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Commons Chamber

Volume 621: debated on Tuesday 7 February 2017

House of Commons

Tuesday 7 February 2017

The House met at half-past Eleven o’clock


[Mr Speaker in the Chair]

Business before Questions

New Southgate Cemetery Bill [Lords]

Motion made, That the Bill be now read the Third time.

Oral Answers to Questions


The Secretary of State was asked—

Foreign Nationals: NHS Treatment

1. What steps he is taking to ensure that foreign nationals who are not entitled to free NHS treatment pay in full for the treatment they have received. (908621)

Under this Government, the amount recovered from international visitors has trebled from £81 million to £289 million. Yesterday, I announced that we were going further by introducing upfront ID checks and payment for elective care, stopping IVF being available for those who pay the health visa surcharge and asking GPs to help to identify European citizens at the point of registration so that we can recharge their costs to their home country.

My constituents in Kettering welcome the Government’s latest crackdown on this abuse of our national health service at a time when we are struggling to find enough money to pay for the care of elderly people who have paid into the NHS all their lives. We simply cannot afford to provide a free international health service.

My hon. Friend is absolutely right. It is a national health service, not an international health service. I was disappointed to see comments from the Opposition yesterday that the money this would raise would be a drop in the ocean—[Hon. Members: “It is.”] We are seeking to raise £500 million. That is enough to finance 5,000 GPs, who could help the constituents of everyone in this House.

Is it not a coincidence that, whenever we hear about disastrous figures for NHS performance and a huge deterioration in waiting times, as we did at the weekend, the Government re-announce yet another measure to crack down on health tourism? Is not the main problem with our health and social care system the fact that it is chronically underfunded, and that this Government are doing nothing about it?

I will tell the right hon. Gentleman what we are doing about the underfunding. We are raising three times more from international visitors than when he was a Health Minister, and that is paying for doctors, nurses and better care for older people in his constituency and in all our constituencies.

Given the Government’s stated objective of reducing health inequalities, will the Secretary of State set out how he will guarantee that those who are, for example, homeless or who have severe enduring mental illness—the most disadvantaged in our society, who are unlikely to have the required documentation—will receive the treatment they need?

I can absolutely reassure my hon. Friend. What we are doing is based on good evidence from hospitals such as Peterborough hospital, which has introduced ID checks for elective care and has seen absolutely no evidence that anyone who needs care has been denied it. This is not about denying anyone the care they need in urgent or emergency situations; it is about ensuring that we abide by the fundamental principle of fairness so that people who do not pay for the NHS through their taxes should pay for the care we provide.

Has the Secretary of State actually been recently to a clinical commissioning group like ours in Huddersfield, where one more duty would really break the camel’s back? We have just heard that the CCG is changing its constitution, excluding GPs and totally changing the nature of the CCG. Like most of them, our CCG is under-resourced and under stress, and asking it to do something else like this, which will be complex, difficult and perhaps impossible, will kill the poor bloody animal.

With reference to foreign nationals, and including a question mark at the end of the hon. Gentleman’s observations.

I very much hope that the extra money we raise from international visitors will help all Members of this House because it will lead to more funding for the NHS, including for Huddersfield CCG.

When I was in the travel industry, I learned that anyone wanting to travel to, say, America had to have medical insurance. Could it not be a requirement for people coming into this country to ensure that they had such insurance?

We looked at this extremely carefully, and I have a lot of sympathy with what my hon. Friend is saying. People do not have to have medical insurance if they visit countries such as America as a tourist, and we do not want to insist on that for visitors to this country because of our tourism industry here. We concluded that it was better to have a system in which people who get a visa to come and live here have to pay a surcharge. That is why we have introduced the visa health surcharge, which raises several hundred million pounds for our NHS.

I have always supported the view that we are not running an international health service, but as well as directing his energies towards that question will the Secretary of State direct them towards stopping the waste of money that occurs elsewhere in the NHS when highly trained surgeons and theatre teams are forced to wait to operate because beds are not available for their patients and have to spend their time doing nothing? How much is wasted in that way because of the chronic underfunding that this Government have introduced?

The constant accusations of underfunding would have a little more credibility if Labour was actually promising any more money for the NHS. Instead, at the last election it committed to £5.5 billion less than this Government.

Post-polio Syndrome

My hon. Friend will be aware that polio was eradicated from the UK in the 1980s. However, between 25% and 80% of sufferers go on to development post-polio syndrome, a condition that, although not life-threatening, can be debilitating. The NHS response centres on structured self-management and pain relief and increasing referrals to both physio and occupational therapy.

As parliamentary ambassador for the British Polio Fellowship, I know that 93% of people are unaware of post-polio syndrome. Low awareness among GPs, and in the NHS more generally, is leaving patients waiting for up to six years for a diagnosis. Will the Government agree to fund a PPS awareness campaign?

I congratulate my hon. Friend on his work for the British Polio Fellowship, which is a good charity that makes a real difference. He is right that the condition is difficult to diagnose; the symptoms are vague and there is no definitive test. NICE is updating its best practice, and the British Polio Fellowship has developed guidelines that we all need to use to build GP awareness of the condition.

As the Minister said, there is no specific test for diagnosing PPS, so will he outline what information is offered to medical professionals to diagnose and treat the syndrome to ensure that the symptoms are correctly collated and not put down to other untestable issues, such as fibromyalgia?

As I said, the symptoms are vague and there is no definitive test. As my hon. Friend the Member for Gillingham and Rainham (Rehman Chishti) pointed out, awareness of the condition among GPs is not as high as it could be, so we need to do more, with the NICE guidelines and the work of the British Polio Fellowship, on GP education, training and information.

Hospitals (Special Measures)

In the last four years, 31 trusts have been put into special measures—more than one in 10 of all NHS trusts. Of those, 16 have now come out, and I congratulate the staff of Addenbrooke’s and all at Cambridge University Hospitals NHS Foundation Trust, which came out of special measures last month.

Let me also take this opportunity to thank Professor Sir Mike Richards, who has announced his retirement as chief inspector of hospitals. His legacy will be a safer, more caring NHS for the 3 million patients who use it every week. He can feel extremely proud of what he has achieved.

Royal Bolton hospital was in special measures four years ago, but it has since come out following a huge amount of hard work. The trust is now running a surplus, which is being reinvested into patient care. Will my right hon. Friend join me in congratulating all the staff on their excellent hard work?

I am happy to do so. It is a fantastic example of what is possible in challenging circumstances with a lot of pressure on the frontline, so the staff should feel proud. Trusts put into special measures go on to recruit, on average, 63 more doctors and 189 more nurses and see visible improvements in the quality of patient care.

The Secretary of State is right to congratulate Addenbrooke’s, which came out of special measures in the last month due to the dedication of its staff, but we still need to reduce pressure on the A&E. One way of doing that is to increase care locally in rural hubs. Does the Secretary of State agree that money spent on the minor injuries unit at Ely’s Princess of Wales hospital would be money extremely well spent?

I remember visiting my hon. Friend in Ely last autumn, and I know how much she campaigns and cares for her local health services. The Cambridgeshire and Peterborough CCG knows the importance of Ely’s minor injuries unit. It is setting up some public engagement meetings, but if any changes are deemed necessary, I reassure her that there will be a formal consultation before anything happens.

The Heath Secretary’s self-congratulatory tone is astonishing. In the last year, the number of people waiting longer than four hours in A&E has increased by 63%, the number of people waiting on trolleys has gone up by 55%, and the number of delayed discharges is up by 22%. While all of us want hospitals in special measures to improve, what is the Health Secretary’s answer to those urgent problems that affect the NHS across the board?

I will tell the hon. Lady what is happening in the NHS compared with when her party was in power: 130 more people are starting cancer treatment every single day; 2,500 more people are being seen in A&Es within four hours every single day; and there are 5,000 more operations every single day. None of that would be possible if we cut the NHS budget, which is what her party wanted to do.

Norfolk and Suffolk NHS Foundation Trust has been taken out of special measures, despite continued growth in the number of people with mental health problems dying in unexpected or avoidable circumstances from things such as suicide. “Panorama” and the Health Foundation have shown that in 33 trusts the number of avoidable deaths has doubled in the last three years as those trusts have collectively experienced a real-terms cut of £150 million. What specific measures is the Secretary of State taking to tackle the problem of avoidable deaths of people with mental health problems?

We have committed, and the Prime Minister affirmed the commitment only last month, to spend £1 billion more every year on mental health services, but we recognise that it is not just about money. It is also about having a proper suicide prevention plan—we have updated the plan—and making sure that, across the NHS, we properly investigate and learn from avoidable deaths. That is why, following the tragedy of what happened at Southern Health, we have now started a big new programme—the first of its kind in the world—whereby every trust will publish its number of avoidable deaths quarterly.

21. A year ago, East Sussex Healthcare NHS Trust was rated inadequate. Thanks to the hard work, dedication and care of all its staff, the hospitals are now good on many measures, albeit further improvements need to be made. Will the Secretary of State join me in thanking the staff? Does he agree that we need to talk up our successes, as well as recognising challenges? (908643)

I join my hon. Friend in doing that. It is really important, contrary to what the former shadow Health Secretary, the hon. Member for Lewisham East (Heidi Alexander), says, that we praise NHS staff when they do remarkable things. There is a lot of pressure everywhere in the NHS, and praising NHS staff is not being self-congratulatory; it is recognising when a good job is being done.

Further to the very important question of my hon. Friend the Member for Bermondsey and Old Southwark (Neil Coyle), Members on both sides of the House may have seen “Panorama” last night. Frankly, it was shocking and disgusting. I am ashamed to live in a country where in the past year there have been over 1,000 more unexpected deaths under the care of our mental health trusts. That is not a reflection of a country that cares equally about mental health and physical health. In spite of what the Secretary of State just told us, the money is not getting to where it is intended. What is he actually going to do to ensure that no person in our country—not a single person—loses their life because they have a mental health condition for which they are not being treated properly?

I agree with the hon. Lady that there is a huge amount that we need to do to improve mental health provision in this country, but a huge amount has been done and is being done. As she knows, we are now seeing 1,400 more people every day with mental health conditions. We are committing huge amounts of extra money to mental health provision, and we are becoming a global leader in mental health provision, certainly according to the person in charge of the Royal College of Psychiatrists. We have to support the efforts happening in the NHS, because we are one of the best in the world.

Mental Health: Children and Young People

4. What steps he is taking to prevent mental illness and provide mental health support for children and young people. (908624)

Last month the Prime Minister made a major speech in which she made it clear that improving the mental health of children and young people is a major priority for this Government. My Department will work with the Department for Education to publish an ambitious Green Paper outlining our plans before the end of the year.

I am grateful to my right hon. Friend and the Prime Minister for their commitment to this important area of health and the parity that the Government are giving it. Does the Secretary of State agree that, as well as providing mental health support in both schools and colleges, community hospitals, due to their locality, status and scale, can often provide a useful forum for providing these vital services?

I am pleased that my hon. Friend raises that point, because when we discuss mental health we often talk about services provided by mental health trusts but do not give enough credit to the work done in primary care, both in community hospitals and by general practitioners, who have a very important role as a first point of contact. He is absolutely right to make that point.

Will the Green Paper look at the role that educational psychologists could play not only in providing support and assistance to young people with mental health problems but in preventive work? Cuts in local authority budgets have meant that the service has become quite fragmented, but there are practical ways in which it could be improved to help young people with mental health problems.

The right hon. Lady is absolutely right. We have looked into this and realised that there are two issues when it comes to improving children’s and young people’s mental health. The first is improving access to specialist care for those who need it. The other is prevention: the work that can be done by teachers within schools and in training people in mental health first aid. Those kinds of things can make a huge difference and we want to make sure we do them both.

I welcome the Secretary of State’s focus on child and adolescent mental healthcare, but what is he going to do about out-of-area transfers, which too often mean that children are found beds 200 or 300 miles away from their home? That is not in anyone’s interest, and it certainly is not in a child’s interest to be that far away from their support network.

I thank my hon. Friend for his continuing campaign on mental health issues. He is right to say that this situation is completely unacceptable, not least because if we want a child to get better quickly, the more visits from friends and family they can have, the better it is and the faster their recuperation is likely to be. We have commissioned 56 more beds, so the total number of beds commissioned for children is at a record 1,442, but we are determined to end out-of-area treatments by the end of this Parliament.

No one is going to disagree with what the Secretary of State has said, but it is not going to help people at Dove house in Dudley, which has been helping people with mental health problems since the 1970s but faces closure this year, for the want of quite a small amount of money. Will he look at this personally and do everything he can to keep this valuable facility open? It is closing because Dudley is losing 20% of its funding, which compares with the figure of just 1% in Surrey, which he represents.

Dudley CCG has seen its funding go up, and we are asking all CCGs to increase the proportion of their spend on mental health. I am happy to look into the situation the hon. Gentleman talks about, but I will be very disappointed if increasing resources are not going into mental health provision in Dudley.

Will the Secretary of State say a little more about how children’s mental health services can work more closely with schools and the education system more broadly?

I am happy to do that. Some interesting innovation is going on in many parts of the country. In Hove, a school I visited has a CAMHS––child and adolescent mental health services—worker based full-time in the school. That had a transformational effect, as it meant teachers always had someone they knew they could talk to and their understanding of mental health improved. That is the kind of innovation we want to encourage.

Further to that, what pressure and persuasiveness is the Minister bringing to bear in the education system, particularly in primary schools, where young people have, on occasion, had this kind of a diagnosis and problems have been created within the school environment?

This is a very important issue because, as the hon. Gentleman knows, half of all mental health conditions are diagnosed before or become established before people are 14, and the sooner we catch them, the better the chance of giving someone a full cure. We therefore need to find a way whereby there is some mental health expertise in every primary school, so we can head off some of these terrible problems.

As my hon. Friends the Members for Bermondsey and Old Southwark (Neil Coyle) and for Liverpool, Wavertree (Luciana Berger) have already said, last night’s “Panorama” showed that mental health services are not funded properly. At the Norfolk and Suffolk mental health trust funding cuts led to community teams being disbanded, a loss of staff and the loss of in-patient psychiatry beds. Most disturbing of all is to hear parents talk of what happens to their children when they are denied support in a crisis—when they are self-harming or suicidal but there are no in-patient beds. One parent called it a “living nightmare”. We do not need any more warm words from this Secretary of State—we need action to make sure that mental health services are properly funded and properly staffed.

Let me tell the hon. Lady what action is happening this year. The proportion of CCG budgets being assigned to mental health is increasing from 12.5% to 13.1%, which is an increase of £342 million. That is action happening today because this Government are funding our NHS.


The Government recognise the value of surrogacy in helping people who cannot have children to create a family. Surrogacy legislation is now more than 30 years old. In view of changes across society, it is time for an independent review of the legislation, so we have asked the Law Commission to include a project about surrogacy in its proposed work programme for 2017 to 2019.

The Minister will be aware of the work of my constituent Nicola and Surrogacy UK, to which I pay tribute. I very much welcome the Minister’s answer, but will she say something specifically about the remedial order to address the situation for single parents, for which my constituent Nicola is waiting?

My hon. Friend has raised this difficult case with me before, and my sympathies go to his constituent. He is right that the High Court has judged that the current provisions for parental orders are discriminatory. The Government are obliged to act within a reasonable timescale, so we will be introducing a remedial order this spring. I am pressing for that to happen by May, but I am in the hands of the business managers. I shall keep the House and my hon. Friend updated.

Naylor Review

6. What plans he has to ensure that the implementation of recommendations in Sir Robert Naylor’s review on the NHS estate is compatible with local sustainability and transformation plans. (908626)

Sir Robert Naylor’s report on the NHS estate will be published shortly. In developing his recommendations, he has worked and engaged with leaders from across the NHS. This will ensure that his recommendations are informed by sustainability and transformation plans, and are designed to help to support their successful delivery.

I look forward to seeing the report, which has been due “shortly” for a while. Knowle West health park in my constituency is exactly the sort of community-based model that we should be promoting in STPs. It was established by the NHS and the council to prevent illness, to promote good health and to assist recovery after medical treatment. However, the NHS Property Services regime means that its bill has increased more than threefold—from £26,000 to £93,000. What assurances can the Government give that the Naylor report will ensure that there is co-operation on estates planning so that my constituents, who rely on the health park’s contribution to preventing ill health, can face the future with confidence?

We have already accepted one of Sir Robert Naylor’s recommendations ahead of the publication of his report, which is to look into bringing together NHS Property Services and other estates services in the NHS. With regard to allocations to the clinical commissioning group, the Department of Health has provided £127 million to CCGs precisely to contribute towards increases in the move towards market rents for property.

22. When the Minister looks at the estates and transformation plans, will he ensure that arrangements for travelling to different sites are taken into account for healthcare professionals, patients and, importantly, patients’ visitors? (908644)

My hon. Friend consistently expresses concern about the arrangements in Essex as we consider a possible reconfiguration of urgent emergency care arrangements. Ensuring that there is good access to A&E is as vital in that county as it is everywhere else.

In Leicester, the CCG is proposing to close a walk-in centre in North Evington and move it to another part of the city. Rather than being a walk-in centre, it will become a drive-in centre. Does the Minister agree that it is important that local people are consulted fully on the proposals?

As the right hon. Gentleman knows, service reconfigurations require public consultation. I am not sure whether that particular walk-in centre qualifies, but I am happy to have a look at that. A number of walk-in centres were established under the previous Government in a random way, and they need to be located more appropriately for local people.

Does my hon. Friend agree that the driving force of STPs is to improve and enhance patient care for our constituents? With regard to the STP for mid-Essex, will he confirm that no proposal that has been put forward involves any closure of an A&E and that, far from downgrading the existing A&Es, this is about upgrading the quality of care for my constituents?

My right hon. Friend is a regular attender at Health questions, and I am pleased to be able to confirm to him, once again, that the success regime for mid-Essex is looking at the configuration of the three existing A&Es, none of which will close, and each of which might develop its own specialty.

Analysis of the STPs by the Health Service Journal this week found that a substantial number of A&E departments throughout the country could be closed or downgraded over the next four years. The Royal College of Emergency Medicine has described that approach as “alarming”. Over the past month, we have all seen images of A&E departments overflowing and stretched to the limit, so surely now is not the time to get rid of them. Will the Minister pledge today that the numbers of both A&E beds and A&E departments will not be allowed to reduce below their current level?

The hon. Gentleman is right to point out that the STPs are looking at providing more integrated care across localities. A number of indicative proposals have to be worked through. At the moment, NHS England is reviewing each of the STPs, and the results will be presented to the Department for its consideration in the coming weeks and months. On bed closures, I gently remind him that, in the past six years of the previous Labour Government, more than 25,000 beds were closed across the NHS. In the six years since 2010, fewer than 14,000 were closed by this Government and the coalition.

Social Care Budgets

7. What assessment he has made of the effect of changes to local authority social care budgets on demand for health services. (908627)

15. What assessment he has made of the effect of changes to local authority social care budgets on the provision of adequate health and social care services. (908636)

The relationship between health and social care budgets is complex. A recent study by the University of Kent has shown that, for every pound spent on care, hospital expenditure falls by between 30p and 35p. The hon. Lady will also be aware that there has been an increase in delayed transfers of care over the past two years, which has resulted in an increase in the number of unavailable hospital beds. Our best estimate of that increase is around 0.7% of total NHS bed capacity due to the increase in social care delays.

It is quite amazing that the Minister is prepared to stand up and accept that there is a crisis in the NHS caused by the lack of social care provision. The crisis in social care means that more and more local authorities are reduced to just washing, feeding and toileting our elderly people. The crisis in residential care means that people from homes are going into the hospitals and choosing to leave the patients with the most complex needs, because they cannot afford the staff to look after them—

Order. I apologise for interrupting the hon. Lady, but we must have a question: one sentence and a question mark, thank you.

There is no comfort for our elderly people. It is not too late for the Government to act. I ask the Minister to look at protecting social care funding. Will he bring forward the £6 billion and the £700 million—

Order. I am sorry. I say to the hon. Lady without fear of contradiction that we must spread things out evenly.

I agree that budgets make a difference, which is why we are increasing spending by £7.6 billion over this Parliament, but so do leadership, grip and best practice. Some 50% of all delayed transfers that are due to social care delays occur in 24 local authorities. Many other local authorities have virtually no delays. I recently visited the IASH team—Integrated Access St Helens—in the hon. Lady’s own constituency, which, working with Whiston hospital, has achieved spectacular results and some of the best outcomes in the country. I am sure that she will want to join me in congratulating those responsible.

My local council of Rochdale has had to make cuts of £200 million in the past six years. It has a further £40 million of cuts to implement, which will pile the pressure on our social care budgets. The 2% precept will raise only £1.4 million, which is a drop in the ocean when our total adult social care budget is £80 million. With our hospitals reporting a 70% increase in delayed discharges, I call on the Minister to bring forward the better care fund scheduled for the end of this Parliament so that our social care services can cope now.

As a direct answer to the hon. Lady’s question on the improved better care fund, let me tell her that it will be allocated in such a way that the combination of the fund and the precept will address real need. That is what we will be doing during the remainder of this Parliament, starting from April. We spend more on adult social care in this country than Germany, Canada and Italy, but it is very important that we spend it well.

It was good to hear my hon. Friend referring to the University of Kent’s research.

Under the guidance of the vanguards and the sustainability and transformation plan, NHS and social services in Kent are working closer together than ever before, although there is still further to go. Does my hon. Friend agree that it is vital that we overcome the barriers between social services and the NHS so that they operate more as one system, meaning that patients can get the sort of care they need in the right place, preferably at home?

My hon. Friend makes a good point about the success of the vanguard in Kent. Last week I visited the care home vanguard in Sutton, which has achieved a 20% reduction in A&E admissions due to better integration and the sort of things that she mentions as being successful in Kent.

If the Minister watched BBC News last night, he might have seen footage showing the extreme demand for treament in Royal Blackburn hospital’s A&E department and the pressure that it is under. We could point to social care changes but, in reality, the situation is down to the closure of Burnley general hospital’s A&E department in 2008 under the previous Labour Government. What more can we do to support and reduce pressure on A&E departments?

My hon. Friend is correct in so far as two thirds of all delayed transfers of care are a consequence of internal NHS issues, not issues between the NHS and councils. The issue regarding Blackburn and Burnley is part of that.

Recent figures on delayed transfers of care ranked Salford 105th out of 154, with 533 delayed days in November 2016. Sir David Dalton has said that overcrowding at Salford Royal hospital is due to its

“inability to transfer patients safely to an alternative care setting”,

and that changes to social care funding are “urgently required”. Salford Council’s budget has been cut by 40% since 2010, leading to the loss of £18 million from social care budgets. Salford royal hospital, rather than the council, is now providing social care. I know that the Health Secretary respects Sir David. Does Minister accept Sir David’s view about the need for funding changes, or will he continue to find people to blame for cuts inflicted by his Government?

Conservative Members very much respect Sir David Dalton. I remind the hon. Lady that she stood for election on a slogan of not a penny more for local government, so it is entirely inappropriate for her to say different things now. There is now an opportunity in Manchester, through the devolution deal, to integrate care and the NHS more effectively, and I expect that to happen.

GP Appointments

Best trend data come from the GP patient survey, which collates feedback from more than 2 million patients biannually. The most recent results show that 92% of patients found their appointment to be convenient—a slight increase on previous results—and that 86% of respondents rated their overall experience of their GP’s surgery as good.

The Minister knows that there was a 30% rise in waiting times in 2016—that is one of the key concerns that constituents raise with me. Local GPs tell me that one of the main pressures they face is the failing social care system. The Minister knows that the answers he gave a moment ago do not address the problem, so will he commit to doing something meaningful?

The answer I gave a moment ago was the results of the GP patient survey. The Government and I accept that the country needs more GPs. GPs are the fulcrum of the NHS, and we have plans for a further 5,000 doctors working in primary care by 2020. We intend to add pharmacists, clinical pharmacists and mental health therapists as part of the solution.

14. It is not just the need for GPs that is relevant. Surely there is a requirement for GPs to work at weekends, and that should be included in the assessment of demand for their services. GPs should also work with better technologies and work together as groups. (908635)

The Government are committed to GPs offering appointments seven days a week, 8 am until 8 pm, by 2020. By 2018, we will have rolled that out in London. Part of this is about GPs working smarter in integrated hubs of between 30,000 and 40,000 patients, thus enabling them to spread out and to offer services such as pharmacy, physio and social care.

In a survey of Enfield North residents that I conducted, 58% agreed that it is difficult to get a GP appointment. The Royal College of General Practitioners has calculated that Enfield needs 84 more GPs by 2020, but between 2010 and 2014, we lost 12 practices and had only one opened. If the 5,000 GPs appear by 2020, what will the Minister do to ensure that Enfield gets those it needs?

As I said earlier, we will have 5,000 further doctors working in general practice by 2020. A chunk of those will be available for every part of the country, and Enfield is included in that. I do accept that the GP system is under stress and that we need more GPs, and the points that the right hon. Lady makes are right.

Employing more GPs is, of course, important, but the Minister is right to say that so is collaboration. How far have we got with spending the £1 billion earmarked by the Chancellor in 2014 for improving GP surgeries? Does the Minister share Ara Darzi’s vision of more polyclinics, which will enable GPs to work more closely together?

The vision set out in the GP five year forward view is of substantially more spend in the community and of an increase, as a proportion, in the amount of money in the NHS going to people in primary care. Part of that will be in polyclinics and the estate generally. As I say, one of the most innovative things we have found in the GP vanguards is that when they start to put together groups of 30,000, 40,000 and 50,000 patients in a GP hub, the quality of care increases dramatically. We are going to accelerate that.

Innovative Drugs and Medical Devices

9. What plans the Government have to increase access for patients to innovative drugs and medical devices. (908630)

The challenges facing our health system are significant, so we do need to improve the uptake of those innovative technologies that can improve efficiency and patient outcomes to help to meet that challenge, while also providing a pool for investment for innovators. By capitalising on advances in genomics, data, digital health and informatics, the accelerated access review will improve access to cost-effective new products.

I know that the Minister will agree with me when I say that it is vital that we endeavour to ensure that the NHS gets better value for money for the drugs bill so that we can afford to get more of the latest innovative products to patients more quickly, but does she also agree that much more work needs to be done alongside the accelerated access review and the forthcoming life sciences strategy to achieve that objective?

I completely agree with my hon. Friend. Medicines are the second highest area of spending in the NHS after staff, and it is vital that the NHS gets best value from that investment. That is why I am pleased that the House supported our recent Bill on the cost of medicines and medicine supplies, which will enable us to tackle unjustified price rises for unbranded generic medicines. We are also working closely with NHS England to promote the use of the new wave of biosimilar medicines and to ensure cost-effective prescribing behaviour.

When will the Government publish their response to the accelerated access review, and will that include a consideration of how to improve patient access to molecular diagnostics?

20. As the Health Secretary is aware, my constituent Abi Longfellow is suffering with a rare kidney condition—dense deposit disease. What plans do the Government have to increase access to specialist drugs for those such as Abi with ultra-rare diseases? (908642)

The National Institute for Health and Care Excellence and NHS England are working together to better manage access to new drugs and medical technologies for rare diseases. We are also working on the UK strategy for rare diseases and its implementation. It has 51 commitments to be implemented by 2020 to improve the lives of constituents such as my hon. Friend’s.

A simple but life-saving use of medical apparatus is tube feeding. Will the Minister join me in welcoming the fact that this is Feeding Tube Awareness Week, which is raising awareness of this important issue and giving support to all the thousands of families in which children or other family members are tube fed?

I thank the hon. Gentleman for drawing our attention to this issue. Sometimes the simplest solutions are the most effective. We want to make sure that such innovations are driven across the NHS more effectively, which is exactly what our academic health service networks are there for.

17. Now that four failures have been recorded of the main drug used to protect UK patients from malaria, and scientists are warning for the first time that resistance may be increasing, will the Minister outline what further steps are being taken to tackle antimicrobial resistance in the coming years? (908639)

AMR is a global issue. We are world leaders in this, and we are working proactively with international partners to identify new and innovative approaches to the treatment of a range of challenging resistant infections, including malaria.

Breast Cancer Drugs

11. What assessment he has made of how the accelerated access review will improve access to breast cancer drugs. (908632)

We are absolutely determined that we will improve access to cost-effective, innovative medicines, including breast cancer drugs. That is exactly why we introduced the cancer drugs fund.

The Minister will know that “cost-effective” is not an easy thing to define. Many women will not get access to the breast cancer drugs they need unless there is a review of how NICE assesses cost-effectiveness. Will she support an independent review of those processes, and will she say something about off-patent cancer drugs?

The hon. Lady and I have debated this in the House before. It is worth looking at our record. The cancer drugs fund has helped 95,000 people to access cancer drugs, to the tune of £1.2 billion, and NICE has approved three breast cancer drugs, while there are others that it has not yet approved. It is important that politicians do not intervene in this debate, as these are very difficult decisions that will always be challenging in the situation where the NHS has a finite budget.

If the hon. Member for Brecon and Radnorshire (Chris Davies) were standing because he has a cancer-related question, I would call him, but if he is not, I will not. He is, so I will.

18. I am delighted to do so, Mr Speaker—thank you very much. Given that there is no general hospital in my constituency and a large number of my constituents have to travel many miles for cancer treatment, what discussions has my hon. Friend had with the Welsh Government to persuade them to fund mobile cancer treatments? (908640)

We have continual discussions with the Welsh Government to make sure that these issues are kept under review. I shall definitely write to my hon. Friend about this. I shall also be happy to meet him if he would like to discuss it in further detail.

Does the Minister agree that not one subject that we have discussed today would not be improved by the better transfer of patient data? How is the Department working towards linking social care with the acute sector, with GPs, with mental health services, with innovation and with cancer drugs in order to understand where we can best target patient outcomes and spend our resources?

My hon. Friend has a leading role with her private Member’s Bill so she is well aware that we are working very hard to improve the connection of patient data, particularly through the role of the national data guardian and her 10 safeguarding rules, which will make sure that we not only protect patient data more effectively but are able to share it in an effective way that improves patient care.

Time is against us, but I would like to make a little further progress with Back Benchers’ questions. I call Michelle Donelan.


Developing a variety of routes into nursing is a priority to widen participation and reflect the local populations served by nurses. That is why we have developed a new nursing associate role and nursing degree apprenticeships, which are opening up routes into the registered nursing profession for thousands of people from all backgrounds and allowing employers to grow their own workforce locally.

Are there any plans to roll out the associate role to include Wiltshire, and to enable the new nursing degree apprenticeship schemes to be offered in larger further education colleges so that counties like Wiltshire that have no university can still make that provision?

We have announced the first 1,000 nursing associates. In fact, the first cohort commenced at the beginning of this month. I visited, in Queen’s hospital, Romford, the first very enthusiastic group of nursing associates. We have announced a second wave of 2,000 associate roles. I regret to say that Wiltshire does not have any of those at the moment, but that will not stop it bidding for them in future. I will look at my hon. Friend’s point about further education colleges.

When the Secretary of State scrapped the nursing bursary, he claimed that his reforms would lead to an increase in nursing applications. Last week, figures from UCAS showed that there had been a drop in nursing applications of 23%—a worrying trend when the demands of Brexit will mean that we need more home-grown nurses. Will he scrap this disastrous policy or, at the very least, give Greater Manchester the ability to opt out of it and reinstate the nursing bursary?

I urge the right hon. Gentleman not to indulge in scaremongering about the number of people applying to become nurses. There are more than two applications for each of the nursing places on offer to start next August. He needs to be careful about interpreting this early the figure for applications from EU nationals, which has gone down significantly, because it coincided with the introduction of the language test for EU nationals.

With the reduction of 23% in applications to English nursing schools, the Minister might want to re-look at the policy. There has been a significant drop—a 90% drop—in EU nationals applying. With one in 10 nursing posts in NHS England vacant and a cap on agency spend, who exactly does the Minister think should staff the NHS?

I say gently to the hon. Lady that there are 51,000 nurses in training at present. The number of applications through the UCAS system thus far suggests that there will be more than two applicants for each place. As I have just said to the right hon. Member for Leigh (Andy Burnham), the reduction in application forms requested by EU nationals has coincided with the introduction of a language test.

Language test applications were more than 3,500 last January, so the reduction after the language test was from that to 1,300. In December, there were only 101 applications. This cannot all be blamed on the language test, so what is the Minister going to do to protect nursing numbers?

There are over 13,000 more nurses working in the NHS today than there were in May 2010. As I have just said to the hon. Lady, the language test came into effect from July last year, since when the number of applicants has been somewhat steady. It is down very significantly, but that is because, frankly, we have had applications from nurses from EU countries who have not been able to pass the language test.

Prostate Cancer

13. What proportion of prostate cancer patients wait for more than two months to begin cancer treatment after the hospital has received an urgent GP referral. (908634)

The national standard is that we expect 85% of all cancer patients to receive initial treatment within two months of an urgent referral. For cancer overall, the most recent data indicate that we achieve 82%, and for prostate cancer around 78%, against that standard. The lower figure for prostate is due to the fact that the pathways are more complex than average.

I am disappointed by the figures, but at least they are available. When I asked this as a written question last month, the information was not available, nor was information available about the number of vacancies for prostate cancer surgeons, their training or the equipment that they use, because that information, I am told, is not collected centrally. When will the Department collect adequate information to run the health service properly?

More information was published on cancer by clinical commissioning groups since the back end of last year than at any time in the history of the NHS. [Interruption.] The hon. Gentleman is right to say that prostate is grouped with neurological cancers in general, and that is the type of surgeon being employed. But the fact is that the Government have been incredibly transparent in terms of information published on cancers.

Last Saturday was World Cancer Day. The theme was unity, and I am still wearing my unity band with pride. We must do all we can to beat cancer, yet the Government are coming to their three-year anniversary of not meeting the 62-day wait target. Treatment quickly after diagnosis is crucial for tackling all cancers. Will the Minister outline what he is doing to ensure that that target is once again met so that patients receive timely treatment?

The volume has increased greatly, and there are something like 2,000 more people being diagnosed every day. The hon. Lady is right: of the eight cancer standards against which we judge ourselves, we meet seven, and the 62-day one has not been met. We need to do more to achieve that, and the cancer strategy set out a pathway for doing so. We have particularly invested in the early diagnosis component; we have invested £200 million in early diagnosis and getting a 31-day all-clear or referral for treatment. That is the pathway to meeting the 62-day target. She is right to raise this, because it is an important indicator and we need to do better.

Topical Questions

We know that a strong primary care system is the bedrock of the NHS, which is why I am pleased to announce today that NHS England will publish the new GP contract, agreed by the Government, NHS England and the British Medical Association. It will see almost £240 million extra invested in GP services; require GPs to establish whether overseas visitors are eligible for free care, allowing the NHS to better recoup the costs of that care; and improve access for patients by removing extra funding if GPs regularly close for afternoons during the working week.

Will the Secretary of State consider putting a GP in every A&E department so that they can additionally triage patients who are not so ill and advise them to go home and see their own GP on another occasion?

My hon. Friend is absolutely right. Actually, the policy is that all A&Es, where space is available, should do that. The hospitals that do it have by far the most successful results—not least Luton and Dunstable, which has pioneered that model.

With respect to A&Es, diverts have been at twice the level of last year, 4,000 people have had urgent operations cancelled, 18,000 people a week in January were waiting on trolleys in corridors, and nine out of 10 hospitals have been overcrowded and are at unsafe levels. I have even read in the Secretary of State’s local paper that his local hospital had to put patients in the gym overnight. Does the Secretary of State agree with the Prime Minister that the crisis facing our NHS amounts to a “small number of incidents”?

The NHS is under a lot of pressure, but what we never get from the hon. Gentleman is any solutions. Our solution is 600 more A&E consultants since 2010, 1,500 more A&E doctors, 2,000 more paramedics, and 2,500 more people being seen within four hours every day. His solution at the last election was to cut the NHS budget by £1.3 billion.

The Secretary of State’s solution has been to blame everybody else but never take responsibility himself.

What is the Secretary of State going to do about the crisis that we are now facing in staffing? Last week, we learned that half of junior doctors are abandoning specialist training. We have already heard that applications for nursing degrees are down by a quarter following the axing of the student bursary and we heard today that there is a shortage of midwives. I know that the right hon. Gentleman has been in the US and that he will try to give us his alternative facts, but when will he give us an alternative plan and deal with the staffing crisis—an issue that the Minister of State, the hon. Member for Ludlow (Mr Dunne), could not respond to a few moments ago?

Let us look at the reality, instead of the hon. Gentleman’s rhetoric. In his own local trust in Leicester, there are 246 more nurses than in 2010 and 313 more doctors. Some 185 more patients are being seen in A&E every day and next year a new £43 million emergency floor will open at the Leicester Royal Infirmary. That is because we are backing the NHS instead of wanting to cut its budget.

T2. The recently introduced one-year cancer survival rate indicator is a beacon of light in a system still too focused on process targets. What more can the Government do to hold underperforming clinical commissioning groups to account for that outcome indicator, given that we are still failing to catch up with international averages when it comes to our survival rates? (908612)

My hon. Friend is right to say that we now publish one-year survival rates for every CCG in the country, and I agree that that is a beacon of light and a transformative step. It also shows differences of more than 10% between the best and the worst, which is unacceptable. The transparency itself will bring improvement, but we have also recently established 16 cancer alliances, whose sole job is to roll out best practice and investigate and bear down on poor performance.

T4. Will the Minister update the House about NHS litigations, which rocketed to £1.4 billion last year? Are they anything like under control? (908614)

The hon. Gentleman is absolutely right; this issue is a very big concern. The only way, in the long run, to reduce those litigation costs is to have safer care. That is why the Government have prioritised safety in everything we do.

T3. If someone in St Ives suffers a severe stroke, they will have a far better chance of a full recovery if they get quick treatment and then proper therapy and rehabilitation in the community. That does not happen for everybody. What is the Department going to do to ensure that there will be a national stroke strategy? (908613)

The current stroke strategy was produced in 2007 and our priority is to implement it fully. Frankly, in my time as a Minister, I would prefer to have detailed implementation plans and not more strategies. My hon. Friend refers to the great differences in performance across the country, in particular in access to speech and language therapy, and we need to achieve better on that.

T5. My Falkirk constituents, Michelle and Justin Young, have been through the lengthy treatment approval process for their son, Michael, to access the Duchenne muscular dystrophy treatment Translarna. Thankfully, Michael is now receiving it. With a growing number of emerging treatments for rare diseases expected in the forthcoming years, what action are the Government taking to increase the capacity of the Medicines and Healthcare Products Regulatory Agency when the UK leaves the EU? Most importantly, will the Secretary of State or the Minister agree to meet Muscular Dystrophy UK— (908615)

I pay tribute to the work of the charity the hon. Gentleman mentioned, which does very important work, and have sympathy for the case he mentioned. The UK’s rare diseases strategy has 51 recommendations, which are driving changes through the NHS and improving the life chances of patients with rare diseases. Our genomics work is also bringing life-changing improvements to patients with rare diseases by diagnosing them faster and improving their chances of receiving treatment quicker.

T6. People in Lancashire will be pleased that the emergency department in Chorley has reopened, providing access for people 12 hours a day. Will my hon. Friend welcome that good news and thank everyone involved? (908616)

I am grateful to my hon. Friend for recognising the work that went into reopening the A&E at Chorley last month. I am delighted, in particular, by the work that was done by the Deputy Speaker and my hon. Friend the Member for South Ribble (Seema Kennedy).

T7. Last year, hospital trusts were urged by Department of Health officials to raid their capital budgets to cover resource funding. Does the Secretary of State think that is a good way forward, and what instructions is he giving officials this year? (908617)

I recognise that it is not a sustainable position to have to do that. Pressures on the frontline meant that it had to happen, but we do need to invest for the future and I agree with the hon. Lady that capital budgets are very important.

Young people with severe anxiety can spend years out of school and become very isolated. Does the Secretary of State agree that we need to think more imaginatively about community and voluntary solutions to reach out to those young people, whose futures we must not give up on?

I absolutely agree. About 3% of schoolchildren have severe anxiety, but if we get treatment to them quickly, often we cure the condition and it does not come back. My hon. Friend is absolutely right that we need to be as imaginative as possible.

T8. I have to report back to a constituent who is desperate for treatment that the current waiting time for the adult ADHD clinic is two years. In 2014, the Secretary of State and I published a vision to achieve comprehensive maximum waiting time standards in mental health so that people with mental ill health had exactly the same right to access treatment in the same time. Why on earth can the Government not end the outrageous discrimination against people with mental ill health? (908619)

I am always somewhat disappointed by the right hon. Gentleman’s rhetoric, given that we are spending about £1 billion more every year than when he was mental health Minister. This April, we will reintroduce maximum waiting times for eating disorders. As he knows, we have committed to publish pathways for all conditions during this Parliament. That will include his constituent who, I agree, is waiting much too long at the moment.

Some GP practices in east Lancashire have, through sheer frustration, started publishing the number of missed appointments. When will the Secretary of State consider giving GPs the power that they want, and that the public want them to have, to charge those who miss repeated GP appointments, including in east Lancashire?

I have sympathy for people who are frustrated about that issue. As I have said before, my objection is not one of principle; it is whether it is practical to do it. Perhaps that is something that GPs could decide at a local level.

T9. The Health Secretary said there was a “small” number of incidents in the NHS this winter. What is his definition of “small”? We had what I would call a large number in my constituency alone. I extend an invitation to him to visit my local hospital and see that for himself, as the shadow Health Secretary will later this week. (908620)

May I gently tell the hon. Lady that I do not think our debates on the NHS are helped by her taking my comments out of context? I was quoting Chris Hopson, from NHS Providers, talking about a specific week when he said there were, in that week, a small number of incidents. We recognise the pressures across the NHS, which is why this Government are backing the NHS with record funding.

A small business in my constituency was driven out of business by slow payments for relatively small sums by NHS providers. Will he ensure strict compliance with the guidelines for timely payments?

My hon. Friend will be aware that best practice for NHS bodies is to pay within 30 days. I am pleased to be able to tell him that figures for the quarter ending in September show that the Department of Health paid 98.4% of our bills within five days—one of the best performances across government.

The Royal College of Psychiatrists warns that half of all child and adolescent mental health training posts are unfilled. With 11% of trainees being EU nationals, how do the Government plan to avoid a Brexit-inspired staffing crisis?

Because, as we have said many times, post-Brexit this country will remain open to the brightest and the best.

My constituent, Nicola Johnson, has had primary breast cancer. The secondary was discovered at 10 months. Will the Minister meet me and Nicola, because she falls within the six-month to 12-month period? She is eligible for neither pertuzumab nor trastuzumab emtansine.

What further efforts have been made to increase the level of nurses’ pay, many of whom have high levels of training, expertise and qualifications?

We recognise that nurses and other health workers deserve a cost-of-living increase. As the hon. Lady will be aware, the NHS pay review body is due to make its recommendations in a few weeks. We will be looking at them closely.

Demand dramatically exceeds supply, as usual, but we will have one last question. I call Tom Pursglove.

Thank you, Mr Speaker. Corby and east Northamptonshire is taking thousands and thousands of new homes. What reassurance can Ministers give to my constituents that GP services will keep up with housing growth?

I can absolutely reassure my hon. Friend that we take that into account in all the funding we give for NHS primary care, but it depends on having a strong economy. That is something this Government will always do for the NHS.

Housing White Paper

With permission, Mr Speaker, I would like to make a statement on the Government’s housing White Paper “Fixing Our Broken Housing Market”, copies of which I have placed in the Libraries of both Houses. I had hoped, Mr Speaker, that this housing White Paper would dominate the headlines this morning, but it seems that someone else has beaten me to it. [Laughter.]

Let me just gently say to the right hon. Gentleman that I did make my statement to the House first. [Applause.] We should not have clapping, as the hon. Member for Colne Valley (Jason McCartney), a strict proceduralist, correctly points out. I am glad that the right hon. Gentleman is in such fine fettle and good humour.

Touché, Mr Speaker.

Our housing market is broken. Since 1970, house price inflation in Britain has far outstripped that in the rest of the OECD. The idea of owning or renting a safe, secure place of one’s own has, for many, now become a distant dream. Over the past seven years the Government have done much to help. We have taken action on both supply and demand, and the results have been positive. Last year saw a record number of planning permissions granted, and the highest level of housing completions since the recession. Between 1997 and 2010, the ratio of average house price to average income more than doubled, from 3.5 to 7. In the five years to 2015, however, it crept up to just over 7.5—just a little but still heading in the wrong direction.

Behind the statistics are millions of ordinary working people. I am talking about the first-time buyer who is saving hard but will not have enough for a deposit for almost a quarter of a century, or the couple in the private rented sector handing half of their combined income straight to their landlord. The symptoms of this broken market are being felt by people in every community, and it is one of the biggest barriers to social progress that this country faces, but its root cause is simple: for far too long, we have not built enough houses. Relative to population size, Britain has had western Europe’s lowest rate of house building for three decades. The situation reached its nadir under the last Labour Government, when, in one year, work began on just 95,000 homes—the lowest peacetime level since the 1920s.

Thanks to the concerted effort of central and local government, last year 190,000 new homes were completed, but it is still not enough. To meet demand, we have to deliver between 225,000 and 275,000 homes every year. In short, we have to build more of the right houses in the right places, and we have to start right now. Today’s White Paper sets out how we will go about doing just that. House building does not just happen. Meeting the unique needs of different people and different places requires a co-ordinated effort across the public and private sectors. There is no magic bullet; rather, we need action on many fronts simultaneously.

First, we need to plan properly so that we can get the right homes built in the right places. To make this happen, we will introduce a new way of assessing housing need. Many councils work tirelessly to engage their communities on the number, design and mix of new housing in their area, but some duck the difficult decisions and fail to produce plans that meet their housing need. It is important that all authorities play by the same rules. We need to have a proper conversation about housing need, and we need to ensure that every local area produces a realistic plan that it reviews at least every five years.

Once we know how many homes are needed we need sites on which to build them, so the White Paper contains measures to help identify appropriate sites for development—not simply empty spaces but useable, practical sites where new homes are actually required. I can reassure the House that this will not entail recklessly ripping up our countryside. In 2015, we promised the British people that the green belt was safe in our hands, and that is still the case. The White Paper does not remove any of its protections.

Government should not be in the business of land banking, however, so we will free up more public sector land more quickly. We will increase transparency around land ownership, so that everyone knows if someone is unfairly sitting on a site that could be better used. Moreover, people need a say on the homes that are built in their area, so everywhere must have a plan in place and ensure that communities are comfortable with the design and appearance of new homes.

The second area of focus is all about speeding up the rate of build-out. At the moment, we are simply not building quickly enough. Whether that is caused by unacceptable land banking or slow construction, we will no longer tolerate such unjustified delays. We will speed up and simplify the completion notice process; we will make the planning system more open and accessible; we will improve the co-ordination of public investment in infrastructure and support timely connections to utilities; and we will tackle unnecessary delays caused by everything from planning conditions to great crested newts.

We will give developers a lot of help to get building, and we will give local authorities the tools to hold developers to account if they fail to do so. Local authorities also have a vital role to play in getting homes built quickly, and I am therefore looking again at how they can use compulsory purchase powers. We will also introduce a new housing delivery test to hold them to account for house building across their local area.

Finally, the White Paper explains how we will diversify the housing market. At present, around 60% of new homes are built by just 10 companies. Small independent builders can find it almost impossible to enter the market. This lack of competition means a lack of innovation, which in turn leads to sluggish productivity growth, so we will make it easier for small and medium-sized builders to compete. We will support efficient, innovative and underused methods of construction such as off-site factory builds. We will also support housing associations to build more and explore options to encourage local authorities to build again, including through accelerated construction schemes on public sector land. We will encourage institutional investment in the private rented sector, and we will make life easier for custom builders who want to create their own home.

Together, these measures will make a significant and lasting difference to our housing supply. It will, however, take time, but ordinary working people need help right now. We have already promised to ban letting agents’ fees, and this White Paper goes further. We will improve safeguards in the private rented sector, do more to prevent homelessness and help households that are currently priced out of the market. We will tackle the scourge of unfair leasehold terms, which are too often forced on hard-pressed homebuyers. We will work with the rental sector to promote three-year tenancy agreements, giving families the security that they need to put down their roots in a community.

In the past few years, we have seen almost 300,000 affordable home units built in England. We have seen housing starts increase sharply, and we have seen more people getting on the property ladder, thanks to schemes such as Help to Buy. We now need to go further—much further—and meet our obligation to build many more houses of the type that people want to live in in the places where people want to live. That is exactly what this White Paper delivers. It will help the tenants of today who are facing rising rents, unfair fees and insecure tenancies; it will help the homeowners of tomorrow to get more of the right homes built in the right places; and it will help our children and our children’s children by halting decades of decline and fixing our broken housing market. It is a bold, radical vision for housing in this country, and I commend it to the House.

I thank the Secretary of State for the customary copy of his statement just beforehand, but really, I have to say, “Is this it?” When the Housing Minister himself admits that the Government’s record on housing is feeble and embarrassing, we had hoped for better. In fact, we needed better. This afternoon’s statement will desperately disappoint millions of people struggling month to month with a cost of housing crisis.

I have to say that the statement was feeble beyond belief. After seven years of a Conservative Government, the Secretary of State says that we need to have “a proper conversation” about housing need, and his top priority is a “new housing delivery test”. How many times before have we heard Ministers say that they will free up more public sector land more quickly?

It is also clear today that we have not just a housing crisis in this country, but a crisis in the Conservative party about what to do about it. The huge 200-page Housing and Planning Act 2016 is not even mentioned today. We heard a boast beforehand of radical action on planning from the Secretary of State, but it has been stamped on by the Prime Minister today. We have heard of rows between Conservative Back Benchers and the Secretary of State, and that local councillors have resigned as a result of the right hon. Gentleman’s decisions. This White Paper is not a plan to fix the housing crisis, and it will do nothing to reverse the seven years of failure on housing that we have seen since 2010.

Let me turn to some of the areas where we needed strong action in today’s statement. The first is home ownership. There were 1 million more homeowners under Labour, but seven years under the Conservatives has seen home ownership falling, and it is in freefall for young people. Yet this White Paper confirms that the Tory party has given up on home ownership, because it waters down the promise to help those who need help to get a first foot in the housing market. I thus say to the Secretary of State: why not reverse the cuts to investment in new affordable homes to buy that has resulted in the number of new low-cost homes built falling to just 7,500 a year? Why not stop those earning over £100,000 getting help through Help to Buy, and make it available only to first-time buyers, not to second-time or subsequent buyers?

Secondly, there is homelessness. After being cut to record lows under Labour, the number of people sleeping rough on our streets has more than doubled, but we did not hear a single mention of that in the statement. Why can the Secretary of State not accept that this shames us all in a country as decent and well off as ours, and why will he not adopt the Labour plan to end rough sleeping within a Parliament?

Thirdly, we need action to help renters. How will simply working “with the rental sector to promote three-year tenancy agreements” help the country’s 11 million current renters? Why will the Secretary of State not legislate for longer tenancies, tied to predictable rent rises and decent basic standards?

Finally, there is the need to build more homes. The Government have pledged to build a million new homes by 2020, but last year the total number of newly built houses was still less than 143,000, while the level of new affordable house building has hit a 24-year low. We need to see all sectors—private house builders, housing associations and councils—firing on all cylinders to build the homes that we need. Why will the Secretary of State not drop the deep Tory hostility to councils, and let them build again to meet the needs of local people?

It is tragically clear from the statement that seven years of failure on housing are set to stretch to 10. We were promised a White Paper, but we have been presented with a white flag. This is a Government with no plan to fix the country’s deepening housing crisis.

Today, the right hon. Member for Wentworth and Dearne (John Healey), as shadow Housing Minister, had a chance. He had a chance to adopt a cross-party approach, to behave like an adult—a mature person—and to help with the difficulties that have faced so many people, under many Governments, for more than 30 years. Instead, he chose to play cheap party politics.

I could respond in the same way. As I said in my statement, work began on only 95,000 homes—the lowest number since the 1920s—in a particular year, and I believe that the right hon. Gentleman was the Housing Minister at the time. However, that is not what people want to hear. People want to hear the truth. They want to hear Governments, and politicians more generally, recognise the size of the problem. They want them to recognise that at this moment, in every one of our constituencies, young people are staring into the windows of estate agents, their faces glued to them, dreaming of renting or buying a decent home, but knowing that it is out of reach because prices have risen so high. The vast majority of that rise in prices took place when Labour was last in power, more than doubling as a ratio to income, from 3.5 times to 7. But people also want to know what we are doing about it, and that is what is in the White Paper.

The right hon. Gentleman asked a number of questions. He mentioned home ownership. Home ownership declined as a percentage under Labour: it declined sharply, because not enough homes were being built. It is time the right hon. Gentleman took responsibility for that. He asked about homelessness. Just over a week ago, on a Friday, we debated the Homelessness Reduction Bill in the House. It was Labour shadow Ministers who tried to destroy that Bill by tabling fatal amendments, and the only reason they backed off was that they were begged to do so by housing and homelessness charities, including Crisis. That is where Labour stands on homelessness.

The right hon. Gentleman talked about renters. We have recognised in the White Paper that we should have a policy that meets the needs of not only those who want to own their own homes, but those who want to rent decent homes. Finally, the right hon. Gentleman talked about councils, and what he said proved that he had not listened to any of my statement. He came into the Chamber with a pre-written speech, not wanting to listen to any part of the debate. If he had listened carefully, he would know that what he wanted me to say was exactly what I said.

The truth is that the right hon. Gentleman had a chance and he flunked it. I do not think that many of his colleagues are with him on this issue. I sense that many of them want a cross-party approach: they want a Government to work with politicians on both sides of the House to deal with the issue once and for all. I certainly know, having dealt with many of his colleagues on local councils, that local Labour leaders are working with the Government because they have given up on this excuse for an Opposition.

There is much to be welcomed in the White Paper. It is essential for us to build new communities and new homes, but to build them in the right places. I am also pleased that the Government have decided not to relax the green belt rules further. The Secretary of State has rightly described those rules as sacrosanct. However, does he understand the deep anger that is felt throughout Sutton Coldfield, where the reasonable views of 100,000 people have been totally ignored by a Labour council during a deeply flawed process involving the unnecessary building of 6,000 homes on our green belt, and their frustration at the fact that the Government have not been able to stop that process?

I know that my right hon. Friend feels passionately about this issue, and I am pleased that he pointed out that the White Paper refers to the retaining of protections for the green belt. He referred to a particular case in his constituency. When local authorities have made a proper assessment of housing need and that assessment has been signed off by an independent planning inspector, it is important for us not to get in their way.

I thank the Secretary of State for giving me advance sight of his statement, and for providing me with a copy of the White Paper. I must say that it is pretty thin. I have it here: this bit is the substance, and this bit is the consultation. However, it was good to hear the Secretary of State acknowledge the gap between the Tory Government’s rhetoric on house building and their actual record. It is always nice to observe a recognition of failure on their part.

We have embarked on another year, and we have yet another housing Bill, with no solutions in sight. We should contrast that with what is being done by the Scottish Government—[Hon. Members: “Oh no!”] The Tories would do well to listen to what I am saying, because we have a record of success. Having exceeded our targets for the previous Parliament, our Housing Minister, Kevin Stewart, has set a target of 50,000 affordable homes in the current Session. We already have local housing strategies and strategic housing investment plans—comprehensive five-year plans which each local authority is required to produce. The Secretary of State might want to have a look at the Glasgow SHIP, which was published recently.

In his statement, the Secretary of State mentioned building on brownfield land. It must be recognised that contaminated, derelict brownfield land may need significant Government investment to make it ready for use, and the £1 billion fund will not go far enough to deal with the contamination that exists. The statement referred to ways of achieving progress in respect of land planning applications. Quality is also important, as is place-making. We need only look at the example of North Kelvin Meadow in Glasgow. The local community felt that what was being proposed was not good enough, and had to take their objection all the way through the Scottish Government’s planning process.

The Secretary of State mentioned types of innovative house building. The Commonwealth games village in Glasgow was built through the use of such innovative methods, and there are other great examples in Scotland that show what can be done. I am glad to note that insurance issues are being considered, because they are incredibly important.

Finally, may I ask the Secretary of State to consult the Private Housing (Tenancies) (Scotland) Act 2016 for examples of good practice? Will he acknowledge the existence of the elephant in the room—the continual ideological pursuit of the right to buy, which is ruining people’s opportunities to gain access to affordable housing?

I want all the people of the United Kingdom to have access to decent homes, to rent or to buy, and that, of course, includes the people of Scotland. As the hon. Lady knows, my remit is only for England, and that is the focus of the White Paper. She mentioned a number of English policies, including the right to buy. We are very proud of that policy, whether it relates to council homes or to our commitment to housing association tenants. I think it right for us to support people who want to own their homes, as well as those who want to rent decent homes. However, there is one thing that both Scottish and English people require in order to have access to decent homes, and that is a decent income, which means having a job. I think that the situation would have been very different for Scottish people if the hon. Lady had had her way and Scotland had become independent.

I congratulate my right hon. Friend on bringing a Macmillan-like sense of urgency to tackling the housing crisis, which causes or aggravates most of the social problems we face. The first step is being honest about how many homes we need and where we need them, so I welcome his bringing forward a new standard methodology for assessing housing need. Can he reassure me that that will include the affordability of housing, so that it deals with the places where the pressure is most acute?

My right hon. Friend makes a very important point. The starting point has to be that every local authority makes a realistic assessment of need, and in order for it to be realistic, it must look at the market pressures locally, which of course include affordability.

I welcome the Government’s recognition that the housing need in this country cannot be met by building homes for sale alone, and that we also need homes that people can afford to rent. May I therefore seek two points of clarification? In the case of schemes that receive public money, will the Homes and Communities Agency, councils and housing associations be allowed to negotiate the right tenure mix for each scheme, including through funding being made available for social housing where that is appropriate? Secondly, on section 106 agreements, will councils now be free to negotiate with developers the right types of affordable housing in each scheme, and will the requirement to give preference to starter homes be dropped?

I always listen carefully to what the Chair of the Select Committee on Communities and Local Government has to say, and he highlights an important issue. He asked two specific questions. On tenure mix and the use of public money, we will certainly make sure that that money is used to help promote homes that are available for rent, whether through the HCA or by working with councils and housing associations. We will also require all local authorities, when they go through their plan-making process, to think about the tenure and the mix that is required in the area, and to allocate accordingly. That will also stretch to when section 106 agreements are applied.

Mid Sussex District Council is keen to build homes, and many people in my constituency work diligently to produce neighbourhood plans, only for them to be undermined by the ruthless behaviour of some rogue developers. Does my right hon. Friend agree that if we are to deliver the imaginative vision he has outlined to the House today, we need to curb that sort of behaviour?

My right hon. Friend highlights the importance of neighbourhood plans. I know that he is aware of the current Bill going through Parliament, the Neighbourhood Planning Bill, which is strengthening that part of the plan-making process, but I think he will also be pleased to see in this White Paper the further steps that we are taking to achieve precisely what he wants: local communities being taken more seriously through their neighbourhood plans.

Constituencies such as mine will be stripped of desperately needed social housing by the proposals in the Housing and Planning Act 2016 for the forced sale of high-value properties. In the spirit of what the right hon. Gentleman is saying today and the White Paper, can he confirm that he will no longer proceed with that policy?

I cannot confirm that, because we are committed to allowing people who live in housing association homes the right to buy. We have started a process of pilots, as I think the hon. Lady will be aware; some 3,000 homes, I think, are involved in that. Once that is complete, we will decide how exactly to take the policy forward.

What lessons can we learn from the Netherlands and Germany, and how can we encourage land pooling, as in Germany, where local authorities work in collaboration with landowners to make serviced plots of land available so that individuals and families can bring forward their own self-build and custom house building schemes?

I thank my hon. Friend for the work he has done to promote self-build and custom build. That is certainly one lesson we can learn from the Netherlands and Germany, and I have seen some good examples in those countries. He also mentioned land pooling, and there are some fantastic examples in the Netherlands; I went to see them, and they were so good that I put them in the White Paper.

I hope the Secretary of State will forgive me, but I think he flatters himself if he thinks that even on a quiet news day this White Paper would have deserved headlines; it is an unambitious and disappointing paper. I want to pull out one particular aspect of it. The paper refers to a family outside London in the market for an affordable home as being on an average income of £80,000 a year. I wonder if I may respectfully ask what planet he is living on. Average incomes in my constituency are £26,000 a year. Does that not prove that what we really needed was a commitment to genuinely affordable homes and the building of 1 million new council homes? Will the Secretary of State instead commit the capital funding to do that, and to lift the borrowing cap so that councils can build again?

First, may I thank the hon. Gentleman for turning up today? The answer to his question is more supply—whether it is council homes, housing association homes or private sector homes, we need more supply. That is the only way to tackle affordability.

Conservative-run Broxtowe Borough Council is doing everything it can to defend our green belt, but that is very difficult because the previous Labour-Lib Dem administration approved a plan for thousands of houses on our green belt. But the biggest problem the council has is that many small builders are having real problems getting access to finance, particularly because of the risk weighting. What steps is my right hon. Friend taking to make sure that small and medium-sized builders have better access to financing, so that, when we can, we build those new homes?

My right hon. Friend makes a very good point. I have talked about the importance of having more small builders. With finance, one particular way that we are helping is through the new home building fund, launched in September with £3 billion of funding, much of it available to the small and medium-sized house building sector. There are also a number of other measures beyond finance in the White Paper to help that sector, and I know that when my right hon. Friend sees them, she will welcome them.

Does the Secretary of State have any special plans to deal with the very difficult situation in inner-city areas, particularly along the river, such as in my constituency, where we have owners coming from way outside this country and leaving flats empty for a very long time? Are the Government not prepared to buy up some of that land themselves and allow local councils to build truly affordable housing?

The hon. Lady might be aware that some of the type of land she refers to will be public land—it might be owned by different Departments or even local government—and there is a lot in the White Paper on what is called the accelerated construction programme, whereby Government can work together with councils and the private sector to develop more quickly.

More generally, the hon. Lady talks about empty homes, but in fact the number of empty homes in England has fallen to its lowest level since records began—the figure is just over 200,000; there is still more to do—and that is partly because of some of the changes we made to the new homes bonus, which gives local councils incentives to bring those homes back into use.

Conservative-run Forest of Dean District Council is working hard to get its local plan in place. It gives out planning permissions to get new homes put in place, but gets frustrated when developers do not build them, and then the same developers put in speculative applications and argue that there is no land supply, because they are not building their own houses. I welcome what is in the White Paper, but what more can my right hon. Friend do to make sure those developers build the houses? As the excellent Housing Minister has said, people cannot live in planning permissions, they need houses.

My right hon. Friend makes an important point. He is right that many local authorities rightly get frustrated when they take those difficult decisions and then do not see the houses being built. There is a lot in this White Paper to tackle that. I gave one example a moment ago in my speech about compulsory purchase in the most extreme cases, but councils will also have new tools. For example, they will be able to put a time limit in place when they give a planning permission, so that it will expire if the developer does not create the homes in time. Also, completion notices will become much easier to serve, which will allow a local authority, when a developer has stalled, to end the planning permission and try again with someone else.

May I tell the Secretary of State that house prices in my part of the country are far removed from those in London and the south-east, yet many, many people are still unable to buy because of low wages? What they require first and foremost is decent, secure rented accommodation, which will come, in the main, from the public and voluntary sector. May I add that in all the years I have done this job, not one—literally, not one—person has ever asked me to be rehoused in the private sector?

I agree with the hon. Gentleman that we need more decent homes for rent. However, this comes back to the same problem, whether in renting or buying, which is that we need a greater supply of homes, particularly for rent. There is a lot in the White Paper that will encourage what we are calling Build to Rent. When local authorities are plan-making, we want them to think about rented accommodation, but we also want to support the sector that will build homes specifically for rent.

I welcome the White Paper, which will enable families to secure a home or to feel secure in their present home. However, the lack of infrastructure funding in my constituency presents a barrier to development, with concerns around amenities, broadband and road and rail networks. Will my right hon. Friend confirm that the housing infrastructure fund will provide vital new money to overcome those issues in areas such as Wealden?

That is right; my hon. Friend is right to focus on the housing infrastructure fund. It was announced in the last autumn statement, and it goes live in April this year. It is just one of the new ways in which we are trying to ensure that, when local authorities make decisions, the infrastructure can quickly be put in place to support them.

My constituents feel that localism is all but dead. Will the Secretary of State expand on how he intends to strengthen the planning laws to ensure that their voices are heard much more loudly than those of the avaricious developers who are trying to thwart the local plan and defy any remaining vestiges of localism?

We rightly follow a policy of letting local authorities set out their plans and determine what is right for their area, but it is important to ensure that that is not used by some authorities—it is only some—as an excuse for avoiding making tough decisions. We have a housing shortage in virtually every part of England. That includes much of the south-east, and I can think of areas in the north as well. We can tackle that only if local authorities are honest about their needs and if they plan on that basis.

People across my constituency will welcome the White Paper, which will make a huge change to people’s opportunities to buy their own home. I particularly welcome the changes in tenure that are set out in the document. Will the Secretary of State think about whether we also need to update the leasehold enfranchisement legislation to take account of the fact that our housing stock is moving towards mixed tenure?

Yes, I can confirm to my hon. Friend that I am doing that. The process has already begun, and I talk a bit about it in the White Paper. I am particularly interested in the possibility that abuse is taking place when people buy a stand-alone home—not a flat—on a leasehold basis. I have seen some of the agreements relating to how the ground rents work, and I am looking into the matter. A consultation has been announced in the White Paper.

House prices in Slough have risen by 39% over the past two years, which is faster than anywhere else in the country, and our affordability ratio is something like double the one that the Secretary of State quoted. What is he going to do for places such as Slough that are built up to their boundaries but are surrounded by Conservative councils that simply will not provide homes in their areas? We are now housing people who commute to London, but we cannot find homes that the local nursery nurses, street cleaners and other people that our community really needs can afford.

One thing that we can do better across the country is to take density more seriously. We need to use the available land that is not green belt much more efficiently. Many cities and big urban areas across Europe have managed density a lot better than we have, and the White Paper contains a requirement that, when local authorities put plans in place, they start to take density seriously. We will even be setting out indicative requirements for provisions that could really help in some urban areas.

I welcome the Secretary of State’s statement, and the protection in the White Paper for greenfield sites and the green belt. I have a question on the issue of appeals. The Muxton ward in my constituency currently has three public inquiries taking place, and a fourth might be coming along. What further reforms to the appeals process could be introduced while ensuring that developers and local authorities can still use the right of appeal under planning legislation?

My hon. Friend makes a good point. People have a right to appeal, and many cases go to appeal in our constituencies, but frankly, some of them are frivolous cases that really should not be appealed. One reason why that happens is that there is currently no cost attached to making an appeal. It is free, so many people do it. That is going to end, and we have announced in the White Paper that we are introducing a fee.

Some councils have fallen short of meeting their housing need for years because their local plans have protected the green belt, limiting the supply of land. If that is also the Secretary of State’s priority, how is he going to achieve his ambition for safe, secure homes, particularly for families who do not want to live in high-rise flats, on the scale that he has outlined today?