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House of Commons Hansard
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Commons Chamber
23 October 2018
Volume 648

House of Commons

Tuesday 23 October 2018

The House met at half-past Eleven o’clock

Prayers

[Mr Speaker in the Chair]

Oral Answers to Questions

Health and Social Care

The Secretary of State was asked—

NHS Innovation

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1. What steps he is taking to introduce innovative technology into the NHS. [907208]

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14. What plans the Government have to improve access to innovative treatments and technologies in the NHS. [907222]

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We are bringing a tech revolution to the NHS to improve patient outcomes and reduce waste. Today I am delighted to announce the selection of the first batch of products under the accelerated access collaborative, as well as funding for tech test beds to ensure that more patients get faster access to the most effective innovations.

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I am grateful to the Secretary of State for his answer. Will he expand further on the recent announcement of the wave 2 test beds project and how it could deliver better outcomes for my residents down in Cornwall?

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The tech test beds programme is about ensuring that we have units around the country that will support local collaborations between the NHS, tech companies and academia to harness new technologies right across the land, including—and no doubt—in Cornwall.

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The National Institute for Health and Care Excellence has so far declined to recommend the new drug Spinraza, despite its ability to transform the lives of patients such as my young constituent Matilda Jamieson, who suffers from type 3 spinal muscular atrophy. As NICE meets today to finalise the guidance, will my right hon. Friend assure me that he will work with the manufacturers, NHS England and NICE to ensure that patients such as Matilda can benefit from that drug?

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I pay tribute to my hon. Friend for making that case so powerfully. We work very closely with NICE, which is rightly the objective decision maker that makes recommendations for Ministers to follow about what drugs should and should not be accessed through the NHS. He makes the case very strongly.

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This question is about innovative technology in the health service. What is the Secretary of State saying today to scientists? For example, 97% of people from the Francis Crick Institute say that our science and our bioscience are in danger because of Brexit. What is he going to do about technology that is suitable for the health service?

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The scientists, like me, want a Brexit that is based on a good deal for the UK, and that is what we are seeking to deliver. In any case, we have put more money into the science budget than ever before, so no matter what the outcome of the negotiations is, there will be more support for science in Britain.

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One of the innovative technologies is the new production and distribution system for flu jabs for the over-65s. Is the Secretary of State aware that this technology is breaking down? In my constituency and elsewhere, there are doctors and pharmacists who simply cannot get hold of stocks, which leads to potential pressures in hospitals. Will the Secretary of State investigate and take action if necessary?

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Having a flu jab is incredibly important, and I hope that Members on both sides of the House have taken the opportunity to do so, including the right hon. Gentleman, with whom I enjoyed working for many years. We have a phased roll-out of the flu jab, making sure that we get the best flu jab most appropriately to the people who need it most, and of course we keep that under review.

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Digital health tools, including decision-support software, have a great potential to increase the quality, safety and cost-effectiveness of care for patients, and nowhere is that more important than in reducing antimicrobial resistance. Will my right hon. Friend respond to the points that we on the Health and Social Care Committee make in our report about the variation in roll-out, which is wholly unacceptable, and what measures will he take to make sure that it is clear where the responsibility for this lies?

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I pay tribute to the Select Committee for the report on AMR that was published yesterday. Of course, digital tools such as the one that my hon. Friend mentions are important in making sure that we make the best use of antibiotics and counter antimicrobial resistance as much as possible.

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If we have a “technological revolution”, in the words of the Secretary of State, surely that depends on capital investment, but that has been cut by £1 billion. For example, we have the lowest numbers of CT and MRI scanners on average in the OECD, hospitals are reliant on 1,700 pieces of out-of-date equipment, and the hospital repair bill now stands at £6 billion. If austerity has ended, can he tell us when this maintenance backlog will be cleared?

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Unlike with the failed national programme for IT, we are delivering modern technology in the national health service. That is underpinned by a record commitment of £20 billion extra for the NHS over the next five years, accompanied by a long-term plan that will show how we will support the NHS and make sure that it is guaranteed to be there for the long term.

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But I asked the Secretary of State about capital budgets, not revenue budgets.

Innovative technology can play a role in prevention, but so do public health budgets. With health inequalities widening, infant mortality rising in the most deprived parts of the population, rates of smoking in pregnancy remaining higher than the EU average and child obesity levels getting worse, will the Secretary of State commit, alongside an investment in technology, to reversing the £700 million of cuts to public health, or is the reality that his promises on prevention are entirely hollow?

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I am afraid that the hon. Gentleman has it slightly muddled up, because technology does involve capital investment, but it also includes revenue investment to ensure that the service element of any technology can continue to be delivered. Maybe he should have another look at how technology is delivered these days. Alongside the capital budget, we have record spending on the NHS to ensure that it is there for the long term. Of course public health is an important element of that, and there has been £16 billion for public health over this spending review period because it really matters.

Childhood Obesity

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2. What steps he is taking to reduce rates of childhood obesity. [907209]

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8. What steps he is taking to reduce rates of childhood obesity. [907216]

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This June we published chapter 2 of the childhood obesity plan, which built on the world-leading measures we introduced in 2016 and included bold plans to halve childhood obesity by 2030. Our consultations on banning energy drinks and on calorie labelling are now open. Later this year we will be consulting on promotion and marketing restrictions, including suggestions of a 9 pm watershed.

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The feedback that I receive locally in Waveney is that childhood obesity needs to be tackled by Government Departments, clinical commissioning groups, medical centres and councils working together, whether in schools or by encouraging breastfeeding and the preparation of weaning foods. Can the Minister confirm that he is pursuing such a multi-agency approach?

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I can, and the plan covers many Departments, which was why I recently announced the trailblazer programme to support innovative local action with local authorities. That has the commitment of key policy teams across many Departments to support participating councils to harness the potential of what they can do and learn from others.

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One in five children in Greater Manchester are classified as overweight or obese, but Prospect Vale Primary School in Heald Green is just one of the schools in my constituency that are getting on and getting moving through the Daily Mile campaign. Will the Minister join me in welcoming that initiative, which brings daily fun and fitness into schools? As more and more adults use wristbands to help them to get fit, what consideration is being given to the use of technology, such as in the UK Fit Kids programme?

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Like my hon. Friend, I pay tribute to Prospect Vale. I have many similar examples in Winchester. We absolutely recognise the importance of physical activity in tackling obesity, which is why as part of chapter 2 we are promoting a new national ambition for all primary schools in England to adopt an active mile initiative.

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So further to the Minister’s previous answer, why did the Government abolish school sport partnerships?

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This Government are investing heavily in school sports through the school sport premium. For instance, the money raised from the soft drinks industry levy—the sugar tax—is going directly to supporting schools’ investment in sports, for instance through the Daily Mile campaign, which has just been mentioned.

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Scotland’s diet and healthy weight delivery plan contains specific recognition that breastfeeding can be a means of preventing obesity. Will Ministers engage with the all-party group on infant feeding and inequalities to see what more can be done in England through early breastfeeding to prevent children from becoming obese later on in life?

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Yes, and I am a big supporter of breastfeeding—I have supported it a lot in my constituency, and we engage regularly with the sector. I will be interested in any proposals that the hon. Lady has.

NHS: Value for Money and Efficiency

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3. What steps he is taking to improve value for money and efficiency in the NHS. [907210]

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7. What steps he is taking to improve value for money and efficiency in the NHS. [907215]

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Having committed an additional £20 billion in real terms, the Government are asking the NHS to deliver a long-term plan that includes continued improvements in productivity and efficiency, and we are reinvesting the savings in improved patient care.

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I congratulate my hon. Friend on his drive to recycle more hospital equipment such as zimmer frames, crutches and wheelchairs, but what steps is his Department taking to encourage more hospitals such as Southport Hospital in my constituency to run recycling programmes to reduce waste in our NHS?

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I am keen to work with my hon. Friend to encourage Southport and other trusts to recycle equipment. I know from my family’s experience that it causes significant frustration when people see hospitals not collecting perfectly good medical equipment that could be recycled. I am keen to work with him and with trusts to ensure that we learn from that.

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Digitising patient records and removing outdated technologies such as fax machines can improve productivity and patient care across the NHS. What steps is my hon. Friend taking to prepare the NHS for the fourth industrial revolution?

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I commend my hon. Friend for his excellent report for the Centre for Policy Studies, which highlights the opportunities provided by technology. I was at a Scan4Safety event last night, looking at how barcodes are being used at six trusts, and at how that could be expanded to deliver 4:1 efficiency savings and improve patient care through the safety it offers.

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Does the Minister believe that the practice of cutting funding to hospitals that miss A&E targets helps to improve the patient experience at those hospitals? Will he agree to meet me to discuss how this issue has affected Leighton hospital, which serves my constituents?

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The hon. Lady may have missed our recent announcement of significant additional funding, ahead of winter pressure, to assist hospitals. As the Secretary of State announced, the extra £20.5 billion real-terms increase is part of a wider commitment to support our hospitals.

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Jack Adcock’s death was a tragedy, but why did the General Medical Council spend £30,000 on getting Dr Hadiza Bawa-Garba struck off, even though she had already faced the consequences of her mistakes in court? Does the Minister think that the GMC needs to sort its act out and that Charlie Massey should resign?

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As the right hon. Gentleman will be aware, Professor Norman Williams looked at the circumstances of this case and produced a report on it for the Government. As a part of that, we are looking at a number of factors.

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Is the Minister aware that in terms of value for money and efficiency, the Government of India’s integrated health Ministry has half a million ayurvedic doctors and a quarter of a million homeopathic doctors? At a clinic I visited recently in Karnataka province, four fifths of the patients who would have normally gone to see a western doctor were treated by those local doctors. Will he build links with the Indian Ministry of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy?

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I pay tribute to my hon. Friend for the longevity and sincerity of his campaigning on these issues. He draws attention to the wider point of how patients presenting with multiple and complex conditions need to be treated in multiple ways, and what he refers to is a part of that wider discussion.

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NHS England is being ripped off to the tune of £230 million a year as the price of some off-patent drugs and non-standard preparations, or specials, have been hiked up hundreds of times, for example to over £1,000 for a bottle of pain-relieving mouthwash. In Scotland, specials remain in-house to keep the price down, but a year and a half on from the Health Service Medical Supplies (Costs) Act 2017, why have the Government not used its powers to stop this drug racketeering?

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The hon. Lady, very astutely and correctly, identifies the issue, which is how we ensure value for money from specials. Indeed, I commend The Times for highlighting a number of these issues. We are looking at this area. As we commit an extra £20 billion in funding to the NHS, our commitment is to ensure that we derive value for money from that investment. That applies to specials, too.

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The healthcare market in NHS England is estimated to cost £5 billion to £10 billion a year and involves 2.5 million nursing hours a week being wasted on non-clinical paperwork. Does the Minister not recognise that this is the biggest inefficiency? Will he commit to reversing the disastrous marketisation of NHS England?

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Again, the hon. Lady draws attention to my work on driving productivity improvements within the system, which looks at a range of efficiencies such as sending texts and emails, dealing with missed appointments and the use of green energy. We can implement a whole range of initiatives as a part of that agenda.

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As the first port of call for patients with often minor ailments, community pharmacists can really help to improve the efficiency of the NHS by taking pressure off GPs. What plans do the Government have to support and enhance the role of community pharmacists?

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My hon. Friend is right to draw attention to the valuable role played by pharmacies. This is part of a wider education campaign within the NHS and increased access to clinicians, such as through 111, is another component of that. We want to ensure that rather than people’s first port of call being a GP, they access the NHS and pharmacies at the appropriate time.

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At the end of the last financial year, trusts owed the Department a staggering £11 billion. NHS providers say that this is locking some trusts into

“a vicious circle of inevitable failure”,

and the King’s Fund says that there is no prospect of them ever repaying. Trusts with the biggest debts are forced to pay the highest levels of interest. How can the Minister expect trusts to be efficient when they are paying an interest rate of 6% on debts to his Department?

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As it happens, I will be at an event with NHS providers—chief execs—this evening, when I am sure that this will be one of a number of issues that we will discuss. The hon. Gentleman is right to draw attention to the very high private finance initiative costs that many trusts face due to contracts signed under the previous Labour Government. That is a real pressure faced by many trusts.

Global Mental Health Summit

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4. What the outcomes were of the October 2018 London global ministerial mental health summit. [907211]

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16. What the outcomes were of the October 2018 London global ministerial mental health summit. [907224]

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This month, we hosted the world’s first ever global ministerial mental health summit. Over 60 countries were represented, and they were united in the ambition to achieve equality for mental and physical health. The legacy of the summit will continue, with the baton now passed to the Netherlands, which has committed to host next year.

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At the summit, I hope that the Government were applauded for appointing a Minister for suicide prevention. Will my right hon. Friend reflect on the fact that many people contemplating taking their life end up in A&E or in police stations, and will he look at James’ Place in Liverpool? That non-clinical centre catches young men in particular, who are very often the victims of this problem, and deals with their mental health issues.

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Part of the purpose of having a cross-Government suicide prevention Minister is to bring together all these issues. I pay tribute to the work of James’ Place and its founder, Clare Milford Haven. We are spending £30 million of taxpayers’ money to increase the number of health-based places of safety for people experiencing a crisis, and I look forward to working with my hon. Friend on that.

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I call Adam Afriyie.

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Question 16, Mr Speaker.

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No, the question has been grouped. The moment is now; the chance is here—let us hear from the hon. Gentleman.

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Thank you, Mr Speaker, for the admonishment, or encouragement—

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Encouragement.

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Thank you very much.

It strikes me that every person in this Chamber, every one of our constituents and every household across the country will have been affected by the issue of suicide, whether that is among family, friends or colleagues. The causes of suicide are multi-faceted—there are so many, including mental health—so I welcome the new ministerial responsibility. Will my right hon. Friend clarify precisely what the role will entail in government?

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I very much agree with my hon. Friend. The role will be cross-governmental. It will involve working not only across national Government, convening the policies that need to be pulled together from various Departments’ responses to support people in crisis and to reduce suicide, but with local government, which has responsibilities here.

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Suicide prevention plans have to be a key element of any mental health strategy, yet the Government are not monitoring the effectiveness of those plans or ensuring that they are fully funded. Will the Secretary of State commit to ensuring that the plans that are put in place are effective and that local authorities have sufficient funds to implement them properly?

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The hon. Lady is right to draw attention to the need to ensure that funding for mental health services has parity with that for physical health services. Getting there is the work of a generation. We did not even measure access to mental health services until this Government brought that in, and we are working towards parity.

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The Secretary of State boasted to the global ministerial mental health summit about the Government’s plans to recruit 21,000 more staff to the mental health workforce by 2021, but he did not tell the summit that by the end of May this year, nearly 25,000 mental health staff—one in eight of the workforce—had left the NHS and that fewer than 1,000 extra staff had been recruited by March, equating to just 0.5% of his target. Does he really think that he is in a position to lecture the rest of the world?

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I welcome the hon. Lady’s commitment to this area. Clearly it is very important to have the workforce in place. As she said, we are making progress, but we still have more to do. As far as the international approach is concerned, the response to the summit was that many countries came together, because collectively we all face the same sorts of challenges. I am in absolutely no doubt that the leadership shown by some countries, including the UK, is warmly welcomed.

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The links between poor mental health, suicide and gambling addiction have been made clear to the Health and Social Care Committee. In that regard, will the Secretary of State make it clear to the Treasury that many across the House want to make sure that action on fixed odds betting terminals is taken forward so that we can have good results in the areas of mental health and suicide prevention?

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My hon. Friend knows my personal strength of feeling about tackling the scourge of fixed odds betting terminals. The links between gambling addiction and mental health issues—and indeed, directly to suicide—are clear in the evidence, and we must address them.

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My constituent David contacted me after his 18-year-old son became severely mentally unwell and needed emergency treatment. His son spent four days in A&E at the local hospital because no in-patient beds were available. This is not a one-off case: on a daily basis, mentally unwell people are being failed by our health service. When will the Secretary of State take meaningful action to fund mental health services properly and stop this scandal?

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I am glad that, like me, the hon. Lady cares so much about getting this right. The long-term plan, which we are writing with the NHS, for how we will spend the £20 billion funding increase is where we can get these details right. Access to mental health services was not even measured before. The first step was to put the measurement in place, and now we can act on that measurement with the huge increase in funding coming to the NHS.

Radiotherapy

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5. If he will ensure that NHS England enables NHS trusts to provide advanced radiotherapy treatment. [907212]

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Yes, we are fully committed to ensuring that the most innovative cancer treatments are available to patients on the NHS. Since 2016, the radiotherapy modernisation programme has seen £130 million of new investment to ensure that all new equipment is capable of delivering advanced radiotherapy.

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I thank the Minister for that reply. May I point out how effective advanced radiotherapy is against many cancers affecting the soft tissue? I must declare an interest as a beneficiary of the treatment myself. The latest NHS research shows that treating prostate cancer with 20 treatments of advanced radiotherapy is far better for patient outcomes and would save the NHS more than £20 million a year, but the current tariffs system disincentives trusts from saving this money, as their income is based on the number of treatments. Will the Minister meet me and representatives of the all-party group on radiotherapy to discuss how we might address this anomaly and improve treatments?

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It is good to see the hon. Gentleman in his place and looking so well—I am glad we looked after him well. He is absolutely right that access to advanced radiotherapy treatments is critical, as is getting them against the key standard. I would be very pleased to meet his all-party group and discuss its manifesto for radiotherapy.

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I call Vicky Ford.

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indicated dissent.

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The hon. Lady was standing. She has changed her mind. All right, never mind. We can always have another go later.

A&E: West Midlands

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6. What assessment he has made of the effect of the planned closure of Telford Hospital’s A&E department on other A&E departments in the west midlands. [907214]

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The planned temporary overnight closure of the Princess Royal Hospital’s A&E in Telford is necessary to ensure that patients continue to receive safe care. The Shrewsbury and Telford Hospital NHS Trust is working closely with colleagues in neighbouring provider trusts and the ambulance service to develop plans for key clinical pathways to minimise the impact.

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The proposed closure of Telford A&E would pile even more pressure on New Cross Hospital in my constituency. If the Government will not step in to stop the closure, as it sounds is the case from the Minister’s answer, will they give New Cross the resources it needs to recruit upfront the nurses, doctors and other staff they need so that patients do not have to suffer longer delays?

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The current modelling suggests that about 11 ambulances will be diverted from the Shrewsbury and Telford Hospital NHS Trust between the hours of 10 pm and 8 am during closure. Of the patients who go to Wolverhampton, any admitted as in-patients will return to Shrewsbury and Telford and any who are discharged will be discharged from Wolverhampton.

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The chief executive of Royal Wolverhampton NHS Trust says that the closure at Telford is the result of bad planning and could have been prevented. Does the Minister agree it is wholly unacceptable that my constituents’ safety should be put at risk by a preventable closure that is the result of bad planning by management, and will he do all he can to ensure that the hospital management have the help they need to properly run our hospital and properly plan for the needs of our community?

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First, may I pay tribute to my hon. Friend, who has campaigned assiduously on behalf of her constituents? She has lobbied me and the Secretary of State and made her case very powerfully to NHS leaders. There has been progress: three additional consultants have been hired and attempts made to recruit middle-ranking doctors to the trust, including from neighbouring trusts. We are making a significant capital investment in the Shrewsbury and Telford Hospital NHS Trust, and these changes must be seen in the light of that.

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rose

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rose—

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No, no; Yorkshire is the most marvellous place, but it is a considerable distance from the narrow ambit of the question, from which the Minister did not stray. The ingenuity of those Members will be served later in our proceedings.

Health and Social Care Hubs

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9. What steps he is taking to support health and social care hubs. [907217]

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Health and social care hubs are a great example of health and care systems coming together through sustainability and transformation partnerships and integrated care systems to transform services in local areas. The NHS long-term plan will set out how we will enable and encourage better integration.

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The Minister will know that Plymouth is leading the way in developing health and social care wellbeing hubs. She will also know that we have bid for £15 million of funding to create more hubs across the city, especially in our city centre, to bring together NHS dentistry and dental schools, sexual and mental health support, social care and new forms of general practice. Will she do all that she can to look positively on that bid, so that we can help to improve our health outcomes?

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I am really pleased that the hon. Gentleman has raised this issue. Plymouth is indeed leading the way in creating hubs and showing how incredibly valuable they are in bringing together all the relevant services in one place, not only to tackle people’s current healthcare needs but to play a vital role in prevention.

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Health and social care hubs provide a real opportunity to ensure that patients are cared for in the right place, and it is vital for that to be extended to those who need palliative care. Can the Minister confirm that the NHS 10-year plan will adequately address the need for equal and appropriate access to palliative care across the country?

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My hon. Friend is absolutely right to mention this. Palliative care is crucial to the experience not only of patients but of their families and carers. He will be interested to know that we have a new indicator from 2018-19 to measure the proportion of people who have had three or more emergency admissions in their last 90 days of life, which will help us to assess how people can be better supported in the community, and to do that better.

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24. Social care hubs could be part of the way forward for social care, but, in response to a recent survey of care providers in my constituency, 71% said that despite the best efforts of staff the quality of care had greatly diminished because of years of chronic underfunding. Does the Minister agree that we need a systemic change in social care funding, given that the extra money provided so far is a drop in the ocean and does not address levels of need? [907232]

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The hon. Lady is right. We know that the adult social care system is under pressure, which is why we are setting out a more sustainable future in the Green Paper which will be published later this year. It is, however, important to point out that more than 83% of adult social care providers are rated good or outstanding, and that, thanks to a range of Government actions, County Durham has received an additional £37 million for adult social care in 2018-19 and was allocated £2,822,376 in the recent winter funding announcement.

Cancer: Early Diagnosis

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10. What steps he is taking to increase the rate of early diagnosis of cancer. [907218]

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11. What steps he is taking to increase the rate of early diagnosis of cancer. [907219]

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Britain is world leading at treating cancer when it is discovered, but we do not diagnose it early enough, so we will radically overhaul our screening programmes, roll out rapid diagnostic centres for people with early symptoms, and expand mobile lung screening units. Our ambition is to ensure that three quarters of cancers are diagnosed at stage 1 or 2 by 2028, up from half today.

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May I first highlight the excellent Guy’s Cancer Centre at Queen Mary’s hospital in Sidcup, a state-of-the-art facility which offers local cancer patients treatment closer to home? Secondly, can my right hon. Friend provide any detail on how the NHS long-term plan will improve cancer services?

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Yes. Focusing on early diagnosis will help to save lives. Indeed, the cancer survival rates have never been higher than they are now. About 7,000 people who are alive today would not have been had mortality rates stayed the same as they were in 2010. However, we want to use the most cutting-edge technologies in order to save more lives.

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In respect of early screening, how does my right hon. Friend expect the measures that he has introduced to move the service forward in the way that we want to see?

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Absolutely central to this is ensuring that we address cancer at the earliest possible opportunity. The earlier the diagnosis is made, the greater is the likelihood of survival, so we want to see more cancers diagnosed earlier across the board.

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22. At the start of October, which is Breast Cancer Awareness Month, my local hospital, Stepping Hill, had to shut its doors to breast care patients in my constituency, because its two-week urgent waiting times had risen to five weeks owing to chronic staff shortages and underfunding. What will the Secretary of State do to improve outcomes for constituents like mine who cannot access those services? [907230]

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The announcement the details of which I have just set out comes with £1.6 billion of the £20 billion uplift we are putting into the NHS written into the long-term plan, so the funding is there to deliver on this policy, too.

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The Secretary of State is right to say that early diagnosis provides more opportunity to cure and treat cancers. Some 60% of those treated for cancer will receive radiotherapy, and nearly every radiotherapy centre in the country has linear accelerators that are enabled to provide the advanced SABR, or stereotactic ablative body radiotherapy, technology, but Government—NHS England—contracts mean that out of the 52 centres in England no more than 20 are contracted to actually use this technology. That means that either patients are not receiving the highest quality life-saving standard of treatment that they could be or that trusts are providing it anyway but are not being paid and valuable data on mistreatment are being completely lost. Will the right hon. Gentleman order NHS England to stop this recklessness, and frankly lethal, nonsense and agree to every—

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Order. [Interruption.] Order. The thrust of the question is entirely clear. I was going to offer the hon. Gentleman an Adjournment debate on the subject until I realised that he had in fact just conducted it.

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And also, Mr Speaker, the hon. Gentleman’s all-party group is meeting my Minister, the Under-Secretary of State for Health and Social Care, my hon. Friend the hon. Member for Winchester (Steve Brine), on this very matter. Since 2016 we have put £130 million of funding in to try to resolve the issue that the hon. Gentleman talks about: to make sure that all new equipment is capable of delivering advanced radiotherapy. Work on this is ongoing.

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In calling the hon. Member for Strangford (Jim Shannon) I promise to make no reference to the result of the match last night between Arsenal and Leicester City.

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Mr Speaker, you had a broader smile on your face this morning than my friend the hon. Member for Scunthorpe (Nic Dakin) and I. We still support Leicester and hope we will pay you back some day.

An important aspect of diagnosing cancer is to find the drugs that address it. What has been done to ensure the partnerships between universities and the NHS can continue, so that they can find new drugs and therefore address cancers at a very early stage?

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There are deepening relationships between universities and the NHS right across the country, especially in this field of the combination of diagnosis and early treatment. Some of the most advanced technology and research in the world is happening in universities in the UK in order to save lives, which is such an important issue here.

Leaving the EU: Access to Medicines

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12. What assessment he has made of the potential effect on access to new medicines of the UK leaving the EU. [907220]

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20. What assessment he has made of the potential effect on access to new medicines of the UK leaving the EU. [907228]

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We will continue to have access to new medicines through the deal we expect to negotiate with the EU. In the unlikely event of no deal, we will directly recognise batch testing of medicines done in the EU. We are currently consulting on the approach to licensing medicines in a no deal scenario, but I am clear that patients should not be disadvantaged and should continue to have timely access to new medicines.

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The reality is that Brexit uncertainty about future medicine approvals and unresolved issues with the European Medicines Agency have caused research firm Recardio to suspend UK recruitment to a drug trial, posing a risk to its business and interrupting the research. As the EMA has no associate membership for third countries, how does the Secretary of State plan to avoid the UK being left out of future clinical trials despite his bluster?

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Not only does the UK bring a huge amount to the table in terms of research, but we fully intend to make sure that we have a robust and seamless system in place. A consultation is out at the moment and we will respond to it very shortly.

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The Government have stated that the new EU clinical trials regulations will not be in place before March, but have committed to aligning with it where possible. What progress has been made regarding data sharing to ensure that clinical trials continue and pharmaceutical and research firms do not leave the UK after Brexit?

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As part of the EU deal we are negotiating, the relationship with the EMA will be extremely close, so I am sure that that will be a part of our agreement.

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Will the Health Secretary confirm that since the referendum the number of EU nationals working in our NHS has actually risen by 4,000, and that regardless of the state of the negotiations their rights will be protected and they will continue to be able to work in the NHS after we leave?

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Yes, my hon. Friend is absolutely right. In fact, the number of EU nationals working in the NHS has now risen by more than 4,000 since the referendum, and we welcome them all.

Orkambi

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13. What recent progress has been made in negotiations between NHS England and Vertex Pharmaceuticals on making Orkambi available on the NHS for people diagnosed with cystic fibrosis. [907221]

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It was disappointing that in July and August, Vertex, the manufacturer of Orkambi, rejected the final offer made by NHS England, as well as rejecting the opportunity for the National Institute for Health and Care Excellence—NICE—to appraise its new medicines, as is required for all companies seeking routine NHS funding for their products. Vertex must re-engage with NICE and NHS England, and I am encouraged that it attended a meeting with NICE on 4 October to discuss next steps.

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As the Minister knows, Orkambi is available for cystic fibrosis sufferers in Ireland, Greece, Denmark and a host of other countries around the world, so when will it be available for cystic fibrosis sufferers in this country?

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I know that the hon. Gentleman takes a keen interest in this subject and that he campaigns assiduously on behalf of his constituents in this regard. He is right to suggest that Ministers are keeping a very close eye on these negotiations, and we urge Vertex to consider NHS England’s fair and final offer. However, it is absolutely right that we have a system—introduced by the Labour party—in which experts, not politicians, determine the fair price for a drug, based on robust evidence.

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I almost thought you had forgotten about me, Mr Speaker.

Last month, speaking on this very subject, the Secretary of State said that he would not let pharmaceutical companies hold the NHS to ransom, but the 5,200 patients who could benefit from Orkambi are left suffering while this war of words continues. What does the Secretary of State have to say, through his Minister, to those patients who are awaiting a resolution to this stalemate?

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The hon. Lady makes a correct point, and we are very keen that patients receive this drug. I understand her ire, but perhaps it should be directed at Vertex, the manufacturer. The offer of £500 million over five years for the size of the eligible population is the largest-ever commitment of its kind in the 70-year history of the NHS, and it would guarantee immediate and expanded access to Orkambi and to other drugs.

Preventive Care

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15. What steps he is taking to improve preventive care in the NHS. [907223]

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Our NHS offers a range of world-leading preventive care services, but we can go further and faster. The Secretary of State has named prevention as one of his top three priorities, signalling a renewed focus on public health, community and mental health services.

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I thank the Minister for her reply. She will know, because I have spoken about this to the Secretary of State’s team, about the pressures on my constituency, and particularly on the Church Lane GP surgery. Specifically on preventive services, wearable tech, health tech and medical tech provide an opportunity to keep people healthier for longer, and can provide early digital diagnosis that can relieve pressure on medical services. What more can be done to pursue this way of relieving pressure on the health service?

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I completely agree that technology can really help in this way. I recently visited Hampshire County Council, which is using a range of gadgets including a really simple one involving a light bulb that comes on when someone gets out of bed in the night to go for a pee. That is ingenious, and it is helping to prevent avoidable falls.

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My constituent Holly Alliston has contacted me about the epipens that her two-year-old son, who has a severe nut allergy, relies on. There is a national shortage of them, and the Northfield Pharmacy has been emailed by NHS England to say that the situation is critical. What is the Minister doing about this? We hear about the possibility of troops having to distribute stockpiled medicines when we leave the EU, but this is hitting us now.

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The hon. Lady is absolutely right to raise this matter. We are working closely with all the manufacturers of adrenaline auto-injectors to improve the supply situation as quickly as possible.

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One in 10 mums gets post-natal depression, and we know that early identification is key to preventing it from becoming more serious. May I urge the Minister to look at the National Childbirth Trust’s campaign to ensure that all mums—as well as all babies—get a six-week check?

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We are really supportive of the Hidden Half campaign, run by the NCT—my colleague the Minister met the trust last week. We must ensure that we are supportive of new mothers’ health needs.

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What improvements have emerged in relation to prostate cancer treatments?

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I am really pleased that the hon. Gentleman has raised that. Clearly, early screening is fundamental and one of the key pillars of what we want to focus on with cancers. Prostate cancer affects so many gentlemen up and down the country, and we know that that early detection is the difference between life and death.

Antimicrobial Resistance

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17. What steps his Department is taking to tackle antimicrobial resistance and inappropriate use of antibiotics; and if he will make a statement. [907225]

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We continue to make good progress against our 2013 AMR strategy ambitions. According to the latest figures, since 2013, antibiotic prescriptions dispensed by GPs have decreased by 13%, and sales of antibiotics for use in food-producing animals dropped by 27%.

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That is encouraging to hear because antimicrobial resistance is caused by the excessive and inappropriate use of antibiotics. Given that we have a Matt Hancock app, should not we have a similar app to try to educate people about when it is appropriate and not appropriate to use antibiotics?

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I will look at what can be added to the Matt Hancock app—there is always room for more.

As luck would have it, today Public Health England has launched its latest “Keep Antibiotics Working” national public awareness campaign, which aims to educate the public about the risks of AMR and urges them always to take the advice of their healthcare professionals on antibiotics and, when necessary, to challenge them.

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AMR poses a grave threat to health. Professor Dame Sally Davies, the chief medical officer, told our Health and Social Care Committee inquiry that if action is not taken to address this

“growing threat, modern medicine will be lost.”

Will the Secretary of State and Ministers heed that warning and ensure that AMR is prioritised?

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Absolutely. The UK is a global leader in tackling AMR and we are currently working on the refresh of our strategy. I was at the G20 earlier this month, where Dame Sally Davies, the chief medical officer for England, showed world leadership and led an exercise with world leaders to strengthen understanding by showing how developed countries would tackle an outbreak.

Public Health Funding

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18. What recent representations he has received on the potential merits of increasing public health funding to local authorities. [907226]

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This Government have a strong track record on public health. Local authorities in England are supported by ring-fenced public health grants of more than £16 billion over the current spending review period. Decisions on future funding are, of course, for the next spending review.

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Substance misuse services are due to be slashed by £34 million owing to cuts imposed by central Government. In Hull, and I am sure in many other parts of the country, there is a growing blight on our streets caused by Spice and other substances. How is it in any way helpful to communities, frontline police or the NHS for the Government to cut services that help people deal with their addictions?

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As I said, we are spending £16 billion of our constituents’ money during this spending review period on public health grants. Decisions about where we go in future are of course not a matter for me but for the Chancellor in the spending review. This House decided in the Health and Social Care Act 2012 to make every upper tier local authority a public health authority. We believe that it is right for local authorities to make those decisions, with the funding that we give them.

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How many health visitors have been lost since 2015? How will the Minister ensure that important investments are made at the start of life to reduce health inequalities?

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As I suspect the hon. Gentleman knows, I do not have that figure at my fingertips, but I will provide it to him. Health visitors are a critical part of the puzzle, and local authorities are well aware of that, as are Ministers.

Topical Questions

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T1. If he will make a statement on his departmental responsibilities. [907233]

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The Department is working with the NHS to ensure that the £20 billion of extra taxpayers’ money is well spent: supporting social care, backing the workforce, using the best modern technology and strengthening prevention. On that note, I can tell the House that we now have a record number of GPs in training: 3,473—10% up on last year.

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I thank the Secretary of State for so promptly accepting our invitation to visit us in East Sussex in January. He will be warmly welcomed. With that season in mind, what assessment has he made of the NHS’s resilience with winter approaching?

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Of course winter always challenges the NHS, and this year will be no different. We have put in extra funding, including more capital funding, to ensure that we get the best possible flow through A&E and to ensure there is further funding for social care so that people who do not need to be in hospital can leave hospital.

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Last week, The Times reported that a young autistic woman with severe learning disabilities and an IQ of 52 was sexually exploited for months after her care provider had a court accept a plan for her to have sexual relations with men at her home. It is unacceptable that the agency charged with the care of this young woman decided that unsupervised contact with men for sex was in her best interest, yet the Government would give all such care providers a role in assessing the mental capacity of the people for whom they care. Will the Secretary of State urgently investigate this case? Given that the case illustrates the conflict of interest that arises from involving care providers in mental capacity assessments, will he pause the Mental Capacity (Amendment) Bill to allow time to make it fit for purpose?

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The hon. Lady is absolutely right to raise this incredibly concerning case. Unfortunately, because the case is ongoing and due to be heard before the High Court very shortly, we are unable to discuss the specifics of the case, but we are incredibly concerned by what it suggests. We have made it clear in statutory guidance to support the implementation of the Care Act 2014 that we expect local authorities to ensure that the services they commission are safe, effective and high quality. Once this case has gone through the High Court, we will look to take further action.

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T2. A constituent has just written to me saying that his diabetic care has been moved from John Coupland Hospital to Lincoln Hospital under the mistaken bureaucratic belief that bigger is better. United Lincolnshire Hospitals NHS Trust, which covers Lincoln Hospital, is struggling. It is treating only 69% of people in A&E within four hours, when the figure should be 95%. What is the Minister going to do to ensure that large rural areas get the best and the same healthcare as large cities? [907234]

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My hon. Friend is right to highlight this. The Secretary of State was at the trust last week, and I visited earlier in the year. There is a specific range of actions, including partnership with Sherwood Forest Hospitals NHS Foundation Trust; advanced clinical practitioner courses, which started in June; £1.8 million of capital to support improvements to patient flow; and a frailty pilot at Lincoln. There is an intensive programme of work with this trust, because we recognise my hon. Friend’s concerns.

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T8. North West Ambulance Service NHS Trust spent £30 million in the past three years on private ambulances. Does the Minister agree that that money would have been far better spent on the recruitment and retention of NHS ambulance staff? [907240]

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As the hon. Lady will know, since 2010, the number of paramedics has increased by more than 30% and the pay band has been increased from band 5 to band 6. She will also know from the excellent work of Lord Carter that there was significant variation between ambulance services and a significant opportunity to make savings that can be reinvested in ambulances by addressing differences in sickness rates, “hear and treat” and “see and treat” rates and other variables. We have also committed additional funding for new ambulances, including in the north-west, which will be in place by this winter.

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T3. I can personally testify to the passion, the care and the professionalism of staff at Hillingdon Hospital. They do a fantastic job, but, sadly, too much of the physical environment in which they work is no longer fit for purpose. I invite my right hon. Friend to visit and see it for himself and to commit to providing the medical facilities that my constituents will need for the long term. [907235]

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My right hon. Friend is an assiduous supporter of his constituents. I look forward very much to taking up his invitation to visit. I have looked into some of the details of the proposal on the table and, indeed, at some of the other proposals that may benefit the Hillingdon area. I look forward to discussing them with him.

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T9. I welcome Baroness Cumberlege’s ongoing review of the impact of the use of Primodos pregnancy tests, but for the families affected to have confidence in this review they must be given sufficient time to give evidence. Will the Health Secretary ensure that that happens? [907241]

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Yes, of course I will make sure the appropriate action is taken in this case. It is a sensitive matter, and I look forward to discussing it with the hon. Lady.

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T4. The NHS diabetes prevention programme, which was one of the first of its kind, has helped many people since 2016. As someone who has been diagnosed as a type 2 diabetic since that point, it is of particular interest to me. Will the Minister assure me that when the long-term NHS plan is published, we will be even more ambitious? [907236]

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We certainly will. I do not wish to pre-empt what the long-term plan will say, but it is an excellent opportunity for us to look at how the NHS can best support people who have or are at risk of developing diabetes, and that includes transformation funding beyond next spring and how technology can be used to help people better manage that long-term condition.

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T10. Will the Minister provide an update on the revised capital bid by Warrington and Halton Hospitals NHS Foundation Trust to provide Halton General Hospital with a secure future? [907242]

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I am not aware of the specific details of that, but I am happy to meet the hon. Gentleman to discuss it if he has particular concerns he wishes to raise.

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T5. Spina bifida is one of the most prevalent causes of infant mortality and disability, and a campaign has been running for quite a long time to try to fortify flour to prevent it. Successive Governments have ducked the issue, so will we now please seize it? [907237]

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We are continuing to review the advice from our expert advisory groups on safe levels of folate intake, but, continuing our tradition of announcing things to the House first, I want to inform the House today that we are going to issue a public consultation, as of now, on adding folic acid to flour.

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The service from the East Midlands Ambulance Service NHS Trust has been a considerable disappointment for many of my constituents in recent months. When I met them about the service, they told me that on a huge number of occasions they have ambulances sat waiting outside accident and emergency departments, rather than getting to the next call. What more can the Government do to make sure we get these A&Es cleared?

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The hon. Gentleman is right to say that we need to improve those handovers. We have improvement programmes in place at 11 hospital sites in the east midlands, alongside which we are making a £4.9 million investment in 37 new ambulances. Part of this is also about the length of stay and addressing the pathway.

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T6. The recent report from the Royal College of Physicians, “Hiding in plain sight: Treating tobacco dependency in the NHS”, made clear the cost savings and health benefits there would be if doctors identified smokers and referred them to smoking cessation services, so will next month’s plan include that, particularly for pregnant women and mental health patients? [907238]

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As my hon. Friend, the chair of the all-party group on smoking and health, knows, those groups are key to delivering our tobacco control plan. We are not complacent at all; the delivery plan that was published in June sets out the actions that different agencies will take to deliver the five-year plan, and that absolutely includes mentor cessation services.

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I very much welcome news of the consultation on the mandatory fortification of flour with folic acid, but are the Government consulting on whether it should happen or on how it should happen?

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We will be taking evidence, including from the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment, which is meeting as we speak, to look at the safe upper limit of folate levels. I am particularly keen to get that right, but I am convinced that the evidence shows overwhelmingly that this is something we should be doing.

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T7. What is it, precisely, about the NHS’s management and leadership that means it seems to be unable to achieve consistent excellence in its hospitals, such as happens at the Salford Royal NHS Foundation Trust? Why is it so hard for lessons learned to be better disseminated? [907239]

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My right hon. Friend identifies a critical factor in improving the future of the NHS, which is to have stronger leadership at all levels, to be able to support innovation and to find out the best that is happening elsewhere and bring it to trusts. I know he has a particular interest in that, and I look forward to working with him on it.

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Foetal alcohol spectrum disorders mean permanent brain damage. In the United States, studies show that one in 20 children are affected. So when will this Government carry out their own prevalence study, so that we can confirm the extent of this entirely preventable disability in the UK?

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Public Health England collects some data on foetal alcohol syndrome, but we recognise that the data do not reflect the range of FASD. These disorders are difficult to diagnose, which is why we are engaging experts and those affected to explore what more could be done to improve our understanding.

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I thank the Secretary of State for the extra £5 million for East Midlands ambulance service and for the £4.5 million extra for Nottingham University Hospitals Trust, which will mean at least 150 more beds this winter, all of which will help with winter planning, but does he agree that it behoves us all to play our own part in keeping fit and healthy and to use the NHS services responsibly?

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My right hon. Friend makes a very important point, which is that, while we drive to ensure that the NHS is prepared as possible for this winter, it is incumbent on everybody to exercise their judgment, yes, to access the NHS where it is needed and important, but also to make sure that they bear a personal responsibility, too.

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The Mid Yorkshire Hospitals Trust is proposing to close our midwife-led maternity unit, telling me that, while it is safe, unless it has 500 births a year, it is not value for money. Is that a new national standard for midwife maternity units, because if so it would close 90% of free-standing units? Will a Minister meet me on this matter, because it is unfair on local parents, and, frankly, we are sick and tired of losing services from our towns?

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I am happy to meet the right hon. Lady and to discuss the matter further.

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I am extremely concerned about the case of Logan, a young boy in my constituency who requires round-the-clock care and the handling of his case by Corby clinical commissioning group. I have written to the Minister raising concerns about this case, but is he willing to meet me and Logan’s parents, Darren and Wendy, to talk about how this could perhaps be resolved and to apply any pressure that he can, because, as a family, they should be making memories at the moment, not battling local NHS bureaucracy?

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Is it true that the Secretary of State is now so worried about the supply of vital medicines in the event of a no deal or a hard Brexit that he has asked the pharmaceutical industry to extend the period of stockpiling from six weeks to 20 weeks?

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No, that is not true. We are working very closely with the pharmaceutical industry to make sure that, in the event of a no deal Brexit, which I regard as unlikely, we mitigate as much as possible the impact on the supply of medicines and that the supply of medicines can be unhindered.

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Will my hon. Friend, the Minister with responsibility for antimicrobial resistance, consider a 10% levy on antibiotics? If such a levy were applied globally, it would raise £3 billion a year, which is the amount specified in the O’Neill review to properly fund research into this area.

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I thank my hon. Friend for his consistent work in this area. Stimulating the pipeline for new antimicrobials and alternative treatments is a complex matter. I can assure him that we continue to work with our international partners—I mentioned the G20 earlier —and that absolutely involves market entry awards, which, as he knows, is a global problem that requires a similar solution.

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Every week in this country, two children are born with spina bifida or anencephaly, and I am delighted that the Minister has just announced the consultation on the fortification of flour, which could stop 70% of those birth defects. Can he tell the House how quickly he hopes to bring about the conclusion of the consultation?

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Let me just pay tribute to the hon. Gentleman for the work that he has done, bringing this matter to the fore and really pushing it forward. The answer is as soon as possible. I also want to make sure that I can involve the other agencies. Public Health England will be very important in this, because, of course, not every woman eats bread and therefore takes the flour supplement.

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I am sure that the Minister is aware that October is breast cancer awareness month. I welcome the ambition that the Prime Minister set out at the party conference for 75% early-stage diagnosis. There is some concern that, as breast cancer is already above that, there is no ambition left for it to do even better. Can he assure me and the breast cancer community that that is not the case?

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That is certainly not the case. We had a very good debate on breast cancer last week. It is BCAM still this month for another week. The 75% was a target, a new national ambition. It most certainly is not the limit of our ambition.

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Will the Government write off the debts of Yorkshire hospitals so that extra money invested can go into patient care?

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As the Secretary of State set out, we are making a significant funding commitment to the NHS—the extra £20 billion—but that is not conditional on writing off debt.

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Will the Minister please provide an update to the House on work to ensure that we train more GPs for England, particularly for west Oxfordshire?

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Yes. My hon. Friend will have heard that we have record numbers of GPs in training— 10% up on last year. I want to see more GPs—5,000 more across the country—and, no doubt, some of those in west Oxfordshire.

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I have a constituent who has Turner syndrome, a female-only genetic disorder that affects one in every 2,000 baby girls. Owing to this, she has to take several medications every day of her life, and this is mounting up as she gets older. She works so she is not on any benefits and has to pay for her medications herself. Will the Minister consider exempting those who suffer from lifelong conditions such as Turner syndrome from paying for their prescriptions? Surely, it cannot be right that people in England should be treated differently from those in Scotland, Wales and Northern Ireland, where such prescription charges have been abolished.

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I would be very happy to meet the hon. Lady to discuss her constituent’s case.

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I am hearing deeply concerning reports about ambulance waits outside Worcestershire Acute Hospitals NHS Trust, and the Minister is aware of these concerns. We welcome the capital funding that is going into this trust, but will he meet me to discuss what more can be done to improve patient handover, which is concerning for my constituents?

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As my hon. Friend says, there is significant capital investment into Worcestershire, as well as a major programme of improvements addressing variation in ambulances, but of course I am also happy to meet her to discuss the matter.

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Last week, the chief executive of the Association of the British Pharmaceutical Industry warned that even associate membership of the European Medicines Agency would not do for our life sciences sector, so can the Secretary of State tell us how much longer we will have to wait and how much more we will have to pay for new medicines if we are outside the European medicines market?

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We will not have to wait longer; we will ensure that we get the best medicines to the people of Britain long after we are members of the European Union, as we did before we were members of the European Union.

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As in the health service under successive Governments of both colours, demand exceeds supply and we cannot carry on indefinitely, but let us hear a few more questions.

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Last week, the Royal College of Paediatrics and Child Health revealed that there has been an increase in infant mortality for the first time in 100 years. Four in every 1,000 babies will not reach their first birthday, compared with 2.8 in every 1,000 babies in Europe. This was warned against as an effect of austerity. What assessment has the Health Secretary done on the effects of next week’s Budget on child health and the longevity of our children?

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I saw that report and we are analysing it. Last week was Baby Loss Awareness Week, and I am glad that there is more awareness of the issue now than there was previously. It is a very important issue that we are looking at right across the board.

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About two hours ago, I rang to book a flu jab less than a mile away from here. Unfortunately, staff said that they had run out and will not be able to do it until 2 November. The Secretary of State is nodding. He seems to know the answer to everything. What is the issue? Will he give me the answer? This never happened under Labour.

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If the hon. Gentleman is claiming that there were not enough flu jabs under Labour, I might agree with him, because there are now more flu jabs. More than 4 million flu jabs have already taken place. I am delighted that lots of people want flu jabs because everybody who needs one should get one. The arrival of the flu jab medicine is phased, because we have to ensure that we get the right flu jabs. If the hon. Gentleman could carry on promoting flu jabs for the elderly, I would be delighted.

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Is the hon. Member for Bolsover (Mr Skinner) satisfied?

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Nevertheless, the hon. Gentleman has had his say, and I feel sure that he will say it again as often as is necessary.

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Will the Minister tell me whether the withdrawal of funding for the Healthy Futures programme in the north-west and Public Health Action in the south-west likely to help or hinder us meeting the smoking cessation targets in the tobacco control programme?

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This comes back to the matter of public health budgets—£16 billion during the current spending review period, with local authorities best placed to make local decisions on what is needed in their local area. That is the same in the right hon. Gentleman’s area as it is in mine.

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Last month, the Mayor of Greater Manchester adopted the five recommendations of my report, “Living Well and Dying Well”, which seeks to include hospice care provision more formally in our NHS and social care planning. Will the Minister meet me and representatives of our hospices to see how we might best make use of these brilliant community health assets?

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Yes, I am happy to meet the hon. Gentleman to discuss the matter. Hospices provide an incredible level of care right across the UK, and we cannot do enough to support them.

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Order. There were 30 topical questions. Although there was scope for many more, I am afraid that we have to stop now. Thank you, colleagues.

Abortion

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

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I beg to move,

That leave be given to bring in a Bill to amend the law relating to abortion in England and Wales, and Northern Ireland; to remove criminal liability in respect of abortion performed with the consent of the pregnant woman up to the twenty-fourth week of pregnancy; to repeal sections 59 and 60 of the Offences Against the Person Act 1861; to create offences of termination of a pregnancy after its twenty-fourth week and non-consensual termination of a pregnancy; to amend the law relating to conscientious objection to participation in abortion treatment; and for connected purposes.

I thank Gordon Nardell QC and Professor Sally Sheldon for drafting the Bill. It is supported by the British Medical Association, the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, the Faculty of Sexual and Reproductive Healthcare, Amnesty International, the British Pregnancy Advisory Service, the Family Planning Association, Marie Stopes International, the End Violence against Women Coalition, Women’s Aid and the TUC.

Abortion in our country is underpinned by the oldest legal framework for any healthcare treatment, with the harshest criminal sentences in the developed world for women having an illegal abortion. Poland, the USA, Canada and parts of Australia do not criminalise women. The law needs to be updated to deal with the advances in women’s healthcare and sex and relationships education, and with the role of the internet—all of which have occurred alongside the changing attitudes in society.

Our current abortion laws date back to the Offences Against the Person Act 1861—back to a time when Queen Victoria was on the throne and women were still decades away from getting the right to vote. Under the 1861 Act, any woman procuring her own miscarriage and anyone assisting her can go to prison for life. In 1967, Parliament voted for the Abortion Act, which gave a route for women in England and Wales to access abortion legally, by setting out specific exemptions and conditions, including the need for signatures from two doctors agreeing that, for example, a termination is necessary to prevent permanent injury to the physical or mental health of the pregnant woman. Women’s lives have been saved in their thousands by David Steel’s 1967 Act, which meant that women no longer had to seek out unsafe, unregulated backstreet abortionists.

So, what are the facts about abortion today? One in three women will have an abortion in their lifetime. These days, 80% of abortions take place in the first 12 weeks of pregnancy and are medically induced by taking tablets, not by surgical procedures. It is the only medical procedure that requires the agreement of two doctors. In 2007, the Science and Technology Committee found no evidence that this requirement

“serves to safeguard women or doctors”.

The 1967 Act has never applied to Northern Ireland, and the chilling effect of the 1861 Act means that abortion hardly ever takes places in Northern Ireland. It is one of the harshest abortion regimes in the world, with no abortion available in cases of rape, incest or fatal foetal abnormality. This is what a woman from Northern Ireland says:

“I spent Christmas Day in casualty with my two children. My husband had beaten me to a pulp…He had repeatedly raped me…Six weeks later I discovered I was pregnant, I could not continue with the pregnancy. Knowing my husband would carry out his threats to kill me if he found out, I went to my GP who told me abortion was illegal in Northern Ireland and refused to help.”

Or let us consider Denise’s story. She was told midway through her pregnancy that her baby had Edwards syndrome and would not survive. Very ill and unable to travel, Denise was forced to continue with her pregnancy because she lived in Northern Ireland. She was repeatedly asked about her baby and that, she said, left her feeling tortured. She said:

“Every minute, every second of the day—you have to live with the knowledge that the child inside you is going to die.”

Or imagine being 18-year-old Emma, who found out at 20 weeks that her baby had anencephaly and would not survive. She could not face traveling to England for an abortion because she wanted to be surrounded by her loving family. She had to continue the pregnancy to term because she lived in Northern Ireland, and she was eventually induced to give birth to her stillborn daughter.

Then there was the mother who found out that her 15-year-old daughter was pregnant and that her abusive partner has threatened to

“kick the baby out and stab it if it is born.”

Feeling that she had no other option, she bought her daughter abortion tablets online. Seeking support for her daughter from their family doctor concerning the abusive relationship—not the abortion—she now faces a potential prison sentence for trying to help her daughter access medical care denied to her by their Government.

Then there is the heartbreaking account this week on Twitter from a Northern Ireland woman who has been live-tweeting at @ratherbehome her experience of having to travel to England for an abortion. She says this:

“I should be at home, in the privacy of my own home. Instead I’m trying to discreetly bleed in a shitty hotel. There’s no dignity. There’s no privacy.”

These are real-life examples of what women in Northern Ireland face under the current abortion law. Consider for a moment the morality of laws that mean that women in Northern Ireland seeking an abortion after being impregnated through a sexual crime, rape or incest, could face a heavier criminal punishment than the perpetrators—the real criminals.

This June, the Supreme Court found that Northern Ireland’s current abortion laws breach women’s human rights in Northern Ireland. In February 2018, the United Nations found that thousands of women and girls in Northern Ireland are subject to grave and systematic violations of their rights, being compelled either to travel outside Northern Ireland for a legal abortion or to carry their pregnancy to term. With the Northern Ireland Assembly not sitting since January 2017, UK politicians can no longer look away while vulnerable women in Northern Ireland, often suffering in desperate circumstances, have their human rights breached. As Hillary Clinton said:

“Human rights are women’s rights, and women’s rights are human rights”.

Let there be no hard borders in the Irish sea over human rights.

Polling research released on 10 October 2018 by Amnesty International shows that 65% of people in Northern Ireland believe that

“having an abortion should not be a crime”,

while 66% supported the view that in the absence of devolved government,

“Westminster should legislate to reform the law”.

If Westminster does decriminalise abortion in Northern Ireland, it will then be for the Northern Ireland Assembly to decide what abortion provision should look like there.

Meanwhile, even in England and Wales, a woman using abortion tablets bought online is committing a criminal offence punishable by life imprisonment—and it is often the most vulnerable women, finding it difficult to access termination services, who turn to the internet. Women on Web, a doctor-led online medical service, says that 16% of women cite domestic or “honour” violence, and 8% intimate partner violence, as reasons to seek tablets online. Whether in Birmingham, Belfast or Bangor, women need a modern, supportive, humane, properly regulated medical regime that encourages them to come forward for the best professional advice and treatment, not drives them, isolated and scared, into the unregulated internet pills market. 

Therefore, my Bill ensures that up to 24 weeks’ foetal gestation, women and clinicians would no longer be subject to the criminal law for consensual abortion. The 24-week time limit remains, and decriminalisation does not mean the deregulation of abortion: safeguards stay in place. My aim is for effective regulation fit for purpose in the 21st century. The existing body of law and professional standards governing medical procedures would stay. It would remain a crime to offer abortion services without being registered to do so, while anyone supplying medication without a legal prescription would breach the Human Medicines Regulations 2012. Clinics would continue to be registered and subject to Care Quality Commission oversight.

Very importantly, my Bill would also strengthen protection for women and target the criminal law on the real criminals. Anyone—an abusive partner, for example —who ends a pregnancy against a woman’s wishes through violence, or by administering abortion pills without the woman’s knowledge, would be subject to a life sentence. My Bill also protects doctors and nurses who conscientiously object to abortion, extending this as a statutory right to Northern Ireland.

It is time to remove Victorian, misogynistic stigma from our abortion laws. My aim is simple—women able to choose what happens to their own bodies: confident, not criminalised, supported, not stigmatised; women able to access professional advice and medical care that is regulated effectively; and an Act of Parliament that is fit for now, not for 51 years ago, and certainly not for 157 years ago.

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Whatever Members’ differing views on abortion, if we respect devolution, we should vote against this motion. It proposes far-reaching changes in abortion law, not only for England and Wales but for Northern Ireland, where abortion has been respected as a devolved matter since 1921. Indeed, it would set a dangerous constitutional precedent of interference.

It is not only unconstitutional. It is untimely, at such a sensitive time in relations between the Westminster Government and the Northern Ireland Administration. It would completely undermine the substance and spirit of the Good Friday agreement, and it is unwanted. Northern Ireland is the most recent part of the UK to vote on abortion law, in 2016, and it voted by a clear majority to retain its law as it stands. The hon. Member for Kingston upon Hull North (Diana Johnson) quoted statistics in her support, but let us hear what the people of Northern Ireland said just last week when asked. Some 66% of women and 70% of 18 to 30-year-olds there said that Westminster should not dictate this change to them.

If, however, the Province in time decide to change their law, that is for them, not for us here as MPs in Westminster to decide. Colleagues will no doubt recall the Secretary of State for Northern Ireland saying in the House recently:

“The Government believe that the question of any future reform in Northern Ireland must be debated and decided by the people of Northern Ireland and their locally elected, and therefore accountable, politicians.”—[Official Report, 5 June 2018; Vol. 642, c. 220.]

That was specifically in respect of abortion. She has also said that

“it would not be right for the UK Government to undermine the devolution settlement by trying to force on the people of Northern Ireland something that we in Westminster think is right”.—[Official Report, 9 May 2018; Vol. 640, c. 661.]

Those sentiments were reinforced by the Prime Minister, when she said:

“Our focus is restoring a democratically accountable devolved government in Northern Ireland”.

In that clear respect, this motion is contrary to Government policy and should be voted down.

Can we in all conscience vote on the one hand tomorrow on a Bill to

“Facilitate the formation of an Executive in Northern Ireland”,

as its long title commences, respecting the authority of that Executive to make decisions on such issues as roads and infrastructure, and then on the other hand today seek to deny Northern Ireland that authority on a matter of such fundamental social significance as abortion? We cannot, and we must not.

Whatever the views of Members across the House on abortion, they should hear what a number of Northern Irish women who wrote to me said:

“Changing the law in Northern Ireland at this sensitive political moment on this sensitive political issue is bad for devolution everywhere.”

The hon. Member for Edinburgh North and Leith (Deidre Brock) has said from the Scottish National party Benches:

“The decisions of devolved Administrations are taken for reasons that people in those devolved nations understand from their point of view”—[Official Report, 5 June 2018; Vol. 642, c. 228.]

Or, as Ruth Davidson, who is in favour of changing the law on this issue, more bluntly puts it:

“as someone who operates in a devolved administration, I know how angry I would be if the House of Commons legislated on a domestic Scottish issue over the head of Holyrood”.

This motion is an ignoble endeavour to take advantage of a temporary Executive lacuna and to foist legislation unconstitutionally on to the people of Northern Ireland. In so doing, it would radically alter our own abortion laws here in England and Wales.

Although the Bill has yet to be published, let us look at what it would do. It seeks to permit a woman up to 24 weeks pregnant to obtain an abortion for any or no reason at all—abortion on demand up to five months of pregnancy. We already have some of the most extreme abortion laws in the world, but this would make them even more so. There is no public call or appetite for this whatsoever. Indeed, it is the opposite; there is clearly grave public concern. Apart from Brexit, I have had more cards from constituents asking me to vote against this ten-minute rule Bill than on any other issue in this Parliament. Only 21% of women in England and Wales want an extension to our abortion laws, and less than 2% of them are in favour of sex-selective abortion, which the Bill would legalise up to 24 weeks. It is no good the hon. Lady arguing, as she has, that clinicians’ regulations or practice could cover that issue. The fact is that if her proposals go through, sex-selective abortion will not be illegal in this country up to 24 weeks. Do we want to go the way of Canada, which is now described as

“a haven for parents who would terminate female foetuses in favour of having sons”?

Do we really want to support a Bill—[Interruption.]

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Order. The hon. Lady must be heard. If she wishes to put the matter to the vote, which I believe she does and which is entirely proper, the House will then cast its judgment, but she must be heard with courtesy.

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Thank you, Mr Speaker. I do want to put the matter to a vote.

Do we really want to support a Bill that could remove the only opportunity that many women have, often at the most vulnerable stage, to speak confidentially and one-to-one with a doctor about their concerns on abortion and what their alternatives might be? If we really trust women and want them to make the most informed decision and give them the best support we can, surely we should not take away this important legal safeguard. The bottom line is that if there is an abusive relationship, and there is no legal requirement for a doctor’s involvement and no need for a reason to be given for an abortion, it is far more likely that a vulnerable woman will be pressurised into having an abortion by an abusive partner. This Bill does not improve protection for vulnerable women. It reduces it.

The hon. Lady talked about the legislation being out of date, but should we reinforce, as this motion proposes, an outdated 24-week time limit when babies are consistently surviving now at 22 weeks, and some even at 21 weeks and a few days? The Bill is out of step with scientific progress and public opinion. Some 70% of women want this time limit lowered.

In recent weeks, lobbyists supporting this motion, as the hon. Lady said, have said that the UN has called for this change. The UN has done no such thing. The lobbyists for this change cite a report by a minor UN sub-committee, which does not have any standing to rule on the UK’s legal obligations in this respect. As for the non-binding judgment of the Supreme Court, which has also been used to justify this motion, there is nothing in that judgment that could remotely be said to give rise to anything approaching a requirement for the Bill. As Lady Hale said there, we in this place do not have to act.

We should not act, particularly in relation to Northern Ireland, on this issue—not only because it would be unconstitutional, though that is enough, but because the complex ramifications of this proposal, which have clearly not been thought through, would result in contradictory and inconsistent results in different parts of the UK. Those are too detailed to be debated here, but Northern Ireland would in fact be left with a total legal void, with no law covering, for example, the place where an abortion could occur and no legal requirement for abortions to be restricted to legally approved hospitals or clinical settings—abortions for any reason or no reason in any place.

The permanent secretary of the Department of Health in Northern Ireland was asked this year,

“What is the situation if the 1861 Act was to be repealed in the UK?”

His answer was:

“This scenario would leave abortion unregulated in Northern Ireland.”

The best people could hope for there would be some guidance from the Department of Health. The hon. Lady honourable places great reliance on regulators, but regulators do not have the standing of law, as we have recently seen in cases of regulatory failure by the Care Quality Commission. Regulation cannot replace legislation. Taking the responsibility for abortion out of the hands of elected representatives and putting it in the hands of unaccountable medical bodies would be a derogation of our responsibility as Members of Parliament.

To close, I repeat that as Members of Parliament, we must respect our devolution settlements, and particularly in this instance that of Northern Ireland. Whatever Members’ views on abortion, we must vote against this proposal. It is unconstitutional, legally incoherent, untimely and unwanted.

Question put (Standing Order No. 23).

Division 244

23 October 2018

The House divided:

Ayes: 208
Noes: 123

Question accordingly agreed to.

View Details

Ordered,

That Diana Johnson, Dr Roberta Blackman-Woods, Dr Sarah Wollaston, Stella Creasy, Nicky Morgan, Liz Saville Roberts, Norman Lamb, Jo Stevens, Anna Soubry, Christine Jardine, Crispin Blunt and Caroline Lucas present the Bill.

Diana Johnson accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 23 November, and to be printed (Bill 276).

Civil Liability Bill [Lords]

Consideration of Bill, as amended in the Public Bill Committee

New Clause 1

Restriction on increase in small claims limit for relevant personal injuries

‘(1) In this section, the “PI small claims limit” refers to the maximum value of a claim for damages for personal injuries for which, in accordance with Civil Procedure Rules, the small claims track is the normal track.

(2) Civil Procedure Rules may not increase the PI small claims limit in respect of relevant injury claims to an amount above £1,000 for the first time unless—

(a) the Lord Chancellor is satisfied, and has certified in writing, that on the day the rules are to come into force, the value of £1,000 on 1 April 1999 adjusted for inflation, computed by reference to CPI, would be at least £1,500, and

(b) the rules increase the PI small claims limit to no more than £1,500.

(3) Civil Procedure Rules may not increase the PI small claims limit in respect of relevant injury claims on any subsequent occasion unless—

(a) the Lord Chancellor is satisfied, and has certified in writing, that on the day the rules are to come into force, the value of £1,000 on 1 April 1999 adjusted for inflation, computed by reference to CPI, would be at least £500 greater than on the day on which the rules effecting the previous increase were made, and

(b) the rules increase the PI small claims limit by no more than £500.

(4) In this section—

“CPI” means the all items consumer prices index published by the Statistics Board;

“relevant injury” means an injury which is an injury of soft tissue in the neck, back, or shoulder and which is caused as described in paragraphs (b) and (c) of section 1(4) (negligence while using a motor vehicle on a road, etc.);

“relevant injury claim” means a claim for personal injury that consists only of, or so much of a claim for personal injury as consists of, a claim for damages for pain, suffering and loss of amenity caused by a relevant injury, and which is not a claim for an injury in respect of which a tariff amount is for the time being prescribed under section 2.’—(Gloria De Piero.)

This new clause would limit increases in the whiplash small claims limit to inflation (CPI), and allow the limit to increase only when inflation had increased the existing rate by £500 since it was last set.

Brought up, and read the First time.

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

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With this it will be convenient to discuss new clause 2—Small Claims Track: Children and Protected Parties

‘(1) The Small Claims Track Limit in relation to claims made by children and protected parties for whiplash injuries may not be increased unless the increase is to an amount which is not more than the value of £1,000 on 1 April 1999 adjusted for inflation, computed by reference to the consumer prices index.

(2) In subsection (1),

“children” means any person or persons under 18;

“protected parties” means any person who lacks capacity to conduct the proceedings;

“lacks capacity” means lacks capacity within the meaning of the Mental Capacity Act 2005’.

This new clause would limit increases in the small claims track limit for those suffering whiplash injuries to inflationary rises only, for people who are either children or people lacking capacity to make decisions for themselves (as defined in the Mental Capacity Act 2005).

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We are again confronted with the reforms in the Bill, which will cost the NHS at least £6 million a year and taxpayers at least £140 million a year, the Government admit. Even they accept that it will result in more than 100,000 injured people not pursuing a legitimate claim that they could pursue now; we say the figure is far higher. Insurers, meanwhile, will get an extra £1.3 billion of profit every year. The Government say that they will hand 80% of that to consumers in the form of reduced premiums, but they have said that before, and insurers have saved over £11 billion since the last Government reforms in this area, in the Legal Aid, Sentencing and Punishment of Offenders Act 2012. Despite a brief dip in 2012-13, premiums are now higher than ever.

The Government have moved a little on the Bill, and in Committee the Minister confirmed what he intimated on Second Reading: that vulnerable road users will be exempted from both the Bill and the small claims limit. That is welcome. As Labour has done repeatedly throughout the process, we will attempt today to make the Bill fairer still by setting out some key amendments.

New clause 1 would ensure that the whiplash small claims limit could be increased only in line with inflation based on the consumer prices index, and it follows Lord Justice Jackson’s recommendation that increases should come in £500 increments and only when inflation justifies them.

One of the most disappointing aspects of this package of reforms is the Government’s attempts to sneak through key changes to the small claims track limit through the use of statutory instruments. Today we want to give those changes the scrutiny they sorely deserve and put them in the Bill.

Whereas the threshold for getting legal representation for personal injuries is currently £1,000, the Government are trying to raise it to £2,000 or £5,000, which will make a massive difference to someone injured through no fault of their own. That position is supported by a raft of experts, including some in the Minister’s own ranks—the Tory Chair of the Select Committee on Justice for one. The White Book, which I took the trouble of sharing with the Minister in Committee, shows that there was an effective 20% increase in the small claims limit in 1999 when special damages were removed from the calculation of the limit. I note that the Lord Chancellor conceded in his letter to the Chair of the Justice Committee dated 15 August 2018 that 1999 is the correct date from which to calculate an increase.

It is worth pausing at this point, since the Government now accept that there was a significant change in 1999, to understand what that change meant. An example is given in paragraph 26.6.2 of the White Book:

“a claim for £4,000 for loss of earnings and other losses, plus a claim for £800 for damages for pain and suffering, is a claim which would be allocated to the small claims track”.

In layman’s terms, a claim may be made for under £1,000 for pain and suffering, but when losses and expenses are added in it could be considerably greater. The example in the White Book suggests that, if an £800 pain and suffering award has a losses and expenses claim of £4,000, although the total value of the claim is £4,800, it still falls into the small claims track. We are talking about claims far in excess of the small claims limit.

Lord Justice Jackson, in his review of civil litigation costs, all the recommendations of which the Government accepted and implemented in the 2012 Act, said in paragraph 1.3 of chapter 19 of his 2009 review:

“Personal injuries litigation is the paradigm instance of litigation in which the parties are in an asymmetric relationship.”

In words that we all understand, this is David versus Goliath. Sir Rupert Jackson went on to say that

“the only reason to increase the Personal Injury small claims limit would be to reflect inflation since 1999”

and that

“I propose that the present limit stays at £1,000 until inflation warrants an increase to £1,500”.

He could not have been clearer, yet the Government appear to have plucked the proposed £2,000 limit out of thin air.

The new clause states that the CPI, which is used for the uprating of pensions and benefits paid to injured workers, should be used to calculate the small claims limit. Even the Chief Secretary to the Treasury agrees that CPI is the way to go. She said earlier this year to a House of Lords Committee:

“CPI is a much better measure of inflation…we are seeking to move away from RPI”.

The Governor of the Bank of England agrees, too. He has said:

“We have RPI, which most would acknowledge has known errors. We have CPI, which is what virtually everyone recognises and is in our remit.”

It is perfectly clear what we need to do: enshrine CPI as the key measure in the Bill.

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I congratulate my hon. Friend on getting the Government to admit that the increases are arbitrary and not linked to inflation in any way. Is it not the case, therefore, that the only reason for the increases is to prevent injured people from getting representation and thereby preclude people with meritorious cases from getting the damages that they deserve?

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My hon. Friend is absolutely right. Even if we use RPI, the Government still do not get to their proposed £2,000 new small claims limit. Instead, using the flawed RPI from 1999 would take the £1,000 to roughly £1,700. That is what we on the Labour Benches suspect is going on here.

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The hon. Lady is making an argument about whether RPI or CPI should be used, but is there not a bigger point here? For almost all claims generally, outside this area, the small claims track limit is £10,000. If we are to be consistent, is there not a case for making it £10,000, the same as everything else?

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We are talking about physical injuries.

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Surely the only gainers here are the insurance companies. Most people, because legal aid has been reduced, cannot afford solicitors.

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Exactly. I do not think anybody in this House will want to shed a tear for those insurance companies whose profits are going up and up. In 2017, profits for Direct Line went up 52% to £570 million and Aviva recorded a profit of £1.6 billion—and I have not even talked about the packages that some insurance company bosses take home.

The Government appear to have rounded this figure up. We say base the figure on the advice and recommendations of countless experts and follow the evidence. Even if the hon. Member for Croydon South (Chris Philp) does not listen to me, I wish he would follow the evidence of the experts. New clause 1 does just that. It would increase the limit only by CPI since 1999 and limit any increase to £1,500. That way, injured people with significant injuries and potentially even more significant losses will get the representation they need and deserve.

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Does my hon. Friend agree that in the case of an accident at work it is even more important that an injured employee is able to get legal representation to take a case against their employer? The employer will be armed with lawyers and their employers’ liability insurance company. That is stacked up against an individual whose task will be hard enough. They will be feeling victimised enough as it is.

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My hon. Friend is absolutely right. It is not an easy thing to take a case against your boss. You need a lawyer to hold your hand, an expert to talk you through, and the Government’s proposals are going to make that so much more difficult. She makes an appropriate point.

New clause 2 would ensure that children and protected persons, for example those lacking mental capacity, are treated the same as other vulnerable groups by excluding them from the small claims limit increase for whiplash injuries. Having made a welcome concession on Second Reading, and clarified in Committee that they would exclude vulnerable road users from the impact of the Bill and secondary measures on the small claims court limit, the Government appear to have forgotten others. Horse riders, pedestrians, motorcyclists and cyclists are rightly to be excluded from the changes, but some of the most vulnerable in our society, who are currently recognised by the courts as requiring special status, will be left, with everybody else, facing a new small claims limit of £2,000 or £5,000. As it stands, any settlement awarded to those who lack capacity to conduct their own proceedings, such as children or someone suffering with a mental disability, must be rubber-stamped by a judge because of the claimant’s recognised vulnerabilities. That will continue to be the case after these changes are introduced.

The law requires children and other protected people to have a litigation friend to conduct proceedings on their behalf. In the small claims court, those who provide this required representation are not and will not be paid for their time. Yet by increasing the small claims limit, there will be a significant increase in the number of people coming through the small claims court with higher-value and more complex cases, where they need a lawyer more than ever. We are asking a litigation friend to take on potentially complicated matters for those most in need, on their own, in their own time, for no pay. Injured horse riders, cyclists and pedestrians and motorcyclists will not be subject to a tariff. The small claims limit for them will remain at £1,000, meaning that they will get a lawyer to act for them for free in any case over that value.

Can the Government not see that children and protected persons need this support, too? How on earth can the Government justify protecting one vulnerable group but not another? Why is the horse rider worthy of exemption, but not a child or a person without the capacity to conduct proceedings? Are we really willing to let some of the most vulnerable people in our justice system be left simply to hope for the good will of others to protect their interests because we in this House have failed to do so?

I know that the Minister is aware of this issue from discussion in Committee with my hon. Friend the Member for Enfield, Southgate (Bambos Charalambous). The Minister suggested returning to this point and that he would be very interested to see an amendment tabled. So here is his chance: a ready-made amendment that makes a simple correction and is an opportunity for the Government to rectify what I presume is an oversight. It simply extends the exemption already provided to others. It removes children from the changes being made to the small claims limit or tariff, and ensures that protected groups are excluded from the increase, the same as horse riders, cyclists and pedestrians. It removes the double standard of some vulnerable road users being granted an exemption and others not. Ultimately, it does little more than extend the protections already afforded to some and allow the Government to show that they care for all.

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Thank you, Mr Speaker, for calling me so early in this debate. I rise to oppose the Opposition’s new clause 1, which seeks to prevent the Government or any other public body from increasing the small claims track limit in relation to these personal injury cases, particularly road traffic personal injury cases, above £1,500.

I strongly oppose the measure. I touched on one of the reasons for doing so in my intervention on the shadow Minister earlier. For the vast majority of general commercial claims and indeed personal claims, the small claims track limit is £10,000. The reason it is as high as £10,000 is that some level of materiality is applied to the claim in question. The view taken by Parliament in the past, rightly, is that matters below the £10,000 limit should be sufficiently simple for a small claims track procedure to be used without the involvement of often very expensive lawyers.

In response to my intervention, the shadow Minister, before she was distracted by another intervention, drew attention to the fact that these are personal injuries. I accept that point, of course. However, the fact of them being personal injuries is not germane, in my view, to the question, which is: is the matter sufficiently simple to be adjudicated via the small claims track rather than through lawyers? That is the question: not whether the matter is serious or not serious; it is whether the matter is sufficiently simple to be dealt with properly by the small claims track rather than through lawyers. That is why I think there is a strong a case, on the grounds of consistency, for a £10,000 rather than a £5,000 limit.

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In road accident claims and particularly in employment liability cases at work, establishing who is to blame for an accident is far from simple. It is an extremely different sort of case from that of establishing whether a fridge was working or not when it was bought, or whether there is something wrong with a car. I really think the hon. Gentleman is not doing justice to the victims of personal injury accidents by the arguments that he seeks to make.

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Of course the £10,000 small claims track limit applies to a far wider range of issues than simply whether a fridge functions or not. The hon. Lady mentions as an example the question of culpability for a road traffic accident. Given that we are talking about much less serious types of injury if the limit is, say, £5,000, determining responsibility for that road traffic accident does not need to be an enormously complicated procedure. For those of us who have been involved in such road traffic accidents, the minor ones we are talking about here, determining responsibility is not a highly complicated matter. I accept that, in much more difficult cases where very serious injuries have been suffered, one must of course take a lot more legal care and attention. For very minor injuries, however, where by definition the accident is a minor one, I suggest that determining responsibility and culpability does not need to be an extremely complicated matter.

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With the greatest respect, I do not think that the hon. Gentleman knows what he is talking about. Given of the relatively low levels of compensation for injury, the effects of a £5,000 injury can be quite severe and debilitating over a period of time. The complexity of personal injury cases, which involve expert evidence and issues of causation, means that they are in a different category. Even the Government accept that, so he is batting on a rather poor wicket.

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The hon. Gentleman’s arguments are ones that the legal community often advance, whether in this arena or others, to justify very high levels of legal and judicial intervention, which is often very expensive. We need to maintain a sense of proportionality, lest legal costs and expenses get out of control.

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Will my hon. Friend give way?

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I shall in just a moment. I have seen figures suggesting that 47% of the pay-outs made by insurance companies for these relatively minor road traffic injuries gets consumed by legal fees. If such a high proportion of pay-outs is being consumed by expenses, it suggests to me that the entire system is out of proportion, and that some reform is therefore needed. I give way to the Chair of the Justice Committee.

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I am afraid that my hon. Friend is not making the best case on the Government side that I have ever heard. Does he accept that lawyers act in the interests of their clients and that when they do, they are bound by professional obligations? Is not a better point that we should assist people through the system by working up a very good and accessible online portal, which the Minister has sought to do, so that we find the means of balancing cost with people’s ability to seek access to justice? I gently say to my hon. Friend the Member for Croydon South (Chris Philp) that that is perhaps a stronger point that the Government have been able to advance. The Minister has taken care to delay the implementation of aspects of the Bill in order to get the online portal up and working, and I suggest that that might be a more fruitful area to consider.

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I am always delighted to take advice and guidance from such a distinguished, learned and experienced Member as my hon. Friend the Member for Bromley and Chislehurst (Robert Neill). He adds further weight to the case by drawing attention to the benefits of the online portal, which I hope could be used to further simplify such matters and enable claimants to manage them, rather than having to rely on lawyers.

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I refer the House to my entry in the Register of Members’ Financial Interests. Is the hon. Gentleman aware that in most personal injury claims, there are fixed costs for lawyers’ fees?

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In many cases there are, but in many cases those costs inflate. I referred to the fact that 47% of the value of pay-outs gets consumed by legal fees. I hope that the fixed tariffs provision, which is not the subject of any amendment but is in the Bill, will further simplify matters.

One reason why we have a problem that needs solving in this area—new clause 1 would inhibit that solution—is qualified one-way costs shifting, which was introduced a few years ago. I understand why it was introduced—the shadow Minister referred to David and Goliath—but under a system of qualified one-way costs shifting, unless the respondent can prove quite a high level of intention, deceit or malfeasance, the claimant’s legal costs are borne by the respondent in any event, even if the claim is dismissed. That creates significant moral hazard, as it means that claimants can bring claims, even if those claims have relatively little merit, safe in the knowledge that they, or indeed their advisers, will never have to bear the cost of the claim. It is a one-way bet, which means that claimants may as well just have a go and see what happens. The number of cases in which a claimant is shown to be so egregiously fraudulent that they have to pay the cost is extremely small. This one-way bet—this free option—that the legal system now provides is one of the reasons why there has been such an explosion in claim numbers.

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I should declare that I chair the all-party group on insurance and financial services. I agree with my hon. Friend’s opposition to the new clauses. Does he have any thoughts on why personal injury claims have risen by 40% over the last decade, yet during the same period, cars have become safer and accidents have reduced by nearly a third?

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My hon. Friend is right—he makes exactly the point that I was about to come on to. Over about a decade in which accidents have reduced by 30% and cars have become safer, the number of claims has gone up by 40%. He asks why, and I think it goes back to qualified one-way costs shifting. There is a huge financial incentive for claimants to have a go—encouraged, of course, by claims management companies—in the hope that they can make a successful claim. Defendants, typically insurance companies, have rather irresponsibly taken the view that because defending one of these claims—probably successfully—will cost £10,000 or perhaps more, they should simply choose to settle, which may involve paying out £3,000 or £4,000, without bothering to defend the claim. Obviously word has spread both in the claims management community and among the wider public that people can simply make a claim and the insurance company will settle, because it is cheaper for them to settle a bad claim than to fight it. That has created the most extraordinary perverse incentives. Insurance companies have been seriously at fault, as they have set up this situation by paying out for claims with no merit, for understandable commercial reasons, but they have made a big mistake, and we now have to correct it through the Bill.

My hon. Friend asks why the number of claims has increased so dramatically. It is because claims management companies have been phoning around, encouraging the public to submit fraudulent claims, and I will elaborate on that in a moment.

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The hon. Gentleman makes my point for me in saying that insurance companies are paying up on a regular basis. They are not even defending these claims, yet the Bill is designed to protect them. What does he say about that?

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The companies are not defending the claims because qualified one-way costs shifting makes it more expensive for them to successfully defend a claim than simply to pay it out. The system simply is not working.

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Does the hon. Gentleman think that any genuine claimants will be hit by this measure and will not receive the compensation that they should get?

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The right hon. Gentleman raises a fair concern. Of course, we need to make sure that we do not overcompensate and find ourselves in a situation in which genuine claimants are prevented from claiming. The way in which we are legislating strikes that balance and genuine claimants can still make a claim. My hon. Friend the Member for Bromley and Chislehurst referred to the use of an easy-to-operate online portal as a way of ensuring that claims can be handled easily, even by laypeople. The concern that the right hon. Member for Kingston and Surbiton (Sir Edward Davey) raises is reasonable, but I think that the Government have addressed it in their handling of the matter. However, I am sure that the Minister will comment further on the right hon. Gentleman’s point.

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This might be a peculiar counter-intuitive point, but it is often the case that whiplash claims are associated with bad headlines in the press. People think that the numbers of claims are dramatically exaggerated. Perhaps it might be helpful if we send a message from the Chamber about discouraging fraudulent claims, which would mean that people with a genuine claim would be more likely to have their cases dealt with more quickly.

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As always, my hon. Friend makes a very good point. As Members of Parliament, we should send out a clear message to our constituents and the wider public that making fraudulent claims is not a victimless crime. They affect the insurance premiums that all of us and all our constituents pay. Fraudulent claims are extremely bad for society as a whole. They encourage a sense that people can somehow get money without really deserving it, which is morally corrosive as well as financially damaging.

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I am sure that no one in the Chamber thinks that we should encourage fraudulent claims—absolutely not—but may I bring the hon. Gentleman back to some facts? Between 2015 and 2017, the number of registered claims for whiplash fell by 15%, while the number of claims being reported through the police also fell, which might have something to do with the 37% reduction in the number of road traffic police officers in the last 10 years.

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Clearly the number of injury claims made via an insurance company is not related to the number of police officers on the street. The hon. Lady mentions the slight but welcome reduction in the number of whiplash injuries. Over the same period, the number of claims to insurance companies for back injuries has increased, so the total number of claims is down only very slightly over the last couple of years, and is still dramatically up over 10 years, which is clearly a more meaningful period. When the two are taken together, therefore, there has not been a significant reduction.

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Will my hon. Friend give way?

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How could I possibly resist my hon. Friend?

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The House will know about my declaration in the Register of Members’ Financial Interests. I am glad that my hon. Friend has mentioned claims management companies. Would he agree that some of the concerns about balancing access to justice with discouraging fraudulent claims—we all agree about them—would be met by continuing to revise and strengthen the regulation of claims management companies, which are not regulated to the degree that solicitors are, and in particular by bearing down on the employment of paid McKenzie friends—non-qualified, quasi-lawyers who are particularly rife in the claims management sector? Will he work with me in persuading the Government to move swiftly to ban them?

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Once again my hon. Friend makes a very good point—two very good points, in this case. The operation of claims management companies, which have been actively engaged in encouraging the public to commit fraud, has had an extremely negative effect in this area. I want an outright ban on them making cold calls, but I am slightly concerned that even if the Government take all the action that he and I would like, these people, being extremely adept in such matters, would adapt their behaviour to circumvent the legislation and regulation. For example, they might start making cold calls from outside the UK’s legal jurisdiction, as we saw following the ban on referral fees that came into force two or three years ago. Insurance companies were banned from receiving referral fees from claims management companies, but some insurance companies and claims management companies sought to circumvent the ban by setting up what they euphemistically termed “alternative business structures”, whereby the claims management company effectively remunerated the insurance company via an equity stake rather than a referral fee. I am therefore concerned that even if we take all the action we can, these often rather dubious characters will find new and ingenious ways of circumventing the legislation.

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I welcome the fact that the hon. Gentleman supports an outright ban on cold calling by claims management companies, but does he agree that the Government’s measures in the Financial Guidance and Claims Act 2018 do not go that far? Rather than punishing injured victims, would it not be far better to introduce that outright ban on claims management companies’ cold calling?

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As I said a moment ago to my hon. Friend the Member for Bromley and Chislehurst, an outright ban would be welcome—it might be something the Government are looking at in any case—but because these people are so ingenious at circumventing even the best-written rules and regulations, there would still be a problem.

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I thank my hon. Friend for giving way—he is being most generous with his time. May I press him on the point made by my hon. Friend the Member for Bromley and Chislehurst (Robert Neill) about McKenzie friends? I am going back years now, but in my day, when I first started at the Bar, the concept worked very well: they were volunteers who accompanied people to court and assisted them, and they certainly were not paid. Surely we just need to go back to the system as was, as I suggest that things would then work very well.

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I agree wholeheartedly with my hon. Friend, who I know has a distinguished legal background. Both he and the Chair of the Justice Committee have powerfully made the point that McKenzie friends should be voluntary and unpaid. I hope the Minister heard that excellent recommendation, which has now been made by two learned hon. Members of this House.

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I congratulate the hon. Gentleman on making a speech against the Bill. He has admitted that the insurance companies should be fighting the claims, that McKenzie friends should not be paid and that claims management companies should be regulated. He might not have realised it, but he has defeated the Bill by himself.

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I am grateful to the right hon. Gentleman for granting to me such wide-ranging powers of persuasion, but I am not speaking against the Bill; I am speaking only against new clause 1. Despite all the measures we have just been discussing, including the three that the right hon. Gentleman mentioned, I do not think that they, on their own, will be enough, for the reasons I have outlined. The financial incentives created by qualified one-way cost shifting will remain, and claims management companies will find ways of circumventing any tightening of the rules that might be legislated for separately. There is no question but that the British public are being incited to submit fraudulent claims on an industrial scale—[Interruption.] The shadow Minister, the hon. Member for Leeds East (Richard Burgon), is tut-tutting and shaking his head in a way that leads me to believe he disagrees with that statement—I think that I have fairly summarised his view.

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Will my hon. Friend give way?

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I was about to reply to the shadow Minister’s implied disagreement, but go on then; I give way.

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I just wondered if my hon. Friend would comment on a previous interaction between me and my hon. Friend the Member for Bexhill and Battle (Huw Merriman) about stock car racers, who obviously are involved in multiple collisions and yet do not seem to suffer any whiplash, or at least not to the same extent as others. In addition, people in Greece make far fewer claims than we do in the UK. Will he comment on that?

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Once again, my hon. Friend makes an excellent point. Not only has the number of claims for such injuries dramatically increased over the past 10 years, at a time when the number of road traffic accidents has fallen, but they are far more prevalent here than in other European jurisdictions—not just Greece but countries such as France and Germany. Could it be that British necks are weaker than French and German necks, or could it be that our system encourages fraudulent claims?

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The hon. Gentleman, who is making an excellent speech, has answered his own question. He has talked about the prevalence of claims management companies and the way they are inciting people to make claims on an industrial scale. Surely those claims management companies, and the insurance companies they are linked to in most cases, should be bearing the brunt of this problem, not the innocent victims of accidents, as would be the case under the Bill.

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The hon. Lady evidently agrees that claims management companies have been inciting fraud on an industrial scale—a point of view that her Front-Bench colleague perhaps disagrees with. That said, claims management companies are only part of the problem. As I said, the incentives inherent in the system have encouraged the kind of behaviour I have been describing.

I want to come to the implied sedentary disagreement from the shadow Minister earlier. I inferred from his gesticulation that he disagreed with my suggestion that claims management companies were inciting fraud on an industrial scale. I will start with a personal anecdote, which I realise does not make the general point, but I will then come on to that more general point. My interest in this area stems from personal experience. About three or four years ago, just before being first elected, I had a minor road traffic accident while driving along the M5 to Cornwall with my wife and our two small children. [Interruption.] I think I am being heckled by the Chair of the Justice Committee.

Nobody was injured in the accident—the bumper was a bit dented, but that was it. It happened at low speed, the traffic having slowed down. For about a year, however, I was bombarded with calls to my personal mobile by people from claims management companies, I think, that had somehow found out about the bump, trying to persuade me that I or my family had suffered a neck injury. No matter how often or how insistently I told them that everyone was fine, they would say things such as, “If you just say your neck hurts, you’ll get £3,000.” The incitement to commit fraud was clear and direct. Subsequently, as recently as in the last two or three months, I have received repeated automated calls—robocalls—again to mobile, although wholly unrelated, I think, to the first set of calls. I received a recorded message saying, “We are calling about your accident. Do you want to talk about it?” There was then a pause during which I was expected to reply. That is clearly happening on an industrial scale.

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Who does the hon. Gentleman think sold his details to that claims management company?

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In the first instance, it was very likely to have been an insurance company that had been circumventing the referral fee ban through an alternative business structure, which is a practice that I wholly deplore, and I encourage the Government to ban it. However, as I have said three or four times before, simply trying to legislate away claims management companies will not in itself be enough when the incentives inherent in the system are so powerful. Raising the small claims track limit to, say, £5,000—which is still half the level of the general small claims track limit—will serve to diminish the financial incentives in the system whereby lawyers are taking nearly half the value of payouts.

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I give way to the hon. Member for Hammersmith (Andy Slaughter).

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The proportion of fraudulent claims is about 1%. If I understand the hon. Gentleman’s argument correctly, he is saying that all meritorious claimants should be debarred from proper representation so we can identify that 1%, because it is too difficult for the Government to legislate. Is not the truth of the matter that the Government, as always, are joined at the hip to the Association of British Insurers, and are simply legislating in its interests?

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I disagree with all three things that the hon. Gentleman has said. First, as I said earlier to the right hon. Member for Kingston and Surbiton (Sir Edward Davey), the Government have no intention at all of preventing legitimate claims from being made. The Government are keen to facilitate those claims, and the online claims portal will help with that. There is categorically no intention of disbarring, preventing or in any other way inhibiting legitimate claims from being made.

Secondly, the hon. Gentleman referred to the 1% fraudulent claims figure. The reason the reported figure, which in my submission is dramatically under-reported, is so low is that insurance companies are, quite wrongly, choosing to settle those claims—even suspicious claims, even claims without merit—without defending them, because the cost of defending them, which is about £10,000 or £15,000, far exceeds the value of the payout. So the 1% figure cited by the hon. Gentleman goes nowhere close to reflecting the true scale of fraudulent claims in this area.

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Will the hon. Gentleman respond to a general point? Does he believe that when we are tackling a problem, in any aspect of society, we should deal with the symptom or the cause?

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Of course we should deal principally with the cause, and that is what the Bill seeks to do. [Interruption.] The right hon. Gentleman asked about causes. We can talk about claims management companies and we can talk about referral fees—those are important issues to deal with—but the cause of this problem is the financial incentives created by qualified one-way costs shifting, whereby claimants, aided and abetted by claims management companies, can have a crack for free, suffering no loss if their unmeritorious claims are dismissed. If the right hon. Gentleman wants to go into the cause of the problem, that is the cause of it, and elevating the small claims track limit to £5,000 will do a great deal to eliminate the cause. If he wishes to address the cause, as his intervention implied, he should vote against new clause 1.

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I give way first to my hon. Friend the Member for Bexhill and Battle.

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I thank my hon. Friend for giving way again. It is not just the case that we do not really know the number of fraudulent cases, although we can certainly make a very fair estimate, given that there are 200,000 extra claims and 85% of them relate to whiplash. The real issue is that we tend not to see any medical reports because of the settlements. It is not just that the cases are not defended; we never see the medical reports, so we do not know exactly what the full figure would be.

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My hon. Friend is absolutely right. Because the claims are settled upfront by the payment of, typically, £3,000 or £4,000, there is often no medical examination. There is therefore no evidence on which to assess whether the claim was fraudulent or not, which is why the 1% figure cited by the hon. Member for Hammersmith (Andy Slaughter) is essentially meaningless.

One of the other provisions in the Bill, which we debated on Second Reading, is the requirement for a medical examination to take place before an offer is made. That is an essential reform. In response to an intervention from me, the Secretary of State for Justice confirmed that such medical examinations would have to be face to face. That would begin to address the issue that my hon. Friend the Member for Bexhill and Battle (Huw Merriman) has rightly raised.

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I thank the hon. Gentleman for giving way to me again; he is being very generous. He mentioned the purpose of raising the small claims limit to £5,000, and what that would do. What it will do is deny victims of injury access to justice, as the Government’s own impact assessment expressly states.

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I do not accept the premise of the hon. Lady’s intervention. I think that in the case of the smaller claims, whose value is less than £5,000, it is perfectly possible and perfectly reasonable for individuals to submit their own claims—these are relatively simple matters—using the online portal to whose importance my hon. Friend hon. Member for Bromley and Chislehurst drew our attention earlier. Members have also referred to the role that unpaid McKenzie friends can play in assisting members of the public who submit claims. I do not accept the suggestion that bona fide claims will be prevented or inhibited by the proposed reforms.

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The hon. Member for Glasgow South West (Chris Stephens) has tried several times to intervene, so I must give him an opportunity to make his point.

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I am grateful to the hon. Gentleman, because he has been generous. May I put a different scenario to him, because this aspect of what he is saying is confusing me? If, in the course of his employment, a resident of Glasgow South West were injured in Croydon South, why would he be treated less favourably because the injury was sustained in the hon. Gentleman’s constituency than he would be in the constituency of Glasgow South West? In Scotland personal injury claims are exempt from the small claims limit, and civil legal aid is available to claimants.

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I infer from the hon. Gentleman’s question that these matters are devolved in Scotland. Is that the case?

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It is a different system.

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The two cases are treated differently because there is an entirely different legal system in Scotland, and there is a devolved Government there. It is perfectly within the competence of that devolved Government to take a different view. Clearly the Government in Scotland, and the Scottish Parliament, have taken a different view, as they are entitled to do, but I, as an English MP—as a London MP—take my own view, and it is the one that I have been expressing here today.

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I thank the hon. Gentleman for that, but does he realise that the Bill affects 407,000 people—Scottish residents who are employed in England and Wales?

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It may well affect residents of Scotland. Of course, it also affects residents of France, Germany, the United States and Kazakhstan who may choose to visit my constituency. I strongly encourage all of them to do that, by the way. If, heaven forbid, they were to suffer an injury in Croydon South, they would be equivalently affected. The mere fact that there are different rules in different jurisdictions is no reason not to change the rules in this one. Which jurisdiction is the hon. Gentleman suggesting that we align ourselves with? Scotland? France?

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Scotland!

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While I admire the hon. Gentleman’s patriotism in inviting us to follow the Scottish example, I am afraid that this Parliament will form its own view on what is appropriate, and I do not think that he can be in any doubt about what I think the right view is on the question before us today.

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The hon. Gentleman is indeed being very generous. However, he constantly claims that the injuries sustained in road traffic accidents are minor. Written into the Bill is that an injury caused by the

“rupture of a…tendon or ligament in the neck, back or shoulder”

that lasts for up to two years will be included within the limits. Does the hon. Gentleman agree that that sort of “minor injury”, which could affect people for such a large portion of their lives, should be included?

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The Government consulted extensively on the definitions before legislating. I understand that the definition to which the hon. Lady has referred was recommended by the Sentencing Council, and I would certainly not wish to second-guess or naysay the recommendation of such an august institution.

I did not quite have the opportunity to finish a point that I was making in response to the hon. Member for Leeds East who, some moments ago, was expressing disagreement with my suggestion that claims were being farmed on an industrial scale. I have given my own personal example, but I also want to submit to the House, in support of what I said, an example uncovered by The Sunday Times in July 2015. It involved a company called Complete Claim Solutions, which was based principally in Brighton but also had an office in the Borough of Croydon—although not in my constituency, I hasten to add. It was discovered to be systematically encouraging members of the public to submit fraudulent claims. It was such a disreputable organisation that it used the film “The Wolf of Wall Street” as an instructional video illustrating the kind of behaviour it considered appropriate. This is no small company; it was responsible for making no fewer than 7 million outbound calls per year. One of its salespeople, Tom Murray, was recorded boasting to a Sunday Times journalist that he was able to easily persuade the public to lie. He said that

“if they want that £2,000, they’ll lie.”

He also said:

“When it comes down to a woman who’s had an accident…I’ll make her cry”

as a way of persuading her to make a claim.

That is just one example of the shocking behaviour of these claims management companies, in this example one making 7 million calls per year.

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I have taken up a great deal of the House’s time. [Interruption.] I am glad that I have at last said something that finds favour with the Opposition Front Bench. I am sure many other colleagues wish to contribute to this debate.

There is overwhelming evidence that our system is broken, in terms not only of the claims management companies and the use of alternative business structures to get information into their hands, but of the fundamental incentives inherent in qualified one-way costs shifting. The proposals the Government are contemplating to increase the small claims track limit will do a great deal to choke off this problem at source—to deal with the cause, as the right hon. Member for Kingston and Surbiton requested a few moments ago. For that reason I will be energetically and enthusiastically voting against new clause 1.

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It is a pleasure to speak in this debate. I welcome the opportunity to try and counter the worst aspects of this Bill by speaking to Opposition new clauses 1 and 2.

Access to justice may sound like a catchphrase or buzzword, but it underpins so much within our society, and it should not be bandied about and dismissed with the cavalier attitude currently shown by this Government. The Bill will cause a regression in the ability of genuinely injured people to seek compensation and justice for their injuries. The narrative of wanting to clamp down on fraudulent claims has long worn thin and the statistics the Government are using to justify these policies are entirely erroneous. Of course fraudulent claims are wrong and should be investigated and clamped down on, but we are not experiencing the epidemic levels we have been repeatedly warned of. In 2017, 0.22% of all motor claims were proven to be fraudulent; bearing in mind that that is for all motor claims, whiplash injuries will be an even smaller percentage.

Instead of looking at empirical evidence to create legislation, the Government are using disputed statistics to legitimise their agenda. This is wrong, and the impact on access to justice that the Bill will have will be substantial: 350,000 injured people without the free legal cover they are currently able to access. That is the true cost of implementing the Government’s package of measures.

As I outlined on Second Reading and in Committee, the changes to the small claims limit—although not on in the Bill, they are intrinsically related to its content—will be utterly damning on any reasonable definition of access to justice. The proposal to increase the small claims limit from £1,000 to £5,000 in road traffic injury cases and from £1,000 to £2,000 in all other personal injury claims would mean thousands of injured people could fall out of scope for free legal advice and representation and could be denied justice. Costs are not recoverable from the losing party in the small claims court, so injured people will either have to pay their legal costs themselves, which is likely to be cost-prohibitive, or, more likely, forgo legal assistance altogether, or simply not pursue a claim.

In giving evidence during the Justice Committee’s inquiry into the small claims limit, the Minister in the Lords, Lord Keen, suggested that injured people could instead seek advice from their citizens advice bureau. I am sure that many Members will understand the great number of cuts that have befallen citizen advice bureaux in recent years, and this suggestion is not only unfeasible but is completely out of touch. If there is to be any change in the small claims limit, it must be done proportionately by pegging it against consumer price inflation.

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rose

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I want to make some progress.

That this must be done in this proportionate way is a widely held view, and those who advocate the approach include the Justice Committee, which published a recommendation in its small claims limit report in May; trade unions, including USDAW; the Association of Personal Injury Lawyers; the Law Society; and over 50 Members of this House who have signed my early-day motion calling for the increase to be in line with CPI inflation. These disproportionate and misguided hikes are, it seems, favoured only by this Tory Government and the insurance industry.

New clause 1 in my name and those of my hon. Friends would limit increase in the whiplash small claims limit in line with inflation and permit the limit to increase only when inflation had increased the existing rate by £500 since it was last set. By linking any rise to inflation, it would remove the power from the Lord Chancellor to determine the level and would instead tie it to an economic measure used by both Government and the Bank of England. The Lord Chancellor has an important role, but it is not one that should be afforded powers to artificially dictate rates such as the small claims limit for political reasoning or motivation. If we remove the politics from the decision-making process by using a widely recognised measure such as CPI, people, whether insurers or injured people, can have confidence in the system. It would provide certainty and clarity, be easy to track and would allow stakeholders to adjust for subsequent rises accordingly.

Complementing new clause 1, new clause 2 would firm up the proposal made by my hon. Friend the Member for Enfield, Southgate (Bambos Charalambous) in Committee that would limit increases in the small claims limit for children and people lacking capacity to make decisions for themselves. The Minister stated in Committee that vulnerable road users will be excluded from the Bill and from secondary measures on the small claims limit. This is welcome, but it is disappointing that no Government amendments have been tabled on Report to shore up that promise and include it in the Bill immediately. I hope that this is not a repeat of the Government’s promise to pass the predicted £1.3 billion-worth of insurance industry savings on to customers. I am afraid that the amendment in Committee on that issue was little more than a fudge, and its effect on customers’ premiums will be negligible at best, while the aggressive changes in the draft tariff system will involve reductions of up to 87% in payments for pain, suffering and loss of amenity from road traffic accident-related soft tissue injuries. Under the proposed tariffs, people will be compensated more for a flight delayed for three hours than for being injured for three months. The widely held and understood values of access to justice should not be undermined on a whim to satisfy the insurance industry.

What these Opposition new clauses highlight above all else is the true damage this Bill will do to access to justice and the principles that uphold the right to access to justice. In Committee, I warned the Minister that the changes made by the Government’s package of measures will be similar in scope to the disproportionate implications of the Legal Aid, Sentencing and Punishment of Offenders Act 2012—LASPO—and the unlawful introduction of employment tribunal fees, both of which are key pieces of Tory legislation that have done nothing but remove the rights of many people in seeking access to justice. What we have been left with is an 84% fall in civil legal aid and a 68% fall in the number of employment tribunal cases as a result of these Tory policies.

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Does my hon. Friend agree that this is part of a wider package of pressure on people who have some of the lowest incomes in our society? I wish to be associated with her new clauses and her points, and does she agree that the Government’s proposed measures are part of a wider package of pressure on the most vulnerable people in society?

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I agree with my hon. Friend. This is yet another attack on ordinary people’s access to justice. Should the Bill pass its remaining stages today, those shunned by LASPO and tribunal fees will be joined by an additional 350,000 injured people who will be left without the free legal cover they can currently access.

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I thank the hon. Lady and fellow Select Committee member for giving way. She has talked about access to justice, but she has not mentioned at all the impact of the online courts. Does she have a feeling about what sort of effect that would have for increasing access to justice?

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I thank the hon. Gentleman for making that point.

The Bill will have a significant impact on access to justice, and we know that the portal system is nowhere near ready to accommodate the changes. It has not been properly tested. Under successive Tory Governments, access to justice has fast become a luxury available only to the few. A recent survey showed that 63% of Unison members would not proceed or be confident to proceed with a claim without legal representation. The small claims limit changes in the Bill will push nearly two thirds of genuinely injured people away from pursuing a claim if they do not meet the arbitrarily imposed criteria dictated by the Lord Chancellor. The idiom of adding insult to injury has never been more apt, and it is surely time to think again.

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I have done something a bit novel: I have listened to what has been said in the debate, and my remarks will focus on that. I did not come here with a prepared speech; I came here and listened to the contributions from both sides.

I would like to start by responding to the hon. Member for Lewisham West and Penge (Ellie Reeves) and taking up a couple of points that she made. The first relates to the idea that the Government are somehow doing this because of special pleading from the insurance industry and that they are somehow in bed with the industry. The aim of the Bill is to reduce premiums for individuals. That is the focus of the Bill. If I were the insurance industry, I would want premiums to go up, but the aim of this package of measures is for premiums to go down for ordinary people. I therefore do not agree with her assertion.

Another point that the hon. Lady made was that the setting of the limit by the Lord Chancellor, or any future Lord Chancellor, was arbitrary, unfair and unjust, but that is why we have this House and why we have Ministers. They are not here just to do interviews on the “Today” programme. We have Ministers to make judgments that they are then held democratically accountable for. I accept that Labour Members—or, indeed, at some point in the very distant future, Conservative Members, when they are sitting on the Opposition Benches—might dislike a judgment that is made by a future Lord Chancellor, but we settle these things through the democratic accountability of this House. To reject that principle and to suggest that every limit in any area of law, whether this or anything else, should somehow not—

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I thank the hon. Gentleman for giving way. He talks with great passion about the democratic accountability of this House. Does he therefore agree that any changes to the small claims limit should not be done by negative statutory instrument, as the Government are proposing, and that they should instead be debated on the Floor of the House?

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That is an interesting point. I have served on many Committees, as we all have, and some have huge amounts of engagement from lots of Members while others have less. But this House is not just this Chamber; it is also all the Committee Rooms. Negative statutory instruments provide a way for significant amounts of secondary legislation—I do not know how many pieces of legislation; probably hundreds—to go through Parliament. I cannot agree with the hon. Lady 100% that using that procedure will always result in a lack of democratic accountability, because frankly, in modern government, it plays a significant part in our governance process. I recognise the point she makes, however, and it is fair to say that sometimes people do not pay as much attention in Committees as they might do, but that is fundamentally the case for this Chamber, too.

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Does the hon. Gentleman therefore agree that, on occasions, statutory instrument Committees do not provide a democratic procedure, as in the case of the cuts to criminal injuries compensation in 2012? At the time, one Committee completely overturned the Minister’s proposals and asked for them to be brought back. A separate Committee was then reconvened, made up of Parliamentary Private Secretaries, and it railroaded through exactly the same criminal injuries compensation cuts. This House should not be seeking to use that kind of procedure for something that is so important to hundreds of thousands of accident victims.

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I do not want to leave the House, or the hon. Lady, with the impression that I believe that statutory instruments are undemocratic. They are democratic, and they are a form of how we do things in this House. I was unaware of the case that she mentioned. The broader point is that getting primary legislation through, particularly in a hung Parliament such as this, will always be difficult—[Interruption.] No, primary legislation is not always the place where we make every single change. That is why we have a Committee system.

I would also like to draw attention to the personal anecdote offered by my hon. Friend the Member for Croydon South (Chris Philp) about being phoned up by various claims management companies. I have had a similar experience—which I will not repeat in full—although I was going to Scotland rather than to the south-west. I am still receiving phone calls from the company, and the fundamental reason for that is the incentive structure under which the whole industry operates. Do I agree with hon. Members on both sides who say that certain things in this area need to change? Yes, I do, but does that mean that I should reject a piece of legislation that is designed to tackle certain injustices? No, it does not. So I agree with my hon. Friend on that point.