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House of Commons Hansard
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Commons Chamber
27 November 2018
Volume 650

House of Commons

Tuesday 27 November 2018

The House met at half-past Eleven o’clock

Prayers

[Mr Speaker in the Chair]

Oral Answers to Questions

Health and Social Care

The Secretary of State was asked—

Local Pharmacies

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1. What steps he is taking to support local pharmacies. [907848]

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Community pharmacies play a vital role in our health service, but we know they can do more, and we are determined to see them do more, to keep people healthy.

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I am grateful to the Secretary of State for that answer, because he is absolutely right in what he says. The Dorset Local Pharmaceutical Committee is very active and is promoting the policy of Pharmacy First, which should help to relieve pressure on our general practitioners, and even on our accident and emergency facilities. What is he doing to support that policy?

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I agree very much with my hon. Friend that pharmacies can play an increasing role in helping to make sure that people get their healthcare where they need it, and in keeping the pressure off GPs and off secondary care by making sure that people can help themselves to stay healthy. We are piloting 111 directing people to pharmacies as well as to GPs and, where appropriate, to secondary care, and encouraging people to use pharmacies for minor ailments, but there is much more we can do together on this.

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The NHS Confederation has warned that, following Brexit, the supply of some medicines and medical technologies may be delayed in reaching patients, and some may not be available at all. The chief executive officer of the Association of the British Pharmaceutical Industry has been clear that we cannot stockpile the amounts we are going to need, because we do not have sufficient cold warehouse storage. The Medicines and Healthcare Products Regulatory Agency is worried therefore that diabetics will not be able to access insulin. What steps is the Minister taking to ensure that community pharmacies are able to supply vital medical supplies post Brexit, particularly in the event of no deal?

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Community pharmacies, like everybody else, should support the Prime Minister’s deal, which will make sure that that eventuality does not occur.

NICE Guidance: Head Lice

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2. What assessment he has made of the potential merits of reversing NICE guidance prohibiting the prescription of head lice treatment by GPs. [907849]

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In the year to June 2017, the NHS spent approximately £569 million on prescriptions for medicines that could be bought over the counter from a pharmacy or supermarket. That is why, following public consultation earlier this year, NHS England issued guidance to reduce the routine prescribing of some medicines for minor, short-term ailments, including head lice treatment.

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Yesterday, I met people from the charity Community Hygiene Concern, which provides cheap, reusable and effective bug-busting kits for less than £5. However, because of these NHS prescription guidance changes, these kits are no longer available, which threatens an epidemic of head lice in our schools. Surely head lice should not be considered a minor ailment. Will the Minister please write to Simon Stevens to encourage him to meet me and Community Hygiene Concern to look at this issue again?

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I have been itching all morning while thinking about this answer. I do not believe there is an epidemic because of NHS England’s actions. Clinical experts in the NHS advise that head lice can be safely and effectively treated by wet combing; I have very recent personal experience of doing this, as I am sure do many parents in this House. Chemical treatment is recommended only in exceptional circumstances. I had not heard of the charity the hon. Lady mentions, but as we discussed before questions, I am happy to facilitate that interaction.

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In France, where head lice are more common per capita than in the UK, people make good use of pharmacies, because it costs money to visit a general practitioner and because the state promotes the role of pharmacies. May I therefore ask the Minister why do we not advertise that we should be using pharmacies more often than not, instead of going to a GP?

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Unfortunately, that has nothing to do with the matter of head lice. [Interruption.] It seemed to be slightly tangential, but never mind. The hon. Gentleman was at least attempting to shoehorn his preoccupation into the question, but I will err on the side of generosity. I know that he knows all about heads and all about hair—

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But not lice!

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Indeed.

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I do not know whether my hon. Friend is familiar with wet combing his hair.

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Only with my gel.

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Only with his gel. He is absolutely right that, as the Secretary of State just said, community pharmacies are experts in so many minor health matters, and Pharmacy First can absolutely be used when it comes to head lice as well.

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rose—

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Is the hon. Gentleman feeling jumpy or does he wish to contribute?

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I was just nit-picking.

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Ah, the House is in a very jocular mood. Long may it last.

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It will soon be Christmas.

Public Health Funding (Local Authorities)

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3. What recent representations he has received on the potential merits of increasing public health funding to local authorities. [907850]

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We have had lots; it is just that none come with any idea of how that might be paid for. The Government have a strong track record on public health. Local authorities in England have received more than £16 billion in ring-fenced public health grants over the current spending period. Decisions on future funding for that area of spending are of course for the next spending review.

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On current projections, over £800 million will have been cut from public health budgets by 2021, £2 million of which has been cut from vital services in my constituency relating to sexual health, and to tackle obesity and smoking. Will the Minister guarantee that the new NHS long-term plan will reverse the cuts to public health budgets?

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I know that Opposition Members like to pretend that the past eight and a half years did not have to happen, but there is a reason why they had to happen—the economy was crashed—and eight and a half years is not a long time to clear up the mess of the last Government. But we are very clear, as the hon. Gentleman should know, that a focus on prevention will be central to the long-term plan. He mentions child obesity—[Interruption.] Opposition Members may wish to listen. The public health grant remains ring-fenced and protected for use exclusively on improving health, but local government spending on health is not just about the public health grant. The Government spend money on many other things, including around the child obesity plan and vaccinations, and that is all around prevention and public health.

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Far too long.

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As local government is reorganised in Northamptonshire ahead of May 2020, will the Minister consider whether it may not be appropriate in all cases for local councils to manage public health budgets, and whether in some cases it might make sense for the NHS to regain control?

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There are active discussions going on between my right hon. Friends the Health Secretary and the Secretary of State for Housing, Communities and Local Government about this, but the bottom line is that Parliament legislated through the Health and Social Care Act 2012 for local authorities up and down the country in England to be public health authorities. We believe that they are well placed to make these spending decisions with the ring-fenced grant—£16 billion —that we have given them.

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The underfunding of public health in Cumbria means that the NHS spends only 75p per child per year on preventive mental health care. Added to that, over three quarters of young people with eating disorders are not seen within the target time of a month, and in the event that they are seen, there is no specialist one-to-one eating disorder service to see them, despite the Government promising three years ago that there would be. Will the Minister meet me and our local NHS so that we can get a better deal for our young people on all three of these points?

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The hon. Gentleman will remember, of course, that £1 billion extra was put into mental health in the Budget last month, but I would absolutely be interested to hear from him. There are very good things going on up and down the country in local authorities with the ring-fenced £16 billion that we have given them. We are very interested to hear about where there are good examples of things going on, and the long-term future discussions around them will take in the spending review, as I have said.

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The Secretary of State claims that prevention is one of his top three priorities, yet this year alone the Government have slashed public health budgets by £96 million. That includes cuts to smoking cessation services, sexual health services, obesity and addiction services and many more. This affects the most vulnerable in our society, so will the Minister do the right thing today and cut the rhetoric, commit to reversing these damaging cuts to public health, and put funding in the long-term plan?

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The hon. Lady—my shadow Minister—knows that I have a great deal of respect for her. She mentioned smoking; smoking rates in England are at their lowest ever levels. We hear spending commitment after spending commitment from the Labour Government; it is like the arsonist turning up at the scene of a fire. I will take very seriously, as I am sure will the Treasury, her bid towards the spending review discussions, but yes, prevention is better than cure and it will be at the heart of the long-term plan.

Healthier Lives

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4. What steps he is taking to support people to lead healthier lives. [907851]

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17. What steps he is taking to ensure that people take greater personal responsibility for leading healthier lives. [907867]

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Prevention is indeed better than cure. As well as having a right to expect NHS services to be free at the point of use, we all have responsibility for our own health, and to use the NHS responsibly.

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I recently met Breast Cancer Now—the Secretary of State will be aware of it. It has 10 priorities for the NHS long-term plan. Has he made an assessment of the impact of the real-terms 5% cut in public health budgets on reducing the incidence of cancer?

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There are many things we need to do to diagnose cancer early, and of course public health is part of that, but there is a much bigger agenda, and that includes more screening. We have seen an increase in the number of people invited to screening, but we need to get the screening right, so I have instituted a review of all our screening processes for cancer and other diseases.

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Will my right hon. Friend look at the work done by Connect Well Bromley, a partnership funded by the local clinical commissioning group but delivered by Bromley Third Sector Enterprise and Community Links Bromley? That partnership sets out what is in effect a social prescribing programme of activities and services to deal with wellbeing issues at an early stage. Is that a model for elsewhere in the country?

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Yes, it is. I have been briefed on the example that Bromley is setting, which has been brought to my attention by its brilliant local representative, my hon. Friend. Social prescribing systems such as this one are on the rise, because the evidence shows that social prescribing helps to keep people healthy and out of hospital.

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A fortnight ago, during his statement to the House on prevention and how the Government intend to keep our nation well, the Secretary of State told me that he would look at my Health Impacts (Public Sector Duty) Bill, which had its Second Reading on Friday. Unfortunately, on Friday, the Government objected to my Bill. Which elements of the Bill did the Secretary of State object to?

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I know the hon. Lady has done an awful lot of work on this, and I respect that work. We did look at the Bill, but we thought it was, unfortunately, technically deficient. I know she cares a lot about this, however, as do I, and I want to work with her to see what we can do.

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According to Office for National Statistics figures, over the past five years, there have been 150,000 excess winter deaths—a mortality rate twice that in Germany and Norway. What specific work is the Secretary of State doing to reduce the number of deaths this coming winter?

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This year, since I became Secretary of State, we have put an extra £420 million in to make sure we are as well prepared as possible. The NHS is of course under pressure, although it is performing exceptionally well, in terms of how much it does for the money going in, and from next year, we will put in the extra £20 billion. I want part of the long-term plan to be about how we can plan for the long term, instead of having this annual cycle of winter pressures.

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Earlier this year, I had the pleasure of joining volunteer leader John Goodwin and others on a health walk around Capstone park in my constituency—one of a number of health walks supported by Medway Council. Will the Secretary of State join me in encouraging more GPs to prescribe walking as a gentle, low-impact form of exercise that is suitable for all ages and abilities?

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With enthusiasm, I endorse the call from my hon. Friend, who did so much work on this at the Department for Digital, Culture, Media and Sport, both before I was in that Department and when I was Secretary of State there. She made the case brilliantly, and she continues to do so. She is absolutely right.

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18. Everyone in the House is indebted to public health workers, who help us to lead healthier lives, be they in local authorities or the NHS. Many of them are EU nationals. Does the Secretary of State share my concerns about the term “queue jumpers”? Will he apologise for it, and will he go further and make sure that no public health worker faces additional costs to remain in their home in the UK? [907868]

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Every EU worker across our health and social care system—whether in the NHS, or working in public health, in local authorities or in social care—is welcome here, and is supported to be welcome here, and we look forward to the settled status scheme rolling out. We are grateful for their service.

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GP appointments are vital for many to lead healthy lives, so will the Secretary of State give his strong personal support to the work of our fantastic GPs, and encourage the NHS to put general practice at the heart of the £20 billion future plan?

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Yes. General practice will be at the heart of the long-term plan. GPs are the bedrock of the NHS. We will put an extra £3.5 billion, at least, into primary and community services to help keep people healthy and prevent them from going to hospital.

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The Secretary of State got into a muddle last week with his GP figures, so may I suggest that he download an exciting new app to his phone? It is called a calculator. He has said that there will be more for community and primary care by 2024. Can he guarantee that there will be the extra GPs and district nurses to provide the services that he is promising?

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Yes, I can; given that we have the money coming into the NHS, we are doing everything possible to ensure that we have the people to do the work. I am delighted to say that we have a record number of GPs in training right now.

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But GP numbers have gone down by 700 in the last year, have they not? There are 107,000 vacancies across the NHS, acute trusts are closing accident and emergency departments overnight, the closure of chemotherapy departments is being considered, and Health Education England’s training budget is the lowest that it has been for five years, with more cuts to come next year. Does the Secretary of State agree that if the long-term plan that he will publish next week is to be credible, he must reverse those training cuts and deliver the staff that our NHS needs?

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That was a bit of a surprise, because the hon. Gentleman is normally such a reasonable fellow. I thought that he would welcome the record number of GPs in training, and the record number of nurses in the NHS. Because we love the NHS, of course we want to do more, and we will.

GP Access: Learning Disabilities

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5. What assessment he has made of the ability of people with learning disabilities to access GPs. [907852]

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People with learning disabilities still face significant health inequalities. Data from 2017 shows that about half of patients with a learning disability received an annual GP health check, and our target is 75% by 2020. We will shortly consult on plans to introduce mandatory learning disability and autism training for all health and care staff.

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There are shocking health inequalities between people with learning disabilities and the general population, and that is recognised by GPs: 60% say that they have received less than a day’s training in how to meet the needs of patients with learning disabilities and autism, while 98% say that they would appreciate more training. The Government are clearly failing people with learning disabilities. Will they commit themselves to ensuring that every new GP who is trained in England is also given training in how to meet the needs of people with learning disabilities and autism?

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Yes. That is already part of the training framework. As I have said, however, we are consulting from early next year on plans to make training on learning disabilities and autism mandatory for all health and care staff, not just medical professionals.

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Let me start by thanking my right hon. Friend the Secretary of State for his support last Thursday on 22q Awareness Day; 22q11 deletion syndrome is second only to Down’s syndrome in its prevalence as a genetic condition, but perhaps surprisingly, there is a remarkably low level of awareness among GPs of this condition, which can lead to avoidable mental health issues in children. Will the Minister meet me to discuss options to increase awareness in the first instance, but also to improve early diagnosis and treatment?

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I congratulate my hon. Friend on all the excellent work that he is doing to draw attention to this condition, and I should be happy to meet him.

Health Inequalities (England)

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6. What assessment he has made of recent trends in the level of health inequalities across England. [907853]

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We know from recent trends reported to the public health outcomes framework that health inequalities persist in this country. We already have world-leading programmes to address the root causes of poor health, including programmes to deal with childhood obesity, control tobacco and prevent diabetes and heart disease. The Prime Minister has set an ambition to ensure that people can enjoy at least five extra healthy independent years of life by 2035, while narrowing the gap between the experiences of the richest and the poorest, and next year the Secretary of State will set out further plans to achieve that in his prevention Green Paper.

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We have known for decades that poverty and economic inequality drive health inequalities. The richer people are, the longer they live, and the longer they live in good health. In addition to the economic analyses of the Prime Minister’s Brexit deal, what assessment has the Minister made of the deal’s impacts on health inequalities, and on life expectancy and healthy life expectancy, which we know are already falling in some parts of the country, and among some groups of people?

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The reasons for health inequalities are complex, but obviously we encourage people to make the lifestyle changes that enable everyone to live longer. I simply do not accept that the direct causality that the hon. Lady has outlined is as clear as that. We will focus on programmes that help people to lead healthier lives with better diets; that tackle tobacco control; and that prevent diabetes.

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As it is the most deprived children who are most overweight, will the Minister call on Kellogg’s to follow the example of Nestlé and put traffic light colours on all its products so that people can make healthier choices?

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My hon. Friend makes an excellent point. Clearly the more we can do to educate people to make informed choices to improve their diet, the better. He is absolutely right: poor health among children used to be indicated by being underweight, but now being overweight is very much an indicator. I congratulate any food manufacturer that is taking action to address the problem.

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The Minister and the ministerial team know that many working-class people do not have good access to GPs, and that GPs treat them differently from more middle-class people, as demonstrated by the number of people from poorer backgrounds with atrial fibrillation who are wrongly diagnosed. If they are diagnosed with an irregular heartbeat or pulse, they are given the wrong drugs. That happens to many ordinary people in this country: there are still all these wonderful GPs prescribing aspirin that will do no good at all. What is going on with GPs and poorer people?

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Our NHS is full of people who are doing their best to deliver the best possible care for all their patients. It is important that GPs and any health practitioners consider the holistic needs of all their patients—

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They’re killing people.

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The hon. Gentleman says they are killing people; that is not the debate I want on the NHS.

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Scotland has the lowest life expectancies of all parts of the United Kingdom, with the figures falling for the first time in 35 years. The average life expectancy in 2017 was 77 years for men and 81.1 for women, compared with 79.2 for men and 82.9 for women in the rest of the UK. What can my hon. Friend do to support the devolved Administration to ensure that Scotland is not left behind the rest of the United Kingdom?

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My hon. Friend is right to draw attention to that. I am always very keen to work with the devolved nations to both learn from what they do well and to share our expertise and experience where we are doing better, and I hope we will all co-operate to do exactly that.

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Initiating breastfeeding at birth can help reduce to health inequalities. Due to the actions of the Scottish Government, breastfeeding rates in Scotland are at a record high, whereas in England they are falling back dramatically because of local cuts. What will the Minister do to increase breastfeeding rates in England?

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I commend the hon. Lady for her leadership on the issue, and she is right that this is one of the most significant public health interventions we can make at the earliest point in life. I will happily line up with her to do more to champion breastfeeding, and there is certainly a lot further to go, not least in ensuring that society is more tolerant of the practice and that women really do enjoy their right to breastfeed.

Childhood Obesity

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7. What steps he is taking to tackle childhood obesity. [907855]

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In June we published chapter 2 of our child obesity plan, which built on the world-leading measures we introduced in 2016, including bold new measures to halve child obesity by 2030.

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Will the Minister join me in welcoming the launch this week of South Gloucestershire Council’s Reach programme? It is an evidence-based service for obese and overweight children aged between four and 16 in South Gloucestershire and their families, aimed at improving the wellbeing of young people and building their esteem, and raising issues of weight gain between and among families.

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I certainly will; we need a collective effort to achieve the national ambition of halving child obesity by 2030, and that means we need local initiatives such as the Reach programme to support families and help them make positive lifestyle choices. I pass on my congratulations to South Gloucestershire Council on its programme.

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22. Many children who are referred for treatment with problems related to being overweight might be suffering from eating disorders. Eating disorders come in all shapes and sizes, from anorexia right through to body dysmorphia. However, a recent ombudsman report says many people are facing longer waiting times and not receiving the help they need. Will the Government now prioritise ensuring people with eating disorders get the treatment they need? [907872]

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Through our work on parity of esteem for physical and mental health, we take eating disorders very seriously. That is not directly related to the child obesity plan, but we are absolutely determined to tackle weight challenges at either end of the scale, because I know that they affect a lot of people.

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Obesity is now one of the biggest risks to health and a significant cause of cancer and other conditions. Is it not time to look at restricting the advertising of junk food up to 9 o’clock?

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I have a lot of time for the hon. Gentleman and do a lot of work with him. He knows that we published proposals in the child obesity plan to launch a consultation on a pre-9 pm watershed ban, and we will be bringing that forward before the end of the year as promised.

Young Cancer Sufferers: Costs of Travel

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8. What estimate his Department has made of the number of children and young people with cancer who are unable to access treatment due to the cost of travel. [907856]

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No child or young person with cancer should be unable to access the treatment they need because of the cost of travelling to hospital. Through the healthcare travel costs scheme, which is part of the NHS low income scheme, parents in receipt of a qualifying benefit or on a low income can claim for the reimbursement of travel costs for their children’s treatment. To date, the scheme has helped some 337,000 people.

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CLIC Sargent, the charity for children with cancer, has shown that families in my constituency with children with cancer can face a 54-mile round trip to get to their nearest treatment location, which can cost them up to £161.58 a month. Families are incurring thousands of pounds of debt paying for parking and driving their children to their cancer treatment. Does my hon. Friend acknowledge that only 6% of parents of children with cancer are reported as having received financial help from the NHS healthcare travel costs assistance scheme? Does he recognise that the scheme is not designed to meet the needs of children and young people who need highly specialised treatment—

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Order. Far too long.

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Yes, we do recognise that there is a challenge there. I gave evidence to the all-party parliamentary group on children, teenagers and young adults with cancer, and I have a copy of the “Listen Up” report here. CLIC Sargent is part of the secretariat for that group. We are looking at this issue through the long-term plan, and I look forward to meeting my right hon. Friend along with CLIC Sargent in the next few weeks as planned.

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An exemplar of eloquent brevity: Helen Jones.

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Access to services is very important for those in the poorest areas of my constituency. Warrington Hospital has been losing services over time, but it has now sought to become a cancer hub for north Cheshire. Will the Minister ensure that, in the case of such applications, access to services for the poorest people is considered along with other factors?

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Yes, we are interested in access to services for all people, wherever they are on the income scheme. The hon. Lady is right to raise that issue. We need to do better on cancer diagnosis, so I would be interested to hear more about the cancer hub that she mentions.

Sexual Health Services

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9. What recent assessment he has made of trends in the level of demand for sexual health services. [907858]

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Since 2013, when local authorities took on responsibility for these services, attendance has increased from 2.9 million to 3.3 million. Tests for sexually transmitted infections and access to long-acting contraception have also increased, which shows that people are taking their sexual health seriously and that services are responding.

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Unfortunately, syphilis and gonorrhoea diagnoses are up 20% since 2016. What are the Government going to do to address this growing trend, given that sexual health services are at their limit?

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The evidence I have is that sexually transmitted infection rates are stable, that rates of teen pregnancy are falling, that rates of abortion are stable and that rates of HIV testing are increasing. However, the hon. Gentleman raises an important point, and I will look into it. The most important thing is not necessarily where or how people access their services, because we want to make tests and long-term contraception available online too. We will keep the issue under review.

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Does the Minister agree with the chief medical officer, who said in her evidence to the Health and Social Care Committee that she thought the cuts to sexual health services had gone too far?

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As I said in my previous answer, the important thing is to look at outcomes. We can see that levels of teen pregnancy and sexual infection are stable and that more people are accessing contraception. We need to ensure that people can access contraception in the most convenient way for them, and we can see that rates of access are on the increase.

Community Hospitals

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10. What his policy is on the future of community hospitals. [907859]

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Community healthcare plays a vital role in helping people stay independent and healthy. Last week, the Prime Minister set out a major new investment in primary and community healthcare worth £3.5 billion a year by 2023-24.

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I am extremely grateful that my right hon. Friend the Secretary of State came down to East Devon on his first visit outside London. He was able to visit the health and wellbeing hub that we have created in Budleigh Salterton, learn about the beds that we have kept in Sidmouth and Exmouth, and see Ottery St Mary Hospital. Will the Minister instruct all her officials to work collectively with us and the local community in Ottery St Mary to ensure that the hospital has a great future and fits in with the rest of local healthcare provision?

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First, I congratulate my right hon. Friend on his elegant Movember facial decoration. I very much recommend that he keeps it.

My right hon. Friend the Secretary of State was delighted to visit the East Devon constituency recently, where he was impressed by the work at some of the existing community hospitals and care hubs and discussed with Royal Devon and Exeter NHS Foundation Trust how it will work on a sustainable future for the constituency’s community hospital in Ottery St Mary.

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Since the Department says that it likes community hospitals, why are services and wards closing at the Richardson in Barnard Castle?

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We know that patients prefer to be treated in their local area, which is much better for preventing hospital admission and getting people out of hospital for longer. However, such clinical decisions must be taken at a local level in consultation with local people.

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Dartmouth has lost its much-loved community hospital. Unfortunately, that loss has been compounded by the closure of River View nursing home, which had been due to house some replacement facilities. The total loss of community beds in isolated coastal communities such as Dartmouth is causing a collapse of trust in such programmes. Will the Minister meet me to discuss the situation in Dartmouth and the loss of nursing home and community beds?

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I will of course meet my hon. Friend. She is right that we need to keep such valuable local resources right in the community, where they are most needed and where they keep people out of acute hospital services and surrounded by their friends and family.

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The usage of Caithness General Hospital in Wick in my constituency is way below what it was originally designed for, causing my constituents great anxiety if they have to travel over 200 miles to Inverness and back. Mr Speaker, you will tell me that such matters are devolved, so will the Government share best practice on community hospitals with the Scottish Government and NHS Highland?

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What a wily fellow to get the question in order. Well done, man.

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I am happy to work with our colleagues in Scotland to push forward best practice in helping to support community facilities and to ensure that they are investing in facilities at the heart of people’s local areas, which is where they are needed.

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Wantage Community Hospital was built and opened by the local community in 1927, but it has been closed for two years. Moves are afoot to improve both our local health centre and health facilities in Didcot, but all that must be joined up and the community needs an answer. Will the Minister use her power to convene a meeting of local stakeholders and her officials to find a way through the maze and a future for our hospital?

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I am always happy to speak to my right hon. Friend about such things. I understand that the intention is now to move to a more place-based approach to health and care planning in his local area, but all such changes are subject to consultation.

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I will be honest, I am confused. We have heard the Minister say several times that community approaches are important, but our walk-in centre in Eastham is yet again being threatened with closure. Which is it—do this Tory Government want crowded A&Es or proper walk-in centres that will prevent people from unnecessarily ending up at A&E?

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I do not think I can make it any clearer: this Government are committed to providing community services right where people need them, and we are putting our money where our mouth is. Last week, the Prime Minister announced a major new investment in primary and community healthcare of £3.5 billion.

A&E Targets

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11. What the timetable is for the NHS to meet its target of seeing 95 per cent. of A&E patients within four hours. [907860]

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rose—

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Hear, hear.

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Thank you very much.

The Government’s mandate to NHS England for 2018-19 clearly sets out A&E performance, and it will see performance improve. So far this year 18 million more attendances have been seen within the standard, and the NHS is introducing more options for urgent patient care. Of course, as the hon. Lady will know, the extra £20 billion a year that is going into the health service will ensure that more patients are seen in A&E.

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According to a recent poll of doctors by the Royal College of Physicians, almost six in 10 doctors report feeling very worried or worried about the ability of their hospital to deliver safe patient care over the winter period. What is the Secretary of State or the Minister doing to help our hard-working NHS staff provide the best possible care for patients?

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The NHS faces a challenging winter, but it has been planning throughout the year for this winter. It has been supported by an extra £420 million to redevelop A&Es, improve emergency care and help patients get home quicker. Those plans, more directly, include reducing the extended hospital stays we saw last year, increasing access to GP appointments and increasing the volume of cases that can be treated by emergency dentists.

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Last week I visited the A&E at County Hospital, Stafford, which achieved 95.8% on the four-hour target in the week beginning 22 October and has consistently achieved over 95% for the past few months. Will the Minister come to Stafford to see what a great job it is doing, and to see how we can use County Hospital more and bring more services into it?

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My hon. Friend has always been an assiduous advocate for his constituents and their concerns. He is right to make that case today. He is also right that, thanks to the hard-working staff in his hospital and across the country, the four-hour target continues to be met for nearly nine out of 10 patients. I will be delighted to come to Stafford.

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Does the Minister agree that what considerably exacerbates A&E waiting times at the weekend is when, on occasion, our highly valued NHS staff come under attack? We should have a zero-tolerance approach to any attacks on those highly valued members of staff.

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The hon. Gentleman is absolutely right. There can be no statement other than complete condemnation of attacks. We have changed the law, and it came into force earlier this month.

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I welcome the Minister to his place. Although he is new, he will know that the A&E waiting target is not a recent initiative. It is a key part of the NHS constitution, but it has not been met for over three years. If he cannot make a commitment today on when the target will be met, will he accept that, at least for this winter under this Government, the NHS will once again be underfunded?

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As I said in my earlier answer, we recognise that this winter will be challenging. We recognise that the A&E performance standard is not currently being met, but, as the hon. Gentleman knows, we are investing an extra £20 billion in the NHS to ensure that the standards are met. The NHS will use that investment to treat 250,000 more patients and to improve A&E performance across the country.

Nursing Higher Education

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12. What recent estimate he has made of the number of people entering nursing higher education; and if he will make a statement. [907861]

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The latest UCAS data from October 2018 show that demand for nursing courses remains strong, with applications exceeding the number of places available this year. The number of acceptances to nursing and midwifery courses in 2018 is consistent with earlier years at approximately 22,000. The final data will be published in December 2018.

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Does the Minister accept that student nurses face pressures from the long hours they have to study and the long hours they spend on placements, which makes it very difficult for them also to carry out paid work? Is there any more the Government can do to support student nurses financially as they go through college?

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As my right hon. Friend the Secretary of State said earlier, we recognise the vital role that nurses play, and we are determined to support them. We are determined to have more nurses in training and more nurses treating patients. At the moment, a student on the loan system typically achieves 25% more in their pocket than they would have had on the bursary, but the Government recognise that there are still pressures, which is why we have the learning support fund, the exceptional hardship fund and support for mature students.

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I talk to local employers who desperately want to support nursing apprenticeships as an alternative to the higher education route, but the uptake of apprenticeships is very disappointing. The levy can be used only for training costs, and trusts have been asked to plug the shortfall in funding for wider capacity building and to cover the 20% of time for which apprentices have to go to off-the-job training. Does the Department recognise this problem? What is being done to address it?

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The hon. Lady is right that the number of trusts that currently use the levy is not as high as it should be. We hope that all will do so. It continues to be a priority for us to broaden the routes into nursing. We will address in the long-term plan the specific matter about which the hon. Lady talks.

NHS: Workforce Vacancies

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13. What estimate he has made of the level of workforce vacancies in the NHS. [907862]

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The NHS employs more staff now than at any other time in its 70-year history. It has recruited 18,200 more doctors and 11,000 more nurses are in our wards since 2010. NHS Improvement publishes vacancy rates using provider information. As the hon. Gentleman will know, the record investment that the Government are providing will ensure that the number of vacancies reduces.

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With Suffolk’s only psychiatric intensive care unit having been closed down from April to October this year because of lack of staff, and with a two-to-three-month waiting list for counselling, does the Minister not understand that his reassurances do not bear much relationship to people’s lived experience?

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I am aware that the local trust has had a number of problems and that there were a number of bed closures—both temporary and permanent —earlier this year. The trust is closely monitoring how those closures are affecting services and patients. The hon. Gentleman will know that beds are being reopened—five beds have been reopened recently—and that there is a plan to put in place the staffing so that the whole ward can reopen in the near future.

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19. The Department’s own statistics show that more than 23,000 mental health staff left the workforce last year. That is an eighth of the total mental health workforce. How can we possibly get parity for mental health when more than one in 10 posts are vacant and staff are leaving? [907869]

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The hon. Gentleman will know that the Government are committed to having more nurses and more staff in training, that we are putting in place extra measures to ensure that specialities are supported through that training process and that the extra £20 billion in the long-term plan will ensure that there are the staff and nurses needed to fill those vacancies.

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We are running over time, so very briefly, please, Dr Philippa Whitford.

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Last week, the Secretary of State claimed that the number of GPs in England had increased by more than 1,000 from June to September, when the data actually showed a drop of 10 full-time equivalent doctors. In 2015, his predecessor promised an extra 5,000 GPs by 2020, but so far there are 1,000 fewer, so how does the Secretary of State plan to meet that target in just the next year?

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As the hon. Lady knows from a previous answer, we are committed to making sure that 5,000 extra GP places are available. There are more GPs in training than before, and 52,000 nurses are now in training. We will ensure that the number of GPs in training meets the target.

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I find that hard to believe when there is only a year left of the five-year promise.

Scotland has 30% more GPs per head of population, but last year we lost 14% of our EU doctors, and England lost 19%. Does the Secretary of State recognise that the hostile language of the Brexit debate is making the UK seem unwelcoming and making it harder for all four UK health services to recruit?

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There are currently more doctors from the EU treating patients in the national health service than on referendum day. We are committed to the 5,000 target.

NHS: Long-term Funding

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14. What steps he is taking to ensure that the NHS has sufficient long-term funding. [907863]

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We are increasing the NHS budget by £20.5 billion in real terms over the next five years. It is a major investment to make sure that the NHS is there for us all.

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Royal Stoke University Hospital continues to be in financial special measures, and local clinical commissioning groups are now projecting significant overspends in their budgets. How will the Secretary of State ensure that stressed health economies such as those in Stoke-on-Trent and Staffordshire get a significant share of the additional £20.5 billion?

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Clearly, part of the £20.5 billion of extra funding that taxpayers are putting into the NHS over the next five years is for ensuring that services can be put on a sustainable footing, and that includes some of the highly stressed services such as those in Stoke.

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How do the Government plan to use funds to better identify perinatal mental health problems? Half of all women with perinatal mental health problems say that the current system does not identify their need.

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I very much agree with the premise of the hon. Gentleman’s question. We need to do much more on this subject. It is incredibly important, and there will be more to hear in the long-term plan.

Leaving the EU: Medicines and Medical Equipment

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15. What assessment he has made of the effect of the UK leaving the EU on the ability of the NHS to access medicines and medical equipment. [907864]

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20. What assessment he has made of the effect of the UK leaving the EU on the ability of the NHS to access medicines and medical equipment. [907870]

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The deal that the Prime Minister struck to leave the EU will ensure access to medicines and medical equipment, so it is another good reason to vote for the deal.

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In the event of no deal, what steps would be taken to secure the supply of medicines beyond the six-week stockpile that has been recommended by the Government to the drug companies?

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Well, of course, while voting for the deal is the best way to ensure the unhindered supply of medicines and medical devices, as a responsible Government we are also planning for the unlikely event of no deal, and that planning includes ensuring that we can continue to get unhindered access after the six weeks for which we are making sure that supplies are available.

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We are currently an influential member of the European Medicines Agency, which gives patients access to new medicines six months sooner than non-members. Given that the political declaration reduces us to exploring the possibility of co-operation with the EMA, will the Secretary of State admit that there are no guarantees for patients and that it is very likely that they will have to wait longer?

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No, because in the event, under any circumstances, we will make sure that there are no further burdens on ensuring that medicines can get licensed here so that patients can use them, but it is another reason why the hon. Lady should vote for the deal.

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rose—

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I will call the right hon. Lady on the condition that she can ask her question in one relatively brief sentence. [Interruption.] No? Go on, you can do it.

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Many people say that the much-heralded £20 billion extra for the NHS is some sort of Brexit dividend. In the event that our country remains in the European Union, will the Secretary of State confirm that that extra 3.4% a year will continue and that £20 billion will be made available to our NHS?

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I am afraid that I will have to let my right hon. Friend know that we are leaving the European Union on 29 March.

Traditional and Western Healthcare

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16. Whether he has made an assessment of the effectiveness of integrated traditional and western medicinal healthcare services in (a) the People’s Republic of China, (b) France and (c) India for the forthcoming NHS 10-year plan. [907865]

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The NHS long-term plan, backed by the extra investment by 2023 and confirmed by the Chancellor in the Budget, will set out a sustainable vision for the NHS to make strides towards it being the safest, highest-quality healthcare system anywhere in the world, learning from everywhere and anywhere in the world over the next 10 years.

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According to the flyer for the post-launch party, the integrated care systems will be considered. Will the Minister make sure that he looks at the use of homeopathy by French pharmacists, the three quarters of a million doctors using traditional healthcare in the Ayush Ministry in India and the 55,000 state hospitals using acupuncture in the People’s Republic of China?

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The NHS should always look to learn from the best healthcare systems and practices anywhere in the world provided they are backed by evidence.

Topical Questions

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T1. If he will make a statement on his departmental responsibilities. [907873]

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This month, we launched our vision for the prevention of ill health that sets out measures to help increase life expectancy by at least five years because prevention is better than cure. We need to give people responsibility for their own health, while empowering them to make the right decisions in the right way. We are also saving more than £1 billion on the NHS drugs budget and committing more than £3.5 billion to primary and community care. Next month, we will publish the long-term plan for how we spend the extra £20 billion committed to the future of the NHS.

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19 November marked the three-year licence of the cystic fibrosis drug, Orkambi, in the UK, which is still not available on the NHS. Will the Secretary of State confirm whether there has been any further consideration to provide interim access to this treatment for patients, such as my constituents Annabelle Brennan and Cameron Jameson, while these negotiations continue?

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The NHS and the National Institute for Health and Care Excellence have written to Vertex, the company involved. I am determined to see progress. We have made the largest ever proposal to Vertex, at half a billion pounds. It needs to engage with this very generous offer, which will mean that everyone wins, most of all those suffering from this awful condition. The ball is in Vertex’s court.

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The learning disabilities mortality review—the LeDeR—investigated 1,000 early deaths of people with learning disabilities in hospital settings, but today major concerns have been raised by the parents of Oliver McGowan about the way in which some deaths have been investigated. The Secretary of State knows that 40 autistic people and people with learning disabilities died in assessment and treatment units, and he has called for a year-long review of the use of seclusion in ATUs. But that is not urgent action. Will he commit to stopping the use of ATUs immediately and to looking urgently at how early deaths are being investigated, particularly that of Oliver McGowan?

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I have met Oliver McGowan’s mum, Paula, on a number of occasions, so I am more than aware of this case. I have spoken to her about the deeply distressing report she has had on Oliver’s death. The NHS is looking into this case and will continue to work with Bristol University to further develop and improve guidance and local review teams.

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T4. The Secretary of State and I spent the night together at Derriford Hospital down in Plymouth, so he will be aware of the unique challenges facing that hospital, which has not had an infrastructure expansion since the 1970s. We have a bid in at the moment. Can we hear whether we have done well before Christmas? [907876]

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I can recommend to anybody spending the night with my hon. Friend in Derriford Hospital, where we learnt a huge amount. The team there were absolutely amazing and it was a brilliant experience. I also learnt a lot about the capital bid, which I have been keeping my eye on very closely. My hon. Friend should hear shortly.

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T2. My niece Maisie turned 14 last week, and she has cystic fibrosis. It is not enough for the Secretary of State to say that letters are being sent back and forth between the drugs company and NICE. Will he get the relevant parties in a room, with him chairing the meeting, so that teenagers such as Maisie can have the drugs that will certainly change their lives, if not save them? [907874]

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I have a huge amount of sympathy for the hon. Lady’s point. We did act to ensure that the parties came together. The offer has been made and the response from the company has frankly not been good enough. It needs to come to the table; the ball is in its court.

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T5. Does the Minister agree that last week’s success by Shrewsbury and Telford Hospital NHS Trust management in securing sufficient qualified clinicians to keep the A&E and Telford’s Princess Royal Hospital open 24/7, rather than closing it overnight, is a positive first step on the journey out of special measures? [907877]

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My hon. Friend is right. I welcome the trust’s recent announcement that it now has enough middle-grade doctors and nurses to keep the Prince Royal Hospital’s A&E open 24/7. It has been receiving some excellent support from NHS Improvement, and I hope that it will achieve similar success in improving the quality of care as that support continues.

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T3. It has been eight months since the child abuse inquiry that the Prime Minister set up recommended urgently that compensation be paid to the survivors of the child migration programmes. The Prime Minister said that she would act; she did not. The Minister said that she would respond; she has not. Twenty-two people have died since that report was published. How can we believe a single word said by the Government today, when so many promises to people who deserve better have been broken? Where is the response to this report? [907875]

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The hon. Lady makes a very good point. When we last discussed this matter over the Dispatch Box, I said that it was my ambition to come back to her as soon as possible, but we have to agree a cross-Government response, which is imminent. However, she is quite right; we really need to respond as soon as possible.

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T6. Last week, I had the pleasure of visiting Oakthorpe Primary School in my constituency to celebrate its gold award for mental health and wellbeing from Leeds Beckett University. Will the Minister outline to the House what further support the Government are offering schools to help them deal with children’s mental health issues? [907879]

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My hon. Friend will be aware that we have brought forward proposals to have a mental health lead in all schools. We are also introducing a brand new workforce to support schools and improve mental health provision. The first wave of staff are being recruited for training now, and we have 210 applicants for the first wave of places.

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T8. To mark the 30th World AIDS Day on Saturday, will the Government commit to a more ambitious, but completely achievable, target of ending all new HIV infections by 2030? [907882]

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I join the right hon. Gentleman in celebrating World Aids Day and ensuring that we redouble our commitment to making sure that we do everything we can. I will certainly look into the precise commitment that he asks for to make sure not only that it is deliverable but that we work not just here but around the world to end this scourge.

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Everyone in this place has lost someone close to them to the terrible and terrifying disease that is cancer. How will the NHS 10-year plan help to improve detection rates?

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The Prime Minister will set out our ambition that three quarters of all cancers will be diagnosed early, up from just half today. Our cancer survival figures are our best ever, but we do not have world-class outcomes yet, as we must and want to. That is why early diagnosis will be absolutely at the heart of the NHS long-term plan—for instance, in radically overhauling the screening programmes that the Secretary of State mentioned earlier.

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I do slightly worry about the staying power of some colleagues. I will not say who, because it would be unkind, but there was a Member I was about to call who has beetled out of the Chamber. People have got to be a bit patient.

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South Tyneside District Hospital recently surpassed targets for waiting times, yet this Government’s forced cuts under the guise of sustainability and transformation plans have left my constituents fundraising to fight the downgrading of key services in court next month. Why is the Secretary of State presiding over this destruction by stealth of our high-performing hospital and the NHS?

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Of course, the STP proposals have to be clinically led and consulted on and discussed with local people. It is right that the allocation of services and exactly how they are configured locally is led locally, so that we can get the best services to people in Tyneside and across the country.

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In England, over 80,000 people have a stroke each year and about 20% of them die within a year. Can my right hon. Friend reassure me, the House and my constituents in Corby and East Northamptonshire that he not only wants to drive down that figure but has a plan to do so?

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Yes, I can. I feel very passionately about stroke and the impact that it has on people’s lives and the health service. We are working very closely with the Stroke Association to develop the new national plan for stroke in England as part of the long-term plan. That plan will build on the success of the Department’s stroke strategy, which ended last month, and look at how we can improve stroke care across the pathway. It will also, critically, include prevention so that we can protect more people from stroke in the first place.

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Despite the Government’s reassurances on the new NHS pay deal, it has left one of my constituents actually taking less money home at the end of the month and being required to pay money back. When I wrote to the Department, the Minister had the audacity to simply respond with a generic factsheet. Does he think this acceptable, and if not, will he give a meaningful reply to my constituent, who has done 30 years in the NHS?

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Yes, of course. We value everybody who works in the NHS. I would love the hon. Lady to take up this individual case with me directly, and I am very happy to look into it.

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I have recently been contacted by a constituent who works as a paediatrician in a nearby hospital. Last Friday, tragically, a baby died in their ward. The cause of death is unknown. Owing to the lack of a coroner service at the weekend, the baby had to stay for three nights with breathing tubes fixed in. For the parents, these are the last memories of their child. What steps will the Minister be taking to guarantee that the seven days NHS requirement also applies to coroners and histopathologists?

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My heart goes out to the parents of this child, my hon. Friend’s constituents, as I am sure it does from everybody in this House. Of course I will happily take up this individual case. But she raises the broader point, too. I am meeting the Justice Secretary on this topic to discuss what further we can do. It is technically a matter for the Ministry of Justice, but I understand entirely why we need to work together to make progress.

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Is not the Secretary of State alarmed that fake psychiatrist Zholia Alemi was revalidated in 2013 under the supposedly strengthened revalidation process? Why did the Government not act on the findings of the Sir Keith Pearson report in January last year, which pointed out this exact weakness in the system?

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The hon. Gentleman raised that matter with me last week. He knows that the Government take it very seriously and that we are asking the General Medical Council for an immediate review of that case, but I am happy to meet him to discuss it further.

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I welcome the new early diagnosis ambition for cancer, but does the Minister agree that for the people of West Oxfordshire, this is about delivery and having the people available to implement the strategy that he has worked so hard to produce?

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My hon. Friend is spot on, as always. Just last week, I spent time with the heads of all 19 cancer alliances in England, which are doing so much to deliver the strategy on the ground, including his Thames Valley cancer alliance, led by Bruno Holthof of Churchill Hospital in Oxford. The alliance was clear that we need more people across the board in “team cancer”, as I call it, and that is right. We especially need more radiographers, and we are working through that with Health Education England in the beyond 2021 plan.

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Today’s report on the amount of police time spent dealing with emergency mental health cases without support from mental health professionals is echoed by police in my constituency, who say that it takes up almost 40% of their time. Will the Government recognise that this crisis should not be dealt with police officers, far less in cells, and sort it out?

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First, I pay tribute to the work that the police do in dealing with people who are in mental health crisis. They view it as part of their core work, but clearly they should not be picking up the slack where services do not exist. I am working closely with the police service and other interested parties to ensure that we have sufficient crisis care, to enable the police to discharge their responsibilities adequately and in a safe way. We will continue to do that.

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My constituent Alice Sloman died during what should have been a routine MRI scan, following complications with the general anaesthetic that had been administered to her. Will the Minister agree to meet me and Alice’s parents to discuss the possibility of people, particularly those with existing conditions, having routine heart checks before such procedures?

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The Government express sincere condolences to my hon. Friend’s constituents. I would of course be happy to meet him and his constituents.

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Will the Minister support Plymouth’s Peninsula Dental School in training more dentists and encourage use of the underspend in the south-west dental spending pool?

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Yes. I would be interested to hear more about anything that can increase access to dentistry in the hon. Gentleman’s part of the world.

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Next year marks 10 years since the passing of the Autism Act. What more can the Government do to support people who suffer from autism?

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To mark the fact that it will be 10 years since the Autism Act was passed, we will start a formal review of that piece of legislation and the autism strategy, to ensure that they remain fit for purpose and heading in the right direction.[Official Report, 29 November 2018, Vol. 650, c. 4MC.]

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My constituents Kirsteen and Wilma Ord have had their lives blighted by the Primodos hormone pregnancy drug. The review that the Government undertook was a whitewash, and now the further review, led by Baroness Cumberlege, will focus only on people in England. She has said that she will consult groups in Scotland, but drug regulation is reserved. What will the Minister do to promise that my constituents will not be let down again?

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I met Baroness Cumberlege just last week, and I know she would be open to hearing representations from constituents in Scotland, to add to her understanding of this issue. We are determined to make full use of that review, so that we can learn lessons from this tragedy.

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Order. I am sorry, but we must now move on.

Ukraine-Russia Relations

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(Urgent Question): To ask the Secretary of State for Foreign and Commonwealth Affairs if he will make a statement on Russian action in the sea of Azov and the subsequent declaration of martial law in parts of Ukraine.

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I thank my right hon. Friend for his question. As my right hon. Friend the Foreign Secretary stated yesterday, we condemn Russia’s aggression against the Ukrainian vessels that sought to enter the sea of Azov on 25 November. We remain deeply concerned about the welfare of the Ukrainian sailors detained by Russia and call for their release urgently. Russia has again shown its willingness to violate Ukraine’s sovereignty, following the illegal annexation of Crimea and the construction of the Kerch bridge.

The United Kingdom remains committed to upholding the rules-based international system, which Russia continues to flout. Our position is clear: Russia’s actions are not in conformity with the United Nations convention on the law of the sea or the 2003 Russia-Ukraine bilateral agreement, which provides free passage in the sea of Azov, including for military ships. The United Kingdom ambassador reiterated that position at emergency meetings held yesterday at NATO, the European Union, the Organisation for Security and Co-operation in Europe and the UN Security Council.

In response to Russian aggression, the Ukrainian Parliament agreed to impose martial law in 10 Ukrainian regions for 30 days, commencing at 09:00 local time on 28 November. We welcome President Poroshenko’s reassurances that martial law will not be used to restrict the rights and freedoms of Ukrainian citizens, and that full mobilisation will be considered only in the case of further Russian aggression. We also welcome the Ukrainian Parliament’s resolution confirming that presidential elections will go ahead on 31 March 2019.

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Does my right hon. Friend agree that this represents a serious escalation of the ongoing conflict between Russia and Ukraine, which has already led to over 10,000 deaths in Donbass since 2014? Will he recognise that we, as signatories of the Budapest memorandum, have a special responsibility? May I therefore welcome the support we are already giving, including the announcement by the Defence Secretary, following his own visit to Donbass very recently, that we will be deploying HMS Echo to the Black sea in 2019?

May I also welcome the Minister’s statement that what Russia has done is a clear breach of international law? Will he now specifically seek to find opportunities for the Prime Minister to discuss this with President Poroshenko? Will he reiterate his call for the immediate release of the 23 sailors now being held by the Russians, some of whom we understand are now in Simferopol in occupied Crimea and six of whom are badly wounded?

Will the Minister also look at imposing personal sanctions on the military personnel who have already been shown to be involved in co-ordinating this operation, as well as at increasing the economic sanctions on Russia, at least to the level that Canada and the United States are already imposing?

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Again, I thank my right hon. Friend. Yes, he refers to a serious escalation that the recent incidents have illustrated, and the UK Government absolutely agree with him on that. I am pleased that he mentioned the recent visit of my right hon. Friend the Defence Secretary. On other proposals, we have no plans to change our conduct of activity in the area.

My right hon. Friend asked whether this is a breach of international law. The United Kingdom’s assessment is that, under the UN convention on the law of the sea, states can require any warship not in compliance with the laws and regulations of the coastal state to leave immediately. However, Russia’s actions in ramming, boarding and seizing vessels do not conform with the law of the sea. Russia’s actions were disproportionate, particularly as the ships had left the area and were returning to the Black sea. The 2003 sea of Azov bilateral treaty between Ukraine and Russia provides for the free passage of the military and civilian vessels of both states through the Kerch strait and in the sea of Azov, so my right hon. Friend is right to suggest that this is a breach of international law. I know the Prime Minister has today received a request to speak to the Ukrainian Prime Minister and that, in her busy timetable, she will be giving that urgent consideration.

On sanctions, measures have been taken in the past in relation to previous activity by Russia and sanctions were recently considered in relation to both the Crimea annexation and of course the building of the Kerch bridge. Any further sanctions will be considered in co-operation with European partners and others. It is very important that there is a sense of unity in response to what has taken place. The United Kingdom was active in calling a meeting of EU partners yesterday, and the other meetings that took place also saw a very strong response from the United Kingdom and others.

The House is right to see this as a serious matter, and it is important that it is not escalated further. That is why we have indeed called for the immediate release of the sailors, and we ask that all parties act with restraint but certainly recognise where the act of aggression came from in the first place.

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Thank you, Mr Speaker, for granting this urgent question. I also thank the right hon. Member for Maldon (Mr Whittingdale) for securing it. The shadow Foreign Secretary, my right hon. Friend the Member for Islington South and Finsbury (Emily Thornberry), sends her apologies for not being here to respond, but she is attending the annual lunch of the Labour Friends of Israel.

The events of the past 48 hours have been deeply troubling for all of us who want to see a return to peace, stability and the rule of law across the whole of Ukraine. Instead, incidents such as this make an already intense situation worse and risk widening the conflict. As the NATO spokesman said yesterday, we need to see calm and restraint on both sides and we need both sides to commit to de-escalation. In particular, Russia must abide by international law, as the Minister just stated, which means allowing Ukrainian ships unhindered access to Ukrainian ports on the sea of Azov. There is no excuse for blocking that access, let alone firing on the ships and seizing them. Will the Minister confirm whether he or his colleague will speak to their Russian counterparts and make clear when that discussion will take place?

At the same time, it has been worrying to see the reaction of the Ukrainian Government in declaring martial law. The Minister has said that he has secured agreement from the President that that will not lead to a cessation of any elections that are due to take place in the new year. While these issues are going on, proper democratic structures need to continue robustly to entrench Ukraine on the democratic footing from which we want it to move forward.

The Minister will agree that if the elections do not take place, that will be a backward step—not just for democracy, but for peace, stability and the rule of law, which we want to see across the whole of the region.

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I am grateful to the hon. Gentleman for his recognition that the Government’s basic position on international law and our response to this are correct. This recent action has come on the back of further disruption over a lengthy period. Since May 2018, Russia has conducted more than 200 stop-and-search boarding operations of civilian vessels transiting to or from the Ukrainian industrial ports of Mariupol and Berdyansk. The regularity of these boardings has increased over the summer, with Russian border guards deliberately delaying merchant vessels transiting the Kerch straits, and this activity culminated in what we saw the other day. It is important for there to be a strong and united international action.

The hon. Gentleman mentioned what he called a “worrying” response from Ukraine; I am not sure I would necessarily say that. In response to aggression from Russia, the Ukrainian Parliament has taken its own decision to impose martial law in 10 Ukrainian regions for 30 days. Bearing in mind the pressure that Ukraine is under, I should have thought that the position of this House would be strongly to support Ukrainian responses in situations of difficulty.

The United Kingdom did not secure President Poroshenko’s reassurance that martial law would not be used to restrict rights and freedoms—that decision was made absolutely by Ukrainian authorities; we did not need to secure it. I can reassure the hon. Gentleman and the House that the Ukrainian President also made the decision that elections would be unaffected on 31 March, so continued progress in relation to the democratic principles may continue.

We support the action that Ukraine has had to take in relation to this aggression, and our concern about Russia’s international position is clear, which is why we welcome the calls for de-escalation so that these matters do not get worse.

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I congratulate my right hon. Friend the Member for Maldon (Mr Whittingdale) on securing the urgent question, and—not that you need it from me—I congratulate you, Mr Speaker, on seeing that this is a very urgent matter that needs to be dealt with.

We are now dealing with a country, in Russia, that is a pariah state. It occupies large sections of Ukraine illegally, and the very fact that it illegally occupies Crimea means that it has no rights under international law as regards this channel or any interventions to shipping that it has been making, notwithstanding the violent intervention made recently.

May I urge my right hon. Friend the Minister and Her Majesty’s Government to make a very big deal of this internationally at the UN, and as loudly as they possibly can? Will they say that this now means that we must have the highest level of sanctions and interventions because this country, which has intervened in Syria and in almost every other area of the conflict in the middle east and now in Ukraine, has to be brought to book—and that we have to do it now?

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I am grateful to my right hon. Friend for that. I reiterate that we strongly condemn Russia’s act of aggression against Ukrainian vessels entering the sea of Azov. As he said, that act of aggression is a further example of Russia’s ongoing violation of Ukraine’s sovereignty and territorial integrity, following its illegal annexation of Crimea and illegal construction of the Kerch bridge earlier this year.

We remain clear in our support of the rules-based international system, which Russia continues to flout. Russia must not be allowed to establish new realities on the ground. We expect all parties to act with restraint and Russia to de-escalate the situation immediately, and we are indeed discussing with partners what concrete measures we can collectively take in response to Russia’s actions.

The EU has recently strengthened sanctions related to Crimea by listing individuals and entities responsible for the construction of the Kerch bridge, which connects Russia with illegally annexed Crimea. By acting in unity with our allies and partners, in the UN and the EU, we can achieve much.

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I, too, thank the right hon. Member for Maldon (Mr Whittingdale) for securing this urgent question. First, let me be clear that we in the Scottish National party absolutely condemn the aggressive actions of Russia and its clear violation of international law. We join the Minister in calling for the release of sailors and others involved as soon as possible. May I also take this opportunity to commend the work of Ambassador Judith Gough and all her colleagues, as she does fantastic work in Kiev?

We know that Ukraine is aware that we are stronger because of respect for human rights, the rule of law and the right of opposition to question Governments. That is something Russia fails to understand—not just in Ukraine, but in the Russian Federation. Will the Minister set out what work is being done with European partners, given our relationship and how important Ukraine is to EU security? Will he set out what his co-operation is with EU partners? Will he also set out more details on how he is looking at individual sanctions, which have been mentioned?

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I am very grateful for such a clear statement from colleagues on the other side of the House—in particular, the condemnation of Russia’s actions and the unequivocal call for the urgent release of the sailors. We welcome that. I thank the hon. Gentleman also for the support he gives to our ambassadors, not only in the region but at the UN, where Jonathan Allen made a particularly strong statement at the Security Council on this matter yesterday.

On the hon. Gentleman’s questions, the EU Political and Security Committee is meeting today to consider the EU’s practical response. As I said earlier, we are discussing with partners what concrete measures we can collectively take in response to Russia’s actions. He can be in no doubt, because of the clear statement by the Foreign Secretary yesterday and clear statements made by ambassadors, that we will continue to do exactly what it takes to try to de-escalate the situation but make clear where we believe the fault lies.

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May I, again, thank you for giving adequate time to this urgent matter, Mr Speaker? This is not the first time we have found ourselves discussing Russia’s pariah nature in this House, nor is it the first time we have seen Russia committing acts of aggression—or, indeed, warlike acts—against countries in the region. We have even debated its warlike acts in our own country. So this is a matter not about a foreign nation about which we know little, but about ourselves and our own security.

Does my right hon. Friend the Minister agree that every time we see one of these acts, we see a moment of Russian weakness being expressed through violence, we see a falling oil price being covered up by an act of aggression, and we see riots about the pensioners who have been stripped of their assets by this brutal regime being covered up by further acts of war? Does this not mean that we must stand with the Russian people? We must stand with the democrats, the journalists and the civic activists in Russia, and defend their interests. By doing so, we stand against those who seek to profit off them—not only the warmongers, but those in our own House, even, who are profiting from Russian business in this country and in the United States.

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My hon. Friend the Chair of the Foreign Affairs Committee makes a series of strong and clear points. He sets out again the concerns the UK shares about a series of actions that has also caused concern abroad. He also made the wider point about the impact of actions on the people of Russia. I should add that Ambassador Jonathan Allen concluded his statement on Ukraine yesterday by saying:

“As my Prime Minister recently made clear, like others here today we remain open to a different relationship with Russia: one where Russia desists from these attacks that undermine international treaties and international security and desists from actions which undermine the territorial integrity of its neighbours and instead acts together with the international community to fulfil the common responsibilities we share as Permanent Members of the United Nations Security Council. And we hope that the Russian state chooses to take this path.”

He sets out clearly why that should be the case, and why a different relationship is open to Russia, but it must entail a change in behaviour.

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I welcome the Minister’s statement. I particularly welcome the description of the ongoing and consistent provocative actions. This has not been an isolated incident; this has been happening and escalating for some time. I endorse the call for unity, calm and restraint, but we must be aware that Russia is seeking other consequences: a wider destabilisation of the region. It is important that we in this House and across the NATO alliance are unified in calling not only for freedom of navigation, and for the release of the ships and the sailors, but for Russia to understand that actions have consequences. We need to be willing to stand by those consequences.

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I think the question was a rhetorical one, and therefore it requires an even shorter reply than the Minister might otherwise be inclined to offer to the House.

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I will offer a very brief answer, but first, let me say that I am sure that the whole House welcomes the fact that the hon. Lady is the new president of the NATO Parliamentary Assembly. We all congratulate her on that. It is a singular honour for not only her, but this House, and we know that she will conduct herself extremely well. The way in which she put her question and the issues that she raised demonstrated that she has a very clear grasp of the facts, and she will be an important addition in that role.

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Will Ministers look again at what further practical assistance we can give to Ukraine, either by increasing our military training or, given Russia’s interference with maritime trade in the sea of Azov, by helping to strengthen vulnerable ports such as Mariupol by, for example, improving the railway links? That will make it less vulnerable to Russian pressure.

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As luck would have it, I have some information here about the UK’s support to Ukraine, and I fully support my right hon. Friend’s comments. The UK is providing some £30 million this year to Ukraine to support a range of areas, including governance reform, accountability, communications and human rights. The UK is also providing £14 million in relation to conflict, security and stability projects to bolster Ukrainian defence reform. We have provided up to £3 million of new funding this year for developing independent media and countering Russian disinformation, alongside £2 million provided through existing projects. The Defence Secretary was there recently, as my right hon. Friend will know, and he is having further talks with his US counterpart this weekend. On practical support for Ukraine, including on the defence side, the UK will certainly continue to be committed to Ukraine’s independence, sovereignty and territorial integrity. Defensive non-escalatory military training delivered through Operation Orbital is fundamental to that support.

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President Putin’s actions have redrawn, by force, the borders of a European nation for the first time since the second world war, and we must never forget or normalise that. We are discussing just the latest in a series of acts of aggression, so will the Government commit to ensuring that they will do everything they can, and to ensuring that their influence on other European nations will not be lessened when—if—the UK comes out of the EU next year?

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The hon. Gentleman, who has great knowledge of these matters, puts it extremely well. He references the latest in a pattern of acts of aggression, and welcomes the UK’s support in responding to it, in co-ordination with others. He can take it from me—I say this very clearly—that there will be no diminution in our support and our working with European partners, no matter what happens in relation to other events next year.

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In 2015, following a great deal of international pressure, France cancelled two Mistral-class amphibious assault ships that were destined for Russia because of the situation in Ukraine. What more will be done at the European Union Political and Security Committee, to which the Minister referred, to impress on our European partners in particular that it is wholly unacceptable at this time to be engaging with the Russian Federation on arms sales?

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I am grateful to my hon. Friend for his description of what happened. He emphasises how important it is for united and collective action to be taken on this issue. It is important that nations work together on this, and his comments about dealing with the sort of supply that was involved with Mistral are well taken. The United Kingdom will be pressing this point to the various committees that we are attending as we speak.

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The Foreign Secretary made an extremely powerful and well received speech yesterday at the launch of the holodomor exhibition, sponsored by the hon. Member for Mid Derbyshire (Mrs Latham), in which he referred to the close, supportive relationship between the United Kingdom and Ukraine. In that context, will the Minister agree to send on behalf of the House our profound sympathy and support to the friends and families of all the sailors who have been injured and imprisoned illegally? What assistance can we offer in the elections in March to support the restraint shown by President Poroshenko?

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I thank the hon. Gentleman for mentioning the Foreign Secretary’s appearance at the holodomor event; it matters greatly to the United Kingdom and the Foreign Secretary, which is why he was there. The hon. Gentleman’s message of support to the families caught up not only in this detention but in others is well made, and it will certainly be conveyed to them. On support for governance, we are already providing £11 million to support reform in Ukraine through the good governance fund, and there are a wide range of programmes to help Ukraine drive forward governance, economic and political reform, and promote greater accountability and transparency. All that will help to make sure that the election process is exactly what this House would expect.

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Sadly, Ukraine suffered hugely at the hands of the Russian and Soviet authorities in the last century, including through the unspeakable cruelty of the holodomor. Does my right hon. Friend share my sense of sadness that in the modern era, when we really all should know better, Ukraine is again on the end of unjustified violence and aggression from Russia?

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My right hon. Friend’s concerns are echoed throughout the House. The support for Ukraine in its present difficulties is well expressed both by Members and the actions of Her Majesty’s Government.

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For six months, Russia has been stopping and inspecting vessels entering and leaving Ukrainian ports in the sea of Azov. That leads to delays and greatly increased costs, and it affects not only Ukrainian vessels, but those flying EU flags. Will Her Majesty’s Government first make the strongest representations to Russia that it should desist from this practice, and secondly seek legal advice on what financial recompense the owners of these ships can seek?

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I am grateful to the hon. Gentleman for his question. On the economic damage, we estimate at present that Mariupol and Berdiansk have seen economic throughput reduce in their ports by some 43% and 30% respectively in the past nine months, so the actions that he referred to have had a profound effect. I am not personally aware of the legal position on redress, but I am sure that the United Kingdom Government will do anything that they can to provide support.

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HMS Echo is due to be deployed to the Black sea in the new year in support of Ukraine. She is a lightly armed oceanographic survey vessel. Would not it be a strong message to Russia if we were to bring that deployment forward, and perhaps also, without any form of escalation, consider deploying her to the Azov sea?

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I am not aware of any plans to change any of the deployments that have been planned and considered. Of course, while we must continue to do exactly what we have said we will, no one is looking for any escalation in these circumstances.

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Ukraine-Russia relations have deteriorated to an all-time low. There have been evidential reports of the persecution of Christians in eastern Ukraine, occupied by Russia. Pastors of churches have gone missing and nobody knows their whereabouts, and churches have been desecrated and destroyed. I ask the Minister gently: has he had the opportunity to highlight and raise these issues with Russia, and to confirm support for Ukrainian citizens expressing their faith and worshipping their God in the way they wish to?

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I am grateful for my hon. Friend’s question; no one could be a more determined supporter not only of the rights of Christians in other countries, but of freedom of belief and religion for all, which he champions. The United Kingdom believes that Russia must uphold its obligations under international humanitarian and human rights law, and we call on Russia to release immediately over 70 political prisoners detained in Russia and Crimea. I will ensure that his comments about minority faith prisoners and detainees are conveyed to the Minister responsible.

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Who benefits?

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No one benefits from actions that are contrary to international law. No one benefits from disruption. The only people who benefit are those who can demonstrate a clear and concise response to such aggression in an effort to return the world to a rules-based system, where there will be de-escalation, and collective security for all because it is not provoked by unreasonable actions.

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I hope that the right hon. Member for New Forest West (Sir Desmond Swayne) will have his question framed, but I give him due warning: if he does not, I will.

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To follow the point made by the hon. Member for North Wiltshire (James Gray), would it not be better to revisit that deployment—not necessarily its time or place, but the type of ship that we send? HMS Echo is a survey ship. Would it not be better to send a ship that can defend itself in these waters, given the events at the weekend? Do those events not also show that it is time for Her Majesty’s Government to have a more muscular and robust policy on Nord Stream 2?

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The Under-Secretary of State for Defence, my right hon. Friend the Member for Bournemouth East (Mr Ellwood), who is sitting next to me, assures me that the survey ship HMS Echo has appropriate armament, but we have to be very careful. I make it clear that there is no change planned to any deployments at this stage, which is important, and I have no instructions on any such action, but it would have to be considered extremely carefully. What the United Kingdom wants to do is stand up for international law, urge others to do the same, see a release of the sailors who have been detained, make it very clear to Russia what it is doing by risking the actions that it is taking and, while not seeking to escalate anything further, be very firm in supporting an international response, because we must see an end to these actions.

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There is real concern that the escalation of Russian action in Crimea will lead to real human suffering, and much more of it. What more can be done to ensure access to Crimea for the United Nations High Commissioner for Human Rights, so that they can look into this?

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My hon. Friend is right: we are very keen for that access to be given, and it is unfortunate that it has not been. Colleagues at the United Nations mission in New York will certainly continue to make this point very strongly.

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More than two years have elapsed since Ukraine referred the issue of access to the sea of Azov to the International Court of Arbitration at The Hague. Why does the Minister think that the process has taken so long, and what can he do to try to speed that up to a conclusion?

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As a former lawyer, I have only a possible explanation of why some of these things—particularly, technical actions in respect of the law of the sea, where claim, counter-claim and many other things need to be discussed—take so long. I have no specific information about why this in particular has taken so long, but the Minister for Europe and the Americas will respond to that by letter. If these claims cannot be decided and international arbitration does not work, the international rules-based order falls to the ground, so it is to the benefit of all states—even those who feel that a resolution might not be to their advantage—to do everything in their power to see these matters resolved.

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The Minister has eloquently told us what the FCO thinks the situation is. Will he explain what the FCO thinks the situation may become? Is what has happened recently just a continuation of low-level aggression? Is it a ramping up of economic warfare by a blockade of Berdiansk and Mariupol? Or is it part of a shaping operation for a more violent assault on Mariupol? If it is one of the last two, what contingency measures is the FCO thinking of taking?

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I know that my hon. Friend has a deep-rooted knowledge of this subject, but he asks the UK Government to speculate on a series of potential outcomes, which I do not think would be wise. The point of his question, however, is to illustrate that from the actions already taken there could be further more serious consequences. Given the concern with which he asked his question—concern that I am sure is echoed by the House—I should be very clear that the UK does not want further escalation. Risks have been taken in the actions we have seen, and it is essential, if those risks are to be de-escalated, that Russia recognises its actions and the concern they have caused, and changes them.

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We know that Russia has been flexing its muscles across the Black sea region for quite a while now, so it was disappointing that the Black sea was not a specific agenda item at the NATO summit in Brussels in July. Can the Minister assure the House that he is pushing NATO allies, including Turkey, which has in the past shown sympathy for Russia, to develop a coherent NATO strategy for the Black sea?

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As I indicated earlier, there were meetings yesterday of the UN Security Council, NATO, EU and the Organisation for Security and Co-operation in Europe. I cannot give a clear answer, because I do not know the technical answer, but given the current level of aggression in the Black sea and the degree of concern raised, and given that the international community responded so quickly yesterday, I suspect that the Black sea is very much a topic of concern. It certainly is for the UK, and it will indeed be pressed.

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What are we doing to keep open the Kerch strait?

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As far as I am aware, the strait is open, but it will be essential to demonstrate that there is free passage without hindrance, and in the near future all actions will be carefully scrutinised. There are ways of ensuring a good international presence and that sea lanes stay open, but any action must be taken collectively. My hon. Friend’s point was well made.

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The Minister has done an excellent job, as always, of answering our questions, but this does smack a little of complacency. Let us remember that 10,000 people have died in the Ukraine conflict, and that Ukraine has been crying out since 2014, since the annexation of Crimea, for us to do something about the sea of Azov. Its economy is being strangled by the economic blockade. What measures are being taken to support the Ukrainian economy? It is very welcome that the House passed the Magnitsky amendment, but what steps have been taken, if any, to follow up on that amendment, to draw up a list of individuals who should be sanctioned, and to put the amendment into practice? To date, we have little or no evidence of the Government doing anything about that.

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In all fairness, the fact that I answer carefully and honestly in relation to these actions must not be considered any form of complacency. I am keen to set out for the record the action the UK has already taken in response to this incident: our convening of the EU meeting, the meetings at the UN, NATO and the OSCE, the clear statement by the Foreign Secretary yesterday, the statement by Jonathan Allen at the UN Security Council, and the work already done on sanctions, including the sanctions on individuals, and the sanctions following the annexation of Crimea and the construction of the Kerch bridge. In addition, the EU’s Political and Security Committee is meeting today, and further action is being considered in company with others. All that is a clear and definitive response to what has happened. Action has been taken against individuals, and further action can be considered, but the point I was making was that collective action was the most important thing. The international condemnation is clear. There is no complacency in anything I have said.

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This latest act of aggression is yet another reminder that Russia does not care about rules, only realpolitik. That fact must inform the UK’s approach. Will my right hon. Friend say more about the steps we are taking together with our allies to make sure that Russia is practically deterred from further action?

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I hope that the actions the UK has taken quickly, in convening meetings of states and speaking very clearly at the UN Security Council yesterday—I commend to the House the statement by our deputy permanent representative Jonathan Allen yesterday, and I will make sure that a copy is placed in the Library so that colleagues can see it—made clear our concerns, and how we are using our international position and our position on various bodies to bring other states together, because collective action is needed.

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The Russian ambassador to the UN, Dmitry Polyanskiy, claims that Ukrainian ships “illegally crossed Russia’s border” and that the

“responsibility lies with those who gave the illegal order”.

This completely ignores the fact that the Kerch strait and the sea of Azov are shared territorial waters, as designated by a 2003 treaty. Will the Minister call on Russia, both directly and through the EU, to allow the backlogged civilian cargo ships to pass through the Kerch strait, as they are legally permitted to do?

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We do not agree with the interpretation of the law of the sea offered yesterday at the UN Security Council. The deputy permanent representative said about the action and the use of military force:

“This further demonstrates Russia’s ongoing contempt for Ukraine’s sovereignty and territorial integrity and its contempt for the global rules-based international system which this organisation serves to uphold”.

The Government fully support that statement.

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What representations were made to the Russians during their illegal construction of the Kerch bridge, the completion of which has allowed President Putin to tighten his grip on the whole region and precipitated this latest illegal act?

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I do not have that information, as I was not in this position at the time, but I can make it very clear to the House, as I did earlier, that action was certainly taken subsequently by way of sanctions imposed on those responsible for the building of the illegal bridge. I have no knowledge of what representations were made at that time, simply because I was not there.

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I congratulate the Minister on his calm and measured tone. Does he know whether there will be any NATO vessels in attendance to provide mutual support to HMS Echo when it is in the Black sea in the new year?

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I understand from the Under-Secretary of State for Defence, my right hon. Friend the Member for Bournemouth East (Mr Ellwood), that there are NATO vessels in the area, but I am not aware of any particular deployment to support HMS Echo. That would be a matter for further consideration.

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As the Minister is aware, I sit on the Council of Europe, which Russia is trying to get back into. Will he please ensure that serious consideration is given in the Council of Ministers, through our representative there, to only allowing the Russians back if they fulfil their national and international obligations and do not break them?

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My hon. Friend’s intervention makes clear what the House wants to see. The House is not in conflict with the people of Russia, but as the deputy permanent representative made clear yesterday, actions taken by Russia make it difficult, if not impossible, to have the sort of relationships that are necessary and that my hon. Friend is looking for. The UK is open to that and urges Russia to respond to international concerns and to set out to our mutual advantage a new relationship with other states based clearly on a rules-based international system.

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As well as the exhibition in the House, does the Minister agree that it is resonant that last weekend there were many commemorations of the holodomor across the UK, including in St Anne’s cathedral in Leeds, and that one lesson is that just as fearless independent journalism was needed in the 1930s from people such as Gareth Jones and Malcolm Muggeridge to expose the holodomor, so it is now needed to expose the fake news coming from the Kremlin?

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As I mentioned earlier, we are supporting the provision of money for journalism that is based on the truth and counters disinformation, but the hon. Gentleman’s remarks about the importance of investigative journalism are clear. We support the actions of correspondents who go to the most difficult areas of conflict at great personal risk, and we support campaigns designed to make sure that journalists are not targets.

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Incredibly, Russia still denies having a military presence in Ukraine, although we know that Russian troops and tanks are there in very significant numbers taking part in a war that is claiming some dozen Ukrainian lives every week. Now that we have seen this blatant, unacceptable and proven act of Russian aggression, can my right hon. Friend confirm that the UK will take firm action, including the provision of hard military support?

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As I have reiterated throughout, it is essential that responses are co-ordinated and collective. The United Kingdom has made its position extremely clear at the United Nations, in collective meetings today and yesterday, and in the Foreign Secretary’s statement. We will work in concert with our partners in seeking to reverse these actions and achieve our objective, which is stability and mutual security in the region—mutual security that is based on respect for territorial integrity and a rules-based international system.

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On the back of the Russian Federation’s illegal and immoral actions in Ukraine, the President of Ukraine is flirting with martial law. Once assumed, martial law powers are rarely given up willingly, and unconsolidated democracies that take them rarely survive. In that context, can the Minister assure the House that the links between the President of Ukraine and Vladimir Putin’s right-hand man, Viktor Medvedchuk, will be fully investigated and exposed, and that we, as a member of the European Union—while we still are—will fully push the rest of the European Union to get its act together and ensure that more solid sanctions are imposed on the Russian Federation?

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As I mentioned earlier, the imposition of martial law by the Ukrainian Parliament was announced yesterday, and will come into effect tomorrow at 0900 hours. We welcome what the President said in relation to the limitation of those powers, and we are monitoring very carefully what the impact and effects may be.

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Sending an oceanographic survey ship sometime in 2019 does not exactly strike me as a robust response to Russian aggression against a friendly state. Russian ships and submarines go up and down the English channel unimpeded all the time. Can the Minister tell the House whether a NATO ship has ever gone under the newly constructed Kerch strait bridge, and when the next NATO vessel will visit the sea of Azov?

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I am grateful to my hon. Friend for asking such detailed questions. I do not have that information, but I will ensure that he is written to.

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I hope that we will have a copy in the Library of the House.

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A copy will be placed in the Library of the House at your request, Mr Speaker.

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Thank you. It will be for the wider delectation of colleagues.

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May I urge my right hon. Friend not simply to ignore the Council of Europe when he considers European action? Will he support the work that I and others have been doing to prevent the readmission of Russia to that organisation?

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As my hon. Friend will know, I do not ignore anything related to Europe—either the European Union or the Council of Europe. I welcome the collective action that we take through our friends, and will continue to do so. I value the Council of Europe, and my hon. Friend’s expression of support for it is well made.

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rose

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rose—

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What a rich choice—I call Mr Kevin Foster.

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Thank you, Mr Speaker. There was the usual contest for last!

The Minister will be aware of the many parallels with past situations. Vladimir Putin’s approach seems similar to the process of heating a frog in water: if he keeps pushing up the heat, it will not produce an instant reaction. Can the Minister reassure me that he is talking to other nations about what will happen if Putin continues to push down this power? We obviously do not want to see an escalation, but let us be clear that it is Russia that keeps escalating these situations.

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I know from my experience in other parts of the international field that what my hon. Friend has said is correct. There is always concern if a state seeks to demonstrate its power through means that are questionable, or sometimes downright illegal. States will sometimes push the envelope. The risk is that at some stage there will be a miscalculation and a confrontation. The United Kingdom will do all in its power to prevent such a thing, but the risk is taken by others, and my hon. Friend’s point is well made.

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Persistent attempts to destabilise Ukraine’s economy are clearly unacceptable. What further practical assistance can we offer Ukraine?

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As I illustrated earlier, there is direct support for economic reform in Ukraine and direct support to assist other reforms, including those relating to good governance and technical matters. Support is also being given in relation to information gathering and the need to combat disinformation. In all those respects the United Kingdom’s support is clear, as has been our response to these particular incidents. My hon. Friend may be assured that our concern will continue, and that further support will be made available to Ukraine as and when the United Kingdom judges it necessary.

Minimum Service Obligation (High Street Cashpoints)

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

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I beg to move,

That leave be given to bring a Bill to require banks to provide cash machines to be made available on designated streets; to enable local authorities to designate streets that require cash machines in towns of more than 5,000 residents; and for connected purposes.

While that may not roll off the tongue, at a time when 2.2 million people in the UK rely almost entirely on cash it is critical that people can gain access to their money easily and free of charge, particularly people on low incomes, older people and people in rural areas. However, figures show that since the beginning of the year, free cash machines have been closing at an unprecedented rate. That has alarmed consumer groups, the Federation of Small Businesses, and, as their support for the Bill demonstrates, Members of Parliament.

I was inspired to introduce the Bill by the experience of residents of Battle, in my constituency in East Sussex. That historic town was the scene of the battle of Hastings. In 1066, Norman invaders marched from the constituency port of Pevensey to give King Harold and his men six of the best. Nowadays, Battle residents are having to make a similarly lengthy journey if they merely wish to access, and spend, the cash in their bank accounts. That is largely due to the withdrawal from Battle’s High Street of the big four banks—with them went their cash machines. The last to go was NatWest.

I wrote to Royal Bank of Scotland, the owner of NatWest, asking it to retain the cash machine. It refused, pointing to the 24/7 provision of a machine outside another store. When that machine, the last 24/7 cashpoint in High Street, was lost this month, I asked RBS to reinstate its cash machine or move one up the road from an out-of-town petrol station. It refused. That demonstrates the need for the Government to take action and require the financial services industry to provide at least one 24/7 cash machine in the high street of every town in the United Kingdom with a population of at least 5,000. I make that suggestion in the hope that the Ministry of Housing, Communities and Local Government will accept it as one of the key strands of the forthcoming review and remodelling of the high street that was announced in this year’s Budget.

It may help if I try to put my finger on the reason for the decline in cash machines, and hence the reason why intervention in the shape of the Bill is needed. Earlier this year, LINK, the UK’s largest cash machine network, announced that it would go ahead with plans to cut its interchange fee by 20% over the next five years. Hundreds of free ATMs have already closed as a result. The interchange fee is the amount that is paid every time a customer uses a free ATM, which funds the entire free-to-use ATM network.

The change was designed to reduce the number of machines in areas where there were too many, while retaining the geographical coverage of ATMs across the UK. That has failed. In 2018, analysis of LINK data showed that in the six months following LINK’s initial announcement—from November 2017 to April 2018—the rate of cashpoint closures increased significantly. It went from about 50 a month in 2015 to 300 a month during that period. LINK’s own figures show that between January and June this year, 500 cashpoints closed every month.

In January 2018, the consumer group Which? conducted a study of ATM provision across the UK, and identified more than 200 communities with poor ATM provision or no cash machines at all. The survey also demonstrated the impact that a potential reduction in the number of free-to-use ATMs would have on the millions of consumers who use the network. Overall, it identified heavy consumer dependency on ATM usage: just under half those surveyed used a cashpoint at least once a week, while four out of five said that access to the free-to-use network was important to their daily lives and payment for goods and services. The removal of free-to-use access would leave one in 10 struggling to make payments, shutting many consumers out of local shops and services. A reduction would also lead to one in seven being deterred from using outlets that accept cash only, placing a strain on consumers and retailers alike.

The threat of ATM closures is particularly pertinent in the context of widespread bank branch closures across the country. Research shows that free ATMs are an important alternative for consumers trying to access their cash when their local branch closes, but latest figures show that bank branches are closing at a rate of 60 a month, leaving people struggling to access the financial services they rely on across the UK.

The UK has lost almost two thirds of its bank branches in the past 30 years. According to parliamentary records, there were 20,583 branches in 1988, but analysis of current account providers shows that there are just 7,586 today. So far this year 670 branches have closed or are scheduled for closure, putting us on course to overtake the number of 2017 closures.

While there has been a decline in cash use, cash remains immensely popular and important for consumers. Almost three quarters of adults in the UK say they use cash at least two or three times a week.

Some might say that cash provision should be taken up by the post office network. I know that the Government recognise the important role post offices play by providing access to cash and banking services. Under the banking framework, 99% of UK personal banking customers and 95% of UK business banking customers can do their day-to-day banking at the post office. That agreement, in operation since January 2017, marked the biggest expansion of face-to-face banking access in a generation. However, post offices and postmasters and postmistresses do not feel that the banks are remunerating them properly for these transactions, and I fear that many will stop providing the service, just as LINK has ceased providing cash machines.

High street banks have a very special place in my heart. I spent my vacations during A-levels and university working as a cashier for Abbey National in Buckinghamshire. I was responsible for the morning refill of the cash machine—a job they might not have given me if they had known I would become an MP. Many a happy hour was spent with my customers, from “accidentally on purpose” setting off the cashier security screens when a customer was rude to colleagues, to repeatedly asking our customer, Mr R. Head, to produce his identification so that we could roll about on the floor laughing when his driving licence showed his first name to be Richard, to taking a phone call from an irate customer concerned about overdraft charges and then phoning the cheque centre with the opening line of “Some old bag is complaining about racking up charges” only to be informed by the voice at the other end of the line, “This is the old bag speaking. I suggest you reimburse the charges or I will have you fired.” I had rung the customer back by mistake—a schoolboy error.

Fortunately, my pursuit of customer satisfaction has improved steadily over the years prior to me becoming my constituency MP. When vulnerable constituents, who are the most in need of our support, cannot access their cash and spend it in support of the stores that make up our vibrant high streets then something is not only wrong, but something needs to be done. I therefore beg to move that this Bill becomes law.

Question put and agreed to.

Ordered,

That Huw Merriman, Simon Hoare, Stephen Crabb, Kevin Hollinrake, Daniel Zeichner, Dr Sarah Wollaston, Frank Field, John Lamont, Henry Smith, Ian Paisley, Sammy Wilson and Louise Haigh present the Bill.

Huw Merriman accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 25 January 2019, and to be printed (Bill 297).

Courts and Tribunals (Judiciary and Functions of Staff) Bill [Lords]

Second Reading

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I beg to move, That the Bill be now read a Second time.

It is a great pleasure to move the Second Reading motion. It is possible that in Westminster at the moment other matters are catching Members’ attention and that the focus of the House has not been sufficiently on the Bill. But I am delighted to have the opportunity to move the motion. The Bill has already been considered in the other place and takes an important step forward for our courts system.

Our judiciary, together with our courts and tribunal service, are rightly regarded as among the finest and most independent in the world. However, the way our courts and tribunals work cannot stand still. They must be able to meet the demands of delivering modern-day justice, meet the needs of the society they serve, and administer justice in the most effective and efficient way.

The justice system must work for all those who use it, as well as for the judges and legal professionals who work in it. That means realising the huge potential of new technology and the law tech revolution to improve people’s experience of and access to the justice system and open up new routes to justice. It is certainly my determination that the UK should be seen as being at the forefront of adopting new technology, whether in our courts and tribunal system, which is the issue before us today, or more widely, with legal professionals making use of technology. That is one of the reasons that we have instituted a law tech committee, led by Christina Blacklaws of the Law Society, which is designed to take us forward in that area. It is an important part of what we need to do.

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My right hon. Friend may be aware that I did an Industry and Parliament Trust fellowship in the law with judges, and my experience of the different courts I went to showed the enormous gap between the commercial courts, which were technologically very superior, and the tribunal system, where we might as well have been using a quill pen. Is this going to solve that problem?

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Our court reform programme as a whole, which I will come on to, will ensure that we use technology wherever possible. It is right that we embrace that. The Bill is part of the process—it is not all of the process—that will ensure that we modernise. I have quoted in the past ways in which artificial intelligence, for example, is being used within the legal profession. An example I have given is a case where AI was used to check a number of contracts to spot potential errors. The rate of success of the AI was somewhat better than that of the experienced lawyers, and if I remember rightly the task was done in 26 seconds rather than 92 minutes. I make that point to illustrate the opportunities that exist in terms of technology and the law.

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Innovation and modernisation are vital, but will the Secretary of State take this opportunity to recognise that the single most important strength of our judicial system is the judiciary who work in it and that everything must be done to ensure that we have a broad pipeline of talent so that they continue to be the best in the world?

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I very much agree. We have a judicial system that is widely respected around the world for its independence and excellence, and that must long continue. I suspect that my hon. Friend is hinting at the question of how we can get more outstanding candidates to apply to the judiciary. It is right that we should address that challenge. He is right to suggest that this is one of our strengths as a country. It will be important in the years ahead as we leave the European Union that our legal system should continue to be widely respected. I believe that there are great opportunities for the UK to become even stronger as a legal centre, and I am keen for that to happen.

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Will the Secretary of State give way?

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I will certainly give way to the Chair of the Justice Committee.

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The Secretary of State makes an important point about the balance that needs to be struck in these areas. He has given an example of the use of artificial intelligence being appropriate for the checking of documents, and work on dealing with disclosure parameters has already been successfully piloted by the Serious Fraud Office. Would he concede that there is a distinction to be drawn between those essentially transactional but important operations, such as disclosure searches, and the application of human judgment that should be brought to, for example, a charging decision by the SFO? Does he agree that any determination of the facts or issues of a case should clearly be done by a human judge, having heard the arguments, and that their workload could be slimmed down but not replaced by the use of AI?

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I agree. I note that my hon. Friends are all quick to make the case for the importance of the skilled human being in these circumstances, and rightly so. We must remember that technology is our servant and not our master.

I make these points because our court reform programme is being undertaken in the context of an embracive technology and the Bill is an aspect of that programme. I will digress no further because it is not essentially a technology-based Bill. However, to follow up on the point made by my hon. Friend the Member for Bromley and Chislehurst (Robert Neill), the importance of skilled individuals will continue to be key, and the Bill will ensure that the time of our most skilled individuals—our judges—is deployed as efficiently as possible.

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I have to say that innovation and modernisation are not normally things that we associate with our courts. Given the feedback that has already come in on things such as making responses on juries online, does my right hon. Friend agree that this is not only useful to the courts but makes life easier for the public?

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Absolutely; that is a key point. Perhaps my hon. Friend has set my Department the challenge of ensuring that people associate the modernisation of technology with the court system. We will know that we have succeeded when he tells us that that is the case. He makes the strong point that this is ultimately about delivering justice. We need to have strong support for the process involved and ensure the satisfaction of those who need to resolve a dispute or to undertake a process. The early signs from our work with online divorce processes are encouraging, and the feedback has been very positive.

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I rise as the co-chair of the Justice Unions Parliamentary Group. I am interested in what the Secretary of State is saying about artificial intelligence, but it seems to me that one of the driving forces behind the Bill is not necessarily to improve the administration of justice but to cut costs by pushing workloads down the grades so that staff will be taking on additional work above their current grade without additional remuneration. Surely he should recognise that making savings in the application of justice comes at a cost to staff and to the public’s experience of justice.

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I do not think that the hon. Lady is correct in the association that she makes. The reality is that we have to ensure that our resources are deployed as efficiently as possible. That is to the benefit of the system as a whole. I will make the case in more detail as to why the steps taken in the Bill to give authorised staff greater responsibility to undertake some roles that they are currently unable to undertake will be to the benefit of the system as a whole. I make no apology for wanting to find efficiencies within the system, but this is in the context of a £1 billion court reform programme. Those efficiencies can improve the experience of the users of the system, and could also ensure that judges will be able to use their time in the areas that are most useful to them. Indeed, the experience of authorised Courts and Tribunals Service staff will be a more positive one, as they will be able to make a greater contribution to the efficient running of the court system.

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Setting aside the whys and wherefores of the Bill, may I invite my right hon. Friend to confirm from the Dispatch Box that the independence of the judiciary and the separation of powers between the judiciary and Parliament will be absolutely sacrosanct and at the heart of everything that he, his ministerial colleagues and the Department will do? This is an issue of great concern to many people, irrespective of the Bill, and people always need to have faith that this central pillar of how we are governed in this country will remain intact, protected and preserved.

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I am grateful to my hon. Friend for giving me the opportunity to respond to that point. The independence of the judiciary is at the heart of our system and a long-standing part of it. It is as important, if not more important, than it has ever been that we reiterate that and support those institutions. As I was saying a moment ago, this is a big part of what our nation is about, and in the years ahead, after we have left the European Union, one of the most important institutions to us will be our independent judiciary. It is a large part of what the UK is about and of how we should project ourselves around the rest of the world.

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My right hon. Friend is making a strong case. Perhaps this is for another time, but in the context of having a strong, independent judiciary, will he look again at the rather arbitrary cap of the age of 70 for magistrates? We have many really qualified people who wish to contribute to the independent justice system of this country but who are prevented from doing so simply because of their age.

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I am grateful to my hon. Friend for making that point, although he takes me away a little from the terms of the Bill. I realise that there is a debate about that matter, and there are arguments either way about the current age limit. I have certainly received representations calling for an increase on the current age of 70, and we continue to look closely at those arguments. I believe that there has to be an age limit, and it is a question of judgment as to what it should be. I would be delighted to discuss this with my hon. Friend in the Tea Room if the opportunity to do so should arise.

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Building on the point that was well made by my hon. Friend the Member for North Dorset (Simon Hoare) about independence, may we have an assurance that under the Bill the procedure rule committees that decide what the authorised staff can do will be able to exercise that discretion free from any interference from the centre, so that they can ensure that only those jobs that ought properly to be delegated to those staff are so delegated, and that extraneous considerations such as cost need not be forced upon them when they make their decisions?

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My hon. Friend brings me back to the Bill and makes a good point—one which came up on several occasions during the deliberations in the other place about the extent to which we should be prescriptive, or whether powers should be left with the rule committees. I share his instinct that as much as possible should be left to the rule committees, because they are best placed to make such assessments. Indeed, that leads to points made by distinguished retired judges in the other place about not being over-prescriptive. Such matters may be a point of discussion this afternoon or at the Bill’s later stages.

I now turn to the Bill in greater detail. The measures will help to provide the greater flexibility and responsiveness that we need within our court system. That includes freeing up judges’ time from the most routine tasks associated with court cases. The Bill will build on existing powers that already enable staff in most courts and tribunals to be authorised to exercise some of the functions of judges. It will continue to allow appropriately qualified and experienced staff in the civil, family and magistrates courts, the High Court, the Court of Appeal, the Court of Protection and tribunals to be authorised to carry out uncontroversial and straightforward judicial functions under judicial supervision. The Bill will enable those arrangements to be extended for the first time to the Crown court, where court officers can only currently undertake formal and administrative matters. Allowing court and tribunal staff to exercise a wider range of judicial functions will potentially free judges up from undertaking more regular tasks, such as changing the start time of a hearing or changing a pre-trial preparation hearing date, so that they can focus on the more substantive matters of the case.

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I welcome the Government’s amendments in the other place to paragraphs 32 and 44 of the schedule, which were secured by my noble Friend Lord Marks, because they ensure that only a judge will have the power to deprive people of their liberty or eject them from their family home. As we give court staff some more powers, it is important that we set down some markers for the types of decisions that should be reserved for trained professional judges.

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Indeed, and I will turn to that point in a moment. I hope that the clarification provided by those amendments will be widely welcomed in this House. The passage of this Bill in the other place was characterised by a constructive and co-operative approach from both sides, and I hope that that will continue to be the case—I suspect it will, but we shall see—because the point of those amendments was to provide particular protections. Other issues debated in the other place included suggestions about being more prescriptive. As I said to my hon. Friend the Member for Cheltenham (Alex Chalk), it is right that we use the judicially led rule committees in many of those areas, but the right hon. Member for Kingston and Surbiton (Sir Edward Davey) makes a perfectly fair point.

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My right hon. Friend is being generous in giving way. He is talking about the use of judicial time, so will he explain in a bit more detail how the measures will address the problem of the backlog of cases and what effect the Bill is likely to have on improving the current situation?

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My hon. Friend raises a good point that comes back to how we ensure that judges’ time is used most effectively, freeing them up from the most routine tasks, such as changing the start time of the hearing, and enabling them to focus on more complex matters. They could then ensure that case preparation and management was resolved proportionately and at an appropriate level. That could also help to improve the overall efficiency and effectiveness of the court tribunal system. There is an opportunity to ensure greater consistency in the current arrangements, and it is right that we strengthen safeguards, as has already been touched upon.

It is important to guarantee the independence of all authorised staff when they are exercising judicial functions. Clause 3 will bring authorised staff under the leadership of senior lawyers. Although we are removing the post of justices’ clerk from the statute, the functions that such clerks undertake will continue to be carried out by heads of legal operations, who have a much greater leadership role across all jurisdictions. The change will ensure that we make all authorised staff ultimately accountable and subject to the direction of the Lord Chief Justice and the Senior President of Tribunals.

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My right hon. Friend is being generous with his time. The place where these changes can have the most effect is in the tribunal system. I have sat through tribunals that have lasted for days for no good reason, tying up three independent assessors. Surely, it is there that the changes he proposes can have the biggest effect.

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My hon. Friend may well be right. The Bill of course relates to courts and tribunals, and it is important to bear in mind the impact on tribunals. Tribunals perhaps do not always attract the attention that they might, but they play a vital role within our justice system. If we can find ways to improve their efficiency, we should all welcome that. That is a key part of what this Bill is about.

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My right hon. Friend mentioned the start times of hearings. As he will know, Northallerton magistrates court, which serves many of my constituents, is due to close under these reforms. It is important that people can get to a hearing on time, so will requiring people to travel further to a more distant court be taken into account? Will there be mitigation, such as video links, and will those things be in place and operating before the court closes?

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Journey times are taken into account. I am conscious that substantial issues can arise in rural areas, but journey times are considered. As for technology, if I remember correctly, the change at Northallerton magistrates court is conditional upon ensuring that the technology is properly in place. In the context of this Bill, authorised staff will be able to play a bigger role in determining start times, for example, and one hopes that that might enable the process to run as smoothly as possible and ensure that people’s concerns about when they can get to court can be properly considered.

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With the distance between courts being a factor not just for claimants and defendants but for witnesses, does the right hon. Gentleman agree that witnesses may sometimes choose not to go to a court if it is too far away, which can cause hearings to be cancelled?

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The hon. Gentleman takes me further in the direction of the debate about the court closure plan, but we need to ensure that our resources are deployed as efficiently and effectively as possible. In that context, we have reduced the number of courts, but that money makes a contribution to our overall finances and can be reinvested as part of the court reform programme. We have to take every opportunity to make use of new technology to ensure that the experience of the justice system—the hon. Gentleman rightly highlights that witnesses are important in many cases—is as positive as possible.

I have touched on this already, but safeguards are important. Clearly, the delegation of certain judicial powers to court and tribunal staff needs to be done sensitively and sensibly, and with appropriate safeguards. Independent, judiciary-led procedure rule committees, which govern the rules within courts and tribunals, will determine which functions court staff may exercise in each jurisdiction and what qualifications and experience they will need. Those rules will then be subject to parliamentary scrutiny. All staff authorised to exercise judicial functions will ultimately be accountable to, and subject to, the direction of the Lord Chief Justice or the Senior President of Tribunals.

I am grateful for the valuable insight that Members of the other place brought to debating and scrutinising the measures in the Bill, particularly in relation to the exercise of judicial functions. Many of them drew on their own wealth of judicial experience and expertise in considering the practical issues of implementation.

Concerns were raised in the other place about the safeguards in delegating judicial functions to authorised staff. For example, concerns were raised that certain powers, particularly those that affect the rights and freedoms of citizens, should only ever be directly discharged by the judiciary. Indeed, the right hon. Member for Kingston and Surbiton raised that point.

We have listened to those concerns, and we tabled amendments in the other place that will prevent specific judicial functions from being undertaken by authorised staff, including authorising a person’s committal to prison; in most cases, authorising a person’s arrest; granting certain injunctions; making orders for repossession of residential property, where the orders are contested; and making search orders.

We tabled amendments that will require the procedure rule committees, when making rules to allow authorised staff to exercise judicial functions, to consider whether the rules should include a right to judicial reconsideration of decisions made by such staff. The amendments will also require that, if a procedure rule committee decides against the creation of such a right, the committee will have to inform the Lord Chancellor of its decision and of the reasons for it. This will ensure much greater transparency and accountability.

The measures in the Bill strike the right balance between creating a framework for the delegation of judicial functions to authorised staff, with appropriate safeguards, and giving discretion to procedure rule committees and the senior judiciary to make the arrangements work in practice.

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Does my right hon. Friend agree that the principle of delegating functions to authorised staff is not, of itself, new? There has been a successful history, particularly in the magistrates courts, of delegating powers to justices’ clerks to carry out a number of functions, which even include such matters as issuing summonses or requesting pre-sentence reports. The principle is in place but, of course, the execution is vital.

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My hon. Friend is right, and his experience is a benefit to the House. He knows of what he speaks. This principle is not new, but it is one where we think we can go further, to the benefit of the courts and tribunals system and of the users of that system. He is absolutely right.

A balance needs to be struck on the safeguards, and we believe we have found the right balance. Indeed, the position was strongly supported in the other place by Lord Thomas, the former Lord Chief Justice, and Lord Neuberger, a former President of the Supreme Court, both of whom have a wealth of experience in this area, having chaired procedure rule committees. The combination of Lord