House of Commons
Tuesday 26 March 2019
The House met at half-past Eleven o’clock
[Mr Speaker in the Chair]
Oral Answers to Questions
Health and Social Care
The Secretary of State was asked—
Children’s Health and Wellbeing
The Department of Health and Social Care works across Government to ensure every child can have the best possible start in life. This includes a significant increase in mental health support in schools.
I thank the Secretary of State very much for that reply. May I first pay tribute to the former Minister, the hon. Member for Winchester (Steve Brine)? I think his actions last night were very honourable, and he has been an exceptional Health Minister.
May I ask the Secretary of State also to look at how we can join up services much more strongly on the ground? Whether it is early years, child mental health or special educational needs and disability support, time and again we hear problems about how services are not joined up.
I agree with the hon. Lady on both counts. My hon. Friend the Member for Winchester (Steve Brine) was an excellent public health Minister, who did exemplary work and drove the agenda with great passion and determination, and he has behaved honourably in every sense.
On the point about cross-government working, the hon. Lady is completely right. The need to join up, breaking down the barriers of silos that sometimes exist between agencies, is vital. There is a huge amount of work under way in all of the areas she mentioned, and I am determined to see that work.
On Friday, I met two clinical commissioning groups that cover my constituency specifically to discuss mental health and children’s health and wellbeing. While it is an extremely complex issue, does the Secretary of State agree with me that, with the perceived rigorous spending rules requiring health providers to spend only on pure health services, it will remain extremely challenging for them to work with other agencies to support methods, such as those to build resilience, that improve outcomes for children’s health?
My hon. Friend is absolutely right to raise this. The most forward-looking CCGs in the country are working with all sorts of partners—the voluntary sector, charities, local authorities—to deliver better services that make people healthier, even if they are not purely medicinal in the first instance. For instance, tennis lessons may sometimes help people, Mr Speaker, as may all sorts of other activities. This is all part of a broadening social-prescribing agenda to get people healthy, however that is best done.
The Secretary of State will be aware that, last Monday, I published my report, with the Royal Society for Public Health, on children’s mental health and social media. May I place on the record my thanks to him for his tweet in support of the report? I have asked Education Ministers and I will be doing this with the devolved institutions as well, but would he agree to a meeting with me—and with the mental health Minister, the Under-Secretary of State for Health and Social Care, the hon. Member for Thurrock (Jackie Doyle-Price)—to look at the report and the recommendations so that we can start working across Government Departments and across devolved institutions?
I would be very happy to meet the hon. Gentleman and his all-party group on social media and young people’s mental health and wellbeing. It is an incredibly important topic. We must make sure that social media is safe and that we protect children’s mental health, which the evidence increasingly shows can be negatively impacted by the wrong use of social media. Social media can be a great, powerful force for good, but it also has its downsides and we need to mitigate those, and there is a lot more coming from the Government soon.
May I ask the Secretary of State to meet the Sport and Recreation Alliance to hear its ideas on how we ensure children and young people lead healthier and more active lives?
Yes, I would love to. I think this is an incredibly important agenda. It ties in directly with the question from my former ministerial colleague when I was at the Department for Digital, Culture, Media and Sport, my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch). There is lots to do on this agenda.
There has been an alarming rise in the need for the use of baby banks for children. While I am proud that organisations such as Little Village in Tooting are doing such amazing work, it is shocking that we even need baby banks in this day and age. Does the Secretary of State agree with me that it is a stain on this Government and highlights the drastic inequalities seen in our society?
We are determined to do everything we can to support people, especially at the time—in the first 1,000 days—that is so critical to people’s whole lives, and that is an incredibly important part of the work. Improving maternity services is important, but the link-up with other broader agencies is also important, and we should not denigrate or downplay the vital role that charities too can play in supporting people.
I thank my right hon. Friend for coming to Hinckley to see co-ordination and social prescribing in action. Will he be taking steps to further develop personal budgets, which save money and improve lives?
Yes, absolutely. Driving the social prescribing agenda, which is based on increasingly strong evidence of the power of social prescribing to help people stay healthy and get them healthy again when they are ill, will also involve wider use of personal budgets. Almost 1 million people have personal budgets.
I join my hon. Friend the Member for Manchester Central (Lucy Powell) in paying tribute to the very hon. Member for Winchester (Steve Brine), and I also pay tribute to my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders). Has the Secretary of State seen Professor Clare Bambra’s research in the Journal of Epidemiology & Community Health this month, showing that inequalities in infant mortality between deprived and more affluent areas fell between 1999 and 2010 when there was a Labour Government, and then increased from 2011 to 2017? Is it not true that only Labour has the range of co-ordinated, cross-governmental policies that reduce inequalities in child health?
No. The NHS long-term plan has a whole swathe of policy in order to reduce health inequalities. The best thing we can do to reduce health inequalities is ensure that more people are in work, and the record number of jobs that have been delivered is a vital part of that agenda.
The long-term plan sets out how we will make the NHS a world-class employer and ensure that the NHS has the people that it needs. The NHS, led by Baroness Harding, is engaging with people across the sector to develop a people plan. That plan will set out how the challenges of supply and demand reform can be met, and it will be published in the spring.
I thank the Minister for that response. In Cornwall we have set up the Health and Social Care Academy, and we use the apprenticeship levy to enable local people to train within the NHS service or social care wherever they want to. However, there are many restrictions around the levy, and I wonder if the Minister will meet me and others to discuss how the levy can actually be about training and supporting people into the NHS, rather than just restrictions about paying fees.
The apprenticeship levy was obviously introduced to cover the training and assessment costs of apprenticeships at a rate that would meet employee demand. I recognise some of the challenges that there are, and I would be delighted to meet my hon. Friend to discuss the issues that he has raised.
The hon. Gentleman knows that I wrote to him on 20 March on this issue, and I outlined that officials from DHSC had contacted the scheme administrator about the issues with Livewell. I can confirm that the members there would still be dealt with in the way set out prior to the implementation date, and I am happy to meet him.
The best way that Kettering General Hospital could deliver the NHS’s 10-year plan would be to have the funding for an urgent care hub. I thank the hospitals Minister for visiting recently. What can he do to ensure that that project is delivered?
I was delighted to visit Kettering and to meet the chief executive and the chairman of the trust again. They made very strong representations. The representations by my hon. Friend and the trust have been heard, and he knows that they are at the forefront of my mind.
Changes to the pensions allowance are particularly impacting consultants in their willingness to do additional shifts, or indeed stay in their roles, so what discussions has the Minister had with the Chancellor about the effect of the changes to pension allowances on the retention of consultants in the NHS?
My right hon. Friend the Secretary of State and I have both had conversations with the Treasury and the Chancellor, and there are ongoing discussions.
The Government have done well to get more medical students into general practice, but we are not doing quite so well at retaining GPs later on. What more can we do to make sure that GPs stay in general practice, so that more of our constituents can go and see a doctor more easily?
NHS Improvement has a number of retention schemes in place, for GPs and for nurses, to look at why some people are leaving. The interim plan being developed by Baroness Harding has an employer of excellence work stream, which will report on a number of potential issues.
May I just take a moment, on behalf of the Opposition Front Bench, to thank the hon. Member for Winchester (Steve Brine) for all his work? We found him a decent, fair-minded Minister, and I wish to pass on my personal thanks for the work that he did on the children of alcoholics agenda.
We have 100,000 vacancies across the NHS. The Brexit mess means that we have fewer EU nurses and health visitors. Across the NHS, voluntary resignations are up 55% since 2011, and the professional development budgets have been cut by £250 million. Does the Minister agree that for Dido Harding’s review to be taken seriously, those cuts to continuing professional development must be reversed?
As the hon. Gentleman heard me say earlier, Baroness Harding is developing the implementation plan, which will then feed into the final implementation plan published after the comprehensive spending review. The cuts, as he describes them, are not cuts. He knows that we are increasing the budget for the NHS in real terms and in cash terms up to 2023-24.
The Minister is responsible for workforce, but does not seem to understand that training budgets have been cut. Baroness Harding’s review will only be taken seriously if it is backed up by real investment.
Outsourcing and transferring of staff, whether to wholly owned subsidiaries or the privatisation of clinical services, further undermines staff morale and creates a more fragmented workforce. The Secretary of State went to the Health and Social Care Committee and said no more privatisations on his watch, yet cancer scanning services in Oxford are being privatised. Will the Minister reverse those privatisations, or can we simply not believe a word the Secretary of State says?
The hon. Gentleman can believe everything my right hon. Friend the Secretary of State says. He has delivered on his promise to work with the NHS to deliver a long-term plan, to deliver the funding that will make it possible, and to deliver the workforce that will ensure the plan is not undermined.
Health Inequalities: Life Expectancy
The latest work from the Office for National Statistics shows that life expectancy is projected to increase, but none the less there are inequalities within those figures. That is why we are taking action to reduce smoking, prevent cardiovascular disease and diabetes, improve cancer outcomes, and, of course, tackle childhood obesity. I can also add that reducing health inequalities is an important component of our NHS long-term plan. All local health systems will be expected to set out how they will specifically reduce health inequalities by 2023-24.
Sir Michael Marmot, the world-recognised authority on public health, has warned that the country has, since 2010, stalled in the task of improving the life expectancy of our population. There are already wide inequalities. For example, a Gateshead man can expect to have 57 years of life in good health, compared to the England average of 63.4 years; and a Gateshead woman can expect to have an average of 59.1 years in good health, compared to the England average of 64.1 years. What is the Minister doing to redress those real inequalities?
As I mentioned, the NHS long-term plan will be asking local health systems to specifically address this issue. Certainly, there are particular trends that I personally want to address. They are the real inequalities that affect people with learning disabilities, which are worse than the figures the hon. Lady mentions. We also see that the outcomes she refers to can be laid at the door of a slowdown of heart disease and stroke mortality improvements, so we really need to focus our interventions there. We are also seeing an increase in the fall in life expectancy due to alcohol misuse.
Medway has some of the highest health inequalities in the country. As the Minister rightly says, high inequalities are linked to a greater chance of a stroke. Despite that, the sustainability and transformation partnership and the clinical commissioning group decided to put an acute stroke service in Dartford, which is very close to London and is served by King’s College London. The criteria was not followed correctly. The matter is now with the Secretary of State to review. Can the Minister assure me that the criteria will be re-looked at to ensure that justice is done?
My hon. Friend will know that this has to be reviewed independently, but the Secretary of State does have duties to consider inequalities in all his work.
I, too, wish to pay tribute to the hon. Member for Winchester (Steve Brine), who I sparred with many times in Westminster Hall. We might not have agreed on how to go about it, but he was clearly passionate about improving health.
The Secretary of State’s vision for NHS England includes video links to GPs, diagnostic phone apps and healthy people undergoing gene tests for a few hundred pounds. Considering his own experience of such a gene test, does he not recognise that this just increases access for the well-off, will drive demand in the system and will actually widen health inequalities?
I do not accept that at all. Apart from anything else, we are seeing younger generations be more technologically savvy. We are taking advantage of that technological innovation to spread good health prevention and to help people look after themselves.
I call Dr Philippa Whitford.
I wish to come in on Question 5, Mr Speaker.
I beg the hon. Lady’s pardon; I thought she wanted two questions on this. Maybe I was misinformed. Very well—she can have another question later.
Medicinal Cannabis Products
The data that my right hon. Friend asks for is not available, but it is important that we take action to make sure the right drugs are available for the right people.
Was it intended to make them as rare as hens’ teeth? What measures is the Secretary of State taking to support clinicians in actually prescribing?
I met the parents of some of the children whose needs are best met through the use of medicinal cannabis. My heart goes out to those who are fighting for this cause. We changed the law in the autumn to try to make it easier, and I am looking very closely at what we can do to make sure that the intention of that decision is met.
The Health Committee heard last week that patients are dying unnecessarily and up to a million families are being driven to criminality by getting medical cannabis illegally, and the situation has got worse since the Government changed the law in November. When are these families going to get access to medical cannabis for their children and other sufferers that they would have access to if they lived in Germany, the Netherlands, Canada or the United States?
As the right hon. Gentleman knows, I supported and indeed participated in the decision to ensure that access was made legal in the autumn, and I am working right now on trying to make sure that some of the challenges in the system are unblocked. Ultimately, these things have to be clinician led, but my sympathy is with those who are campaigning, whom I have met, because I know of the anguish that this problem is causing.
Prescription Charges: Asthma
Extensive arrangements are already in place to help people afford NHS prescriptions. Those include a broad range of prescription charge exemptions, for which somebody with asthma may apply.
More than 90% of people on low incomes say they struggle to afford their prescriptions, and 71% told Asthma UK they skipped their asthma medication due to cost. Given the health inequalities in this country, will the Minister investigate that injustice?
People on low incomes who do not qualify for an exemption may be eligible for either full or partial help with prescription charges through the NHS low-income scheme. In addition, for those who do not qualify for that, the prescription pre-payment certificate is available, under which everybody can get all the prescriptions they need for only £2 a week.
Of the 300,000 who have missed out on their prescriptions, a quarter have had a flare-up of their asthma and 13% have ended up in hospital. Does the Minister not accept that prescription charges simply are not cost-effective and should be abolished, as they have been in Scotland?
Almost 90% of prescription items dispensed in the community in England are free of charge. That includes medicines for the treatment of asthma. The fact is that people who, like me, suffer from asthma and need those prescriptions have to decide, as taxpayers—as the people funding our NHS—whether we would rather contribute to those prescriptions or see the underfunding we have seen in Scotland, where GPs have been underfunded by almost £660 million over the last four years. It is a case of priorities.
I miss the former Minister, the hon. Member for Winchester (Steve Brine), but commend him for his principled stance.
The Minister is missing the point on prescription charges. It is now more than 50 years since the eligibility criteria for medical exemption charges were reviewed, and next week prescription charges will rise again, placing a financial burden on many who require regular medication for long-term conditions. Does she agree that it is high time the Government moved to address the very many anomalies in the system? How can it be fair that patients with some chronic illnesses get free prescriptions for all their ailments, while asthma sufferers pay for everything? When will she review this unfair system?
We all miss my hon. Friend the Member for Winchester (Steve Brine), so I thank the hon. Lady for her comments.
Since prescription charges were introduced, Governments of all colours have decided that some patients should pay prescription charges to contribute to the cost of running the NHS, but almost 90% of prescription items are dispensed in the community free of charge, which I think the hon. Lady will agree is an enormous amount.
On 11 March, I held a meeting with all the parties to discuss how best to ensure that people with cystic fibrosis and their families can benefit from the best drugs as soon as possible. Vertex, the National Institute for Health and Care Excellence and NHS England met on Thursday and have agreed to take those discussions forward.
Does the Secretary of State support immediate interim access to Orkambi while the negotiations are going on, and has he asked NHS England, NICE and Vertex to consider this option?
We are having constructive discussions—I am delighted that finally Vertex has agreed to participate in them; the parties have committed to providing the data needed for an objective assessment of the drugs in question, and I look forward to the discussions proceeding effectively.
A constituent of mine came to see me in my surgery. He had been born with cystic fibrosis and told me what a transformative effect the drug had had on him. He was lucky enough to be accepted on the trial, but he says we need to raise awareness because millions of people are not getting the drug. What response can the Secretary of State give to him and fellow sufferers?
My hon. Friend’s constituent is absolutely right about raising awareness of the issue and the need for these drugs. I know the impact that cystic fibrosis can have on people and of the hope that these drugs will save lives. We have made a significant offer to the pharmaceutical company, Vertex, to allow these drugs to be provided in the UK, and I very much hope we can come to an agreement.
On NICE decision making, my young constituents Nicole and Jessica Rich have the life-limiting rare condition Batten disease. Last month, NICE turned down a proven treatment for the condition after a year of deliberation. I and several cross-party colleagues wrote to the Secretary of State to ask if we could discuss this urgent matter, but we received a reply from the Under-Secretary of State for Health and Social Care (Baroness Blackwood), saying that she could not meet us because of diary commitments. This is insulting. Will the Secretary of State meet us to discuss this urgent issue?
Yes, of course I will. I understand exactly where that process has got to. It concerns a different drug from the one in the question, but it is also a very important consideration for a number of people.
Will the Secretary of State agree to or consider temporary interim access to Orkambi while the negotiations continue, and has he had any discussion so far on that subject?
I am happy to consider all options that can secure access in a way that provides value for money based on an objective assessment of what is clinically right. That is the basis of our discussions.
I am glad that the Secretary of State is taking a personal interest in this matter. In Thursday’s debate, I mentioned the case of Oli Rayner, who gave evidence to the Health Select Committee. He fell ill in his 30s and was given Orkambi just to make him well enough to undergo a lung transplant operation. Is it not ludicrous to wait until people are virtually at death’s door before being prepared to give them the drug?
That is one very important consideration. Having met people suffering from cystic fibrosis and heard directly the stories they tell about the impact on their lives and how it potentially shortens their lives, I think it is very important that we find a solution, which is why I was so determined to bring the parties together.
Antimicrobial Resistance: Vaccines
The new five-year national action plan to tackle antimicrobial resistance contains the commitment to support more research into new and alternative treatments, including vaccines and diagnostic tests, to promote broader access to vaccines for both humans and animals.
Stopping the spread of diseases such as TB by using vaccines will play a key role in tackling AMR worldwide, so what plans does my right hon. Friend have for building on the excellent work of the UK Vaccine Network, with all the funding that goes with that, to ensure continued UK leadership in vaccinology?
My right hon. Friend is right to raise this issue. Of all the challenges facing the world, the risk that antibiotics will fail to work in the future is a huge one that we cannot afford to allow to come to pass. We are putting significant research money into the production of new antibiotics, and also ensuring that we roll out vaccines so that antibiotics do not have to be used.
The use of antibiotics in the chicken population in the United Kingdom has fallen by more than 70% over the last five years. This is doable: we will provide the money that is necessary to ensure that people can use antibiotics well into the future.
May I beg the Secretary of State to snap out of the trance that he now seems to be in, and wake up to the fact that many of the key researchers in this area are going back to their European homes because of the threat of Brexit? We are losing Spanish nurses, for instance, on whom my constituents absolutely depend for healthcare. Up and down the country, our health system is haemorrhaging talent because of the Secretary of State’s lack of action. Wake up, Secretary of State, and smell the coffee!
I am afraid that I profoundly disagree with the hon. Gentleman, who used to be so sensible. Antimicrobial resistance is a global problem and we contribute to global funds, because only by coming together as a whole world will we be able to tackle it— and that is what we are going to do.
NHS Nursing Associates
Health Education England is leading a national nursing associate expansion plan to train 7,500 apprentice associates in 2019, building on the 5,000 who were trained in 2018.
Will the Minister face the House, please? Andrew Lewer.
The University of Northampton successfully carried out its partnership with Northampton General Hospital in training the first wave of nursing associates in the United Kingdom, as the Secretary of State saw when he visited the hospital recently. What can he and his team do to encourage other universities and local hospitals to form partnerships to deliver similar results?
I know that the Secretary of State enjoyed his visit, and was very impressed by what he saw. Health Education England has led the establishment of test site partnerships across England. There were 11 test sites in the first wave and a further 24 in April 2017, and the programme is now being rolled out all over the country.
What discussions has the Minister had with nursing associations and the Home Secretary about the recruitment of nurses and social care workers from the European Union after we leave, and about how it can be made easier?
I know that my hon. Friend the Minister for Care met the Home Secretary last week, and that there are ongoing discussions.
The National Institute for Health Research is supporting the study of Lyme disease by researching markers that would offer a faster and more accurate diagnosis. Meanwhile, the National Institute for Health and Care Excellence has published clinical guidance for the diagnosis and treatment of the disease for healthcare professionals.
Lyme disease is often misdiagnosed or diagnosed late, which results in widespread suffering such as joint pain, paralysis and brain damage. Will the Minister therefore join me in congratulating the charity Caudwell LymeCo, which has pledged £1 in research funding, and will her Department commission research on a better test for the disease?
My right hon. Friend is absolutely right to raise this issue. We know that the outcome of Lyme disease depends on whether it is diagnosed and treated at an early stage. That is why my Department commissioned four separate independent systematic reviews of all the relevant literature on the diagnosis, treatment, transition and prevention of the disease, which were published in December 2017 and which assess the existing evidence for the research community, research funders and the public. We welcome all independent researchers who want to do more work on that basis.
My constituents have faced many challenges in relation to Lyme disease. They have had to go overseas in order to be tested and given a diagnosis. However, the NHS does not recognise those tests. What is the Minister doing about that?
Most people are diagnosed and treated successfully by GPs and recover uneventfully, but in a few cases people who are diagnosed late or are not treated adequately may develop significant complications. That is why the National Institute for Health Research welcomes applications for research funds.
My hon. Friend is absolutely right to raise this: we do need to do more in this space, and that is why we are investing over £1 billion a year in health research through the National Institute of Health Research.
What evaluation is being put in place to see how effective the 2018 NICE guidelines for clinicians on managing Lyme disease are in improving the treatment of this dreadful disease?
All NICE guidelines are permanently kept under review. If the research we are investing in throws new light on any issues, that will always be taken into consideration.
NHS Access Standards
It is a great pity to see the hon. Gentleman back up there on the Back Benches as he was such a force—and a rare force—for reason and progress on the Opposition Front Bench until recently.
Standards in the NHS should be based on clinical evidence, and NHS England’s proposals will be rigorously field-tested to gather further evidence on clinical, operational, workforce and financial implications, all with the goal of improving the quality of care.
I thank the Secretary of State for his tribute—although it is not going to change the question I am going to ask. He will be aware that since July 2015 the four-hour A&E target has not been met and last month saw the worst performance on record, so regardless of any clinical reviews, is it not time that Ministers admitted that the four-hour A&E target has effectively been abandoned?
Of course, we are aiming to meet and improve against the targets, including with the injection of the extra money—£34 billion extra in cash terms over the next five years. At the same time we must make sure that the standards to which we hold the NHS are the right ones clinically for the times, and that is what this review of standards is all about.
We have some of the highest HPV—human papillomavirus—vaccination rates in the world. This month we launched a major new national campaign to increase the number of women attending cervical screening across England, and throughout the NHS long-term plan we have committed to radically overhaul screening programmes and further invest in the latest technology to transform diagnosis and boost research and innovation.
Figures from Jo’s Cervical Cancer Trust show that 200,000 women in Greater Manchester have missed their smear test, including half of women aged 25 to 29, yet we know that smear tests save lives. What are the Government doing to raise awareness of the importance of attending screening to prevent cervical cancer?
My hon. Friend is right: cervical screening saves up to 5,000 lives every year, so we cannot do enough to encourage women to take advantage of the screening. It is not the most pleasant experience to go through, but it can save lives. I would encourage everyone to take advantage of the screening, and we will continue to do our best to promote it.
In Newcastle cervical screening rates have fallen since 2010: they range from 85% to just 23% and are consistently lower in poorer areas and among younger women and ethnic minority women, and across the UK women are more likely to die in more deprived areas. What specifically is the Minister doing not just to encourage women to attend but to make screening more available at the weekends, out of hours and closer to where people live?
The hon. Lady makes some excellent points and highlights those areas of the community where take-up is much lower. We need to be more imaginative about how we promote the need for screening, and in that regard I am very pleased to see the work of Jo’s Trust, and also that of the Eve Appeal to raise awareness. We can all do our bit, and I would encourage everyone to spread the word about the need to get screened.
I too want to start by paying tribute to my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders)—he is a big loss to the Front Bench—and also to the Minister I used to shadow, the hon. Member for Winchester (Steve Brine). Credit where it is due: I know cancer charities and campaigners are all tweeting their regret, because the hon. Gentleman was, and hopefully will remain, a true ally of that cause.
Cervical cancer is the most common cancer in women. Smear tests can prevent 75% of cervical cancers from developing, but one in four women do not attend their smear tests and screening is now at a 21-year low. This was not helped by the failure of the outsourced screening to Capita, which failed to write to 48,000 women in six months. What are the Government going to do to ensure that women and girls know what happens at a smear test, what it is for and why it is so important?
As the hon. Lady will know, we have brought that service back in-house, but we should leave no stone unturned in relation to thinking more imaginatively about how we spread the word about the need for screening. I should like to pay tribute to those celebrities who have tweeted pictures of themselves going for their smear tests, because it is only by normalising it and ensuring that everyone realises that it is something they should do that we are going to encourage take-up.
Access to GPs
Primary and community care are set to receive an additional £4.5 billion a year of taxpayers’ money as part of the NHS long-term plan, to ensure that we can get the best possible access to GPs.
In parts of my constituency, it is very difficult for people to see their GP. For example, in the area of Park Wood there is just one GP for 4,000 patients. I welcome the extra money going into primary care that my right hon. Friend just mentioned, as well as the additional GP training places and the fact that a Kent medical school is coming our way, but we need more nurses, physios and other health professionals in primary care. What is he doing to ensure that people can see the right health professional when they need to do so?
This is an incredibly important agenda that is close to my heart. It is at the core of the prevention of ill health to ensure that we have the right primary care services. Yes, that includes more GPs, but it also includes more of the other health professionals who support them. We have 1,000 extra non-GP clinical staff already working in general practice compared with just two years ago, but there is much more to do.
But what is the Secretary of State doing about retaining GPs? This is a real problem, and we have seen more and more GPs taking early retirement in recent years. What is he doing specifically to support retention?
This is a core question that Baroness Dido Harding’s workforce review will be looking into, and work is going on right across Government to try to fix it.
GPs are the first line of defence against superbugs and antimicrobial resistance, and the Secretary of State is already proving to be a world leader in this area. The idea of a resistance tax has the support of other world leaders including Lord O’Neill and Dame Sally Davies. Would he consider this approach?
I am happy to look at all approaches to how we can reduce the overuse of antibiotics in order to preserve them so that they work effectively where they are needed. Of course GPs have a role to play in that, and the number of antibiotics prescribed by GPs has fallen in recent years, but again there is much more work to do.
Will the Minister outline whether his Department is willing to enter into an agreement with medical students to wipe out their student loans if they contract to carry out five years of GP service?
That is an interesting proposition and I would be happy to talk to the hon. Gentleman more about the idea. I was in Northern Ireland last week looking at medical services there and at what we can learn, and that might be another idea.
STPs: Five-year Workforce Plans
Workforce is a key priority for the Government, which is why my right hon. Friend the Secretary of State asked Baroness Dido Harding to develop an interim workforce implementation plan for the spring, including a 2019-20 action plan. It is right that local leaders and clinicians should be empowered to shape the services they need, which is why NHS Improvement has written to all system leaders in England to ask for their views on the vision that is coming forward.
The all-party parliamentary group on mental health’s recent report found that workforce is the biggest challenge to delivering improvements to mental health care. Given that there are 4,000 fewer mental health nurses than there were in 2010, what additional guidance and funding will the Government provide to ensure that local partnerships can recruit mental health nurses, and what are they doing to expand medical school places so that we can train more doctors, particularly in psychiatric specialties?
The hon. Gentleman asked a number of questions there. It is true that the NHS has recently asked all sustainability and transformation partnerships and integrated care systems to create new five-year plans by autumn 2019 setting out how they are going to transform services. He will know that mental health is a priority in the long-term plan, and that we are expanding the number of places for clinicians.
Will my hon. Friend meet me to discuss the severe shortage of pathologists to carry out post mortems? Professor Peter Hutton’s report referenced some ideas that we could take forward.
My hon. Friend has already mentioned several such ideas and I would be happy to meet him to discuss them.
The hon. Gentleman is right: early diagnosis of cancer is vital for successful outcomes. The Government are absolutely committed to a cancer workforce with the skills and expertise to ensure that 75% of all cancers are diagnosed early, not just the top 10. As I have said several times, that is why we asked Baroness Dido Harding to develop a detailed workforce plan to ensure that that can be delivered.
Blood cancer is the fifth most common and the third biggest killer in the UK. What assurances can I get that the workforce in that area will be increased?
My hon. Friend has been a champion of this cause for a long time, raising the matter on the Floor of the House several times. He can be assured that, as I said to the hon. Member for City of Chester (Christian Matheson), Baroness Harding has been asked to bring forward detailed plans for the cancer workforce in her implementation plan.
Mental health nurse numbers have fallen for the second month running, and learning disability nurse numbers have fallen by 40% since this Government came to power. Nearly 13,000 mental health staff left their roles between May and October 2018, and the vacancy rate is now almost 10%. The King’s Fund, the Nuffield Trust and the Health Foundation say that
“Urgent action is now required to avoid a vicious cycle of growing shortages and declining quality.”
Is it not time for Ministers to start taking such advice, rather than giving it?
The Department of course takes such things seriously. My hon. Friend the Minister of State for Care met Baroness Harding last week to discuss how to ensure that there are nurses and carers to help people with learning disabilities. The money that has been promised to make that possible comes in the new financial year, which starts next week.
Tackling Violence: Public Health Approach
We are pursuing a multi-agency approach to prevent and tackle serious violence. Healthcare is of course one of the important and relevant agencies that need to work together right across Government to reduce knife crime.
The Government are committed to a public health approach, but we heard the Secretary of State dismiss it just a few weeks ago. What assurances can he give that he is now fully signed up to the approach? What evidence is his Department collating? How is the Department working with the Home Office to ensure that we have a long-term strategy for keeping our young people safe?
I am a huge fan of the public health approach to tackling knife crime. In fact, I was in Croydon yesterday to talk to charities and to students at Croydon College about the role the NHS can play in tackling the scourge of knife crime. I am a big fan of this agenda, and I look forward to working with the hon. Lady and colleagues from across the House.
Relationships and Sex Education
All children should receive good-quality relationships and sex education so that they understand the benefits of healthy relationships and how to protect themselves against sexually transmitted infections, HIV, unplanned pregnancy and abuse.
Does the Minister believe that the £6 million allocated for relationships and sex education is enough when it equates to a few hundred quid per school? Her Department has cut £3.2 billion from public health spending, meaning that many young people now cannot access STI testing, and we are seeing a boom in STIs among young people.
The hon. Gentleman’s question is actually a matter for the Department for Education, but I do not accept his statement. The new relationships and sex education proposals were widely welcomed across the House when they were announced, and we will improve children’s ability to look after themselves and have healthy sexual relationships.
We all in this House have huge admiration for the dedicated staff who work night and day to deliver world-class care to patients in our NHS. We should recognise that today marks the 75th anniversary of the publication of the White Paper on the establishment of the NHS, delivered in this House by a Conservative Minister, under a Conservative Prime Minister.
The prescription of powerful painkillers has soared, as has the number of overdoses and deaths from these prescription drugs, with some of the worst statistics in the poorest areas of the country. What is my right hon. Friend doing to reverse this worrying trend?
My right hon. Friend is absolutely right to raise this. There has been a rise in opioid-related deaths, and we need to work across Government to tackle the problem. Public Health England is reviewing prescription drug dependence, including opioid dependence, and we recently announced a review of over-prescription in the NHS to make sure patients are taking the right medicines for the right amount of time.
There are still 2,295 patients who are autistic or who have learning disabilities in hospital in-patient settings, despite a Government pledge in 2012 that no one would be in inappropriate settings by 2014. In 2015 the Government said they would close up to 50% of these in-patient places, and they failed to meet that pledge, too, because of a lack of social care funding. Will the Secretary of State now commit to proper social care funding for this programme and renew the pledge to end the misery of these placements by 2022?
The NHS long-term plan has made it clear that learning disability and autism are one of the key clinical pillars in its absolute priorities. This transforming care work is incredibly important. Where people need access to in-patient services for assessment and treatment of their needs, it has to be for as short a time as possible, it has to be as close to home as possible and it has to be with a very clear discharge plan in place.
I will certainly do that, and I am very surprised and disappointed to hear what my hon. Friend has to report. I pay tribute to her work in leading on this agenda, including setting up the all-party parliamentary group. She has campaigned hard to get the Scottish Government to act. Given the progress we have made on the target—by 2021, 95% of children and young people with an eating disorder receiving treatment within one week for urgent cases and four weeks for routine cases—we are on track to meet it. That is something we should be discussing, at the very least, with our Scottish colleagues.
We have a range of work going on to improve access to innovative new treatments, both pharmaceutical treatments and the broader treatments that the hon. Gentleman describes, including ensuring, through an accelerated access collaborative led by the former Labour Minister Lord Darzi, that we drive innovation and that those innovations are taken up by other parts of the NHS.
Order. Last night, in the heat of the moment, I was discourteous to the right hon. Member for Chelsea and Fulham (Greg Hands), and thereafter I apologised to him. However, I take this opportunity in the Chamber today to repeat that apology unreservedly to the right hon. Gentleman, and I hope he will accept it in the genuine and sincere spirit in which the apology is intended.
My right hon. Friend was not only a very good Whip, but is a very good constituency MP. He has made his case very well. “Shaping a healthier future” is no longer supported by the Department of Health and Social Care, NHS Improvement or NHS England. The NHS will look at parts of the proposals that are in line with the long-term plan, such as the aspects that are focused on expanding the treatment of people in the community. As for the changes in A&E in west London that are part of “Shaping a healthier future”—for instance, those at Charing Cross Hospital, which he mentioned—these will not happen.
The hon. Lady makes a very good point. I had regular discussions with the sadly departed Minister for Disabled People, Health and Work, who provided really great challenge within the Department for Work and Pensions about how it handles such assessments. We must do all we can do to humanise them, especially when people are going through periods of ill health.
I commend my hon. Friend for his commitment to raising the local priorities of his constituents and for the campaigning he does on behalf of the local NHS. I think that these plans are best worked through by the local NHS. However, if he would like, I would be happy to meet him to discuss the concerns that he has on behalf of his constituents.
The hon. Gentleman is absolutely right to draw the House’s attention to how vital local community services are in supporting people and to say that we really do need to invest in them. Clearly, these matters of investment are for local areas, which is why we allow CCGs to make these decisions, but I am more than happy to meet him to discuss the matter.
Will the Secretary of State give an evaluation of the “Future Fit” programme? We have secured more than £300 million for investment in our local hospital trust. What is his understanding of where the “Future Fit” programme has got to?
I have called in the independent review panel and asked it to consider all the evidence, at the request of the local council, to ensure that we properly assess all the evidence. We have made the money available, but we must ensure that the plans are the best ones possible for both Shrewsbury and Telford.
The Government take this very seriously. The NHS long-term plan sets out priorities for the NHS, and deaths from respiratory disease is a key indicator and an absolute priority. However, it is only right that people who can afford to pay for their prescriptions, like me—I am an asthma sufferer and I can afford to do it—do so. Local areas have to decide those priorities. At the moment, 90% of prescriptions are free.
Can Ministers outline the latest steps to support the children of alcohol-dependent parents? In the forthcoming alcohol strategies, will greater support be promoted for the families of alcoholics, who are often best placed to help to reduce alcohol harm in their loved ones?
Absolutely. My hon. Friend is right to stress the role of families in supporting the children of alcoholics. We made progress on that and were able to announce funding just last week. I pay tribute to my hon. Friend the Member for Winchester (Steve Brine) for all his work—I enjoyed doing it with him—to do everything we can to support the children of alcoholics.
The relative funding across the country for different areas is assessed independently, and by law NHS England makes that assessment. I am happy to write to the hon. Gentleman with the precise details of how those allocations are devised—I am sure that he has got them; they are widely available—and an explanation of the conclusion that NHS England independently reached.
What is being done to improve co-ordination between orthopaedic surgeons, osteopaths and chiropractors to reduce the burden on surgeons?
It is an important part of the agenda that we look right across the piece at interventions that can benefit patients. I know full well, not least because I am married to a former osteopath, the positive impact that that can have.
In a debate on 24 January in this Chamber, many contributors outlined the dangers of using graded exercise therapy in treating ME. What conversations has the Department had with NICE on that issue before the proposed publication of the revised treatment guidelines in October 2020?
There are ongoing conversations. As the hon. Gentleman knows, NICE is updating existing clinical guidance on the diagnosis and management of ME and chronic fatigue syndrome. That guidance will be published in 2020.
I met the Secretary of State to discuss my campaign for a new health centre in Hornchurch and I welcome his subsequent announcement that NHS trusts can apply for NHS property assets. Will my right hon. Friend let me know how and when they can make those applications and whether he will consider fast-tracking any bid we make, given how close we were to receiving capital funding?
There is no better advocate for Hornchurch in the Chamber than my hon. Friend. She made her case with passion and commitment and I was very impressed by it. I will write to her with the full details, once they are published, of exactly how the process will work, and I look forward to working with her.
The north-west of England has only half the number of ambulances per head of population as London. In rural Cumbria, the situation is far worse. Will the Secretary of State agree to our proposal for an additional two ambulances for Westmorland so that we can keep our communities safe?
The hon. Gentleman will know that, in the winter funding round, extra ambulances were provided across the whole country. I am happy to meet him and discuss his proposals, which I will then consider carefully.
ADHD Solutions is a community interest company based in the constituency of the shadow Health Secretary that serves children and young people with ADHD across Leicester and Leicestershire. Fifty per cent. of its referrals come from the NHS, yet it does not get funding for those referrals; however, those NHS services are able to meet NICE guidelines because ADHD Solutions is doing the job. Will the Health Secretary meet me and the shadow Health Secretary to discuss that?
I have corresponded with my right hon. Friend and the hon. Member for Leicester South (Jonathan Ashworth), but I am more than happy to meet them to discuss that issue. From my perspective, services for people with ADHD are a bit of a Cinderella and I would like to do my best to address that, working with colleagues across the House.
With a throwaway answer to the right hon. Member for Chelsea and Fulham (Greg Hands), the Secretary of State has just pulled the West London strategic health framework, which has governed the delivery of hospital and community services for most of the last decade, absorbed tens of thousands of hours and cost hundreds of millions of pounds. Why has he not thought it appropriate to bring forward a statement so that the many of us who are concerned with this issue have an opportunity to interrogate the many very serious implications that this has for the delivery of healthcare across west London?
The hon. Lady and the hon. Member for Hammersmith (Andy Slaughter), who is sitting next to her, have run, over a number of years, totally inappropriate scare stories about what they said were potential changes to A&E in west London as part of “Shaping a healthier future”. It has been one of the worst aspects of local parliamentary campaigning and I am absolutely clear that the changes in A&E in west London as part of “Shaping a healthier future” will not happen. However, there are elements of “Shaping a healthier future” that are about more community services and treating more people in the community. We look forward to working with the local NHS on those parts of the proposal.
Will the Secretary of State, on behalf of this House, thank doctors and nurses in the NHS for the amazing news that death rates from breast cancer are falling at a faster rate here than in the six largest countries in Europe and that, since 2010, death rates have fallen by 17.7%? He will know that I raised the issue of my constituent, Nicola Morgan Dingley, who is suffering from terminal breast cancer. He very kindly wrote to me. Will he agree to meet Nicola so that she can describe to him the challenges faced by women with triple negative breast cancer?
Yes, of course, I would be delighted to meet my hon. Friend and his constituent. He is right that the fall in deaths from breast cancer is huge progress that we have made as a country. I pay tribute to the work of the NHS on that but, of course, every such death is a tragedy and we need to do yet more.
“Shaping a healthier future” was the biggest hospital closure programme in the history of the NHS, with the loss of two major hospitals, including Charing Cross in my constituency. It was fully supported by the Conservative party not only nationally, but locally, as the right hon. Member for Chelsea and Fulham (Greg Hands) well knows. After seven years, millions of pounds wasted in consultants, staff leaving through insecurity and 2 million people across west London threatened with the loss of essential and world-class hospitals, is that it today? Abandoning “Shaping a healthier future” is a victory for the people of Hammersmith, for the Save our Hospitals campaigners and for our Labour council, but there has been appalling judgment by a succession of Governments and Secretaries of State. Will this Secretary of State now apologise to my constituents?
It is astonishing, is it not? My right hon. Friend the Member for Chelsea and Fulham (Greg Hands) has made this case with objective clarity and reasonableness, is supporting his constituents and led to a very positive outcome, keeping the A&Es open but still doing the positive work in the community, and all we continue to get is information that I regard as erroneous from the hon. Gentleman, who has campaigned in the most terrible way on this over many years.
A nine-year-old constituent of mine, Lydia Heptinstall, is a very brave sufferer of hypermobile Elhers-Danlos syndrome. She suffers from joint pain, headaches and numerous other symptoms and cannot do the things that other children can do. Will the Minister meet me to discuss Lydia and what the Government are doing to raise awareness of this condition?
Yes, of course, I would be very happy to meet my hon. Friend and talk about her constituent’s concerns.
I am wearing purple today for Epilepsy Day. What assessment has the Secretary of State made of the causes of ongoing shortages of epilepsy medications? What action is being taken to address those problems and what impact will Brexit have on the supply of those medicines?
I, too, am wearing purple—purple socks in my case—to support this important campaign. Of course, we have done enormous amounts of work across the NHS. I pay tribute to the NHS and to suppliers for working to ensure that, whatever the Brexit outcome, there will be the continued supply of medicines, but there is one thing that the hon. Lady can do if she really wants to make sure that we put this issue to bed once and for all—vote for the deal.
Order. I am sorry for disappointed remaining colleagues, but we must now move on. Before I take a possible point of order appertaining to business of which we have just treated, I want to say something with reference to yesterday’s decisions and tomorrow’s business.
I understand that the right hon. Member for West Dorset (Sir Oliver Letwin) will be tabling a business of the House motion at approximately 4 pm today. Members have until the rise of the House this evening to table motions to be considered tomorrow under the indicative votes procedure. The indicative votes procedure itself, I must advise the House, will be set out in the amendable business of the House motion, which the House will debate tomorrow. I will leave it there for now. The Leader of the House will be making a supplementary business statement later, after the urgent question on Yemen. I hope, as a guide, that is helpful to the House.
Points of Order
On a point of order, Mr Speaker.
We cannot have a replay of Question Time because people are disappointed with the answers they got or whatever, but if there is some material point of order to be articulated briefly, I will hear it.
Can you advise me, Mr Speaker? I think the Under-Secretary of State for Health and Social Care, the hon. Member for Thurrock (Jackie Doyle-Price), might have inadvertently misled the House in her response to Question 3 on health inequalities when she stated that there was an increase in life expectancy. In fact, the latest figures show that life expectancy has been revised downwards. Public Health England has done an investigation into this trend. Can you advise me, Mr Speaker, on how she might correct the record?
What I would say to the hon. Lady is that every Member in this place is responsible for what he or she says in it. If a Minister believes that an error has been made from the Treasury Bench, it is of course incumbent upon that Minister to correct the record. We shall have to wait to see whether the Minister judges that that is necessary in this case. If it is and it happens, I dare say the hon. Lady will be at least partly satisfied. If it is not thought to be required and therefore does not happen, my advice to her is to persist, if she wishes, through the use of the Order Paper, repairing to the Table Office to table questions, and seeking opportunities to ventilate the matter further at appropriate junctures in the Chamber.
On a point of order, Mr Speaker. As always in Health questions, you did your level best to get as many Back Benchers in as possible, so that we could put questions on behalf of our constituents, but obviously the desire of Members of this House to hold the Government to account on the NHS is such that Health questions is oversubscribed, as always. Every time we have Health questions, there are more people standing than the time allows. As Back Benchers, what can we do either to get more time for Health questions, which is so important, or to have them more regularly, so that Back Benchers can properly represent their constituents?
There are two possibilities. One is that Members can table further written questions—if they have already tabled some—or table them for the first time on the matter about which they are concerned and in relation to which they did not have an opportunity at oral questions. That is one avenue open to the hon. Gentleman and other Members.
Secondly, if the hon. Gentleman has a bigger concern, which I detect perhaps he has, and thinks that the salience of the issues and the level of interest in them are such that they warrant a greater allocation of time in the Chamber, my advice is to write to the distinguished Chair of the Procedure Committee, his hon. Friend the Member for Broxbourne (Mr Walker), to inquire what the Committee might think about allocating greater time to these matters by comparison with others. For my part, as the hon. Gentleman would know, I would happily sit in the Chamber all day and probably all night, listening to nothing other than the dulcet and mellifluous tones of my colleagues in relation to these important matters.
On a point of order, Mr Speaker. Could you further clarify your advice to the House about the processes to be followed tomorrow, and your suggestion about tabling proposed amendments before the rise of the House? There is a risk—we do not know—that the business on the Order Paper might collapse early. Would it not be more opportune to set a time by which all amendments should be tabled in case the business were to collapse and the House rise early?
I am grateful to the hon. Gentleman. I confess that I had not considered that point. The Clerk at the Table, having consulted his scholarly cranium with characteristic speed, has swivelled around to advise me on this matter, and he does not think it necessary; on balance, I do not think it necessary either. The hon. Gentleman is obviously concerned about the possibility that the business of the House might conclude early, but it is not automatically to be assumed that that will be so. If that eventuality were to arise and Members were to be disadvantaged as a consequence, I would have to revisit the issue because my concern is to facilitate colleagues.
As things stand, I am working on the assumption—considering matters lying ahead, and playing for time as I do and as colleagues can see—that this need not arise. We have an urgent question on the situation in Yemen, consideration of the Healthcare (International Arrangements) Bill and a number of other items of business, including the consideration of Lords amendments to the Offensive Weapons Bill and a motion regarding section 5 of the European Communities (Amendment) Act 1993 that is amendable. I give the hon. Gentleman a hint that hon. Members may have expressed an interest to me in amending that motion. I can therefore see some hours of learned and eloquent debate ahead of us. I hope that allays his concern.
On a point of order, Mr Speaker.
Oh, very well.
Sorry to disappoint you, Mr Speaker. It appears that hon. Members are able to submit oral questions for the weeks beginning 8 April and 15 April. Is that accurate, and has future business been amended?
I am advised that it may be a glitch in the system. The short answer is that the business for those weeks has not been announced. As I think the puckish grin on the hon. Lady’s face testifies, she knows that the business is a matter of some uncertainty at this stage. I do not know any more than she does, and as of this moment I possibly do not know any better than Members on the Government and Opposition Front Benches as to whether the House will be sitting in the weeks of 8 April and/or 15 April. It is a matter still to be determined.
On a point of order, Mr Speaker. I am sure that the whole House will join me in condemning the abhorrent racist abuse directed at England footballers during their match last night. I know that you will agree that we must do everything we can to stamp out this vile behaviour. Can you advise me whether it would be reasonable to expect the Secretary of State for Digital, Culture, Media and Sport to come to the House and make a statement on what the Government are doing to protect our players abroad and what action they are taking to push for the strongest possible punishments?
It is certainly perfectly reasonable for the hon. Lady to hope for a statement. Whether the Secretary of State has a plan to do so imminently—in truth, I do not know. It may be intended. There are other ways in which the House can air its concerns on the matter. I share entirely the hon. Lady’s view. Any and all racist abuse is to be utterly and unreservedly condemned, and all of us who have public voices—if I may put it that way—should take the opportunity to make it clear that there can be no justification for that behaviour by anyone, anywhere and at any time. A huge amount of work has been done by anti-racist organisations in football and more widely across sport to try to change behaviour and change the attitudes that underlie abhorrent behaviour. It is only a pity to note that, despite some fantastic work—of which the hon. Lady will also be well aware—much still remains to be done.
To ask the Secretary of State for Foreign and Commonwealth Affairs if he will make a statement on the situation in Yemen.
I hope you will indulge me for just one moment, Mr Speaker, while I pay tribute to my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), who has left office and, in a normal state of affairs, would have been answering this question. He is a very old friend of mine. We have shared offices not just in the Foreign Office but in Portcullis House. I know that he will make a great contribution to international affairs and elsewhere, not least in the middle east, in the rest of his time in Parliament.
Today is the fourth anniversary of the intervention by the Saudi-led coalition into the conflict in Yemen, at the invitation of the Government of Yemen, which began when the Houthi rebels captured most of the capital, Sana’a, and expelled the internationally recognised Government. Since then, Yemen’s humanitarian crisis, the largest in the world, has continued to worsen, as many hon. and right hon. Members know. We call on both sides urgently to implement the agreements made at the Stockholm peace talks and bring an end to this dire conflict.
The United Kingdom is at the forefront of work towards a political solution to this conflict—there can only be a political solution, in the long term—and we will continue to show leadership as part of international efforts to end the appalling suffering that millions are facing. My right hon. Friend the Foreign Secretary visited the region at the beginning of the month in a display of the UK’s support for efforts to secure peace. During this time, he visited the port city of Aden, becoming the first western Foreign Minister to visit Yemen since the conflict began. He also attended the peace talks in Stockholm last December. This year—the tax year 2019-20—we have committed an additional £200 million of UK aid, bringing our total commitment to over £770 million since the conflict began. This support will save, and indeed is saving, lives by meeting the immediate food needs of more than 1 million Yemenis each and every month of the year, treating 30,000 children for malnutrition, and providing more than 1 million people with improved water supply and basic sanitation.
The UK continues to support the work of the UN, and the UK-led UN Security Council resolutions 2451 and 2452 were unanimously approved by the Security Council in December 2018 and January 2019 respectively. Those resolutions enshrined the agreements made in Stockholm and authorised the deployment of monitors within the UN Mission to Support the Hodeidah Agreement, thus bolstering the peace process further. We believe that the Stockholm conference was a landmark point, as the first time that the parties had come to the negotiating table in over two years, but we all know that there is a serious risk that this window of opportunity to make progress towards lasting peace may slip away. The UK therefore urges both sides to act in good faith, to co-operate with the UN special envoy and General Lollesgaard, and to implement the Stockholm agreements rapidly. We have been clear that a political settlement is the one and only way to bring about long-term stability in Yemen and to address the worsening humanitarian crisis. We shall continue to make every effort to support the UN-led process to get to the solution that so many Yemeni civilians so desperately require.
Thank you, Mr Speaker, for granting this urgent question.
Let me begin by completely agreeing with the Minister about the terrible loss from the Foreign Office Front-Bench team of the right hon. Member for North East Bedfordshire (Alistair Burt), who might well have been answering this question today were it not for his decision on a matter of principle. Labour Members applaud the right hon. Gentleman for that today, as we do the equally principled stance taken by the Minister for Asia and the Pacific. We will miss both the substance and the tone that the right hon. Gentleman has brought to our debates from the Front Bench over the past two years.
Unfortunately, however, the former Minister is one of several Foreign Office and Defence Ministers who have told us repeatedly from the Dispatch Box, in written answers and in evidence to Committees that Britain is not a party to the conflict in Yemen. Most crucially, for the past three years, that phrase has been used time and again by Ministers to explain that it is impossible to assess alleged individual violations of international humanitarian law in Yemen because we are not a party to the conflict. Yet this weekend we read reports in The Mail on Sunday that members of British special forces had been engaged in gun battles with the Houthi rebels in Yemen while providing support to the coalition forces.
I am not for a second expecting the Minister of State to comment on the activities of our special forces—something that the Government never do—but I want to ask him two important questions of principle. First, in the light of these reports, do the Government still stand by their long-standing statements that Britain is not a party to this conflict? We already know about our support for the Saudi air force and our supply of billions in arms for the Saudi coalition. If, in addition to all that, our forces are engaged in actual gun battles with the Houthi rebels and that does not constitute being a party to the conflict, I really do not know what does.
The second question of principle is this. It is an equally long-standing position of the Government that there is no military solution to this conflict. Indeed, the Minister has reaffirmed that today. So I simply ask this: why, if these reports are accurate, are British forces being put in harm’s way trying to deliver that military solution?
Finally, there was one especially disturbing allegation in The Mail on Sunday report that our forces are providing support to locally recruited, Saudi-funded militia and that many of the fighters—up to 40%, it was alleged—are children as young as 13 years old. Is that in any way true? If it is, that would confirm that our forces are not just a party to this conflict but witnesses to war crimes.
I thank the right hon. Lady for the tone of her contribution. She will appreciate—indeed, she expressly appreciated—that in relation to special forces we do not comment either to confirm or deny any involvement. Clearly, she is well aware that we have liaison officers who are based in Saudi Arabia, and have been routinely. I am very keen not in any way inadvertently to mislead the House on this matter, and therefore I will, if she will forgive me, ensure that she has a written response, liaising with the Ministry of Defence, about the issue of other engagement or involvement of British personnel in Yemen at the moment. We still hold to the firm view that we are not a party to the conflict. Clearly, we are supportive of Saudi Arabia, which has been a long-standing ally, as she is aware. There is no military solution to this matter.
I have never been to Yemen myself, but my late father’s first engagement out of Sandhurst was in Aden, in a different time. He had the fondest of memories, as indeed many people living in that country have of this country. That is why we have been a pen-holder at the UN Security Council.
I have also, of course, read the article in The Mail on Sunday, if perhaps slightly later than the right hon. Lady did—only this morning. It makes some very serious allegations. I am keen that we get to the bottom of those allegations. Again, I am very keen not in any way to mislead the House, but allegations made in relation to any engagement that involves bringing child soldiers on board would be appalling. I very much hope that the journalist will be in a position, within the sources that he can reveal, to make it clear what knowledge he had on the ground. Clearly, that will be investigated as a matter of urgency.
Order. I am very much hoping to move on no later than 1.30 pm, so brief questions and answers would be greatly appreciated.
The whole House will be grateful for the words of the Minister and the shadow Foreign Secretary about my right hon. Friend the Member for North East Bedfordshire (Alistair Burt). I have worked with him on international development matters for the last 14 years, and the Government can ill afford to lose such a capable Minister at a time like this.
The welcome change of direction on Yemen that the new Foreign Secretary has ushered in is greatly to be applauded, but there were exceedingly serious, credible and authoritative allegations in the Sunday media that serving British military personnel have been seriously wounded in operations in Yemen. That flies in the face of assurances given from the Dispatch Box on countless occasions, including in emergency debates that you have authorised, Mr Speaker. I tabled a number of questions last night to the Ministry of Defence, and were it not for the all-consuming nature of Brexit, I suspect the House would want to explore this as a matter of urgency.
I thank my right hon. Friend. I know he has a long-standing interest in this issue, not least the humanitarian aspect, from his time as International Development Secretary. He is right; these are very serious allegations, and I am keen that I do not inadvertently give reassurances on the Floor of the House that could turn out not to be the case. We need to have an internal investigation. I will perhaps take this up in writing with him, but I suspect that we will come back to this issue on the Floor of the House before too long.
May I add my own remarks about the right hon. Member for North East Bedfordshire (Alistair Burt)? This is a loss that the Government, never mind the FCO, can ill afford. He was a fine Minister, and I am sorry to see him go.
In the deepening humanitarian crisis, some aid agencies are saying that they cannot now work around Hodeidah, and the cholera crisis is spiralling out of control. How are we using our influence? We have been told that the Government are using their influence through arms sales. What influence has £4.6 billion-worth of arms sales delivered in? The Minister said in response to the shadow Foreign Secretary, on the subject of the Mail on Sunday allegations, that
“we are not a party”
to the conflict, but “we are supportive”. Can he give more detail about what the difference is? What advice is the Foreign Office giving to the Home Office about those who manage to flee the conflict in Yemen, who are being diverted to Sudan at the moment? What advice is it giving about the safety of young families who have been sent there?
For obvious reasons, there is constant dialogue between the Home Office and the Foreign Office. I will get back to the hon. Gentleman on specifics, if I may. As far as the broader issue of arms sales is concerned, I appreciate that other Members may wish to raise this, but let me say generally that, as he will be aware, we have one of the strictest arms sales regimes in the world.
Well, as the right hon. Lady will be aware, it is a regime that came into place under the new Labour Administration.
It has been pushed to the limit.
I can confirm to the right hon. Lady that in my part of the world—in Asia and the Pacific—the issue that I probably spend the most time on is arms licences. All Foreign Office Ministers take that work extremely seriously. I have a strict rule in my mind that if the recommendation is to refuse, I will endorse that, but if it is to accept, I will look very carefully through the papers and will often ask for further and better particulars or will push back to refuse. That causes all sorts of day-to-day concerns with the Department for International Trade, but we do that. We take that very seriously as Foreign and Commonwealth Office Ministers—something I am sure she looks forward to doing at some point in the near future.
To what extent are offensive coalition air operations continuing? What is their intensity?
I will have to get back to my right hon. Friend on that matter. It is more an issue for the Ministry of Defence, I guess, than for the Foreign Office.
May I echo what has been said about the former Minister, the right hon. Member for North East Bedfordshire? He will be a huge loss to both the Foreign Office and the Department for International Development.
On Saturday in Birmingham, friends of Yemen from across the country came together with a very powerful voice for the diaspora. Can the Minister seek to ensure that, the next time Martin Griffiths is in the UK, he has a meeting with representatives of the Yemeni diaspora who live here, so that their voice can be heard in this process?
That is essential, and we will try to organise that. I will try to ensure that my private office gives the hon. Gentleman as much notice as possible of Martin Griffiths being here in the UK. We can be very proud of what we are doing on the humanitarian aspects of this. That links into the Yemeni diaspora in this country, and we hope that they will feel that they can play an important part in a better future for that country.
The Minister rightly says that a political settlement is the only way to end this crisis, but pressure must be exerted from all sides. Does he have a message for the Government of Iran about how they can use their influence with the Houthi people to bring about peace?
I thank my hon. Friend for her question. She will be aware that this war did not begin with a Saudi-led intervention. This whole matter began six months after Houthi rebels, representing no more than 15% of the Yemeni population, captured most of the capital, Sana’a, and expelled the internationally recognised Government. As she alludes to, they have been supported by Iran, and clearly the international community needs to try to come together. It is a desperate humanitarian situation on a scale that few of us can comprehend. I have been out to Cox’s Bazar, where the Rohingya are living, but this is on a scale literally 30 times as great; it is really quite horrific.
I join the shadow Foreign Secretary and others in commending the incredible work of the right hon. Member for North East Bedfordshire.
This is a grim anniversary. Since the ceasefire was announced, three civilians have died in this conflict every single day, and there are 110,000 cases of cholera. Three dates are essential: the date that we can have the next meeting of the Quad, the date when the peace talks will resume and the date for the appointment of a new Minister with responsibility for Yemen. When will those be? It is important that we have proper ministerial focus. The Minister cannot run the whole world. We need someone as focused as the right hon. Member for North East Bedfordshire.
That is a fair question. I would like to think that I can do the job at least for urgent questions and the like, but I take on board what the right hon. Gentleman says. As far as a date for peace talks is concerned, we are desperate to ensure at the UN and with all our partners that there is momentum from what happened in Stockholm, which was very positive, but we feel that the momentum is coming to an end. As far as the Quad is concerned, there are ongoing discussions, and no doubt we will again try to get more movement and momentum to ensure that the progress made is built upon and does not dwindle away.
Are there any restrictions on our very large aid budget that would prevent us from applying it to a warzone such as this?
My right hon. Friend will recognise that that is an issue for the Secretary of State for International Development, but there are restrictions on it—in fact, fairly strict restrictions in international law, and our own legislation has come into play in that regard. Clearly this is a desperate humanitarian situation. I think all of us feel that it is right that a significant amount of international aid is placed there. There is a recognition that it is sometimes difficult to get to the most vulnerable on the ground, but we shall do our level best to ensure that that happens.
I very much echo the comments that others have made about the right hon. Member for North East Bedfordshire. He was one of the very best, most thoughtful and most dedicated Ministers, and his departure from the Front Bench is a loss to the Government and the country.
There has been a huge reluctance on the part of the Government to criticise the Saudi regime, even in the face of the most appalling humanitarian situation in Yemen, which the Minister described, and the appalling conflict. It seems unacceptable that we continue to sell arms to Saudi Arabia. I do not call that leadership. Instead of leveraging our influence from our trading relationship with Saudi Arabia, it seems that we are silenced by it. Does the Minister share my assessment that, after Brexit, we will be in a weaker position, not a stronger one, to criticise states with a bad human rights record?
No. The truth of the matter—I see it even in my part of the world—is that the diplomatic channels are open, and we regularly express human rights concerns with countries with which we have trade. I reiterate that we do take our export licensing responsibilities extremely seriously, and we operate a very robust arms export regime. There is a respectable case that says we should not be in the arms business and should just not sell any at all, but we would like to think that our regime means that in many ways we are able to present a more robust case than many other countries that sell arms across the world.
The Foreign Secretary has said that there are 50,000 metric tonnes of grain stuck in Hodeidah. Is it possible that we could use the port of Aden, which used to be a great port, to deliver aid and divert it another way?
I should say to my hon. Friend that the most vulnerable areas are in the north-west of the country, and important though Aden is as a port, Yemen is a large country and it is actually too far away. The roads from Aden to the most affected areas are of course particularly dangerous to traverse at this time.
What action is being taken to prevent children from Sudan from being used and exploited in the conflict in Yemen?
I thank the hon. Lady for her question, and I look forward to crossing swords with her now she is on the Foreign Affairs Committee. We take the issue of children very seriously, and part and parcel of our work with non-governmental organisations and international bodies is ensuring that children are not used in any sort of conflict, particularly those being pushed across borders in the way she describes. We will do our level best, and if we have more specific information, I will obviously ensure that it is brought to her attention.
The Iranian-backed “party of God”—Hezbollah—which is mainly based in Lebanon, has been supplying training, weaponry and missile technology to the Iranian-backed Houthi insurgency. To what extent does the Minister believe that Hezbollah is egging on the Houthis not to adhere to the terms of the ceasefire?
I very much agree with my hon. Friend. We have very long-standing concerns about Hezbollah’s involvement in Yemen. Hezbollah and Iran are of course providing training and weapons to the Houthis, contrary to UN Security Council resolution 2216 and the embargo on the export of weapons by Iran. We shall continue to encourage Iran, the state sponsor of Hezbollah, to demonstrate that it can be a constructive part of the solution, rather than continue with its current conduct. We hope it can promote stability.
With nearly 110,000 new cases of cholera since the start of the year, a third of which involve children under the age of five, does the Minister agree that any strategy to protect children must not only stop the appalling attacks on children, such as the attack on the school bus last summer, but to take action against killer diseases such as cholera? Will he tell us what we are doing to achieve that?
It is an absolute tragedy of the first order. I am often reminded that cholera was discovered, if that is the right word, in my constituency, a stone’s throw from here, back in the 1840s, when it was discovered that it was a water-borne disease. It is obviously unthinkable that people would suffer from cholera in this country, and we are doing all we can to ensure that there is fresh water, and indeed that water supplies are as pure as possible. The hon. Gentleman will appreciate that there is probably also cholera in some of the more difficult to reach far-flung areas, where it is difficult to get access.
The initial optimism of the peace talks bringing the two sides together seems to have waned. What influence is my right hon. Friend seeking to have on the different parties to bring them to the negotiating table so that international aid can be provided to relieve the humanitarian suffering?
As we see it, the next phase of the Stockholm agreement is to provide for a mutual redeployment of the forces away from Hodeidah. Again, we are looking to work, as we need to do, with both sides of the conflict for an agreement on that, which would obviously have a big impact on the humanitarian situation. That has not been implemented to date, and to be frank with my hon. Friend, until that happens the ceasefire is unlikely to be sustained.
To go further on that point, can the Minister give examples of how, practically, he is ensuring that aid is being delivered to all parts of Yemen, no matter who is holding that ground?
The detailed aspects of this are slightly sensitive. They are a matter for the Department for International Development, and I will do my best to write to the hon. Gentleman with some details.
Without wishing to repeat what others have said, keeping Hodeidah port open is absolutely critical to the flow of aid and food supplies to those most in need in Yemen. Given the heavy weapons fire between the warring parties in the city this week, what urgent pressure has the Minister sought to exert to restore the ceasefire there?
The work we are doing within the UN is clearly vital. We have to bring both sides of this conflict together, and we have done our level best to do that. We think the Yemeni Government understand the importance of this issue, and it is the single most important issue that will have such an impact on the lives of the many millions of Yemenis having to put up with this dreadful conflict.
May I add my compliments to those paid to the right hon. Member for North East Bedfordshire?
The allegations about child soldiers are very serious. I have previously raised them in the House, and it is very disappointing that it has taken us so long to discuss them. UNICEF has reported how many child soldiers were employed by the Houthis, the BBC has reported that they were being shot in the back, and we have seen other such crimes such as the use of mines. When are we going to take Yemen seriously, instead of discussing some issues around the edges that do not affect the situation in Yemen?
To be honest, until all parties in Yemen are committed to the peace process or start down that path, it is going to be very difficult. That is the truth. We will do as much as we can on the humanitarian side, and we will obviously continue to do as much as we can diplomatically, but there needs to be a sense within Yemen of all parties being committed to peace. Unfortunately, four years in, that is not yet the case. I entirely share the hon. Gentleman’s deep-seated concerns about the dreadful notion of child soldiers being used in this conflict.
The Minister has talked of two sides being involved in this, but there is a third, which is Iran. What is being done to bring Iran into the process so the humanitarian crisis can be solved?
As I mentioned in the answer to my hon. Friend the Member for Kettering (Mr Hollobone), we obviously recognise that Iran has an important part to play, not least because it is the state sponsor of Hezbollah. We will continue, in whatever way we can, to make representations to the Iranian Government—we do that out in Tehran, obviously, but also in the international community—and to try to impress on others the importance of their influence. As he says, it has all too often been a malign influence, and it needs to change.
To follow up on that question about Iran, what further measures can the Foreign and Commonwealth Office bring into play to make sure that Iran, which obviously has a proxy in this conflict in Yemen, is brought to account for what it is doing?
On bringing Iran to account, the hon. Lady is absolutely right that it has had a proxy in what has happened, as it has for some years, not least in encouraging the Houthi insurgents. We have recognised that if Yemen is to have unity, sovereignty, independence and territorial integrity, Iran clearly has an important part to play. We hope it will use its influence with the Houthis to encourage a de-escalation of the current crisis and to end their attacks on coalition countries, but also to support the moves back towards a political track.
As I have often said here about diplomacy, sometimes it is a matter of taking three steps forward and a couple of steps back. Stockholm was definitely three steps forward, and I think we are in a far better place today than we were six months ago. Equally, we do not want those advances to slip away. Iran has had an important part to play in that process, and will do in the years to come.
The Minister is right to focus on the peaceful and negotiated solution that needs to be sought to bring an end to this conflict, but what discussions are there about long-term support to stabilise and rebuild the country? This is not just about bringing the fighting to an end; the long-term solution is about ensuring that it does not restart.
My hon. Friend is absolutely right, and of course there is thought going into that. I see it in a different part of the world—in Afghanistan, where obviously we have had an engagement—and one realises just how long a haul this must be. As my hon. Friend says, an important aspect of that is to build up a sustainable economy. Of course, one does not start from zero in that regard. We need to work together with the international community to build up a sustainable economy in Yemen that can provide prosperity for future generations.
The right hon. Member for North East Bedfordshire (Alistair Burt) was dedicated in office, a decent person, and dignified in the leaving of office. He was also helping me with the case of my constituent Luke Symons, who has been held captive by the Houthis for two years in Sana’a, and we were, I hope, making some progress. Will the Minister—or perhaps the Foreign Secretary, who is aware of this case—agree to an urgent meeting with me in order that we do not lose momentum, given the former Minister’s departure?
I could not suppress a slight smile when the hon. Gentleman talked about my right hon. Friend the Member for North East Bedfordshire (Alistair Burt); it was as though he had died. I think he is still alive and kicking. He is probably having a quiet pint and a quiet afternoon—though maybe not. The hon. Gentleman raises a serious point about Luke Symons, on whose case he has worked extremely hard. He is aware that the Foreign Secretary brought up the case during his visit to Yemen earlier in the month. We have been providing consular advice to the UK-based family since 2017, and will continue to do so.
I wish to put it on the record that although I appreciate there were particular reasons why Luke Symons was out there—his wife is a Yemeni national—we now advise against all travel to Yemen, and therefore we are unable to provide consular assistance out in the country. Anyone who travels to Yemen against our advice is putting themselves at considerable risk.
Of course I would be very happy to meet the hon. Gentleman, and indeed representatives of the Symons family.
I, too, would like to share my gratitude to the right hon. Member for North East Bedfordshire (Alistair Burt) for his work. I was very glad to be able to listen to Yemenis last week who were in London for events. They included Dalia Qasem Farea, Laila Al-shabibi and Hisham Al-Omeisy—the House may remember that he was held by the Houthis, and I have raised his case in the House.
Of ongoing concern to many aid agencies is the ability of goods and people to travel around Yemen to get to the places and people who need them. Can the Minister tell us more about what is being done to ensure that aid reaches those who need it the most?
The hon. Lady makes a very good point. I have already alluded to that subject in several answers. Our immediate focus, obviously, remains on ensuring that enough food is getting through to the desperate Yemenis to prevent starvation and a disastrous famine. With the operating environment in Yemen extremely difficult for humanitarian organisations we are now focusing our attention on UN agencies, NGOs and other donors, in order to get out to those more difficult areas. Part of that is to assess the acuteness of need in those parts of Yemen, but that of course is an ongoing process and we feel that we have made some significant progress along with NGOs and other international partners.
At a recent lobby of Parliament by Save the Children and Oxfam, my constituents were quite clear that the arms sales to Saudi Arabia need to end if the famine in Yemen is to end. Does the Minister share their sentiments?
The hon. Gentleman and I have spoken on the whole issue of the arms trade. He is putting forward a perfectly respectable position, but I think it is not necessarily shared by us all. I hope that the fact that we have safeguards in place that are, I think, more stringent than most other countries’ should give some comfort to his constituents; but I think that we will have a very active and live debate in this House, in relation to not only Yemen but the whole world, in the years to come.
Diolch yn fawr iawn, Mr Speaker. In an answer to a parliamentary question that I tabled, the British Government confirmed that they had directly trained 102 Saudi pilots over the last 10 years. Last year they signed a deal to sell 48 Typhoon jets to Saudi Arabia. How many of those pilots and planes have been operational in Yemen? Or is it the case that once the pilots are trained and the planes are sold, the British Government wash their hands?
The hon. Gentleman will recognise that I cannot answer that question directly, simply because we obviously do not have that information to hand. And no, it is not a matter of our washing our hands. We have military liaison in Saudi Arabia, and part of that is to try and encourage a sense of ethics. We have military liaison, of course, in a number of other countries that are at the heart of war zones as well. I obviously cannot give a direct answer because I do not have that data to hand, but I very much hope that the liaison officers that we have with the Saudi military are inculcating some of the values that we need, within warfare, to be properly adhered to.
I am sure that the best wishes of the whole House will go out to those members of the British Special Forces who have been reported injured in Yemen. I do not expect the Minister to comment on the details of the operations that they might have been involved in, but can he say whether any members of the British armed forces operating in Yemen have observed, or been witness to, the use of child soldiers by the Saudi Arabian side?
I refer to my earlier answers. I do not wish to fob the hon. Gentleman off. Some serious allegations were made in the Mail on Sunday article. I am sure that they are well sourced, so I would be interested to know more about those sources. There will be an investigation on the matter.
The Government clearly recognise the scale of the humanitarian crisis in Yemen, because they have recently increased aid; yet, sickeningly, unlike Germany, Norway, Denmark and Finland, UK arms sales to Saudi Arabia continue. Does the Minister feel that these continued arms sales are helping to cease or intensify the relentless and indiscriminate murder of innocent children and civilians?
I can really only refer the hon. Lady to what I said earlier on arms sales. Many of these are long-standing contracts, with arms that are in the hands of some of the combatants in the Saudi-led coalition in this regard. There is nothing that I can usefully add to that answer.
The Government contract the manufacture of UK arms for Saudi Arabia. They contract the issuing of bombs into UK aircraft in the Kingdom. They have RAF soldiers in command centres, and now we learn that we have ground assets in Yemen. So can I ask again, because I do not think the Minister answered the question: if this does not constitute being a member of the coalition, what on earth does? What legal advice have Her Majesty’s Government received about potential complicity in war crimes and international humanitarian law abuses, which we could now be liable for?
Will the hon. Gentleman please be assured that there is ongoing legal advice on all the matters to which he referred? I should perhaps also say, to correct the record in that regard, that we do not have our liaison officers or others in command centres with the Saudis. The liaison is in Saudi; they are there in a training and advisory capacity.[Official Report, 10 April 2019, Vol. 658, c. 4MC.]
Like many hon. Members, I attended some of the #YemenCantWait events over the past week. I was struck by one quote:
“We’ve had 4 years of WAR, and the SUFFERING is reflected on every face you see.”
The situation is beyond dire. What will the Minister say to the UN’s Martin Griffiths when he visits London—I believe this week—regarding the urgency of a continued effort on the peace process?
I thank the hon. Gentleman for what he has said. It is an absolutely desperate situation. We are working closely with Martin Griffiths, and will continue to do so.
As I said at the outset, the most important thing is to try and move towards a political solution. We had some real progress, for the first time in two years, in Stockholm at the end of 2018, and we now need to build upon that. That is the message that goes out: how can we work together to build upon the progress that has already been made? It is, though, an utterly desperate situation.
Mr Speaker, you will be glad to know that we are 110 seconds within your limit, so I could filibuster a little bit longer. [Laughter.] No, I do not wish to be too glib on this. I know that we shall come back to the subject repeatedly in future. I thank all right hon. and hon. Members for their contributions. I appreciate, and they will appreciate, that for obvious reasons, one or two of their replies will have to be provided in writing. I think it is greatly to our credit that we are a UN penholder on this Yemeni issue. It is very close to our hearts. We shall be doing a lot of work, continually, on the humanitarian side. Some of the most important work that we do across the globe will be done, and many, many lives will be saved courtesy of the British taxpayer.
Business of the House
To assist the House, I would like to make a short business statement. The first business tomorrow will reflect the decision taken by the House yesterday. At the conclusion of that business, the Government will bring forward the draft European Union (Withdrawal) Act 2018 (Amendment) Regulations 2019 for consideration.
I thank the Leader of the House for the statement. We welcome the fact that we can approve the statutory instrument to extend the exit day. I just have a couple of questions. When will the meaningful vote be brought back, given that the Prime Minister said it would be coming back this week? Can she confirm that it is also the Government’s understanding that: if the meaningful vote is passed, exit day is on 22 May; if there is no meaningful vote we leave by 12 April; and there will be a further extension if we show purpose? We welcome the fact that the uncertainty of 29 March has now moved, albeit to 12 April.
I thank the hon. Lady for her questions. What I can say is that, as the Prime Minister has made very clear, the Government continue to believe that the best way to leave the EU is with a deal. The deal that she has negotiated has taken the best part of three years and is extremely complicated. It remains our view that it represents the best compromise for leaving the European Union while keeping a close economic and security partnership. As the Prime Minister has said, she will continue to have discussions with colleagues across the House to seek to build support for her deal, so we can, if possible, this week approve the deal and guarantee Brexit.
On the hon. Lady’s specific question, the draft statutory instrument the Government hope to bring forward tomorrow will provide for two durations that were agreed with the EU27. Exit day, as amended, would be 22 May if the withdrawal agreement is approved before 11 pm on 29 March. Otherwise, it would be 11 pm on 12 April.
Order. I understand the appetite of colleagues. This is an important business statement by the Leader of the House, but its terms are relatively narrow and it is not the normal business statement so it really should focus on tomorrow, which is the subject matter on which the Leader focused.
Will the Leader just clarify? I thought the 2018 Act required an exit date, not two optional dates. So I am surprised that the statutory instrument is actually naming two dates. I would have thought that the right thing would have been to have 12 April and then extend later if need be. Am I also right in thinking—I am sure the Leader would agree—that if those statutory instruments go through both Houses of Parliament, we will be coming out of the European Union, at least domestically, in three days’ time?
My hon. Friend raises an incredibly important point. This House voted on 14 March for a short extension to article 50. The EU Council’s conclusions were turned into a legal decision with which the Prime Minister of the United Kingdom agreed. Those conclusions came into force last Friday. So the date for our departure from the EU has already changed in international law. The draft statutory instrument provides for both the durations that were agreed with the EU27. As I said to the hon. Member for Walsall South (Valerie Vaz), exit day, as amended, would be 22 May if the withdrawal agreement is approved before 11 pm on 29 March. Otherwise, it would be 11 pm on 12 April. I want to be very clear that a rejection of the statutory instrument that the Government seek to bring forward tomorrow would create a clash in UK law, because a large volume of EU exit legislation preparing the UK statute book for the moment that EU law ceases to apply is due to enter into force automatically on exit day. In international law, the exit date has already changed. The statutory instrument seeks to clarify that in UK law. I hope that that is clear to all Members.
We all look forward to the Leader of the House’s motion tomorrow, so this can be properly discussed. I think we are all particularly looking forward to a little bit of parliamentary innovation tomorrow. I am looking around for Prime Minister Letwin. He must still be with the Queen discussing the Parliament party legislative programme, which we will obviously get an opportunity to consider and debate tomorrow.
I get the sense that Parliament is about to take control of this process with all the enthusiasm of the first lieutenant of the Titanic taking over from Captain Edward John Smith. Can the Leader of the House confirm today that the Government will observe and respect whatever outcomes are agreed tomorrow, by a majority, in this great piece of parliamentary novelty? That is what the House really needs to hear from the Leader. We are sick and tired of voting repeatedly on motions that are passed, only for the Government to casually and contemptuously ignore them. Will they co-operate fully in ensuring that we get to some sort of solution with this House, and will they respect and observe it?
I reject what the hon. Gentleman says about the Government ignoring this House. It is, of course, as a result of the motion that was passed by this House on 14 March that we have an extension to article 50. As he knows well, as Leader of the House of Commons I take very seriously my role to be Parliament’s voice in Government.
On the options that will be brought forward tomorrow, what I can say to the hon. Gentleman is that, at this stage, we do not know which options will be debated and voted on, let alone which will pass. To use his analogy, my right hon. Friend the Member for West Dorset (Sir Oliver Letwin), the new “Prime Minister” for West Dorset, has not yet indicated that manifesto. Nor indeed has the right hon. Member for Leeds Central (Hilary Benn) indicated his manifesto. I think we need to wait for that advice. I do jest, in case any hon. Member is determined to take offence at my joke there, Mr Speaker. I say that for clarity in this Chamber.
The second point is that any options passed by this House must be negotiable. They have to be deliverable in negotiations with the EU and they would also have to take account of how long those negotiations would take.
Finally, as my right hon. Friend the Prime Minister pointed out in the discussion yesterday, and as the shadow Brexit Secretary also made clear in the House, it would not be possible for different parties to accept proposals that their party manifestos rejected at the last general election. [Interruption.] The shadow Brexit Secretary was clear in the House yesterday that Labour would reject certain potential outcomes as inconsistent with the Labour manifesto. [Interruption.] The hon. Member for Wallasey (Ms Eagle) shouts “Rubbish”, but she needs to talk to her Front Bench. It is absolutely vital that this House delivers outcomes that are negotiable, feasible and in line with the will of the manifestos and the referendum on which we all stood.
If the measure was defeated or the Prime Minister stayed her hand, then the European Communities Act 1972 would cease to apply on Friday evening and we would be free, wouldn’t we?
My right hon. Friend is correct to say that a commencement order is required under section 25(4) of the European Union (Withdrawal) Act 2018 in order to give effect to the repeal. The timing of that commencement order will depend on the date we leave the EU. We need to commence the repeal of the 1972 Act on the date of our departure, which is either 12 April as things stand if the deal is not approved, or 22 May if the deal is approved.
May I join the Leader of the House in welcoming her resistance to what I must now call the anarcho-Brextremists on her own side who want to mess around by voting against the motion she has brought today to put UK law in line with the international treaty agreements that the Prime Minister has made? Will she clarify something she said in her statement? Yesterday, the Prime Minister said she was no longer going to bring the deal back for a third meaningful vote, but the Leader of the House has just said that that might happen this week. Can she clarify which is true?
The Prime Minister has said that she will continue to seek further support for the withdrawal agreement and political declaration. Should she succeed in that, we will seek to bring back the meaningful vote for this House to consider. To be clear again, it is only if this House approves the withdrawal agreement before 11 pm on 29 March that there is then an extension to 22 May.
If this House does not approve the withdrawal agreement—indeed, it might be that it is not possible for the withdrawal agreement to be brought back before this House anyway—and if the Prime Minister therefore decides that exiting on World Trade Organisation terms is preferable to no Brexit, is there anything that this House can actually do to prevent the Prime Minister ensuring that we exit on WTO terms? I think the answer to that question is no, isn’t it?
I think my right hon. Friend poses an unanswerable question, because of course the ingenuity of the House knows no bounds. What the House has been clear about is that it does not want a no-deal Brexit or a Brexit on WTO terms. I share that desire, but, as we have always been clear, the way to avoid a no-deal Brexit is to vote for the deal. If I may, Mr Speaker, I will quote directly from the European Council conclusions:
“The European Council reiterates that there can be no opening of the Withdrawal Agreement that was agreed between the Union and the United Kingdom in November 2018. Any unilateral commitment, statement or other act should be compatible with the letter and the spirit of the Withdrawal Agreement.”
So all the terms under which the UK leaves the EU are subject to the agreement by this House of the withdrawal agreement.
It is potty to announce today that we are going to have the statutory instrument tomorrow evening, at the fag end of the business. That is absolutely ludicrous when we could perfectly easily do it on Thursday.
May I ask the Leader of the House whether we will be sitting on Friday? I have a particular interest: Friday is Brain Tumour Research’s Wear A Hat Day, and it is encouraging everybody around the country to wear a hat to work on that day. As you will know, Mr Speaker, “Erskine May” is now silent, on page 451, about whether we can wear a hat in the Chamber, although I think we are expected to speak uncovered. Would it not be a good idea for the Leader of the House to announce now, if we are sitting on Friday, that we are going to do that on Friday, or if not, that we call all wear hats on Thursday?
Excellent. I once wore a hat because I wanted to take my hat off to the right hon. Baroness Jowell, who sadly is no longer with us, for her brilliance in establishing Sure Start. I can tell you, Mr Speaker, that you tolerated my wearing of a hat in honour of what I felt was a very good cause.
The hon. Gentleman asks a very specific question. As he will be aware, at the moment there are no plans to sit on Friday. If there were plans to do that, it would require the passing of a motion to that effect, which the House would have to agree.
Can my right hon. Friend confirm that to get the longer extension requires the passing of the withdrawal agreement, not the withdrawal agreement plus the political declaration, and that the political declaration provides for a wide spectrum of potential outcomes for the long-term relationship between the UK and the EU?
My hon. Friend is right that the European Council decision requires that this House has agreed the withdrawal agreement—or has introduced the withdrawal agreement—in order to get the long extension ready for the legislation. I encourage all hon. Members to consider that a lot of the proposals being put forward for tomorrow would themselves require a withdrawal agreement to be approved in order for them to be taken forward. We need to be clear that what we will be talking about in the indicative votes tomorrow are, potentially, replacements for the future arrangements as opposed to replacements for the withdrawal agreement. I urge hon. Members again to consider the Prime Minister’s deal and to accept the reality, which is that the European Council requires us to look positively at the withdrawal agreement.
The Leader of the House knows, and I welcome the fact, that I am now semi-clear about what the future progress in the House will be, but does she agree that it is most important in this troubled and tumultuous time that we inform our constituents about what we are doing as honestly and openly as possible? Will she stop her colleagues in the Cabinet going on radio and television and saying that there has been a vote on a people’s vote, or a second referendum? That has not taken place. A minority group in the House moved a motion, on which most of the Opposition abstained. There has not been a major vote on the people having the opportunity of a new referendum. Will she stop her Cabinet colleagues saying there has been?
There very much was a people’s vote. That was in June 2016, and the people decided to leave the European Union.
Will the Leader of the House confirm that the very act of the Prime Minister signing what is, in effect, an amendment to the Lisbon treaty under royal prerogative makes whatever we have to say on the matter of an extension rather irrelevant?
This House voted on 14 March for a short extension of article 50. At the time, the Prime Minister made it very clear that if this House were to vote for that short extension, she would seek to negotiate it but that she could not be certain what the EU would offer in return. My hon. Friend is right. The Prime Minister agreed a short extension. That was not necessarily every individual’s definition of exactly what that should be, but she agreed it on behalf of the United Kingdom. As such, in international law, the date of our exit from the EU has now changed irreversibly to 12 April, or to 22 May if we have agreed to progress with the withdrawal agreement.
Is it the Government’s intention to table their own business motion for the Speaker to deliberate on regarding tomorrow’s business?
As I set out just now in the business statement, the first business tomorrow will reflect the decision taken by the House yesterday, and at the conclusion of that business the Government will bring forward the draft European Union (Withdrawal) Act 2018 (Exit Day) (Amendment) Regulations 2019.
Given that the Leader of the House has said that we are not sitting on Friday, and given that House business takes priority tomorrow, does she expect to make a business statement at the end of House business tomorrow announcing that the meaningful vote will take place on Thursday?
I cannot give my hon. Friend absolute certainty on any issues of future business right now. As I have set out, we are continuing to seek support for the Prime Minister’s deal, and that is absolutely the focus for the Government. Should we feel that there was sufficient support for that deal, we would seek to bring that vote back, because that would mean we would be in a position by the end of this week to have an orderly departure from the European Union, with a close economic and security partnership to go with it.
I am sorry if I missed it, but will the Leader of the House clarify tomorrow’s business? Will there be protected time for the SI? It seems strange to cram it in tomorrow, given the decisions the House has made about debates tomorrow. Will she clarify how much business there will be, whether we will have protected time for it, and whether the Government will table their own business motion to deal with the indicative votes tomorrow?
Hon. Members will realise that the vote yesterday was that the Government would not be responsible for tomorrow’s business. The Government are seeking to engage in a productive and constructive way with those who have control of tomorrow’s business to ensure that we debate this very important statutory instrument, which will provide certainty—not certainty about our departure date but legal certainty between 29 March and, in the first instance, 12 April—to businesses and citizens. The Government are working closely with those right hon. and hon. Members who are controlling the business tomorrow to seek agreement that Government business will be able to carry on after the moment of interruption. As is normal with statutory instruments, I would expect that to be a 90-minute discussion followed by a vote, but that is not in my hands.
There has been a real lack of clarity in what the Leader of the House has said about whether meaningful vote 3 will come back this week, next week or perhaps even the week after. Given that the question sessions for the weeks beginning 8 April and 15 April are now available for tabling on Parliament’s Member hub, will she confirm what we all know to be self-evident: that recess is cancelled?
As the hon. Lady will know, I have announced the dates for the Easter recess, but recess dates are always announced subject to the progress of business. We will need time in the House either to find a way forward or to pass the withdrawal agreement Bill, and I think the country will rightly expect Parliament to be working flat out in either scenario. Further announcements on future recess dates will be made in due course in the usual way.
In answering my hon. Friend the Member for Perth and North Perthshire (Pete Wishart), the Leader of the House said that anything the House proposed had to be negotiable and deliverable before the Government could support it. Tomorrow, with cross-party colleagues I will be bringing forward an amendment on the revocation of article 50 to avoid a no-deal Brexit. Given that revocation has the virtue of requiring no negotiation and is deliverable, will she confirm that were that to be passed in an indicative vote tomorrow, she would respect that vote?
We will wait to see what the indicative votes are on tomorrow before deciding how to respond.
The Leader of the House has talked about the Easter recess. One of the dates she mentioned this morning is during that recess. The Table Office is already populating that fortnight for questions. When will the Government come clean and tell us the Easter recess is cancelled?
I refer the hon. Gentleman to the response I just gave. The Easter recess has been announced, but it will be subject to the progress of business. Of course, we hope to have a clear way forward in the next few days, and I will make a further statement on recesses as soon as I can.
I am sorry if I missed this, but, following the question from the hon. Member for Eltham (Clive Efford), will the Leader of the House clarify whether the four SIs on the Order Paper tomorrow—on exiting the EU and food, the protection of trading interests, animals and constitutional law—will remain as Chamber business? I ask because I have a rather excellent Adjournment debate that I do not want Members to miss out on.
As I said in response to an earlier question, we are in pro-active discussions with my right hon. Friend the Member for West Dorset (Sir Oliver Letwin) on what Government business can take place tomorrow.
As my hon. Friend the Member for Rhondda (Chris Bryant) has referenced the silence of “Erskine May” on sartorial matters, perhaps the newly elevated right hon. Member for West Dorset (Sir Oliver Letwin) could appear in the toga he once wore when he appears before us.
On tomorrow’s business, will the Leader of the House clarify what the Government’s attitude will be if, as expected, tomorrow’s indicative votes do not come up with a solution and more time is required? Will the House have to wrestle that time from the Government again, or, instead, given the clear views of the House, will they be prepared to provide more time to settle the matter?
There is no question of wrestling; what we do in this place is vote and take decisions. The Government’s position is that the withdrawal agreement and future political declaration are essential to an orderly and proper departure from the EU. That is the Government’s position. Anything else that is voted on by the House will have to considered as and when it arises.
The Conservative manifesto at the last general election was defeated. Is that true?
It feels as though the Leader of the House and the Prime Minister still have not grasped that last night’s vote was because Parliament is fed up with this broken record about the only way to avoid a no deal being to vote for the withdrawal agreement the Prime Minister negotiated. To quote one of the most reasonable and respected Ministers, who resigned last night, the Government continue to play roulette with people’s livelihoods. The Leader of the house has not answered this question yet: what will the Government do to respect the votes tomorrow and what measures will be in place to contact the EU and plan for legislation to respect them?
The hon. Gentleman says it is boring, but it is actually true: the only way to avoid no deal is to vote for a deal. The second very important truth is that hon. Members can put forward other bespoke solutions, but they have to be negotiable—that is the absolutely incontrovertible fact. The House cannot just decide; it requires the EU to negotiate the other side of that transaction. The Government will look very carefully at what the indicative votes show tomorrow and then respond accordingly.
Point of Order
On a point of order, Mr Deputy Speaker. I had hoped to raise this matter directly with the Speaker, as it arises from his exchange with the hon. Member for Tooting (Dr Allin-Khan), who raised a point of order about racism in football. In response, the Speaker from the Chair gave us a homily on racism in football and its evils, which was particularly welcome, coming as it did from a former secretary of the immigration sub-committee of the Monday Club. I have, however, raised previously my concerns about the bias of the Speaker, and I would be grateful if you could convey it to him, Mr Deputy Speaker, that the fewer views he expresses, either from the Chair or as the Speaker, the less anxious we will be about his bias.
I think we now need to press on with the business in hand.
Decarbonisation and Economic Strategy Bill
Presentation and First Reading (Standing Order No. 57)
Caroline Lucas, supported by Clive Lewis, presented a Bill to place duties on the Secretary of State to decarbonise the United Kingdom economy and to eradicate inequality; to establish a ten-year economic and public investment strategy that prioritises decarbonisation, community and employee-led transition from high-carbon to low and zero-carbon industry, and the eradication of inequality; to require the Government to report on its adherence to the strategy; to establish higher environmental standards for air, water and green spaces; to make provision to protect and restore natural habitats; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 5 April; and to be printed (Bill 365).
Compensation Orders (Child Sexual Abuse)
Motion for leave to bring in a Bill (Standing Order No. 23)
I beg to move,
That leave be given to bring in a Bill to require the Lord Chancellor to report on the use by courts of compensation orders for child sexual abuse offences; and for connected purposes.
People come to this House for many reasons—to deliver Brexit, to fight racism, to champion social justice, to reform Parliament—but I am sure that everyone in the House, from all parties, comes here to help the victims, the vulnerable, and those with the least voice, and there can be fewer in our society more in need of our help than the victims of crime, and in particular victims of child sexual abuse. In this place, we regularly discuss the abuse that has occurred in our country. It has occupied much of our time in the Chamber. We have discussed the horrendous abuse that took place in the 1970s and in the Catholic Church and the Church of England.
More recently, we have spent much time talking about the horrific and widespread abuse in towns up and down the country such as Rotherham and Bradford. The suffering of those children is indescribable and unimaginable, and it is only right that this place does all it can to reduce the possibility of such things happening again. Nobody can take away from those victims the pain that their abuse has caused, the trauma and the suffering that they have endured, not just as a child when the abuse happened but, all too often, in later life, when the trauma comes back and bubbles to the surface.
We all want to do our very best in this place for those survivors. As someone who was himself a victim of child sexual abuse, I know how difficult and traumatic it is to discuss such issues. I kept my secret hidden for some 40 years. I locked it away, chained it down and hoped it would never surface. I convinced myself that if I did not give it words, I could deny it a reality. That was my view. How wrong I was! Talking about what happened to me, and explaining it to other people, was the best thing I could have done. I hope that other people who see this debate or read my testimony will think about coming forward and speaking out about their abuse and the trauma they have suffered.
To talk about these things takes courage. If it took sitting in a psychiatric ward with a psychiatrist for me to be able to talk about my trauma, how much more difficult must it be for victims who find themselves in the courtroom—in that intimidating and forbidding place—who have to suffer cross-examination by a skilled and forensic barrister? All too often, they have to face the perpetrator—the person who caused them so much pain and anguish over their lifetime—across the courtroom. And yet they do it. They speak out. They find, from somewhere within, the courage to be able to do that. Surely we—Parliament, the judiciary and the police—should support them in any way we can if we are to stamp out the scourge of child abuse that we see all too often in our country.
The House has mandated support for those victims. One of the objectives of the Criminal Justice Act 1982 was to increase the use of criminal compensation orders to ensure that victims of crime were compensated by right, as a norm, without the need for expensive civil litigation and the prospect of having to retell and relive the story of their abuse in the courtroom. That was consolidated in the Powers of Criminal Courts (Sentencing) Act 2000. The Sentencing Council itself says:
“the court must order compensation wherever possible and should not have regard to… other sources such as civil litigation or the Criminal Injuries Compensation Scheme.”
So if everyone agrees that survivors should receive compensation as of right, and judges have the power to award that compensation straight away, at the time of sentencing, CCOs in child sexual abuse cases should be used regularly and to good effect. Surely that is a given, is it not? Sadly, the answer is a resounding “No”.
In 2017, the last year for which figures are available, there were some 6,861 convictions: 6,861 people were found guilty and sentenced for committing a child sexual abuse crime. Yet in how many of those 6,861 cases in which a CCO could have been used was one received? How many would the House suggest—50%, 25%, even 10%? The shocking reality is that just 26 people received compensation: just 0.4%. That is a criminal act. We should be ashamed that we are treating victims of child sexual abuse in that way. It is an outrage. We are letting down the survivors, and we must do something to change that.
The power is there. It lies in the hands of the judges, but they are simply choosing to ignore the use of CCOs. Despite all the guidance that the Ministry of Justice has issued and all the advice that has been given to the judiciary over many years, the courts are simply ignoring it, either by design or by accident, and compensation is not being given to the people who so justly deserve it. Moreover, although the police are supposed to be providing the CPS with information at an early stage so that judges can make the necessary decisions when sentencing, that information is simply not being collated. The crazy thing is that all too often the police do collate information for the courts, but when in this instance, when there seems to be an obvious opportunity to use CCOs for a good purpose, the information is not being gathered.
Evidence shows that victims are being let down through a general lack of awareness and a lack of purpose behind a fundamental statutory provision. How can it be that we are not using such a simple tool to help those victims? I am sorry to report to the Minister that the Ministry of Justice’s “Victims Strategy” document, although it is a great document—very worthy and very laudable—makes no reference to the use of CCOs.
My Bill asks the Government to report routinely to Parliament on the use of CCOs in child sexual abuse cases. Let me quote a well-known phrase that my dad used to use: “What gets measured gets done”. I firmly believe that such reporting, if adopted by the Government—in association with other simple and straightforward methods—will stimulate the judiciary to secure for the victims the compensation scheme that they deserve.
I thank all the Members who have supported the Bill so far, particularly my hon. Friends the Members for Lewes (Maria Caulfield) and for Congleton (Fiona Bruce), the hon. Members for Rotherham (Sarah Champion) and for Batley and Spen (Tracy Brabin), and my hon. Friend the Member for Truro and Falmouth (Sarah Newton), all of whom have been hugely helpful, as has Alan Collins of Hugh James, the solicitors, whom I also thank. However, there must be more that we can do to help those victims. It is in the Minister’s hands. Victims of child sexual abuse deserve better, and we can deliver it. I ask the House please to accept the Bill.
Question put and agreed to.
That Andrew Griffiths, Sarah Newton, Fiona Bruce, Sarah Champion, Tracy Brabin, John Mann, Dr Philippa Whitford, Antoinette Sandbach, Carolyn Harris and Jim Shannon present the Bill.
Andrew Griffiths accordingly presented the Bill.
Bill read the First time; to be read a Second time on Friday 5 April and to be printed (Bill 366).
Healthcare (International Arrangements) Bill (Changed to Healthcare (European Economic Area and Switzerland Arrangements) Bill) (Programme) (No. 2)
Motion made, and Question put forthwith (Standing Order No. 83A(7)),
That the following provisions shall apply to the Healthcare (International Arrangements) Bill (changed to the Healthcare (European Economic Area and Switzerland Arrangements) Bill) for the purpose of supplementing the Order of 14 November 2018 (Healthcare (International Arrangements) Bill (Programme):
Consideration of Lords Amendments
(1) Proceedings on consideration of Lords Amendments shall (so far as not previously concluded) be brought to a conclusion two hours after their commencement at today’s sitting.
(2) The proceedings shall be taken in the following order: Lords Amendments Nos. 1, 2, 8 to 10, 18 to 20, 3 to 7 and 11 to 17.
(3) Any further Message from the Lords may be considered forthwith without any Question being put.
(4) The proceedings on any further Message from the Lords shall (so far as not previously concluded) be brought to a conclusion one hour after their commencement.—(Paul Maynard.)
Question agreed to.
Healthcare (International Arrangements) Bill (Changed to Healthcare (European Economic Area and Switzerland Arrangements) Bill)
Consideration of Lords amendments
Power to make healthcare payments
I beg to move, That this House agrees with Lords amendment 1.
With this it will be convenient to discuss Lords amendments 2, 8 to 10, 18 to 20, 3 to 7 and 11 to 17.