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House of Commons Hansard

Commons Chamber

10 January 2018
Volume 634

    House of Commons

    Wednesday 10 January 2018

    The House met at half-past Eleven o’clock


    [Mr Speaker in the Chair]

    Oral Answers to Questions

    Cabinet Office and the Chancellor of the Duchy of Lancaster

    The Minister for the Cabinet Office and the Chancellor of the Duchy of Lancaster was asked—

    Local Authorities: Voting Services

  • 1. What steps he is taking to ensure that local authorities have sufficient resources to deliver an effective service for voters at elections. [903186]

  • Before I answer the hon. Lady’s question, Mr Speaker, I hope that you will allow me briefly to thank and pay tribute to my predecessors in these roles, in particular my right hon. Friends the Members for Ashford (Damian Green) and for Derbyshire Dales (Sir Patrick McLoughlin). They have done great service for their constituents, this House and their country during their time in office and I want to put my thanks to them on the record. I also thank my hon. Friends the Members for Romsey and Southampton North (Caroline Nokes) and for Kingswood (Chris Skidmore) for the work that they did in the Cabinet Office before moving on to other responsibilities.

    The Electoral Commission’s report shows that, overall, the 2017 general election was successfully delivered by a committed community of electoral administrators. We work with the commission, the Society of Local Authority Chief Executives and the Association of Electoral Administrators to ensure that returning officers are effectively supported to run polls.

  • I thank the Minister for that response and welcome him to his new role. As well as the snap general election last year, my local authority of Rochdale Borough Council presided over the Greater Manchester Combined Authority mayoral elections, for which it received no central funding, which is surprising considering that one of the functions is to replace the police and crime commissioner’s role, which did receive central funding. What action will the Government take to help local authorities such as mine deliver well-run elections for these new roles?

  • The responsibility of the Cabinet Office lies in reimbursing local authority returning officers for the costs incurred in the administration of national elections. The responsibility lies with local authorities for the costs arising out of local elections. Local authority resources will be more than £200 billion over the current spending review period, including real-terms increases for both 2018-19 and 2019-20.

  • May I be the first Member also from the 1992 intake to offer my right hon. Friend congratulations on his latest appointment? Is he aware of the landmark ruling of the Supreme Court of the United States, which has said that the boundary changes in North Carolina are unconstitutional and gerrymandering? Will he join me in praising the work of the boundary commissions—despite their appalling recommendations for Lichfield—for at least being transparent, quasi-judicial and non-partisan?

  • It has always been an accepted strength of our constitutional arrangements that we have a parliamentary boundary commission for each part of the United Kingdom that is wholly independent of party politics and party influence. I hope, therefore, that all parties in this House will rally behind the recommendations of the parliamentary boundary commissions.

  • On behalf of the Opposition Front Bench, I welcome the Minister to his new role.

    The chair of the Electoral Commission has warned that our electoral system is facing a “perfect storm” due to funding pressures, and 43% of local authority election teams have experienced real-terms cuts since 2010. Will the Minister outline why the Government’s democratic engagement plan fails to address these concerns, and will he ensure that a full and comprehensive review of the delivery and funding of electoral services is implemented as a matter of urgency?

  • I thank the hon. Lady for welcoming me to my new responsibilities. I repeat to her what I said in my initial response: the Electoral Commission concluded that, although there were problems in a number of specified constituencies, overall the 2017 general election was successfully delivered. The Government are committed to strengthening our electoral processes. As part of that, we are planning to run pilot schemes in a number of local authorities later this year to test requirements for voters to present ID before voting. We will look seriously at recommendations to us from the Electoral Commission on these matters.

  • Electoral Registration Process

  • 2. What steps the Government are taking to maintain the security and integrity of the electoral registration process. [903187]

  • Every application to the electoral register is now subject to identity verification checks, making our system more secure than before. In late December, the Government laid draft legislation aimed at further improving the registration process, including addressing recommendations from the Pickles review of electoral fraud.

  • Last month, a 21-year-old man was convicted of voting twice—first by post, and then by varying his name and voting in person. He then bragged about it on Twitter. I understand that more than 1,000 similar complaints are being dealt with by the Electoral Commission, mostly relating to students. What steps are the Government taking to deal with this distortion of our democracy?

  • I share my hon. Friend’s concerns and am glad that he has brought those examples to light. I understand that, following the examination of these reports—or perhaps of reports other than those to which he refers—the Electoral Commission has stated that there is

    “a lack of evidence of widespread abuse.”

    None the less, we will continue to work with the police and the Electoral Commission to reduce the risk of double voting.

  • I welcome the hon. Lady to her position. Does she agree that the electoral process, particularly in Northern Ireland, was severely corrupted some eight months ago by thousands upon thousands of proxy vote applications? The previous Member for Foyle, Mr Mark Durkan, lost his seat as a result of thousands of proxy vote applications that were approved without any electoral or photographic identification.

  • I struggled to hear the hon. Gentleman owing to some noises off. As he knows, and as he knows I know, the electoral system in Northern Ireland is devolved. I am sure that my new ministerial colleagues at the Northern Ireland Office will be taking his concerns very seriously and working with the devolved Administration, where appropriate, to look into them.

  • I, too, welcome the Front Benchers to their new responsibilities. I am delighted to see the strong team in the Cabinet Office.

    Is the Minister giving any consideration to restricting registration for national elections to one address, which may help with the problem of double voting raised by my hon. Friend the Member for North West Leicestershire (Andrew Bridgen)?

  • I thank my right hon. Friend for her views. I refer to the breadth of the Pickles review of electoral fraud, which gave us the basis for a number of reforms of our electoral system, all designed to reduce fraud and improve security. In that context, I will look carefully at all its recommendations. As you will know, Mr Speaker, the Government have already accepted and will be moving forward with a number of them. I would be delighted to discuss any issue further with my right hon. Friend.

  • One of the ways in which the Government could look to give more security to the electoral register is by moving to automatic registration when national insurance numbers are given out. Will the Minister comment on the private Member’s Bill introduced by my hon. Friend the Member for Cardiff Central (Jo Stevens), which would resolve any issues with individual registrations?

  • I am very well aware of the arguments, although I confess that at this point, 24 hours into the role, I have not yet had a chance to study that particular private Member’s Bill. I shall be happy to do that and take up the conversation from that point.

  • May I, too, welcome the Minister to her post? She is the fourth I have had the privilege of facing in the past two years.

    The biggest threat to the integrity of the electoral registration process is the fact that millions of our citizens are not on the electoral register. All the Minister’s predecessors promised that they would bring forward proposals to address this problem. We were told that there would be a plan at Easter last year, then in the summer, then in December, but still nothing. When will she bring forward proposals to make sure that we can increase the number of people on the register?

  • The hon. Gentleman will know that in fact we have near-record levels of participation in our democracy. Voter turnout has risen. The completeness and accuracy of the electoral register have improved. There have been 30 million new registrations to vote since the introduction of IER—individual electoral registration—in 2014. Seventy-five per cent. of those used the “Register to vote” website, which I am sure he will agree is an important reform. The electoral register for the 2017 general election reached a record level of over 46 million electors. I do not agree with his assessment.

  • Government Contracts: SMEs

  • 3. What steps the Government are taking to ensure that small and medium-sized enterprises can access opportunities to secure Government contracts. [903188]

  • I call Minister Oliver Dowden.

  • Thank you, Mr Speaker, and hon. Members for that very warm welcome.

    Small businesses are the backbone of our economy, and this Government are committed to supporting them in securing Government contracts. To that end, we have already streamlined our procurement processes to assist small businesses. Our small business panel is working to improve accessibility of Government contracts, and we continue to focus on breaking down the barriers that might deter SMEs.

  • I thank the Minister for that answer and welcome him to his position. He will know that many small businesses are put off trying to get contracts by the amount of information they need to supply and the bureaucracy they have to go through. What more can the Government do to reduce that bureaucracy and amount of information?

  • My hon. Friend raises a very important point. It really is vital that small businesses can access Government contracts as simply as possible, so to achieve this we have already taken action to ensure that bidding processes are simplified across the public sector, with complex pre-qualification questionnaires abolished for low-value contracts. We will continue to look at ways to reduce burdens for business, particularly small businesses.

  • Given what the Minister has said, what information does he have that there has actually been an increase in the number of small and medium-sized businesses accessing Government contracts?

  • I would point to three pieces of information: direct spend with SMEs is up 80% since the Conservatives came to power in the coalition in 2010; more small businesses than ever are bidding for Government business; and the Government now spend about £5.6 billion directly with SMEs.

  • As a fellow Hertfordshire MP, may I congratulate my hon. Friend on his well-deserved new role? Does he agree with me that it may be possible for prime contractors with Government contracts to do more to bring in small and medium-sized businesses, particularly in specialist areas, where Hertfordshire is of course so strong?

  • I thank my right hon. and learned Hertfordshire Friend for his welcome. He raises an important point. There are two aspects of this: there is the direct spend—as I have said, it is about £5.6 billion—but we also need to ensure that we get spend into contracts lower down, with people who have Government contracts then spending with small businesses, which is something we are committed to doing as a Government.

  • Too often, rather than outsourcing to SMEs, very large companies are employed. In this respect, despite being under investigation by the Financial Conduct Authority and reportedly having debts of £1.5 billion, the massive outsourcing company Carillion remains a major supplier in terms of Government procurement. If it were to collapse, it would risk massive damage to a range of public services. Do the Government have a contingency plan for such an eventuality, and what is the likely cost to the taxpayer?

  • As the hon. Gentleman would expect, we of course make contingency plans for all eventualities. If I could briefly update the House, Carillion, as Members will know, is a major supplier to the Government, with a number of long-term contracts. We are committed to maintaining a healthy supplier market and working closely with our key suppliers. I can tell the House that Carillion’s operational performance has continued to be positive. For example, it advanced its work on Crossrail over the Christmas period.

  • The truth is that the Minister has failed to answer the central question. The Government have been outsourcing public services to large outsourcing companies on an industrial scale. When these massive outsourcing companies fail, as too often they do, does the Minister really think it is fair that the costs stay with the taxpayer, while the profits are creamed off by the shareholders?

  • I do not think there is anything wrong with profit. Profit is a reward for investment made by businesses. Perhaps if the hon. Gentleman had listened to my answer, he would not have had to read a pre-scripted question. I gently suggest to him that this is something the Government take very seriously. We, for the first time, as a Government—this had not been done for 13 years previously—started measuring the number of small and medium-sized enterprises that have Government contracts. We set a target of 25% in the last Parliament, and we have delivered on that, so I think that is a record of success for this Government.

  • Democratic Processes: Foreign Influence

  • 4. What steps he is taking to ensure that democratic processes are protected against foreign influence. [903189]

  • The first duty of the Government is of course to safeguard the nation, and we take the security and integrity of our democratic processes very seriously. Although we have not seen evidence of successful foreign interference, we are not complacent, and we will continue to do what is necessary to protect ourselves.

  • In order to protect ourselves, the chair of the Electoral Commission has said that we need new rules for online political advertising to combat external influence, particularly via Facebook and Twitter. When will the Government bring forward the legislation we need?

  • One of the very first things for me to do in my new role is to meet the Electoral Commission, and I look forward to discussing that with it.

  • I welcome the new Minister. Does she agree with me that one of the ways of reducing foreign influence in our democratic processes would be for Members of this House not to go on Russia Today and Sputnik, and indeed be paid money for doing so?

  • Hearing from the right hon. Gentleman reminds me of the heady days during the coalition Government when we served in and around the Cabinet Office together. His question reminds us that there are hon. Members of this House who seem to feel the need to do as he says. I think it would be more helpful if we recalled the words of the Prime Minister in her Mansion House speech, which were that we should be well aware of what Russia seeks to do and should seek to protect to the UK from it.

  • Electoral Registration: Disabled People

  • 5. What steps the Government are taking to support people with disabilities to access the electoral registration process. [903191]

  • 8. What steps the Government are taking to support people with disabilities to access the electoral registration process. [903198]

  • The Government are considering the responses to our call for evidence on the accessibility of the voter registration system. We have recently released the Government’s plan for democratic engagement, which includes strategies for disabled electors. The Government have also implemented the findings of an accessibility review of the website “Register to vote”.

  • For those who are disabled physically and visually who want to carry out a normal role in voting like the rest of us, will the Minister confirm that those who have disabilities and are in wheelchairs can gain access to polling stations and that ballot papers in Braille are available for those who are visually disabled?

  • Notwithstanding the caveat that in Northern Ireland the system is devolved and in some ways different from that in Great Britain, we certainly should not regard people with disabilities as in some way restricted in using the voting system in one way or another. Polling stations are equipped with, for example, tactile voting devices. More broadly, there are arguments around whether Braille brings some opportunity to identify a voter, but I very much welcome the hon. Gentleman’s question and would look forward to any further conversation he would like to have.

  • I welcome my hon. Friend to her new role. In my constituency of Southport, three excellent schools specialise in teaching children with autism as well as behavioural and learning disabilities. Does she agree that encouraging children with those conditions to learn about our political structure will make them more likely to engage with the electoral systems as adults?

  • I agree with my hon. Friend and I am glad he has raised those points here today. My predecessor in this role, my hon. Friend the Member for Kingswood (Chris Skidmore), did excellent work in the Every Voice Matters project where he focused on this as a matter of social justice. Of course, the citizen—any citizen—should be at the heart of voting and be able to cast their vote as a matter of public service.

  • Government Procurement: Small Businesses

  • 6. What recent assessment he has made of the level of Government procurement from small businesses. [903193]

  • In November 2017, we published the 2015-16 figures for central Government Departments. The Government are fully committed to supporting our small businesses, which are the engine room of our economy, so we are continuing to take action to meet our target of a third of procurement being with small businesses by 2022.

  • It is good to see the Minister looking in a state of high excitement, as well he might.

  • Those 2015-16 figures show procurement to small and medium-sized enterprises to be falling, from 27% to 24%. The majority goes through indirect procurement, so is not the truth that wholesale changes are needed in a Government procurement system that just delivers crumbs from the table of large contractors to SMEs?

  • The hon. Gentleman is right to highlight the fact that this is a challenging target, but, as I said previously, we set a challenging target in 2010 and we met it by the end of the Parliament. I am confident that we will meet our target again. In particular, we will be taking further measures in relation to SMEs. We will use transparency to encourage large businesses to employ more SMEs and make prompt payment part of the selection process for larger suppliers, which is the point that he raised. I can tell the House that we will be bringing forward proposals on that very shortly.

  • Social Mobility

  • 7. What steps his Department has taken to co-ordinate the Government’s work on social mobility. [903197]

  • The Cabinet Office is responsible for co-ordinating action to increase socioeconomic diversity in the civil service. We are delivering on all recommendations made by the Bridge Group in its 2016 report.

  • The recent Social Mobility Commission report found that the worst-performing areas on social mobility are no longer inner-city areas but remote, rural and coastal areas and former industrial areas. What steps will the Government take to redress the funding imbalance that the north faces and to tackle social mobility issues in post-industrial towns such as Leigh?

  • The Social Mobility Commission report identified action on education, housing and employment as the key steps needing to be taken, and those are the exactly the things to which the Prime Minister and the Government are giving priority. For example, we have 1.9 million more children in good or outstanding schools than we did in 2010.

  • I am absolutely delighted to see that the right hon. Member for Bexleyheath and Crayford (David Evennett) has been promoted from the Whips Office and can now speak.

  • Thank you, Mr Speaker.

    Does my right hon. Friend agree with me that social mobility is essential to maximise the potential of individuals and our country and that while the Government have achieved a great deal so far, there is still more to be done?

  • I completely agree with my right hon. Friend. The Government look forward to delivering in full on the social mobility action plan for education that my right hon. Friend the Member for Putney (Justine Greening) announced just before Christmas.

  • Cyber-Security: Public and Private Sector Organisations

  • 9. What discussions he has had with Cabinet colleagues on ensuring the cyber security of public and private sector organisations. [903199]

  • Cabinet Office Ministers and officials meet regularly with colleagues across the Government to discuss the cyber-security of public and private sector organisations. We are investing £1.9 billion in that work, as detailed in our national cyber-security strategy.

  • What resources are available for organisations to better protect themselves against cyber-attacks?

  • The National Cyber Security Centre gives direct help and advice to public sector organisations and also offers private sector organisations advice, guidance and help in responding to attacks. I encourage all to use its services. [Interruption.]

  • Order. There is far too much noise in the Chamber, with very loud and persistent private conversations going on. Let us have a bit of order at Topical Questions.

  • Topical Questions

  • T1. If he will make a statement on his departmental responsibilities. [903201]

  • I intend to continue the work of the Cabinet Office to deliver its purpose: to maintain the integrity of the Union of the United Kingdom, to co-ordinate the security of the realm, to sustain a flourishing democracy, to ensure the delivery of the finest public services and to help to implement the Government’s policies and the Prime Minister’s priorities.

  • The Government have withheld a dozen documents relating to the Government’s European policy in the early 1990s. What are they trying to hide? What embarrassment is the Tory party trying to cover up? Will the Minister release those documents?

  • I am happy to look at the particular case, if the hon. Gentleman would like to write to me, but I can assure him that documents are not withheld lightly. Sometimes individuals are named, or documents contain information that is still diplomatically sensitive. [Interruption.]

  • Let us have a bit of order for a Dorset knight: Sir Robert Syms.

  • T2. One of the Minister’s new responsibilities is the important negotiations with the devolved Assemblies and Parliament. When will my right hon. Friend undertake meetings for those important discussions on the future of our country? [903202]

  • It is true that the Prime Minister has asked me to continue with my predecessor’s responsibilities of overall supervision of intergovernmental relations within the United Kingdom. I spoke yesterday evening to the Deputy First Minister of Scotland and the First Minister of Wales and assured them that I hope to visit both Scotland and Wales in the near future. I hope also to visit Northern Ireland.

  • T3. Earlier, the Minister remarked that the 2017 snap election had been well run, but following that election the Association of Electoral Administrators felt the need to provide its members with a free counselling service. What action will the Government take to address the significant staffing pressures and unsustainable workloads experienced by our election staff? [903203]

  • One of the challenges facing electoral staff this year was an unprecedented number of people taking advantage of the opportunity to register online, and administrators had to sort out duplicate registrations. We are looking at the lessons to be learned from that, but we should not fail to acknowledge the fact that online registration has made it easier for people to register and has been a great boon to many of our citizens.

  • T5. With over 25% of overseas development money being spent outside the Department for International Development, is there a role for the Cabinet Office in encouraging more cross-departmental spend and better reporting across all Departments? [903205]

  • My hon. Friend, with his expert knowledge of Africa, makes an important point. The national security adviser based in the Cabinet Office is responsible for roughly £3.2 billion of cross-departmental overseas development aid spending. I look forward to discussing with him how that money can best be spent and will certainly take account of my hon. Friend’s views.

  • T4. Lewisham has over 2,000 residents in temporary accommodation, and three quarters of those who have contacted me are not on the electoral register. I am not happy with this. Are the Government? If not, what will they do about it? [903204]

  • Despite the success of online registration, we accept that there is more to do. It is important that we encourage all our citizens to take advantage of their democratic right to cast a vote, both locally and nationally.

  • A number of my constituents have suffered terribly as a result of the contaminated blood scandal. Will my right hon. Friend please update the House on the progress towards the appointment of a chair and the timescales for the inquiry?

  • The contaminated blood scandal was an appalling tragedy from which individuals and their families are still suffering. I regard this as a very high priority for me. We have asked the Lord Chief Justice to nominate a judge to chair the inquiry, and I hope to announce the name of that judge soon.

  • T6. After the Prime Minister’s painful and protracted reshuffle clearly failed to ensure that the Cabinet reflected diverse and modern Britain, what steps is the Minister taking to increase diversity in the civil service? [903207]

  • We are implementing in full the recommendations in the report to which I alluded earlier and are encouraging all Departments to step up their work in making sure they recruit people and seek to recruit people from groups in society that have been harder to reach than others in the past. It is important that that work continues. The Prime Minister’s commitment to the racial disparity audit, which in 13 years of Labour Government we never saw from the party opposite, is an indication of the Government’s seriousness of purpose on this point.

  • The Minister will be aware that personal assurances we given to me and colleagues that the Government would bring forward amendments to clause 11 of the repeal Bill, but they have failed to do so. Will he assure me that the Government remain committed to working with the devolved Administrations to find a form of words that will be agreed and will allow a legislative consent motion to be passed?

  • I can certainly give my hon. Friend that commitment. When I spoke to the Deputy First Minister of Scotland last night, I said that we were disappointed that we had not been able to reach agreement with the devolved Administrations on an acceptable form of words for such an amendment but that I was committed to intensifying our discussions with the devolved Administrations to seek to reach an agreed form of words in time for proceedings in the House of Lords.

  • T7. On new year’s eve, another four young people lost their lives to knife crime. We have failed to tackle this epidemic because we have failed to recognise that the solution—[Interruption.] [903208]

  • Order. There is a lot of noise in the Chamber. The question is about knife crime. This is a matter of the utmost gravity. Please, it is the last question—let us hear it and the answer.

  • Thank you, Mr Speaker.

    On new year’s eve, another four young people lost their lives to knife crime in London. We have failed to tackle this epidemic because we have failed to recognise that the solutions span health, education, poverty and aspiration. What can the Minister do in his role to get Departments working together to find a long-term solution?

  • On behalf of myself and, I am sure, the whole House, may I send our unreserved sympathy and condolences to the families of those four young people, who must be going through hell at this time? The hon. Lady will be aware that the Government’s stance on knife crime is tougher than ever—we have increased the punishments for repeat offenders and banned cautions for the most serious offences—and the latest figures show that more people are being sent to prison for knife crime than in the past. I accept that this has to be cross-departmental work. It has to involve local government and the Mayor of London in a big way. My right hon. Friend the Home Secretary is very committed to seeing further action taken to drive down the rates of these appalling crimes. I promise the hon. Lady that I will give what support I can from the Cabinet Office to the Home Secretary’s work.

  • Prime Minister

    The Prime Minister was asked—


  • Q1. If she will list her official engagements for Wednesday 10 January. [903171]

  • I hope that it is not too late to wish all Members and staff in the House a very happy new year.

    This morning I had meetings with ministerial colleagues and others. In addition to my duties in this House, I shall have further such meetings later today.

  • I, too, wish members of staff a happy new year.

    At least 1.4 million households across the UK have been victims of unfair practices in the leasehold market, including my constituent Emily Martin. In advance of any intended legislation, what commitment will the Prime Minister make to ensure that Emily and thousands of people tied into this PPI-like scandal are compensated by developers now?

  • We are concerned when we hear of unfair practices taking place. I am sure that the Housing Minister will be happy to hear of this particular case as an example. We are looking to see what action the Government can take to ensure that people are secure in their homes and are not subject to practices that they should not be subject to.

  • Q3. In December, when the Brexit Secretary met Michel Barnier, they hugged. In that spirit, would my right hon. Friend the Prime Minister passionately embrace—not me, Mr Speaker; don’t worry—the agenda that she set out last year to build a Britain fit for the future, to encourage home ownership, improve education, health and life chances, and leave this country in a better place than we found it? [903173]

  • My hon. Friend talks about passionate embraces; I do not think that he has ever had the kiss that he once asked for. He is absolutely right: we are determined to deliver a Britain that is fit for the future. That means that we need to get Brexit right and do a lot more. He references house building; yes, we are committed to building the homes that this country needs. That is why we have made £15 billion of new financial support available over the next five years, and why we scrapped stamp duty for 80% of first-time buyers. We are also improving school standards—there are 1.9 million more children in good or outstanding schools today—and we are protecting our natural environment. We are building a Britain that can look to the future with optimism and hope.

  • Mr Speaker, may I wish you, all the House and all our staff a very happy new year? [Hon. Members: “Hear, hear.”] Everybody is agreed? Yes? Thank you. I know it seems a long time ago, but just before Christmas, I asked the Prime Minister about the 12,000 people left waiting more than half an hour in the back of ambulances at A&E departments. She told the House that the NHS was better prepared for winter “than ever before.” What words of comfort does she have for the 17,000 patients who waited in the back of ambulances in the last week of December? Is it that nothing is perfect, by any chance?

  • I fully accept that the NHS is under pressure over winter. It is regularly under pressure at winter time. I have been very clear: I apologised to those people who have had their operations delayed and to those people who have had their admission to hospital delayed, but it is indeed the case that the NHS was better prepared this winter than ever before. [Interruption.] Yes. It might be helpful if I let the House know some of the things that were done to ensure that preparedness. More people than ever before are having flu vaccines, and 2,700 more acute beds have been made available since November. For the first time ever, urgent GP appointments have been available across the Christmas period across this country, and more doctors are specialising in treating the elderly in accident and emergency.

    The right hon. Gentleman mentioned the last exchange we had in this House. In our last exchange, he said mental health budgets have been cut; that is not right. Simon Stevens from the national health service has made it clear that mental health spending has gone up both in real terms and as a proportion of the overall spending. So will the right hon. Gentleman now apologise for what he previously said?

  • The Prime Minister knows full well that child and adolescent mental health services budgets have been raided and many people who need help are not getting that help. We saw on “ITV News” the other night that nurses are spending their entire shift treating people in car parks because of backed-up ambulances. We know the Prime Minister recognises there is a crisis in our NHS because she wanted to sack the Health Secretary last week but was too weak to do it, and if the NHS is so well resourced and so well prepared, why was the decision taken last week to cancel the operations of 55,000 patients during the month of January?

  • I say to the right hon. Gentleman—[Interruption.] Members on the Labour Front Bench say “Apologise”; if they had listened to the answer I gave to their right hon. Friend the Leader of the Opposition, they will have heard me make it clear that I have already apologised to those whose operations have been delayed, and we will make sure they are reinstated as soon as possible. We are putting record funding into the NHS and record funding into mental health, but the right hon. Gentleman keeps on about the preparations for the NHS and I was very pleased last week to be able to go and say in person a thank you to staff at Frimley health trust from both Frimley Park and Wexham Park hospitals for the work they have been doing to deliver for patients across this period of particular pressure across the winter. Our NHS staff—not just doctors and nurses, but support staff such as radiographers, administrative staff, porters, everybody working in our national health service—do a fantastic job day in and day out, and they particularly do that when we have these winter pressures. In terms of being prepared, this is what NHS Providers said only last week:

    “Preparations for winter in the NHS have been more extensive and meticulous than ever before.”

  • We all thank all NHS staff for what they do, but the reality is that the 55,000 cancelled operations means those 55,000 people join the 4 million already waiting for operations within the NHS.

    Perhaps the Prime Minister could listen to the experience of Vicki. Her 82-year-old mother spent 13 hours on a trolley in a corridor, on top of the three hours between her first calling 999 and arriving at hospital. Vicki says:

    “A volunteer first responder from Warwickshire heart service whose day job is in the Army kept mum safe until paramedics arrived.”

    Her mother had suffered a heart attack just a week before. This is not an isolated case. Does the Prime Minister really believe the NHS is better prepared than ever for the crisis it is now going through?

  • Nobody wants to hear of people having to experience what Vicki and her mother experienced. Of course we need to ensure that we learn from these incidents, and that is exactly what we do in the national health service. I am very happy to ensure that that particular case is looked at, if the right hon. Gentleman would like to provide me with the details. But week in and week out in the run-up to Christmas, and now today, he has been giving the impression of a national health service that is failing everybody who uses it. The reality in our NHS is that we are seeing 2.9 million more people going to accident and emergency, and over 2 million more operations taking place each year. Our national health service is something that we should be proud of. It is a first-class national health service that has been identified as the No. 1 health system in the world. That means that it is a better health system than those of Australia, the Netherlands, New Zealand, Canada, Switzerland, Sweden, France, Germany and the United States of America.

  • We on this side of the House are all very proud of the principle of the national health service—healthcare as a human right—but the reality is that, in the past year, 565,000 people have spent time on trolleys when they should have been being treated. The number of elderly people being rushed into A&E from care homes has risen by 62% since the Tories took power, and Care Quality Commission figures suggest that nearly a quarter of care homes need improvement. This is not only robbing older people of their dignity, but putting pressure on A&Es and ambulance services. So why, instead of dealing with the social care crisis, has the Prime Minister rewarded the Health Secretary with a promotion and a new job title?

  • There are many voices across the House, including from the right hon. Gentleman’s party, who have been encouraging me to ensure that we have better integration between health and social care. I am pleased that we have recognised this by making the Department of Health now the Department of Health and Social Care. That has been recognised by Age UK, which has said that this is a

    “welcome and long overdue recognition of the interdependence of health and social care”.

    I saw for myself last week at Frimley Park the good work that is being done by some hospitals up and down the country, working with GPs, care homes and the voluntary sector, to ensure that elderly people can stay at home safely and do not need to go into hospital, with all the consequences of them coming into hospital beds. That is the way forward, and we want to ensure that we see the integration of health and social care at grassroots level. From the way in which the right hon. Gentleman talks, you would think that the Labour party had all the solutions for the national health service—[Interruption.]

  • If the Labour party has all the answers, why is funding being cut and why are targets not being met in Wales, where Labour is responsible?

  • The Prime Minister leads a Government who are responsible for the funding of national Governments, such as the one in Wales, and she knows full well what has been cut from Wales. She is also directly responsible for the NHS in England, and giving the Health Secretary a new job title will not hide the fact that £6 billion has been cut from social care under the Tories. Part of the problem with our NHS is that its funds are increasingly being siphoned off into private companies, including in the Health Secretary’s area of Surrey—[Interruption.]

  • Order. Mr Shelbrooke, calm yourself, man! You are supposed to be auditioning to become an elder statesman, but on present evidence, there will be many more auditions to come. Calm yourself; it will be good for your health.

  • Even more money is being siphoned out of our NHS budgets into private health companies. In the Health Secretary’s area of Surrey, a clinical commissioning group was even forced to pay money to Virgin Care because that company did not win a contract. Will the Prime Minister assure patients that, in 2018, less NHS money intended for patient care will be feathering the nests of shareholders in private health companies?

  • First, this Government have given more money to the Welsh Government. It is a decision of Labour in Wales to deprioritise funding for the national health service in Wales. On the issue of the private sector and its role in the health service, under which Government was it that private access and the use of the private sector in the health service increased? [Interruption.] No, it wasn’t.

  • Order. I say to the shadow Secretary of State for Health, the hon. Member for Leicester South (Jonathan Ashworth), that he, too, is supposed to be auditioning for something. He is normally a very amiable fellow, but he is gesticulating in a very eccentric fashion. He must calm himself. It is not necessary and not good for his image.

  • First of all, we have put more money into Wales, but the Labour Government in Wales have decided to deprioritise funding for the national health service. Secondly, the increase that was seen in private sector companies working in the health service did not happen under a Conservative Government; that was under a Labour Government of whom the Leader of the Opposition was a member.

  • My hon. Friend the shadow Health Secretary is auditioning to be Health Secretary, and he shows real passion for our NHS.

    Under this Government, Virgin Care got £200 million-worth of contracts in the past year alone—50% up on the year before. The Prime Minister needs to understand that it is her policies that are pushing our NHS into crisis. Tax cuts for the super-rich and big business are paid for—[Interruption.] Yes, Mr Speaker, they are paid for by longer waiting lists, ambulance delays, staff shortages and cuts to social care. Creeping privatisation is dragging our NHS down. During the Health Secretary’s occupation of the Prime Minister’s office to keep his job, he said that he would not abandon the ship. Is that not an admission that, under his captaincy, the ship is indeed sinking?

  • This Government are putting more money into the national health service. We see more doctors and nurses in our NHS, more operations taking place in our NHS, and more people being treated in accident and emergency in our NHS, but we can only do that if we have a strong economy. What would we see from the Labour party? We have turned the economy around from the recession that the Labour party left us with. What do we know about the Labour party’s economic policies? Well, we were told all about them in a description from the shadow Secretary of State for Education, the hon. Member for Ashton-under-Lyne (Angela Rayner), who I see is not in her place on the Front Bench today—

  • She is in hospital.

  • I do apologise. I did not realise that the shadow Education Secretary was undergoing medical treatment, so I apologise unreservedly for that comment. However, I have to say that she described the economic policies of the Labour party in unparliamentary terms, which included the word “bust”, saying that the Labour party’s economic policy was “high-risk”. That means high risk for taxpayers, high risk for jobs and high risk for our NHS. That is a risk that we will never let Labour take.

  • Q5. Moving on to a positive note about the NHS, my NHS trust, Morecambe Bay, has turned around from being one of the worst in the country—it was safe to say that five years ago—to one of the best. That happened due to injections of huge amounts of cash, but the staff were amazing and turned the hospital around. Jackie Daniel, the chief— [903175]

  • Order. I gently invite the hon. Gentleman to be sensitive to time. We want not a long spiel, but a short question with a question mark at the end of it.

  • Jackie Daniel has received a damehood for turning around the Morecambe Bay trust along with the staff, which is very positive. Does my right hon. Friend the Prime Minister look forward to working with Jackie Daniel’s successor to carry on turning the trust around, and will she wish Jackie well?

  • I am happy to join my hon. Friend in paying tribute to the work of staff at the Morecambe Bay trust. I particularly wish Dame Jackie well, and I recognise and pay tribute to her work in turning that trust around. This is just another example of the huge gratitude we owe to our NHS staff, who work so tirelessly on our behalf.

  • Mr Speaker, I wish you, all staff and all Members a guid new year.

    The Government’s European Union (Withdrawal) Bill is quite simply

    “not fit for purpose and must be changed.”—[Official Report, 4 December 2017; Vol. 632, c. 731.]

    Those are not my words; they are the words of the hon. Member for East Renfrewshire (Paul Masterton). Does the Prime Minister agree with her colleague that we must amend clause 11, which is nothing more than a power grab from Scotland?

  • The right hon. Gentleman knows full well that we have said we will look to improve clause 11. Indeed, my right hon. Friend the Chancellor of the Duchy of Lancaster made it very clear when he was answering questions earlier that we continue to look to amend clause 11. However, as I discussed with the First Minister before Christmas, we are looking to work with the devolved Administrations to ensure that we put the right frameworks in place so that, when we come to bring forward any amendment, it is done in the best possible way in the interests of all concerned. I thought that had been accepted by the Scottish National party, but we will be looking to bring forward amendments in the Lords.

  • That is simply not good enough. The Secretary of State for Scotland promised a “powers bonanza” for Scotland and that, crucially, amendments would be tabled ahead of next week’s debate. Yesterday it was revealed that no amendments will be tabled. The Tories always promise Scotland everything and deliver nothing. The Prime Minister has one last chance. Will she assure the House that amendments will be tabled ahead of next week, as promised?

  • The SNP says it wants to work with us on the future frameworks; we are doing exactly that. It says it wants clause 11 amended; we are doing exactly that. My right hon. Friend the Chancellor of the Duchy of Lancaster is intensifying his discussions with the Scottish Government and, indeed, with the Executive in Wales as part of that. We will be bringing forward amendments. The right hon. Member for Ross, Skye and Lochaber (Ian Blackford) says this is a Government who never deliver for Scotland. An extra £2 billion as a result of the Budget—that is delivering for Scotland.

  • Q10. Speaking of delivering for Scotland, the Stirling and Clackmannan- shire city region deal is a massive investment in Scotland’s economy and a huge vote of confidence in Scotland by a Conservative and Unionist Government. With projects such as the UK Institute of Aquaculture and the national tartan centre, which will have UK-wide impact and global reach, will the Prime Minister now confirm that the UK Government are ready to sign off the heads of agreement with the Scottish Government and the local councils so that we can get to work? [903180]

  • I am very happy to give that commitment to my hon. Friend. This is another example of how this is a Government who are delivering for Scotland. I know the importance of the Stirling and Clackmannanshire deal, which will be transformative. He has championed this cause since he was elected, and he is doing a great job for his constituents. We are all working to get an agreement as soon as possible.

  • Q2. I have been contacted by 11 constituents who are frightened, many of them suicidal, because they have been told either by Hull clinical commissioning group or by East Riding of Yorkshire clinical commissioning group that their desperately needed pain infusion treatment will be stopped. This is the cruel reality of the NHS having to ration treatment due to funding cuts. Will the Prime Minister personally intervene to ensure that the Hull and East Riding CCGs review their decisions and guarantee my constituents the additional funding that will allow this treatment to be delivered? [903172]

  • We are putting extra money into the national health service. We are not cutting funding for the national health service. CCGs will be taking individual decisions about how they apportion their funding, but to stand up here and suggest that we are cutting funding for the national health service is plain wrong.

  • Q11. Telford is a rapidly growing new town where thousands of new houses are built every year. People come to Telford to buy their home on a new-build estate and live their dream, but for far too many the reality is unfinished communal areas, unadopted roads, non-compliance with section 106, developers failing to take responsibility and the local council passing the buck. Colleagues on both sides of the House see similar problems in their constituencies. Will the Prime Minister agree to strengthen the rights of home owners on new-build estates so that people can come to Telford, or to any other new-build area, and buy a new-build home confident that they can live their dream? [903181]

  • I am happy to say to my hon. Friend that of course we recognise the concern she has raised; this is a similar issue to the one raised by the hon. Member for Weaver Vale (Mike Amesbury). I understand that it is Telford’s 50th anniversary, so I congratulate it on that. We are committed to legislating in relation to the unfair practice my hon. Friend has identified, because it is only fair that freeholders should have the same rights as leaseholders to challenge the reasonableness of the service charges they are being submitted to.

  • Q4. On a scale between one and 10, how does the Prime Minister think her Brexit is going, with 10 meaning everything is going perfectly, we know what we want to achieve and we know how to get it; and one being chaotic cluelessness? I know what I would give the Prime Minister, but what would she give herself? [903174]

  • I think—[Interruption.]

  • Order. Let me just say to the hon. Member for Perth and North Perthshire (Pete Wishart), whom I have known for a long time, that when he comes to reflect on his conduct, he will know that he can do better than that.

  • Thank you, Mr Speaker. I say to the hon. Gentleman that anybody who saw the success we had in negotiating phase one of Brexit, and getting that sufficient progress, will say that this Government know what they are doing, and that they are getting on with the job and doing well.

  • Q12. Environmentalists across the UK were delighted with the announcement of co-operation with the Woodland Trust to develop the new northern forest, but will the Prime Minister assure us that plans to create new landscapes will not obscure the need to protect existing areas of outstanding natural beauty? Will she confirm her commitment to protecting the Chilterns AONB as we pursue the Government’s economic and housing development plans? [903182]

  • First, I congratulate my right hon. Friend on becoming a Dame in the recent new year’s honours—it is very, very well deserved. I assure her that we are committed to maintaining the strongest protections for AONBs and other designated landscapes. As regards the Chilterns AONB, I have to say to her that I enjoy walking in the Chilterns. I recognise the value of that particular environment, and we are committed to protecting AONBs.

  • Q6. I was a teacher and a headteacher for 34 years, so I know that I speak on behalf of thousands of teachers and support staff when I ask the Prime Minister this: in the light of the recent announcement of a fall in teacher training application numbers by a third, will the Government listen to professionals and fully and fairly fund our schools and colleges; end the toxic culture of targets and tests; deliver a broad and balanced curriculum; and, most of all, return the joy of teaching and learning to our classrooms? [903176]

  • We are putting record sums into our schools. More than that, we are ensuring that we are seeing increasing standards in our schools. That is why today there are 1.9 million more children in good or outstanding schools than there were in 2010, and I hope the hon. Lady would welcome that.

  • Q13. The Prime Minister will be aware that there is great potential in the south-west to increase prosperity and productivity. Will she therefore confirm how her Government will be backing the south-west, in particular on the need to invest in our vital road, rail and digital infrastructure? [903183]

  • My hon. Friend is absolutely right about that, and he is a great champion for the needs of the south-west. We do want to increase prosperity and productivity in the south-west—and indeed right across the country—and we are taking some particular steps. Across the country we are committing significant sums in relation to infrastructure investment and the road investment strategy. We are committed to creating an expressway to the south-west, which will be part of an important development. We are investing more than £400 million into the rail network in the area. I am pleased to say that more than 600,000 homes and businesses in the south-west now have access to superfast broadband as a result of our superfast broadband programme. There is more we can do for the south-west, and I look forward to working with my hon. Friend in doing that.

  • Q7. The Secretary of State for Health said that the Government wanted the UK to be the best in the world for cancer diagnosis, treatment and care. Today, according to a memo from the head of chemotherapy at Churchill Hospital in Oxford, terminally ill cancer patients will have their chemotherapy cut because of a massive shortfall in specialist nurses. Will the Prime Minister apologise to cancer patients and their families for this appalling situation? [903177]

  • That trust has made it clear that there are absolutely no plans to delay the start of chemotherapy treatment, or to reduce the number of cycles of treatment given to cancer patients. Simon Stevens has said that over the past three years the NHS has had the highest cancer survival rates ever. The latest survival figures show that over 7,000 more people are estimated to be surviving cancer after successful NHS treatment, compared with three years prior. There are 3,200 more diagnostic and therapeutic radiographers than in May 2010. We will continue to look at this issue and we are continuing to put in the funding that is enabling us to improve treatment for cancer patients.

  • Q14. With record funding, our NHS is doing more than ever, but when the UK is in the bottom third of countries for heart-attack deaths, when we have significantly worse survival rates for stroke than France and Germany, and when our closest matches for cancer survival are Chile and Poland, is it not time to act on calls from all parts of the House, backed this week by the Centre for Policy Studies, to establish a royal commission on health and social care in this, the 70th anniversary year of our most cherished national institution? [903184]

  • My hon. Friend is right that we need to continue to look at the national health service and ensure that we continue to improve its performance in a variety of areas. The independent Commonwealth Fund has been clear that the national health service is the best healthcare system in the world, and that it is better than systems such as those in Germany, France and the other countries I listed earlier, but of course we need to look at what more we can do. That is why we are putting more funding in and looking at the better integration of health and social care on the ground. It is about making sure that we are making a change and doing that integration now, because that is when it is going to make a difference to people.

  • Q8. The Prime Minister said that she had reshuffled her Ministers so that they look more like the country they seek to represent. I am not sure about that, but in that spirit, will she acknowledge the massive problems in the private rented sector with absentee private landlords? Will she commit to come to visit Easington to gain her own appreciation of the scale of the problems that face many working-class communities? In the spirit of good will, will she support and give free passage to the Bill on homes fit for habitation that my hon. Friend the Member for Westminster North (Ms Buck) is promoting? [903178]

  • I have many fond memories of the time I spent in the north-east when I was a candidate up there. We do need to ensure that we have a good private rented sector in this country, but the one set of policies that would damage the private rented sector are the policies put forward by the Leader of the Opposition.

  • I was delighted last week to hear the Secretary of State for Environment, Food and Rural Affairs confirm the Government’s commitment to supporting farmers after we leave the European Union. Will my right hon. Friend assure me that the unique needs of Scottish farmers and, indeed, crofters will be taken into account in the design of any new system?

  • My hon. Friend is right that as we leave the European Union, we will of course be able to put in place our own policy of support for farmers. We want that policy to recognise the particular needs of farmers in all parts of the United Kingdom, and that will of course include the particular needs of farmers in Scotland.

  • Q9. My constituency office and local citizens advice bureau are receiving ever-increasing complaints about personal independence payment claims. Assessments are being refused and 65% of decisions are currently overturned on appeal at tribunal. The growing number of appeals means that the tribunal process is taking longer—anything from four to seven months. Does the Prime Minister agree that the PIP assessment process is fundamentally flawed? What action can she take to avoid the unnecessary expense of going to court and, more importantly, the undue stress and hardship being caused to my constituents and others throughout the country? [903179]

  • I understand the hon. Gentleman’s point about ensuring, as we want to, that these assessments are being conducted as well as they can be, and that people are getting the awards that they should be getting and that they are entitled to. Since we introduced the personal independence payment, we have carried out around 2.9 million assessments, 8% of which have been appealed, but only 4% of those decisions are changed following an appeal. In the majority of cases, that is because new evidence is presented at the appeal, which was not presented when the original case was put forward. The Department for Work and Pensions continues to look at ensuring that, when these assessments are made, they are done properly and that people get the right results.

  • My constituent, Justin Bartholomew, was just 25 when he committed suicide late last year. His family is convinced that his intake of high-energy drinks—more than 15 cans a day—increased his anxiety and contributed to his death. Given the increased safety concern around the high-energy drink market and the actions of people such as Jamie Oliver and Waitrose, will the Prime Minister consider introducing a national ban on the sale of these energy drinks for the under-16s?

  • My hon. Friend has raised a tragic case, and I know that the thoughts and the sympathies of the whole House will be with the family and friends of Justin Bartholomew. We have introduced the soft drinks industry levy. We recognise that there are issues around drinks that are high in sugar and we know that energy drinks high in sugar can be damaging to children’s health. We are supporting schools and parents to make healthier choices and to be able to identify those through clearer labelling and campaigns. Of course this is an issue that the Department of Health and Social Care will continue to look at, and it will continue to look at the scientific evidence in relation to these drinks.

  • Q15. I have a constituent who escaped an abusive relationship and has been passed from pillar to post between the old Child Support Agency and the new child maintenance service. After four and a half years of that, she has now been told by the CMS that she has to start the whole process all over again. On top of that, it is insisting that she passes on her personal and her bank details directly to her ex-partner to receive payment. Will the Prime Minister agree to help resolve this problem and to look at the system that has allowed this abuse to continue? [903185]

  • The hon. Lady raises what is obviously a distressing case; I recognise that. Arrangements are in place that ensure, as I understand it, that an individual does not have to pass on their bank details directly. The fact that her constituent has been asked to do so is something that should be looked into. I am sure that if she passes those details to the appropriate Department, it will look into the matter.

  • Does the Prime Minister welcome the findings of the Social Research survey that the majority of Scots believe that the rules on trade and immigration should be the same in Scotland as in the rest of the UK? It looks like they agree that we are better together.

  • My hon. Friend has raised a very important point. People across the UK want to see controlled immigration—that is people in Scotland as well as people in the rest of the United Kingdom. As we leave the European Union, we will be able to introduce our own immigration rules and to control that immigration to Britain from Europe. The only point of differentiation is that, of course, we do have a Scotland-only shortage occupation list to recognise the particular labour market needs in Scotland. For the most part, that actually matches the UK-wide shortage occupation list, which shows that this is an issue for the whole of the UK, and that we need the same policy approach.

  • In a March 2005 interview, the Prime Minister said:

    “Not getting things done; and seeing people’s lives hurt by government bureaucracy”

    makes her depressed. In light of that comment, can the Prime Minister tell me whether she considers it reasonable and acceptable for the Driver and Vehicle Licensing Agency to withhold the licence of my constituent, Mr Coleman, for more than 18 months despite evidence showing that he was fit and able to drive, as she has not responded to my letter of 5 December?

  • I will ensure that the hon. Lady receives a response to her letter. She has raised a particular case in this House. I will need to look at the details of that case and I will respond to her letter.

  • Last week, Cleveland Potash announced 230 job losses at Boulby mine in my constituency, which is devastating for Loftus and the wider east Cleveland community, where the mine is by far and away the largest employer. Tees Valley Mayor Ben Houchen, the hon. Member for Redcar (Anna Turley) and I all agree that it would be incredibly helpful if some of the funds remaining from the 2015 SSI rescue package could be repurposed to support people leaving Boulby. Will the Prime Minister agree to look into that with the Business Secretary, and will she make a commitment that Government agencies will do everything they can to support people affected by this dreadful news?

  • My hon. Friend is right to raise this case. It is obviously a worrying time for the workers who are affected by the announcement by Cleveland Potash. We will help people to find other work, and support those affected through the rapid response service of the Department for Work and Pensions. We will co-ordinate with the Tees Valley combined authority to ensure that we work together to make the best possible support available and ensure that it is aligned. The Department for Business, Energy and Industrial Strategy will look at the situation and the specific issue that my hon. Friend has raised.

  • Ava has been a foster-carer for years. When her privately rented home failed the inspection for an electrical certificate, which she needed to continue fostering, her landlord evicted her because he did not want to do the repairs. Now Ava and the kids are living in temporary council accommodation in a converted warehouse in the middle of a working industrial estate in Mitcham. The council that placed her there is going to withdraw her right to foster because her accommodation is not good enough. Can the Prime Minister tell Ava, kids in care who need foster-carers and the overworked British taxpayer how that makes sense?

  • As the hon. Lady has set it out, that does not appear to make sense: as a result of what has happened, we will lose someone who has been a foster-carer. I would like to pay tribute to the work that her constituent has done in foster-caring. We owe a tremendous debt of gratitude to those who care for people as foster-parents. As the hon. Lady has raised this in the House, I am sure that the local council will want to look at it again.

  • Finally, Richard Grosvenor Plunkett-Ernle-Erle-Drax.

  • Thank you very much, Mr Speaker. While most of us were celebrating on new year’s eve, the crews of the Poole-based tug, Kingston, and the Swanage and Weymouth lifeboats were battling mountainous seas and 70 mph winds off the coast of Dorset to prevent a cargo ship from being blown on to the rocks. Thanks to the skill of the tug’s crew the tow was fixed and a disaster prevented. Will my right hon. Friend join me in praising the professionalism, courage and determination of all those involved, not least the volunteers of the RNLI?

  • I am very happy to do that, and to praise all those involved in averting a disaster—both the tug crew and the RNLI. Indeed, I would like to go further. RNLI volunteers do a fantastic job around our coastline day in, day out, and we owe them a huge debt of gratitude.

  • Points of Order

  • Order. It would not be a full day without a point of order from the hon. Member for Na h-Eileanan an Iar (Angus Brendan MacNeil).

  • Thank you very much, Mr Speaker. May I congratulate you once again on your pronunciation of “Na h-Eileanan an Iar”, which was absolutely perfect?

    On a point of order, Mr Speaker. Both the Leader of the Opposition and the Prime Minister talked about “the NHS” today, seemingly unaware that in fact there are four NHS services in the UK. I seek your guidance on what can be done to insist on knowledge and accuracy from the most senior parliamentarians in the Chamber, or is the Chamber indeed just the English Parliament?

  • If I did not know the hon. Gentleman as well as I do, I would think that he was being mischievous, but I cannot imagine that he would behave in that way. However, I am on the one hand flattered by his exhortation, and on the other hand at least a tad intimidated, for the idea that the Chair can be expected to insist upon knowledge and accuracy on the part of any Member or among any group of Members is an unrealistic ambition on the part of the hon. Gentleman. That is not a matter for the Chair. Members take responsibility for their statements in this House, but in so far as the hon. Gentleman was seeking to draw attention to what he regards as the singularity of the Scottish health service, I think he has accomplished his objective.

  • Or even the plurality of services, as he witters from a sedentary position. I think he has accomplished his objective.

  • On a point of order, Mr Speaker. I seek your advice on how best I can raise the urgent issue of cancer treatment in Oxford with the Minister responsible. Seriously and terminally ill patients at the Churchill Hospital now face delays and cuts to rounds of chemotherapy due to a chronic shortage of specialist staff. The next health questions are not until 6 February and the people of Oxfordshire need answers now. After all, cancer does not wait.

  • I will make a number of observations to the hon. Lady. First, the matter was at least raised at Prime Minister’s questions today with considerable force and alacrity, albeit not by the hon. Lady on this occasion. Secondly, I know that she will not take offence when I say this, but I was looking meaningfully at her and was very keen to call her to ask a question of the Prime Minister—admittedly not of the cancer services Minister, but of the Prime Minister—and the hon. Lady, in an uncharacteristic display of reticence, did not respond to my exhortations. She did not seem to wish to rise to her feet at that time. Thirdly, notwithstanding that health questions are a considerable distance away, business questions are tomorrow, and if she wishes to leap from her seat with alacrity to put a question on this matter to the Leader of the House, she can. Finally, if she applies for an Adjournment debate, she might be successful.

  • On a point of order, Mr Speaker.

  • I am saving the hon. Lady up.

  • On a point of order, Mr Speaker. I hope you might be able to advise me on how I can ascertain Government policy and action on an urgent matter that affects my constituency in Norwich. As you will know, hundreds of jobs could be lost with the closure of the Colman’s mustard factory and the Britvic factory in my constituency. I have repeatedly asked the Business Secretary to come to Norwich to meet the highly productive workers there and see the highly profitable factories. So far, he has not got back to me. Although I understand that he is still in his place at the Department, there are several new junior Ministers whose positions and responsibilities we do not know. May I ask for your guidance on how we might get clarification on that point and answers from the responsible Ministers very urgently, given the hundreds of my constituents who face losing their jobs?

  • I can and will respond to the hon. Gentleman. I preface my response by thanking him for his courtesy in giving me advance notice of his point of order. I say with great seriousness that I appreciate the importance of this matter to him and his constituents. I have two points to make. First, on the specific question that he raised—which member of the new ministerial team has responsibility for the matter—it is customary for the Government to publish from time to time a list of ministerial responsibilities. It would certainly be helpful to Members on both sides of the House if the division of ministerial responsibilities within Departments could be publicly clarified as soon as possible. Meanwhile, the hon. Gentleman has put his concern on the record and I am sure that it will have been noted on the Treasury Bench.

    Secondly, on the back of my experience as a Member before I became Speaker, my advice to him about seeking a visit is: persist, man, persist. Make what I would call a polite nuisance of yourself. Keep going, keep asking, keep requesting, keep putting the matter in the minds of Ministers. On the whole, I tended to find when I was a Back Bencher that by making a nuisance of myself in that way, more often than not, I got at least a significant share of what I was seeking for my constituents.

  • On a point of order, Mr Speaker. This point of order is pursuant to the one I raised last night, on which you made good, clear suggestions. I now understand that the Secretary of State for Exiting the European Union has issued a statement, but not an official statement. Given the words that were spoken on 6 December, have you heard from the Secretary of State whether he intends to come to the House to rectify the record?

  • The short answer is that I have received no indication of any intention on the part of a Minister to make an oral statement on this matter. However, I think that the Chancellor of the Duchy of Lancaster and Minister for the Cabinet Office referred to the matter during his Question Time session, so I think there is an indication to the hon. Gentleman of how the Government intend to proceed on the matter. It may not satisfy him, but it is what we have got at present.

    Moreover, it will not be beyond the wit and sagacity of the hon. Gentleman and some of his colleagues who are similarly exercised about the matter to highlight their concerns during the Report stage of the European Union (Withdrawal) Bill. I look forward with bated breath, eager anticipation and beads of sweat upon my brow to hearing him express his concern, for the simple reason that I intend to chair the bulk of those sessions on 16 and 17 January. Much excitement awaits me.

  • On a point of order, Mr Speaker. In answer to my question on behalf of my homeless constituent, Ava, who is also a foster carer, the Prime Minister appeared to suggest that there was some doubt that she would be deregistered as a foster carer because of her poor homeless accommodation. I confirm that she has been deregistered for that reason. How will I put that on the record?

  • The hon. Lady has achieved her objective. It will appear in the Official Report and if she wishes to send a personalised and signed copy of said Official Report to the Prime Minister, it is open to her to do so.

  • Planning (Agent of Change)

    Motion for leave to bring in a Bill (Standing Order No. 23)

  • I beg to move,

    That leave be given to bring in a Bill to require specified planning controls in relation to developments likely to be affected by existing noise sources; and for connected purposes.

    This Bill is designed to protect existing music venues from closure or crippling cost arising from the development of new residential properties in their vicinity, especially over questions of noise.

    Why is that a problem? The Music Venue Trust and UK Music have been campaigning on the matter for some time and estimate that more than a third of music venues have closed over the past decade. Many Members of Parliament have examples of much-loved venues in their area that have been closed or are under threat. That is why there has been such widespread cross-party support for this Bill, as shown by the number of Members who have already pledged their support and the turnout at this morning’s photocall. This important issue was also raised on 3 November in an Adjournment debate by my hon. Friend the Member for St Helens North (Conor McGinn). There has also been welcome support from some of the music greats. Sir Paul McCartney said today:

    “Without the grassroots clubs, pubs and music venues my career could have been very different. If we don’t support music at this level, then the future of music in general is in danger.”

    I accept that there is a variety of reasons for the decline in venues, but many relate to changes in the neighbourhood, increasingly when redundant commercial or industrial premises are converted to residential, or are knocked down and rebuilt, or as empty sites are developed. Of course, much of that is very welcome. It is part of the regeneration of our inner cities, restoring their historic vibrancy and creating much-needed homes. However, it can sometimes lead to the loss of what makes parts of those areas attractive in the first place, especially to younger residents. Incidentally, that applies not just to music venues but to the wider fabric of inner-city life, and there are important questions as to how we preserve the vibrancy and diversity of city life more generally across our main conurbations.

    My short Bill is a modest and focused measure that would adopt the principle of agent of change into planning law. That basically means that when buildings are converted to residential use or a new development is put up, the onus is on the developer—not the venue—to ensure that the new dwellings are protected from factors, particularly noise, that could be held to affect their general amenity and enjoyment.

    Moves are already being made around the country to address these concerns. Many grassroots campaigns are being mounted to save local venues. For example, among my Bill’s sponsors are my hon. Friends the Members for Bristol East (Kerry McCarthy) and for Bristol West (Thangam Debbonaire), who have been campaigning with the Music Venue Trust in support of The Fleece in Bristol—a city, incidentally, that I am informed has more office-to-residential conversions than anywhere else outside London.

    Two other sponsors, my hon. Friends the Members for Cardiff West (Kevin Brennan) and for Cardiff Central (Jo Stevens), have been supporting the “Save Womanby Street” campaign, along with my hon. Friends the Members for Cardiff North (Anna McMorrin) and for Cardiff South and Penarth (Stephen Doughty). That has led directly to the Welsh Labour Government’s welcome adoption of the agent of change principle across Wales. Another sponsor, the hon. Member for Somerton and Frome (David Warburton), is concerned to protect the rapidly growing Cheese and Grain—a much valued venue in Frome—which shows that this is not just about the inner cities. The Mayor of London, with “London’s Grassroots Music Venues: Rescue Plan”, has that he will be introducing an agent of change rule into the next London plan. As I mentioned, the Welsh Government have announced a similar move, and this is also already under consideration by the Scottish Parliament and Government.

    My Bill will provide the legislative reinforcement for that. It aims to give much greater clarity and greater power for local councils and the planning inspectors to incorporate the principle into planning decisions. Why do it? Why was I so receptive to this idea, and why is there such strong public support? Because it matters. Of course it matters to those who enjoy the entertainment and for whom it opens new horizons. Obviously, it also matters for the staff and owners of the venues. But it matters a lot more than that—and not just for the nearby late-night kebab shops.

    For a start, there is the impact on musicians, which is why the Bill is being supported by the Musicians’ Union. Less venues means less work and less opportunity to develop talent—or even for musicians to find out that they are not going to make it in the industry. It also means less opportunity to move up from amateur to part-time to full-time professional, and to national or even international stardom. I was talking today to Billy Bragg, who mentioned that he tried three times to move from having an ordinary job and working part-time to being a full-time musician. It was the existence of the clubs, pubs and venues that enabled him finally to make it on to the national stage.

    We are in danger of taking away the ladder that has served both individual musicians and the music industry so well for so long. And what an industry—not only are domestic sales rising again, but we are second to the United States in international reach and sales. It is a huge boost to Britain’s standing around the world and our soft power—not to mention millions in overseas sales last year—let alone being a significant part of our tourism offer. But there is a real concern that the industry is now depending on a great past, with a lot of grey hair around. Now, I declare an interest, as I am in favour of good representation of grey hair, but I also support refreshing the pipeline with new talent. That is no comment on yesterday’s Government reshuffle. There is a danger of mining, rather than farming, our musical heritage. Losing music venues also narrows a route of opportunity for working-class youngsters, many from our deprived inner cities and left-behind industrial towns.

    As a west midlands MP, I am of course proud to represent part of the area that gave birth to heavy metal, and I am particularly focused on the cities and conurbations. However, I also recognise how damaging the loss of venues can be to the life and attraction of smaller towns, and to retaining youngsters and slowing the drift to the cities. All those factors are important, but there is another factor that makes this provision imperative, and it is why the matter requires urgent action either from Parliament or the Government—given the wide level of cross-party support from ex-Ministers, as well as members of the MP4 band, I hope that the Government will adopt this measure and help to push it through. That factor is Brexit.

    As Brexit is happening and we face an uncertain future, it is vital that Britain is made more efficient and effective across the board and that we maximise every possible advantage that Britain has. One of these is clearly our cultural and entertainment offer, not only in London but in our other great centres around the country, many of which, including Birmingham and Manchester, are attracting increasing foreign investment and work—although, of course, Birmingham is the best venue for Channel 4.

    Companies clearly locate initially for a range of hard-headed, financial, economic and communication reasons, but the quality of life is also significant. It is partly about personal safety, environmental quality and a pleasant streetscape, but it is also about the answer to the basic question, “Would I want to live there?” That is a question not only for companies, but for the staff they are seeking to attract, especially the highly mobile, technically skilled and talented international and multinational workforce, not least in our huge creative sector. The cultural and living environment is important to them. That means art galleries, theatres, concert halls, opera, ballet, football clubs, rugby clubs and other sporting environments, but it also means music venues and the street scene. It poses a question to those companies who are being enticed to move abroad after Brexit: “Would you and your family—especially your children and, equally importantly, your employees—prefer to live in London, Birmingham or Manchester, or in Frankfurt?”

    I hope that this measure will provide some small but useful assistance and relief to a valued industry. I commend the Bill to the House.

    Question put and agreed to.


    That John Spellar, Kevin Brennan, Sir Greg Knight, Pete Wishart, Jo Stevens, Mr Edward Vaizey, Kerry McCarthy, David Warburton, Conor McGinn, Mr Nigel Evans and Thangam Debbonaire present the Bill.

    John Spellar accordingly presented the Bill.

    Bill read the First time; to be read a Second time on Friday 19 January, and to be printed (Bill 149).

  • Friday 19 January is a very good day; it is my birthday.

  • Opposition Day

    [7th Allotted Day]

    NHS Winter Crisis

  • I beg to move,

    That this House expresses concern at the effect on patient care of the closure of 14,000 hospital beds since 2010; records its alarm at there being vacancies for 100,000 posts across the NHS; regrets the decision of the Government to reduce social care funding since 2010; notes that hospital trusts have been compelled by NHS England to delay elective operations because of the Government’s failure to allocate adequate resources to the NHS; condemns the privatisation of community health services; and calls on the Government to increase cash limits for the current year to enable hospitals to resume a full service to the public, including rescheduling elective operations, and to report to the House by Oral Statement and written report before 1 February 2018 on what steps it is taking to comply with this resolution.

    I begin by paying tribute to the extraordinary efforts of our NHS and social care staff for all their work this Christmas and new year, and this winter. They continue to do all of us in this House proud.

    It is almost a year since the House debated the national health service in the first Opposition day debate following the Christmas and new year break. A year ago, we debated winter pressures with a backdrop that was characterised by the Red Cross as a “humanitarian crisis”. Here we are again, a year later, debating a winter crisis worse than last year’s. This winter crisis was described by Taj Hassan, president of the Royal College of Emergency Medicine, as “even worse” than last year’s. He also said:

    “In some cases, I’ve heard of 50 patients in an emergency department waiting for a bed. We have to try to manage them…as best we can, in cold, draughty corridors, while dealing with new emergency patients.”

    His words are backed up by the realities on the ground, revealed in the weekly reports of what is happening. Since the start of this winter, more than 75,000 patients waited for over 30 minutes in the back of an ambulance. Almost 17,000 patients waited for over 60 minutes. This is despite the NHS Improvement directive last year that emergency departments should accept handover of patients within 15 minutes of an ambulance arriving.

  • Does my hon. Friend recognise the pressure across the system? At Arrowe Park on the Wirral, staff made 48 extra beds available for the winter crisis and over Christmas, and in the event they had to make 40 more extra beds available by cancelling all elective surgery. Does he believe that this is the way to plan for the winter, and does he believe that the Department of Health made robust and appropriate plans?

  • My hon. Friend speaks eloquently about the pressures on her local hospital. She will also be aware of how foolhardy it would have been to close the Eastham walk-in centre on the Wirral, as was proposed because there were not enough staff at Arrowe Park Hospital. Fortunately, because of her campaigns and those of my hon. Friends the Members for Wirral South (Alison McGovern) and for Wirral West (Margaret Greenwood), the Eastham walk-in centre has been saved. That is because of Labour MPs working in their constituencies.

  • King’s College Hospital NHS Foundation Trust in my constituency, one of the largest trusts in the country, has recently been taken into financial special measures. Does my hon. Friend agree that the failure of King’s is a canary in a coalmine for the NHS, and must be a wake-up call for the Government on the level of resource that our outstanding NHS staff need so that they can deliver for patients? Will he join me in calling on the Health Secretary to ensure that King’s emerges from financial special measures with the additional funding it needs to deliver safe, effective, world-leading care for patients?

  • I am grateful to my hon. Friend for raising this issue. She has been a passionate defender of King’s, speaking out in this House on numerous occasions. Before Christmas, we saw the resignation of Lord Kerslake as the chair of King’s, when he spoke out about the real pressures facing our NHS, which were dismissed at the Dispatch Box by the then Minister when we had a debate in this House.

  • Does the hon. Gentleman acknowledge that it was under a Labour Government that a walk-in centre in Broxtowe closed? However, I do not seek to blame a Labour Government, because it was a local decision made by local practitioners. Would he not at least accept, in a spirit of trying to build some sort of sensible debate about our NHS instead of always weaponising it, that this Government have put in an extra £437 million specifically for the winter period? Would he not at least give the Government credit for that planning, which we have never seen before?

  • The right hon. Lady is a former Health Minister, so she will know that in her local hospital trust 771 patients have waited longer than four hours on trolleys, unable to get a bed. She talks about the winter money. We were calling for winter emergency money back at the general election, and we repeated those calls in September. That money did not come through until the November Budget, and hospital trusts were not told about their allocations until a few days before Christmas. That is no way to prepare for the winter. I suspect that when she was a Health Minister, she would have been saying that to the officials in her Department.

  • The point is that for the first time a Government have done everything they possibly could—[Hon. Members: “No.”] They have, because no Government can predict what the weather may be like, or the uptake of flu vaccinations. It is wrong to suggest that this is the fault of the Government in England when there has a problem across the whole of the United Kingdom, including Scotland and Labour-run Wales.

  • The right hon. Lady will know that we have had eight years of sustained underfunding of our national health service because of decisions by this Government, of which she was a member until very recently.

  • I refer to the comments made to the Health Committee by Jim Mackey, the head of NHS Improvement back at the start of October, three months ago:

    “It is true that we are running tighter than any of us would really want to and we have not had the impact from the social care investment this year that we had hoped for; so, it will be difficult—it will be very tight—over winter.”

    This Government knew what was coming, yet they have let the whole country down.

  • My hon. Friend, who is an excellent member of the Health Committee, speaks with great eloquence, pointing out the hubristic response of Tory Members in saying that this was not predictable or preventable. This winter crisis was entirely predictable and entirely preventable.

  • Two hundred and thirty-three patients were left in ambulances for more than 30 minutes outside King’s Mill Hospital in the week of 25 to 31 December. That is more than 40% of those arriving by ambulance in that week. Does my hon. Friend agree that those patients and their families deserve an apology and a promise that that will never happen again?

  • Absolutely. I have absolute praise for the staff at King’s Mill—it is where my first daughter was born, in fact. The way in which patients have had to wait for ambulances outside King’s Mill is entirely unacceptable, and this Government need to do something about it.

  • Let me make a little progress, if I may. I will try to take as many interventions as possible, but this is only a half-day debate and I know that many people want to speak.

    We have heard the stories of ambulances backed up outside hospitals. Ambulances have been diverted from gridlocked A&E departments 150 times. Our hospitals are overcrowded and our bed occupancy levels are running at unsafe levels. In the run-up to Christmas eve, over one third of England’s children’s care units were 100% full, with not a single spare bed. We have had reports of whole children’s wards being used for adults. In fact, we do not know the full scale of the crisis because this year NHS England is not reporting which hospital trusts have issued the OPEL—operational pressures escalation levels—alerts revealing hospital pressures. I hope that, given the Secretary of State’s keenness on duty of candour, he will explain why the OPEL data is not being collected and published nationally for England, as it has been in recent years.

    But of course behind every single one of these statistics is a real human story. We have heard stories of elderly, fragile patients treated in the backs of ambulances in the freezing January weather, or elderly patients, sometimes confused, languishing on trolleys in corridors, such as the 80-year-old epileptic man with severe dementia who was stuck on a trolley for 36 hours waiting to be treated at the Royal Stoke. His daughter, Jackie Weaver, said:

    “it was absolutely horrendous. You couldn’t get past for all the trolleys”.

  • Given that this is about Stoke, I will give way.

  • We had 67 people sitting on trolleys. We ran out of corridor space. Two hundred people medically fit for discharge had nowhere to go. The pressure on my constituents and those of my hon. Friends in North Staffordshire was appalling, but so was the pressure on the staff who had to cope with looking after those patients. My constituents deserve better and the staff deserve better. We need money for social care—and we needed it last year.

  • My hon. Friend makes a moving contribution to the debate. Those people in Stoke whose relatives have been waiting so long on corridors will see the Prime Minister saying, “Nothing is perfect”, but the truth is that we do not want perfection—we just want a bit of dignity and humanity in our health service.

  • I give way to my hon. Friend, who has been working in her constituency over Christmas.

  • This time last week, I went out with an East Midlands Ambulance Service crew for a shift, and they told me that over the Christmas period they were waiting two hours and more outside A&E at Lincoln Hospital. They also said that they were not even just sitting in the ambulance—one of them, a paramedic, was going inside and cannulating patients, working in resuscitation, and clerking patients. Will my hon. Friend comment on that and on what we will do about it in government?

  • My hon. Friend makes a powerful, and indeed raw, contribution to our proceedings, because she was working over the Christmas holiday on the frontline in Lincoln. I pay tribute to her and all her colleagues there. I hope that the Secretary of State reflects on her contribution and responds to it in his remarks.

  • The stories are indeed heartbreaking, and no one wants that for their constituents or their relatives. Will the shadow Secretary of State therefore recognise and welcome the investment that the Government have made in the units for elderly and frail people? As I have seen in my hospital, the Alex, that investment has made a massive difference. It is too early to tell whether that will solve all the problems, and we of course want to do more, but it is making a real difference on the ground, as is the additional Government funding of nearly £4 million, which was put in place in time. The hospital has been in special measures, but its leadership is turning it around. Does he welcome such real examples of good practice that are helping our constituents?

  • I do welcome examples of good practice, but I share the hon. Lady’s frustration, which she has put up on her website, about the money taking so long to reach the frontline:

    “while the money has been approved, the current frustration is the time it is taking for the Trust to gain access to the money.”

    I agree with her: this money should have been announced sooner for our national health service.

  • Will the hon. Gentleman give way?

  • If I may, I will make a little progress. I have been generous, but I will try to take as many other interventions as possible.

    We have heard about Stoke, but what about the story of 87-year-old Yvonne Beer, who suffers from dementia? She was at Worcestershire Royal when, forced to wait 10 hours in hospital to see a doctor, she had to be tied into a wheelchair with a scarf after her bed was taken away. We learn that Southmead Hospital in Bristol has had a capacity of 104%. Yesterday, a leaked memo revealed:

    “Acute Medical Unit physicians have been on their knees with workload pressure”,

    and that the

    “biggest risk remains patients in corridors in the Emergency Department with no allocated doctor, no allocated bed and no treatment—some of these are very sick indeed”.

  • In my local hospital in Barnsley, general and acute bed occupancy reached 100% on 31 December, despite the incredible effort of the staff. Does my hon. Friend agree that safety targets are simply not being met, and that that is not good enough?

  • Absolutely. Bed occupancy rates at such a level are unsafe. I know the Secretary of State is committed to patient safety—he has made it one of his signature issues—yet he is presiding over a health service in which bed occupancy in acute hospitals is routinely well over 85%.

    We have heard about the pressures in South Yorkshire, but what about the pressures in West Yorkshire? Of the hospital ward in Pinderfields where people were left lying on the floor, a witness said:

    “The man who was lying on the floor at the bottom of my husband’s bed was being sick. He was asking for a trolley to lie on but there wasn’t one to give him.”

    Of course, their plight was dismissed in the House on Monday by the then Minister, the hon. Member for Ludlow (Mr Dunne), who told us there were enough chairs to sit on.

  • Will my hon. Friend give way?

  • I will give way to the local MP, and I will then try to make some progress.

  • I am sure my hon. Friend will join me in thanking the staff for their gargantuan efforts this winter and over the festive period. Just this week, I spoke to a nurse at the very same hospital, who advised me that staff had had to clear out the cleaning cupboard to put in a bed for a patient to receive an infusion. Does he share my horror at that? What on earth is our NHS coming to under this Government?

  • Beds in broom cupboards—the Tory NHS: isn’t it a disgrace?

  • I will make a little bit of progress.

  • I give way to the former Minister.

  • In relation to the incident at Pinderfields Hospital, it is completely unacceptable that people should be lying in corridors, but the hospital informed me before I made the statement on Monday that the patients who were photographed had been asked whether they wanted to sit down on a seat and had decided not to do so.

  • I am grateful to the hon. Gentleman for taking the opportunity to clarify the situation for the House. Perhaps he should have done so on Monday. I do not know, but he may well still have been in place as a Health Minister if he had said that on Monday.

    There have been huge pressures on the North East Ambulance Service, because of which it has been asking some patients, where appropriate, if they have alternative transport options, such as a family member. The East of England Ambulance Service has said that some patients were being sent taxis to get them to hospital, with paramedics stuck in ambulances queuing at hospitals for more than 500 hours in the past four days. Of course, clinicians have spoken out. Richard Fawcett of the University Hospitals of North Midlands warned that his hospital had

    “run out of corridor space”.

    He also felt compelled to apologise for, in his words, the “third world conditions”.

  • Let me make a little progress, if I may, because I have been generous in giving way.

    What is the response of the Prime Minister and the Secretary of State? A perfunctory apology, and the unprecedented blanket cancellation of elective operations.

  • The hon. Gentleman mentioned the East of England Ambulance Service. He will be aware of the case of the elderly lady who lost her life while waiting four hours for an ambulance to arrive. That is often a result of having ambulances stacked up outside hospital, as he has described. Does he agree that it is now time to end these intolerable incidents—such failures of care are apparently widespread across the country—and to have a mature national conversation about how to increase the funding for our NHS and our care system to ensure that people get care when they need it?

  • I agree entirely. I am entirely happy to have a conversation about how to increase funding in the national health service, but I have huge scepticism about whether this Government—having overseen eight years of desperately tight funding allocations for the NHS, with cuts to community health services—are prepared to engage constructively in such a conversation.

    On the specific case that the right hon. Gentleman mentioned, the hon. Member for Clacton (Giles Watling), whom I cannot see in his place—I apologise if he is in the Chamber and I have not spotted him—has called for an inquiry. He has actually warned that if that incident was a result of underfunding, we need to put more funding into ambulance services, and I share his concerns.

  • If I may make a little progress, because I have been generous; I will then try to take more interventions. I am conscious, however, that this is only a half-day debate.

    The consequences of this crisis are not only for those in urgent need, but for everyone using the NHS. Let us be clear that this panic cancelling of elective operations means that patients will suffer. Not only will patients suffer longer waits for operations while in pain and distress, but they will wait for appointments with the uncertainty of not knowing what is wrong with them, and the knock-on effects on NHS services and the wider society are huge. Already, patients are facing a waiting times crisis with 4 million on the waiting list.

  • Will my hon. Friend give way?

  • Let me make a bit of progress.

    A lost month will mean that thousands of patients across the country are stuck with their lives on hold. To call this “routine care” misses the fact that these are big issues for the individual patients affected. The young man awaiting heart valve surgery, who will have arranged time off work and for his family to be around to care for him, now has to cancel it all and does not know when his operation will happen. He also runs the risk of a deterioration in his heart function, which could lead to further hospitalisation in an emergency, adding to the pressures on our emergency services.

  • I give way to the hon. Lady, who has been very persistent.

  • Will the hon. Gentleman at least recognise that the NHS is doing more operations than ever before? In my area of Mid Essex, an incredible 72,000 operations were carried out last year, which is over 9,000 more than back in 2010. Will he join me in thanking the incredible NHS staff for the many better outcomes they are delivering?

  • Yes, I will. I of course thank the NHS staff. Of course, if the hon. Lady wanted to thank the NHS staff, she could have supported us when we brought in motions to give the staff a fair pay rise, but I do not think she did so.

  • I give way to the hon. Gentleman, who I know always wants to contribute to such debates, but then I will make some progress.

  • The hon. Gentleman is extremely generous, and I always follow his remarks with a great deal of interest. Any cancellation is appallingly bad, but does he understand that the worst possible cancellation is one on the day of surgery, which is clinically unacceptable? Will he at least give the system credit for at least trying to introduce some sort of planning this year, for the first time that I can remember since 1984?

  • The hon. Gentleman will know that the system is in such a state because of years of sustained underfunding. His answer would be a cross-party commission, a sort of royal commission, and I have huge respect for his contributions to these debates, but let us be clear that for eight years the NHS has not been getting the level of funding it should be getting in historical terms.

  • My hon. Friend is being very generous in giving way. Down in Sussex, patient transport was privatised and given to a company called Coperforma. Seven months after the contract was awarded, the company was stripped of it for its appalling practices and for completely underperforming in every way, shape and form. It now transpires that Coperforma has been given more money for seven months than it would have received if it had performed properly for a full year. Is that not indicative of the way in which the NHS is being run?

  • Order. May I appeal for brief interventions? I would just point out to the House that no fewer than 38 Back Benchers wish to speak, and even if the debate is allowed to run on beyond 4 o’clock, which is in the hands of the usual channels, probably half of them will not be able to do so. I say now that they will just have to sit, wait and hope—I am not publishing a list; we do not do so—but long interventions do not help.

  • I will take that as my second telling off from you today, Mr Speaker. Given your guidance, I will try not to take any more interventions, but on the particular point raised by my hon. Friend the Member for Hove (Peter Kyle), the privatisation of patient transport services to Coperforma in his area of Sussex was an absolute disaster for patients and for the ambulance drivers, who I met—they went for eight weeks, as I recall, without pay. He has been campaigning on the issue, as has the GMB trade union, which I congratulate on the campaign it has run. We now learn that, having ended the contract, money is still going to that firm, which is an absolute scandal. I hope there can be a full inquiry into what has gone on, and I praise my hon. Friend for leading the campaign.

    I have talked about the real impact of cancelled operations—for example, on someone waiting for a hip replacement who is forced to stay at home, unable to walk properly, and who, due to the pain, will no doubt at some point need to see a GP again in an emergency, which again adds to the pressures on the service. Perhaps someone in need of a cataract operation has had that operation cancelled and is now at risk of falls because they cannot see. Such a person could well end up in A&E, again needing a hospital bed. These are real people who rely on the NHS and whom the Government are letting down. The domino effect of not providing proper, timely care increases the crisis and pressures on the wider NHS.

  • Will the hon. Gentleman give way?

  • I did say that I would try to make progress. It is clear that a lot of Members want to speak, so I will continue if I may. I have been generous in giving way.

    Now we are beginning to hear that it is not just routine non-urgent operations being cancelled. Today, The Times reports of a hospital in Oxford considering delaying the start for chemotherapy due to staff shortages and lack of capacity—a four-week delay on all new patients needing chemotherapy—and there are proposals for those on the first cycle to have full chemo, but then discriminate against those on cycles 2, 3 and 4—second, third and fourth-line chemo—giving those patients a reduced number of cycles, which is a two-tier chemotherapy system.

  • Will the hon. Gentleman give way?

  • Let me make some progress.

    In The Guardian today, we read the story of Carly O’Neill, who went into hospital for her cancer operation and who was waiting in her gown with wristbands on in the hospital, only to be told her operation would have to be cancelled because there was no bed available.

  • Will the hon. Gentleman give way?

  • Let me finish the point.

    How about my constituent Mr Geoff Brooker, who was diagnosed with cancer of the bladder? He has had his planned operation cancelled twice this winter. When Mr Brooker was asked about the Secretary of State’s apology, he said:

    “He may have apologised for postponements but it was as if he was apologising for the cancellation of a jumble sale.”

    My constituent went on to say that Ministers were “uncaring” and he blamed “poor planning”. He added:

    “If operations like mine are postponed then it’s likely it will cause deaths. The decision could even be the death of me”.

    There we have it: cancer patients having operations cancelled and trusts looking at delaying chemotherapy, yet these Ministers sit there with their NHS badges on their lapels. They should be ashamed of what is happening in the NHS today.

  • I will give way for the last time and then I will make progress.

  • Goodness knows the hon. Gentleman knows I am no apologist for Oxford University Hospitals Trust, but it is important that we do not make a crisis where there is not one. I have been assured by the University Hospitals Trust today that the leaked memo does not represent the current reality. I, like him, have concerns about recruitment, and I, like him, am worried about the future of recruitment in the NHS, but it is really important that we do not worry current cancer patients who will continue to receive their treatment.

  • I thank the hon. Lady for her contribution. The memo was emailed to oncology department staff in the last few days. If the trust is now backing down on that, all of us across the House will welcome it, but the point still stands: the trust was looking at delaying chemotherapy by four weeks and it referred to a lack of staff and capacity. As we know, this trust has cut many, many beds in recent years, including cancer beds and renal beds, and we know that it is under huge pressures.

  • Will the hon. Gentleman give way?

  • I will make some progress.

    The hon. Member for Banbury (Victoria Prentis) rightly said that we do not want to make this more of a crisis, but the Secretary of State knows that cancelling elective operations impacts on hospital finances. It means a loss of revenue for trusts that are already struggling to meet their deficit targets. Rather than allowing waiting times—

  • Will the hon. Gentleman give way?

  • I am not going to take any more interventions, I am afraid.

    Rather than allowing waiting times to escalate further, why will the Secretary of State not commit today to giving hospitals emergency funds, so those cancelled operations can be rescheduled as soon as is reasonably possible and hospitals do not lose revenue and get further into problems with their deficits?

    The Secretary of State knows that cancelling electives impacts on training of the next generation of surgeons and junior doctors, who are warning that they could lose out on as much as a sixth of their six-month training because the operations are not there for them to do. Will he tell us, if these cancelled electives continue, what is his plan to ensure that our junior doctors and surgeons can catch up on the training they need? Our patients deserve the best-trained surgeons and junior doctors in the world. Cancelling those electives impacts on their training. Will he tell us his plan for dealing with that?

    We all agree that every penny counts in rising to the challenge of the winter crisis caused by Downing Street. I know the Secretary of State will tell us that we have had the—

  • Will the hon. Gentleman give way?

  • I said that I would not take any more interventions.

    The Secretary of State will tell us about the winter funding, but we also know that the winter funding came far too late. NHS Providers has warned that it came far too late in December, and I am sure that many hospital trusts will be telling him privately in his morning phone calls that it came too late. Hospital trusts have to turn to expensive private staffing agencies to get through this winter due to the Government’s failure to invest in an adequate workforce to enable the NHS to deliver the care the nation needs. In many places, NHS trusts are effectively held to ransom by staffing agencies.

    Last month, NHS Improvement refused a freedom of information request to publish how much these private agencies are costing individual trusts. Does the Secretary of State agree that that is unacceptable and that we should know how much extra money set aside for winter is going to private agencies? Will he undertake to produce a league table naming and shaming every single agency and stating how much they have been getting from each and every trust, so we can have clarity on this matter?

    The Secretary of State will no doubt tell us that the problems we are experiencing have arisen because we have an ageing society. Of course, we see pressures on the service because of the demographics not just in winter, but all year round. Patients with less acuity, often with sometimes three or four comorbidities—in particular, those being treated at this time of year—put huge pressure on the service throughout the year.

    However, these demographic changes in society did not just drop out of the blue sky in the last few weeks. We have known about these trends for years and years, which makes it even more criminal that the Government have presided over eight years of underfunding in the NHS—£6 billion of cuts to social care—and have acquiesced in a reduction of 14,000 beds. We will probably see more bed reductions if we pursue the sustainability and transformation plans across the country. We have seen delayed transfers of care increase by 50% these last years.

    On social care, the Secretary of State may have the name in his title now, but he has no plan to deal with the severe £6 billion cut we have had to social care in recent years.

  • Will the hon. Gentleman give way?

  • I am not giving way because we are pressed for time.

    The fact that makes this winter crisis even more serious than anything that has gone before is not just the cuts to social care and to the community care sector, nor is it the underfunding of the NHS; it is that the crisis takes place against the backdrop of some of the most serious and far-reaching neglect of health perpetrated on the people of this country for more than century.

    Sir Michael Marmot, a recognised authority on public health, has warned that this country has, since 2010, stalled in the task of improving the life expectancy of our population and that differences in life expectancy between the poorest areas in the country and the better off have widened in recent years. This is what happens with austerity and cuts. This is what happens when the Government fail to invest in housing and the insulation of our housing stock. This is what happens when the Government allow fuel poverty to increase and oversee falling real incomes, benefit cuts for the poorest and rising child poverty. The shocking consequence is that the number of hospital beds in England taken up by patients being treated for malnutrition has doubled since 2010. Is not that a shame? Is not that a disgrace?

  • The hon. Gentleman is right about one thing, which is demographic change. That and an ageing population are directly behind some of the malnutrition figures, and he must not misuse those. Is it not the case that, as the Royal College of Nursing told the Health Committee just two or three years ago, the failure to plan for a rising and ageing population is a feature not of the past five years, but of the past 10 to 15 years? He should not pretend that the problem has appeared overnight.

  • When we had a Labour Government, we trebled in cash terms the investment going into the NHS. When we had a Labour Government, we had trolley waits, but under this Government we have had 560,000 people waiting on trollies and 2.5 million people waiting more than four hours in A&E. That is the difference between a Labour Government planning for the health needs of this country and a Tory Government cutting for the health needs of this country.

    This is not just a winter crisis; it is an all-year-round funding crisis, a year-round staffing crisis, a year-round social care crisis and a year-round health inequality crisis, manufactured in Downing Street by this Government. We have had eight years of underfunding and cuts; 14,000 beds have been lost; the number of district nurses has been cut by 3,500; the number of mental health nurses has been cut; child and adolescent mental health services budgets have been raided; the number of GPs has fallen and we are 40,000 nurses short; community and mental health services have been privatised; and social care has been savaged and staff demoralised.

  • In my borough of Lewisham, CAMHS are facing a budget cut of up to £200,000, leaving many children without the treatment and services they need. Does my hon. Friend agree that the Government have failed to provide mental health services to some of the most vulnerable in society, particularly at this difficult time?

  • Half this country’s clinical commissioning groups are raiding children’s mental health services because the money is not in the wider NHS. Yet this Secretary of State remains in place, even though the truth is that doctors and nurses have lost confidence in him, patients have lost confidence in him, and it seems the Prime Minister has lost confidence him. He fights for his own job, but he will not fight for the NHS. Our patients are crying out for change, but they will look at the Health Secretary, still in post today, and see that, to coin a phrase, “Nothing has changed. Nothing has changed.” I commend our motion to the House.

  • I, too, start by offering, on behalf of the whole House, a massive “thank you” to all staff across the health and care system who went beyond the call of duty and gave up their Christmas and new year to keep patients safe. Their dedication makes the NHS the best healthcare system in the world. They visibly demonstrated their values, constantly putting the needs of patients before their own.

    Attempts to politicise pressures on the NHS are a serious mistake. The last time the NHS had a difficult flu winter was 2009—the hon. Member for Leicester South (Jonathan Ashworth) might know that, because he was working in Downing Street at the time. In 2009, the shadow Health Secretary was Andrew Lansley. He refused to attack the Government, because it was an operational issue—in fact, the then Health Secretary, Andy Burnham, thanked him for his “measured tone”, which meant that

    “together we can give a reassuring message to the public”.—[Official Report, 12 June 2009; Vol. 493, c. 1056.]

    Sadly, I cannot say that to the shadow Health Secretary today.

    The hon. Gentleman, who has used some extraordinary language today, says that the NHS is on its knees. Let us look at the facts: since 2010, we have 14,000 more doctors, 12,000 more nurses on our wards and 5,000 more operations every single day; and in A&Es, which he talked about a lot, 1,800 more people are seen and treated within four hours every single day.

  • In the spirit of sounding conciliatory, I thank the right hon. Gentleman for giving way. The Royal Bolton Hospital made provision for the Christmas period, but despite that it has had to cancel all routine operations, as well as elective operations in trauma and orthopaedics, until 1 February. What financial assistance will he give my local hospital, so that it does not suffer as a result?

  • We did provide an extra £1.4 million to the hon. Lady’s local hospital before Christmas, to help it to deal with the immediate pressures, but let me deal with this issue of cancelled elective care operations. I agree with the shadow Health Secretary that it is a big deal for patients who are told that their planned procedure is to be postponed. No one minimises the distress that that causes, but last year and in previous winters operations were cancelled at the last moment, which is much more distressing and challenging for hospitals to plan around. The decision was taken this year to take a much more planned approach. We hope that, overall, fewer operations will be cancelled at the last moment, but we need to do this in a planned way.

  • I cannot help but intervene, because last year someone very close to me—a member of my family—was one of those people who was about to go into the operating theatre when the procedure was cancelled. I came to my right hon. Friend about the case. I can tell the House that that was not a good experience, so it is a much better approach to plan ahead and give people notice. Yes, emergencies will happen, but planning ahead makes for a better system. I think the Government have made a good move.

  • My hon. Friend is absolutely right. I hope she will not mind my saying that her case involved cancer, and one of the things that the planned approach allows us to do is make sure that we do not have to cancel cancer operations, which are the most important, at the last moment. That is essentially what we are trying to do: protect everyone who is in a life-critical situation.

  • I have to intervene. I had treatment and an operation for cancer. If my operation had been cancelled, I would have been able to come to this House and ask the Secretary of State personally to intervene, but I am speaking today on behalf of Carly O’Neill, who went to the press to talk about her cancer operation. What explanation does the Health Secretary have to give Carly O’Neill and other cancer patients for their operations being cancelled?

  • I say, very directly, that the instructions from NHS England could not have been clearer that cancer operations should not be cancelled, because they are deemed to be urgent. From the perspective of the Government and NHS senior leadership, such cancellations are not acceptable. If the hon. Lady knows of individual cases, she should raise them with me and we will look into the matter. It is precisely because we want to preserve capacity for people who need it the most that we have taken these difficult decisions.

  • The Secretary of State complains about politicisation of the NHS, but 90 colleagues from all parts of the House, including many Conservatives, are offering a different approach—a cross-party mature conversation to find a solution. Lord Saatchi, Baroness Cavendish and Nick Timothy are now arguing for the same thing. Will he now embrace that approach—a civilised approach to come up with a consensus for this country on how we secure our health and care system?

  • I have said publicly that, as we come to the end of the five year forward view, we need to seek a consensus on the next stage for the NHS. We will need significantly more funding in the years ahead, and we need to build a national consensus on how to find that funding. My view is that we should try to do that for a 10-year period, not a five-year period. I am open to all discussions with colleagues about the best ways to do that, but, as we heard earlier from the shadow Health Secretary, the Labour party is not interested in being part of those discussions, which illustrates how difficult it is to reach consensus.

  • I will make some progress before giving way again.

    Let us look closely at what the hon. Member for Leicester South has said. He used a lot of hyperbole today. He says the Government are sleepwalking into winter. This, of course, has been directly contradicted by Professor Sir Bruce Keogh, the medical director of NHS England, who has said:

    “I think it’s the one”—


    “that we’re best prepared for…This year we started preparing”

    a year earlier. He continued:

    “We have…a good plan.”

    Chris Hopson of NHS Providers, who regularly criticises the Government when he disagrees with us, has said:

    “This time preparations have never been more thorough.”

  • I will make some progress and then give way further.

    Let us look at those preparations. We have put £1 billion into the social care system. The biggest lesson from last year was that pressure in the social care system was making it difficult for hospitals to discharge. What has been the result of that investment? Combined with the extra £337 million in the Budget, it has freed up 1,100 hospital beds by reducing the number of delayed transfers of care. In total, 2,700 additional acute beds have been commissioned since November. The shadow Health Secretary told The Independent:

    “It is completely unacceptable that the 85% bed occupancy target…has been missed”.

    What was bed occupancy on Christmas eve? It was 84.2%, so this had a real impact.

  • I have said I will give way in a moment, but I want to make some progress, too.

    Secondly, because many patients can be better seen by GPs, last year’s spring Budget allocated £100 million of capital to help hospitals to set up GP streaming services. In the year the shadow Secretary of State says the Government were sleepwalking, the number of type 1 trusts with GP streaming tripled to 91% of all such trusts across the country. At the same time, we made it massively easier for people to access GPs and nurses over the Christmas period. For the first time, people could get urgent GP appointments at their own surgery, or one nearby, from 8 to 8, seven days a week, except on Christmas day. The number of 111 calls dealt with by a clinician increased to nearly 40%—nearly double the figure in the year before. That, too, has massively reduced pressure on A&Es.

  • I draw to the Secretary of State’s attention the fact that we continue to have no Northern Ireland Executive and therefore no local Health Minister, meaning that there is a specific problem in Northern Ireland. The NHS staff there are absolutely superb, but they have also been under enormous pressure in recent weeks, as have the ambulance crews. It is terribly demoralising and wearisome for them. The Government must take some responsibility, given the continued absence of a Northern Ireland Executive. What recent discussions—and with whom—has the Secretary of State had in Northern Ireland about dealing with the crisis in the NHS and among ambulance crews in Northern Ireland?

  • The hon. Lady will understand that because I am the Health Secretary for England, I have not been having an enormous number of discussions about the terribly challenging political situation in Northern Ireland, but I agree that it is incredibly unhelpful for the NHS in Northern Ireland if there is not an Executive. The former Northern Ireland Secretary—I know that the whole House wishes him well with his medical challenges—was very engaged in trying to address that issue, and I know that the new Northern Ireland Secretary will make it her top priority, too, precisely because it matters so much for public services.

  • The Secretary of State does not want to get drawn into Northern Ireland—I understand that—yet the Prime Minister seems willing at every opportunity to attempt to smear the Welsh NHS. Can we have some facts before us? Spending per head on the NHS and social care in Wales is 8% higher than in England, and it went up 4.5% last year. We are dealing with winter pressures and we are putting funding up, yet the Prime Minister seems to suggest otherwise.

  • The hon. Gentleman rather inconveniently forgets that the Barnett formula is a major reason why spending is significantly higher in Wales, but I do have something to say about the situation there, so I will oblige him a little later.

  • May I bring the Secretary of State back to the benefit of having GP-led services in hospitals to take the pressure off A&Es? I commend Solihull Hospital for doing just that and reducing appreciably the number of examples of winter pressures being raised with us? Could that be replicated across the NHS?

  • This is what is so disappointing about some of the shrill tones we have heard this week in the media and today in the House. Reforms across the NHS are making a real difference. I totally commend what is happening at Solihull. The key to solving the long-term pressures on our emergency departments is to be better at treating people in the community. The growth in emergency admissions in the vanguard areas of the NHS is about half the national average. This is the five year forward view that we are rolling out across the country. We need to celebrate the successes.

  • I want to make some progress before I give way again.

    A very important point that we have not talked about much in this debate, although it is extremely relevant to people on the NHS frontline, is flu. This year, we have had a much bigger spike in the number of flu cases than at any time since the winter of 2009, but we also have in this country the most comprehensive flu vaccination programme in Europe. This year, for the first time, it was made available to those who are eight years and under and to care home staff. As a result, a million more people have been vaccinated for flu this year than in the year before. Uptake among NHS staff is at 59.3%, which is its highest ever level.

    I say that because while the shadow Secretary of State tries to make the case that no preparations were made, the reality is that the NHS could not have been working harder to prepare for this winter. The result of those preparations is that A&E performance, having declined for six years in a row, last year stabilised for the first time, according to the latest verified data. In the week after Christmas, compared with the year before, we had fewer A&E diverts and more calls to NHS 111. Many Members have talked about trolley waits. It is totally unacceptable for people to be left on a trolley for a long time, but November’s figures, which are the latest verified figures, showed that the number of trolley waits had fallen by three quarters compared with the previous November, so a huge amount has been happening.

  • Does the right hon. Gentleman think that patients being treated in cleaning cupboards and six patients in four-bed bays without lockers, curtains or call bells are signs of good preparation for the winter crisis?

  • That is completely unacceptable, but it is disappointing that the hon. Lady stands up and runs down the NHS when her own trust, which received £3.4 million before Christmas to help with winter, has managed to improve its performance: last November’s figure was 91.8% compared with 77.7% a year earlier. That is a huge achievement for Mid Yorkshire Hospitals NHS Trust. Why will she not praise what is happening, rather than running the NHS down?

  • I support the leadership that the Secretary of State has offered during this winter crisis and the tone he has adopted in this debate. As a result, there is not the kind of crisis we have had in past years. Now that he has widened responsibilities for social care, will he help West Berkshire and Wokingham, which have had problems with past formulas and do not have enough money to take pressure off the hospital in the way he would like?

  • I will certainly revisit the issues in my right hon. Friend’s local authorities because I have looked at them before and know that there are particular pressures there. He alights on something else that the Opposition have not wanted to talk about, but which is very significant: the Prime Minister’s commitment to the integration of health and social care, which eluded the previous Labour Government over 13 years, despite their talking about it a lot. We are starting to see that happen in this country. Monday’s decision means that policy leadership will come back to the Department of Health, which will help us to make even faster progress.

  • I would like to take the Secretary of State back to his point about caring for people before they get to hospital and, in particular, issues to do with GPs. My local area has had difficulties recruiting GPs. It is vital that there is investment in increasing medical training for new doctors, so I plead with him to consider seriously the bid from Anglia Ruskin University to become the first medical school in Essex, where there is currently no pathway for our talented young people to train as doctors within the county.

  • I note my hon. Friend’s persuasive plea for her local university, Anglia Ruskin, but this is not a decision that I will be taking, because my own local university is also keen to offer more medical places. However, she is absolutely right to say that training the next generation of doctors and nurses is the long-term solution to these pressures.

  • I will make progress and then take a final set of interventions.

    The heart of the shadow Health Secretary’s case is that winter pressures are caused by political decisions, not operational issues. Let us put aside the difficult winters that Labour had in 1999, 2008 and 2009, but if he is to drag politics into this, he cannot first say that this is the fault of politicians in England and then totally gloss over the responsibility of politicians in Wales, which the Royal College of Emergency Medicine says is “a battlefield” where

    “patient safety is being compromised daily”

    and the situation

    “is unsafe, undignified and distressing for patients and their family members.”

    I simply ask the shadow Health Secretary this: if it is the Government’s fault that one in nine A&E patients waits too long here in England, whose fault is it that one in six does in Wales? Whose fault is it that people in Wales are nine times more likely to wait too long for test results?

  • I thank my right hon. Friend for giving way. On the Welsh NHS, he is absolutely right. Mr Speaker, I ask for your indulgence while I quote an A&E nurse in Wales, speaking last week: “On every shift, both corridors are full of patients on trolleys. We are housing ambulance crews for longer than ever, due to beds not being available in the hospital. Patients are being nursed in inappropriate areas due to no space. I have seen nurses in tears. I myself have been in tears. This is the first time that I have ever been demoralised and embarrassed to say that I am an A&E nurse in Wales.” That is in Wales, under Welsh Labour. Does my right hon. Friend agree that there is pure hypocrisy coming from Labour Members, who should take notice of the mistakes being made in Wales?

  • I totally agree. This is the central flaw in the Labour party’s case. We know that winter is the most difficult time, but Labour says that there is political responsibility in one part of the UK while saying absolutely nothing about Wales. I notice that the shadow Health Secretary is looking down at his notes as we talk about Wales, but the reality is that that completely blows apart his case. According to the British Medical Association, there is one area in Wales where not a single doctor was available overnight, and the performance of one A&E has fallen to 40%, which is unheard of in England—or, indeed, Scotland.

    However, there is a political decision, which my hon. Friend the Member for Chelmsford (Vicky Ford) mentioned, that has a big impact on NHS winter performance: the number of doctors we train. Not once in my time as Health Secretary have I heard Labour call for an increase in training places. [Interruption.] No, I have not. The simple truth is that there is no point throwing money at a problem if there are not doctors and nurses available to spend the money on. While I have been Health Secretary, we have had 40,000 more doctors, nurses and other clinicians working in the NHS, but we need more. That is why, under this Prime Minister, we have announced the biggest increase in training places for doctors and nurses in the history of the NHS.

  • I will give way to the hon. Member for Eltham (Clive Efford), and then to my hon. Friend the Member for Brigg and Goole (Andrew Percy).

  • I congratulate the Secretary of State on facing down the Prime Minister on Monday, when what emerged was one man, two jobs, no governor. He must accept that the £6 billion in cuts to social care since 2010 has had a major impact, particularly on winter crises. Does he regret the Government’s decision to take that money out of social care?

  • In 2010, we faced the worst financial crisis since the second world war. The hon. Gentleman will know which Government were in charge when that happened. People were talking about a run on the pound—I notice that the Labour party continues to talk about that—and the crisis had to be addressed. We, like other countries, had to make significant reductions in public funding, but when we got the economy back on its feet and started creating jobs—1,000 jobs a day since 2010—the first place into which we put extra money was the NHS and the social care system. There is £600 million more in the social care system than there was two years ago.

  • I want to make progress, because a lot of Members want to speak, but I did say that I would give way to my hon. Friend the Member for Brigg and Goole.

  • I thank my right hon. Friend for giving way. He knows of my interest in ambulance services. I was on duty for Yorkshire Ambulance Service as a responder this Christmas and new year, and will be again tomorrow night. When he talks about workforce planning, he rightly talks a lot about doctors and nurses. Will he say something about how our incredibly well-trained paramedics can be used better to relieve pressure in A&E and reduce delays there?

  • I thank my hon. Friend for his work as a first responder; that is a fantastic example in his community. We have 1,700 more paramedics than we did seven years ago. My hon. Friend is absolutely right because the role of paramedics has changed dramatically over recent years. It used to be about scooping people up and taking them to hospitals; now, we are treating many more people on the spot. Paramedics have an extraordinarily important role, but it has changed. There is a changed emphasis, as in other parts of the NHS—a move towards doing as much as we can to treat people safely outside hospitals and to keep them at home, because we know that is the safest way.

  • I am grateful to the Health Secretary for giving way. The simple fact is that if we want more care in the community, the Government have to stop slashing social care budgets. If we want to stop people appearing at hospital with preventable conditions, we need to stop cutting public health funding. The Government do not have an economic record to be proud of, but even looking at the public spending that is being made, we see that the Government are penny wise and pound foolish.

  • I am sorry, but 3 million additional jobs have been created, so we do have a strong economic record, and that is why we have increased funding for social care recently. We have increased NHS funding significantly. As for slashing funding, the hon. Gentleman’s local trust received £9.7 million before Christmas.

  • Will my right hon. Friend reflect on the issue of beds? As a result of the measures that he has taken in recent weeks, Shrewsbury and Telford Hospital NHS Trust in my area managed to release an extra 120 beds to help it to cope with the significant winter pressures that it faced. Does he agree that community hospitals such as my area’s Bridgnorth Community Hospital and Ludlow Community Hospital, which have community beds, have a role to play in releasing pressure on acute hospitals from patients who no longer need acute care?

  • I agree. I want to take this chance to thank my hon. Friend for being an absolutely superb Minister of State at the Department of Health. The fact that the NHS is better prepared this year than it has been for very many years is partly because of his efforts, and I commend him on his fantastic contribution.

  • I shall give way one final time before I conclude my speech.

  • Does my right hon. Friend agree that the calibre of local trust leadership can play a huge role? In Gloucestershire, new trust leadership has tackled serious internal financial failings head-on. As a result, A&E times have been slashed and turned around, which meant that A&E waiting targets were met in December. Does he agree that that shows what can be done with the right leadership?

  • It absolutely does, and no one campaigns more vigorously for his local trust than my hon. Friend. Just before Christmas, I visited his trust’s Gloucester site and met the management and staff. The situation there is extraordinarily impressive and a great inspiration to many parts of the NHS.

    I finish on the issue of funding. The shadow Health Secretary has been using very strong language, but he has conveniently overlooked the fact that in the past four years, real-terms funding for the NHS has increased by £9.3 billion, which is £5.5 billion more than his party promised in 2015.

  • Will the right hon. Gentleman give way?

  • I will conclude, because a lot of hon. Members want to speak.

    The shadow Health Secretary is right that there are real pressures, so what are the facts? We spend 9.9% of our GDP on health, which is 1% above the EU average, and about the same as the EU15—the western European countries—but we want to spend more, so in England, from 2011, funding went up by 15.6%. In Wales, Labour chose to increase funding by only 8%. This motion is about money. When it comes to NHS funding, Labour gives the speeches, but Conservatives give the cash.

  • Like others across the House, I thank all staff in all four UK systems, who, as the Secretary of State has said, have gone above and beyond the call of duty to focus on their patients, and I do not think any debate we have in here is intended to upset or insult any of them.

    Before the hon. Member for Ludlow (Mr Dunne) perhaps leaves the Chamber, I want to thank him for his service as a Minister of State for Health, whom I often met across the Chamber, but I also want to correct a comment he made in answer to my question on Monday. He claimed that the number of patients waiting longer than 12 hours in A&E in England was half the level of that in Scotland.

    Naturally, I would have expected the Minister to know all the stats and what they mean: in England data are only published for the percentage of patients who meet, or do not meet, the four-hour target. There is no publication of data on eight hours or 12 hours. The clock restarts for patients who require admissions, and that is defined as from the decision to admit until they get a bed and is known as trolley waits. So 48,000 patients waited over four hours on a trolley after their four-hour wait in A&E to get a bed, and the 109 he was referring to had waited over 12 hours on a trolley for a bed after the four or five hours they had waited in A&E. Therefore, it was utterly incorrect to compare that with the Scottish data, where we have a single clock from when the patient starts right through until they get to where they need to go. I simply want to clarify that while the hon. Gentleman is in the Chamber.

  • I know that comparing England and Scotland is one of the pastimes that Scottish National party Members like to engage in—it is a fascination for them—but the reality is that in my constituency of Stirling, served by the excellent NHS Forth Valley in Larbert, only 57% of patients were seen within four hours in the last week of last year because we have a flu epidemic in Scotland, as they do in England, and that should be acknowledged.

  • If the hon. Gentleman gives me a little longer, he will find that I intend to talk about the flu epidemic, but before he gets too celebratory he might want to wait until tomorrow when we will have comparable data, because while in Scotland the data are published every week, in England they are published only every month. I am glad, however, that we no longer wait six weeks after the end of a month, which is 10 weeks after the start of it, but get it a fortnight later. So that will be available tomorrow, and then he can compare hospital trusts in England with hospitals in Scotland to his heart’s content. I would have thought that, as someone who celebrates the United Kingdom, he might want to praise the fact that Scotland has led the entire UK since March 2015 on emergency admissions and A&E.

    Having corrected that, all of us recognise that this is a particularly tough winter because there has been an outbreak of flu on top of a bad freeze. I point out to those who think the worst is past that the flu season lasts until March and at the moment this is an outbreak, not an epidemic, but it comes on top of underlying pressures, and across the four nations this has involved staff having to go above and beyond the call of duty.

    Whether it was how Public Health England said it or how the media reacted to it, this business of stating in public that the flu vaccination does not work is unfortunate and irresponsible. The flu vaccination recipe is planned by the World Health Organisation at the beginning of each year. It will already be working on next year’s flu. It does not have a crystal ball and people who have what we in the medical profession call a retrospectoscope should recognise that that tool was not available at the time when the decisions were made. Producing vaccine is a biological process that takes months, so the decision is made in March for the northern hemisphere, and all the companies produce to that recipe. Headlines in Scotland implying that the Scottish Government popped down to Boots and took the wrong vaccine off the shelf are therefore facile, and that also encourages people not to bother.

    We already have falling vaccination rates in childhood vaccination and in flu. We should be pointing out that multiple flu viruses are circulating. While all the talk in the media is of Australian flu, in Scotland that is about a quarter of the strains that are circulating.

    One of the issues with flu is that it happens in cold weather, and in Scotland we get the coldest weather in the United Kingdom, so we have double the rate of flu that there is down here in England. We also had a worse freeze, and are continuing to have a worse freeze. So when the data come out tomorrow, I think we will see that Scotland will still lead the UK. We will not be performing to the level we want; we have not met the 95% target for emergency departments since August, but England has not met them since 2015 and, sadly, Wales has not met them since 2008. So this is a challenge across the board, but Scotland has been more resilient. I call on all MPs to encourage staff and other people to get a flu vaccination, because this will continue until March and it is still absolutely worth doing.

    The Secretary of State often talks as if the problems in A&E are due to people who should not be there. If we talk to anyone who works in A&E, they will say that, by and large, that is not the case. With people getting fractured ankles and fractured wrists on the ice, A&Es will have been very busy with having people carted in and having people X-rayed and what we call in Scotland getting a stookie put on before they go home. That is all going to take time, but anyone who works in A&E would say that the key issue is frail, sick people, often with multiple conditions, and whether they fractured their hip falling on the ice or have a respiratory problem secondary to flu, they need a bed and the issue in England is that there are not enough beds.

  • I work in A&E and spent some shifts in recess working in A&E—on new year’s eve and just a few days ago, on Sunday. I agree that many of the people attending A&E, particularly at St George’s where I work, are there because they are frail, but they are also there because this Government have ensured they cannot get an appointment with their GP, our social care is in crisis and we do not have mental health budgets.

  • I thank the hon. Lady for her intervention.

    Obviously, the shape of medicine has changed. More is delivered in primary care—as a surgeon, I well know that more surgeries are delivered in a day—but if we are doing a straightforward operation on an older patient, they will still always require longer rehabilitation; they are more likely to stay overnight or several days, and if they have fractured their hip, they will require full rehabilitation before they go home. The problem is that the number of beds in England has been halved since 1987—under successive Governments—and the NHS stats released for the end of the second quarter of 2017-18 show that almost 1,000 beds have been lost even since the winter of last year, when the situation was described as a humanitarian crisis. That was a mild winter that did not have a flu outbreak on top.

    England has only 2.4 beds per 1,000 population, whereas the EU15 that the Secretary of State refers to has 3.7, and we in Scotland have more than four. If we are running constantly with bed occupancy rates of over 85% or 90%, that is where the issue lies.

  • The hon. Lady refers to the decreasing number of available beds; does she agree that we have a bottleneck now in many hospitals due to the lack of social care? In one day over the festive period in my area, just over half of ambulance transfers were completed within the required period. The Secretary of State likes to quote statistics at me, but I would like to give him that one to think about.

  • There will obviously be lots of bandying around of figures, and talking about the four-hour target and the achievements and the numbers, and, as I have said, it serves as a thermometer to look at the entire system from the patient turning up at A&E to their going home. That is what this is a measure of, and it is there to flag up concern. While we will be getting that data, we do not need it; we have already seen ambulances 12-deep, and have already heard that 75,000 patients are stuck in an ambulance for between half an hour and an hour and 17,000 stuck in an ambulance for more than an hour. As was mentioned by the right hon. Member for North Norfolk (Norman Lamb), who is no longer in his place, this means that those ambulances are not available to respond to other 999 calls, which endangers patients.

  • I think the hon. Lady for giving way, and I apologise if she was still answering the point made by the hon. Member for Dewsbury (Paula Sherriff). I accept her point that many of those who are in A&E need to be in A&E, but the reality is that admissions to A&E have gone up 20% over the past 10 years to 6 million per year. Does she agree that more interventions could be made by GPs to prevent some of those admissions from being made and to allow people to be looked after in their own homes?

  • I am not 100% sure whether the hon. Gentleman meant attendances at A&E or admissions, which is what he said—

  • Attendances at A&E tend to be higher in the summer, when kids are on bikes and trampolines, and up trees. It is admissions that are higher in winter, when A&E is dominated by people who are sick. Of course we want primary care and the 111 system to work, so that people do not use A&E as a first port of call, but the problem comes when that all gets too complicated and patients cannot work out where they should go. That is when they go to A&E. It is important to make it really clear where they should go to address which problems.

    Having seen the crisis last year, when there was no flu, snow or ice to blame, I believe that there are underlying structural problems. The target was met comfortably until 2013, when the Health and Social Care Act 2012 changes kicked in and NHS England started to become fragmented and to be based on competition instead of co-operation. I would welcome the establishment of a cross-party group here to work on this, so that we did not always have to have these debates, but it would have to look at the structure and unpick what has been done to NHS England in the past four and a half years. Carrying on breaking it apart will not provide a solution.

  • Does the hon. Lady agree that the Government’s plans to establish accountable care organisations, which will exacerbate the fragmentation in the NHS, through secondary legislation are completely wrong and will make the NHS crisis even worse?

  • I completely agree that establishing accountable care organisations only through secondary legislation is utterly wrong. We have had multiple debates about STPs, and I have said that going back to place-based planning is the right way to integrate and develop a local service, but there should not be a private company at the top making the decisions. There needs to be a publicly accountable body. There is going to be yet another big reorganisation in NHS England, and the proposed structure needs to be debated in this place, not behind closed doors. Yes, money is tight, with the NHS seeing rises of just over 1% a year in the past seven years compared with almost 4% in the past, but it is estimated that between £5 billion and £10 billion is being wasted in the healthcare market itself, through bidding, tendering and profits, and now through this habit of companies suing if they do not win a contract.

    It is crucial to move back to developing services for a community. It is also crucial that health and social care should be integrated, and I welcome the combination of both titles in the Secretary of State’s role, if that means that we are going to work towards meaningful integration, but it must be done in a structured, responsible and legalistic way.

  • The Government spend an awful lot of time attacking the Welsh NHS. In terms of the Secretary of State’s new cordial attitude in not attacking any NHS services, will the hon. Lady join me in condemning former Prime Minister David Cameron’s comment that Offa’s Dyke was the line between life and death, depending on which country one lived in? Wales has an integrated health and social care service, which is also integrated with local government, with a £60 million fund having been established over the past five years. She referred to the cross-party working that could happen, particularly if the Government were willing to engage properly in these services rather than attacking the Scottish and Welsh Governments on NHS care. Does she agree that we could use such working to learn good practice?

  • The four health services are very different. In essence, we have four laboratories. NHS England is by far the largest, but they all face different as well as similar challenges. I am sure that if there were more discussion of how things have been done, there could be more lesson-learning in different directions.

    In 2010, we were promised that there would be no more reorganisation. The same promise was made in 2015, but NHS England is now facing another reorganisation, in the STP system and in accountable care. It is crucial that the focus should be not on bottom-line, budget-centred care but on patient-centred care. It is wrong that any such changes should be introduced through secondary legislation. They must be introduced in this place—either through debate, in Committee, through convention or in a royal commission—to enable us to come up with a structure that will function. Since 2013, the deficits have gone up, the waiting time failures have gone up and the stress on staff has gone up, making it even harder to keep hold of people. Let us put the patient in the middle, but let us also support the staff who look after the patient.

  • Order. We are grateful to the hon. Lady for her contribution. I must advise the House that, on account of the large number of Members interested in contributing to the debate, there will be a four-minute limit on Back-Bench speeches with immediate effect.

  • It is good to be back after using the NHS’s maternity services.

    I am proud of our NHS, and I am tired of Opposition Members talking it down. Our healthcare system is one of the best in the world, and while there is more to do, we should continue to improve our NHS with excitement for the opportunities ahead. We need to be honest about our current situation. We have an ageing and expanding population, and other strong-performing healthcare systems around the globe are facing the same pressures as we are. As a member of the all-party parliamentary group on Taiwan, I was fortunate to see at first hand the excellent healthcare provision over there, yet Taiwan’s own Ministers shared with the delegation the fact that they are facing the same pressures as we are.

    It is a wonderful thing that we are living longer. It is a credit to advances in medicine and evidence of the effectiveness of this Government’s care policies and the strong performance of our NHS. This Government began preparations for winter pressures earlier than ever before. They drew up plans to free up 2,000 to 3,000 beds, extended the flu vaccine programme and provided help to GPs to extend working hours. In my own area, the Mid Yorkshire Hospitals NHS Trust and the Leeds Teaching Hospitals NHS Trust each received an extra £3.4 million for their winter preparations. As the director of acute care at NHS England has stated, the NHS is better prepared for winter than ever before. Furthermore, from 2015, the Government continued to increase investment in the NHS, from £101 billion in 2015 to £120 billion by 2020. It is simply false for the Opposition to claim that the health budget has been cut since 2010.

    But this is not always about how money is invested; it is also about how it is used. During my university studies, in a dissertation focusing on economic and healthcare policy, I looked at investment per capita compared with healthcare outcome. There is a lot of waste in the NHS, but the Government’s strong record on tackling it has put us in a better position than ever before to tackle winter pressures. Cutting the use of expensive agency staff, the positive impact of NHS self-driven improvements and the consolidation of services are only some of the examples of areas in which excellent progress has been made in order to deliver better value for money for the taxpayer, to deliver results in the light of our ageing and expanding population and to prepare us better for winter.

    Having sat on the Health Committee, I am fully aware that there is still more to do, but I am strongly encouraged by the Government’s actions and those of my right hon. Friend the Secretary of State. I would like to take this opportunity to congratulate him on his additional responsibilities. Integrating health and social care makes sense, and it will only serve to better prepare the NHS for winter. I wish him much success with the important task ahead. I know that this is an area he is passionate about. GP working days and a seven-day NHS are only some of the areas in which work has begun, and this will ensure that the winter preparations get better and better. I join my right hon. Friend in urging those on the Opposition Benches to look at their own record in Labour-run Wales.

    During the winter months of last year, I myself required the care and help of the NHS on a number of occasions. During my pregnancy I developed a temporary heart condition, and I have to say that the care was absolutely excellent. The Government’s investment in mental health provision for people having babies is also excellent. The NHS also saved my husband’s life when he had stage 4 cancer. I commend the Government for their work, and I wish my right hon. Friend every success in his new role.

  • I want to talk about the situation at my local hospital, the Royal Stoke University Hospital. Winter crises there are hardly new, but they have escalated year on year, and our hospital features luridly in the national press each winter. It is often the most affected, and it is no coincidence that its funding deficit is England’s worst. This winter, however, is the first time that Royal Stoke consultants have taken to social media to apologise for 36-hour A&E waits, for corridors yet again jammed with the frail elderly on trolleys, and for what they now describe as third-world conditions.

    The background is that of all the areas subject to the so-called sustainability and transformation plans, Staffordshire is the worst performing in the country. Before the 2015 general election, we exposed locally a funding deficit, prior to the STP, that would have reached £250 million a year by 2020. Since then, the issues have been exactly the same, but the figure for health and social care has now more than doubled. The Royal Stoke now accounts for over £100 million of it, having taken over the crisis-ridden Stafford hospital, for which extra Government funding has now ended. The response so far has not been to invest in change, but to launch a scorched-earth policy. Community hospitals have been closed, rehabilitation wards shut, drug and alcohol services axed, and lip service paid to the prioritising of mental health. The effect is most acutely felt at A&E and in admissions to Royal Stoke University Hospital, which is already brimming to capacity and struggling to discharge hundreds of patients because social services are also in crisis.

    On 23 November, I attended a clinical commissioning group “Designing Your Future Local Health Services” consultation at Bradwell Hospital in Newcastle-under-Lyme. It is a hospital close to my heart. At the turn of the millennium, before I became an MP, I chaired our local “NHS Care for All” campaign, which saved Bradwell Hospital as a facility precisely to take pressure off the Royal Stoke. My father passed away there in 1997 and my mother, a former nurse, passed away there after a catastrophic stroke three years ago.

    At the end of March last year, our local CCGs closed Bradwell Hospital, with Longton and Cheadle community hospitals have gone beforehand, and wards at Leek Moorlands Hospital have closed since then. I was not the only person at the November meeting to label the consultation a sham. I also said that I wished the meeting could have happened at the end of February this year instead, after the winter crisis, the flu and the norovirus had bitten, as they are doing now. The CCGs had tried to pull the plug on Bradwell in the autumn of 2016, but they had to keep it open for another six months to cope with last year’s winter crisis. As late as November, they were saying they had no plans to reopen the hospital, but there was an inevitable volte-face in December.

    Lurching from crisis to crisis is no way to run and plan a health system, and it is not only MPs, campaigners, patients and their families who are saying that. Last year, working with local councillors, including Charlotte Atkins at Staffordshire County Council and the indefatigable Joan Bell at Stoke-on-Trent City Council, the reformed local “NHS Care for All” campaign, which is chaired by the energetic Councillor Allison Gardner from Newcastle-under-Lyme, succeeded in getting our hospital closures referred to the Secretary of State. The advice of his independent reconfiguration panel was published just before Christmas, and it was damning of the CCGs. The verdict was delivered to him on 18 October—well before the winter crisis—and we would have thought that he would have reacted, but just one week later the chief executive of two of our local CCGs was appointed to run all six Staffordshire CCGs. That is the reward for failure in our area. Things have to change. The Royal Stoke University Hospital has to be given more investment, because more cuts will simply mean that next winter’s crisis will be even worse.

  • Unfortunately, I had to rush a family member to hospital last Saturday afternoon at a time when my local GP surgery is no longer open, but that gave me a chance to see at first hand how the winter pressures are being dealt with, and I have some good news to share with the House.

    Our local GPs came together this year and agreed to run an urgent care centre at the hospital with a doctor on duty 24/7. On arrival, we saw a notice in reception stating that the average waiting time was three and a half hours, so I settled down to see how it was all going to work. The absolute key to the smooth running of this healthcare frontline was triage. Calmly and efficiently, a doctor and nurse quickly assessed who needed to be seen by whom and where. People could either just turn up or they could ring 111. The hon. Member for Central Ayrshire (Dr Whitford) is right that things need to be just that simple or people will just go to A&E. Sensibly, children and frail elderly patients were seen the quickest, so we were in and out of the hospital in an hour and a half, and we were even directed by the thoughtful GP to a pharmacy that was still open late at night. So I want to place on the record my thanks to the staff at Solihull Hospital and to our CGG, led by Dr Anand Chitnis, for their foresight in conceiving how to provide better emergency cover, and I commend the model to the House.

    Today’s motion states that the Government have failed

    “to allocate adequate resources to the NHS.”

    However, investment in the NHS will increase from £101 billion in 2015 to £120 billion in 2020, which is £2 billion more than the NHS asked for in its own plan for the future. The question of how much money is needed is just as important as how it is spent. It is right to remember that we are not the only country with an ageing society that is facing such challenges. Not only do we spend more than the EU average, but new research shows that we spend more on healthcare than the average for OECD countries.

    For all my 20 years as MP, Labour has claimed at every election that the Conservatives will privatise the NHS, but we have not. It is dishonest and misleads the public, worrying them unduly, and distorts the view of young people who do not yet have years of experience of Conservatives consistently putting more money into healthcare. I am therefore glad that the Prime Minister has given the Secretary of State the additional responsibility of social care, because every grown-up politician knows that we cannot sort out the problems of the NHS without also working out how to get people out of hospital in a timely fashion and into proper support in the community. Our attempts to tackle that funding issue were discredited at the general election when our policy was characterised as a dementia tax, which shows that no party will crack the problem on its own without cross-party determination. I therefore challenge the Labour party to give up the vote-harvesting approach to the NHS and to support a royal commission on health and social care for the sake of everyone who needs it.

  • Time is short and many hon. Members want to speak in this important debate, so I will get straight to my points. There is no doubt that the recent winter crisis is the result of the Government’s chronic underfunding of our health service. I know it, Opposition Members know it and, most importantly, the public know it. Even the Government know that the crisis is down to the underfunding that has happened while they have been in power, so why are they doing nothing serious about it? The answer is similar to what they are doing with local government funding: they are doing nothing because they just want to push their ideological agenda of privatisation.

    The Government know that hospitals must still provide services, and hospitals are forced to put many contracts out to tender under the Health and Social Care Act 2012. The Government know that, willing or not, hospitals will eventually have to turn to private companies that can provide services to the NHS at cut-rate prices. One example of that back-door privatisation is currently happening at hospitals serving my constituents. Bradford Teaching Hospitals NHS Foundation Trust has been forced by Government-imposed budget restraints into planning to set up a private company to provide services that are vital to the people of Bradford, and that private company will actively seek to make a profit. Just let that sink in for a moment—hospitals are setting up private companies with the intention of making a profit for the hospital. That is how bad it has become, with hospitals needing to supplement their funding through whatever means possible. It is a slippery slope from here towards ever increasing privatisation and private company involvement in the NHS. Hospital trusts are services, but this Government are turning them into businesses.

    Privatisation will not save the NHS from the ruin that the Government have eagerly forced upon it. The only way that private companies will be able to offer cut-rate prices is by cutting the employment rights of staff and cutting corners. That will not prevent another winter crisis; it will only encourage one, with private companies putting the safety of health services at risk. I am very concerned that the private company being established in Bradford will put safety at risk by lowering the rigorous hygiene standards, by cutting cleaners and slashing cleaners’ hours. Healthcare services should be provided by the best operator, which in almost all cases is the NHS itself, not the lowest bidder.

    The Government need to recognise that the public will not thank them for privatising the NHS, because that will not solve the crisis in our NHS—only proper funding at the level the NHS says it needs will do that. We have to ask whether the Government want to be thanked by the public and their plans for the NHS are in the best interests of the public, or whether they want to be thanked by big business and their plans are in the best interest of big business. This crisis makes it clear to me which one it is.

  • It is a pleasure to follow the hon. Member for Bradford East (Imran Hussain).

    It is depressing to hear the Opposition laying into the NHS, which is an extraordinary group of real people working day in, day out to look after all our constituents when their health needs to be supported and mended. I commend all the staff across Northumberland’s healthcare family who work so hard not only over the past few weeks but 365 days a year to look after all of my constituents.

    Much can be achieved through good planning to pre-empt the winter health crisis, as it is known, and the increased impacts that winter brings. I have an unfair advantage in Northumberland because Northumbria Healthcare NHS Foundation Trust has been led and built into what it is now under the great auspices of Jim Mackey, whom we lent to NHS Improvement for a couple of years to try to share those skills across the whole NHS. It is lovely for us to have him back, so I thank Ministers for sending him back up to Northumberland.

    As a result of 15 years of intelligent planning by senior leadership, we have had no blanket cancellations in Northumberland, and we have an unchanged schedule except only for specific cases. No clinically time-sensitive operations will be cancelled, and most operations are carrying on as normal. In November, the trust decided to transfer one surgical ward to general medicine to ensure greater capacity—thinking ahead to the regular changes that winter weather tends to bring.

    We have almost no delayed transfer of care in Northumberland, thanks to the sophisticated planning set in motion by Jim Mackey and his team some years ago, working directly with Northumberland County Council so that our social care and our healthcare work hand in glove. It works, and we are doing it in Northumberland. I urge every MP to encourage their councils to build that relationship, because it genuinely works. I also continue to encourage the Government to make sure our accountable care organisation is one of the first to be signed and sealed so that our holistic healthcare family works for patients.

    Flu hit the north-east first, but we are functioning and coping well. Our statistics are good, with bed occupancy at 91%, and yesterday we met our A&E waiting time targets in 95% of cases. Our nursing vacancies are at a historic low of only 1%, again thanks to planning and a positive recruitment campaign in specific staff group areas where we knew there would be shortages. As a result, our nursing agency usage in Northumberland is very low.

    Nothing is ever perfect, so I continue to raise the thorny local issue of community hospitals, where our bed provision is currently lower than it should be. Increased provision would help to relieve pressures caused by delayed transfer of care by ensuring that there is support for those who have a level of vulnerability and who cannot, or should not, go home straight from the acute hospital environment. In a rural patch, community nurses cannot practically provide such support in the way that it could be provided in an urban environment. Community nurses just cannot get to as many places in a day when they have to travel miles and miles between patients. The community hospital framework must be part of the new bigger social care model.

    I thank both the Prime Minister and the Health Secretary for fighting to bring healthcare and social care together in one place, because that will start to do what we already see in Northumberland. I would like every MP to be able to tell the same positive story in the months and years ahead.

  • Here we are again discussing the latest winter crisis in our NHS. I stood here last year and spoke of the horror stories I had heard from my constituents and ex-colleagues, of hospital staff working their fingers to the bone and doing the jobs of two, three or even four people, often without food, breaks or even time to go to the toilet. Yet, 12 months on, here we are again with many of the same challenges and none of the fixes promised by this Government.

    I join my parliamentary colleagues in expressing a huge thank you to each and every one of our hard-working NHS staff—doctors, nurses, receptionists, cleaners, porters, radiographers and everyone else. I often speak of our public sector heroes, and today is no different. Thank you from the bottom of my heart.

    I express a special thank you to the paramedics who rushed my father, my dear dad, into hospital on 28 December. My gratitude is infinite.

    Last year, the Government said the winter pressure was due to more patients being seen by the NHS. That figure is rising year on year, so why have the Government not put sufficient resources in place to deal with it? The Health Secretary previously said there are far more doctors and nurses in our NHS than there were seven years ago. In my area, the Mid Yorkshire Hospitals NHS Trust currently has 230 nursing vacancies, compared with 110 last year, with nursing numbers across the trust down over the same period from 1,752 to 1,607. That picture is somewhat different from the one painted by the Secretary of State, who has used figures that the Library says should be “used with caution” as

    “Changes in the number of staff can sometimes reflect organisational changes and changes in the structure of services, rather than genuine changes in staffing levels.”

    Indeed, staffing levels are so low at Mid Yorkshire Hospitals NHS Trust that the Care Quality Commission has deemed it to be a risk to patient safety.

    My colleagues and I were heavily criticised during last year’s debate for asking the Government to spend more money, and once again we hear the same criticism this year. Will they tell us what the solution actually is? We need more nurses, and obviously there are training implications, but more money is needed to pay for them, and it is the same with doctors. There needs to be less bed-blocking, and more money is needed in social care. It is only right that serious questions are asked in this House when the Budget gives more money to pay for Brexit than to pay for our NHS.

    The sad reality is that NHS deficits are rising astronomically across the country, with multimillion-pound shortfalls being recorded and balancing the books becoming impossible for most trusts. The £350 million made available in the Budget is no more than a drop in the ocean, and it has been proved over and again over the past few weeks that the money does not even scratch the surface.

    And what of the cost of cancelled operations, both to trusts and especially to patients? People are being left in tremendous pain and at significant risk as a result of cancellations. I know of one man who is waiting for an operation to close his skull following life-saving brain surgery earlier this year. The surgery itself is not classed as urgent, but until it is completed, he is at increased risk of death should he bang his head accidentally. As a result, he rarely leaves the house and has to wear a helmet at all times. Another person who contacted me is waiting for a new knee. He is in excruciating pain and is unable to move around unaided. He has been on sick leave for three months and is suffering severe financial hardship as a result of loss of earnings.

    As well as the accounts of cancelled operations, in recent days I have heard stories from local hospitals of six patients being squeezed into four-bed bays with no curtains and no dignity, no lockers and no bells. Patients are being given hand bells or are being told to ask the patient next to them to ring the bell should there be an emergency. Patients are being placed in store cupboards, as we heard earlier. It has now become almost the norm at this time of year—

  • Like many Members, I wish to start by paying tribute to our primary care staff—the GPs, practice nurses, receptionists, community staff and district nurses; all those working in acute trusts in my local hospitals; mental health staff; social care workers; ambulance staff; and of course the volunteers, to whom we owe so much. They are a team, and any part of the NHS is weaker if one part is weaker, which is why I hugely welcome the change in the Secretary of State’s title, whereby we now have Department of Health and Social Care. That is a long overdue move, but we should all welcome it.

    At my local Luton and Dunstable University Hospital NHS Foundation Trust, the increase in activity in recent years has been phenomenal: 83,000 more people were seen in under four hours in A&E in 2016-17 than in 2009-10; 17,000 more operations and 46,000 more diagnostic tests were carried out in 2016-17 than in 2009-10. I pay tribute to the enormous amount of work. There are 166 more hospital doctors and 224 more nurses there now than in 2010. All that is welcome, as was the £1.116 million of extra winter pressure money put in.

    I have spoken to the director of operations at the hospital this morning, and she told me that it was the busiest new year we have seen in a long time and that this situation had started two days before new year and gone on until this weekend. She said things have returned to a more normal basis now and, although they have a number of contingency beds open there, things are nothing like they were over the new year period. I pay tribute to the extraordinary way in which they coped with very difficult circumstances.

    I received a letter on Monday from the East of England Ambulance Service NHS Trust, which said that on an average day it receives 3,000 calls but that on new year’s day, it received 4,800 calls. I defy any ambulance trust in the country to be able to cope with that significantly increased number of calls adequately. Indeed, I understand that on the days before and after the number of calls was also topping 4,000 a day. Our constituents want us to tell it as it is, and I received an email from a practice manager in one of my local surgeries saying that on 4 January there was a six-hour wait for a blue light ambulance. Just as the Prime Minister apologised, I would absolutely want to say, as a Member of Parliament, that I am not satisfied with that situation and we have to try to do better, notwithstanding the heroic efforts made.

    We have committed to train 25% more doctors and 25% more nurses, and I hugely welcome the new nursing associates and nursing apprentices. What are we going to do in future, however, to put the NHS on more of an even keel? Let me briefly suggest six areas where we can make progress: first, it is unacceptable that nearly 10% of NHS England’s budget goes on type 2 diabetes; progress on tackling obesity is vital; more progress on the Getting It Right First Time scheme, which is saving billions for the NHS, will help; I make a further plea to the Treasury to make sure that we stop GPs leaving—those on the old pension scheme are disfavoured by the tax treatment; and we have to drive through the sustainability and transformation partnerships to really integrate health and social care.

  • Thank you for giving me the opportunity to speak in this debate, Madam Deputy Speaker. I have worked in the NHS since 1996, as a doctor, in hospitals, as a GP and as a commissioner of services, and I must say that it feels as though we are going back to the ’90s at the moment, with long waiting times. Even before this unprecedented decision to suspend operations for a month, we were already breaching 18-week targets in many trusts. From a patient point of view, it feels as though the standards are deteriorating, particularly in my constituency, with the difficulty people face in accessing an ambulance when they need it.

    I wish to share two insights into the problem and two potential solutions. My first insight is that, no matter what Ministers say, some of this is about the money. We have seen an anaemic level of growth in NHS funding in the past eight years. As we have heard from others in this debate, we have also seen cuts to social care funding and to public health budgets. We have also had a long-standing underinvestment in prevention, general practice and out-of-hospital care, although I appreciate that that is being reversed now. The money that came in the Budget was too little, too late. It is hard for commissioners and providers to spend that money when they get it at the last minute, because they have to get people to come in to do the work to spend that money. Had the money come earlier, we would have been able to put in place much better contingencies.

    As well as this situation being about money, it is also about having the wrong strategy. There has been planning for reactive services, but at the same time we have been cutting prevention. We have been doing planning for healthcare services, but not enough planning for social care services. We have also been planning by giving this emergency injection of cash into acute hospital services, but while we have been cutting, prioritising and fragmenting community services. We have seen 5,000 fewer community nurses and a 45% reduction in the number of district nurses since 2010.

    What do I suggest should happen now? We need to change the strategy. We cannot just respond by providing more and more acute hospital beds. We need to focus on prevention; on having good-quality community services, community nursing, social care; on having better palliative care, because most people want to be able to die in their own home, not in hospital; and on having more emphasis on screening. We also need to focus on poverty reduction and tackling deprivation, as people living in poverty are much less likely to access prevention and much more likely to be acutely admitted to hospital. I include in that people with mental health problems—the most vulnerable people.

    Integration is the right direction of travel, but we have to change some things about how it is being achieved, the first of which is the name. Calling these organisations “accountable care organisations” lends people to think that this is an idea captured from the United States. We might call them “public health boards”—something that puts the needs of populations at the centre of healthcare and of healthcare planning. We need to make sure that the leadership teams of these organisations are focused on out-of-hospital care and not on just providing more and more acute hospital services.

    There is also a fundamental contradiction to address, because we still have section 75 of the Health and Social Care Act 2012, which mandates competition, yet we are trying to get organisations to collaborate.

    So it does not have to be like this—it is not inevitable. Huge praise must go to the staff, and I myself have done shifts over the short recess. With the right type of investment, the right preventive strategy and proper collaboration, uninhibited by competition, we can do better.

  • It is a great pleasure to follow the hon. Member for Stockton South (Dr Williams), who qualified in 1996. I have about 10 years on him, and since 1984 I cannot recall a winter when there was not talk of pressure. We have to understand that this is not a new phenomenon. I particularly recall the bad winter of 2009, and the very positive way in which the then Opposition approached it and helped the then Government, in the interests of not politicising and not weaponising this issue. It is pity we have not seen the same thing repeated.

    We need to give due credit to managers in the NHS. They come in for a lot of flak all the time, but we have seen a managed process this year and it has taken a great deal of input to make sure we do the best we can to disadvantage patients the least; I pay tribute to that much-maligned group. The only way in which I can see we can make this better is by running a lower bed occupancy rate, which is okay but it has opportunity costs attendant upon it. The reality of doing such a thing, which would avoid the sort of cancellations we have seen this winter, as in any winter, is severe, and I do not think many right hon. or hon. Members would wish to see those things.

    That brings me on to the Commonwealth Fund, which was rightly cited by the Prime Minister earlier in response to my question in Prime Minister’s questions. She was right to say that on access, equity, the care process and administrative efficiency—four of the five points the Commonwealth Fund looks at—the NHS does very well. The problem is with the last one, which is clinical outcomes, where we run 10th out of 11, with the 11th being the United States of America, which nobody here wishes to emulate. We do not do well on clinical outcomes—we do not do well on cancer, on stroke or on heart attack—and we need to do something about it. It is no good citing OECD averages. We need to be comparing ourselves with Denmark, Germany, France and the Netherlands, not with the basket of countries included in the OECD.

    Where does all that lead us? It leads us to a debate about resources. Having talked about management, which is vital, we need to address long-term resources. I entirely support those who wish planning to be done on a 10-year rather than five-year basis. That is vital, and we must also ensure that we have the necessary funding for the improvements we need to achieve to get outcomes up to the level enjoyed by our peer-group nations in western Europe, not the basket of nations with which we are often erroneously compared. How do we do that? We have to take the public with us and work across party boundaries. None of the decisions that will ultimately be made about the future of our national health service in this, its 70th anniversary year, are necessarily going to be easy. It is important that we at least try to get some level of cross-party consensus. We can do that by establishing a body that is above politics. The route to which I am drawn is the establishment of a royal commission, with all its problems.

    The Merrison commission 40 years ago was the last big royal commission that considered matters to do with the health service. It came in for a lot of criticism, but most of its recommendations, made 40 years ago, were ultimately rolled out into Government policy. With the right terms of reference, such a body would be effective. That seems to me to be the right and proper way to deal with the future, particularly the sustainable funding future of our most treasured of national institutions. I very much hope that my Front-Bench colleagues will listen to those of us from all parties—particularly the recommendation from the Centre for Policy Studies this week—who think we should set up a royal commission in this 70th anniversary year to consider the future of our national health service.

  • It is a pleasure to follow the hon. Member for South West Wiltshire (Dr Murrison).

    As a nurse who has worked in the NHS for more than 40 years, I know too well the effects of the winter crisis. Yes, winter is the time when the NHS faces pressures, but the Government have claimed that they were better prepared for this winter crisis, with their national medical director explaining that they had been preparing since last winter. How can that be true when the Government announced that they would postpone non-urgent operations? Not only does that put patients’ physical and mental health at risk, but it creates a backlog of operations, which NHS staff will still have to catch up on.

    Unison spoke out about the handling of the NHS only in February last year. It also highlighted the Government’s promise in their manifesto to properly fund the NHS. In their 2017 manifesto, the Government pledged to give the NHS the resources it needs. In the autumn, they also pledged that the NHS would receive an additional £377 million to ease winter pressures, but they failed to disclose the fact that although they are providing funding, they are undercutting that by asking the NHS to make savings in some areas.

    Where has the funding the Government provided to ease winter pressures gone? The Royal Wolverhampton NHS Trust provides services to the hospitals in Wolverhampton that care for patients in my constituency. Hospital staff have been working under increasing pressure, because for more than half the days between 20 November and 31 December last year, bed occupancy in the Wolverhampton trust was above 90%. Over the same period, one in six ambulance handovers were delayed for more than 30 minutes. This would not be happening if, as the Government claim, the NHS was well prepared.

    There has been widespread outrage over this winter crisis, but NHS staff have been highlighting the pressures on the NHS throughout the year, and for many years. We have campaigned, met the Minister, written articles and held protests about the Government’s treatment of the NHS and the underfunding over the past seven years. When will the Government face the fact that the funding they have provided is simply not enough?

  • I do not want to go through the increase in the number of operations carried out by the NHS, or to describe the enormous pressure of the numbers of people being seen by the NHS—plenty of other Members have already done that. I wish to concentrate on delayed discharges of care, which are an important factor not only when it comes to increasing the throughput of people in the health system, but in ensuring that people do not go into hospital in the first place.

    In Oxfordshire, we have addressed delayed discharges of care in two ways, as part of our future planning for the NHS. First, with respect to the hospital in the town of Henley, I have been among those who have been active in trying to achieve the right balance with social care by ensuring that there are no beds in the hospital. There are beds in the neighbouring care home for those people who urgently need to stay, but all the emphasis is on ambulatory care—the treatment of patients in their own home—on which I have worked closely with the Royal College of Physicians. More and more patients now understand that they can get the right sort of treatment in their own homes and do not have to spend time in hospital. The approach has been taken up on the best of medical advice and I am grateful to the doctors who have supported it. I invite Ministers to come to see for themselves how the hospital works.

    Secondly, we do cross-party work in the county involving all MPs who represent Oxfordshire. I chair the group that has a relationship with the clinical commissioning group, not so much to hold it to account, but to ensure that it is focused on the things on which it says it will focus. One of the CCG’s great achievements is its focus on delayed discharges of care. I shall cite a couple of the figures so that Members will understand the CCG’s enormous achievement over the past year in planning for the better treatment of delayed discharges of care. At the end of December, the number of Oxfordshire patients whose discharge of care was delayed was 96, whereas the number in May had been 181. That is a magnificent achievement, as the number of delayed discharges of care has been almost halved. When Ministers hear about that half, they should understand that it is not a half increase but a half decrease in the number of people whose discharge of care was delayed. That improvement has been achieved by making sure that the right resources are in place for those patients who need them to return home. It has not happened because people are going home without the support that they need.

    Finally, on the story in The Times this morning about Churchill Hospital, I have with me a letter from the hospital saying it has not implemented any changes to cancer treatment whatsoever. I am happy to provide a copy of that letter to the Library so that Members can read it.

  • It is a pleasure to follow that thorough speech by the hon. Member for Henley (John Howell).

    On Monday, I asked the then Minister of State, the hon. Member for Ludlow (Mr Dunne), what the Government were doing about the crisis in the ambulance service. He responded by saying that a new ambulance response programme has been introduced to try to deal with category 1 calls more rapidly. The reality is that two months after so-called improvements were put in place in the north-east, an elderly constituency of mine who collapsed in his own home on new year’s day had to wait 14 hours for an ambulance.

    Last week, in the intensive care unit at the University Hospital of North Tees in Stockton, two people died from influenza on the same day. One of them was a constituent of mine. On new year’s eve, I attended the urgent care centre at the University Hospital of Hartlepool and then the ambulatory care unit at Stockton with my son. The car parks were crammed full, the sick were presenting themselves thick and fast, and the ambulances were once again backed up. When will the Government admit that this is not just a winter crisis, but a crisis in our NHS full stop—a crisis of their own making?

  • I am really pleased to be able to contribute to the debate. Although the Opposition have, as expected, used this occasion yet again to weaponise our NHS, I want to take this opportunity to praise it and all those who work in it, particularly in my constituency, where the staff at Southport Hospital are professional, dedicated and hard-working.

    There will always be times when our NHS comes under great pressures, and winter is one of them. That was why, in 2017, the Government and the NHS began preparing for the winter earlier than ever before. Last autumn, the Secretary of State visited my local hospital. He had a meeting with me and the interim chief executive in which we talked through the plans that had been put in place for the coming winter, as well as paying tribute to excellent staff who had work