could be more like a billion pounds a year, not £200 million. I would expect that to be passed on to ordinary members of the public and not pocketed by insurance companies. Aviva has committed to do that, but if, after a year, it turns out that the insurance companies have simply pocketed the extra money and not passed it on, I would expect the Competition and Markets Authority to be encouraged by the Government—or even required, if the Government have that power—to conduct an investigation to make sure that those savings are passed on to the hon. Gentleman’s constituents and mine. I do not expect these savings to end up in the back pockets of the insurance industry.

I would also like to see another practice ended. Again, this is a point for the insurance industry. A few years ago, there was a ban on referral fees, which is money that a claims management company would pay an insurance company to hand over the details of somebody who had been involved in a motor traffic accident. They are circumventing that ban through what they call alternative business structures. That is where the insurance company has some form of equity or profit share stake in a claims management company, the details still get passed on, and the insurance company effectively gets paid via the equity stake as a means of circumventing the referral fee ban. That is clearly an abuse and we should take steps to end it.

Finally, there are many examples of insurance companies procuring services such as car hire, legal services or vehicle repair services very cheaply, and they get recharged to the at-fault party’s insurance company at a significantly marked-up price. That is profiteering and, again, steps should be taken to prevent it happening.

In summary, I very strongly support the measures proposed in relation to soft tissue injuries. They will end a whole cottage industry that is morally corrosive because it is encouraging huge numbers of people to commit fraud, and costing our constituents £40 each per year, per car insurance policy. I welcome these proposals. I hope to see them brought on to the statute book at the earliest opportunity, and look forward to supporting them on the Floor of the House when that happens.

It is a pleasure to serve under your chairmanship, Mr Davies. First, I congratulate my hon. Friend the Member for Wolverhampton South West (Rob Marris) on calling this incredibly important debate. Although it is a broad debate, I will focus on an area that I have spoken about many times before and sadly find myself having to speak about again—one that, as a former employment lawyer, I know well: the devastating impact that the introduction of employment tribunal fees has had on access to justice.

I will not repeat the entire history of this issue—the Minister knows the landscape well—but I will summarise. In July 2013, for the first time a person had to pay a fee before they could proceed with an employment tribunal claim—two fees, in fact: one at the commencement of the claim and one before the final hearing. Following the introduction of fees, the number of single employment tribunal claims plummeted by 67%, from an average of 13,500 per quarter to just 4,400 per quarter. One of the oft-cited reasons for the introduction of fees was that it would deter vexatious and weak claims, yet the proportion of unsuccessful claims has remained stable. It is therefore clear that all that the fees system has done is deter people who have valid claims from upholding their rights. That conclusion is shared by the cross-party Select Committee on Justice and a range of specialist organisations that submitted evidence to it, including Citizens Advice, Maternity Action and the Bar Council.

The Justice Committee reported that many judges say that they now hear no money claims at all. The report says:

“Prior to the introduction of fees money claims were often brought by low paid workers in sectors such as care, security, hospitality or cleaning and the sums at stake were small in litigation terms but significant to the individual involved. There are few defences to such claims and they often succeeded.”

Have all those employers suddenly changed their behaviour and is everyone now getting paid correctly? No. What is far more likely is that those whose wages are being docked are simply saying, “Well, it will cost me more to go to a tribunal to recover this money than the amount I have lost, so I can’t afford to take that risk.” That, to quote the Prime Minister from just a few days ago, is an example of the

“everyday injustices that ordinary working class families feel are too often overlooked.”

Is the hon. Gentleman not forgetting the other measure that was taken, which was to require claimants to go to ACAS? Is he not aware that the number of cases going to ACAS has gone up from 23,000 a year to 92,000 a year, and that the effect has been that about half of the cases have been resolved or dealt with in a way that meant they no longer need to go to the tribunal—so 45,000 cases are dealt with for free?

The Minister presents those statistics but forgets to mention that the arbitration system with ACAS was actually introduced some time after employment tribunal fees were introduced, so it does not explain the initial drop-off. The Justice Committee said the claim that this has diverted more people to mediation was

“even on the most favourable construction, superficial.”

It is true that there has been an increase in the number of cases going to conciliation, but just 16% have been formally settled by ACAS, 19% proceeded to a tribunal case and 65% were neither settled nor proceeded to a tribunal. What has happened to all those cases?

Despite the overwhelming evidence, the Government refuse to acknowledge the problem, as we have just heard. Last month, I challenged the Under-Secretary of State for Women and Equalities over the outrageous fact that only 1% of women discriminated against at work brought a claim to tribunal. I asked whether she would make representations to the Ministry of Justice about the raft of evidence suggesting that tribunal fees deter genuine complaints. The reply I got was:

“There is no doubt that the number of tribunals has gone down, but in actual fact there is good news here”.—[Official Report, 8 December 2016; Vol. 618, c. 363.]

I fail to see what that good news is.

Perhaps the Government’s own internal review will tell us what has happened to the many complaints that have disappeared through ACAS, if they ever decide to release it. It was commissioned in July 2015; the review was completed within a few months, and it has been gathering dust for over a year now.

On a point of order, Mr Davies. The hon. Gentleman is putting forward as an assertion of fact something that is completely incorrect. Is that in order?

I am only referring to what the previous Minister for Justice said in evidence to the Select Committee about the report being completed, but if I am wrong about that, that is fine. What we are more interested in is the Government actually releasing it. I hope that when the Minister responds he will confirm a final date for when we will see the Government’s own internal review.

Mr Davies, your rights are only as good as your ability to exercise them. Be in no doubt that every year now, thousands of people are unable to do this. Employment rights are not just about dignity and respect in the workplace. They bring important social and economic benefits to this country. They ensure that more people can participate in the labour market without facing unfair discrimination. They give vulnerable workers more job security and stability of income. They help to encourage a committed and engaged workforce and the retention of skilled workers. They allow people to plan their life, plan for a future, knowing that if they do a good job, if their employer runs its business well, they are likely to stay in work.

What we have instead is a hire-and-fire culture where workers are seen as disposable commodities—figures on a spreadsheet—rather than real people with real lives who matter. For most people in the UK, the concept of secure employment no longer exists. Even for those who are lucky enough to avoid the pervasive traps of zero-hours contracts, agency work, bogus self-employment and the gig economy, workplace protections are now so watered down they are virtually worthless. During the referendum campaign, we saw that telling someone on a zero-hours contract or in agency work that there is a risk to their job from Brexit was futile. Until we begin to address these issues and reinstate the concept of secure employment, we will stand no chance of rebuilding our fractured society.

At the moment, we have a system where justice exists only for those who can afford it. A banker on a six-figure salary who is unfairly dismissed can still take their employer to a tribunal, while a factory worker on the minimum wage is much less likely to have the option and ability to uphold their rights. This situation is an embarrassment; it is an injustice and it must come to an end.

I will conclude with another quote from the Prime Minister, who said only three days ago:

“when you try to raise your concerns but they fall on deaf ears; when you feel locked out of the political and social discourse and feel no one is on your side, resentments grow”.

She also said that

“it is the job of government…to correct the injustice and unfairness that divides us wherever it is found.”

I say that it is time that those words were put into action.

It is a pleasure to serve under your chairmanship, Mr Davies. I will speak about reforming the soft tissue claims process. I have a special interest in the subject: I am chairman of the all-party group on insurance and financial services, and I spent 25 years as an insurance broker, 20 of those running my own business, so it is fair to say I have seen the evolution of these claims. When I first started in the industry, whiplash or soft tissue injury claims were non-existent, but over time they have grown to be a significant industry which, as we have heard, costs motorists anywhere between £40 and £90 extra on their policy. Critically, it is an industry where in many instances the claimant is not the main beneficiary.

Although the amounts of compensation paid out in soft tissue claims are relatively small, the associated claims handling costs, including the costs of investigation, processing, lawyers’ fees and medical reports, are disproportionately large. For example, a claimant claiming about £1,000 may ultimately cost the insurer two or three times that amount. As such claims are pretty common—there are about 800,000 a year—the effect on motor insurance premiums is significant.

I will focus on two key areas of the reform proposals, the first of which is general damages. It is clear that the reforms in the Legal Aid, Sentencing and Punishment of Offenders Act 2012 have not had the desired effect of tackling the compensation culture. They went some way to tackling issues such as referral fees, but frequency of claims has not been tackled as claimants can still enter into a no win, no fee agreement and a substantial portion of their claim is taken by the lawyer or claims management company to cover legal fees, so claimants sometimes get only half of the amount awarded to them. Is it access to justice when somebody else benefits more than the person who was injured in the first place?

To highlight the scale, although it is fair to say that the number of claims described as whiplash registered with the DWP’s compensation recovery unit has decreased, as mentioned by the hon. Member for Wolverhampton South West (Rob Marris), that is coupled with a corresponding dramatic increase in the number of soft tissue injury claims for neck and back injuries. In 2015-16, the number of road traffic accident soft tissue injury claims rose by 5.8% from the pre-LASPO level of 2012-13. However, in the period before LASPO was introduced, there was a particularly high volume of claims as claimant lawyers rushed to submit claims to avoid the reforms. This can be seen when looking at the total number of soft tissue injury claims in 2013-14, with the total number of claims in 2015-16 decreasing by only 0.3% over the previous two years, and in fact increasing by 1.2% from the previous year.

The claims portal, which is used to process low value personal injury claims in road traffic accidents, demonstrates even more clearly the rising number of claims following the LASPO reforms. On the portal, although the number of claims notified decreased by 3% from the pre-LASPO high in 2012-13 to 2015-16, the number of claims notified actually increased by 11% in the two-year period of 2013-14 and 2015-16. It highlights how the number of people claiming whiplash injuries in 2011-12 was 543,899 and the number of people who had neck, back and soft tissue injuries in the same period was 285,000. The number of people claiming neck, back and soft tissue injuries increased to 441,000 in the period 2015-16, so we can see it has been displaced.

My second point relates to the small claims track. The threshold needs to increase for whiplash, as the current limit has not been increased for 25 years. Figures from the ABI show that in 1991 50% of claims would have been valued within the SCT limit. That dropped to 9% in 2012, which highlights that an increase is well overdue as 91% of pain, suffering and loss of amenity claims now fall outside its remit, which cannot be in the best interests of the consumer.

From my discussions with the insurance industry, it is clear to me that it supports the principle that full compensation should be given for more serious injuries, and it is committed to simplifying and streamlining the process so that savings will be passed on to the consumer and the policyholder. Critically, there will be access to justice for everyone. Claimants with more minor injuries will still get their vehicle repaired, there will still be access to loss of earnings compensation and, rightly, there will be a focus on rehabilitation. Having dealt with such injuries for many years, that is what most people want. They want to be back in the position they were in before the claim. It is right to ask why there should be a link to a cash settlement on top of this when many of the minor injuries that we are talking about are similar to those sustained on sports pitches around the country day in, day out, where no one would give a second thought to making a claim against an opponent.

The UK is still one of the safest places to drive in the EU and vehicles are safer, so it is important that we go ahead with the proposals made in the former Chancellor’s autumn statement.

I congratulate the hon. Member for Wolverhampton South West (Rob Marris) on securing this debate and giving us the opportunity to take stock of the human impact of the reforms to access to justice. Every time I think about the way in which this Government have ensured that ordinary people are denied even the opportunity to try to get justice, I cannot help but think of the words my parents used to dread: it’s not fair—and it really isn’t, Mr Davies.

One of the four objectives of the reforms was apparently to

“discourage unnecessary and adversarial litigation at the public expense”.

I cannot disagree with that sentiment, but I have been working with a constituent who some people would argue falls into that category. Indeed, some have written him off as vexatious. There is a Scots word we use when someone has not had access to justice and is like a dog with a bone: the word is “thrawn”, and my constituent has had to be. He is a whistleblower: someone who tried to do the right thing—and trust me, he was doing the right thing. He is someone who believes in justice.

If the right hon. and learned Gentleman does not mind, I will struggle to get to the end of my speech without fainting. I am not well today. Unless he wants a medical emergency, I will carry on and try to get to the end—do not worry, I am not actually going to faint.

As I was saying, my constituent is a whistleblower trying to do the right thing. In trying to help others find their voice and hold power to account, he appears to have become a victim of it. He told me of repeated bullying in the workplace as a result of the whistleblowing, which continued when he was on statutory sick leave, undermining his already deteriorating mental health. Access to an employment tribunal, secured by legal aid, has been a lifeline, but it has taken long, thrawn years to get to a position where the might of an institution can be questioned. He will have his day in court, but had he lived in England or Wales he simply would not be able to afford it. That is not me saying, “Scotland good, England and Wales bad”; what I am saying is that it is not fair.

It is not fair on the people who in 2015 found themselves unable to access justice. Statistics provided by the TUC and Unison comparing cases brought in the first three months of 2013 with cases brought in the first three months of 2015 showed the following reductions—I think some have been mentioned already—in the number of cases for the most common types of claims: working time directive, down 78%; unauthorised deductions from wages, down 56%; unfair dismissal, down 72%; equal pay, down 58%; breach of contract, down 75%; and sex discrimination, down 68%.

Maternity Action said that since the fees were introduced there has been a 40% drop in claims for pregnancy-related detriment or dismissal. Is the Minister proud of that record? Does he truly believe that all those additional people in previous years were bringing vexatious—or frivolous, as the hon. Member for Wolverhampton South West said—claims?

Another area of law removed from legal aid was housing. My constituent, Maisie, is an elderly woman with a range of health issues that have negatively impacted on her ability to care for herself and sustain her tenancy. After a small house fire, her son moved in to support her. John balanced his own parenting responsibilities to his son from a past marriage with his commitment to his studies and his mother. They lived in cramped and totally unsuitable conditions and found themselves more or less ignored by their housing association, which refused to put in the disability adaptations they so badly needed because they had asked three years previously to be moved. For the housing association, it was simply not worth the money because they were going to move, anyway.

Offers of accommodation were not forthcoming and this 80-year-old woman and her carer son were trapped. They have now been rehoused in far superior accommodation and are very happy, but the housing association did what they could have done three years previously for two reasons. First, my team and the Legal Services Agency, a wonderful Glasgow charitable law centre, quoted the relevant provisions of the Human Rights Act to remind it of its responsibilities; and, secondly, there was a threat of legal action. That was possible because my constituents could claim legal aid, as they lived in Scotland. As it happens, the housing association saw sense and things did not get that far, but if a similar thing were to happen to a constituent of the hon. Member for Wolverhampton South West, the threat of legal action would be taken with a pinch of salt. That is not right. I thank the Legal Services Agency and my team, because now the 80-year-old woman in question can live out her days with her son in comfort and dignity.

On Sunday, the Prime Minister promised to introduce wide-ranging reforms to correct what she called the “burning injustices” in modern society. She proposed a “shared society”; she also proposed to lead a “one-nation” Government, working for all and not the “privileged few”. She said that the Government’s role is to

“encourage and nurture these relationships and institutions where it can, and to correct the injustice and unfairness that divides us wherever it is found.”

How on earth can she square that with taking away the means to correct those burning injustices from all but those who can afford to pay high legal fees? There are many people relying on us in Parliament and willing us to make the right decisions. I want to be able to tell them confidently that when something is unfair, it will be condemned by us in this place and changed. The situation I have outlined needs to be changed.

It is a pleasure to serve under your chairmanship, Mr Davies. I congratulate my hon. Friend the Member for Wolverhampton South West (Rob Marris) on obtaining the debate. I was going to go quite thoroughly into the subject of employment tribunals, but I feel that there is no need to do that. As an employment lawyer, my hon. Friend dealt with it comprehensively. However, I want to say that I managed a citizens advice bureau where we saw many people who were very reluctant to take action against their employers; any barriers put in the way will deter people from getting what is rightfully theirs. In fact, Citizens Advice recently revealed that 82% of people say the fee increase will deter them from taking a case against their employer.

The statistics bear that out. Why would someone pay £390 for a £200 wage claim when they know that only 49% of claims are paid in full? It is appalling to put another barrier in the way and impose such fees, which appear horrendous. There has been a decrease in claims. I warned when the change was first debated that a decrease would not mean success, but merely that the individuals concerned had given up, and had not gained what they were entitled to. I would be interested to know why people have not pursued ACAS claims. According to evidence from Citizens Advice, 90% of people would consider a reduced fee limit of £50 reasonable and thought that they could perhaps afford that when making a claim. I wonder whether the Minister has looked at the question of reducing the fee.

My hon. Friend the Member for Wolverhampton South West and other hon. Members dealt extremely well with the issue of whiplash. However, I am concerned about the raising of the small claim limits—and that, not whiplash, is what the consultation specifies. Why were workplace injuries included in that? What evidence is there of fraudulent claims against employers? In my experience, it is difficult to encourage people to make a claim even when the employer has been negligent, because they are extremely worried about the possible consequences. When that is coupled with the fact that if someone is unfairly sacked, there is a tribunal fee, I feel that people are beginning to lose faith in the justice system.

I want to mention the advice deserts, particularly in housing law, which my hon. Friend the Member for Wolverhampton South West also covered. Many small providers—including not-for-profit providers—are giving up their contracts as unviable. That has recently happened in one case in my area. Where are people to go about housing issues, such as severe disrepair, that they cannot get dealt with and that are giving them health problems? People can only have a housing claim if their case is at the severe end. How are people to get justice and avoid further illness, which will put more strain on our already overstretched health system, if they cannot get advice at a place they want to go to and can afford to travel to?

There is a risk that the civil legal aid system is becoming unsustainable. Will the Minister commission an independent review into the system’s sustainability? It is at risk of falling over. Even with sufficient providers, the Legal Aid, Sentencing and Punishment of Offenders Act 2012 reduced the possibility of obtaining early advice on housing and family law. Having been the manager of a citizens advice bureau, I cannot stress enough that early advice relieves the pressure on families, who will probably go to other services if they do not get it, which means they will put pressure on local authorities, housing associations and medical professionals. That is why it saves money. In the case of welfare benefits, £8.80 is saved for every case of early advice; in the case of housing advice, more than £5 is saved. Leaving everything to the last minute is simply the wrong way to deal with people’s problems, not only for them and their families, but for the state.

We must ensure that ordinary people are given an even chance in the justice system. Where is the equality of arms that solicitors always talk about? We need to ensure that people can receive the compensation they are entitled to, and timely advice—the right advice as to whether their claim is viable. I have often found that telling someone at an early stage that they did not have a case prevented them from going as a litigant in person. If they cannot get such early advice, they will be clogging up the court system. Many of the most recent reforms have had the opposite effect and deterred people from getting what they are entitled to. I agree with the hon. Member for Croydon South (Chris Philp) that we need to stop the cold calling. If the proposed changes to the small claims limit are included with the range of proposals, in addition to what has already happened to take access to justice away from ordinary people, I do not believe that people will any longer have faith that ours is a fair and just society.

It is a pleasure to serve under your chairmanship, Mr Davies. I congratulate the hon. Member for Wolverhampton South West (Rob Marris) on securing an important and timely debate. We have enjoyed some thoughtful, passionate and wide-ranging speeches, not least of which was his own tour de force.

As hon. Members have stated, access to justice is fundamental to our society, a key principle of the rule of law and an important component of the right to a fair hearing under article 6 of the wonderful European convention on human rights. It is almost exactly a year ago that we had a debate here, introduced by the hon. Member for Aberavon (Stephen Kinnock), on the same subject. Many of the points raised then still apply every bit as much now, because I do not think there is much doubt that under the present Government and their coalition predecessor, access to justice has become significantly more difficult.

Much of that debate focused, as did the remarks of my hon. Friend the Member for Glasgow North East (Anne McLaughlin) today, on legal aid restrictions imposed under the Legal Aid, Sentencing and Punishment of Offenders Act 2012 and the subsequent cuts to the legal aid budget. I continue to find the thinking behind some of those cuts hard to comprehend. They are indeed counterproductive. The drastic fall in the number of legal aid-funded cases has once again been highlighted today, including even for victims of domestic violence, who in theory should not be excluded. Amnesty International’s recent report, “Cuts that Hurt”, highlighted the particularly poor situation of children and vulnerable people in fields such as social welfare law, immigration law and family law.

As we have heard, the Justice Committee, the National Audit Office and the Public Accounts Committee have all been critical of some of the reforms. One of the most powerful points made by the Justice Committee was:

“The Ministry’s efforts to target legal aid at those who most need it have suffered from the weakness that they have often been aimed at the point after a crisis has already developed, such as in housing repossession cases, rather than being preventive.”

I suspect the Chamber is largely filled with lawyers at the moment, and I am sure that most of us get the point. Surely a better way to reduce legal aid spending is to invest in avoiding expensive crises in the first place.

Ministers argue that it is better to encourage mediation than to provide legal aid for adversarial proceedings. I am all for encouraging mediation. However, legal aid spending should fall as a result of successful voluntary mediation, and it cannot be said that mediation is successful or voluntary if someone is forced into an agreement because they cannot afford to go to court, and perhaps do not even have a proper understanding of their legal rights at that stage.

The other key Government contention in such debates is that the legal aid system in England and Wales has been one of the most expensive in the world. Of course I accept that all Governments have to look carefully at ways to ensure that the budget remains affordable. However, in making that claim, the Government are to an extent comparing apples and oranges. As hon. Members are fully aware, continental legal systems are inquisitorial systems in which less input from legal representatives is generally required but significantly more resources are spent on prosecution services and the courts. Taking all those factors into account, although we can say that England and Wales has one of the more expensive legal aid bills in Europe, the court system overall comes about a third of the way down the European league table.

Equally, there are other ways to keep the legal aid budget under control without having to slice and dice the scope and slash availability. I point to Scotland as an example, because as I understand it, legal aid spending per capita there is less than in England and Wales, but at the same time, the coverage and scope of the legal aid system is more generous. There are numerous reasons for that. For example, England and Wales have far more very expensive fraud trials, and so on. However, a key point is that the focus in Scotland has been on simplifying procedures so that the cost of court proceedings is much less than it was, so there are different ways to go about doing things.

Hon. Members have all rightly pointed out that access to justice goes beyond questions of legal aid. On fees, we shared opposition to criminal court fees and their predictable consequences and we welcome their withdrawal. We also welcome cancellation of the ludicrous 500% increase in fees for the asylum and immigration tribunal, although who knows how many people have had to leave the country as a result in the meantime? Employment tribunal fees have had a drastic effect on access to justice, as other hon. Members have pointed out, and they too should be withdrawn. I am pleased that the Scottish Government propose to do just that when the powers are devolved.

However, the fact that the Government have to make and consider those U-turns suggests that they need a much more fundamental rethink of their approach. Other speeches have covered the changes to personal injury rules and the small claims limit—I should have predicted that and looked into the issue in more detail. The hon. Member for Wolverhampton South West kindly pointed out the different system that exists in Scotland.

I share hon. Members’ general scepticism and concern about what exactly the proposed changes will achieve. I say that, having had to confess to colleagues who have worked for Thompsons, that I previously trained with an insurance-financed defenders firm—I do apologise. None of that is to say that the problem does not need to be addressed. The hon. Member for Croydon South (Chris Philp) highlighted the issue of horrendous cold-calling. I had a similar issue when I managed to reverse into my garage wall—quite how I was supposed to sue the garage wall I am not sure. All I would say to him is that some of what the Government propose to solve the problem would surely mean throwing the baby out with the bathwater. There must be other ways of tackling that without having to go as far as the Government suggest.

In Scotland there are significantly fewer personal injury claims, and there has never been the problem of the industrialisation of such claims as has happened in England and Wales. Scotland has therefore not had the same sort of problem of a claims culture that we are trying to address.

That is an interesting point. I suppose we have to examine why that is the case, because we have not managed to get rid of that in Scotland by excluding all sorts of cases from courts, so it would be interesting to look into that further.

There are a lot of access to justice issues that we could speak about, but before finishing, I will focus on something that has not been spoken about yet: the particular barriers to justice that the Government are putting in place for those who are seeking asylum or who are migrants. Last year Opposition MPs highlighted that the Immigration Bill, which was then making its way through the House, would make people have to leave their families and jobs in order to conduct appeals against Home Office decisions from abroad, would cut back on appeal rights against refusal of asylum support, leaving vulnerable, destitute people without any legal recourse, and would introduce procedures allowing families with children to be summarily evicted without so much as a court order, never mind a court hearing.

I know that MPs here today have disparate views on immigration and the rights that migrants should have, but I cannot understand how anyone can say that migrants should be deprived of proper access to a court in order to vindicate the rights that they do enjoy. Denying access to justice should not be a means of trying to control immigration. Various other significant concerns arise right across the sphere of immigration and asylum law, and I will mention three or four before concluding.

Just so you are aware, Mr McDonald, I have allowed up to 10 minutes for Front Benchers, so you have a reasonable amount of time left.

Thank you, Mr Davies. The first concern is about the massive restrictions on appeal rights, previously introduced by the coalition Government and now replaced by an administrative review scheme that the chief inspector of borders and immigration said was operating very poorly. The second concern is about the difficulties in accessing legal aid-funded solicitors. As an important example, that includes unaccompanied asylum-seeking children who are transferred under the national transfer scheme, who may find themselves moved to a part of the country where there is simply no face-to-face advice available. A third challenge is the lack of legal aid—in contrast to Scotland—for too many immigration and asylum issues, including for too many children, detainees, mentally ill and other vulnerable persons. All that is exacerbated by a difficult fee remission scheme. Finally, I highlight the slow speed of justice, with huge waiting times for a hearing at the asylum and immigration tribunal.

The scale of the problems caused by all these cuts and changes is hard to be precise about, even if the anecdotal evidence is very worrying. The Government have so far refused to measure the number of people appearing as party litigants at the asylum and immigration tribunal. That prevents us from properly assessing what is going on as a result of Government policy. The Lord Chancellor and Secretary of State for Justice is receiving representations from the Joint Council for the Welfare of Immigrants on this matter, and I hope that she will listen.

In conclusion, the Government can talk about sustainably funding the justice system, but if funding decisions are preventing access to justice, then justice itself is not being sustained.

It is a pleasure to serve under your chairmanship, Mr Davies. I thank my hon. Friend the Member for Wolverhampton South West (Rob Marris) for securing the debate and for his typically persuasive speech. Such speeches are what earned him his reputation as a fantastic lawyer and then a fantastic MP. I certainly agree with his description of access to justice as a pillar of the welfare state—how right he is.

I pay tribute to all hon. Members who have spoken today from all parties, not only for their contributions, but for the work they do in their constituencies. Each and every Member of Parliament in Westminster Hall today—and of course, in the main Chamber earlier—has experience of attending advice surgeries, to which constituents come who are unable to get the legal representation they so desperately need. That is often why they end up at our advice surgeries. Sadly, much of that is because of the Conservative Government’s cuts to legal aid since 2010.

My hon. Friend gave a comprehensive analysis of the problems with the Government’s proposals for the small claims limit. I will not retread the ground that he covered, but to pick up on a point made by my hon. Friend the Member for Makerfield (Yvonne Fovargue), this is not just about so-called soft tissue claims. I recommend that all Members on both sides of the House, including the hon. Member for Croydon South (Chris Philp), read the full title of the consultation, which is: “Reforming the Soft Tissue Injury (‘whiplash’) Claims Process: A consultation on arrangements concerning personal injury claims in England and Wales”. It is not just about whiplash claims and includes injuries in the workplace, as other hon. Members have said.

I am concerned that the proposals will affect the lower-paid most adversely. In assessing claims, their value includes the lost wages arising from any injury, so those who are paid higher wages might more easily surpass the £5,000 limit, leaving the lower-paid less likely to be able to cover their costs. To borrow a phrase used by the hon. Member for Croydon South, I consider that to be morally corrosive.

It is almost a year to the day since the publication of the annual report to Parliament from the Lord Chief Justice, Lord Thomas, in which he said:

“Our system of justice has become unaffordable to most.”

That is as clear and authoritative a judgment on the state of access to justice as could be hoped for. The reasons for that assessment are clear: employment tribunal fees, LASPO—the Legal Aid, Sentencing and Punishment of Offenders Act 2012—and “Transforming Legal Aid”.

It was the coalition Government who introduced employment tribunal fees. As I have said before, I will never forget the first time I lodged an employment tribunal case after they introduced those fees, when I was an employment tribunal lawyer at Thompsons. The message flashed up on the employment tribunals service website: “Customer, please enter your credit card details”. It says a lot about the Government’s view of workers seeking justice that citizens attempting to assert their workplace rights are viewed as consumers or customers. Employment tribunal fees have resulted in a 70% reduction in the number of cases.

The hon. Gentleman makes a passionate and persuasive argument. Does he agree that if the purpose of hiking employment tribunal fees was to get rid of vexatious claims in the system, it has failed entirely? The win-loss ratio is exactly the same as it was before the fees were hiked. That is the evidence that the Justice Committee heard, and it makes the policy redundant.

The hon. Gentleman is correct. I put it to hon. Members that the real purpose of introducing employment tribunal fees was not to reduce vexatious claims, but to reduce claims full stop. Employment tribunals received about 60,000 cases in the year before fees were introduced, but that fell to below 20,000 the year after. As my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) indicated, that is not because of a reduction in illegal or unfair treatment by employers in that time—if only!

In June 2016, the Justice Committee released its report on court and tribunal fees, which complained that it was

“unacceptable that the Government has not reported the results of its review one year after it began and six months after the Government said it would be completed.”

Unbelievably, seven months later, the Government continue to sit on a review of the fees. We can only suppose what the reason for that is, but perhaps the Minister will enlighten us.

LASPO, which was enacted by the coalition Government, removed most social welfare law cases from eligibility for legal aid assistance. Those seeking assistance for debt advice, housing—apart from in homelessness cases—and welfare benefits advice were left with few places to turn, as my hon. Friend the Member for Makerfield knows from her experience running a citizens advice bureau. The barrier that has been put up in such cases has hurt some of the most vulnerable people in our society. The lack of benefits advice is of particular concern because many appeals against the Department for Work and Pensions succeed. Between December 2014 and June 2015, 53% of those who appealed “fit to work” decisions had them reversed. Removing advice on such cases risks people missing out on benefits to which they are eligible.

Last year, the Law Society launched its campaign to end legal aid deserts—areas of the country in which legal aid advice for housing cases is disappearing. In a Westminster Hall debate on 30 November 2016, the Minister denied that such legal aid deserts exist. I wonder whether he has told the Law Society that its research is wrong. In July last year, Young Legal Aid Lawyers, the Legal Action Group and the Legal Aid Practitioners Group wrote to the Prime Minister, highlighting the huge drop in civil legal aid cases since LASPO. In 2012-13, before LASPO, 724,243 civil law cases were publicly funded, but in 2015-16 there were just 258,460. They described that, correctly in my view, as

“a picture of justice denied”.

Last week, the Justice Secretary’s own actions confirmed the need for a review. LASPO removed most private family law matters from the scope of legal aid, which naturally led to an increase in people representing themselves, as has been described. The increased number of litigants in person led in turn to violent and abusive people cross-examining their victims—usually their former partners—in court. Recently, the senior family court judge, Sir James Munby, said:

“I have been raising since 2014 the pressing need to reform the way in which vulnerable people give evidence in family proceedings. I have made clear my view that the family justice system lags woefully behind the criminal justice system.”

Well, last week that reform was promised: apparently the Justice Secretary will review the situation. That is as good as an admission that the legal aid reforms to the family courts have caused the problem that now needs a solution. Although the Government’s initiative would be a step in the right direction and provide some measure of comfort to victims of domestic violence, it is no substitute for both parties in family proceedings having representation.

When the coalition Government passed LASPO, they committed to reviewing its effects in three to five years, and we are now well within that timetable. The review ought to have begun a long time ago—the words of the Lord Chief Justice last January, which I quoted earlier, make that clear. However, that is not the only barrier to access to justice that has been erected and maintained by the Government.

Does my hon. Friend agree that the review needs to take place urgently, because the impact assessment of LASPO said that it would disproportionately affect women and the disabled, but that that was a price worth paying?

I agree that this is a matter of the utmost urgency; I also agree that such a detrimental impact on some of the most vulnerable people and minorities in our society is never a price worth paying.

In 2013, the then Justice Secretary, the right hon. Member for Epsom and Ewell (Chris Grayling), introduced other reforms. In summary, they involved restrictions on the availability of judicial review; restrictions on the ability of foreign nationals to receive publicly funded legal assistance; removing publicly funded legal assistance for nearly every area of prison law; further cuts to immigration law and family law; and cuts to fees for litigation in criminal cases. However, plans to tender criminal defence representation to competition were abandoned.

The right hon. Member for Surrey Heath (Michael Gove) then became Justice Secretary and, thankfully, reversed some of his immediate predecessor’s worst policy blunders. He also postponed a planned further cut of 8.75% to the fees of criminal solicitors until April 2017, which is now just around the corner. I am sure it would be welcomed, both in the House and outside, if the Minister confirmed today that that 8.75% cut will not happen.

When the right hon. Member for Epsom and Ewell was in post as Justice Secretary, he wrongly asserted that the legal aid bill was spiralling. He claimed that the public had lost confidence in the legal aid system and he dismissed many who rely on judicial review to hold the state to account as “left-wing campaigners” using the courts as a “promotional tool”. He provided no objective evidence or serious substance for those claims. He, too, holds responsibility for the crisis in access to justice that we face.

When my right hon. Friend the Member for Islington North (Jeremy Corbyn) became Leader of the Opposition in 2015, he promoted and set up an independent review, the Bach review, into access to justice. He has long understood the place of legal aid and access to justice in a civilised society, as we all do in the Opposition. The Bach review is considering how the justice system should operate in the 21st century: it should harness new technology without compromising fairness or due process. The Government need to act now to reverse their most botched reforms, so that access to justice is no longer “unaffordable to most”.

I congratulate the hon. Member for Wolverhampton South West (Rob Marris) on securing this debate, and I thank Members who have contributed to it. Some important points were made. However, regarding the hon. Gentleman’s criticism that the impact assessment on the whiplash changes does not show a saving, I must say that it makes it very clear that the saving is £1 billion, which, of course, accounts for the £40 cut in premiums for every motorist in the land that I mentioned. Are we to sacrifice that simply to uphold a threshold that has been in place for so many years, since 1991, and in the interests of solicitors?

The hon. Gentleman very fairly made the point that he was from Thompsons Solicitors. I think that the Labour party spokesman, the hon. Member for Leeds East (Richard Burgon), is also from Thompsons. There was one other who did not reveal himself, but I suspect that it is the hon. Member for Ellesmere Port and Neston (Justin Madders). They are the three musketeers of the Thompsons world. Anyway, it is a very fine firm, and I have to confess that I have been instructed by it on one occasion in the past, and it prepared the brief very well.

My hon. Friend the Member for Croydon South (Chris Philp) made a very important speech, explaining the industrial nature of the problem we face with these whiplash claims and the dubious practices that go with it. For those from Scotland, such as the hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald), the Scottish National party spokesman, it will be hard to understand this claims culture; Scotland does not have it. It is hard for people to understand it if it has not developed in their part of the UK. It has got to the point at which it is a massive problem. I will cover the point made about employment fees in a moment.

My hon. Friend the Member for North Warwickshire (Craig Tracey) made a very knowledgeable speech. He pointed out that we have to consider not just the pure whiplash claims, but those that are whiplash-related—those described as a back or neck injury, but that are, in effect, whiplash cases. That, of course, explains the figures that I outlined earlier.

It has been a good debate, and I wanted to make the point at the start that the Government are committed to ensuring that the justice system works for everyone. I will describe some of the actions that we are taking. The SNP spokesman made the good point that this is not just about legal aid; it is also about simplifying procedures and changing the way that the legal system works. Of course, that is what we are doing. The Lord Chancellor, the Lord Chief Justice and the Senior President of Tribunals jointly announced plans that are about renewing and transforming our justice system. Of course, we are putting in a massive investment of £1 billion to reform and digitise our courts, to make sure that this vital public service reflects modern needs and expectations.

The reforms will deliver swifter justice and, I hope, a less stressful experience for those involved. We will get cases out of court that do not need to be there, whether by using online procedures or through more alternative dispute resolution. We will apply the full force of judge and courtroom only in those cases that require it, and will strip away unnecessary hearings, redundant paper forms and all the duplication in the system, because we have the best legal system in the world but it also needs to be the most modern. That is what we aim to achieve. The guiding principle is to have a system that is proportionate and accessible, and is there for the vulnerable, victims of crime, members of the public, legal professionals, witnesses and litigants. We want a system that is a statement of our values as a country and leads the world.

Our legal aid system is important. The coalition Government faced unprecedented financial challenges; it is all very well people talking as though there were no pressures, but there were huge financial pressures at the time, and the Government had to reform. They concentrated legal aid on the most important areas—on cases where an individual’s liberty or home is at stake; where children might be taken into care; or where there is domestic violence. Although the reforms were substantial, it is right to follow through on our intention, which we set out at the beginning, which is that there should be a proper review. We have said that it will take place by April 2018 at the latest. We are well within the period during which we could start the review, and we will announce our intentions on it in the coming period.

I want to emphasise that we have made sure that litigants in person get help and support. Since 2015, we have provided £3.5 million to the litigants in person support strategy, through which we are working closely with the advice sector, voluntary partners and the pro bono sector; they are enhancing the local signposting of local and national legal support services and co-ordinating their work. We have seen a fast-expanding number of personal support units. The citizens advice bureaux do a fantastic job, and I pay tribute to the hon. Member for Makerfield (Yvonne Fovargue) for mentioning them. We also have many pro bono providers and local law clinics. This strategy has momentum, and it is wrong for the hon. Member for Wolverhampton South West to say that the result of having litigants in person is longer cases. That is not what the evidence shows; in fact, the average length of a civil case is becoming shorter, year by year.

I want to make family court processes safer for victims of domestic abuse, and our recent announcement contributes to that. It is right to have a system in which the victims of domestic abuse do not face cross-examination by their abusers. That sort of cross-examination is illegal in criminal courts, and we would like to see it outlawed in family courts. I have mentioned alternative dispute resolution.

Both the hon. Members for Ellesmere Port and Neston, and for Wolverhampton South West, mentioned employment tribunal fees. The Government are reviewing the impact of the introduction of fees in those tribunals. There is not a report gathering dust on my desk or anything like that; we are completing the work. I explained all this when I appeared before the Justice Committee recently. The work that we are completing is about the categories in the discrimination field; we are looking at the implications for each of those groups. We are getting to the point at which we will soon be able to produce a report; it will not take much longer. I said that I would produce it as soon as possible in the new year and I meant it.

Since it has been mandatory to go to ACAS, it has been resolving far more cases. The effect is that there are now 92,000 cases going to ACAS, whereas previously there were only 23,000. There used to be about 17,000 cases that did not then go on to the tribunal; now, it is something like 45,000 cases, so ACAS is having a big effect in this area. I understand the frustrations of those who say that the review has taken too long, but it will be comprehensive and it is not far away.

We face whiplash cases on an industrial scale. The number and cost of those cases, and their adverse impact on the price of motor insurance, is a concern for Government. There have been huge improvements in car safety, so how can it be that 770,000 road traffic accident claims were made in 2015-16, compared with only 460,000 in 2005-06, with around 90% of the claims in 2015-16 being whiplash-related? That figure is too high and the Government must take action to tackle this issue and protect consumers.

The previous Prime Minister held a Downing Street summit on this issue and we have recently made changes, such as introducing the new MedCo system, which improves the medical expert side of things. There was also a recent consultation on raising the small claims limit for personal injury claims to £5,000, and on damages for road traffic cases involving whiplash—soft tissue injury. If we can save £40 per head on motor insurance policies, clearly those are issues that we should be consulting on and considering very seriously. Also, it is worth bearing in mind that the £1,000 limit for these cases was set in 1991, more than 25 years ago. Since then, the small claims limit for everything else has gone up to £10,000, so the review is very much needed.

Finally, to provide reassurance to Members, people can still employ a lawyer to help them with a case that is in front of the small claims court, and they can try to reach an agreement with their lawyer about how their case is funded. Of course, the point is that they cannot recover costs, but there is no ban on taking legal advice, though clearly people would need to look at the economics of that. The other point to make is that if someone has a complex case that should perhaps be dealt with by the county court in its full setting, that is possible; they can make an application to that court, which can transfer—

Musculoskeletal Services: Greenwich

[Mr David Hanson in the Chair]

I beg to move,

That this House has considered musculoskeletal services in Greenwich.

What a great pleasure it is to serve under your chairmanship for the first time, Mr Hanson.

In 2016, Greenwich clinical commissioning group decided at an inquorate meeting to allocate a £73 million contract for musculoskeletal services to Circle Holdings plc. There were two rival bids at that time: one from Circle and one from a consortium of local providers led by Lewisham and Greenwich NHS Trust and involving local GPs and Oxleas NHS Foundation Trust.

A freedom of information request has exposed the fact that neither NHS England nor Greenwich CCG undertook an impact assessment prior to making requests for tenders or when allocating the contract to Circle. The purpose of an impact assessment is to ensure that no minority or vulnerable group is disadvantaged as a consequence of a decision to let a contract, and it is legally binding. How did Greenwich CCG satisfy itself that no one would be disadvantaged? Responses to the FOI requests to the CCG and NHS England have confirmed that neither party had answers to those questions at that time. As a result of local campaigning, which was led by the local authority, local Members of Parliament and the local community, we now have a review and an impact assessment being carried out subsequent to the contract being let.

The Minister was told by NHS England that it had reviewed the process by which the contract was let, but that is not satisfactory. She may have received assurances that the contract process had been reviewed, but what has not been reviewed is the impact on vital services that had nothing to do with the contract. They may be undermined by the fact that the NHS is so heavily cross-subsidised for providing vital services.

Because members of one of the rival bids were members of the clinical commissioning group, they were required to leave the meeting. That is custom and practice and happens in many fields, but it made the meeting inquorate. In order to allocate a £73 million contract, people who remained in the room were allowed to be double-counted in order to make the meeting quorate. I happen to have a friend who is a lawyer and an expert in health law, and I asked him whether what happened was within the rules. His answer was simple: “No, it is illegal.” At a subsequent health scrutiny panel meeting at Greenwich Borough Council, which was held to investigate the circumstances surrounding the allocation of the contract to a private provider, a representative of NHS England passed the procedure off as common practice. Can the Minister tell me whether it is common practice? Is it acceptable procedure? Is the advice that I have been given—that it is illegal—correct? Does she believe it to be a satisfactory way for such contracts to be allocated? If she is not satisfied, what do the Government intend to do?

The Minister will be aware that it is not permissible to pay anything other than the NHS tariff for services. Circle promised savings of £12 million as part of its successful bid for the contract. We do not know how much Circle intends to take out of the £73 million for its profits, but she will be aware that it is required to be paid the national tariff. If that is the case, will Circle be treating the same volume of patients as are currently being treated under the MSK process? If not, where are the savings and the profit for Circle going to come from?

I asked the Minster some questions to satisfy myself that the Government were happy with the procedure that had been followed. Were NHS England or the Minister informed of how Greenwich CCG achieved its quorum and the fact that the required number of GPs were not present? It was the GPs who were part of the consortium that was bidding who were required to leave the room. When the White Paper was launched by Andrew Lansley, he made it clear that local clinicians should be at the heart of decision making. In this case, we see that local clinicians were anything but at the heart of decision making.

I asked whether the local healthcare trust had been consulted at all in the process, and the Minister told me in an answer that it had been discussed at a meeting in March 2016 and as part of an assurance procurement process in August. That did not happen. Lewisham and Greenwich NHS Trust managers have no recollection of a meeting in August where the matter was discussed. Who told the Minister that the meeting had taken place when it clearly had not? It was not possible for anyone to give that assertion to the Government when the meeting simply had not taken place.

The Minister was also told that Circle was engaging with Lewisham and Greenwich NHS Trust, but the trust says there is no clarity around the clinical model and no commercial offer. That was still the case in November at the council’s scrutiny meeting, with the contract then due to begin on 1 December. The trust had no idea of the money or business that would come its way as a result of the Circle contract.

The Circle contract is a prime contractor model. That means that all patients will be directed to Circle, which will triage them and direct them to whichever services. Lewisham and Greenwich NHS Trust receives something in the region of £10 million for MSK services. It has nothing in its future budget for that service, because it is simply unaware of what it can expect from the contract that will be managed by Circle. How is that acceptable? The trust has to plan ahead for other services, and it is finding that impossible.

The trust has been through a couple of scenarios of what would happen if it was forced to cut its services as a result of losing elements of the MSK contract. It currently has a team of surgeons and some 45% of their surgical workload comes through the MSK contract. Those surgeons are vital to the support of other services, such as A&E. If those surgeons are lost, it will have an impact on other services in the trust. Activity could be reduced in consultant trauma services at Queen Elizabeth hospital which support the A&E. There would be an impact on doctors’ training and rotas; on the quality of training provided to junior doctors and other staff; on related professional services and posts such as nursing and physiotherapy; and, in the longer term, on recruitment at Queen Elizabeth hospital and specifically to its trauma service, including the emergency department, which is a designated trauma unit. It is disgraceful that no impact assessment was carried out to assess these impacts on other services.

The new Eltham community hospital was very much welcomed by my local community. Lots of lobbying has gone on. The local community watched the much loved and admired local building, the Eltham and Mottingham community hospital, being knocked down because they had been told they were going to get a walk-in GP service and a new hospital in the heart of their community, which they could attend for blood transfusions, X-rays and other diagnostics; more importantly, there were to be 40 rehabilitation beds for people leaving hospital and returning to the community. The community were very supportive of that scheme, which started in 2007. I and others in the local community lobbied very hard to make sure that the project stayed on track, and it finally opened in 2014.

Within 18 months of the opening, 20 beds were closed temporarily, to save money during the summer period when there was allegedly a low level of demand, but they were due to open again when winter came along. Now we are told that the beds are not opening. Lewisham and Greenwich NHS Trust is lobbying very hard because it desperately needs the beds back—it is now running at more than 100% occupancy for beds in its hospitals. We are now told that the space available for those 20 beds is part of the MSK project. That is not what my local community signed up for. It is not acceptable that the whole business plan for that hospital and the services to be provided there has been completely changed without any consideration of the local community.

I accept that there is a need for change in the NHS. I do not accept that we need the private sector to do it. If we continue to privatise services like this on the pretext of saving money, we will see a lot of money that should be being spent on patients going out in private profit. It is time to call a halt to the drip, drip of privatisation in our national health service.

If we want to modernise the NHS we need to find ways of doing that, but I wonder how someone could come to the conclusion that Circle is the organisation to take us forward. We know what happened at Hinchingbrooke hospital—Circle walked away the day before the Care Quality Commission was to put the hospital in special measures. At the Nottingham NHS treatment centre, a dermatological national centre of excellence, the consultants walked out. Chris Clough, who was appointed to investigate what was going on there, described it as “an unmitigated disaster”. To keep that service going, Circle brought in locums from overseas costing £300,000 a year. Today, the centre is no longer a centre of excellence.

The Government and NHS England did not learn a single lesson from what happened with the Cambridgeshire and Peterborough social care contract, where the private provider handed the contract back after eight months, saying that it was not viable. They ignored warnings from the National Audit Office about that in July 2016. It seems that the Government are happy to see any process go forward as long as the services are being privatised.

The process is completely and utterly flawed and is completely unsafe. The meeting in June last year was inquorate. It let a £73 million contract without any consideration of the knock-on effects on other vital health services, particularly A&E. The illegality of the process was disregarded and Ministers were given false assurances about the process and the consultation with Lewisham and Greenwich NHS Trust. There was no proper assessment of the suitability of Circle as a health provider. It provides not one clinician in the process—it is purely a management operation and another tier of bureaucracy. We hear endlessly from the Government about the need to cut back bureaucracy, but Circle is simply a signposter in the process, and for the pleasure of doing that it will take private profit out. It contracts with existing private services. In Bedford, there has been a 30% reduction in its contracting with the local Bedford hospital for MSK services and the private services in that area are brimming with profitable elective MSK surgery.

The process for awarding the contract is unsafe and has put patients at risk. Worse still, it has put at risk patients who are not in need of MSK services, due to the knock-on effect on other services. It cannot be that patients will unwittingly attend their local hospital and find that services have been cut because another service in the local health economy has been privatised. It is time to call a halt to this process. I hope that the Minister will step in, stop the process and stop the contract being let to Circle plc, because it is clearly flawed and not in the interests of patients in Greenwich.

It is a great pleasure to serve under your chairmanship, Mr Hanson. I congratulate the hon. Member for Eltham (Clive Efford) on securing this debate. I know that the subject is extremely important to him and his constituents. He has very eloquently raised the different concerns, which is no less than I would expect of him from our shared days on home affairs matters. I would warn him, however, that I doubt whether I will be able to answer every single one of his questions in detail. I will endeavour to get through the best I can and then reply with further detail in writing.

First, I would like to pay tribute to the many staff who work exceptionally hard every day for our NHS and deliver high-quality care for patients. As the daughter of an NHS doctor and nurse, who are now retired, I have seen at first hand how much personal sacrifice that involves from both NHS workers and their families, who often have to spend a lot of time apart from their dedicated NHS family members. It is a sacrifice that I am sure all of us here today would like to honour, especially during this busy time.

It is important to say at the outset—I know the hon. Gentleman is aware of this—that procurement of local health services by means of competitive tendering is a matter for the local NHS. Greenwich clinical commissioning group, which is the deciding body in this case, is a clinically-led independent statutory organisation. We believe it is right that local NHS systems are best placed to understand the health needs of their local populations and to use that knowledge to commission services for local people, to ensure the best clinical outcomes for all patients at the highest quality and best value to the taxpayer.

I know the hon. Gentleman knows that musculoskeletal services are currently provided to about 9,500 Greenwich patients by the four NHS trusts and one private provider, but despite the hard work of local health workers, the latest data show that Greenwich CCG’s referral rate to treatment trauma and orthopaedics performance is only 80.8%, against a target of 92%. It also shows a high number of out-patient appointments—more than 50% higher than the national average—with many seeing a consultant surgeon and then not having surgery. That paints a clear picture of too many patients waiting for too long. Even when they do get an appointment, they do not always see the right health professional, which means another wait for physio or other interventions.

As someone who has a chronic, complex illness and was misdiagnosed for more than a decade, I understand how dispiriting it is to wait in pain only to endure the disappointment of inappropriate or unnecessary appointments or tests and to end up on a new waiting list still in pain, just more frustrated. I know that because I lived it. We have to do better to get the right care to the right patients in the first place.

Taking such steps not only improves patient care and their experience of the NHS, but cuts out wasted appointments and tests, and frees up hugely valuable consultant and technician time, saving money that can be spent on appropriate care instead. That is why the CCG identified the musculoskeletal hub model, which has been successfully implemented using a range of different kinds of providers, private and public—I am agnostic on that point—across the country. It concluded that it would secure better value for money from that more streamlined service model, especially at the point of referral.

Given the hon. Gentleman’s description, I think he knows this, but I will say it anyway: the hub model means identifying one healthcare provider to act as a single point of access for all Greenwich musculoskeletal patients. That healthcare provider then offers patients who need an in-patient operation a choice of where the operation takes place. It is also able to triage patients more effectively into physio and other non-surgical treatments sooner, which means that surgery can often be prevented because it is possible to intervene quicker, which is better for patients.

The hon. Gentleman expressed concern in his parliamentary questions about the procurement process. However, I am sure he welcomes the fact that there was some consultation prior to procurement. He questioned the information that has come to me, and I will double-check it, but I have been told that the draft specification was shared with the CCG patient reference group and the pensioners forum for their comments prior to finalisation. When the musculoskeletal service was put out to tender in April 2016 in an open procurement process, the prospective bidders were required to put forward a programme budget within the range of £14 million to £14.8 million a year.

Lewisham and Greenwich NHS Trust made about 50 requests for information about the scope of the contract it was being asked to bid for during that process, and it received very few responses from Greenwich CCG. It is very difficult to say that there was adequate information or consultation about the impact of the service, because very little information came from the CCG.

I am sure more information could have been made available, but there certainly were attempts to engage with patients to ensure the contract was shaped to meet patient need.

In the end, two bids were received. They were anonymised and evaluated by a panel that included clinicians. According to the information I have received, the CCG had at least four GP members in attendance at the governing body meeting of 29 June, as well as three other voting members. The musculoskeletal specialist was from another area, specifically so that the panel could benefit from his experience without risk of conflict. Following the evaluation section of the meeting, all members with a conflict of interest were asked to leave the room, as the hon. Gentleman said. Those members’ votes were transferred to other governing body members, in line with the CCG’s constitution. I am not sure where the hon. Gentleman’s information about the numbers in the meeting comes from. According to the information I have received—which I will check—the remaining members of the CCG governing body then voted, and the meeting was quorate, in line with the actual numbers in the room. They voted on the still anonymised bids. Following that process, the five-year contract was awarded to Circle Health. The bid was assessed by NHS England to be according to the NHS standard procurement process, which is obviously legal.

As the hon. Gentleman said, under the proposed model, Circle will triage all patients registered with a Greenwich GP who require physiotherapy or planned orthopaedic surgery to ensure they receive the most appropriate medical professional support the first time to avoid inappropriate patient experiences. The aim is to reduce the number of first out-patient appointments, because many have been found clinically unnecessary. Further, if the trust experiences fewer unnecessary out-patient appointments, surgeons will have more time to carry out elective surgery, which will reduce waiting times for those who really need it. Over the lifetime of the contract, the CCG expects the average waiting time at Lewisham and Greenwich NHS Trust to reduce from 7.8 weeks to below 7 weeks.

As I said, regardless of the details of the procurement, which we will check, ensuring that patients are better served with the right care at the right time must be something that colleagues from across the House support. I heard the hon. Gentleman’s concerns about the impact on existing services and his view that the assessment should have been carried out further. At any rate, I am pleased it is being carried out now. As I understand it, Greenwich CCG discussed the procurement with Greenwich Council’s healthier communities and adult social care scrutiny panel—which is very snappily named —at a meeting on 3 November. The panel accepted that the process had been correct, but due to the level of public concern it requested that the CCG and the trust co-commission an independent assessment of the likely impact on orthopaedic activity at Lewisham and Greenwich NHS Trust and also that the outcome of that assessment be shared with the HCASC prior to the CCG’s signing the contract. That is what is happening, and it is clearly the right thing to do.

The main concern raised by the HCASC is that the trust may see a reduction in elective orthopaedic activity, as the hon. Gentleman said, which would affect trauma services. The impact assessment will review the likelihood of a range of impacts—from a minus 40% shift in elective orthopaedic surgery to a plus 40% shift—and the resulting effect on local trauma services, emergency department services and other interdependent services at Queen Elizabeth hospital, as well as the risk to the clinical and financial viability of the trust. It will also consider the potential impact, should there be such a shift in orthopaedic surgery, on sustaining undergraduate and postgraduate training, capacity plans and backlogs, interdependent clinical services, the delivery of the national constitution standards for referral to treatment, and the implications on future recruitment of orthopaedic clinicians and support staff. Those are the parameters that were requested by the trust and others, so I think we can be confident that it will achieve its purpose.

The impact assessment is due to be presented to the Greenwich CCG board on 22 February. The report will be shared with the healthier communities and adult social care scrutiny panel the following day and published on the CCG website. The outcome of the assessment remains to be seen, but I am sure the hon. Gentleman agrees that it is essential that the CCG proceeds with what has clearly become a highly politicised decision with the best interests of patients as its core priority. As I said, the data show that we need to work to improve care for musculoskeletal patients in Greenwich, to ensure that all patients are getting the right care at the right time.

Question put and agreed to.

Crown Prosecution Service: Funding

The previous debate finished a couple of minutes early, but as the proposer of the next debate and the Minister are both present, if Members are content, we will commence the debate.

I beg to move,

That this House has considered the funding of the Crown Prosecution Service.

It is always a pleasure to serve under your chairmanship, Mr Hanson. Before I begin, I must declare my interests. I am a member of Wilberforce barristers’ chambers in Hull, but am not currently practising. My wife is a criminal duty solicitor with Williamsons Solicitors in Hull, and she is also a part-time judge. I thank the Criminal Law Solicitors Association, the London Criminal Courts Solicitors Association, the Bar Council and the Law Society for contacting me regarding this debate, and for very helpfully providing me with information, which I think will benefit this House.

Expenditure on the Crown Prosecution Service has been reduced significantly from £672 million per annum in 2009-10 to £487 million in 2015. That is a reduction of a massive £185 million per year. At the same time, the number of cases brought to magistrates courts is down from approximately 641,000 to 539,000. On the finances of the CPS, I understand that since 2010, some £83 million has been spent on redundancies, with £20 million of that spent on only 153 staff, or upwards of £131,000 per—senior, I suspect—member of staff.

What has been the effect on cases? The effect has been significant: there is a staggering 23% increase in vacated trials—cases that are due to go to trial but, probably on the day of trial at Crown court, are vacated for whatever reason. In my submission, the reason is often that the CPS is not prepared or ready. In my area of Humberside, 55% of cases are vacated, according to the Public Accounts Committee inquiry of May 2016; the lowest proportion of vacated trials was 11%, in Cleveland.

The hon. Gentleman is making a powerful speech. I refer the House to my declaration in the Register of Members’ Financial Interests. Is it not right that whether the CPS is ready at trial is down to several factors, and not only funding? In fact, the CPS’s ability to be ready at trial and to perform well has improved over recent years, in spite of funding not having gone up, as he rightly pointed out.

I will read out a whole load of stats and talk about what is happening in the profession in the real world—about what lawyers and solicitors from the defence, and barristers who prosecute and defend, are saying is really happening. The hon. Gentleman wants to pretend that everything in the garden is rosy. Good luck to him, but I have to disagree. I know what is happening, not least because my wife is a defence solicitor in Hull and experiences the pressure on CPS lawyers day in, day out—although at the moment she is on maternity leave. Only today I was contacted by members of the profession, and they described a scenario in which a caseworker burst into tears when sitting in the Crown court behind counsel. If the hon. Gentleman thinks that things are rosy, he is mistaken.

Similarly, I declare an interest: I am still a defence solicitor, and if I catch your eye later, Mr Hanson, I will speak about my experiences. I will probably share similar experiences to those of the hon. Gentleman. He does angry well and quickly, but he was actually asked a genuine question on clarifying the stats. There are lots of reasons to vacate trials, and they can involve issues beyond funding-related prosecution preparedness; that was what the question was about.

The hon. Gentleman is of course right, but I was less than two minutes into my remarks when the hon. Member for Cheltenham (Alex Chalk) intervened. If I am allowed to, I will come on to clarify the points being made by the Government Back Benchers.

I refer the Chamber to my entry in the register. The statistic is this: in 2014-15, the Crown Prosecution Service spent £21.5 million preparing cases not heard in court; of that, only £5.5 million can be attributed to factors not within CPS control.

My hon. Friend is absolutely right. I will make that point myself. Excluding guilty pleas, conviction rates in magistrates courts and Crown courts are significantly down, despite the headline figure of an 80% conviction rate. I think the conviction rate in magistrates courts is about 50%, and in Crown courts it is about 25%, excluding guilty pleas. Since 2010, CPS staff numbers have fallen by a whopping 2,400. The CPS is suffering a brain drain and haemorrhaging experienced in-house lawyers, who leave for independent practice, or simply take the money and run.

On a serious note, I mentioned a caseworker bursting into tears in open court, clearly because of the pressure. I am told that the stress levels at the CPS are seriously high. Interestingly, a 2012 LawCare survey of the law profession revealed that more than 50% of the legal profession generally felt stressed, and that 19% were suffering from clinical depression, with more than one fifth of the profession suffering from mostly avoidable and preventable mental ill health. Stress at the CPS must be off the scale, particularly considering a recent Law Society survey in which 95% of respondents said that they were stressed at work.

Furthermore, in May 2016 the Public Accounts Committee inquiry found that

“The criminal justice system is close to breaking point.”

According to the National Audit Office report of March 2016, “Efficiency in the criminal justice system”, the number of cases outstanding in Crown courts had increased by 34% since 2013, and the waiting time for a Crown court case to be heard had increased from an average of 99 days to 134 days—an increase of about 35%.

In 2014-15, the Crown Prosecution Service spent £21.5 million preparing cases that were not heard, as the shadow Solicitor General, my hon. Friend the Member for Torfaen (Nick Thomas-Symonds), helpfully said. What has happened to those cases and the £21.5 million? If memory serves, it costs just shy of £1,000 to prepare a case for Crown court—the CPS says that being trial-ready costs it about £1,000—and £21.5 million has been spent on preparing cases that got nowhere. One must assume that the evidential test had been passed, and that the CPS reviewing lawyer had determined that there was enough evidence—that is, on balance, more evidence than not, and a more than 50% chance of a successful prosecution—and that it was in the public interest to prosecute that case. Twenty-five million quid was spent on preparing cases that went nowhere. The Solicitor General might be able to correct me and clear the matter up, but I assume that that is down to cases coming to nothing. In the magistrates court or, worse still, the Crown court, perhaps the CPS lawyer just gives in for whatever reason. I do not know; I am guessing. I have no idea.

I am anxious to answer as many questions as possible. In the Crown court, cracked and ineffective trials that have not gone ahead for prosecution reasons have, as a proportion, fallen to only 13.5%. That proportion of the total is falling; it is important to bear that in mind when looking at the overall context. I hope that helps the hon. Gentleman.

That is a fair point, but nevertheless £21.5 million is a staggering amount of money to be spent by the CPS on preparing cases for trial only for them not to come to anything. It is easy to mention such figures, but we must have some thought and regard for the victims in the cases, who will be anxious for the case to make progress and to have their opportunity to give evidence for the prosecution, and desperate to find out what happens in the trial. In my submission, the victims suffer the most from all that. [Interruption.] I will not give way, because I have been notified by the Attorney General’s office that some Government Back Benchers have indicated a wish to make a speech in the debate.

Interestingly, Her Majesty’s Crown Prosecution Service inspectorate found that charging decisions were not correct in 18.2% of cases. There is clearly a problem between the police, who are either, in cases where they are authorised to charge a case without referring it to the CPS, authorising charges that they perhaps ought not to and probably not getting advice from a CPS lawyer, or—I say this carefully—perhaps not giving the full information to the CPS reviewing lawyer.

It would not be fair if I did not say that I have the highest possible regard for CPS lawyers individually. Prior to my election to the House, I prosecuted for a fair while from chambers, and I found that CPS caseworkers and lawyers had the highest professionalism. They were committed and extremely capable individuals who cared a great deal about the job they did. I pay tribute to each and every one of those CPS lawyers, who are under incredible pressure. I also pay tribute to the Director of Public Prosecutions, Alison Saunders, whom I know personally. When I was shadow Solicitor General and shadow Attorney General, I met her on a good number of occasions, and I know that the Solicitor General meets her regularly, too. I find the DPP very professional, extremely impressive and extremely committed to the task in hand. Unfortunately, she is under considerable pressure, but she does the very best in difficult circumstances.

The decisions that I referred to should have been reviewed by a Crown prosecutor prior to the charge being authorised, but—this is a staggering figure—in 38.4% of cases, decisions were not reviewed before the case was first heard at a magistrates court. Prior to being elected to this place, I practised as a junior. I was the one who prosecuted for the CPS. Before my next day in the magistrates court, if I was lucky—sometimes it was on the morning—my clerk would give me a big, black CPS bag containing files for the next morning. I would go home and prepare 10, 12 or 15 files for trial. It would often take me through the night. All night long, I would drink large quantities—[Interruption] —of coffee, the Solicitor General will be rather relieved to know.

I would go into the courtroom the following morning to find that witnesses were not there, police officers were not available, shift patterns had changed all of a sudden, reviewing lawyers were unavailable, and the caseworkers who were available on the end of the telephone were not in a position to make any decisions. The defence, who were keen to crack the case and put it to bed, might offer me a section 5 public order offence, rather than the section 4 offence that had been charged. I would read the file and think that whoever had authorised the section 4 charge had been optimistic, to say the least, and would want to drop it in preference for a section 5 charge, which would be easy enough to get home and get a conviction for, but no lawyer would be available for me to speak to.

That was then. I have not been in a magistrates court to prosecute—I have recently been in one in a pro bono matter—since 2010. Things were bad enough then, but they are getting worse. Things are much worse now than when I was on my feet in magistrates courts before I left Wilberforce chambers in April 2010.

Some 38.4% of cases are not reviewed before they first come before the magistrates court. In reality, that means that if the prosecuting lawyer has been really lucky, they open their file and they have their witnesses ready, they have interviewed them individually, they have checked that what the police say in their statement is what they are about to give as evidence and is correct, and they are ready to crack on. But then they find that things are not quite right. The charge is probably not correct, in truth. Whoever has reviewed it probably has not done so very well, or things have been kept from the reviewing lawyer that are particularly important to their charging decision. The fact that 38% of cases are not reviewed means that when a prosecuting lawyer goes in to prepare cases for trial, nearly half of them will not even have been reviewed by a CPS lawyer. They have one arm very definitely tied behind their back.

I have kept Members long enough, but given that Government Members will say that everything is great, I want to talk about what the profession says—what individuals at the Bar say about their experience in the CPS. It would not be right for me to name people, but this is from an experienced CPS prosecutor of 30 years’ call:

“CPS hesitate to instruct QCs to prosecute even murders. Very serious, high publicity, or multiple murders will get a Silk prosecuting; otherwise not. The decision tree is on the CPS website”,

which I helpfully have in front of me. He continues:

“As a fairly senior junior barrister…I have over the last 5 years prosecuted some 12 murder cases. I have done this as single counsel. About 8 of those have been prosecuting against QC and a junior. One was of two defendants both with QC”

and their respective juniors. The CPS provided him with a CPS lawyer—a higher court advocate—in that case. He was against two silks, effectively—two Queen’s counsel —with their own juniors. I am talking about a junior not of the level I was at prior to coming into this place but of probably 20 years’ call, who has prosecuted and defended for an awfully long time and has a great deal of experience of being junior to leading counsel, and of prosecuting a murder on his own without leading counsel.

That CPS prosecutor says that, in contrast, judges

“have some influence on Defence getting a QC, and will say in open court ‘This being a murder case the Defendant should’”—

the judge of course is right—

“‘have leading counsel’ and the legal aid is then likely to be extended to cover that.”

In that scenario of a double-handed case with two defendants, why should the victim, whose loved one has allegedly been murdered, have counsel bringing the case for the prosecution against two leading counsel and two junior counsel? How does the victim feel in that scenario?

I hope it will not annoy you too much, Mr Hanson, if I talk briefly about some other cases that have been mentioned to me.

Order. Before the hon. Gentleman continues, I remind the House that the debate will finish at 5.30 pm. The hon. Gentleman has the floor, but other Members have indicated that they wish to speak.

I will be as quick as I possibly can be, but it is crucial that I mention what the junior members are saying. This person says:

“I often work in the magistrates court, where matters are unfortunately often in chaos so far as prosecutions are concerned. The CPS are dealing with hundreds of cases, often of a domestic violence nature and many of which are doomed from the start because Complainants had told the police in terms either that they won’t be coming or for which no statement has even been taken.”

He or she goes on to say:

“They do not appear to have such resources, either for these sorts of cases or indeed others.”

It is chaotic in the magistrates court. Another lawyer emailed me to say:

“The problem is not just money”—

the point made by the hon. Member for Cheltenham—

“it is doctrine, dogma and management double speak. I get six cases to prosecute in the magistrates at 4pm the afternoon before”

the case is due to be aired in court. He or she continues:

“Each of those cases will be defended by a separate lawyer who only has that one case to deal with. The hearing record sheets”

are not there, and all sorts of things are missing from the files. It is utterly chaotic.

I have got a huge number of cases that I could read out, Mr Hanson, but I will not annoy you by doing that. I want to give other Members an opportunity to tell us, if indeed they want to, that everything is rosy in the garden, despite the fact that £185 million per annum has been cut from the CPS budget.

The hon. Member for Kingston upon Hull East (Karl Turner) was entitled to speak for as long as he wished, but we now have a limited time before I have to call the Front-Bench Members. I hope that Members can self-regulate on these matters.

It is a pleasure to take part in the debate. I declare an interest as a criminal defence solicitor. I have an interest in defence, but primarily an interest in the criminal justice system, which we all share. We need a good, efficient and effective CPS as part of the criminal justice system. That is good for all: for defendants, for witnesses, for victims and for public confidence. It is a collaborative effort, so in many ways it is important not to see this issue in isolation.

There are funding challenges—we could have another debate about the funding challenges for the criminal defence service and the challenges for the police and others—but there is a collaborative effort, which is why I welcomed the inspection by the Crown Prosecution Service inspectorate and Her Majesty’s inspectorate of constabulary in 2015, which helped us to home in on some of the issues. Yes, one can look at the statistics on cracked trials, but when one looks deeper one sees, as the hon. Member for Kingston upon Hull East (Karl Turner) said, the issue of the police’s charging decisions and the impact that has down the line. Getting it right first time was very much the NAO’s mantra in relation to getting value for money for taxpayers.

I will try not to take up too much time but I want to draw attention to the statistics. First, it is important to recognise that there has been criticism for some time. There is also the challenge of cuts. Back in 2014, the independent inspectorate’s report on the CPS looking at the period 2013-14 said:

“The background of continuing resource reductions is now having an impact on the ability of the service to deliver effectively across the whole range of its activity.”

That was then; now, we are looking at what the challenges have been to that. If one brings in the NAO report and other inspectorate reports, one sees that there is a serious challenge from cuts, but if one delves deeper, one sees other issues, including a large variation in performance across the country in the service provided to victims and witnesses. One cannot therefore look just at the money; one has to ask, “Why are there variations? How can we have a more uniform approach that provides a good service to all?”

There has been some progress. I will not seek in any way to cover over the cracks—there are serious challenges and serious problems. I go to courts and I see and hear them and the way they affect morale and confidence in the system. That is a collective challenge that is affecting the criminal justice system. Nevertheless, given some of the statistics, it is worth saying for balance that the proportion of effective trials in magistrates courts has increased from 34% in the year ending September 2011 to 39%. There has been an increase, although it is not enough.

On the issue that the NAO and inspectors have looked at time and again, yes, mistakes are happening, but they are happening through the currency of cases. Early decisions should have been made and what had gone wrong identified. No doubt, the anecdotal evidence provided by the hon. Gentleman can be repeated by the prosecutors. The fact that two thirds of cases still do not progress as planned shows that that needs urgent attention.

The reality, and what I have experienced myself, is that the most frustrating thing about funding challenges and staffing is that, when it comes to the need for an early decision, at court—or preferably beforehand—there needs to be an appropriate review. A review can take place before the door of court so that appropriate decisions can be made for the benefit of the whole criminal justice system. That is something that I think is not happening enough, and down the line, whether in the magistrates court or the Crown court, it leads to vacated trials.

More needs to be done, but during my 20 or so years of practising, there has been a sea change, not least in terms of the recognition of the need for reforms—that the present situation cannot continue. The only way we will get better value for money and better public confidence is by grasping the fact that, in particular, the legal system has been one of the last to come up to date regarding paper and the need for a digitised criminal justice service. That is not the only answer, but we know that when we are struggling to find where that advance information or that disclosure is, we ring up and try to find the duty officer, who then tries to get someone. Thankfully, those things are now part of the past. The future is proper digitisation, which can help in getting prompt disclosure and appropriate decisions made and should lead to early decisions. We are still not getting those appropriate early decisions. The report of the last joint inspection in 2015 made the point that too many police charging decisions were incorrect and picked up too late by the CPS in court. The fact that 38.4% of cases were not reviewed before court must be seriously challenged for the sake of the system and for the benefit of all.

I want to make some brief points on what could be done. I remain concerned about transparency and accountability in the criminal justice system. The decisions made, such as those made by magistrates on the mode of trial—whether the case goes to Crown court—are still not clear enough for everyone

There is variation between areas. There have now been improvements to crime mapping for victims, but we should look much better at justice mapping and the accessibility of justice in a given area. The challenge of less localised magistrates courts and less reporting and less public awareness of what is happening in local courts means that we need the digital service to map better what is happening in our areas to see the impact of decisions, going back to charging decisions and particularly to decisions made in court and their impact. That will help to build confidence and public perception that is not based just on anecdote or the latest scandalous headline in a tabloid.

Transparency is needed, but we also need accountability. One of the frustrations I feel on behalf of the defence service is that I am directly accountable if I make a bad decision—if I have not got my act together and got my witnesses together, or if I have mucked up in court, I will get it in the neck from a senior partner or others, and not least from the client—but I do not see that same accountability for the Crown prosecutor. There is accountability for the police officer handling his case and there is much more in the Crown court, but at the magistrates court, with a pile of cases, when something goes wrong and a decision needs to be made quickly that perhaps goes against the victim and against the interests of justice in the long run, the Crown prosecutor—strained and challenged though they and the system are—is not challenged and accountable. We do not allow wasted costs orders now because of decisions about publicly funded cases, so the Crown prosecutor does not get it in the neck about wasted costs and lessons are not learnt—it is not so much about berating that individual prosecutor but about the system learning the lessons. Is there a way to provide greater accountability for the CPS, particularly when decisions are made?

Can we recover more costs for the system through costs orders? Can we have more full costs orders in CPS cases, not just contributions to costs? Yes, there are those who cannot afford those, but there are others who certainly can afford to pay prosecution costs. Other agencies will apply for the full costs of a case, including the police enforcement costs; can the CPS introduce full costs orders? Can the CPS also benefit from successful proceeds of crime applications, and can that funding go to the CPS and those prosecuting agencies, rather than to the coffers of the Treasury and the Home Office?

I was not planning on speaking, but having heard some of the remarks that have been made, I thought I would briefly volunteer a few thoughts of my own.

I am surprised to hear that the hon. Gentleman did not intend to speak. I received an email that said he intended to do so.

First, by way of background, like the hon. Gentleman, I worked through the night to prepare long lists for the CPS, from 2002 to 2005. I went around the courts in Hertfordshire—going to the magistrates court and the Crown court, prosecuting and defending cases involving everything from rape to murder to terrorism offences.

I take this opportunity to agree with the hon. Gentleman that the calibre of some of the prosecutors and caseworkers in our Crown Prosecution Service is very high and stands up to comparison with any other prosecuting authority anywhere in the world. One thing I found disappointing was that prosecutors or caseworkers who were exceptionally conscientious or hardworking did not seem to get advancement any faster than people who were not quite as attentive. I thought that was a little unfair.

I agree with the hon. Gentleman on equality of arms. It is vital, particularly when dealing with a serious case, that the prosecution is able to show that there is equality of arms. It is therefore absolutely right, in a serious case, that silk should be instructed if they are up against silk. Where I begin to part company with the hon. Gentleman is on his bald assertion—made with the best of intentions, I accept—that everything can be attributable to funding.

Well, one might be forgiven for thinking that that was part of the assertion. If one looks at the figures from 2010, although the hon. Gentleman is absolutely right that there has been a decline, I am afraid it is wrong to suggest somehow that there were no problems previously but there are now.

From my experience when I was in court, all too often the reason cases cracked, if there was a problem with the prosecution, was system failure. For example, if witnesses had not been warned, if dates to avoid had not been provided or if disclosure had not been served. Those were systematic failings. My hon. Friend the Member for Enfield, Southgate (Mr Burrowes) correctly made the point that systematic change can sometimes be as significant as financial change. The changes we are seeing to the digital case system are causing such an important step change in the quality of the prosecuting service that, for example, when one turns up at the Crown court, one can immediately see on the system that a disclosure has taken place. It provides for that in a far more efficient way.

Does the hon. Gentleman think that those “systematic failings”, as he puts it, are getting better because the CPS is experiencing a £185 million a year cut to its funds?

Let me make it crystal clear: of course I would like to see more funding for the CPS. There is no question about that. However, I take slight issue with the blandishment that if we simply put in the money that has been taken out, everything would be improved. The reality is that, unless we reform the system to make it more efficient, we will be throwing money at the situation and not taking a sensible, radical and reform-minded approach. The simple point I make is that, where we are making real progress as a country, and where the CPS, through its diligent prosecutors and caseworkers, is able to make a difference, is through systematic changes such as those to the digital case system, which are achieving a step change and improvement in quality. That point is worth making.

The hon. Gentleman also rightly praised that excellent public servant, Alison Saunders. In that vein, is it not worth listening very carefully to what she herself said? She came before the Justice Committee, and I think it was I who asked—by the way, I have no difficulties with asking an open question to get an answer that might be unhelpful to the Government—if the CPS has enough money. I would have been perfectly prepared for her to say, “No, it’s hopeless; we’re going to hell in a handbasket and something has to be sorted out”, but her response was:

“Yes, we think we do, particularly now that we have the CSR settlement. I am not saying that it is easy; let me say that first. Over the last five years, our budget has reduced by 23% or so.”

She went on to talk about the sensible and pragmatic steps that have been taken, but she answered that question in the affirmative. On a subsequent occasion, she indicated she fully agreed with this CPS comment:

“This settlement will allow the CPS to respond to a changing caseload and the significant increase in complex and sensitive cases, such as terrorism, rape and serious sexual assaults and child sex abuse.”

One cannot have it both ways by saying she is a fantastic public servant—which she is, by the way—and ignoring what she says.

I respectfully and completely agree with the hon. Gentleman’s intentions. He wants an excellent Crown Prosecution Service. I do, too. He values excellent Crown prosecutors. I do, too. Equally, however, we have to look at this in a sophisticated way, not simply through the blunt instrument of funding. I believe, broadly speaking, that we are on the right track. We have excellent public servants; we should allow them to get on with their job.

First, I should say that my wife is a non-practising solicitor. For the avoidance of doubt, that is my declaration of interest.

I recently met the chief Crown prosecutor for Wessex, Kate Brown, who is based in Hampshire. She and I discussed the “CPS 2020” plan. It seems to me that it is a clear plan to continuously improve the way the CPS works—those are its own words. I must say to the hon. Member for Kingston upon Hull East (Karl Turner) that the picture he paints is certainly not the whole story. It may be one side of the story; it is more likely part of the story from a particular perspective. While I respect his views and experience, in the interest of fairness, it is important that some of the successes of the CPS are also placed on the record in the short time available.

For instance—I have different statistics from the hon. Gentleman—net annual expenditure since 2011-12 is down £101 million. Yes, a reduction in expenditure has led to a 27% reduction in headcount from that date, but convictions remain steady at around 83%. Some £84 million has been put back into public funds through the proceeds of crime being recovered, even though, owing to the way the criminal justice system has evolved, there is a shifting case load.

There are now 28% more sexual offence cases and 23% more fraud and forgery cases than five years ago. How? Because the CPS has changed the way it works. It is building stronger cases from the start and encouraging more early and appropriate guilty pleas. Some 76% of pleas are now guilty, up from 69% in 2011-12. While Crown court cases remain steady at around 100,000 cases per annum, there has been a 36% reduction in magistrates court cases. The way the CPS works is changing to deliver the right outcomes for citizens across the country.

I am afraid, in the interest of time, I cannot. As the CPS put it, it will deliver an efficient operating model through

“digitisation”—

which has been referred to—

“Better Case Management and Transforming Summary Justice.”

Digitisation alone will potentially save more than 5% of the £3.3 million cost of paper and couriers. That is one small element of the savings that can be made in the CPS budget.

The CPS budget is constantly reviewed, which is important. When the Attorney General was asked about that, he made it clear that he has regular discussions with the Director of Public Prosecutions, but that she and he

“both believe that the spending review settlement enables the CPS to respond effectively”.—[Official Report, 14 January 2016; Vol. 604, c. 978.]

I think that sums it up. It is clear, if we look at those statistics and at the “CPS 2020” plan—which is the CPS’s document, not this Government’s—that the CPS’s funding should be reviewed, as it always is, but that more importantly, it is delivering for the needs of decent people across this country who want to see justice done.

It is a pleasure to serve under your chairmanship, Mr Hanson. I have already referred to my entry in the Register of Members’ Financial Interests.

I congratulate my hon. Friend the Member for Kingston upon Hull East (Karl Turner) on securing this debate and pay tribute to the work he did as a shadow Law Officer. When I came into this House, I watched him carry out the role of shadow Solicitor General and, subsequently, shadow Attorney General, and his was a model to follow. His passionate speech at the start of the debate sums up his depth of feeling about the issues before us.

It was great to hear the speech of the hon. Member for Cheltenham (Alex Chalk). His praise of the work done by Crown Prosecution Service staff was very well put, and I think we all agree across the House that tremendous work is done in the circumstances in which those staff find themselves. The hon. Members for North East Hampshire (Mr Jayawardena) and for Enfield, Southgate (Mr Burrowes) both spoke powerfully and talked about digitisation, which clearly will be an issue.

I think all Opposition Members agree with the hon. Member for Cheltenham that this is not purely about money. Obviously it is not. However, it is now 2017, and the Conservative party, either in coalition or on its own, has been in power and responsible for our criminal justice system for nearly seven years. It has to bear responsibility for the system as it is today.

We have heard eye-watering figures about the cuts in the budget. My hon. Friend the Member for Kingston upon Hull East talked about the overall cut in expenditure. Indeed, the resource budget has seen a real-terms cut of 24% since 2010-11. I am grateful to the Solicitor General for answering my written questions about the staffing budget. The figures given show that the staffing budget in 2015-16 is 40% of what it was in 2010-11.

I will make two broad points about the Crown Prosecution Service. The first is about where our criminal justice system is in 2017. No doubt the Solicitor General will have read the Public Accounts Committee report last May, which said:

“The criminal justice system is close to breaking point.”

We also have to look at how the system is performing today. Let us take the Crown court, for example. From March 2013 to 1 March 2016, there was a 34% increase in the backlog of cases. We can also take average waiting times. I have the quarterly criminal court statistics published in September, which look at the previous six months. Whether this is purely about money or not, the performance of the system is as follows. What is the average waiting time in weeks at the Crown court? For both triable-either-way offences and indictable-only offences, it is now above 20 weeks. There has been a steady increase, going back to 2013. There may be slight variations quarter to quarter, but that is the trend from 2013, when the one figure was below 18 weeks and the other was below 15 weeks. That is the performance of the system.

The hon. Gentleman draws attention, quite properly, to a very salient figure, but how can one be absolutely clear that that is to do with the Crown Prosecution Service as against the list office, the offence or the actions of the court? Why focus specifically on the CPS?

I hoped I had made it clear that this is about the performance of the system. The Conservative party, in one way or another, has been responsible for that system for seven years. Wherever in the system we isolate the cause, the Conservative party cannot escape blame for the performance of the system. That is the point I have been seeking to make.

When we talk about money, we have to be extremely careful about false economies, because things can seem as if they will save money. Let me give an example. I drew attention to the staffing budget, which I asked a specific written question about, and the Solicitor General was kind enough to answer very directly. It has been substantially reduced, but at the same time the Crown Prosecution Service is spending substantial amounts of money on agency staff. The response to my written question showed that in 2015-16, more than £7.8 million was spent on agency staff.

When we look at this in the round, we have to do so in two senses. First, of course this is not purely about money, but when money is cut from certain budgets, we have to be conscious of the effect on the system and whether false economies are causing problems further down the line or mean that we have to hire agency staff instead. The second point is about the whole system of which the Crown Prosecution Service is a part. I hope that all of us across this House want to see these measures improve. The responsibility is on the Government for these measures to improve. I am sure they accept that responsibility, but they have to act, and act quickly, because the performance of the system clearly needs to improve rapidly.

It is a great pleasure to serve under your chairmanship, Mr Hanson. I know, on a personal level, that you have had a long interest in these matters. I hope the debate has been of particular salience to you.

I thank the hon. Member for Kingston upon Hull East (Karl Turner), my former shadow. It has been nice to be together again in that sense. I have often thought that it would have been great if he and I had done a case against each other, but I was in another part of the country from him. When he was reminiscing—not quite eulogising—about his days carrying large amounts of files to the magistrates court, it took me back to my time back in the ’90s when I did precisely the same thing.

Here is the rub: times have changed. The hon. Gentleman will be glad to know that he does not now have to carry all those files. He can have it all on an iPad or a laptop, because of the Transforming Summary Justice initiative in the magistrates court. That means there is far more efficiency now in the use of digital technology in the court. If he came with me to CPS offices, he would be amazed that in magistrates court divisions now, paper is the exception, rather than the rule.

It is all very good when it works, but people are reporting to me that, sadly, it does not work and often goes wrong—very badly wrong. Cases are vacated as a result of the very thing the Solicitor General mentions.

I am grateful to the hon. Gentleman for sharing some powerful anecdotes. I do not underplay anecdote; it certainly helped to inform me in my long career at the criminal Bar. However, the overall statistics tell the full story about what is happening across the system. There is no doubt that in the magistrates court, we are seeing an increase in efficiency. For example, guilty pleas at the first hearing in the magistrates court have increased as a proportion of total cases from just over 62% back in 2010 to over 70% in the past year. That is indicative—

No, it is not. It is indicative of much better preparation by the prosecution of the cases, so that when defendants appear, they face a case that has been properly put together. That is also reflected by the increase in the overall guilty plea rate, which has gone up from just under 68% to 76.3%.

The hon. Member for Kingston upon Hull East talked about inefficiency. I am pleased to tell him that average hearings per case for both guilty pleas and trials have reduced. For trials heard in the magistrates court, we are now looking at just under three days, as opposed to three and a half days or more. Compliance with judges’ orders was always an issue when it came to the Crown Prosecution Service. Hon. Members will remember “mentions”—my hon. Friend the Member for Cheltenham (Alex Chalk) will know exactly what I am talking about. I am glad to say that we have seen an increase in timely compliance with judges’ orders in the Crown court in recent years. The rate has increased to more than 80% in the last two years.

Does my hon. and learned Friend agree that we need an ongoing discussion about how the CPS can be more efficient and effective in its work and that that should continue?

My hon. Friend represents a city that has a Crown court and a magistrates court. It is an important court centre in the east midlands. I know from my visits to many regions across England and Wales that those conversations continue. There is local liaison and local discussion.

To respond to the point my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) made about accountability, joint performance management, which is what we are talking about, takes place in most areas and enables local agencies, whether the courts themselves or the defence community, to challenge the CPS when performance is not acceptable. Line managers individually assess prosecutors in the CPS, so accountability is an important part of this.

The Solicitor General read out some of the statistics about magistrates courts. Of course we all want to see and welcome improvement, but is he as concerned as I am that the average number of days from an offence to completion in a magistrates court has increased from 155 days in the second quarter to 2015 to 162 in the second quarter of 2016?

The hon. Gentleman is right to make that point, but the point made by my hon. Friend the Member for Cheltenham is the right one. Here we are debating funding for the CPS and we are eliding two issues: the overall performance of the criminal justice system with the performance of one part of it. What is happening with the caseload, particularly in the Crown court, is that complexity is increasing. There has been a marked shift—the hon. Member for Torfaen (Nick Thomas-Symonds) will agree—away from the sort of volume cases that might take a day or two to quite complex and often difficult cases involving sexual allegations. I am told by many resident judges in the Crown court centres I visit that they now form the lion’s share of court work in the lists. That complexity is definitely resulting in more challenges for the Crown court.

I was glad to note that in recent years the Ministry of Justice has increased sitting days. That has certainly helped to reduce any backlog, but with respect to the hon. Gentleman, it would be a little unfair to lay the problems of delay completely at the door of the Crown Prosecution Service. Let us focus on the debate called by the hon. Member for Kingston upon Hull East on funding.

I accept, of course, that as a result of the tough decisions we had to make in 2010, expenditure was reduced. I pay tribute to the hon. and learned Member for Holborn and St Pancras (Keir Starmer), who stewarded the CPS through that period. He did a remarkable job of delivering efficiency and providing leadership, which was then taken up by Alison Saunders, the Director of Public Prosecutions, who has rightly been praised here today. The hon. and learned Gentleman proved that the job could be done with a declining share of expenditure. When we look at the figures—my hon. Friend the Member for North East Hampshire (Mr Jayawardena) mentioned this—we see that performance and conviction rates have stayed remarkably steady through the years.

I am delighted to see on my visits to regional offices that there is smarter use of personnel within the CPS. I will give an example. North-east prosecutors will be able to work remotely—and do so—on south-east cases. That is a good emblematic example of how the CPS is making sure it uses all the resources available to it from whatever part of the country they come. That is certainly a boon to the south-east. I know it happens with prosecutors in Wales who are helping out in cases in London. That is another example of how we must not let regional boundaries become barriers to better working.

Digital case management has now made its way into the Crown court and is making a real difference. With my long years at the coalface of the criminal Bar, I was the first to be sceptical about digital and the use of IT. I have seen it before, but, believe you me, when I saw the pilots in Southwark, for example, I was delighted to see judges embracing that and telling me that the system was user friendly and starting to make a difference. Now that it has been rolled out across the country, it is starting to bear fruit.

Hon. Members talked about the challenges of the CPS and about charging decisions. It is right to say that the police have a role with regard to some charging decisions. There was a sea change, in that motoring offences were largely transferred to the police for decision making. That of course added to the reality that, with the increase in sexual offences, the CPS was now dealing with an entirely different caseload. There was not a like-for-like transition, and that complexity means extra challenges for CPS lawyers.

The hon. Member for Torfaen referred to the use of agency workers. I make no apology for that, because I think that using the independent Bar—whether to do agency work in the magistrates court or, vitally, to prosecute serious cases in the Crown court—is exactly what the Crown Prosecution Service should be doing. I am glad to say, having spoken with chief Crown prosecutors across the country, that it is increasingly using the experience and expertise of prosecutors to manage cases effectively within the system, so that we have the excellence in advocacy that we get from the independent Bar and the excellence in case management that we get from experienced CPS employees.

I do not think that there would be any disagreement about the excellence of the advocacy of the independent Bar. I was simply making the point that when we see apparent cuts in the staffing budget, we have to look at the overall picture. We have to look at the temporary staff as well in adding things up to a single figure.

Again, I have spoken directly to many CPS staff, particularly in Wales; indeed, a lot of them used to instruct me. Some of the staff have been there for 30 years—the CPS’s retention rate is extraordinary. I think I get a bit of frankness from them, and they tell me that, in many respects, working practices have improved. The reduction in offices has helped them to work more smartly. They are now physically co-located in buildings with the police. They are working in ways that they did not dream were possible before.

Does my hon. and learned Friend the Solicitor General agree with me, and indeed the hon. Member for Kingston upon Hull East (Karl Turner), that if one is to use the independent Bar, it is also important to ensure that equality of arms is observed? There comes a point at which victims’ groups and victims’ families can rightly note the disparity that apparently exists between the seniority of counsel for the defence and the relatively junior status of counsel for the Crown.

My hon. Friend makes an important general point. Equality of arms is, of course, enshrined in article 6 of the European convention on human rights. It is something that we all understand as practitioners. It would be wrong of me to comment on individual cases, but I will say that where the Crown Prosecution Service is having to deal with complicated and complex issues relating to homicide, resource is never a bar to using the most experienced and senior counsel available, and that of course includes leading counsel.

Time is extremely short, and I want to give the hon. Member for Kingston upon Hull East a minute to respond, but let me say this. With regard to engagement, the most recent survey of employees of the CPS, of which two thirds took part, showed a welcome increase this year of 5%, right up to a figure of just over 59% telling us that morale in the CPS is good. They face significant challenges, but with increased numbers, particularly in the rape and serious sexual offences units, and an emphasis on the prosecution not just of volume cases but of serious sexual offences, conviction rates continue to stay steady and the numbers of people being brought to justice continue to rise, particularly in the important area of violence against women and girls. I could say much more, but I am mindful of the time.

I am grateful to the Solicitor General for what he has said, but I am disappointed that he has not been prepared to admit that everything is not entirely rosy in the garden at the CPS. He describes a scenario in which senior people in the CPS in his own area, who indeed instructed him—