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Commons Chamber

Volume 673: debated on Tuesday 10 March 2020

House of Commons

Tuesday 10 March 2020

The House met at half-past Eleven o’clock


[Mr Speaker in the Chair]

Oral Answers to Questions

Health and Social Care

The Secretary of State was asked—

Public Health Grant

The 2019 spending round announced real-terms growth in the public health grant for next year, so local authorities can continue to invest in prevention. Every local authority will see a real-terms increase in their grant allocations, which I expect to publish imminently.

Despite the urgency of the coronavirus situation at the moment, we could see local councils planning to cut numbers of nurses, even though they would be very much needed, simply because the councils do not know what their public health budgets are. Does the Minister think that is acceptable?

No, and that is why I have just announced that every local authority will see a real-terms increase in their grant allocation so that that does not have to happen.

Between 2017 and 2020, the Government have cut nearly £4 million from Lewisham Council’s public health grant, and the public health team is facing many challenges, not least from coronavirus. What does the Secretary of State mean by “imminently”? Councils need certainty. Given the pressure that local teams are under, will he look to restore funding to 2010 levels, in line with population growth and inflation?

As I say, every local authority will see real-terms increases in their allocation, and by imminently I mean in the next couple of days.

The Secretary of State keeps saying that local authorities do not need to worry about any of this, as the Government have said that they will be giving local authorities more money. Well, I asked my local authority on Friday whether that reassured it, and, surprise, surprise, it did not. That is because “more” can mean anything. Is it a penny more? Is it a pound more? Is it £100 more? Is it £1 million more? There is a bit of a difference. When will he let them know? He has now said that “imminently” means in a couple of days’ time. Exactly what is he waiting for? Is it the Budget?

As I say, the good news is that local authorities can all plan, with confidence, on the basis that these budgets are going up in real terms, and the exact details will be set out imminently.

Traditionally, public health was about infectious diseases and sanitation. More recently, it has become about lifestyle issues. Given the epidemics of the 21st century, particularly covid-19, what measures will the Secretary of State be taking, in allocating the public health grant, to refocus on infectious diseases, both current and those that are likely to come?

That is an incredibly important question—one that we will be addressing in the run-up to the spending review. The truth is that the public health grant is but one small part of the overall effort of local authorities to improve the health of the residents they serve. Although it is an important part, and it is good that it is going up in real terms for every local authority, we have clearly got to ensure that the whole effort of a local authority is there to improve public health.

All the evidence suggests that coronavirus is of greatest risk to those who are older in our population. The average age in my constituency is 10 years above the national average, yet in public health allocations Cumbria gets only £36 per head, as opposed to the national average of £63 per head and £100 per head for many parts of London. Does the Secretary of State agree that that is a dangerous inequality? Will he fix it in the upcoming statement?

The inequalities in health outcomes are what I am particularly concerned about, especially the length of healthy life expectancy, which is of course affected by both communicable and non-communicable diseases, the public health around both of those important considerations and the wider issues that my right hon. Friend the Member for South West Wiltshire (Dr Murrison) just mentioned. We will take all of that into account as we look at how the public health grant is best allocated and best used, ahead of the spending review.

GP Appointments

5. What steps his Department is taking to increase the availability of appointments in GP surgeries. (901420)

We are creating an extra 50 million appointments a year in primary care, and we are growing the workforce by some 6,000 more GPs and 26,000 other clinical staff on the frontline. We are encouraging everyone to “Think Pharmacy First”, so that access to the right healthcare professional is there when people need it.

Shortly—I thank my right hon. Friend for that. First, I should like just to whip over the statistics. In December, there were nearly 400 more nurses, 200 more doctors and 1,000 more other staff providing patient care in primary care than there were a year earlier. By encouraging recruitment and retention, and minimising unnecessary bureaucracy, we will help primary care to support the patients in the most appropriate way and ensure that everyone has faster access to appointments sooner. If you would indulge me for a second, Mr Speaker, I would like to thank all those in primary care and across the NHS, who are working harder than ever to provide support to patients as our response to coronavirus ramps up. Everyone has a part to play in getting through the next few weeks and months. We are rightly proud of how our NHS has and will continue to support anyone affected, but we need also to support them.

At a time when the Government are rightly committed to increasing GP provision, my constituents and I are deeply concerned that Sandiway surgery in the north of Eddisbury has been earmarked for closure by its practice group. What can my hon. Friend, or Cheshire clinical commissioning group, do to help the practice to improve its overall standard so that it can continue to treat its 3,700 patients for many years to come?

The closure of any GP practice stirs up understandably strong emotions in the local community. The Care Quality Commission inspection last May highlighted safety concerns at Sandiway surgery, and significant investment is required to bring the premises up to standard. I believe Danebridge medical centre has consulted on and looked into the difficult decision to close the practice and increase appointments and services at the other two local practices. As ever, I am happy to meet my hon. Friend to discuss how we can ensure that Sandiway residents have access.

I note what the Minister said about GPs and their role in responding to covid-19, and I entirely agree with her. GPs want to do their very best for their patients. They need quicker access to protective equipment and they need clear guidance. Will the Minister lift all the bureaucracy that GPs currently face? I am talking about appraisals and the quality and outcomes framework end-of-year requirements. Will she suspend those requirements so that GPs can focus entirely on responding to coronavirus?

I am currently having discussions to make sure that, within the bounds of making sure that patients stay safe, we can lift all bureaucracy where appropriate. We now have more than two thirds of personal protective equipment rolled out into GP surgeries, with the rest arriving imminently.

Many of our constituents, especially those with underlying conditions—from emphysema to chronic obstructive pulmonary disease, diabetes and asthma—will look to GPs for guidance. When they see what is happening today in Italy, they will be extremely frightened. What is the Government’s advice to those with underlying conditions? Will the Minister tell the House, for the benefit of our constituents, what lessons the Government have learned from the Italians about their handling of coronavirus to date, and why we are taking a different approach?

As we have laid out from the beginning, our approach will be science-led and about the safety of everybody. That is why at some point in future doctors will make decisions and clinical judgments, and those with existing co-morbidities or at the more serious end of an illness will be triaged up into an appointment first. That may mean that some people have to wait a little longer during this period, but it will always be done on clinical advice and with the safety of the patient at the heart of things.

Last year, 85% of doctors surveyed by British Medical Association Scotland said that the pension taxation crisis would have a significant effect on NHS services, such as through waiting times. The Government’s proposal to raise the taper threshold to £150,000 does not fully solve the problem and would cost the Treasury more than it would to reverse the policy, so what is the Minister doing to address the issue?

I am sure the hon. Gentleman will understand that my right hon. Friend the Chancellor might be a little upset if I started to make announcements from the Dispatch Box today. It is a work in progress. It has been a little trickier with general practice than it is in the health service, because GPs do not do specific shifts, making it a little trickier to organise.

Scotland’s Cabinet Secretary for Health, Jeane Freeman, wrote to the Chancellor last month to call for a sustainable resolution on this matter in the Budget. Ahead of tomorrow’s Budget, what assurance can the Minister offer that the joint Department of Health and Social Care and Treasury review of the impact of pension taxation on the NHS will produce a long-term solution that will work for all doctors?

16. All the advice given by the Department of Health and Social Care is to self-isolate and not to go to see our GP, but if someone does need to see a medical professional, can they use any of the current digital technology in the NHS to provide them with the advice that they need? (901432)

Yes, they most definitely can. Many surgeries are making sure that “Digital First” is becoming part of their everyday offer to patients across the land. We have a real chance to ensure that we both protect the health of the nation and embrace digital technology to improve access to GPs still further.

For years, GP numbers in Sunderland have been falling at a much steeper rate than in the rest of the country. Since 2015, we have lost 29 permanent family doctors. Given the major health inequality issues that we already face, when will the Minister get to grips with the worsening situation that we face in Sunderland?

We are committed to providing those extra 6,000 GPs across the country. We have also made sure that incentive schemes are in place in areas where it is difficult to recruit, and they have been found to be very effective in driving additional GP numbers into challenging areas such as the hon. Lady’s constituency. We are working on the matter.

Antimicrobial Resistance

The UK is a world leader in tackling the global challenge of antimicrobial resistance. Since 2014, we have invested £615 million in the area, over half of which is in research and development, as part of our vision to contain and control AMR by 2040.

Regrettably, the coronavirus outbreak has demonstrated the susceptibility of global society to pandemics and antimicrobial resistant organisms. Lord O’Neill, who chaired the review, estimated that some 10 million people a year could die by 2050 because of AMR. The previous chief medical officer said that we could easily get to a state where fully half of people die from untreatable infectious diseases. Is my right hon. Friend content with the level of work and research being done in his own Department with respect to novel approaches such as genomics, combination drugs and new sorts of vaccinations? Will the importance of those things be reflected in the forthcoming spending review?

Yes, absolutely. My right hon. Friend is right to highlight the threat of AMR, because microbial illness and disease is just as much of a threat as viral disease and we must ensure that we retain the tools that we currently have through antibiotics to tackle it. We are investing in that space with more to come.

New Hospital Projects

We have announced £2.7 billion of funding for six new hospital schemes under HIP1—the first tranche of the health infrastructure plan; and £100 million of seed funding for a further 21 schemes covering 34 hospitals under HIP2, ready to go to the next stage. That is 40 new hospitals in total.

I am hugely grateful to my right hon. Friend the Secretary of State for granting Harlow the capital funding for a brand new hospital. Does the Minister agree that our new hospital will transform the patient experience for Harlow residents and the working environment for our brilliant NHS staff, and deliver state-of-the art healthcare for our town and surrounding villages?

It is thanks to this Government that we have £500 million of investment in the Epsom and St Helier University Hospitals NHS Trust, not only to improve existing hospitals but to build a third new one as well. Does the Minister agree that this is excellent news for local patients and will he encourage my constituents and those in surrounding areas to get involved in the consultation on where the new hospital is to go?

My hon. Friend is absolutely right. It is indeed excellent news. As he will be aware, the public consultation process is under way. It would be wrong for me to prejudge that, but I encourage everyone to participate.

Does the Minister agree that it is important to spend taxpayers’ money well, and that to spend it on a site that is going to cost 20% more than St Helier—away from the people with the greatest health needs—is not the best way to spend public money?

I gently say that I am not going to prejudge the outcome of the consultation, in which I am sure that the hon. Lady would encourage others to participate. Regardless of the outcome, I am sure that she would want to welcome the £500 million investment from the Government that will benefit her community and others.

During the election campaign, the Prime Minister promised 40 new hospitals, but the Government have only pledged funding for six: £2.7 billion. After more than five years of raiding capital budgets, when will the Government provide the £6.5 billion that is required to fix the maintenance backlog alone?

As I have made clear, we have set out the funding for the six new hospitals in the first tranche; we have invested seed funding in the development of the schemes for the further 34; and further capital announcements will be made in due course.

NHS Workers: Immigrants

6. What steps he is taking with the Home Secretary to fast-track immigration applications from doctors and nurses who want to work in the NHS. (901422)

9. What steps he is taking with the Home Secretary to fast-track immigration applications from doctors and nurses who want to work in the NHS. (901425)

This Government will be introducing an NHS visa, which will offer reduced fees and fast-track access for overseas doctors, nurses and allied health professionals to work in the UK. My right hon. Friend the Home Secretary will be outlining detailed plans in due course.

Scotland has an increasing crisis of GP shortages, and in NHS Grampian—where £1 million had to be spent on agency nurses this winter—we have an increasing nursing crisis. Some people are understandably concerned that the changes to immigration rules will have an adverse effect. Can my hon. Friend confirm that the new NHS visa will be applicable in Scotland as well?

Yes, I can absolutely give my hon. Friend that assurance. The NHS visa will be available for doctors, nurses and allied health professionals coming to work in the NHS across the whole United Kingdom.

As we all know, nurses, midwives, paramedics and physiotherapists are highly skilled roles, and the Government have been clear that they meet the immigration skills threshold. What steps is the Department taking to dispel the level of fake news on the subject, and to encourage the brightest and best from around the world to apply for these important roles?

The salary thresholds for people coming to work in the NHS in the roles that my hon. Friend mentioned are linked to NHS pay bands, and applicants will have more than enough points to apply under the new immigration system. We are working with NHS employers to encourage international applicants. I thank my hon. Friend for giving me the opportunity once again to dispel any myths in this area.

The Minister will have to try a bit harder, because the Chartered Society of Physiotherapy is certainly very concerned that its positions are not going to be covered. Others, such as care assistants, are also below the salary threshold. We are talking about vital roles. There are 100,000 vacancies across the NHS, so will the Minister go back to the Home Office and ask staff to look at the detail of these proposals so that they do not make the NHS staffing crisis any worse than it already is?

The NHS visa is in place. There are also plans in place to ensure that we have international recruitment alongside investment in a home-grown workforce, and that we increase retention rates and the number of returners to provide the NHS with the staff it needs.

Many skilled health professionals in this country who have been granted refugee status are finding it difficult to get accreditation from the regulating bodies. May I commend to the Minister the healthcare overseas professionals programme of Sandwell and West Birmingham NHS Trust, and invite her to visit that trust? Will she have discussions with the regulating bodies to try to speed up the process for these people, who have the skills and want to work, and whom we need?

Work has already been done by the regulating bodies. For instance, we are already speeding up the process for nurses from overseas who want to come here to work in the NHS. I would be very happy to have further correspondence with the right hon. Member about the specific problem, and would be delighted if he could send me an invitation to make the visit that he mentioned.

I congratulate the Department on securing the NHS visa but, as the Minister knows, it does not apply to nurses and care workers in the social care sector. What is the Department’s assessment of the gap there will be in the social care workforce as a result of this new immigration policy, and how are discussions going with the Home Office and No. 10 on that issue?

I thank my right hon. Friend for his question. I am well aware of concerns in the social care sector, particularly in areas where there are higher vacancy rates. It is important that employers make sure that they are taking the steps they can take to make sure that social care jobs are attractive and, of course, well paid, as they should be. I recognise as well a role for Government in this, supporting the role of working in social care, and overall making sure that we come together and fix the social care crisis.

Care for Young Carers

7. What recent estimate he has made of the number of GP practices that have adopted the care for young carers package. (901423)

NHS England outlined the care for young carers offer in GP surgeries in June 2019. The offer includes a package of practical plans and actions to help young carers. Uptake will be monitored at a regional level in England through integrated care systems.

I am grateful for the Minister’s response. However, can she further break down the number of surgeries that have offered priority appointments for carers for home visits and additional mental health checks, and double appointments for the carer and those they provide for? What is she doing to see this rolled out in every GP surgery throughout the nation, bearing in mind that 40% of carers struggle with their own mental health?

My hon. Friend makes a really important point about support for carers and young carers. I cannot answer on the details of his question right now, but I will take it away, talk to the Under-Secretary of State, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), who is responsible for primary care, and the Under-Secretary of State, my hon. Friend the Member for Mid Bedfordshire (Ms Dorries), who is responsible for mental health, and come up with a better answer for him.

NHS Medicines

10. What steps his Department is taking to increase the range of medicines available to patients on the NHS. (901426)

The systems that we have in place are already securing access to effective new medicines for many thousands of NHS patients—for instance, cystic fibrosis patients through the drug Orkambi. Our commitment to getting new drugs into the NHS through an innovative medicines fund will further expand the access to medicines for NHS patients.

My right hon. Friend is aware that two children in my constituency have families who are self-funding the cannabis drug Bedrolite, which is their only means of controlling their severe epilepsy. He has very kindly agreed to meet me to discuss their case, but what action is being taken to make Bedrolite available on the NHS for families such as the two in my constituency for whom this really is the last resort?

My hon. Friend is right to raise this issue, and I look forward to meeting him later this month to discuss it. These are desperately difficult cases. We have to trust doctors to make the right clinical decisions for each individual patient. Two licensed cannabis-based medicines have recently been made available for prescribing on the NHS. We keep working hard with the health system, and with industry and researchers, to improve the evidence base. Also, the costs need to be brought down by industry. Last week, the Under-Secretary of State, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), held a roundtable with leading industry figures. I look forward to continued work to make sure that we can get these drugs to the people who need them.

Women suffering from endometriosis often do not get the medicine or treatment they need. One in 10 women suffer from this condition and it takes, on average, seven years to have a diagnosis. Will the Secretary of State please meet me and the all-party parliamentary group on endometriosis to discuss how we can develop research into this condition, and look at the work being done at Hull University?

Yes, I am very happy to look at that research and for either me or the Minister to meet the hon. Member and those whom she represents through the APPG. This is of course a very important issue. I think that it has been under-discussed for too long and should be brought up the agenda.

Peterborough is the UK’s fourth fastest growing city, home to over 200,000 people, and our hospital serves many, many more. Despite this, Peterborough and fenland patients are forced to travel to Cambridge, or further, for percutaneous coronary intervention and other cardiac medicines to treat or prevent heart attacks. Will my right hon. Friend support my ambition, and that of the trust, to ensure that there will be an elective PCI and other medicines cardiac service at Peterborough City Hospital?

I am very happy to look into that individual case and to meet my hon. Friend, or for the Minister to meet him, to see what we can do.

Points-based Immigration

11. What assessment he has made of the potential effect of the proposed points-based immigration system on the provision of health and social care. (901427)

23. What assessment he has made of the potential effect of the proposed points-based immigration system on the provision of health and social care. (901440)

The points-based immigration system is designed so that the UK can attract the brightest and best individuals to work here. As the hon. Member no doubt knows, jobs where there is a recognised shortage of supply, such as nurses, are on the shortage occupation list, and people filling those roles will score more than enough points to come to the UK. We are also introducing the NHS visa to make it easier for doctors, nurses and health professionals from all around the world to come to work here.

The sector is understandably worried about what a points-based system will mean for their ability to recruit the workforce they need. Soon I plan to reintroduce my private Member’s Bill, which sought an independent review of the impact of Brexit on the sector, but will also now include an independent evaluation of having such a points-based system. Given the importance of an evidence-based approach to policy making, will the Minister agree to meet me and others to see how we can all work together to ensure that the long-term needs of the health and social care sector are met based on the evidence available?

I thank the hon. Member for his question. I am in contact with stakeholders, as a relatively new Minister in this post, reaching out as much as I can. I am mindful of concerns about vacancy levels but absolutely committed to making sure that, across health and social care, we have the workforce we need.

Not only do this Government treat the Scottish Government with contempt, but they treat their own Scottish Tory colleagues in the same way, as they were reportedly livid about the points-based immigration system introduced. Given the implications for health and social care staffing in Scotland, will the Minister ask Cabinet colleagues to reconsider our proposals for a Scottish visa?

We have the NHS visa, which applies to the whole United Kingdom. The Migration Advisory Committee has been clear that UK immigration policy must benefit the whole UK, and Scotland benefits from its own shortage occupation list, which will continue to exist.

Does my hon. Friend agree that a German-style system of social insurance for adult social care would relieve the burden and reduce the requirement for overseas workers, by allowing a loved one, a neighbour or a friend to provide that care and be properly remunerated for it?

I am well aware that my hon. Friend is very keen on that particular approach. He has hopefully received a letter from the Secretary of State, inviting colleagues to come to talk to us about the proposals and options for fixing our social care crisis, and I hope he will take that up.

Will the Minister consider waiving the NHS surcharge for overseas staff who want to come to work in our NHS?

I am well aware of concerns about the surcharge. Many overseas nurses coming to work in the NHS do not have to pay the surcharge, as it is covered by their employer.

The phrase “brightest and best”, when it appears in immigration talk, is obviously subjective and deliberately vague. What the private sector and local authorities want to know is: under the new Government system, will they be able to get people to come in who want to provide care—people we are desperate for?

For the NHS, we have the NHS visa and a clear route to come to work in the health sector. For social care, there is a job to be done by employers, to make sure that working in social care is an attractive job that is well paid. I also recognise that there is a role for Government and for all of us in Parliament, to come together and support changes to how we fund social care. We need to fix the social care system for the future.

Low-risk Medicines

12. What steps his Department is taking to increase the range of healthcare professionals permitted to administer low-risk medicines. (901428)

18. What steps his Department is taking to increase the range of healthcare professionals permitted to administer low-risk medicines. (901434)

We are currently considering all options to increase the range of healthcare professionals permitted to administer low-risk medicines. This is all part of making sure that our NHS workforce is as flexible as possible, and we will do that in the light of what can be done, while of course keeping a highlight on patient safety.

My constituent Jessica Warr works as an operating department practitioner in Leighton Hospital. She and her colleagues make a huge contribution to patient care. Would the Secretary of State agree to meet Jessica and other ODPs to hear their case for why allowing them to prescribe would allow them to enhance the care they provide for patients even further?

Yes, of course, I would be very happy to meet my hon. Friend and those he represents to make sure that we can get the right balance—the maximum possible flexibility, subject of course to patient safety.

Would my right hon. Friend join me in welcoming the Government’s commitment to an extra 26,000 primary care staff and confirm that this will improve access to primary care services for my constituents in Stoke-on-Trent Central?

Yes, the 26,000 extra staff, as well as the extra GPs in primary care, are going to improve the position, but we also taking steps to improve access by making sure that people can access primary care in the best possible way. I can be clear to the House today that we will take a digital first approach to accessing primary care and out-patient appointments, so that, wherever clinically and practically possible, people can access—and should access—primary care through phones and digital means. This is especially important in the current coronavirus outbreak. Already, a roll-out has started, but we will make this across the country with immediate effect.

We have been waiting for a year for the Greenwich clinical commissioning group to reopen a nurse-led practitioner drop-in centre on the Horn Park estate. This was a place where people from that local community could pop in and get minor treatments, but also vaccinations, and it could prescribe low-risk drugs. May I commend this service to the Secretary of State? Could he assist me in urging Greenwich CCG to reopen it as quickly as possible, but also look at it as a possible model for other areas?

Ovarian Cancer

Last year, 1.5 million more people with suspected cancer were seen by a specialist compared with the numbers in 2010, thanks to our dedicated workforce. We want to go further and diagnose three quarters of all cancers early—more if possible. I am grateful to those charities, particularly ovarian cancer charities, that are raising awareness this particular month. For cancers like ovarian, where symptoms are vague and can be harder to detect, it is more difficult. To achieve the ambition, we are radically overhauling screening to improve access to uptake and investing £200 million in diagnostic equipment.

What is the Minister doing to ensure that all women who are referred on this are diagnosed with ovarian cancer or ruled out within 28 days, in line with the faster diagnosis standard?

Under the long-term plan, we are rolling out the rapid diagnostic centres, giving GPs another important route to patients. With the Mike Richards screening review, we are making sure that we get patients to the clinicians—where they need to go—so they can access treatment faster. It is more important than anything else that we get the cancer early, so we can treat it well and give people a real chance of a long life.

Brain Tumour Research

As I say, cancer survival is our priority and that was made clear in the long-term plan. Unlike many cancers, we have not moved the dial really far enough for patients with brain cancer. To ensure better outcomes for those affected by brain tumour, we need to focus and redouble our efforts on innovative research and new methods of diagnosis and treatment. That is why we have pledged £40 million over five years to stimulate brain tumour research, working alongside the Tessa Jowell brain cancer charity.

That is welcome news. Ten per cent. of all cancer deaths of people under 50 are from brain tumours, but the cancer receives only 2% of the money spent on cancer research funding. The previous Government established an inquiry into this to see what more could be done. Does the Minister agree that this month, which is Brain Tumour Awareness Month, would be a good time to re-establish that inquiry?

I would be more than happy to meet the right hon. Gentleman to talk about his ambitions. The funding is going up and, as I have said before, it is always welcome to me when cancer charities drive awareness, so that people are more aware of the symptoms, particularly of cancers where we are not moving forward fast enough.

MMR Vaccine

I strongly urge all parents to ensure that they vaccinate their children. Public Health England and the NHS are implementing actions from the measles and rubella UK elimination strategy, designed to increase the take-up of the MMR vaccination in children, adolescents and adults. That includes providing additional opportunities to catch up on missed vaccines and improving information to the public that emphasises the importance of getting the MMR vaccination.

I hear what the Minister says and of course all our thoughts are on coronavirus at the moment, but is she aware that last year 143,000 people, mainly children and young people, died from measles and that the measles epidemic is going to come here as the rate of protection from the MMR vaccine decreases? This is a real issue. Will she join my campaign to make sure that every child who goes into pre-school care and early school has a certificate saying they have had the MMR vaccine?

I would love to meet the hon. Gentleman to talk about his campaign because the Government are looking at any way we can improve vaccination rates. Vaccinations work on protecting the herd and losing the World Health Organisation status on measles last year was very sad. That is something that we should all be mindful of. We should make sure that we all look to help people to access MMR vaccines for their children.

Cromer Hospital

My hon. Friend is a strong advocate for Cromer hospital. It is relatively new, but the area’s 2015 cancer strategy projected a 200% increase in the need for cancer care over the next 10 years. So last year we saw the start of the £4.15 million proposal for a new cancer centre at Cromer, in partnership with Macmillan. However, I know he and his trust a more ambitious than that.

I thank the Minister for that answer. North Norfolk is one of the oldest constituencies by demographics. It is very rural and a very long way from the Norfolk and Norwich hospital. What I am looking for is an enhanced urgent treatment centre with mental health facilities. That would really help my constituency and, not only that, it would take pressure off the Norfolk and Norwich hospital. Will the Minister support my campaign for more improvements there please?

My hon. Friend is right to highlight that his constituency has the highest average age in this country. As an assiduous reader of the Eastern Daily Press I recently saw the story outlining the trust’s plans for a UTC. I look forward to seeing those proposals develop further. The key to delivering them, or their making progress, will be partnership. I look forward to the hospital trust, my hon. Friend and the CCG working in partnership to deliver an outcome.

Life Expectancy

Life expectancy at birth is the highest it has ever been. Figures this week showed that last year mortality was the lowest since 2001, but we are not complacent. Already we have made clear our bold commitment to level up left-behind areas.

The truth is that if you live in poverty you will get ill quicker and die sooner. For my constituents in Pharos ward in Fleetwood, life expectancy is 10 years shorter than just five miles down the road in Carleton, and following the report that came out last week we know that life expectancy has stalled and for the poorest women it is now declining. What kind of damning verdict does the Secretary of State think that is on his Government’s 10 years of Tory cuts and austerity?

I agree with most of what the hon. Member said and the starting point in particular—that the gaps in healthy life expectancy are far too big. She will have heard me articulate from this Dispatch Box how important it is that we close those gaps. The news out this week of lower mortality in 2019 was good news that she ought to welcome, but it certainly does not mean that the campaign to close the gap in healthy life expectancy is over. There is far more to come.

Coronavirus has a bearing on life expectancy and I have a particular concern in relation to GPs in surgeries in my constituency. A world-leader on the transmission of infections raised with me a vital question, which is the provision of protective suits and training. At the moment, I am told that they are not being given to GPs, but exclusively to hospital staff. Will the Secretary of State please look into that and do something about it?

I am right across this issue. My hon. Friend is right to raise it, but I can reassure him fully that we have now rolled out personal protective equipment to two thirds of primary care and the rest of it is in progress. We will absolutely address this issue. It is quite right that we did. We wanted to get the timing of the roll-out right so that the equipment is there should the epidemic hit in a very large way. We have to make sure we protect our health staff.

A&E Waiting Times

20. What steps he is taking to reduce the number of patients who wait longer than four hours for treatment in A&E. (901437)

Despite the NHS seeing a substantial rise in demand, with 1 million more attendances at A&E in 2019 than in 2018, our amazing NHS staff continue to work hard to ensure that everyone gets the care they need, including seeing 1.7 million more people within the four-hour standard than in 2010.

This morning, as I scanned the NHS England winter situation report covering Barking, Havering and Redbridge University Hospitals NHS Trust in my constituency, I saw that it had massively underperformed in terms of ambulance handover delays. Across this winter, it averaged 38% of handovers taking at least 30 minutes. The national average was just 14%. How do the Government explain the fact that, despite trusts seeing 16,000 fewer arrivals this winter, there were 22,000 more handover delays?

The hon. Gentleman will know that the London ambulance service serves the whole of London. His trust does see increased demand and increased challenges associated with winter, but I would also point out the positive. His trust received £1.2 million of winter capital in 2018 to aid preparations for winter. He will also know that the 20 hospital upgrades programme includes the St George’s site, serving the trust more broadly with a health and wellbeing centre, which will ease pressures.

Topical Questions

The global coronavirus outbreak is clearly growing. Last night, Italy placed the whole country in quarantine. We have updated our travel advice to advise against all but essential travel to Italy. All those returning from any area of Italy must self-isolate for 14 days. That is in addition to our advice that anyone who visited the specific areas of northern Italy that were originally locked down in the past two weeks should self-isolate for 14 days. We will do everything we can to keep people safe, based on the very best scientific advice.

A recent survey by the Teenage Cancer Trust found that 29% of young people who were treated for cancer did not have a discussion about their fertility with a healthcare professional. Of those who did, 44% were not satisfied with that discussion. Will the Secretary of State meet me and representatives of Teenage Cancer Trust to work towards some much needed progress in assuring young people and their families that fertility is of extreme importance?

I know that the hon. Lady has personal experience in this area. I entirely understand the concern she raises. The personal plans that are being brought out from next year should help to address this problem, but the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), is very happy to meet her to make sure we get this exactly right.

T2. Over three and a half years ago, Grantham Hospital was closed overnight owing to temporary measures. This has gone on for far too long. Enough is enough. Can the Secretary of State help me and offer any guidance or update on what we can do to get those doors back open 24 hours a day? (901443)

It is vital that the people of Grantham are able to access 24-hour care for both accident and emergency and urgent treatment needs. I urge my hon. Friend to continue to work with his local health services and commissioners to develop plans to ensure the needs of his constituents are met. I know he has already been a strong advocate on this matter in this House for his constituents since his election, but I am of course very happy to visit him in Grantham if that would be helpful to him.

Personal protective equipment can be as important in social care settings as it is in hospital or GP settings, but care staff report having to buy their own gloves and one care provider had their order of protective equipment requisitioned by the NHS. The Secretary of State says that he is all over this issue, so what plans does he have to ensure that care staff have access to protective equipment to protect them and the people they care for?

Of course care staff too are absolutely vital in the national effort to address coronavirus, not least because of the increased risk to many people who are in residential settings and who receive domiciliary care. The work to make sure that protective equipment is available extends to social care staff. Of course, most social care is provided through private businesses, and the delivery model is therefore different, but that does not make it any less important. I am very happy for the hon. Lady and the Minister for Care to have a meeting to make sure that we can listen to the concerns that she has heard about, because we want to address them.

There are already 120,000 vacancies in the care workforce and we now face the prospect of large numbers of care staff having to self-isolate because of coronavirus. With the NHS also needing staff, as we have discussed already, what plans does the Secretary of State have to ensure that care providers are still able to fulfil their contracts and provide their clients with support?

This is also an incredibly important issue that we are considering and working on. We will make sure that we address any barriers to social care operating. In all contingency plans on the reasonable worst-case scenario, plans are needed for being able to operate with a 20% reduction in workforce, but making sure that the best care can be provided in what is going to be a difficult time for social care is a really important part of the effort that we are making.

T5. When he announced the medicines and medical devices safety review of, among other things, vaginal mesh implants, the then Health Secretary, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), described the response to these tragedies as “not good enough”. Will the Secretary of State assure me that women who now need mesh removal are receiving all the support that they need and that adequate resources are in place for the treatments that they require? (901447)

My hon. Friend is quite right to raise this—it is true that that the NHS has had to rise to address the scandal over mesh. There is a lot of work still to be done.

T3. The Secretary of State is absolutely right to say that we need to take advantage of all the medical evidence. In the light of that, is it not deeply damaging for the Prime Minister to go on morning television and start musing on the idea that we might have a theory of letting coronavirus have its bounce out and see how it goes? Does that not absolutely fly in the face of the efforts that the Secretary of State is making? Can he clarify that that is not the policy of this Government and tell us what the hell the Prime Minister was talking about? (901444)

No, the hon. Gentleman is wrong to raise this issue in this way. It was addressed in the House yesterday actually—the Prime Minister was explaining that that is not Government policy.

T7. Loneliness will affect most of us during our lifetime. It can define our lives and have a significant impact on our health and wellbeing, as well as increasing pressure and costs on our health services. There are some brilliant voluntary health support services to combat loneliness, so can the Secretary of State advise me on what plans he has to join up the NHS, health and social care and our voluntary support sector to provide the best possible care for victims of loneliness? (901450)

My hon. Friend is right about both how widespread loneliness is and the costs. The cross-Government loneliness strategy does indeed join up the voluntary sector and many parts of Government, led by the brilliant Baroness Barran in the Department for Digital, Culture, Media and Sport. For our part, in this Department we are particularly supporting the growth of social prescribing, which enables GPs to direct their patient to a host of activities, many of which help people to overcome loneliness.

Let us try to keep a sense of perspective. Last weekend, Government sources indicated that the worst-case scenario would be 100,000 deaths due to the current virus outbreak. Given that China has reported just over 3,000 deaths and that it has been at the epicentre of the virus for 10 weeks but has a population 20 times greater than the United Kingdom, was the 100,000 figure a helpful reference?

Of course we have to plan for a reasonable worst-case scenario, but we are working incredibly hard to avoid it. The Chinese Government undertook some very significant actions, and it is not yet clear whether the impact of those actions was to slow the spread such that when those actions are lifted the spread will continue, or whether the virus has in effect gone through the population of Hubei. We do not yet know that, so it is not yet possible to interpret the epidemiological consequences of the deaths figure in China.

Last Friday I held an open meeting so that my residents could better understand the proposals for Epsom and St Helier University Hospitals Trust. While I understand that the Minister cannot comment on the consultation, does he not agree that my residents would do better to consider the evidence that shows these proposals will improve access and quality and have no adverse impact on health inequalities?

My hon. Friend is right. I do not intend to prejudge the consultation, but I agree that his constituents should look very carefully at the evidence of what it will do to save lives and improve healthcare and respond accordingly.

T6. In response to an urgent question from the shadow Health Secretary yesterday, the Secretary of State confirmed that emergency legislation being introduced to tackle coronavirus would include changes to statutory sick pay. Can he confirm to the House that the emergency legislation will include specific proposals to remove the lower earnings limit of £118 per week in order to provide access to statutory sick pay for 1.8 million low-paid workers? (901448)

I can confirm that we will ensure that whatever the status of people working across the economy, whether they are self-employed or employed but working fewer than the set number of hours a week, they will get the support that means they are not penalised for doing the right thing.

Workforce pressures are rightly on the agenda at the moment, and we hear a lot about recruiting internationally, but what are we doing to promote the home-grown workforce—through training and lifelong learning—and get people to enter the health profession at any time of life?

There has been much discussion today of international recruitment, but alongside that we are committed to boosting our home-grown workforce, particularly to achieve our ambition of an extra 50,000 nurses in the NHS and 6,000 more GPs.

At a time when the NHS is under pressure as never before because of coronavirus, does the Secretary of State agree that to close Mildmay Mission Hospital in my constituency would be an act of unbelievable folly? It is a specialist unit for people with HIV/AIDS, and to force those patients into the mainstream would endanger lives. Can he commit today to providing the much needed additional funding of £5 million a year to save this very important hospital, which is doing very important work?

I welcome, as I am sure we all do, the huge advances in HIV/AIDS care and treatment in recent years. The hon. Member and her trust came to see me recently to discuss this case. Following that meeting, I understand that NHS England, the clinical commissioning group and others met the trust to discuss the issue and the way forward. That is the right forum in which to find the right way forward—a way forward driven by the clinical evidence of the right approach.

In Windsor we have an ageing but distinguished population, and we recognise that adult social care is one of the biggest challenges facing the country and local authorities. I thank the Secretary of State for his dedication to resolving these issues, with the better care fund allocation and his call for input from MPs, among others. In those discussions, will he have an open mind to the concept of a precept for adult social care for local authorities?

My hon. Friend will be aware that already some of the funding that adult social care receives is through a council tax precept, but I would be delighted to meet him as part of the cross-party talks we have initiated to address the challenges in social care.

There are numerous reports of people with symptoms of coronavirus being refused a test by 111 because they cannot name an individual who has been diagnosed with the virus. Yesterday the Secretary of State’s ministerial colleague, the noble Lord Bethell, said about 111 that there must be people who had had “bad experiences”. Will the Secretary of State confirm whether it is indeed policy not to test those with symptoms who cannot be contact traced, or whether many people are simply having a bad 111 experience?

The 111 protocols are of course driven by the clinicians. I will look into the specifics of the case that the hon. Lady mentions was raised in the other place yesterday, but we keep those protocols under constant review—not least as the epidemiology of the virus changes as the number of cases increases—to ensure that we have the very best advice.

Although Blackpool Victoria Hospital has one of the busiest accident and emergency departments in the region, its staff reduced A&E waiting times this winter thanks to changes in the triage process. Will my right hon. Friend congratulate those staff, and will he work with them to ensure that the planned £11 million investment in A&E can reduce waiting times still further?

I thoroughly enjoyed my visit to Blackpool. I cannot remember whether it was in November or in the first half of December, but it was very enjoyable. It was great to see what the trusts are planning to do with the extra investment that is coming their way. I also want to congratulate all those at the trust who have done such a fantastic job in deciding how best to ensure that people are treated as quickly as possible. They have improved their systems, they have learnt from what works, and they are doing brilliantly.

Research has shown that CT scans can diagnose covid-19 with 98% accuracy, taking less than 10 minutes. Have the Government any plans to use CT scans in diagnosis?

Yes, we are looking at all possible methods of diagnosis, and we have funding to ensure that we can improve the research. Diagnostics must be effective, but our goal is to for them to be done next to the patient and turned around rapidly, which, obviously, is what everyone the world over is seeking.

I thank my hon. Friend the hospitals Minister for his personal attention to Kettering General Hospital, and for the plans for a new £46 million urgent care hub. Can he assure me that progress on the delivery of that facility is on track?

I am happy to give my hon. Friend that assurance. The fact that the money is being invested is largely due to his campaigning efforts and those of his colleagues. I look forward to the opportunity to visit him again soon, and to see progress on the ground when I meet the team.

Turkey-Greece Border: Refugees

(Urgent Question): To ask the Foreign Secretary if he will make a statement on what representations the UK Government have made to EU counterparts regarding the situation at the Turkish-Greek border and the refugee crisis in Greece.

With your permission, Mr Speaker, I will answer the urgent question, because the Minister for the Middle East and North Africa is currently travelling back from the middle east.

The Government are very concerned by the situation on the Greek-Turkish border, but we should not allow the crisis to detract from the reality that has created it. Continued brutal violence, particularly in Idlib, by the Syrian regime and its Russian supporters, has driven millions of refugees into Turkey and beyond.

On 3 March, both the Prime Minister and the Foreign Secretary discussed the situation with their Turkish counterparts, and we have also discussed it with the Greek Foreign Minister. Dialogue is key, so we welcomed yesterday’s talks between President Erdoğan and European Council President Michel on the 2016 EU-Turkey migration deal. We will continue to support the implementation of that deal, as it is crucial to the effective management of the migratory flows and to preventing people from risking their lives by attempting to cross the Aegean. At the same time, we recognise Turkey’s generosity, and the burden of supporting millions of refugees who have fled the civil war in Syria.

Both Greece and Turkey face additional challenges as a result of increased migrant flows, and we are providing support for their response. As well as providing humanitarian assistance in Syria, the UK is providing interpreters in the Greek island hotspots and search and rescue operations in the Aegean, and we are taking part in a range of capacity-building projects with Turkey’s Directorate General of Migration Management. We are also working across Government to explore where the UK can provide further support to improve the conditions for migrants, especially the most vulnerable.

As I have said, the principal cause of the migration situation is the reckless and brutal nature of the Syrian regime and the Russian offensive in Idlib. The Syria conflict has been one of the most destructive in recent human history, and we want the war to end as quickly as possible. We very much welcome the recent ceasefire between Turkey and Russia, but it cannot stop there. We also continue to support efforts to renew political dialogue to bring a lasting end to the Syrian conflict. We support the constitutional committee in Geneva as a first step towards obtaining the peace that the Syrian people so desperately need, and we regret that those talks have broken down. The regime and its backers must now demonstrate commitment to resolving this conflict by engaging in good faith with the constitutional committee and with the UN’s efforts. Preventing a further worsening of the humanitarian crisis is imperative, and the UK will do all we can to support those in need, while pressing for an end to the Syrian conflict that has impacted so many around the world.

I thank the Minister for his answer. Last Friday, I met my constituent Sally Wainwright to hear about her experiences as a volunteer helping refugees and migrants on the Greek islands. As tensions have risen, mobs have attacked press and aid workers, refugee facilities have been set on fire and non-governmental organisations have had to pull out.

It is clear that the 2016 deal between the EU and Turkey is breaking down. Last week, Turkey decided to open its borders with Greece, and it even bussed migrants close to the north-western border. We have seen the troubling pictures of hundreds of refugees or migrants attempting to land small boats on the Greek islands. Tens of thousands of people have headed for the land border and become trapped between Turkey and Greece. Greece has halted all asylum claims for a month and sent riot police and border guards to turn people back, to deter them from entering the country. Aggressive measures have been employed, and we have seen migrants stripped naked and beaten before being sent back across the border. We have had reports of a refugee being shot dead by live ammunition and of a child dying at sea.

Yesterday, as the Minister said, President Erdoğan visited Brussels for talks, and there have been reports that the EU is considering taking up to 1,500 child refugees from the Greek islands to ease the pressure on the overwhelmed camps. My constituent tells me that hundreds of those child refugees are unaccompanied. In the Prime Minister’s Greenwich speech on 3 February, he said that

“the UK is not a European power by treaty or by law but by irrevocable facts of history and geography and language and culture and instinct and sentiment.”

British citizens such as my constituent Sally have lived up to that sentiment and done what they can. I want to know what the UK Government are going to do on the ground to ease this humanitarian disaster.

The Government have also spoken about protecting vulnerable children and said that that will remain a priority after Brexit, so may I ask the Minister three specific questions? First, can he tell us what the UK is going to do to ease the plight of child refugees, particularly the unaccompanied ones, on the Greek islands? Secondly, what representations have the UK Government made to Greece and Turkey to end the human rights abuses that have been reported and to ensure that Greece follows the rule of law in relation to asylum applications? Thirdly, how will the UK Government assist the British non-governmental organisations that have been forced to suspend their operations amid concerns about the safety of their staff and their volunteers?

I thank the hon. and learned Lady for bringing this question to the House this morning. Clearly, we are extremely concerned about the pressure that the changes at the border have caused. This has put the Greeks in particular under great pressure. We are encouraged by the words of President Erdoğan yesterday, and we hope that the EU-Turkey migration plan can be put back on track. She is absolutely right to say that that has been brought under pressure. We remain absolutely committed to supporting Greece’s efforts to manage the migration effectively, but it is imperative that we urge all sides to avoid any actions that may endanger human life. We fully support the rights of states to control their borders, but we expect them to fulfil their international obligations under the 1951 refugee convention. It is also imperative that the human rights of migrants are protected and promoted.

On resettlement, as the hon. and learned Lady will know, we work closely alongside the United Nations High Commissioner for Refugees. Our resettlement programmes resettle more refugees than those of any other EU member state. In 2018, almost one quarter of all resettlement to the EU was to the UK. We also aim to resettle in the region of 5,000 of the world’s most vulnerable refugees in the first year of our new UK resettlement scheme.

First, may I place on record the thanks I think we should all give the Turkish Government for their work in hosting so many refugees out of Syria? May I also pay huge tribute to the Department for International Development, which I believe is still the largest contributor of aid to the region, contributing more than the whole of the rest of the European Union combined?

What are the Government doing to help the Greek Government not just to guard one of Europe’s borders—the hon. and learned Member for Edinburgh South West (Joanna Cherry) put it with perhaps a bit more force than some might feel necessary—but to empty the camps, manage the flow of people and offer a proper asylum process?

We continue to work across government to come up with a plan to explore what further assistance the UK can provide to improve the conditions for migrants. The EU has pledged all the support necessary, including €700 million, half of it immediately. We continue to have dialogue. We are talking not just with our Greek friends, but with the Turkish. The Prime Minister and the Foreign Secretary have raised this issue in the past week.

Thank you, Mr Speaker, for granting this urgent question, and I also thank the hon. and learned Member for Edinburgh South West (Joanna Cherry) for securing it. As she has rightly said, the behaviour of both Greece and Turkey towards the refugees stuck on their mutual border is utterly shameful—Turkey for wilfully putting them in that impossible position in the first place, knowing that there is nowhere for them to go; and Greece for its unacceptable, heavy-handed response, including the use of tear gas and water cannon, even against people in flimsy dinghies in treacherous conditions.

Much as the self-interested sympathies of Germany and other neighbouring EU countries may lie with the Greek Government, there is no right or wrong in this crisis. Turkey is using the threat of a refugee crisis as leverage to scare up EU and NATO support for its disastrous intervention in Idlib, and Greece is ignoring its obligations under the refugee and human rights conventions by responding with such brutality. Both are equally in the wrong and should stand equally condemned, both legally and morally. The question is: where do we go from here? While there are no easy answers, there are, as ever, two starting points.

First, is the welfare of unaccompanied children and adolescents at severe risk of exploitation, neglect and abuse? Can the Minister give us his estimate of how many children and adolescents are affected? He has been asked this question several times by several Members, so I will ask again: will the UK be joining Finland, France, Germany, Luxembourg and Portugal in offering these children help?

Secondly—again, as always—we must address this crisis at source and stem the increasing outflow of refugees from Idlib. We therefore urgently need an internationally agreed political solution to end the war in Syria, with the safe and peaceful resettlement of refugees at its heart. May I therefore ask the Minister, in closing, what action is currently being taken towards that end?

The right hon. Lady is right to raise those points. We are absolutely focused on supporting the response of the Governments in that region. We continue to provide support to Greece in the migrant camps, with half a million pounds of funding for humanitarian supplies for those hotspot islands that have been affected, as well as crucial search and rescue operations in the Aegean sea. Key to this is the EU-Turkey deal of 2016, which has reduced the pull factors and led to a significant reduction in the number of people attempting that dangerous crossing. We are very keen, and will support all efforts, to ensure that those talks land in a satisfactory conclusion.

The whole House will be grateful to the hon. and learned Member for Edinburgh South West (Joanna Cherry) for raising this matter and to the Minister for his measured statement and for pointing out that Britain has been by far the largest contributor of humanitarian relief. Will he bear in mind two specific points? The first is that Turkey has been fantastically generous in its support for refugees and migrants. Indeed, there are many who have faced the dreadful misery of all this who owe their lives to the Turkish support. Secondly, Europe—and that must inevitably mean the European Union above all—has failed to come up with the right solutions and, in particular, to forge a comprehensive approach to tackling the migratory crisis and misery.

There is not a lot to disagree with in what my right hon. Friend says. The European Union has very much pledged all the support that is needed, and that includes the rapid border intervention team. We are committed to providing at the root source of the problem, and let us not forget what the root cause of the problem is: the Syrian regime and the Russian forces, in particular their actions in Idlib. Last week, we announced a new package—a further £89 million in humanitarian aid—to help save lives and protect those Syrians who are at an increasing risk of violence in Idlib.

I commend the Minister for his statement as far as it went. It is right that we were focusing on the talks in Brussels with President Erdoğan and the EU Ministers. It is a matter of great sadness to me that the UK was not in that room and was not in those talks. Can the Minister assure us that the UK will continue to act in concert with the international community? I likewise pay tribute to the Turkish Government for the major humanitarian efforts they have undertaken to date. The UK is in a position to influence the Turkish Government on this. As a NATO ally and as a major donor, we are in a position to make a difference.

To pick up on the point we have heard already about unaccompanied minors, the organisation Safe Passage estimates that there are 1,800 unaccompanied children right now on the Greek islands, and the international community has pledged, as we have heard, to look after them. But the UK is in a position to act right now. Can the Minister again give us some information about how many children the UK will take in?

What I can tell the hon. Gentleman is that we are pushing for a more co-ordinated global management of migration that promotes greater responsibility at source. As I mentioned in one of my earlier responses, in the new UK resettlement scheme, we are aiming to settle in the region of 5,000 of the world’s most vulnerable refugees. Previously, we have helped more than 22,800 refugees: our initial target was 20,000. The vast majority, as he will know, were Syrian refugees, and clearly, if they are the most vulnerable, that is likely to include high numbers of children.

A lasting political settlement in Syria is key to addressing this tragic issue, but meanwhile there are so many people who are stranded and struggling in Greece and on Greek islands. I welcome the Government’s commitment to look at more ways to help those migrants in the situation they find themselves in. Meanwhile, there are a lot of aid agencies and local agencies that are working—in my constituency, Hope and Aid Direct volunteers are going to the Greek islands to help people there. Will my hon. Friend join me in commending the wishes of so many people to help out during this time of need?

Absolutely. NGOs, volunteers and support organisations are crucial in helping those who are in difficulty in the camps. We continue to be focused on supporting the Government’s responses in the region, and I join my hon. Friend in commending all those organisations that are putting the work in.

My right hon. Friend the Member for Islington South and Finsbury (Emily Thornberry), the shadow Foreign Secretary, and the hon. and learned Member for Edinburgh South West (Joanna Cherry) have already asked about child refugees, who are vulnerable by any definition. Can the Minister please confirm that the Government are joining the coalition of the willing led by the German Government to relocate 1,500 child refugees to try to help with some of the pressures in this crisis?

The hon. Gentleman raises an important point. He will be aware that this matter has to be discussed with Home Office representatives, but I repeat the fact that our resettlement programmes have resettled more refugees than any other EU member state. Under our new scheme, at the risk of repeating myself, we aim to resettle in the region of 5,000 of the most vulnerable refugees in the first year.

I spent a few months volunteering on the island of Lesbos at the height of the crisis in 2016. We worked to pull refugees out of the ocean, and we worked with unaccompanied minors who were deeply traumatised. Will my hon. Friend please confirm that we will always be on the side of humanitarian workers who simply want to save lives? Will he raise with his Greek and EU counterparts the abuses by Greek forces and Frontex, the EU force, against refugees, which I personally saw at first hand?

Indeed. I commend my hon. Friend for her work on Lesbos, which is one of the islands that is very much under pressure. As she will know, we are one of the largest donors to the crisis in the region. We will continue to provide assistance in the affected area, as well as in Syria, and it is not just the Foreign Office. The Department for International Development, in particular, has been a significant donor and is committed to pushing projects inside Syria, as well as in the affected area.

In many ways, the EU-Turkey deal of 2016 has allowed the EU to bury its head in the sand on this situation. We know refugees will flee wherever they can through whatever method they can, so a lot of refugees are not in established or recognised refugee camps but on the islands, not because they have chosen those places but because they were the first place of safety. What are the UK Government doing to rehouse, move and take responsibility for these refugees, not just those in recognised camps?

The United Kingdom is doing a significant amount. We are supporting Turkey to implement the EU-Turkey statement, and the United Kingdom has made €483 million of bilateral and EU budget contributions towards the €6 billion facility for these refugees.

Have the Government formed a view on what Turkey is doing on the ground inside Syria, other than suppressing our allies, the Kurdish-led Syrian Democratic Forces, and supporting Islamist fighting groups?

We keep such matters under constant review, and the Foreign Secretary is due to meet Foreign Ministers from the region shortly. I am sure there will come a point when an update to the House will follow.

The Minister has mentioned resettlement, and I am glad to hear the commitment to 5,000 places under the resettlement scheme, but I have two questions. What are his Government currently doing to improve access to the resettlement scheme on the ground? I have heard from refugee NGOs that it can be very difficult to get on to the scheme. Also, has the Home Secretary continued negotiations with the EU on the unaccompanied children about whom we have heard so much? We have heard about a letter, but what else has happened?

Progress is being made with participating states. We are working very closely with the UNHCR on the referral and transfer of more eligible children, and those transfers continue.

I join others in commending Britain’s work. The aid package we have provided is incredible, but that effort is undermined by the fact we have been unable to find a long-term political solution to Syria. Britain, Europe and the international community—the west—must take some blame for that. Turkey has raised NATO article 4, and the UN Security Council is paralysed because of the Russian veto. Brexit is now done, and we are not distracted by that. May I urge the Government to play a more influential role on the international stage in standing up to state-sponsored aggression?

Absolutely, and I am sure all of us in this House condemn the actions we have seen in the region, particularly by the Syrian regime. Let us not forget why we are in this position and why these people are in this position: it is because of the behaviour of the Syrian regime, supported by the Russians. We continue to support efforts to renew political dialogue, and we want a political end to this conflict. Syria, above anybody, needs a negotiated political settlement to end the conflict and to ensure the rights of all Syrians. We support the constitutional committee in Geneva as a first step towards obtaining that peace.

No matter how much money we put into the efforts of Greece and Turkey in the region, all we are ultimately doing is sustaining a situation that creates an environment in which the people traffickers and others involved in organised crime can flourish. If we are serious about treating refugees with the respect and compassion they deserve, we need to work with our European neighbours to devise safe and legal routes to sanctuary. What are the Government doing to achieve that?

Supporting the EU-Turkey managed migration process is key. There is huge pressure on Turkey, and we must thank it for its efforts thus far. It is a matter of regret that the borders were opened in this way 10 days ago, and we want to see this resolved. We are encouraged by yesterday’s talks, in which President Erdoğan was involved. We will continue the dialogue with Turkey and hope the process moves on.

Does the Minister agree that those who are so quick to lay into Turkey would be well advised to visit the Syria-Turkey border, as I did recently, to see the work Turkey has been doing on the part of refugees? Is it the Government’s intention to continue with the facility for refugees in Turkey, the EU programme, or will they be funding refugees through another vehicle, perhaps the German housing initiative, which plans to provide temporary housing for Syrian refugees who want to return and whose return can be guaranteed to be safe and dignified?

I am not as familiar with that particular programme as my right hon. Friend the Minister for the Middle East and North Africa, but I am sure we will be able to find a full response to that question.

What specific assessment have this Government made of the situation and the number of children caught up in this crisis? The Minister has just said that the UK will do all we can to support those in need, and we have heard repeatedly about hundreds of unaccompanied child refugees, so what specific additional measures will the UK Government put in place to protect those most vulnerable children?

As the hon. Lady will have heard, we are putting significant amounts of humanitarian aid into those border areas, and we are committed. Over 22,800 refugees have already been resettled under UK schemes, and we aim to resettle a further 5,000. Of course, immediate humanitarian aid is required, and we are providing that support—£89 million was committed last week—so I can assure her that the UK has stepped up to the plate in this regard.

As a nation, we can be incredibly proud of the support and generosity we have shown towards Syrian refugees and others in the region. I am somewhat concerned about the role of the EU in these recent challenges on its border. Can the Minister say a little about the strategic involvement of NATO in these geopolitical matters?

My hon. Friend raises an important point. Standing NATO maritime group 2 is deployed in the Aegean sea to support all international efforts to cut the lines of human trafficking and illegal migration. Everyone knows that has been happening and that people are being exploited. Additionally, NATO ships are providing real-time information to the coastguards and the relevant national authorities of Greece and Turkey, as well as to Frontex, which will help them in their efforts to tackle the crisis.

My constituent Joanna Hudak is working on the Aegean islands with Action for Education, and she points out that 42,000 asylum seekers currently reside there, whereas there is capacity for only 6,000. So further support for these reception centres is welcome, but that is not the comprehensive response needed. Surely the comprehensive response must include the relocation of some of these asylum seekers around Europe, and the UK should be part of that process as well.

The hon. Gentleman is spot on, and I could not disagree with him. However, we have to ensure that this process is done in a managed way, which is why we are supporting Turkey, bilaterally, in particular. We have been very proactive in providing significant levels of bilateral support to Turkey and Greece, because it is very important that we manage these migration challenges in a much wider and much more managed way.

I, too, have visited refugee camps in Turkey, on the Syrian border, and it is incredible the amount of aid that Turkey has been giving to refugees, as has the UK. We have provided more humanitarian aid to Syrian refugees than the whole of the European Union put together. Is it not clear that a large share of responsibility for the misery and chaos that has been caused falls to the European Union, which needs to step up to the plate, not only on humanitarian aid, but in sorting out the chaotic asylum in Greece and in securing the external EU border?

My hon. Friend raises a good point, but we should not allow that to detract from the reality that has created this situation, which is the continued brutal violence, particularly in Idlib, of the Syrian regime and its Russian supporters, which has driven millions of refugees into Turkey and beyond. He is right to say that the UK as a whole should be proud of the part we have played thus far.

Some 5.5 million people have been forced to flee brutal war in Syria, with more than 3.5 million fleeing to Turkey. The European countries have refused to do their fair share and instead have built a fortress to keep out people in need of safety. That is what we are witnessing at the Greek border. In the light of that, will the Government finally do what is right and significantly step up efforts, including by opening up safe and legal routes?

I am sure the hon. Lady will agree with my earlier point that we should absolutely condemn the offensives in Idlib. We must also welcome the ceasefire. We have repeatedly called for an immediate end to this, but preventing the further worsening of the humanitarian crisis is a key priority for us. Much more must be done to bring forward a lasting political settlement.

I am not sure that the Minister responded to the question put by my right hon. Friend the shadow Foreign Secretary about whether the UK will be joining countries such as France and Finland in the commitment they have made to these vulnerable children.

I have made the commitment that under our new resettlement scheme we aim to resettle 5,000 of the world’s most vulnerable refugees. On the agreement that the hon. Lady refers to, I am more than happy to get her a detailed response.

The Minister will be as worried as everybody else about the reports of the refugee camp being burned and of the vigilante groups on the ground. What support are the Government giving, particularly to NGOs, to help to de-escalate the situation out there?

The hon. Gentleman is right to mention the incidents that have been reported. It is fair to point out that the Greeks are under considerable pressure. We remain committed to supporting their efforts to manage migration effectively, but we would say to Greece and to all sides that they must avoid any actions that may endanger life. We continue to support the humanitarian work in the area. I mentioned the half a million-pound funding for humanitarian supplies for islands that are particularly affected—the hotspots—by the current crisis.

The situation on the border in Turkey is appalling, and a meaningful ceasefire and lasting peace are badly needed. When will the UK Government finally step up to the plate and use their influence to end this abhorrent conflict?

The hon. Gentleman brings, at the end of this session, the most sensible question about the root cause. We want a lasting ceasefire. We welcome the announcement that Turkey and Russia have agreed a ceasefire in Idlib. We have consistently called for such a lasting ceasefire. Preventing a further worsening of the humanitarian crisis, however, is our priority. On 3 March, the Prime Minister spoke to President Erdoğan to express condolences for the deaths of the Turkish soldiers in Idlib and support Turkish efforts to negotiate a cessation of hostilities. As I have said, the Foreign Secretary conveyed those messages to the Turkish Foreign Minister and President during his visit to Ankara on 3 and 4 March.

Point of Order

On a point of order, Mr Speaker. In January, I had it confirmed that the 2018 report on the factors driving food bank usage was complete. In oral questions, I asked the Secretary of State for Work and Pensions why the report had not been published, but she did not even know that the report existed. I have since received a letter from the Under-Secretary of State for Work and Pensions, the hon. Member for Colchester (Will Quince), who has responsibility for welfare delivery, advising me that the report is not complete and that there is no date for its publication. This is not the first time the Government have suppressed a report on food banks. Can you advise me how I can elicit some clarity on the status of this report and its publication date?

I thank the hon. Lady for giving me notice of her question. It is certainly on the record for others to listen to, but it is not something for the Chair. My advice would be to pursue it, with advice from the Table Office. I am sure that the people there will assist her in getting the answer she wishes to have.

Bill Presented

Victims of Abuse (Support) Bill

Presentation and First Reading (Standing Order No. 57)

Munira Wilson, supported by Wendy Chamberlain, Layla Moran, Daisy Cooper, Sarah Olney, Christine Jardine and Wera Hobhouse, presented a Bill to establish a right to specialist sexual violence and abuse support services for victims of sexual, violent and domestic abuse; and for connected purposes.

Bill read the First time; to be read a Second time on Friday 27 March, and to be printed (Bill 109).

Aviation Banning Orders (Disruptive Passengers)

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

I beg to move,

That leave be given to bring in a Bill to make provision for court orders to prohibit disruptive passengers from flying.

Hardly a day goes by when there is not a report of a violent passenger on an aeroplane who has assaulted cabin crew, threatened people, and otherwise endangered the safety of an aeroplane or those on it. This Bill aims to prevent those convicted of such behaviour from being able to get back on another plane for a period of time set by the courts.

In the past 12 months, an estimated 4,145 incidents of disruptive behaviour took place on UK planes. That represents a 9% increase on the year before, compared with a general 3% increase in the number of passengers, which means that so-called “air rage” is undoubtedly on the increase. This Bill would enable the courts to ban people for a period of time from flying on commercial planes if they are convicted of using or threatening violence on a plane, or otherwise endangering the safety of an aircraft. We currently ban people from driving if a criminal offence is committed in a car. We ban people from football matches if they take part in hooliganism. We even ban people from being directors of companies, but we happily allow people who assault airline staff to get back on a plane without any power from the courts to stop that. Airlines can ban people from using their own company again, but they cannot ban them from using others, and so letting the courts stop the worst offenders will not only help protect cabin crew and passengers, but act as a deterrent to anyone tempted to be violent on a plane. This Bill is not a silver bullet that will end this problem, nor is this perhaps the most pressing issue for the airline industry today, which is taking a hit over the coronavirus crisis, but it is a simple measure that can add to a range of measures to deal with this serious and growing problem.

Some people have said to me that the solution to this whole problem is just to ban alcohol from aeroplanes or airports, but I disagree. It is correct to say that about half of all incidents of violence on a plane are alcohol-related, but although more can be done to stop duty-free alcohol being consumed on planes, we should not ignore the fact that the vast majority of people who have a drink or two on a plane or at an airport cause no problems whatsoever. It is the selfish, violent behaviour of a few people that we need to target, not the innocent actions of the overwhelming number of passengers who drink responsibly.

Violent air passengers are a particular danger. The confined nature of an aeroplane makes an out-of-control individual a cause for far more concern than such an individual on any other mode of transport. It can be terrifying for nervous fliers and deeply worrying for everyone on a plane on which just one person is acting in a violent manner. If there is a group of people, the situation is much worse. Cabin crew should not have to deal with such incidents and should be protected by this place when carrying out their duties.

Just the day before yesterday, a Jet2 flight had to divert from Turkey to Croatia because of a 60-year-old man who became violent. I know that Jet2 does not tolerate incidents of that kind; indeed, the whole aviation sector seems keen to work together to stop unruly passengers getting back on planes. I hope that the Minister responsible for aviation, the Under-Secretary of State for Transport, my hon. Friend the Member for Rochester and Strood (Kelly Tolhurst), who is in her place, will work with the industry to find a way forward, through either legislation or some kind of voluntary code.

We need to send out the message that if someone is going to get on a plane and disrupt that flight by threatening violence, being violent or in any other way endangering that flight, they will not be allowed to fly. Decent people and crew should not have to put up with it. This small, simple measure can help to keep flights safer.

Question put and agreed to.


That Gareth Johnson, Craig Whittaker, Tracey Crouch, Gareth Bacon, Craig Mackinlay, Mr Tanmanjeet Singh Dhesi and Henry Smith present the Bill.

Gareth Johnson accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 15 January 2021, and to be printed (Bill 110).

Telecommunications Infrastructure (Leasehold Property) Bill

Consideration of Bill, as amended in the Public Bill Committee

Clause 1

Code rights in respect of land connected to leased premises

I beg to move amendment 2, in clause 1, page 2, line 3, after “lessee in occupation” insert

“, or a person who is a legal occupant of the property and who is in a contractual relationship with the lessee or freeholder,”.

This amendment is intended to expand the definition of persons who can request an operator to provide an electronic telecommunications service to include rental tenants and other legal occupants who may not own the lease to the property they occupy.

With this it will be convenient to discuss the following:

Amendment 1, page 2, line 16, at end insert—

“(f) the operator does not, after 31 December 2022, use vendors defined by the National Cyber Security Centre as high-risk vendors.”

Amendment 4, page 2, line 16, at end insert—

“(f) the operator does not use designated high-risk vendors, as defined by the National Cyber Security Centre, in newly deployed electronic communications services.”

This amendment would prevent vendors designated as high-risk being used by operators granted Part 4A orders.

Amendment 3, page 5, line 14, at end insert—

“(8) Any operator exercising Part 4A code rights is obliged to ensure that alternative operators can easily install the hardware needed to provide their own electronic communications service.

(9) The definition of ‘easily’ in sub-paragraph (8) is to be provided by Ofcom.”

This amendment is intended to ensure that tenants are not “locked in” to using services provided by a single operator and to encourage market competition.

Amendment 5,  page 5, line 14, at end insert—

“(8) Any operator exercising Part 4A code rights must publish a plan setting out how they will remove high-risk vendors, as defined by the National Cyber Security Centre, from their network.”

This amendment would ensure companies exercising part 4A rights have clear plans in place to remove vendors who are designated high-risk and a national security concern.

Amendment 6,  page 6, line 37, at end insert—

“Information on cyber security

27HH Any operator exercising a Part 4A code right must provide written information to new customers in the target premises on best practice on cyber security when using the electronic communications service that has been provided.”

This amendment would require operators to equip new customers with literature on how best to keep their home cyber secure, particularly in the era of the Internet of Things and with recent reports of hacked domestic devices such as baby monitors.

I welcome the Secretary of State to his place. It is somewhat surprising to see him, as my hon. Friend the Member for Batley and Spen (Tracy Brabin) had expected to see him in the Commonwealth debate yesterday and I was expecting to see the Under-Secretary of State for Digital, Culture, Media and Sport, the hon. Member for Boston and Skegness (Matt Warman) today. As I understand it, after saying almost nothing over weeks in his post, the Secretary of State’s first moment at the Dispatch Box may be to reverse completely the Government’s position on part of the Bill. That raises the question: what information has changed and did the Government know what they were doing in the first place?

As we are taking all the amendments together, I shall consider the whole Bill. It is a great pleasure to speak on the Bill as shadow Minister for Digital. I have an interest to declare: before entering the House, I worked as a telecommunications engineer for 23 years, rolling out telecoms infrastructure in countries as diverse as Germany, Nigeria, Britain and Singapore. I am passionate about digital technology and the positive difference it can make; however, the 10 years for which I have been in Parliament have coincided with a rapid decline in the relative quality of our telecoms infrastructure under successive Conservative Administrations. Without the required ambition, this Government risk wasting a decade more.

The UK has a proud technological history, from the earliest days of the industrial revolution to the invention of the first fibre-optic cable and, of course, the worldwide web. That is why it was with such regret that on Second Reading I highlighted the fact that the OECD ranks us 35th out of 37 for broadband connectivity, even though ours is the fifth largest economy, and that 85% of small and medium sized enterprises said that their productivity was adversely affected by unreliable connections in 2019.

Sadly, our wasted 10 years in telecoms have not been limited to fixed infrastructure; both mobile and the online infrastructure of regulation have also been left to languish, reducing the impact of the Bill. Conservative Governments have entrenched the digital divide in the United Kingdom: 11 million adults lack one or more digital skills and 10% of households do not have internet access. At this rate, in 2028 there will be 7 million people without digital skills, which is tantamount to leaving one in 10 of our population permanently disenfranchised. Our part-time Prime Minister has changed his tune—[Hon. Members: “Oh!”]

I suspect I am going to agree with some of the things that the hon. Lady says later in her speech, but before we get to that point, let us not be too prissy about the party political element of this matter. The original problem with our telecoms industry started with the asset stripping of the industry by the Labour Government under Gordon Brown, with the spectrum auctions. The hon. Lady should recognise that if she is to make a sensible case.

I, too, look forward to the point at which we agree on something, but let us be absolutely clear about this: the telecoms infrastructure that the Labour Government oversaw was, in terms of competition and investment, an example for the world. If he does not believe that, the right hon. Gentleman can consult the figures.

The hon. Lady is, of course, making her party point—I accept that—but in 2003 it was a Labour Government, under one T. Blair, who allowed Huawei into the UK in the first place.