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House of Commons Hansard
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Commons Chamber
18 June 2019
Volume 662

House of Commons

Tuesday 18 June 2019

The House met at half-past Eleven o’clock

Prayers

[Mr Speaker in the Chair]

Oral Answers to Questions

Health and Social Care

The Secretary of State was asked—

Care Home Safety

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1. How many care homes are rated good and outstanding for safety. [911401]

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No compromise can be made on the safety of care homes, and that is why the Government introduced robust inspection regimes led by the Care Quality Commission. Latest figures from 3 June show that 80% of care homes have been rated good or outstanding for safety, with 84% of adult social care providers rated as good or outstanding overall.

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I draw the Minister’s attention to one example of a care home run by a private provider: Ellesmere House, which offers residential care for dementia sufferers. In February 2015, there was a serious safeguarding incident leading to the death of a resident after an incident with another resident, yet its latest CQC report underlines continued failures in management. Is the Minister confident that we have a generation of providers with the skills, training and facilities needed to keep dementia sufferers safe and well cared for?

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I thank the hon. Lady for that question. It is of course incredibly concerning when we hear cases of abuse or neglect in care homes. That is why the Government asked the CQC to inspect them in the first place and why we have put in place training through Skills for Care and given councils access to a lot more funding to help support them. However, abuse and neglect of any kind must not be tolerated.

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I welcome the fact that the latest report from the Care Quality Commission indicates that four out of five adult social care services in England are rated either good or outstanding, but there is no room for complacency. Will the Minister expand on how she will ensure that that becomes five out of five?

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My hon. Friend is absolutely right to highlight that four out of five care homes are rated good or outstanding. That is largely down to the more than 1.5 million adult social care professionals, who work with great professionalism and integrity. We drive up quality by supporting them better and ensuring that we can recruit more people into this incredible profession. We have had a very important adult social care recruitment campaign called, “Every day is different”, which looks to attract people with the right values into the sector to drive up quality and provide robust social care.

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I know from my family’s personal experience that just because care homes have a CQC rating of good does not mean that there are not dangerous and serious issues lurking beneath the surface that impact patient safety and care. Will the Minister outline today what the Government are doing to look into reports from CQC homes that are rated good?

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The hon. Lady has often spoken very movingly in the House about her personal experiences, and she is absolutely right: abuse of vulnerable people is absolutely abhorrent. We are very determined to stop it, and we want to prevent it from happening in the first place through the tough inspection regime. We want to shut down poor-quality homes and, most importantly, we have made sure that across the country, police, councils and the NHS work together to help to protect people in the long term.

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The integrity of CQC ratings was dealt a mortal blow by the uncovering of abuse at Whorlton Hall by BBC “Panorama”. Watching the abuse on that programme is made worse by the knowledge that the abuse may have started five years ago. The unpublished inspection report from August 2015 described allegations of assaults on patients, the undocumented use of a seclusion room and the use of rapid tranquilisation not backed by an organisation policy. I do not have any confidence that the review called by the CQC will uncover the truth behind that abuse. Will the Minister agree to set up an inquiry into this matter, so that we can establish whether the care regulator is fit for purpose?

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The hon. Lady is absolutely right: abuse of any kind must not be tolerated, and we have heard horrific accounts of abuse that must be tackled. That is why in May, we announced much stronger commissioning oversight arrangements, where people are put in place out of area. Local commissioners must visit regularly. The CQC has commissioned two independent reviews, and the findings and recommendations of both will be published. The point is that opportunities to intervene have been missed, and we must be open and transparent in getting to the bottom of what happened.

NHS: New Technology

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2. What steps he is taking to increase NHS access to new technology. [911402]

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To increase the access to new technology across the NHS, we have expanded the accelerated access collaborative to get the best technologies in faster, and NHSX is delivering our tech vision to drive forward digital transformation of the NHS.

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I welcome the way my right hon. Friend has really put a stamp on ensuring that technology is at the heart of his health policy. Can he tell me whether the accelerated access collaborative will engage locally, particularly with the sustainability and transformation partnerships, so that it eventually leads to better outcomes for our constituents?

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Yes, my hon. Friend is absolutely right. There is a reason why we care about using the very best technology in the world in the NHS, and that is that it improves treatment for patients. The regional delivery of better technology is critical. The 15 regional academic health science networks are a key part of the AAC and they work closely with local hospitals.

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24. The Secretary of State will know that in Greater Manchester we spend over £1 million a year on keeping and storing paper-based assessment records made in the early years by health visitors. Will he work with us to eradicate that cost and get the digital licences we need? [911425]

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Yes, 100%. One of the reasons we have put NHSX in place is to drive exactly this policy agenda, where we can get better treatment for patients and save money.

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Earlier this year, the Secretary of State attended the launch of a report on artificial intelligence by the all-party parliamentary group on heart and circulatory diseases. Can I get a commitment from him that AI is very much part of the future through the NHS long-term plan?

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A most enthusiastic commitment! My hon. Friend has led on this agenda and driven it, because it is all about using technology to save lives. The report that he mentions is optimistic about the power of using data better to ensure that people can live longer.

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On new technology and saving lives, I met the Secretary of State last month to discuss making the innovative enzyme replacement therapy Brineura— the only treatment available for Batten disease—available on the NHS urgently. I have heard nothing since that meeting, and the wait is agonising for the families, so what will he do urgently to make this life-saving treatment available to children in England?

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I had an incredibly moving meeting with the hon. Lady, my hon. Friend the Member for North East Somerset (Mr Rees-Mogg) and others, and some of the families and children who have Batten disease. I have since met the chief executive of the NHS. The decision on the availability of the drug in question is, of course, one for the National Institute for Health and Care Excellence and NHS England, but I have had those meetings and I continue to make the case.

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The electronic prescription service is now used by more than 90% of GP practices, and more than 70% of prescriptions are issued in that way. As well as providing a better patient experience, how much money has this saved for the NHS?

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My hon. Friend is dead right to say that this provides a better service and saves money. I do not have the figure at my fingertips, but I will write to him with the answer and ensure that it is published for the whole House to see.

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Patients in my constituency have to travel vast distances—often in excess of a 200-mile round trip—to be seen at Raigmore Hospital. As and when properly working visual teleconsultations are brought into being, when that technology is developed, may I appeal to the Government to share the technology with the Scottish Government and with NHS Highland?

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Absolutely. Places like Caithness are a great example of where GP consultations that can be done over the phone or over a video conference can save people hours and hours. Of course they sometimes need to see their GP in person, but not always. We are driving this agenda hard in England, and I would be happy to work with the NHS in Scotland to ensure that that technology is taken up there, too.

Male Suicide

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3. What his Department’s strategy is to reduce the level of male suicides. [911403]

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Men remain the group at the highest risk of suicide and continue to account for three quarters of all suicides. Clearly, targeting suicide in men must be the main thrust of our suicide prevention strategy. We are investing £25 million to support local suicide prevention plans in every local area, and that funding is testing different approaches and sharing best practice. We also announced £600,000 yesterday to support local authorities with exactly these processes.

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It devastates me to have to tell the House that St Helens has the highest rate of suicide in the country, and three quarters of those who take their own lives are men. We know that working class men in deprived areas are 10 times more at risk than those in the most affluent areas, so will the Minister recognise class and community, and poverty and place, as key factors in male suicide and its causes? Will she come to St Helens to see and support the vital work that is being done to prevent the tragic crisis of suicide that is affecting more families in my community?

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I agree with much of what the hon. Gentleman says, and I would be delighted to go to St Helens, not least because the more we can do to share good practice around combating male suicide, the more we can prevent it. Everybody in this space wants to do more to prevent suicide, and location is important, too, which is why a big part of my plan is to ensure that we are putting in good measures in the places that attract more suicides.

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A few weeks ago, I held a debate in this Chamber on the subject of suicide in the farming community. What are my hon. Friend’s plans to improve the mental health of males under 40 in rural areas?

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I am delighted that my hon. Friend is highlighting the farming community. He is right that the incidence of suicide is particularly high in that community, not least because those people work in remote areas, have less engagement with others and have access to the means. We must ensure that all vulnerable men feel that they can reach out to people who can support them. I encourage everybody to get the message out that if we see people who look vulnerable or struggling, we should be comfortable about reaching out to them. We have heard amazing stories of when just the simplest intervention, such as, “Are you all right, my friend?” can make the difference between life and death.

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Sharing information saves lives when it comes to suicide prevention, but families are too often unnecessarily excluded because clinicians may be unaware of or do not follow the consensus statement guidance on seeking consent and sharing information in the patient’s best interests. I thank the Minister for meeting me and the National Suicide Prevention Alliance recently. She will know that the Matthew Elvidge Trust has highlighted the importance of how consent is sought, and it has suggested the following wording:

“In our experience, it is always much better to involve a family member, friend or colleague whom you trust in your treatment and recovery... This will result in you recovering much quicker. Would you like us to make contact with someone and would you like us to do this with you now?”

The Minister will agree that there is a huge difference between that and just asking someone whether their mum can be phoned. Will the Minister set out how she will raise awareness of the consensus statement?

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I am grateful to the hon. Lady for her continued interest in this matter. She will recognise the cultural challenge of encouraging all practitioners in the NHS to embrace the change, because we quite rightly have a culture in which discretion is paramount. Practices are in place to encourage information sharing, and I highlight our support for the Zero Suicide Alliance—£2 million was provided last October—and central to its work will be spreading understanding of the consensus statement throughout the NHS.

NHS Staffing

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4. What steps he is taking to ensure that the NHS has sufficient staff to meet its long-term needs. [911404]

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The interim people plan that we published this month puts the workforce at the heart of the future of the NHS and will ensure that we have the staff needed to deliver high-quality care.

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The Secretary of State will be aware that recruitment and retention is particularly difficult for hospitals in special measures, such as the Worcestershire Acute Hospitals NHS Trust, which he recently visited. Such hospitals have to rely heavily on agency staff, which puts pressure on their finances. What specific steps is he taking to help those hospitals with their financial and recruiting pressures?

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We are working closely with that trust, and it was good to visit and see just how hard working the staff are. They are dedicated to the cause and well supported by their MPs. My hon. Friend is quite right to make that case, and we have a direct package of support for the Worcestershire Royal Hospital and the trust more broadly because it faces unique challenges, some of which are not at all of its own making. The staff at Worcester are working incredibly hard to deliver for their local citizens.

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My constituents find it very difficult to access their GP, as we have a recruitment shortage in the constituency. The “General Practice Forward View” pledged to boost the GP workforce by 5,000 by 2020. Are the Government on course to meet that target?

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We retain that target of 5,000 more GPs. We have managed to increase the number of staff working around GPs, because a GP does not need to do everything in primary care, so we have a more mixed workforce with physios and practice nurses working alongside GPs. There is more work still to do, and the NHS long-term plan sets out how we will make that happen.

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The leadership team at King’s College Hospital NHS Foundation Trust has asked for assistance from NHS Improvement to put in post a clinical director at the emergency services department, which has just been rated inadequate by the Care Quality Commission. This vital post, however, remains unfilled. What assurances can my right hon. Friend give that NHS Improvement can help trusts when they request assistance in this way?

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My hon. Friend makes an important point. This is a vital post in a hospital and a hospital trust that does amazing work—some of the best medicine in the world is done at King’s—but it also has significant challenges with delivery, especially with respect to meeting financial targets and delivering value for money. King’s needs that support, which we are putting in place. I will raise the specific issue of the post he mentions with the head of NHS Improvement.

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The Royal Stoke University Hospital, in partnership with Staffordshire University and Keele University, is training the next generation of clinicians, but the Secretary of State will know those universities need to be properly resourced to continue that vital training. What conversations is he having with the Department for Education to make sure that partnership thrives?

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The hon. Gentleman raises an important point. We have expanded the number of medical training places; we have more people going into medicine; and we have a record number of GPs in training. This takes time, of course. I spoke to my right hon. Friend the Secretary of State for Education about this recently, and I will make sure that we keep pushing hard.

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Our future immigration policy will be key to ensuring that our NHS is sufficiently staffed across the country. What discussions has my right hon. Friend had with the Home Secretary specifically on the £30,000 annual minimum income? I believe that limit is very detrimental to the sector.

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I have had those discussions, and the Migration Advisory Committee has raised a specific concern about social care. We need to deliver better social care, with people coming from all around the world in addition to domestically trained people. I take on board my hon. Friend’s point.

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Pinderfields Hospital in Wakefield has struggled to retain midwives. As a result, the trust has proposed to cut and close the popular midwife-led maternity unit in Pontefract. Local mums are up in arms, as it is completely unfair. We keep seeing this pattern. When the NHS is under pressure from austerity, from shortages or from management issues, it is the services in towns that are hit. What will the Secretary of State do to make sure we have enough midwives across the country so that we can keep Pontefract’s midwife-led unit open and so the NHS can continue to sustain services that are vital to our towns?

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The right hon. Lady, as always, puts the case for Pontefract very powerfully. The truth is that we will need more nurses and more midwives, as well as other health professionals, over the next five years because we are putting in a record amount of funding. More people are needed to deliver better services, and I am happy to meet her to discuss this specific case. Coming from and representing towns myself, I understand the importance of keeping services such as maternity services close to the people they serve.

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Will my right hon. Friend make sure that his interim people plan looks again at the hugely underutilised resource of the allied health professions, including osteopaths and chiropractors? What is the point of having a professional standards authority to regulate them if the Department will not use them?

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My hon. Friend makes an important point, one that we have frequently discussed. As he knows, I am married to an osteopath, so I do recognise the value that osteopaths bring to all of us.

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Research shows that the ratio of registered nurses to patients is one of the most important factors in patient safety, so members of the Royal College of Nursing are calling on the Secretary of State to follow Wales and Scotland and to bring in safe staffing legislation. What is his answer to them?

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Of course we need to have the right number of nurses. We need to make sure that we also put in the funding. If the SNP Government in Scotland had put the same funding increases into the NHS in Scotland, there would have been half a billion pounds more there over the last five years. So let us start with getting the money in that we are putting in in England, but is not fully being reflected by the SNP Government in Scotland.

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The SNP in Scotland spends £185 a head more than England, so the Secretary of State should check his figures. At over 11%, the nurse vacancy rate in England is more than double that in Scotland. Whereas student nursing numbers have increased every year in Scotland, there are 570 fewer nursing students this year in England. Is it not time to follow Scotland’s approach, reintroduce the nursing bursary and end tuition fees?

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I am not going to let the SNP spokesman get away with this. Normally, she brings a thoughtful contribution to health debates, but she said that there is more spending in Scotland per head. The truth is this: the increase in spending in England over the last five years is 17.6%, but in Scotland the increase is only 13.1%. That represents half a billion pounds less: the increase in spending that we have seen in England that they have not seen in Scotland. She should recognise that fact.

Mental Health Services

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5. What steps he is taking to ensure the long-term provision of adequate mental health services. [911405]

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21. What steps he is taking to ensure the long-term provision of adequate mental health services. [911422]

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Under the NHS long-term plan, there will be a comprehensive expansion of mental health services, with additional funding of £2.3 billion a year by 2023-24. That will give greater mental health support to an extra 345,000 children, at least 380,000 more adults, and 24,000 more new and expectant mothers.

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Across the country there is a real challenge in recruiting qualified mental health nurses. Will the Minister work with me and the Devon Partnership NHS Trust to encourage as many qualified professionals as we can to come to work at the excellent in-patient wards at North Devon District Hospital?

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I completely agree with my hon. Friend; it is important that we have the right workforce in place. That is a considerable challenge, but it is essential if we are to achieve the best outcomes. I am pleased that the Devon Partnership NHS Trust has seen an increase of 47 mental health nurses between February 2010 and February 2019, which shows that it is doing exactly as he says and going out of its way to recruit the best possible people. That work must continue, as is recognised in our “Interim NHS People Plan”

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I recently met representatives from Somerset’s NHS trust and its child and adolescent mental health services to look at young people’s mental health services and I heard some worrying stories of bed allocation. This has led to teenagers with mental health problems being moved out of the county, sometimes a huge distance from home, or sharing wards with very young children. So what is the Department doing to ensure that young people are not held in care for extended periods, which can exacerbate their difficulties, and that provision is sufficient for them to remain close to family and friends in an appropriate environment?

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It is essential that we end the practice of out-of-area placements because, as my hon. Friend rightly says, being in close proximity to family and friends is clearly going to aid the recovery of anyone suffering from mental ill health. This has been a particular problem for children and young people, and a particular problem in the south-west, but I can report to him that NHS England is making sure that we have more adequate bed provision across the country, and we will continue to drive down these out-of-area placements.

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Somebody is much more likely to need mental health services if they have experienced childhood adversity. The all-party group on the prevention of adverse childhood experiences has looked in detail at the evidence base on policies to prevent this adversity. What is the best thing the group can do to influence the Government’s prevention strategy?

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I have to say, the hon. Gentleman does it very well: he continually makes noise about this important issue. He is absolutely right that adverse childhood experiences inform people’s future mental health, or mental ill health. We are currently looking at our provision for early years intervention and the first 1,001 days—the hon. Gentleman and I have discussed the importance of that—but we need to make sure that state organisations take advantage of every contact they have with children, to ensure that we pick people up when they are vulnerable.

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My learning disabled constituent, who also has mental health and substance abuse issues, was placed in poor-quality housing and left without food and heating by a local care provider called Focus. What is the Department doing to ensure that subcontracted social care providers are fit for purpose?

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The case that the hon. Lady mentions is clearly very concerning. It is for local authorities to make sure, when they commission care providers, that they are fit for purpose and discharge their responsibilities in the local care plan, but we also need to recognise that people with learning disabilities as well as mental health issues are particularly vulnerable. We need to make sure that local authorities and local NHS services work together more effectively to ensure that care needs are not neglected.

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I was interested to see recent comments by the Secretary of State regarding the use of music to combat over-medicalisation—I should declare that I am married to a music therapist—so does that mean he shares my interest in the use of music therapy to combat mental health issues, as well as dementia and other conditions?

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I am pleased that my hon. Friend has declared his interest in this matter. He is right that mental wellbeing is about not only clinical interventions but very much the kind of things that he describes—wider social prescribing. We cannot overstate the role of the third sector in giving wraparound support to people going through periods of mental ill health. I am giving clinical commissioning groups the clear message that they need to look at what else they commission in this space, alongside clinical interventions.

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In Manchester on Saturday, people were giving away free “Unknown Pleasures” t-shirts, partly to mark the 40th anniversary of one of the greatest albums ever made. But, as anyone who knows the history of Joy Division will know, there is also the important related issue of male suicide and people were being encouraged to donate to charities, particularly those that work with young men at risk of suicide. I was sent one of the t-shirts, Mr Speaker, but I thought you might rule it out of order if I wore it. These charities obviously do great work, but they are trying to fill real gaps in the system. How can we ensure, when we consider long-term health plans and long-term mental health services, that there are not gaps that people fall between?

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The hon. Lady articulates the issue extremely well. The purpose of local suicide prevention plans is very much to make sure that we have a joined-up approach to combating male suicide and to identify exactly where the gaps in the services are. The £600,000 that we announced yesterday for the sector-led improvement package is to enable local authorities to share expertise and to make sure that, holistically, they provide the leadership to make sure that the gaps are plugged. I am grateful for the hon. Lady’s interest in this matter.

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This week, the Children’s Society published research to show that more than 110,000 children and young people were turned away from mental health services because their problems were not deemed serious enough—that is despite suicide rates for teenagers almost doubling in eight years and research from YoungMinds that shows that three quarters of parents feel their child’s mental health has deteriorated while they wait for treatment. Why are so few children able to get the support from mental health services that they so desperately need?

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As the hon. Lady and I have discussed previously, I would be the first person to recognise that we are not where we would like to be in respect of the provision of mental health services, but that is why we are investing an additional £2.3 billion to expand access for children by 345,000. In addition to that, we are investing in a brand new workforce in all our schools so that we can have exactly the kind of early intervention that will not require more lengthy periods of care and treatment. It is essential that we equip all schools and young people with tools to manage their wellbeing.

Junior Doctor Contract: Exception Reporting

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6. What recent assessment he has made of the effectiveness of the exception reporting process in the junior doctor contract 2016. [911406]

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Our junior doctors work incredibly hard caring for patients around the clock. We introduced exception reporting in 2016 and it has been a major step forward in ensuring safe working. The British Medical Association, NHS Employers and the Department reviewed the effectiveness of exception reporting as part of the junior doctor’s contract agreement, which we announced last week. Revisions will be made to exception reporting subject to the endorsement of the BMA.

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Is the Minister aware that research by the Hospital Consultants & Specialists Association shows that, despite thousands of exception reports from junior doctors in unsafe hospital trusts, no changes to shift patterns were made at all. The chief executive of NHS Employers has said that, undoubtedly, there are circumstances where trusts would like to make changes, but because they do not have sufficient staff in place they are unable to do so. What can the Minister do to ensure that, in future, these changes are actually implemented?

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The hon. Gentleman is right: every exception report has to be addressed. Changing the rota is one possible outcome. He will recognise that there are other possible outcomes as well: the doctor may agree to work extra hours and be given extra time off; timing of the ward rounds in clinics may be adjusted, so that educational opportunities can be taken: and timing of the ward rounds can be adjusted so that support from other senior staff can be there as well. There are many ways around this.

Thames Valley Scanning Contract

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7. For what reason he chose not to refer the Thames Valley PET-CT scanning contract to the independent reconfiguration panel. [911407]

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I am aware of the views that have been expressed on this matter. I can confirm that, having taken advice, we considered that the letter received from the Oxfordshire health overview and scrutiny committee does not constitute a valid referral under the relevant regulations. However, I have emphasised to NHS England, Oxford University Hospitals and InHealth the importance of continuing local discussions and working together at pace to find a service offer that works best for patients.

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The Churchill’s PET-CT cancer scanning service is world renowned, yet NHS England, apparently with the consent of this Government, is forcing it into partnership with a private company. That is what is happening. It is not a discussion; it is being forced into a partnership. NHS England has even warned the trust against staff raising their voice on this issue because of their concerns about patient safety. Surely this unprecedented partnership is illegitimate and must be called in by this Government.

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As I have said to the hon. Lady, we do not consider it to be a valid referral. What I would say is that NHS England remains committed to ensuring that the public are involved in decision making. Part of the extensive public engagement included completing a 30-day engagement about the phase 2 procurement proposals in 2016. I understand the strong passions that this has raised on both sides of the House and I urge all parties to continue working together.

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I have made it clear to my constituents that, in principle, I have no objection to private companies providing NHS services, but totally legitimate concerns have been raised about the consultation involved in awarding this contract. May I simply thank the Minister for agreeing to meet Oxfordshire MPs this afternoon? I know that she is very much engaged in this issue and, although it may not technically be overseen by the Department of Health and Social Care, I know that she will do all she can to help us to reach a solution.

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I thank my right hon. Friend for his question. I am looking forward to the meeting this afternoon. As I have said, I am assured that the decision will maintain services in Oxford and that there will be improved patient access, with new scanners in Milton Keynes and Swindon for people living there as well.

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Surely the reason we have got to this point is that the clinical commissioning group was never actually consulted on what was right for the local population. How can the Minister ensure that, in future, centralised procurement services and local CCGs are always consulted as a matter of course?

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As I have said, there has been engagement with local people, Members of Parliament and the local health community. I think that the outcome that we are all looking for is good PET-CT scanners for the people in Oxfordshire and for the whole of Thames Valley.

Free Prescriptions

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8. What steps he is taking to ensure that vulnerable people are not unfairly penalised for incorrectly claiming free prescriptions. [911409]

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Last year, prescription and dental fraud cost the NHS an estimated £212 million. It is absolutely right that the Government take steps to recoup that money, so it can be reinvested into caring for patients. Our system for claiming free prescriptions should be simple for people and clinicians to understand, which is why we are currently piloting technology that allows pharmacies to check digitally whether a patient is exempt from charges before prescription items are dispensed.

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I appreciate the Minister’s response, but I am afraid that that is just not the reality out there. One of my constituents—a woman with severe learning disabilities and anxiety, who is entitled to free prescriptions through her employment and support allowance claim—was hit with a £100 penalty charge when the NHS failed to obtain the correct information from the Department for Work and Pensions. My office challenged that decision and got the £100 back to her, but the situation was extremely distressing, and the communication is clearly at fault and punitive. Will the Minister implement a review into the prescription penalties to protect vulnerable people?

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It is distressing to hear of such a case, and these situations are very distressing for patients and their carers. The NHS Business Services Authority has taken steps to make things clearer, including with an easy-read patient information booklet and an online eligibility checker. We are also running a national awareness campaign, but of course we do need to ensure that people are not claiming for things to which they are not entitled.

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I have constituents who are furious at repeatedly receiving penalty notices that subsequently have to be quashed. The system is rubbish, isn’t it?

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I do not agree with my right hon. Friend that the system is rubbish. If somebody does receive a penalty charge notice incorrectly, there are procedures in place to challenge that notice. If somebody thinks they have received a penalty charge that they should not have received, they should contact the NHS Business Services Authority.

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What is not rubbish is the very pithy line of questioning typically deployed by the right hon. Member for New Forest West (Sir Desmond Swayne). I will call the hon. Member for Westmorland and Lonsdale (Tim Farron) if his question consists of a sentence, rather than a speech.

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Access to prescriptions is made much harder given the closure of 233 community pharmacies in the last two years, so will the Minister introduce an essential community pharmacies scheme to support rural pharmacies such as those in Cumbria and keep them open?

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Well done.

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We recognise the importance of community pharmacies. Pharmacists are specialists who have a great role in primary care, which is why they are highlighted in the NHS long-term plan.

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Since 2014, 5.6 million penalty charge notices have been issued, including a staggering 1.7 million to people who are entitled to free prescriptions. FP10 prescription forms and the criteria for eligibility for free prescriptions are far from straightforward. Some people in receipt of universal credit are eligible for free prescriptions and some are not—and, by the way, universal credit is not mentioned at all on the form. Those claiming exemption on grounds of low income can see their eligibility change from one month to the next. Is it any wonder that some patients tick their box? What steps are the Government taking to sort out this chaotic system that is too often treating vulnerable people like criminals?

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A wide range of activity has been undertaken to help people to understand whether they need to pay for their NHS prescriptions, and I remind the House that 84% of NHS prescriptions are available for free. My Department and the DWP are working together to provide further clarity to universal credit, and hopefully we will be adding a universal credit tick box to the prescription form.

NHS: Changing Places

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9. What steps he is taking to ensure that people can access Changing Places facilities when they use NHS services. [911410]

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Last year, I announced £2 million funding for NHS trusts in England to install Changing Places facilities in hospitals; this is now available for trusts to bid for. We estimate that 250,000 people in the UK cannot use standard accessible toilets, and the fund could help to install well over 100 more Changing Places facilities.

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Many of the disabled children who use Changing Places facilities also have a life-limiting or life-threatening condition. I welcome the increase in Changing Places facilities, but in this national Children’s Hospice Week could I ask my hon. Friend to go further in protecting these vulnerable children by increasing the children’s hospice grants to £25 million to give them the financial security they need?

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I am really pleased that my hon. Friend has mentioned that it is Children’s Hospice Week. It is a great opportunity to pay tribute to the incredible work that children’s hospices do up and down the country, supporting some of our most poorly children and their families. I thank my hon. Friend for the work that she does on the all-party parliamentary group for children who need palliative care. The short answer to her question is yes; the NHS will match fund CCGs that increase their investment in children’s palliative care, including hospices, by up to £7 million. That is increasing support to a total of £25 million a year by 2023-24.

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There are only about 40 Changing Places facilities in the NHS at the moment. I congratulate the Minister on the work she is doing on this, but will she continue to work with campaigners like Lorna Fillingham in my constituency to make sure that it not only happens quickly and on a timely basis but that we build on it in the future?

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I am grateful to the hon. Gentleman because it was he who introduced me to Lorna Fillingham and the amazing Changing Places campaigners in the first place. It is really down to their incredible work that we have seen the growth of this very important issue. There are about 38 Changing Places facilities on NHS England estates at the moment, but the £2 million pot will definitely help to improve that number significantly.

NHS Staff Retention

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10. What steps he is taking to improve the retention of NHS staff. [911411]

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13. What steps he is taking to improve the retention of NHS staff. [911414]

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The interim people plan sets out how the NHS will become a great employer with the culture and leadership needed to retain staff. NHS programmes to retain its highly talented staff are already having an impact. There are now more nurses working in the NHS than at any other time in its 70-year history. In addition, about 1 million NHS workers will benefit from the new Agenda for Change pay and contract deal.

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I welcome the recent announcement of a consultation on NHS pensions arrangements for senior personnel. I hope that that will look at the taper impact, which raises the effective tax rate to an unacceptably high level. Retention of key personnel is critical across the Shropshire health economy, as well as in other parts of the country. Can my hon. Friend reassure me that senior-level changes in Shrewsbury and Telford Hospital NHS Trust’s management will not delay the Secretary of State’s consideration of the Independent Reconfiguration Panel’s report on proposed acute hospital reconfiguration?

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I thank my right hon. Friend for his welcome for the pensions proposals and the consultation. The Department has received initial advice from the Independent Reconfiguration Panel on the Future Fit hospital reconfiguration. The Secretary of State is currently considering that. He will respond to the IRP’s advice in due course, and I will ensure that he informs my right hon. Friend.

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May I thank the Secretary of State again for saving the A&E department at Charing Cross Hospital, which was a very, very popular move? Our brilliant hospital will benefit from the work that the Government are doing to increase the number of nursing associates across the NHS. What more can we do to get more nursing associates at Charing Cross Hospital, Chelsea and Westminster Hospital, and across the whole NHS?

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I thank my right hon. Friend for his comments on saving the hospital department—that is very important. He is right to raise the important role of the nursing associates, who deliver hands-on care in a range of complex settings. Thousands of nursing associates began training in 2017 and in 2018. Health Education England is leading a programme to recruit more than 7,500 into training in 2019, and I am sure that some of them will benefit his constituency.

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15. Bradford NHS Trust is pressing ahead with plans to set up a wholly-owned subsidiary company. Last week, 97% of Unison members voted for strike action. Given that the trust is currently run by a temporary chair and a temporary chief executive, and is acting on guidance from a now-defunct body, will the Minister, to improve retention, call on the trust to drop these plans and keep the NHS family as one? [911416]

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The hon. Lady knows that a wholly-owned subsidiary is created as a legal entity. It is 100% owned by NHS organisations. It is also the case that local trust board members sit on the boards of those subsidiary entities. It is therefore appropriate that the local organisation takes that decision.

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The King’s Fund says that the earnings threshold in the Government’s immigration proposals, which was mentioned earlier, will definitely impact on the ability to retain and attract NHS staff. The proposals for a transition period during which many social care workers would only be allowed to come here for a limited time with no entitlement to bring dependants will, again, negatively impact on the ability to retain staff. When will this Government realise that immigration is good for our public services and good for our country, and that badly thought out policy in this area that impacts on the retention of NHS staff is wrong and nonsensical?

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The hon. Gentleman is right—immigration has benefited the national health service. This Minister, this Secretary of State and this ministerial team celebrate the fact that global immigration has benefited the NHS. From 2021, the new system will allow people with skills to come to the UK from anywhere in the world. It will remove the cap on skilled migrants, abolish the requirement to undertake the resident labour market test, and should improve the timeliness of being able to apply for a visa.

NHS Funding: Cambridgeshire

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11. What recent comparative assessment he has made of the adequacy of NHS funding in Cambridgeshire and local population growth. [911412]

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NHS England is responsible for the allocation of resources to clinical commissioning groups. Funding is distributed on the basis of a weighted capitation formula informed by the Advisory Committee on Resource Allocation. Population estimates are provided by the Office for National Statistics. This year, as the hon. Gentleman will know from a debate that we had last week, ACRA recommended and NHS England accepted a wide-ranging set of changes to that formula. Those changes are likely to benefit his constituency.

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We had a discussion last week, but the Minister was unable to answer my question so I will try again. Is Cambridgeshire’s clinical commissioning group correct that it will have less money to spend on providing health services next year than it does this year?

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As I pointed out to the hon. Gentleman last week, we recognise that historically, Cambridgeshire and Peterborough CCG has received less funding per person than neighbouring CCGs, but as I also pointed out to him, the CCG has received an absolute increase of 5.7% in 2019-20, bringing the funding up to £1.1 billion. We had a disagreement about the figures, because I could not agree the figures that he provided. As he knows, I have promised to write to him when I have been able to resolve his figures.

Childhood Obesity

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12. What recent assessment he has made of progress in implementing Childhood obesity: a plan for action, chapter 2, published in June 2018. [911413]

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14. What recent assessment he has made of progress in implementing Childhood obesity: a plan for action, chapter 2, published in June 2018. [911415]

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The Government are taking a world-leading approach to obesity. We have held consultations on ending the sale of energy drinks to children, calorie labelling in restaurants, restricting promotions of sugary and fatty foods by price indication, and further advertising restrictions, including a 9 pm watershed. We are considering all the feedback, and will respond later this year.

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Alongside prevention, we have to do more to help the growing number of children who are already overweight or obese. It is more than a year since the Health and Social Care Committee highlighted the lack of tier 3 and 4 services. Voluntary groups such as Shine Health Academy in my constituency fill the gap. They take children on referral from GPs, but they do not receive any public funding. There can be no other serious health condition affecting children where the NHS says, “Sorry, we can’t help.” Will the Minister take action and agree to meet me to discuss it?

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I completely agree with the hon. Gentleman that childhood obesity is a massive challenge to our nation. It is a problem internationally, and we are taking serious steps to tackle it. I am happy to meet the hon. Gentleman to hear more about Shine.

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Public health budgets have fallen by over 5%, with millions more in cuts anticipated. In both Lewisham and Bromley, the ring-fenced public health budget has fallen by 2.6% this year. The Government expect local authorities to play a greater role in tackling obesity while simultaneously cutting funding to councils, schools and the NHS. When will the Minister take action to tackle childhood obesity by restoring funding for public health?

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I have set out to the hon. Member for Sheffield Central (Paul Blomfield) the measures we have taken. Through the childhood obesity trailblazer programme, we are working with local authorities—I am hoping to visit one in Blackburn later this week—that want to see how they can use their powers to best effect, doing things such as limiting new fast-food outlets. We have spent billions of pounds over the past five years. The public health grant will be subject to the spending review.

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Given that 46% of food and drink advertising is spent on unhealthy food—and unhealthy foods are three times cheaper than healthy food—will the Minister follow in the footsteps of her predecessor, and go to the Netherlands to look at the Marqt supermarket, which has 16 stores around Amsterdam and does not market any unhealthy food to children. It is a profitable business and a model for our supermarkets, so will she go and look at it?

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I thank my hon. Friend for his interest in this area. The Amsterdam model has been very successful, but it is not just about food—it is about place and culture. I would hope to be able to visit the model very shortly.

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If the hon. Member for South West Bedfordshire (Andrew Selous) has been trugging round Amsterdam in pursuit of the public interest he is a remarkably assiduous and dedicated fellow. We are all deeply obliged to him—it is way beyond the call of duty, but we are appreciative none the less.

We now come to topical questions. I call Justin Madders.

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rose—

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rose—

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The hon. Gentleman will think it is a conspiracy, but he will get his moment in a moment. I call Mrs Hodgson.

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Thank you, Mr Speaker. The Government’s second childhood obesity plan will celebrate its first birthday a week today, but we will not be celebrating. The Government have ducked and dived on their responsibility to the children in this country and have failed to produce any policies as a result of the six consultations the plan has promised, but the rate of childhood obesity is still at a record high. Instead of waiting for the chief medical officer to report on obesity, will the Government act now to tackle the childhood obesity crisis, and introduce and implement the policies they have consulted on already?

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We have a very ambitious aim to halve childhood obesity by 2030. We are still considering all the answers to the consultations, and we are hoping to respond to them very shortly.

Topical Questions

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T1. If he will make a statement on his departmental responsibilities. [911426]

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This week is Children’s Hospice Week, Loneliness Awareness Week, National Breastfeeding Week and Learning Disability Week, and today is International Fathers Mental Health Day. The Government have made plans to more than double funding for children’s palliative care and end-of-life care services, developed a loneliness strategy and launched a consultation on folic acid in flour to support expectant mothers, and yesterday the Prime Minister announced a package of further work to support people from all backgrounds in the UK with their mental health. I and my brilliant ministerial team will continue to drive forward the health of the nation.

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We are indebted.

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I want to bring to the Secretary of State’s attention some mental health waiting times that my constituents have recently come to me with. Someone with an urgent referral for trauma counselling is looking at a minimum six-month wait. A teenager who has attempted to take her own life is waiting over a year to see a psychiatrist. Several adults have been told there is a three-year wait just to get a diagnosis of attention deficit hyperactivity disorder. These waits are appalling. The Secretary of State billed himself as the leadership candidate for the future, but he is the Secretary of State for Health now. What is he going to do to address this appalling waiting system?

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The hon. Gentleman is right that we need to ensure that access to mental health services improves. As part of the increase in funding we are putting into the NHS, the biggest increase is in mental health services, and it is a critical part of what we need to do to address the sorts of problems he rightly raises.

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T3. Will my hon. Friend take up as a matter of urgency the recommendations of the Public Administration and Constitutional Affairs Committee report on eating disorders treatment, which we have released today to follow up on the Parliamentary and Health Service Ombudsman’s report from 2017, named “Ignoring the alarms”? Does she agree with us that too many people are dying from eating disorders, which still have the highest mortality rate of any mental health condition, and that much more must be done to train health professionals, support sufferers and their families, and enhance and accelerate treatment and care in the community? [911428]

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Far too long!

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I thank the Committee for its report, which follows the health ombudsman’s report on the tragic death of Averil Hart. It is clear that we have made significant improvements in eating disorder provision since then, but there is still more to do. We have made considerable progress with regard to treating children, and that progress now needs to be translated to the care of adults with eating disorders. My hon. Friend is right that it is the mental health disorder that has the highest mortality rate. At any one time, 1% of the population will be suffering from an eating disorder, and we need to make this more of a priority to make sure that services are available.

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rose—

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I know the shadow Secretary of State will be brief, because he will not want to crowd out his colleagues. That would be an uncomradely thing to do—inegalitarian no less—and he would not do that.

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Indeed.

I dare say that this is the Secretary of State’s final outing at Health questions, because we believe he has secured transfer to pastures new. In his time here, he has failed to deliver a social care Green Paper and failed to deliver a prevention Green Paper, while he is privatising Oxford cancer scanning services and we have hospitals charging £7,000 for knee replacements. Does he really think that is a record deserving of Cabinet promotion?

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I am agog—and aghast. Over the last year, we have not only delivered £33.9 billion of increased funding, but we have produced the long-term plan for the future of the NHS. Starting this year, with the money already flowing, we are seeing the biggest increase in funding for community, primary care and mental health services. We have developed our work on the prevention agenda, and we have instituted a new verve and energy into the adoption of new technology in the NHS. I look forward to driving forward all these things in the future.

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Will the Secretary of State tell us about the verve and energy in his own constituency in Suffolk, where 32 health visitors are being cut because of his cuts? He is apparently now supporting a candidate who wants £10 billion-worth of tax cuts for the richest in society. Will that not mean further cuts to public health, further cuts to social care and, ultimately, cuts to the NHS as well?

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For the majority of its 71-year history, the NHS has been run under the stewardship of a Conservative Secretary of State. At this moment, it is getting the biggest funding increase and the longest funding settlement in its history, along with the reforms to make sure that everybody can get the health care that they need.

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T4. What steps is my right hon. Friend taking to improve the diagnosis and treatment of prostate cancer, in particular increasing the use of new technologies such as gel spacers, laser ablation and MRI in diagnosis? [911429]

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More than 94% of men survive prostate cancer for one year, and 86% for five years, but there is more to do. That is why last April the Prime Minister announced £75 million over five years so that 40,000 men can take part in innovative research into early diagnosis and treatment. The long-term plan sets out our commitment to speed up the path from innovation to business as usual, spreading proven new techniques and technologies faster. Safer and more precise treatments in diagnostic techniques will continue to improve prostate cancer survival.

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T2.   Kensington has an ageing population, many of whom will need residential care at some point, yet our council seems determined to move needy elders out of the borough, far from family and friends. Our last ever council-owned care home was sold off to a provider of caviar care, which lets luxury flats at £300,000 a year, with care, plus caviar, on top, for those who can afford it. Will the Minister explain what, if any, statutory obligations councils are under to provide affordable residential care for their residents? We are not all billionaires in Kensington. [911427]

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The Care Act 2014 gives councils a responsibility to provide residents with a choice of quality care options in a local area. More broadly, we are backing up councils with increased funding. Over the last three years, we have increased funding in real terms by 8%. That has given councils access to about £10 billion to help ensure that there is provision in local areas.

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T7. Will the Secretary of State assure my constituents in Kettering that taking advantage of the local government reorganisation in the county to establish a combined health and social care pilot is one of his Department’s very top priorities? [911432]

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The House will not be surprised to know that the hon. Gentleman has raised this with me and my right hon. Friend the Secretary of State on a number of occasions. I am happy to reconfirm to him that we do consider it a top priority to make sure that all of his constituents get the care they need.

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T5. With abortion rates for women over 30 rising, I am sure the Secretary of State will agree with Professor Lesley Regan, the president of the Royal College of Obstetricians and Gynaecologists, who said:“Women must have access to effective contraception and sexual health services to enable them to take control of their health and fertility by preventing unwanted pregnancies and sexually transmitted infections.”Does the Secretary of State also agree with Professor Regan’s comments on the need to end the fragmentation of commissioning, and the underfunding of services that disproportionately affect women? [911430]

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The hon. Lady is quite right. As part of the long-term plan, we have considered the best way to commission sexual health services, which were moved over to local authorities five years ago. We think that the responsibilities are sitting in the right place, but we need to see far more co-commissioning, where local authorities and the NHS together ensure that there is more joined-up provision, rather than the siloed provision that she mentions.

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T10. I welcome the successful trial of the new NHS app. How does the Department plan to use APIs to allow third-party developers to improve the app for patients? [911435]

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My hon. Friend is quite right to celebrate the development of the NHS app. More than 80% of people are now able to use the NHS app to link to their GP practice. Our plans for the year ahead include API-based connections to a number of third-party products, including the NHS app. More importantly, I want the opening of this system to allow other innovators to be able to develop products for patients to use in a way that we have not imagined before. I want a load of innovations so that people can get the best possible access to their NHS.

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T6. In York, it has taken 46 weeks for children and young people to commence the diagnosis process for autism—and demand and the number of referrals is going up. It takes a further 12 months, once there is a positive diagnosis, for parents to even access the SEND—special educational needs and disability—course. Precisely what service improvements can families expect to see in the next 12 months, and how will they be achieved? [911431]

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The hon. Lady is absolutely right to draw attention to this issue. We are very concerned about the diagnosis times, which is why we are reviewing our autism strategy this year and are extending it to include children, whereas before it catered only for adults. We want to ensure it remains fit for purpose. We have launched a national call for evidence and have already received in excess of 1,000 responses.

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Patient safety in the NHS depends on compassionate care training and staffing levels, but it also depends on patient safety systems. What progress is the national health service making towards implementing those systems in every place where patients are cared for?

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Patient safety, as my hon. Friend suggests, remains an absolutely key priority for the NHS. NHS Improvement and NHS England are developing a national patient safety strategy, which will sit alongside the NHS long-term plan. It will be published this summer and will build on existing work to provide a coherent framework that the whole NHS can recognise and support.

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T8. There are fears that NHS medical data could be on the table as part of a desperate post-Brexit trade deal with the US on digital services, where patient data would be mined by companies to develop medical technology that would then be sold back to the NHS. What guarantees can the Secretary of State give that private companies will not be profiteering from NHS assets in that way? [911433]

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I wish my hon. Friend, with whom I have worked closely and whom I admire very much, great success in her leadership bid. I wish her more success than I had. With the hon. Member for Streatham (Chuka Umunna) sitting next to her, I am sure they will run a great race. I want to reassure her that, as I said the week before last, the NHS is not on the table in trade talks. We now have that assurance from the Americans. NHS data must always be held securely, with the appropriate and proper strong privacy and cyber-security protections.

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I am sure the Secretary of State means well, but I am not entirely sure that the hon. Lady’s joy at the endorsement from the right hon. Gentleman was undiluted.

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Will the Secretary of State support one of the key recommendations of the joint report from the Health and Social Care Committee and the Housing, Communities and Local Government Committee into the future funding of social care, which is for a German-style system of social insurance?

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Absolutely. We are very keen to look at the Select Committees’ recommendations and the contributions of all key stakeholders. We are committed to ensuring that everyone has access to the care and support we need. The Green Paper will include ideas to protect people from high and unpredictable care costs.

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T9. Over the weekend, I was contacted by a number of parents of severely disabled children with very distressing news. Up until now they have been receiving five pads a day, because their children, grown up or otherwise, are very severely disabled. However, they have been told by the clinical commissioning group that that has been cut to three. This is incredibly distressing. Some of the parents are on universal credit and the additional cost they will have to pay themselves will be £80 a month. That is unacceptable. Will the Secretary of State agree to meet me and representatives of my constituents, the parents of these very disabled children from Eastbourne, so that we can try to sort this out before it really gets out of hand? [911434]

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I am very grateful to the hon. Gentleman for raising this case. The ministerial team has not seen the details in advance, but if he would like to write, the appropriate Minister will of course meet him.

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The inquiry into the contaminated blood scandal, the biggest treatment disaster in the history of the NHS, is currently taking place in Leeds. What is the Department doing to compensate the victims of this scandal and to make sure their voices are heard?

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My hon. Friend will wish to know that we are collaborating fully with the inquiry, and it has raised with us several issues about payments. We have made available an additional £30 million to give to those affected and will consider any conclusions the inquiry ultimately draws.

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As the Minister will know, two weeks ago I went to the Netherlands with Teagan Appleby’s mother, Emma, to collect one month’s supply of medical cannabis. The Department laid down the requirements for Emma to meet with Border Force, and she met them by providing a UK prescription. Will the Secretary of State and Ministers meet me to ensure that there is no more ambiguity in a policy that currently criminalises parents in possession of a UK prescription bringing their much-needed medicine into the country?

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As the hon. Lady and other colleagues know from having worked on this important issue, we acted swiftly to change the law to make sure that medicinal cannabis was available. Those patients for whom it is clinically appropriate can now be prescribed medicinal cannabis. As she knows, whether to prescribe is a clinical decision, but those prescriptions are available and flowing and are being issued where it is judged clinically appropriate for the patient. We will continue to work on this to make sure we get it right.

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Time for another dose of Somerset I think. I call Mr Jacob Rees-Mogg.

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My constituent Max is aged eight and has Batten disease. He is one of only two sufferers of this disease who are not receiving the medicine that can improve their quality of life and keep them alive. Eleven other children in this country with Batten disease are receiving the drug, which is very effective but very expensive. The drug manufacturer has offered six months’ free supply to Max and the other person not getting it and has made other proposals to NHS England, which is currently refusing even to have meetings with the drug company to discuss how my constituent, this dying child, may receive the drugs he needs. Will my right hon. Friend intervene and use whatever reserve powers he has to ensure that my constituent gets this life-saving drug?

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My hon. Friend speaks for the whole House about the need for these rare diseases to be given the attention they need so that sufferers such as Max can get the medicines if at all possible. As he knows following our meeting, the formal legal responsibilities lie with NHS England and NICE. I have raised this case, and that of others mentioned earlier, with the chief executive of NHS England and will raise it once again following this Question Time. We will do all we can to resolve this.

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Thousands of my constituents will be left without access to dental care because a Swiss-owned investment firm has decided to shut three practices in my city. What is the Department doing to ensure that the people of Portsmouth have access to vital oral health services?

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I understand the hon. Gentleman’s concern. As I understand it, the Colosseum dental group practices will remain open until 31 July. NHS England has put in place plans to ensure that where possible patients currently undergoing dental treatment will complete their course of treatment before the practice closures and is working with other local dental practices to provide additional capacity to treat patients as well as considering the longer-term options for procuring dental services in the Portsmouth area.

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I declare an interest as a doctor’s wife. If the sub-dean at Chelmsford’s brilliant new medical school continues to teach the students and work in the hospital, she faces a 90% tax rate. If she continues to do the weekend hours the hospital needs, she faces having to pay more in tax than she is earning. Will the Minister look again at the taper, which is driving our consultants out of our hospitals?

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As I said in response to an earlier question, we are putting out a consultation on pensions that will allow for looking at a number of issues, including the taper.

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Order. I am very sorry, but, as in the national health service—under Governments of both colours, I emphasise—demand invariably exceeds supply. I will take the remaining questioners whose names are on the Order Paper and who wished to ask substantive questions but did not manage to get in. That seems only fair, as they have been bobbing up and down for the duration. Let us hear them.

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Regardless of which type of Brexit we face this autumn, bureaucracy, customs charges and stockpiling costs will inevitably drive up the price of imported drugs and medical devices. Will the Secretary of State undertake to provide additional funds for NHS England and the devolved nations to cover those Brexit-induced costs and to avoid cuts in clinical services?

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Additional funds have already been provided to ensure that medicines are available throughout the country, whatever the Brexit scenario.

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Given the increased likelihood that the next Prime Minister will be determined to leave the European Union at the end of October, deal or no deal, will the Secretary of State update the House on what preparations are currently being made to protect the import of critical supplies such as insulin and radioisotopes?

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Meeting the need for unhindered medicine supplies was an incredibly important piece of our Brexit planning, which was successfully completed ahead of 29 March. Of course we are updating those plans as we speak, but the ability to reassure people that there will be no impact on the supply of medicines is an important part of that work.

Syria: Civilians in Idlib

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To ask the Minister for the Middle East what assessment he has made of attacks on health facilities and the fate of civilians in the Idlib area of Syria, and if he will make a statement.

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The Government are extremely concerned by the current escalation of violence in north-west Syria, and are appalled by the disgraceful and wholly unwarranted attacks on civilians and civilian infrastructure such as hospitals and schools. The UN has confirmed that since the end of April at least 25 health facilities—including at least two major hospitals—and 37 schools have been damaged by airstrikes and shelling in north-west Syria. These attacks are a clear breach of international law, and we call on the regime and Russia in the strongest possible terms to cease them and end the suffering of those in the Idlib governorate.

The deteriorating situation is causing immense suffering to a civilian population who, as the hon. Lady will know, are already highly vulnerable. Even before the current escalation of violence, nearly 2 million people in the region had already been forced to leave their homes at least once, and nearly 3 million are in need of humanitarian assistance.

Let me take this opportunity to highlight, briefly, the assistance that we are providing for those who are in such dire need across north-west Syria. Last year alone, the UK provided over £80 million in humanitarian assistance in the region, which included supporting the provision of food, shelter and other essential items for those caught up in the conflict. We are continuing to support that effort this year as well. In response to the recent situation, the partners of the Department for International Development are scaling up their humanitarian response to meet the growing needs on the ground by, for instance, supporting health facilities.

A further escalation of violence, triggering waves of displacement, would be likely to overwhelm an already stretched humanitarian response. Once again, I call on all parties to cease violence in Idlib, to respect previously agreed ceasefires, and to bring an end to the needless and deplorable attacks on civilians, hospitals and schools in the region.

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The first thing that has to be said, Mr Speaker, is that, as you and I both know, it should not be me who is standing here. It should be Jo Cox, and, three years after her brutal killing, we miss her every single day.

The second thing that I must do is thank you, Mr Speaker, for welcoming the surgeon David Nott to Speaker’s House to discuss his book and his work, which has included helping the Syrian people. It was kind of you to host him.

As the Minister has said, the conflict in Syria has escalated once again and despite talks of so-called reconstruction it is far from over. Just in recent months reports say that nearly 500 civilians have been killed due to airstrikes.

This is a complex conflict but I want to focus on simple facts today and, as the Minister has described, we have seen yet again the bombing of hospitals. Reports from the region tell of scores of hospitals being attacked, and millions of people in the Idlib area are in desperate need of healthcare.

A bad situation is being made much worse by our failure to enforce the basic rules of conflict. What representations has the Minister made to UN agencies about fixing this system, because people there are saying the UN system is simply not working—the co-ordinates of those hospitals are not safe with the UN, and the protection that should be in place for medical systems in Syria, even at this late stage in the conflict, has now failed? What meetings has the Minister had to discuss this with UN agencies, what action is he proposing to take, and what work is he doing with our colleagues in the international community to fix this broken system?

Secondly, I would like to ask some questions about UK aid. The Minister mentioned food and basic supplies, but what about medical supplies, and what assessment have the Government made of the current risks given the political situation we are now facing in relation to Syria and the effectiveness of UK aid? It is a simple thing, surely, to get basic medical supplies that are needed over the border to the doctors who require them. Also, what action has the Minister taken to prioritise civilian access to medical supplies?

Finally, it is Refugee Week this week, and I do not always thank the Government but on this occasion I would like to thank them, and specifically the Minister for Immigration, who is not in her place at the moment, for her decision to extend the VPRS—Syrian vulnerable persons resettlement scheme—that brings vulnerable refugees to our country. But we need to go so much further than that. We have failed to deliver against the values of this country when it comes to the victims of this conflict. What conversations is the Minister having with his colleagues in Government about getting more vulnerable Syrians to the UK for safety and shelter, and will he meet me and a delegation of Members of Parliament to discuss that point? We have failed Syria but we need not continue to fail Syrians; will the Minister help us get more Syrians to safety?

This weekend many people will gather in towns and cities across our country for “Great Get Togethers”: they will remember our colleague Jo, and they will think about what we have in common, not what divides us. So I simply finish by asking the Minister to work with all of us across this House for the people of Syria.

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I am very grateful to the hon. Lady, and of course I join with her in her heartfelt tributes to our colleague Jo Cox.

The hon. Lady will know that we committed £400 million in the Brussels conference in March to Syria. That puts us in the premier division of donors to this. [Interruption.] She shakes her head, but that is a huge amount of money.

The hon. Lady asked what we are doing about refugees and she will know full well that in general refugees are best helped close to their homes so they can return to their homes, but she will also be aware of the refugees we have taken from this region to the UK, and I hope she will salute the local authorities who are warmly accommodating those refugees, including my own local authority.

The hon. Lady asked what we are doing with our partners. She might be aware that on 10 May and 14 May the UN met in emergency session to discuss the deteriorating situation and she might also be aware that later on today it will be meeting in emergency session to discuss this deteriorating situation, and the UK will play a full part in that discussion. The important thing is to get back to UN Security Council resolution 2254; it is the cornerstone and basis of any long-term settlement in Syria.

The hon. Lady asked about other partners to this, and I am sure she will share my concern that the Sochi agreement of last year between two of the principal players in this has unfortunately not been carried out in the way we would wish and that the deteriorating situation is in significant part due to Russia’s attitude towards what appeared at the time to be a very promising new beginning. I entirely agree with the hon. Lady that we need to work with others to attempt to bring some sense to the warring parties in this, but I emphasise that the UK is simply one player in this, and it is of course a multi-dimensional jigsaw.

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Thank you, Mr Speaker, for granting this urgent question, and I thank too the hon. Member for Wirral South (Alison McGovern), my co-chair of the all-party group on Syria.

The much respected and senior British military officer Colonel Hamish de Bretton-Gordon has just returned from Idlib where he is an adviser to the Idlib health directorate and he says this today:

“Nearly 700 civilians have been killed this year in Idlib and there are 500,000”

internally displaced people crammed into Idlib

“many without homes living in the open and off scraps”.

He adds that there is

“evidence of another chemical attack. There have been 29 attacks on hospitals by Russian and Syrian aircraft with many now out of commission. A handful of hospitals and doctors are now trying to care for 3 million civilians.”

The Minister will know that the Foreign Office is collecting evidence of those involved in atrocities and breaches of international humanitarian law. Can he confirm that the Foreign Office is seeking to identify, name and shame not only the aircraft attacking these hospitals, which are mainly marked with red crosses, but the pilots and people operating those planes? This is clearly a breach of international humanitarian law; it is arguably a war crime and we must ensure, wherever we can, that there is no impunity for such grotesque actions.

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I entirely agree with my right hon. Friend: either the regime and its supporters’ statements are wildly inaccurate or its targeting is wildly inaccurate. He will know that the UN provides co-ordinates of sensitive sites including schools and hospitals. He will share my despair at the number of those institutions, including two major hospitals, that have been damaged in this, and I am sure he will also share my enthusiasm that those who responsible for this are, sooner or later, brought to book.

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I thank my hon. Friend the Member for Wirral South (Alison McGovern) for asking this urgent question. I feel she spoke for the whole House when she spoke of Jo Cox at the beginning of her speech, and I thank the Minister for his response.

Once again we find ourselves here in this place shocked and appalled at the threat to hundreds of thousands of civilians in Syria. We had Aleppo, we had Raqqa, we had Ghouta, and now today it is Idlib: homes and livelihoods destroyed; civilians and children fleeing and dying; and, yet again, hospitals bombed and deliberately targeted.

Three years on from UN Security Council resolution 2286, medical facilities are still being hit in Syria—an unthinkable 29 hospitals in the past six weeks according to some reports. Amnesty International says these attacks targeting hospitals constitute “crimes against humanity”. The International Rescue Committee says that these attacks continue to happen with “absolute impunity”. This is shocking and reprehensible; even wars are supposed to have rules.

What steps is the Minister taking with our international partners to ensure that these appalling attacks on health facilities do not go by with impunity and, as he says, that these people are brought to book? Can the Minister tell us more about the UK’s promised protection of civilians strategy—exactly when it will be delivered and whether it will be accompanied by a clear framework for accountability and implementation?

It is absolutely necessary that we urgently get all sides around a table to find a peaceful, political resolution to this horrific conflict. That is the only thing that will bring the carnage in Idlib to an end. That is the only thing that will protect the lives of those health workers still operating in Idlib and the civilians they are working to save. So what is the Minister doing to realise this? That peace must be achieved, and let me end by echoing the words of the president of Médecins Sans Frontières who put it so simply when she called on all warring parties to:

“Stop bombing hospitals. Stop bombing health workers. Stop bombing patients.”

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I am grateful to the hon. Gentleman for his remarks and questions. It is important that we work with international partners to apply pressure to those who are responsible. He will be well aware of the difficulty of working with the regime in Damascus and its supporters, but the Sochi agreement at the end of last year held out such promise. Those were baby steps, perhaps, but it was the start of a process that might have brought some sense to this troubled region. I very much regret that Russia has decided to take the steps that it has and I prevail on it, even now, to think about its responsibilities that it signed up to with Turkey at Sochi.

It is important that the UN continues to meet in emergency session. I look forward to its deliberations this afternoon and we will take a full part in them. Ultimately, UN Security Council resolution 2254 has to be applied. That is the only way that we can restore peace and equanimity to this very troubled part of the world.

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It is definitely a war crime to attack either a school or a hospital—there is no doubt about that. Do we have good evidence that Russian aeroplanes have attacked such targets and if so, are we raising the matter in the Security Council, which is in emergency session, as the Minister stated?

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I am grateful to my hon. Friend for his question. Russia is clearly a party to the current situation. It is supporting the regime and is responsible for a lot of the trauma that is now afflicting the Idlib governorate, and it must be held to account. It must be answerable for the consequences of its actions. As my hon. Friend said, the deliberate targeting of schools and hospitals is a crime. It is caused by criminals and, as with criminals everywhere, they must ultimately be called to account.

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We also pay tribute to Jo Cox’s memory in the House today and to David Nott and his incredible work as a surgeon in Idlib; he recently won the Robert Burns humanitarian award for what he has done.

We in the Scottish National party are shocked and horrified by the reports that, since Syrian regime forces and their Russian allies began their offensive in Idlib in April, more than 24 medical facilities have been attacked. Tragically, the targeting of healthcare facilities is not new in Syria’s civil war. The US-based Physicians for Human Rights documented more than 500 attacks on medical facilities between 2011 and 2018.

The deliberate and strategic bombing of hospitals carrying out their medical functions is a war crime. These latest attacks have eliminated vital lifelines for civilians in desperate need of medical care and medical centres are no longer sharing their co-ordinates with the UN for fear of being a target of Syria and their allies. However, the prevention of and protection from mass atrocities remain almost wholly absent from the UK’s national framework of civilian protection. What steps is the Secretary of State taking to cover this glaring omission? Furthermore, will he ensure that the upcoming review of the Government’s protection of civilians in conflict strategy reflects the changing nature of modern conflict, which blurs the lines between combatants and non-combatants?

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I am grateful to the hon. Gentleman for his remarks. He must know that what we are able to do depends very much on access and safety and whether or not we can get to those who are most in need. At the moment, that is extremely problematic. We would prevail upon all parties to this to allow humanitarian access and to allow those of us who wish to protect civilians to be able to access those civilians wherever they are, so that the necessary protection can be afforded. However, he has to understand the difficulty of assuring the safety and security of those now delivering aid, and I pay tribute to those who provide aid under extremely difficult circumstances. He will be aware that a number of those individuals in our troubled world today have paid with their lives for that. It is absolutely a duty that we in Government and our agencies have to ensure that they are not put at risk more than is absolutely necessary in trying to do their vital work.

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I very much support what the hon. Member for Wirral South (Alison McGovern) said about taking on more refugees from the area, and I pay tribute to my right hon. Friend the Minister for Immigration for her decision. What does the Minister think can be done to help to make the good Russian people aware of what is being done in their name by their Government? Surely they would be as horrified as the rest of us by the deliberate targeting of hospitals, schools and other humanitarian facilities.

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My hon. Friend is right to say that the Russian people would indeed think that, if they knew the full extent of the actions being taken in their name by President Putin’s Administration. This is a terrible calumny. It is a devastating thing for which Russia must ultimately assume responsibility. We have to hope that members of the Russian Administration are ultimately called to account for these atrocities. Knowing the Russian people as I do—I suspect that my hon. Friend knows them rather better than I do—I know they are good people and often misunderstood, since they are often seen through the prism of Moscow and the terrible acts, I am afraid, that President Putin and his people are too often associated with in our world today.

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I congratulate the hon. Member for Wirral South (Alison McGovern) not only on securing this urgent question, but on the very moving way in which she introduced it, and I absolutely share and endorse her tribute to Jo Cox.

It is heartbreaking to read the testimony coming out of Idlib, and it is horrific that there have been 257 attacks on hospitals and medical workers in the last year alone. I say to the people who are carrying out these attacks that it is beyond grotesque. The fact that doctors feel that they can no longer share co-ordinates with the United Nations is also a damning indictment of the international community’s failure to protect some of the most vulnerable. I am reassured that the Minister wants to see people brought to book, but what further support could the UK provide to the United Nations or others to gather evidence, so that when the time comes and justice can be done, the information will be there?

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The hon. Lady knows that this is an ongoing piece of work, as my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell) rightly referred to. It does not relate simply to this current offensive; it goes back a long, long way. In particular, we have been at the forefront of condemnation of the regime with respect to chemical weapons, which are an abomination. All those who have been involved in the use of these illegal weapons must be called to account. Clearly, our imperative at the moment is humanitarian assistance—of course it is—but a slower piece of work is gathering evidence that ultimately will be used to ensure that those criminals who have been involved in perpetrating these atrocities are brought to book.

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This shocking new bombing campaign will lead remorselessly to more innocent loss of life, and up to 2 million people could be displaced into Turkey. I recently met a constituent who works very closely with charities that operate there and in the area, one of which is Syria Relief. What engagement has the Department had with charities on the ground, such as Syria Relief, which can do this work and have the local knowledge? Is work ongoing in that respect?

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The truth is that we engage on an ongoing basis with charitable organisations, but I will not comment specifically on those organisations, really for their security. Much of our effort is channelled through the UN and its agencies, but I salute those across the charitable sector who engage in this extremely difficult and traumatic work. I will continue to engage with them as much as I can, the better to understand the challenges they face and their experiences on the ground.

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The Minister and everyone who has spoken has rightly pointed out that this is a complex political situation, and that it is complex for us to do anything about it. However, there is one piece of the jigsaw that we are entirely responsible for, and that is the number of refugees that we allow into this country. I speak as someone who has refugees from Iran and Kosovo in my own family who grew up in a place that has always provided a safe home for every wave of desperate refugees, and I ask the Minister, in the light of what we know is going on in Idlib: can we not do more to bring more people here?

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The first thing to say about the recent onslaught in the governorate of Idlib specifically is that virtually all those involved are internally displaced people within that governorate. They are therefore not accessible, and it would simply not be practical remove them to a place of safety in this country. The hon. Lady knows very well that we have been generous in relocating people who have been triaged by the United Nations, with the most vulnerable and needy being relocated to this country. We have all taken people from right across the demographic, but the UK has been particularly impressive in relocating vulnerable people, including women, children, elderly people and disabled people. That is the mark of a truly humanitarian nation, and I am immensely proud of that.

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Can I just be clear about the Government’s position on civilians in Idlib? Is it the Government’s view that the Russians and the Syrians are being reckless and careless in the delivery of their ordnance, or is it their view that they are deliberately targeting medical facilities?

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Our investigation into this is ongoing, and I am not going to pre-empty the outcome of our investigation into attribution or, indeed, intent. All I would say to my hon. Friend is that it seems to us that a very large number of schools and hospitals, including two major hospitals, have been hit, and that a regime and a country that were intent on protecting civilians, particularly the most vulnerable, would do their utmost in any conflict to avoid those targets. I see no evidence of that having been done, and the consequences are as we have seen. It is vital, if those institutions have indeed been deliberately targeted, that the criminals responsible should be held to account.

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What is the Government’s latest assessment of the assertions about a chlorine chemical weapons attack in the Idlib area on 19 May? We have heard the Minister’s responses—“Let’s bring people to justice. Let’s find who they are. We really implore the Russians not to do this”—but this is happening every day. We are a permanent member of the United Nations Security Council, and we are supposed to eyeball those who are committing these atrocities and deliberately targeting hospitals, but what are we doing, other than saying, “Oh, well, let’s take them to court at some point in the future”? That is not remotely good enough. The UK and our allies need to show some backbone in this and show that there are consequences for these grotesque war crimes, because every day that Russia gets away with this makes the world a less safe place. It is not being governed by the rules that we are supposed to have set up so that we can all live under international law.

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First, I have an apology for the hon. Gentleman. Yesterday in the urgent question, I think I associated him with the Opposition Front Bench. I am afraid that this was a facet of my general excitement on that occasion, and it was of course entirely wrong. My apologies to the hon. Gentleman. I share his frustration—I really do—and I hope that that has come across, at least in the tone of some of the things I have been saying, but I have to ask him what on earth he thinks we could be doing, other than the things that we are doing with our partners and through the United Nations. Ultimately, this has to be dealt with not by escalating the situation but by dialling it down and ensuring that we restore the focus on UN Security Council resolutions. Although I am all ears, I doubt very much that the hon. Gentleman has many suggestions beyond that.

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I thank the Minister for his response. In my constituency, we have six Syrian Christian families who have been relocated under the Government scheme. The community and church groups are helping those families with accommodation, education for their children, pastoral care, language instruction and furniture and clothes. Other members of those families are threatened in and around the Idlib area, and I spoke to the Immigration Minister about this the other week. Will the Minister work with her to reunite those families in the United Kingdom, and particularly in my constituency of Strangford?

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As I indicated in my remarks, my local authority has also been active in this area. It is important that the process should be conducted properly, and that relocations to places of safety in the United Kingdom should be done on the basis of assessed need. We all know of heart-rending cases, particularly involving families and children, where the best option is indeed relocation to this country, and I am proud of what this country has been doing in that regard. Ultimately, however, I do not think that this situation will be resolved simply by removing people from their homes. The sense we get is that most of them ultimately wish to return home, and I am proud of the fact that this country is in the premier division of providing financial assistance to ensure that proper humanitarian aid and support is given to those in the region itself.

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I am grateful to my hon. Friend the Member for Wirral South for securing this urgent question and for reminding us of the legacy of our dear departed colleague. I would like to ask the Minister to think again and to talk to his colleague, the Minister for Immigration. Her announcement yesterday about the resettlement schemes was welcome, and he is right to say that this country gives an enormous amount in aid, but my hon. Friend the Member for Birmingham, Yardley (Jess Phillips) is also right to say that we could do so much more. There are 12 million people who have been displaced by this conflict in Syria, of whom 6 million are internally displaced and at least 6 million are in the border countries or not far off. The Minister is right to say that we want people to stay close to their country of origin, but we could be resettling so many more people and giving them a home, safety and sanctuary. I think that that is what the people of the United Kingdom expect from us in living out our values, so will he think again and talk to his colleague, the Immigration Minister, about increasing those numbers?

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I am pleased that the hon. Lady welcomes yesterday’s statement, which indicated that these matters are always kept under review. The Government will have heard the views being expressed across the House on this matter, but I come back to the central point that we have relocated people. They tend to be the most vulnerable, and that is important. One of the things that characterises this country—I hope she will endorse this—is that we have looked after, first and foremost, the most vulnerable: women, children, the disabled, the elderly and the sick. That is a tribute to the people of this country and their generosity, and I do not think it is right simply to dismiss some of the other aid and assistance that we have been giving in this terrible situation.

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My constituent Sarah Ainsley, who is a sixth-former at Woodbridge High School, came to see me recently to express her concern about the Syrian refugee situation closer to home in Calais, where conditions for refugees—particularly young people coming of age—are not what we would expect for any of our children, and we should not expect them for children and young people in those circumstances. What assurances can I give her that the Government are taking that issue seriously in their bilateral conversations with the Government of France? Further to the points made by my colleagues on these Benches, does the Minister accept that there is more that the UK Government could be doing in the region, notwithstanding what is already being done?

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The hon. Gentleman will have heard yesterday’s statement and will hopefully have been reassured, at least in part. The situation in Calais clearly goes well beyond Syria and is part of a much bigger piece. I hope that he will agree that the way to resolve that situation is to ensure that we prevent people from making perilous journeys in the first place. That is the view taken by both the French and UK Governments. Although it is a big piece of work and will take a long time, the imperative has to be to deal with the things that drive people to make that journey and end up in the unsatisfactory situation in France that he describes.

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The signatories 70 years ago to the fourth Geneva convention, which is international humanitarian law, would not have been surprised that the hon. Member for Wirral South (Alison McGovern) has had to request this urgent question.

As a constituency MP with more than 40 Syrian families seeking refuge in my home town of Clydebank in West Dunbartonshire, it is my duty to represent them here. I have two specific points to raise with the Minister. First, in engaging with the United Nations, and maybe reforming international humanitarian law, we need to recognise that NATO leads on what is now called the importance of civilians in operational planning to ensure the protection of civilians. Secondly, with any increase in refugee numbers, will he assure existing refugees across the whole United Kingdom of Great Britain and Northern Ireland that the necessary investment to ensure their safety, wellbeing and health will not only continue but increase?

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I am pleased that the hon. Gentleman’s local authority area has been helpful in accommodating refugees. My experience in my constituency is that they have been warmly welcomed, and I have been pleased with how they have been accommodated in my small part of the south-west of England. Refugees clearly need to be provided with the necessary resources to sustain themselves and to look forward to a potential long-term future, meaning all the things that those of us who are fortunate to have been born and brought up in a pacific part of the world take for granted. I am sure that that applies in his constituency, as it does in mine.

The hon. Gentleman is of course right to underscore the importance of the protection of civilians. As I said earlier, the difficulty in Syria, as in many conflicted parts of our world today, is with providing access to civilians. Our first duty must be to ensure that those who are undertaking that work are safe, and we will continue to ensure, so far as we possibly can, that that is the case.

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It is right and proper to think about why refugees are refugees and to think about ultimately getting them to return to their homes. However, as other Members have pointed out, right now, today, tomorrow, and the next day, people are being killed. This place is a hell-hole on earth. We have two big bases in Cyprus, which is close by, with 3,500 service personnel and helicopters. Why can we not go in now and get these people out in good numbers and take them to Cyprus? It is not far away, but it is safe enough for them.

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In relation to the current escalation, as I said before, these are internally displaced people. They are within the Idlib governorate, so it is not simply a question of airlifting them to Cyprus, even if Cyprus were to agree to such a thing. However, we hope that the displaced people who are outside Syria will feel able to return home when it is safe to do so. It is not the United Nations’ assessment at the moment that it is safe for them to do so, but that assessment must ultimately change. It will change, and at that point we will do our utmost to assist them to return to their homes, which I would maintain is the wish of the vast majority of refugees and those who currently find themselves displaced.

EU/British Citizens’ Rights

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(Urgent Question): To ask the Secretary of State for Exiting the European Union if he will make a statement on what efforts the British Government have made to fulfil the instruction of this House, dated 27 February 2019, to seek agreement on EU and British citizens’ rights and in particular the protection of British citizens in the EU in the event of no deal.

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I start by paying tribute to my hon. Friend the Member for South Leicestershire (Alberto Costa). It is testament to his passionate defence of the rights of EU citizens and UK nationals that the amendment he brought before this House was passed unanimously—a rare feat. I congratulate him on his work.

I thank my hon. Friend for organising a recent meeting with representatives from British in Europe and the3million to discuss their proposal to seek a joint UK-EU commitment to adopt part 2 of the withdrawal agreement in any scenario. The Secretary of State was grateful for the opportunity to hear their views and the views of my hon. Friend on that matter. As my hon. Friend will be aware, we have written the EU’s chief negotiator, Michel Barnier, to report those views, particularly to make it clear that in a no-deal scenario adopting the citizens’ rights agreement is far superior to 28 unilateral solutions. I have also had representations from the devolved nations of the UK indicating their support for that approach. For example, Mike Russell, the Scottish Government’s lead Minister on EU exit recently wrote to the Secretary of State to set out the Scottish Government’s support for adopting the citizens’ rights agreement.

The Government have been steadfast in their commitment to protect the rights of EU citizens. They are our friends, colleagues and neighbours, and we want them to stay. We are already implementing our no-deal offer to EU citizens in the UK, and the EU settlement scheme opened successfully on 30 March, with over 750,000 EU citizens having now applied. The Secretary of State wrote to the EU to seek its views on adopting the citizens’ rights part of the withdrawal agreement in any scenario, and Michel Barnier responded on 25 March. Last night, the Secretary of State issued a response to Michel Barnier, reporting recent conversations with my hon. Friend for South Leicestershire, the3million and British in Europe, and asked for officials to be able to continue to work together to explore how best we protect the citizens’ rights in all scenarios.

In the response, the Secretary of State reaffirmed that adopting the citizens’ rights part of the agreement as a UK-EU solution will offer the greatest protection for UK nationals in the EU and EU citizens in the UK. That is due to the importance of rights, such as the agreed social security co-ordination provisions, that cover areas such as reciprocal healthcare and the accumulation of pension contributions, which require a reciprocal agreement to provide the best level of operation. The Secretary of State wrote to my hon. Friend this morning with a copy of that letter, which was deposited in the Library and published on gov.uk.

Finally, I want to reaffirm that citizens’ rights have been a priority throughout the negotiations, and it is an area that both the Government and this House take extremely seriously. As such, the best way to guarantee those rights, both for UK nationals in the EU and EU citizens in the UK, is for this House to approve a deal.

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I thank the Minister for his response. I also want to put on the record my gratitude to the Secretary of State for meeting with the3million and British in Europe a few weeks ago. It is inconceivable that a British Government—let alone a Conservative Government—could allow the rights of British nationals working, living or studying in the EU to vaporise overnight on 31 October. However, we find ourselves in a deeply unpalatable position in which our fellow citizens, and EU nationals resident in this country, have had their rights wrongly placed on the negotiating table.

I am not here to criticise the outgoing Prime Minister. I am here to invite whoever is going to take over, and the current Minister and his team, to ratchet things up a few notches to ensure that the will of this House, which was unanimously passed on 27 February, to carve out the citizens’ rights element of the withdrawal agreement, thereby protecting under international law the rights of British nationals in the EU and the rights of EU citizens here, is carried out. We have seen two letters thus far, and I am inviting the Government to do the right thing, which means ensuring that a task force is set up urgently. Members of the existing Government, senior civil servants and other stakeholders should meet urgently with Michel Barnier, Donald Tusk and other stakeholders in the EU to convey the unanimous will of this House. There is no disagreement across the House or, indeed, across the Brexit divide on the protection of citizens’ rights—no disagreement at all. This is low-hanging fruit, yet, for some reason or another, we simply have not achieved that agreement.

I welcome the Minister’s work, and I know he has done a lot of work in particular on the voting rights of EU nationals here. I compliment him on his work, but when this House is united and when the devolved nations of our country have backed the House of Commons on this issue, there is no excuse for the UK Government to do anything other than intensify their efforts to get an agreement on the rights of citizens.

I end how I started. Never in peacetime, never, have the rights of over 1 million British citizens been placed on the negotiating table like this. I say to the British Government once again that, as a responsible Conservative Government, the rights of our citizens, along with the rights of EU nationals, must be protected whatever the outcome of Brexit.

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My hon. Friend rightly calls on us to ratchet up the pressure, and I assure him that we will. I also assure him that, whoever takes forward the leadership of our party and our country, will feel pressure not only from him but from Back Benchers on both sides of the House to continue pressing on this issue. Of course, we made a commitment to him and to British in Europe that we would respond to Mr Barnier before the next European Council on 20 June. I am glad that we have been able to deliver on that commitment today.

As hon. Members on both sides of the House will know, the European elections were held between 23 and 26 May and Government activity had to respect the purdah period imposed because of those elections, but it is right that we pressed forward swiftly after that to ratchet up the pressure on ring-fencing, as my hon. Friend said.

Meanwhile, I assure my hon. Friend that there is a large citizens’ rights team in my Department that is working closely with colleagues in other Departments, including the Home Office. The team has been working tirelessly to ensure that citizens are given the certainty they need to plan for life once the UK leaves the EU. Our no-deal policy paper confirms that EU citizens resident in the UK by exit day can apply to the settlement scheme to secure their status in a no-deal scenario. As I mentioned earlier, the settlement scheme, which launched on 30 March, has had over 750,000 applications. Almost 700,000 of those applications have been concluded, with none being refused.

The UK pushed hard in negotiations for reciprocal voting rights, but as my hon. Friend knows, they did not form part of the withdrawal agreement. We have set out that we will seek to agree bilateral deals with all member states to secure those rights for the future. We are pleased to have now made significant progress on bilateral agreements, having signed agreement with Spain, Portugal and, today, Luxembourg. The Secretary of State signed the latter just a few hours ago, and we hope it will set a strong precedent for reaching agreements with other EU neighbours and friends to protect the right of UK nationals to continue voting in local elections.

We are very aware of my hon. Friend’s key point. His amendment enjoyed the unanimous support of the House, of all parts of the United Kingdom and of all parties from all parts of the spectrum of opinion on Brexit. We remain committed to delivering on citizens’ rights, and we are focused on making sure that we reach an overall agreement to secure an orderly EU exit for the UK, but we remain committed to executing the will of this House and we eagerly anticipate Michel Barnier’s response to our letter on ring-fencing.

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I start by paying tribute to the hon. Member for South Leicestershire (Alberto Costa), who has won respect on both sides of the House and in the country for the way in which he has championed the cause of EU citizens in the UK and of British citizens in Europe. We were pleased to back his cross-party amendment on 27 February.

The hon. Gentleman is right to be worried that, as Conservative Members apparently prepare to crown a leader who seems willing to take the country to a no-deal Brexit, EU citizens face new uncertainty. Many of the disastrous consequences of a no-deal Brexit have been spelled out, not least by the Chancellor of the Exchequer, who has talked of the deep damage it would do to our economy and our living standards. It would have helped if the Prime Minister had not spent so long talking up a no-deal Brexit as a viable option, but insufficient attention has been paid to the consequences for citizens’ rights. Lives have been thrown into uncertainty by our current situation.

It did not have to be like this. If instead of making bargaining chips of EU and British citizens, as the hon. Member for South Leicestershire pointed out, the Government had accepted our motion back in July 2016 to provide a unilateral guarantee to EU nationals in the UK, we could have quickly secured reciprocal agreements to protect the rights of Brits in the EU27. Those agreements would have stood ring-fenced, insulated from the calamity of the Government’s withdrawal agreement.

It was clear in December 2018, when the Government backed off from their vote on the deal, that this issue would have to be addressed, so why did it take the action of the hon. Gentleman and the vote of this House to secure that action from the Government? After Michel Barnier wrote to the Secretary of State on 25 March, why did it take three long months for him to reply?

It has taken this urgent question to bring the issue back to the Floor of the House. Why did the Government not report back to the House sooner? The deep uncertainty facing the 3 million EU citizens in the UK and the 1.2 million Brits in Europe, who are by far the biggest national group affected by Brexit, is of huge importance, so why are the Government not treating it with that urgency?

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There is a great deal on these issues on which the hon. Gentleman and I agree. I suspect we take the same dim view of the attractiveness of any kind of no-deal exit, but where I disagree is on his narrative about the Government’s urgency. We have always put citizens at the forefront of negotiations, and we reached an agreement with the EU on the detail of a citizens’ rights agreement some time before the House voted on the amendment in February.

The EU has said repeatedly throughout this process that nothing is agreed until everything is agreed. We have challenged that in taking up the call of my hon. Friend the Member for South Leicestershire for ring-fencing, and we will continue to press the case for ring-fencing, but it is a bit rich for the hon. Member for Sheffield Central (Paul Blomfield) to suggest that the Labour party takes this more seriously than my party does when the Opposition Benches are a gaping empty space for this urgent question.

It is vital that we all work together, reflecting the cross-party nature of the amendment to secure these rights. In that respect, I hope the hon. Gentleman will welcome the progress that has been made today and the further progress that we intend to make in the months to come on the issue of voting rights.

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A number of my constituents or their family members, even children, are caught up in this, and many of them have contacted me. Whatever one’s views—whatever my views and whatever their views—of our future relationship with the European Union, they frankly do not deserve the very real anxiety this is causing.

Given what the Minister has said today about where the block now lies, it is not now a lack of will on the part of Her Majesty’s Government, although they could have gone a lot further before the withdrawal agreement was set. Will he convey to Mr Barnier my sentiments and those of my constituents before he replies to the Secretary of State’s letter? This is not a game. This is the lives of people living in my constituency and in many other constituencies. The very real anxiety of which I spoke is there, and Mr Barnier can address it. He must understand that before he replies to the Secretary of State’s letter.

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I fully appreciate my hon. Friend’s point. The Secretary of State’s letter to Mr Barnier has gone, and there is a copy in the Library, but this is something we should reiterate to our European counterparts at every opportunity. We have all said this, and the EU has said, I trust in good faith, that it wants to put citizens at the forefront of negotiations. We have an opportunity to do so, and we should continue to remind people that it is about individuals living in all our constituencies. We really value them, and we want to provide them with the greatest possible reassurance.

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I commend the hon. Member for South Leicestershire (Alberto Costa) not only for securing this urgent question but for his tireless efforts on behalf of EU nationals in the UK and of UK nationals overseas. I welcome the assurances in the Secretary of State’s letter, but two big questions still remain. First, why has it taken so long to get not very far? Three years since the referendum, the UK Government have still failed to give the assurances that the Scottish Government were prepared to give the day after the referendum if only they had the powers to do so. I welcome the assurances from the Government, but those assurances ring hollow when we remember the shameful complacency this Government showed two weeks ago when they completely washed their hands of the fact that thousands of these same citizens were denied the basic right to vote in European elections. Why do the Government still insist on a settled status scheme based on, “You apply and we might say no”? And they do say no; far too often, and for no valid reason, they turn down applications from my constituents and others. Why do the Government not go for the scheme the Scottish Government have suggested, which is simply an approach of, “This is your home, thank you for being here, please stay”? Why can we not have a system that recognises residency here as a matter of right, not as a privilege at the whim of the Home Office?

The Secretary of State’s letter said that devolved Administrations support his approach. The letter he referred to from Mike Russell finished with the words that EU citizens

“are our friends, our colleagues and our family and they deserve to stay in the place they have chosen to call home without the insecurity that Brexit has created.”

If the Government agree with that, why do they not get rid of the insecurity right now, and guarantee unconditionally and permanently the rights of all 3 million EU nationals who currently call these islands their home?

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I recognise the hon. Gentleman’s passion to ensure that those rights are guaranteed. If he looks at what we have done in terms of the negotiated agreement and the no-deal paper on citizens’ rights as to what will be done, he will see that that is exactly the guarantee that we are providing. He asked an important question about the nature of the settled status scheme and why we feel it needs to constitutive rather than declaratory. With the best will in the world, a purely declaratory scheme risks causing confusion and difficulty for people further down the line. We saw that with Windrush. We want to ensure that people have a simple way of proving their rights under this agreement and we think a constitutive system is a better way to achieve that. We are continuing to work on this with EU citizens’ groups up and down the country, including in Scotland, to make sure that they have all the information they need to secure that. He says that applications have been refused. There are some applications where people are being asked for more evidence or more detail, but there are no applications that have been refused.

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I welcome the urgent question from my hon. Friend the Member for South Leicestershire (Alberto Costa) on the EU/British citizens issue, as it concerns a large number of my constituents and I am very concerned. I commend the Minister for his statement, his response to this urgent question and the work he has done. The Government have made a commitment, but does he share my disappointment that the EU has not been more positive and proactive on such an important issue?

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I do share my right hon. Friend’s disappointment that this has not got further at this stage. Interestingly, a number of MEPs have spoken out asking the EU to go further, as have some of the Parliaments of EU member states, including, recently, the Dutch Parliament, which has called for further progress on this issue. We will continue to press the EU to make progress on this matter because we all recognise the benefits of providing the maximum reassurance to our 4 million citizens.

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The best way to ensure the rights of EU citizens in the UK is for us to stay in the EU. The very least the Government should do is guarantee that we will not leave the EU until those citizens and UK citizens in the EU are guaranteed the exact same rights and status as they have now. This affects more than one in five of my constituents, and their friends and family, so will the Minister commit to that—or are we at the mercy of the Dutch auction that is the Tory leadership shambles?

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I respect the passion with which the hon. Gentleman makes his arguments, but he must understand that this country had a vote on whether to leave the EU and that vote was decided by the people. We should now make sure that we provide precisely the guarantees he is talking about for our citizens. As I said in my statement, the best way to achieve that is through a ring-fenced citizens’ rights agreement or a whole withdrawal agreement. That is better than anything we can do or 27 EU member states can do unilaterally.

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Many of my constituents are affected by this issue, either because they are EU citizens in Chelmsford or they have relatives living in other EU countries. I am particularly concerned about women who may have taken career breaks to care for vulnerable relatives and who therefore find it more challenging to provide the paperwork to prove where they have been. Clearly, it is in our interests and those of EU member states to resolve this as quickly as possible. Does the Minister have any further indication from individual EU member states of the progress they want to make, now that the European elections are over and as soon as the European Parliament starts sitting?

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My hon. Friend asks an excellent question. We have been meeting a range of EU member states and we always press them on these issues, both in terms of their own unilateral preparations and to make the case for a wider agreement on this front. There are of course a variety of responses. We have seen in the unilateral arrangements of EU member states that every single one has done something to reassure UK citizens, but the level of the response varies. We will continue to press them on this, so that they continue to reciprocate the strong offer that the UK is making.

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I find it hard to contain my anger at the charlatans and snake oil salesmen who will again tonight, on television, be claiming that no deal presents no difficulties; it might present no difficulties for them. I wish to ask the Minister a specific question. In response to a letter that I sent to him, the Minister for Europe and the Americas said:

“If the UK leaves the EU without a deal, and there is no agreement with Germany to continue reciprocal healthcare arrangements, UK Nationals would no longer receive coverage through the S1 form.”

The advice he gives is for them

“to take out German health insurance.”

Can the Minister here today give an assurance to me, and to all UK citizens who might be in that position in any EU country, that the UK Government will pay for their health insurance, rather than them?

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Order. Just before the Minister responds, let me say that I recognise and respect the very strong feelings on this matter, but I am sure that the right hon. Gentleman, a former Deputy Leader of the House, whom we all hold—or I certainly do—in the highest esteem, would not refer to any Member of this House as a charlatan. I am sure he would not do that. If he were doing so, dexterous as he is in the use of language and given the full vocabulary with which he is blessed, I know that he will withdraw that term and substitute it with another.

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I would like to make it clear that I am certainly not referring to any Member of the House present in the Chamber today as a charlatan or buffoon.

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I am afraid that I detect the sight and sound of a very large shovel, as the right hon. Gentleman is digging himself deeper. He has made his point with force and eloquence, but I appeal to him, a seemly Member in normal circumstances, to make it clear that he is attacking the views of Members but he would not impugn their integrity.

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Thank you, Mr Speaker. I am happy to withdraw; I am not impugning their integrity, but I am certainly attacking their views, which I find outrageous.

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We all want to secure the best possible arrangements on healthcare for our UK citizens overseas. The best way of doing that is through the withdrawal agreement—the citizens’ rights agreement—or, failing that, a ring-fenced citizens’ rights agreement. Separately to that, of course, the Department of Health and Social Care has written to every EU member state to look at negotiating individual unilateral agreements with those member states. The Commission initially told EU member states not to respond to that offer because it wanted to make sure that we could have an overall agreement and to focus on that first and foremost, but of course it is our intention to put in place the best arrangements to support UK citizens on their healthcare, wherever they are and we shall do that through whatever means are available to us.

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Some 11,000 of my constituents are nationals of other EU countries—that is one of the highest proportions in this House. Not only are they welcome, but they are essential members of my local community. May I commend the Minister for the work he is doing on the rights of British subjects overseas, because I suspect I also represent one of the highest proportions of those? I thank him for the agreements he has made—he mentioned the one with Portugal and the one with Luxembourg just in the last couple of days. Could he point a constituency MP such as me to where all these agreements are held in a central place, so that when I receive inquiries I can immediately check what each of those EU27 countries are doing?

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My right hon. Friend makes an excellent point. Perhaps I should declare an interest, because during the week I am one of his constituents, and EU citizens live either side of me in his constituency. I would be happy to write to him and to put a copy of that letter in the Library of the House so that all Members have that information. So far, we have reached agreements with Spain, Portugal and Luxembourg. We hope to come to many more agreements in the months to come.

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The Minister says that EU27 citizens can apply for settlement, and I understand that, but my EU constituents have seen how the immigration service works when it is at its worst, rather than at its best. They have seen the egregious excesses of the treatment of the Windrush generation and they have seen how asylum seekers have been treated, and they are not confident that their cases will be treated fairly. I hope the Minister can reassure us—he is a trustworthy man, I am sure. What conversations has he had with his colleagues in the Home Office and in particular with the Minister for Immigration about making sure that the immigration system is watertight, so that EU27 citizens can have absolute guaranteed confidence in the system, which they currently do not have?

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I absolutely recognise the concerns that the hon. Lady has raised. I have had my own challenges in dealing with constituency casework on some of these issues in the past. My right hon. Friend the Minister for Immigration shares my determination to make sure that the settled status system is different culturally—it is about helping people to prove their right to stay and making sure that they get the documentation that they need for that—and she and I continue to work closely on that. More than that, we have also been working with the consulates and embassies of EU member states and with diaspora groups up and down the country to make sure that we take their concerns and needs into account. I absolutely assure the hon. Lady of our determination to get the system right so that it delivers for all of the 3 million. We hope that EU member states will make a similar effort for UK citizens—indeed, we will urge them to do so.

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The hon. Member for South Leicestershire (Alberto Costa) has been incredibly patient on this topic, as has, indeed, the whole House. In case the Minister has forgotten, the hon. Gentleman’s amendment was passed in February. I genuinely do not understand. We are the ones doing the divorcing. If this matter was a real priority for the Government, why did it take three months for them to reply to Michel Barnier’s letter? I have thousands of EU citizens in my South Cambridgeshire constituency, and I just do not see any urgency at all. Might the Minister offer to update the House at least monthly between now and 31 October, so that citizens can have some assurance that their futures are going to be secure?

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We absolutely respect the urgency of this issue. We took the House’s vote up with the European Union very shortly after that vote. We then had meetings with British in Europe and the3million to make sure that in taking the matter forward we would accurately represent their views. In the meantime, as I have explained, we have had the purdah period for the European elections. It is right that the Secretary of State has been at the General Affairs Council today to press the issue, and that he has sent the letter. We will absolutely continue to update the House as and when progress is made on the matter. The hon. Lady has to recognise that currently the broader negotiations are not necessarily moving forward until we have clarity on the issue of the next Government.

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What a rum business—I did not see the feller standing before. I call Nic Dakin.

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When is this finally going to be sorted?

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The simplest answer to the hon. Gentleman’s question is that it would have been sorted already if we had all voted for a withdrawal agreement and secured it.

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The Erasmus programme is probably the most successful student exchange scheme in the world. My local university, Bangor University in Wales, shares in that success, with around 100 agreements in 20 countries. The university sector is devolved, but I note that in his initial response the Minister did not mention any communication with the Welsh Government, although he did mention communication with the Scottish Government. What meetings and communication has he had with the Welsh Government to ensure that Welsh students and staff in the EU27 and the EU staff and students in Wales have equal rights in the event of a no-deal Brexit?

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I reassure the hon. Gentleman that we have had meetings with the Welsh Government, and I have met universities in Wales to discuss this issue specifically. As he will know, the Government are supporting an association with the Erasmus scheme and have provided specific guarantees for funding the scheme, even in the event of no deal. We will continue to discuss the issue with all the devolved Administrations. Just to correct the hon. Gentleman slightly: I did mention the devolved Administrations—plural—in my initial statement.

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I commend the hon. Member for South Leicestershire (Alberto Costa) for his courage and integrity in securing this urgent question. I notice that the number of Members in attendance from Her Majesty’s official Opposition has been somewhat sparse, but we in Her Majesty’s unofficial Opposition, the great remain alliance, are happy to defend the rights of our EU citizens. To that end, will the Minister give the House an undertaking that at the conclusion of the exchanges on this urgent question he will go and speak to the Prime Minister’s aides and all those who advise her? She is looking for a legacy, and there could be no greater legacy in the next four weeks than for her to secure the rights of our 3 million EU citizens and the 1.4 million British people working in the EU and do the right thing by them. Frankly, after three years, and with only four months to go before we are due to crash out without a deal, this is simply not good enough. This matter must be resolved. Human beings must no longer be used as bargaining chips.

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The right hon. Lady makes a serious point, but first let me congratulate her on having invented yet another name for her grouping in Parliament.

The Prime Minister is already agreed on this matter and we are already taking it up as a matter of Government policy, which is why the letter on ring-fencing has gone to Michel Barnier today.

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A significant number of my constituents in Edinburgh South West are EU nationals, and many have been in touch with me to say that such confidence as they had in the British Government’s commitment to their rights post Brexit has been severely dented by what happened, as my hon. Friend the Member for Glenrothes (Peter Grant) mentioned, on 23 May, when many EU citizens throughout the United Kingdom were denied their right to vote. What specific steps is the Minister taking to rebuild the confidence of EU citizens in the UK in the Government’s commitment to their rights, given that many of them were denied the basic right to vote in the EU elections?

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The hon. and learned Lady will have heard from Cabinet Office Ministers about the Electoral Commission’s work to review all elections and how they were handled. The commission will report back on the recent European elections and we look forward to seeing that report. On the concrete steps, it is important that we are pressing ahead to secure bilateral agreements on voting rights, and we have written to every single EU member state on that. It is important that the Government, reflecting the views that we have heard from across the House, sent the letter on ring-fencing last night.

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I stay in close contact with members of the3million in my Bath constituency and understand their real anxieties, particularly in respect of vulnerable and elderly EU citizens who do not have access to computers and are not particularly computer-savvy. The Department has set up a little outlet in Bath to which people can come from across the south-west to get help with their application, but it is simply not good enough. People have to travel a long distance, and many elderly EU citizens do not even know that they have to apply for settled status. What are the Government doing to help elderly EU citizens who do not have access to computers? The Government should commit to ensuring that each local authority will have a centre such as that in Bath and that each local authority has the means to contact EU citizens who are older and do not have access to a computer. Will the Minister make that commitment?

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I am grateful to the hon. Lady for acknowledging that there is such a centre in her constituency. Progress has been made on widening the range of centres available. The Home Office has provided additional assistance to community groups, some of which may be best placed to reach out to EU citizens in the UK. Additional assistance to the tune of around £9 million has been allocated to a wide range of community groups, including groups that support people with disabilities and people who are elderly.

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Contrary to what the Minister said earlier, the problem for the Windrush generation was not the fact that their status was declared in law; the problem was that they could not access documents to prove their status. Against that background, why do the Government continue to ignore calls from the3million to provide citizens with documentary proof of their status, rather than merely digital proof?

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The hon. Gentleman will recognise that, across Government, there is a move to go digital—to put more online. It is absolutely right that there should be help for those people who may find that most difficult, and that comes to the substance of my answer to the hon. Member for Bath (Wera Hobhouse). The view is also that documents, as a one-off thing, can be lost. It is better for people to have a secure and permanent digital status.

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The Minister said that 750,000 EU citizens have applied through the settlement scheme, but that means that more than 2 million have not yet applied. Having spoken to many of those EU citizens, including many in the academic sector, in the NHS, and in education, I can tell the Minister today that they are not feeling the love. Does he not he realise that by continuing to use language such as “prove their rights” with regard to EU citizens, it sets the wrong tone when we are also trying not just to encourage them to stay, but to guarantee the rights of British citizens in the EU?

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We want to keep reiterating the message that these people are valuable and valued members of their communities. They are making a big contribution, whether they are UK citizens living in the EU, or EU citizens living in our own constituencies, and we should continue to reiterate that, but I make no apology for saying that we want to help people prove their rights under this agreement. That is a good thing to do. We want to secure those rights permanently. The settled status scheme, which was designed to do that, is the best way of achieving that.

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The worry for people is that this has been going on for far too long. In the highlands, this issue affects families and neighbours and the very sustainability of communities, businesses and services. It is an aberration to ask highlanders to register to apply to stay in their own homes. Does the Minister not realise that the best thing to do is to simply acknowledge and grant the right for people to stay and live in their own homes?

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We want to acknowledge and grant that right, but we also want to ensure that, in the years and decades to come, these people have the ability to prove that they are individuals who are protected by the agreement that we reached with the EU. That is important and it is something with which we should continue to press ahead.

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I am sure that the hon. Member for South Leicestershire (Alberto Costa) shares my concern about the vacant Benches opposite and the fact that, on such a serious matter, the hon. Member for Scunthorpe (Nic Dakin) from the Opposition Whips Office had to scurry up the back to bob up and down to ask a question. On 21 January this year, the Prime Minister committed to a review of the ongoing concerns of Irish nationals under the Good Friday agreement to exercise their Irish and therefore their European rights in Northern Ireland and across the rest of the United Kingdom after Brexit. Will the Minister tell the House whether he has read the Good Friday agreement? Secondly, will he tell us when the Prime Minister will publish the review before scurrying back to the Back Benches?

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I have read the Good Friday agreement. I read it as the Parliamentary Private Secretary at the Northern Ireland Office, and I have read it as a Minister in my Department. I think that it is absolutely right that we should protect all elements of that agreement. Of course the hon. Gentleman will know that the issue of EU citizens and UK citizens sits alongside the common travel area arrangements and the commitments that we made under the Good Friday agreement, which stand regardless. I am very glad that we have been able to work very effectively with the Irish Government to convince all the other EU member states that those issues should be respected whatever the outcome of the negotiations and whatever the arrangements we reach between the UK and the EU.

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I would like to know how many of the affected citizens the Minister has actually spoken to. Does he understand the crippling doubt and uncertainty that is affecting so many hundreds of thousands of people, particularly with the spectre of no deal hanging over their heads? Is there somebody else that the Minister should be speaking to at this particularly crucial moment? I am talking about the right hon. Member for Uxbridge and South Ruislip (Boris Johnson) whom he should go and speak to right away to find out what on earth he is planning to do, because nobody else seems to be hearing a word from him.

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I have met EU citizens’ groups up and down the UK in a number of embassies and at a number of events that we have held across the country. I have met British citizens and their representatives in a number of EU member states that I have been visiting. I continue to listen to their concerns and to ensure that those are reflected at the highest levels of Government. I am sure that my right hon. Friend the Member for Uxbridge and South Ruislip (Boris Johnson) can answer for himself, but I will certainly be making the case to whoever takes on the leadership of our party and our country that securing the rights of EU citizens and UK citizens needs to be a top priority.

Hong Kong

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(Urgent Question): To ask the Secretary of State for Foreign and Commonwealth Affairs if he will make a statement on the subject of democracy and protests in Hong Kong.

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The huge protest march this weekend was a further demonstration of the passionate strength of feeling among the people of Hong Kong about the proposed amendments to extradition laws. The people of Hong Kong have peacefully exercised their rights in recent days to freedom of speech, assembly and expression, all of which are guaranteed by the Sino-British joint declaration of 1984 and enshrined in Hong Kong Basic Law.

The most recent march was, thankfully, free of the scenes of violence witnessed during protests on 12 June. I note the allegations of inappropriate use of force by the Hong Kong police, which should, of course, be fully investigated by the Hong Kong Special Administrative Region Government.

It is positive that, on 15 June, the Government committed to pause, reflect and consult widely before taking further action. However, it is clear that this commitment did not fully address the concerns of the people of Hong Kong. I welcome Chief Executive Carrie Lam’s statement today, in which she said that she would not proceed with the Second Reading of the Bill if the fears and anxieties of the people of Hong Kong could not now be addressed.

In considering the way forward, it is vital that Hong Kong’s high degree of autonomy and the rights and freedoms set out in the joint declaration are respected in full. Those principles, along with the commitment to one country, two systems underpin Hong Kong’s future success and prosperity. As a guarantor of the joint declaration, the UK has a responsibility to monitor its implementation. This is a responsibility that we all take very seriously.

The joint declaration is a legally binding international treaty between the United Kingdom and China, and it remains in force. It is as relevant today as it was at the time of the handover in 1997. The Prime Minister and the Chancellor of the Exchequer both raised the situation in Hong Kong and the importance of upholding the joint declaration with Chinese Vice Premier Hu during the UK-China economic and financial dialogue that took place in London yesterday.

The permanent under-secretary at the Foreign Office also held a meeting in the Foreign Office with the Chinese ambassador yesterday, reinforcing our view that the joint declaration is an extant document underpinning one country, two systems and it is guaranteed until 2047. It must be upheld. I can assure the House that the UK Government are, and will remain, fully committed to the preservation of Hong Kong’s high degree of autonomy.

I am delighted that, in addressing this matter on the Floor of the House for the fourth time in six sitting days, there is such widespread support from all corners of Parliament for the rule of law, independence of the judiciary and the freedoms for the people of Hong Kong.

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I thank the Minister for that answer and I thank you, Mr Speaker, for allowing this urgent question. There are literally millions of people in Hong Kong who follow the proceedings in this House and who look to us for support in their fight to protect their human rights. It matters to them there that we here remember their position, and it is right that we should recognise your role, Mr Speaker, in getting this issue ventilated in the House.

The news that the Executive in Hong Kong had suspended the legislation for the extradition amendments was welcome as far as it went, but the message should go out from this House that it did not go far enough. We in this House stand with the 2 million people who took again to the streets in Hong Kong on Sunday to say that suspension is not enough. That legislation must be withdrawn for good. Will the Minister make it clear to the chief executive that that is the position of this country and that that is what her Administration must now do?

In recent weeks, the Chinese Foreign Ministry declared that the Sino-British joint declaration was meaningless and that it no longer had any realistic meaning. I welcome what the Minister has said on this today, but will he assure us that that will continue to be put forcefully to the Chinese Government at every opportunity, because for a fellow permanent member of the UN Security Council to take this view undermines the very idea of a rules-based international order. Will the Government now demand of the Chinese Government that they should resile from the view that they have previously expressed in relation to the joint declaration? It is a binding bilateral treaty registered with the United Nations. China cannot be allowed to pick and choose the obligations in international law that it will observe and honour.

People across the world were shocked to witness the violence used against peaceful protesters in Hong Kong last week. Legitimate democratic Governments do not use tear gas and rubber bullets against their own people when they choose to exercise their democratic right to protest. We hear that the Chief Executive is due to make an apology today to the people of Hong Kong for her handling of the affair. Does the Minister agree with me that that apology should extend to those who were harassed and injured as a result of what was done, and can we in this House send the message that we continue to watch what happens in Hong Kong and we will not sit mute as those who protested then are prosecuted when the spotlight of world attention has moved on?

The events of recent weeks in Hong Kong have been horrifying, but they should not have been surprising. For years now, the People’s Republic of China has been salami slicing the commitments it gave under the joint declaration. Sadly, the Executive Council has too often been complicit in that, but the commitments that have been broken are commitments to which this country has been a party. Will our Government now send the strongest possible message that we will not stand by and allow that process of salami slicing to continue?

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I am very grateful to the right hon. Gentleman for his kind remarks. As the House knows, it is not for the Chair to arbitrate between the Government and the Opposition—between the policies of one party and those of another—and I do not do so, but this question has been granted, and it is the third time the House has treated of this matter in the last week, precisely because I sense that the House of Commons is genuinely shocked and outraged by what is happening. We respect the position of those demonstrators and we utterly deplore the treatment of them. This matter will continue to be aired in this Chamber for so long as Members wish it to be aired here.

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Thank you, Mr Speaker. I am grateful that the whole House has a similar view on these concerns. The right hon. Member for Orkney and Shetland (Mr Carmichael) is absolutely right; we are addressing these matters, this debate will be shown in Hong Kong and it is important that we stand by the Hong Kong citizens whose rights are part of the duty that we have to uphold in order to ensure that one country, two systems is maintained.

We have called for the suspension of the extradition Bill and for further consultation. That is the right thing to do for two fundamental reasons. First and foremost, this must ultimately be a matter for the Hong Kong people. It is absolutely unacceptable for the UK Government to dictate terms, as it is for the Chinese Government to dictate terms in Hong Kong or other parts of the world. We are standing by the joint declaration and its terms, but ultimately it must be for the people of Hong Kong to determine. I am very well aware that, in diplomatic terms, it is important that we find a way for face to be maintained; that is important in the part of the world we are discussing. Therefore, the most desirable outcome would be a severe suspension sine die, but this is ultimately a matter for Hong Kong. Indeed, any judicial aspects of the matter are for an independent and free judiciary—a system that we believe is being upheld in Hong Kong, in contrast to what happens elsewhere.

The right hon. Gentleman makes a very good point regarding the rules-based order. As he says, given that both the UK and China are permanent members of the UN Security Council, there are opportunities there to raise the specific concerns he mentioned. We have made it very clear that not only do we regard the joint declaration as being extant—it will continue to be in place for the period of the one country, two systems approach—but we will also continue to have six-monthly reports. We have made this very clear to the Chinese ambassador to the UK and to other officials. We get criticised every six months and we will make very plain our concerns including that, although we think that one country, two systems is operating fairly well, there is clearly some strain, not least in relation to freedom of expression and freedom of assembly. Clearly, the next report will go into great detail once the dust has begun to settle on what has happened. I thank the right hon. Gentleman for continuing to express his strong interest, and I know he speaks for many in the House. The Foreign and Commonwealth office led with a statement last week, and we will continue to keep the House updated.

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I hear what the Minister says about this being a matter for the Hong Kong Government, but does he agree that some 2 million people repeatedly taking to the streets in Hong Kong is a sign of wider concerns about Hong Kong’s increasing democratic deficit over the past few years—with booksellers being abducted, democratically elected representatives not being allowed to take their seats and academics being imprisoned over freedom of speech? It is not just about the proposed extradition Bill; there are concerns much more widely about freedoms in Hong Kong. Does the Minister agree that the Hong Kong Government should be initiating democratic reforms to avoid a repeat of such incidents?

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My hon. Friend is absolutely right. Hongkongers are used to having rights, freedoms and the rule of law, but they do not have access to the political levers that citizens of other advanced economies take for granted, so when their Government try to push through a law that the great majority of the public bitterly oppose, they cannot simply vote that Government out of office; and because so many opposition legislators have been removed, they also cannot rely on their elected representatives to block the law. As a result, action on the streets has tended to be the only answer. We think there should and must be another way. Perhaps we will discuss later during this urgent question some of the democratic reforms that might be put in place.

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Thank you, Mr Speaker, for granting this urgent question; I congratulate the right hon. Member for Orkney and Shetland (Mr Carmichael) on securing it.

Hong Kong is one of the most important international cities in the world, but in the past fortnight it has been plunged into utter chaos. Over the weekend, 2 million people took to the streets to protest against the extradition Bill. That is nearly one third of the entire population of Hong Kong. Although the Opposition welcome the suspension of this disastrous Bill, suspension is not enough. The Bill needs to die. It is an affront to democracy and the rule of law in Hong Kong, and a fundamental breach of the one country, two systems principle. A grovelling apology by Carrie Lam this morning and promises of greater consultation do not change this fact. The Hong Kong Executive now have a choice to make. If they listen to their citizens, the Bill will be scrapped. These protests should also prompt serious reflection on the condition of democracy in Hong Kong, and on the increasing crackdown on dissent and protest. It is time to put democratic reform back on the agenda in Hong Kong.

I am disappointed that the Minister does not feel able to take a view on the contents of the Bill. We do not have an extradition agreement with China, so why should Hong Kong? I raised my next point during the last urgent question on the subject, but did not get a very clear answer, so let me ask the Minister again: if the Hong Kong Executive decide to push on with the Bill’s implementation, will the Government review the UK’s extradition arrangements with Hong Kong?

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The hon. Lady will be aware that extradition issues are a Home Office matter—that is not to try to get out of the issue, but clearly I do not want to step on the toes of another Government Department in making a firm commitment along the lines that she would have me make. We agree very much with her view that although the proposal is not necessarily in breach of the joint declaration, which is silent on the issue of extradition, it is clearly in breach of the notion of one country, two systems as well as the sense that there should be the rule of law and the idea of the common law system that is in place.

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Ah, a noted Sinologist—I call Richard Graham.

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The Hong Kong Government have suspended the extradition Bill, and may withdraw it altogether, because of the freedoms of expression and assembly. That is the direct link to the joint declaration and its importance. It is a tribute to the people of Hong Kong that they have exercised their rights so effectively. I congratulate the Minister and the Secretary of State on their defence of the joint declaration and on their tone, for Hong Kong is a territory whose future we wish to be very bright. Does my right hon. Friend agree that the Chinese ambassador has continued to be wrong in saying that the joint declaration is a document that is effectively past its sell-by date, and will he ensure that when, in due course, a new Chinese ambassador arrives at the Court of St James, this point is made very clear to him or her?

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I thank my hon. Friend, who is, as Mr Speaker rightly says, a well-known Sinologist and has a lot of experience and knowledge of this matter. He will appreciate that diplomacy requires that I have discussions in private, but I felt it was unacceptable when we heard the ambassador, only last week on the BBC’s “Newsnight” programme, make the statement, which has been made in writing in the past, that this was a historical document that had no relevance to the future of Hong Kong. Nothing could be further from the truth. As I mentioned in my initial comments, the permanent under-secretary had a conversation with him in the Foreign Office only yesterday, making very clear the UK Government’s position on this matter.

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Thank you, Mr Speaker, for allowing this urgent question. The right hon. Member for Orkney and Shetland (Mr Carmichael) was right in his sentiments about the importance of this issue and in saying that the UK has a particular responsibility to Hong Kong. To be fair, the Minister has acknowledged that himself in maintaining the commitments in the joint declaration, and also in highlighting the importance of the international rules-based order to us all. I know that he agrees, but it would be good if he could reiterate, that citizens of a free society must be able to express their views freely without any fear of violence. We need to send that message out from across this House. No protest must ever be met with violence, and any resolution to this crisis must have the protection of the rule of law at its heart. Does he agree that the rule of law and adhering to the rules-based system is going to be key to Hong Kong’s future prosperity as a society, but also to its economy?

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I very much agree. I thank the hon. Gentleman, and indeed the SNP, for their very constructive views on this matter. It is very powerful that the House holds together on this issue. Of course there will be times when we have disagreements on the way in which we go about this, or other bits of business, but I think we are sending a very powerful message to our friends in Hong Kong, but also to the Chinese Government, about the unity of minds on this. Yes, we will very much stand up for the idea of the rule of law. That is vital for the success not just of Hong Kong but of China.

Let me turn to the economic dialogue. As I think hon. Members will understand, these things are organised many months in advance, and it is a coincidence that at the height of the Hong Kong crisis we were having an international economic dialogue here in London. One of the cases we made very robustly was about the importance for China of Hong Kong as a financial, and indeed professional, services centre reliant on a rules-based system but also on a UK legal system. That has provided much confidence for external investors. Without Hong Kong, the ambitions that China has for the belt and road initiative, and other bits of its infrastructure planning for the future, will be much more difficult to achieve. That is very much the case that we make to our Chinese counterparts—that having this special status for Hong Kong is in China’s interests as much as Hong Kong’s.

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Whether in respecting one country, two systems or the Chinese constitution that supposedly respects and protects the cultural diversity of various regions within China’s borders, the Chinese regime, as it has consistently shown itself, is not to be trusted. One need only look at the 1 million Tibetans who have lost their lives since the Chinese invasion, the countless hundreds and thousands more who have disappeared or are languishing in Chinese jails well away from their families with no access from their families either, or the 1 million Uighurs currently in so-called re-education camps. I therefore welcome the robust position that the Government are taking and urge them to go further. Will the Minister also remember that it is not just Hong Kong where we need to have serious concerns about the Chinese human rights record?

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I thank my hon. Friend for his great and long-standing interest in the proactive approach that we take to human rights, and the rule of law, in trying to influence these matters. We will raise, regularly and at all opportunities, broader human rights issues with the Chinese authorities. However, as he will be aware, Hong Kong has a special status. The nature of the joint declaration means that Hong Kong is in a different position. There are two systems as well as a single country at stake. While I very much accept what he says about the broader human rights issues, there are some fundamental, distinctive issues in relation to Hong Kong, and it is right that we take this opportunity to put them very firmly on the record.

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Given previous reports of individuals who have disappeared from wherever they were only then to turn up in China facing charges, the whole House understands completely why the people of Hong Kong are so anxious about their rights and so opposed to this piece of extradition legislation. The best thing that Carrie Lam can do is to say that it is being scrapped altogether. What remedy is there if either of the parties, but in this case China, decides not to abide by commitments freely entered into in the joint declaration to protect the people of Hong Kong and the one country, two systems state in which they thought they were living?

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The right hon. Gentleman makes a good point about remedy. There is not an arbitration process as part of the joint declaration, but it is none the less a document that is very publicly on the record after two leading members of the international community signed it freely some 35 years ago. On a direct legal remedy, I am afraid that I cannot provide the assurance that he might ideally be looking for. In 2016—he has alluded to this—we called out a breach of the joint declaration following the involuntary removal of the Causeway booksellers from Hong Kong to the mainland. This was, to date, the first and only time that we have called out a direct breach of the joint declaration. As he says, the issue of remedy is a complicated matter. However, at a time when China wishes to be trusted and to play a much broader role economically, militarily and diplomatically in the international community, I very much hope that the sense in which it is directly breaching aspects of a joint declaration made some 35 years ago will make it think twice.

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Was the Minister struck, as I was, not just by the sheer size of the demonstrations in Hong Kong but by the incredibly peaceful and responsible way in which people protested, which makes the response of the Hong Kong authorities all the more shocking? Does he agree that the right to peacefully protest is one of those essential, cherished democratic freedoms that we believe in and that we believe should be in place for the people of Hong Kong?

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I very much agree with everything that my right hon. Friend says.

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As the House is aware, the three pillars of good foreign policy are national security, human rights and trade. Is the Minister completely sure that yesterday’s dialogue with Mr Hu, in which the economic relationship was debated, got the balance right between the human rights question, particularly in relation to Hong Kong, and trade? I ask that because we need to be strong with regard to the trade question, despite the position that we find ourselves in domestically, so that we can have the backbone and the strength to have good relationships on all these other matters. We also need to give assurances to the people of Hong Kong that they shall never walk alone.

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I very much hope that we have given the latter assurances to which the hon. Lady refers. We do not see this as being a choice between securing growth and investment for the UK and raising human rights—we will always do that. There will be a time to do it, perhaps quietly outside the public domain. I think it is respected more by many of our Chinese counterparts if we do not engage in megaphone diplomacy. Our experience, as we make very clear to our Chinese counterparts, is that political freedoms and the rule of law are vital underpinnings both for prosperity and for stability, and that by having a strong relationship with China, including over Hong Kong, we are able to have the more open discussions on a range of difficult issues, including human rights in other parts of mainland China.

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For 2 million people to demonstrate out of a total of 7 million is a phenomenon in itself, and it would be invidious, in some ways, to pick any one hero out of those 2 million heroes. However, will my right hon. Friend join me in praising the work and bravery of a 22-year-old young man, Joshua Wong, who has spent more than half of the past seven years in prison because he believes in the rights and freedom of the people of Hong Kong? Further, will my right hon. Friend maintain that it is wrong to send him to prison for simply asking for the rights that are enshrined in the agreement?

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As my hon. Friend rightly says, it would be invidious to pick out one individual. We do stand up for the independence of the Hong Kong judiciary, so the sense that there was anything improper in the legal proceedings is not something with which I would necessarily wish to associate myself. He makes a good case: there are some very brave people who recognise that this is a crossroads moment—a vital moment. It is one reason why it is important that we are standing up for Hong Kong. It would perhaps be easy for us to step back, and that signal would be misinterpreted by Beijing. We do not wish that to happen. We will stand up for one country, two systems as long as the joint declaration is in place, not least, as I have again said, because we believe it is in the interests of Beijing and China, as much as in the interests of the Hong Kong people.

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The Minister has quite rightly set out the framework of rights that underpins the one country, two systems approach. Clearly, the reality on the ground is that democratic freedoms have been eroded, as of course has the right to privacy, with increasing covert surveillance. What practical steps can the Minister and the Government take to put democratic reform back on the agenda in Hong Kong?

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The hon. Gentleman makes a valid point. He is right—we have mentioned in recent six-monthly reports that we have had a sense, as he said, that there has been an erosion of individual rights. There has not been an erosion of commercial rights. In many ways, the commercial thing continues at quite some pace.

Ultimately, it must be for the people of Hong Kong to determine the way in which they appoint both their Chief Executive and their Legislative Council. I think there will be a move towards reform in that regard. As the hon. Gentleman is well aware, there are safeguards, and within that there is an electoral system for groups. As for the election of a Chief Executive, that is largely led by Beijing. It is worth pointing out that we have worked closely with Carrie Lam. I have met her on a couple of occasions, and she is a dedicated public servant. To be candid about talk about removing her from office, one should be careful about one wishes for, because if someone else were appointed, particularly under the current rules, they could be a much more hard-line Beijing figure.

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The words “rule of law”, are much used on both side of the argument, both in Hong Kong and in the People’s Republic of China. Does my right hon. Friend agree that the rule of law is only there if one looks at the rules themselves, at how they are made, and at punishments? In addition, they should be underpinned by the universal declaration of human rights. That is what the rule of law means.

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I would agree with what my hon. Friend says. He takes these matters seriously, and has dealings with leading figures from Taiwan who are based in London. He will be aware of the constraints that we are under in the Foreign Office and the Ministry of Defence in standing up for One China. Equally, there is a terrific amount of work that goes on in relation to trade and in educational exchanges with Taiwan. Taiwan is succeeding very rapidly as a country, not least because it stands up for the rule of law in the way in which my hon. Friend describes.[Official Report, 19 June 2019, Vol. 662, c. 5MC.]

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Without true democracy there is no real accountability, so protest is all that the people of Hong Kong have. I hope that they feel the solidarity from all parts of the House. What can the Minister tell us about the worrying allegations of police violence? What more can he tell us about his inquiries, or inquiries by his Department, into the nature, extent and possible consequences of allegations of violence and whether any of the alleged victims are UK citizens? What more is he doing to impress on the Chinese that this is not an appropriate response to peaceful protest?

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As far as I am aware, there are none who are UK citizens, and clearly there would be consul considerations if that were the case. It is worth pointing out to the hon. Lady that it really is not for us to dictate. We would like the Hong Kong authorities to recognise that it is their responsibility, as they did in relation to the Umbrella protests, in which some police who used brutality were fined and others were imprisoned as a consequence. It really is not for us—it is a dangerous line to tread if, as an outside Government, we try to dictate what should happen in Hong Kong when it comes to what is ultimately a judicial matter. We very much call on the Hong Kong authorities to take the allegations seriously and investigate them properly.

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I confess that I have been moved by the passion with which Hong Kong citizens have sought to defend the sacred principle of the rule of law, and they have sent an incredibly powerful message across the world that has certainly been heard in London. The Minister anticipated my question in one of his answers, but does he agree that the one country, two systems principle is beneficial not just for the inhabitants of Hong Kong but for those in mainland China, because the legal certainty in Hong Kong offers them a commercial gateway through which to access the rest of the world? We do not need to find ourselves in conflict with Beijing in defending the territory’s unique characteristics.

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I thank my hon. Friend. She is absolutely right, and that is a message that we try to put across. She will be aware that Hong Kong, along with Shenzhen and Guangzhou, is part of a greater bay area. One hopes that the experience will permeate that part of mainland China, so that people recognise the benefits of a one country, two systems approach. While the guarantee is in place until 2047, it is very much the UK Government’s hope that the benefits of one country, two systems in Hong Kong and perhaps a wider area will exist beyond that time, with benefits for China looking forward. It is important that we make that case to our Beijing counterparts in all that we do in relation to the issue of Hong Kong’s unique position.

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I congratulate the right hon. Member for Orkney and Shetland (Mr Carmichael) on securing the urgent question. Does the Minister agree that the reality is that all that the People’s Republic of China is seeking to achieve in Hong Kong is the legalisation of what it has been doing for years, which is legally kidnapping people from Hong Kong and taking them to China?

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As I have said, and as the hon. Gentleman will understand, we felt that there was a direct breach of the joint declaration in the episode to which he alludes, which happened some three years ago. This is unacceptable. Hong Kong citizens and British national overseas have particular rights that we will constantly stand up for. We feel that it is the wrong way forward—it is not something that we accept, and we feel that such episodes are absolutely in breach of the joint declaration.

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The Minister will have seen reports from lawyers in Hong Kong that the police in Hong Kong have access to the health authority system to check whether injured protesters have been admitted to hospital. What representations has he made to ensure that the protesters’ civil and legal rights are respected?

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I am very concerned by what the hon. Gentleman says on this matter. I think we all know there is great concern about what has been happening in Xinjiang state in north-west China. There is a sense that what is potentially happening for 1 million citizens may apply to many others. We are living in a world with more opportunity for electronic and other surveillance by authorities—and that applies to authorities in the west, as it does elsewhere. There are concerns, and we would be concerned if we heard that individuals who found their face on a CCTV camera were quietly arrested in the months ahead. We will keep an eagle eye on that development, and we hope as parliamentarians that we are made aware of any such breaches, because it is something that our consul general, Andy Heyn, and his team in Hong Kong would wish to make clear to the authorities would be totally unacceptable.

Bill Presented

Universal Credit Sanctions (Zero Hours Contracts) Bill

Presentation and First Reading (Standing Order No. 57)

Chris Stephens, supported by Frank Field, Neil Gray, Rosie Duffield, Mhairi Black, Ruth George, Hannah Bardell, Neil Coyle, Grahame Morris, Jonathan Edwards and Steve McCabe, presented a Bill to amend the Welfare Reform Act 2012 to provide that a Universal Credit claimant may not be sanctioned for refusing work on a zero hours contract; and for connected purposes.

Bill read the First time; to be read a Second time tomorrow, and to be printed (Bill 406).

Domestic Energy Efficiency Plan

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

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I beg to move,

That leave be given to bring in a Bill to require the Government to publish a plan for meeting the domestic energy efficiency targets in the Clean Growth Strategy; to make provision for monitoring performance against milestones in that plan; to establish an advisory body on implementation of the plan; and for connected purposes.

Just last week in this Chamber, we committed ourselves to net zero carbon by 2050. That means delivering a core Conservative value and a key manifesto pledge to leave the environment in a better condition than we found it for future generations. It is not only the right thing to do, but it has the potential to unite the nation in a common purpose. The vast majority of people of all ages and businesses from right across the UK support more Government action on climate change. This target is both af