House of Commons
Tuesday 21 June 2022
The House met at half-past Eleven o’clock
[Mr Speaker in the Chair]
Oral Answers to Questions
Foreign, Commonwealth and Development Office
The Secretary of State was asked—
Ukraine: British Diplomatic Support
The UK has been steadfast in its diplomatic support for Ukraine in the face of Russian aggression. My right hon. Friend the Prime Minister travelled to Kyiv on 17 June to meet once again with President Zelensky. They discussed the situation on the ground, and the Prime Minister announced a major training programme for the Ukrainian armed forces to help sustain them in their heroic defence of their people and their homeland. The United Kingdom will continue to strengthen the hand of our Ukrainian friends to finish the war on terms that President Zelensky has laid out.
I commend the Secretary of State, the Prime Minister and the entire team for all their work on diplomacy in Ukraine. We can all be very proud of it. I was pleased to see that the leaders discussed ending the blockade of grain in the south. Will the Minister update the House on how those discussions went?
The House, and indeed the whole world, should be under no illusion: it is Russia that is blocking Ukraine’s grain exports in an attempt to cripple Ukraine’s economy and use hunger as political leverage. We support the United Nations’ efforts to negotiate a safe corridor for exports by sea and we are engaging internationally to call on Russia to end the blockade. Only Russia can lift the blockade. Ukraine’s ports are vital for global food supplies, and we will keep supplying the weapons that Ukraine needs to bring the war to a successful conclusion.
Last Sunday afternoon, I spent a couple of hours meeting a Ukrainian family who have moved to the Worth valley in my constituency under the Homes for Ukraine scheme. They are so incredibly grateful for the work that the Government are doing, but they did reiterate that we cannot rest until full Ukrainian sovereignty and territorial integrity is restored in Ukraine and until Putin fails. Will my right hon. Friend update the House on recent conversations that he has had with global allies on how we can take a co-operative approach with international partners to ensure that that happens?
I thank my hon. Friend and his community for hosting Ukrainian refugees. Praise is due in every corner of the House for our constituents doing just that. I assure him that my right hon. Friend the Foreign Secretary, my right hon. Friend the Prime Minister and other Ministers in the Foreign and Commonwealth Office and other Departments, as well as officials at every level, are engaging with our international friends and allies on this issue. It will be raised at the Commonwealth Heads of Government meeting, the G7, the G20 and the NATO meeting in Madrid. I also assure him that the UK will not rest in its support of the Ukrainian Government and the Ukrainian people, and we will not rest in advocating on their behalf with the international community.
My hon. Friend makes an incredibly important point. With your indulgence, Mr Speaker, I will reassert the position that the Ukrainian Government have confirmed. Foreign nationals fighting as members of their armed forces must be treated as prisoners of war—that includes the British nationals captured by the Russian forces—and all prisoners of war should be treated in accordance with international humanitarian law, including the Geneva convention. We will of course continue liaising with the Ukrainian Government on the treatment of prisoners of war and any negotiations they might have with Russian forces on the issue.
I thank the Minister for the responses he has given to hon. Members. We as a House of Commons stand united with the people of Ukraine in the face of Russian aggression. May I ask the Minister sincerely what assistance the British Government and NATO allies are giving to the people and Government of Ukraine to tackle Russian disinformation?
The hon. Gentleman makes an incredibly important point. When I speak to my Ukrainian counterpart and others facing direct or indirect Russian aggression, they often bring up disinformation and cyber-attacks. This is a theatre of war, and the integrated review, which was published last year, recognises that. I assure him that we will continue working closely with our friends and allies to counter disinformation and to help them defend themselves against cyber-attack as well as physical attack.
All our hearts and support are with the people of Ukraine, but the conflict is having a significant impact worldwide. Particularly affected are people in east Africa, where grain shortages have coincided with the most dangerous drought in 40 years, cuts to aid and covid-19. Save the Children and Oxfam report that one person is dying of hunger every 48 seconds in Ethiopia, Kenya and Somalia. Will the Minister commit to front-loading future resilience funding to bring forward funds now to prevent a famine?
The hon. Lady makes an incredibly important point. As I said in my earlier answer, Vladimir Putin is using hunger in the global south as a weapon of war and as a point of leverage. It should be noted that the 25 million tonnes of grain currently stuck in Ukraine is equivalent to the yearly consumption of the least developed countries in the world. She is absolutely right to be focused on this issue. My right hon. Friend the Foreign Secretary has said that we will prioritise our humanitarian response in future funding for the Department, but I can assure her and the House that it will remain a priority for the Government.
It is very clear that Putin is indeed the using the starvation of the world’s poorest people as a tool of war. As we seek to fight back against Putin and use all diplomatic powers, does the Minister agree that it would be easier to build a coalition against Putin across the developing world in particular, and of course morally right, if we reversed the cuts to international aid or kept them?
The hon. Gentleman is conflating two fundamentally different issues. The world should be clear that it is Vladimir Putin alone who is creating these problems with his blockade of grain exports from Ukraine. He could turn on the tap of food to the global south tomorrow, and we demand that he does. We will continue to work with our international partners, including the United Nations, to try to facilitate those grain exports, but the world should be clear that it is down to him and that the Russian blockade of the Black sea and Sea of Azov ports is creating that hunger. He should be held accountable for it.
I agree with much of what the Minister has had to say. The shadow Foreign Secretary and I met a delegation of Ukrainian MPs last week and heard at first hand the devastating impact Russia’s illegal actions are having on civilians across Ukraine. May I bring the Minister back to a point I have raised with him a number of times? We need to stay the course in our support for Ukraine, and the whole world needs to stay the course with Ukraine. That will involve substantial costs. Will he look again at not only freezing Russian assets but their seizure and repurposing to ensure that we can support humanitarian and reconstruction efforts in Ukraine?
The hon. Gentleman and I often disagree—that is the nature of being in different parties—but on this issue he is absolutely right that there is a unanimity of voice across the House. I can assure him that we are looking at the issue he raises on seizures and repurposing the value of those seizures. Nothing is off the table. The pain and suffering being inflicted on the Ukrainian people by Putin and his faction must be paid for, and paid for by them.
I echo the comments that Foreign, Commonwealth and Development Office staff and the diplomatic core worldwide do a great job under difficult circumstances, but they are being undermined by talk of politically motivated appointments at home, job losses across the civil service as a whole, and the cut to the 0.7% commitment on aid, a manifesto commitment now betrayed. Surely now is the time to reverse all that talk and actually support civil servants doing tough jobs in tough times?
I thank the hon. Gentleman for the praise he gives to our civil servants both here in the UK and across the world. He is absolutely right: they are doing a fantastic job. I can assure him that my right hon. Friend the Foreign Secretary and my ministerial colleagues across Government Departments liaise with them regularly. They are highly focused, highly motivated and absolutely determined to help deliver the UK’s Government priority, which is to support the Ukrainian people and support the people across the world who are being impacted by the food shortages Vladimir Putin is creating. They are doing so in a way that makes me and the whole House proud. I have no doubt that they will continue to do so.
The UK condemns in the strongest terms the targeting of civilians and regularly raises this issue with the Government of Iran. We welcome the fact that those responsible for the plot against the conference in Paris in 2018 have been held to account. The Belgian courts have convicted four individuals, including Asadollah Assadi, who received a 20-year sentence. We continue to work with the international community to ensure that all countries, including Iran, abide by international rules and norms.
I am trying to hide my disappointment in the answer. Asadollah Assadi orchestrated a planned terrorist attack in mainland Europe that would have resulted in mass casualties, including five Members of the British Parliament, including me. At the Munich security conference earlier this year, the Iranian Foreign Minister, Hossein Amir Abdollahian, met his Belgian and Swedish counterparts for private talks, which included seeking a petition for the release of Assadi and others through prisoner swaps. It would have been ironic if those of us who oppose the joint comprehensive plan of action had been victims, as the terrorists were using resources that came from the sanctions. May I ask the Secretary of State again to meet with her Iranian counterpart to make it clear that any future JCPOA must ensure human rights in Iran and must ensure that terrorism activities are relinquished across the region, including those aimed at mainland Europe?
I am not able to speculate on the context of bilateral talks between Iran and other countries. The UK’s position is absolutely clear: the behaviour of Iran in a whole number of areas is unacceptable. We raise this regularly, and I know that my right hon. Friend the Foreign Secretary has raised our concerns about the Iranian Government’s behaviour on numerous occasions. We will ensure that we continue to call on the Iranian Government to abide by international rules and laws and to respect human rights at every level, including the right of criticism on the international stage.
Colombia: Human Rights
Colombia is an FCDO human rights priority country and UK Ministers and senior officials regularly raise human rights issue as well as specific cases of concern with the Colombian Government. Most recently, my noble Friend Lord Ahmad discussed human rights and the security situation in Colombia in his meeting with President Duque on 12 April, and I raised it with Vice-President Ramírez in February.
I am sure that the Minister will join me in congratulating Colombia on electing a new Administration committed to peace and human rights under Gustavo Petro.
According to human rights groups, on 28 March the army killed several civilians in the village of Remanso, in Putumayo, with outgoing President Iván Duque later praising the attack and describing the victims as armed dissidents. Given that the Colombian military has a history of killing civilians then falsifying the record, what steps are the Government taking to ensure that a proper investigation is carried out?
We congratulate Gustavo Petro on his election as President. We look forward to working with him on many shared priorities after his inauguration in August. He has made it very clear that he is committed to the peace process with the FARC. I also congratulate Colombia on a peaceful election.
Bilateral relations between the United Kingdom and Colombia have gone from strength to strength in recent years, particularly in areas of mutual concern such as trade and investment, tackling drug crime and the environment. Will my hon. Friend assure me that we will continue that same high-level engagement with the new Colombian Administration?
My hon. Friend is absolutely right. We have very many areas of shared interest with Colombia, such as trade and the environment. Tackling drug crime is also a major issue. Colombia is a key partner to the UK and Latin America. We will continue to work closely together on a broad range of issues, and we look forward to working with the new President Petro after his inauguration in early August.
Colombia is once again the most dangerous country in the world in which to be a trade unionist, so when the Minister and the Government engage with President-elect Petro and his new Government will they ensure that the peace process, which is focused on the Government and the FARC, also includes the civil society and trade union groups on which we have perhaps taken our eye off the ball?
The hon. Member makes an important point about protecting civil society. Peace in Colombia was always going to be a difficult challenge, but we have been a leading advocate of that peace process. We will continue to prioritise support for the Colombian Government, and the new President has made it clear that he is committed to the peace process with the FARC, so we will continue to work with them.
I have just returned from Colombia as part of a delegation funded by Justice for Colombia, details of which will shortly be declared in the Register of Members’ Financial Interests. Gustavo Petro’s victory in Colombia’s presidential election should provide new impetus towards the full implementation of the peace agreement in that divided country, but the UK Government have sat idly by as violence against social activists and indigenous peoples has raged on across the country. As the penholder for Colombia at the United Nations, the UK has a responsibility to play its part, so will the Minister commit to changing course and working with the new Administration to finally bring this appalling violence to an end?
I absolutely refute the idea that the UK has been standing by. To date, we have spent more than £69 million through the conflict, stability and security fund. This is supporting the implementation of the peace agreement, and it has been supporting the Government’s rural developments, reintegration programmes and transitional justice mechanisms and strengthening the security and participation of communities in conflict-affected areas. We have also put in over £240 million of international climate funding in the past decade. That is helping to stabilise particularly vulnerable environmental areas by tackling environmental crime and the issues that affect local people. We will continue to prioritise that work, because stability in Colombia is vital for the whole of Latin America.
Ukraine: International Support
It is vital that we continue to back Ukraine. This is about freedom and democracy in Ukraine, and it is also about freedom and democracy in Europe and across the world. That is why we are determined to provide more weapons, impose more sanctions and back Ukraine in pushing Russia out of its territory.
I am pleased that my right hon. Friend mentioned sanctions. Last week she announced a new wave of sanctions, including against Patriarch Kirill, a very public and vocal supporter of Putin’s war. Can she confirm that we will continue to put pressure not just on Putin but on his supporters until Putin fails and Ukraine succeeds?
My hon. Friend is absolutely right. I am proud that the United Kingdom has sanctioned more individuals than any other nation. We have to keep increasing that pressure. Last week we sanctioned Patriarch Kirill, and we also sanctioned the Russian children’s rights commissioner, who has been involved in the barbaric treatment of Ukrainian children. We will continue to impose sanctions and to stop importing goods from Russia until we see Russia fully withdraw from Ukraine.
The new head of the Army was very clear this week when he said that the UK must be
“capable of fighting alongside our allies and defeating Russia in battle.”
Does the Foreign Secretary believe that our defence capability, which is a key arm of UK foreign policy, has all the resources it needs to do that?
It is very true that we face a much more insecure Europe and a much more insecure world, and it is right that we are increasing defence spending. We are increasing our capabilities, particularly in areas such as cyber, but we are also making sure that we have fully trained and efficient armed services, not just to be ready but to ensure that we are training up Ukrainians, for example, and helping our allies, particularly on the eastern flank, who face that direct threat from Russia.
The harvest in Ukraine is going to have to start in the next few weeks. The problem is that there are 25 million tonnes of old crop filling up all the stores, so there will be nowhere to put the new crop. It will have to be piled on the fields, and the Russians will seize it and use it as a weapon of war to buy influence around the world. What more can my right hon. Friend do to ensure that there is international passage for that grain out of Odesa and other ports?
We are doing all we can to secure the export of that very important grain from Ukraine. My hon. Friend is right to say that we have only a number of weeks to be able to achieve that. We are backing the UN plan, but we are also doing what we can with our allies to provide safe passage and to make sure that Odesa is fully defended. Tomorrow, I will be travelling to Turkey to talk to people there about how we could do more to get the grain out of Odesa.
Part of any diplomatic support for Ukraine must include a strategic diplomatic support package for Ukraine’s neighbours in Moldova, Romania, Bulgaria, Poland, Lithuania, Latvia and Estonia. When I spoke to the Polish Defence Secretary a couple of months ago, he detailed what he felt was a very lonely station on the frontline beside Ukraine. Will the Foreign Secretary update us on how he may not feel that way now?
We are working very closely with Poland on our joint defence support, and we are working with Poland and Ukraine on helping Ukraine get NATO-standard weapons. We are also backing Poland, our Baltic state friends and others, including Moldova, particularly through NATO and the bolstering of the eastern flank. We have the NATO summit coming up next week and the UK is pushing hard for more support in the eastern area of Europe.
Sri Lanka: Human Rights
We are closely monitoring the difficult human rights situation and the lack of progress towards post-conflict accountability in Sri Lanka. It is important that the current economic situation does not distract from human rights. We urge the Sri Lankan Government to engage meaningfully with United Nations Human Rights Council resolution 46/1. We continue to raise our concerns in international forums, including by doing so at the UNHRC on 4 June.
The economic crisis on the island has indeed led to increased militarisation in Sri Lanka. The Rajapaksa Government are falling apart and, as we speak, a draft bail-out is being asked for from the International Monetary Fund. As chair of the all-party group on Tamils, and on behalf of Tamils in Carshalton and Wallington and around the world, may I urge my hon. Friend to ensure that the UK does what it can at the IMF to ensure that any bail-out is attached to human rights conditions, similar to the GSP Plus—generalised scheme of preferences plus—arrangement, so that Tamils can have the peace and justice they have been waiting so long for?
I thank my hon. Friend for the work he does in this area. I reiterate that it is really important that the current very challenging economic situation does not distract from efforts to improve human rights. Although the articles of the IMF do allow for conditionality linked to economic policy or to tackling the balance of payments, there is no provision to impose political-linked or human rights-linked conditionality in the IMF process. Therefore, we will work with fellow members on international debt forums on a solution to the country’s debt problem, as well as continuing to lobby the Sri Lankan Government and working in other international forums on human rights.
Thank you very much, Mr Speaker. Later this week, Commonwealth leaders will meet in Kigali for the Commonwealth Heads of Government meeting, and this will include Sri Lanka. We expect the Government to voice their concerns about the long-term peace and justice issues, but pressing economic matters will also threaten stability, both within Sri Lanka and in the region. Will the Government go above and beyond what the IMF is offering and recognise the role of the Commonwealth now to step into the leadership gap and support Sri Lanka’s people with access to food and medicines, by helping to bring economic stability as soon as possible to this great friend of the UK?
The hon. Lady is absolutely right to say that Sri Lanka is a great friend of the UK. Indeed, our Prime Minister spoke to his Sri Lankan counterpart on 30 May and has underlined the UK’s continuing support for the people of Sri Lanka during their economic difficulties. He has offered UK support through multilateral organisations such as the World Bank and IMF, and international forums such as the Paris Club. We have a very significant voice on international debt forums and we are working closely with Paris Club members and multilateral organisations to find solutions to the debt crisis.
Northern Ireland Protocol
We have been clear with the EU that the Northern Ireland protocol needs to change in order to uphold the Belfast/Good Friday agreement, ensure that we have a free flow of goods from east to west, and protect the north-south relationship. Our preference is for a negotiated solution, but in the absence of the EU being willing to change the protocol, we are pressing ahead with legislation.
I am grateful for that reply, but on the Northern Ireland Protocol Bill—which, we note with interest, has not yet found a date for its Second Reading—is there any precedent where the United Kingdom has cited the legal concept of necessity for overriding a treaty that it has freely entered into? We should bear in mind that in this case not only did the Government negotiate and sign the Northern Ireland protocol, but the Prime Minister at the time described it as being
“in perfect conformity with the Good Friday agreement”—[Official Report, 19 October 2019; Vol. 666, c. 583.]
We are clear that our legislation is both necessary and lawful, and have published a Government legal statement laying out exactly why that is. Our priority as the United Kingdom Government is the Belfast/Good Friday agreement, and we know that the Northern Ireland protocol is undermining that agreement. We have not seen the institutions in Northern Ireland functioning since February, and we know that the issues caused are baked into the protocol—namely the customs provisions and the VAT provisions—so we do need to change that.
As I have said, we remain open to negotiations with the EU. That is our preferred course, but they have to be willing to change the issues that are causing real problems for the people of Northern Ireland.
The business community in Northern Ireland is clear that they want to see mutually agreed solutions, and that those are the only way in which they can protect their access to the EU single market. The key ingredient in all this is trust and partnership. The Minister’s Bill is entirely counterproductive in that respect, so what is her strategy for getting back around the negotiating table with the European Union to find those mutually agreed outcomes?
We are very open to negotiations with the European Union, but they have to be prepared to change the protocol itself. The problems we have with customs and people in Northern Ireland not being able to access the same VAT benefits as people in Great Britain are baked into the protocol itself, and the legislation we have introduced, with green lanes and red lanes, protects the EU single market. It does not make the EU any worse off, while at the same time enabling free-flowing trade from east to west.
We need to achieve both of those things. I want to do so through negotiations, but we have been trying for 18 months; as yet, the EU have refused to change the protocol itself, and we simply cannot allow the situation to drift. We cannot allow more trade diversion, and we cannot allow the undermining of the Belfast/Good Friday agreement.
I hear what my right hon. Friend says about negotiating. We all agree that a negotiated settlement would be the best solution, but there is no point in negotiating with somebody who does not have a mandate to agree with any of the negotiation points being put to them. Does my right hon. Friend agree that it is up to the European Commission to change the mandate of its negotiator, Commissioner Šefčovič, so we can have those negotiations and come to an agreement, and so that the people of Northern Ireland can live safe and secure in the knowledge that we are coming to an agreement on this issue?
My hon. Friend is absolutely right that we want a negotiated solution. We have been part of those negotiations for 18 months, but fundamentally the mandate does not allow for the solutions that will help restore the primacy of the Belfast/Good Friday agreement and get rid of the unacceptable frictions that we are seeing in east-west trade. I suggest that Opposition Members direct their calls for negotiations towards the European Union and the goal of securing a new mandate. I think that would be a better use of their time.
The protocol Bill introduced to this House last week breaks international law. It risks the integrity of the Good Friday agreement. It divides the UK and the European Union at a time when we should be pulling together against Putin’s war on our continent, and it risks causing new trade barriers during a cost of living crisis. It is not even enough to get the Democratic Unionist party to commit to return to Stormont. Will the Foreign Secretary now quit posturing for Back Benchers who have lost confidence in the Prime Minister, and get back to the hard work and graft of negotiating a practical way forward?
I am afraid to say that nothing the right hon. Gentleman has just said is accurate. The fact is that our Bill is legal, and we have laid it out in a legal statement. We are putting forward solutions—a green lane and a red lane—that protect the EU single market as well as allowing goods to flow freely around the United Kingdom.
We are very prepared to have those negotiations with the EU, but, at present, we have a negotiating partner that is unwilling to change the issues that are causing the problem in Northern Ireland. The right hon. Gentleman should go to Northern Ireland to see the impact that is having on businesses, hauliers and traders who are facing this customs bureaucracy. It is fundamentally undermining the Good Friday agreement.
I will confess some puzzlement over this. The EU has negotiated a variety of changes to refine the protocol. There are dispute resolution mechanisms within the protocol. There has been a number of opportunities for talks. I have read this idea that the Government need to invoke necessity when there are already other ways of fixing this. That is garbage from start to finish.
In what possible sense can the Government claim that this illegal Bill, which they have brought forward but not scheduled, is a sensible way to resolve the situation when the EU is ready and open for talks? Most people in the Northern Ireland Assembly support the protocol. I counsel the Foreign Secretary that this is also a grievous miscalculation, because it has massively undermined trust at a point when trust is utterly fundamental to resolving this matter.
The hon. Gentleman is wrong. We have been very open to negotiations for the past 18 months, but the EU has been unwilling to change the protocol. He can read last week’s comments of Vice-President Šefčovič that these customs procedures have to remain in place. The fact is that it is the customs procedures—the bureaucracy—that is preventing trade between Northern Ireland and Great Britain. We are seeing trade diversion towards north-south trade and away from east-west trade, and it is undermining the Belfast/Good Friday agreement. That is why it is necessary that the UK Government act. The hon. Gentleman should focus his effort on getting the EU to change its negotiating mandate so that we can have a real negotiation.
Brazil: Violence against Journalists and Activists
I start by reflecting on the very sad disappearance of Dom Phillips and Bruno Pereira in the Amazon region of Brazil. Our thoughts are with their families. I offer thanks to all those involved in the search and rescue operation that was trying to find them. I pay tribute to both men and their commitment to improving our understanding of the Amazon, to its peoples and to the challenges currently faced there. Both men have left a strong legacy of defending and supporting the rights of indigenous peoples in Brazil.
Attacks on environmental activists and indigenous rights defenders in Brazil have increased in recent years, and we raise that regularly with the Government.
I thank the Minister for that response and I echo her comments about the tragic killings of Dom Phillips and Bruno Pereira, but they are not alone. In 2020, at least 182 indigenous activists and 20 environmental campaigners were killed in Brazil. It is the relentless drive to develop the Amazon rainforest that is behind these murders. What are the Government doing to put maximum pressure on the Bolsonaro Government to reverse that trend, but also to reduce our complicity in this through our supply chains and the involvement of British companies in financing this?
We regularly engage with indigenous leaders and civil society organisations. We are in regular contact with Brazil’s national foundation for indigenous people. We are absolutely committed to defending and promoting the human rights of all and we continue to monitor very closely developments around indigenous rights in Brazil and raise concerns with the Government. We have already committed £259 million to help protect the Amazon, with £3 billion more of further funding committed at COP. We have also made it clear that trade should not be at the expense of the environment, climate commitments or, indeed, the concerns that the hon. Lady raises.
It is thanks to journalists and environmentalists such as Dom Phillips and Bruno Pereira that record deforestation, mining and logging, predatory fishing and drug trafficking have been exposed. Dom and Bruno were not on some travel adventure in Brazil, as has been suggested; like others who have been killed over the years, they were doing their job to report on the environmental damage taking place in Brazil that ultimately impacts on us all.
Will the Government work with other international authorities to have the case investigated in a swift, transparent and independent manner, without any interference—not just to seek justice for the families of Dom and Bruno, but to protect future journalists and environmentalists in their important work?
My hon. Friend is right that the case should be investigated. We are grateful to the Brazilian authorities for their help and engagement to date. There has been very close contact between, for example, the local and national police with our embassy team on the ground. It is really important that those who committed this heinous crime are held to account.
Rape and Sexual Violence in Conflict
The use of rape and sexual violence in conflict is a war crime, and I have made tackling it a top priority. The UK is campaigning for it to be treated as a red line on a par with the use of chemical weapons. We will host a conference against sexual violence in November.
We have seen appalling reports of atrocities and the use of rape and sexual violence. We launched the Murad code earlier this year, which sets the global standard for safe evidence collecting. We have dispatched a team from the United Kingdom to the region to help with that evidence collection—by interviewing witnesses and survivors and preserving and collecting images and videos, for example.
Near Upper Committee Corridor there has been an exhibition in the last few days showing the experiences of young women and girls who have been raped and sexually abused in Myanmar, Syria and Nigeria. What the perpetrators of those awful crimes need is accountability. Can there be someone who will take the evidence and ensure those people know that some day they will go to prison, or even worse? They will receive that in the next world, but let us make sure they get it in this world.
Through the International Criminal Court and the work we are doing on evidence collecting, we are working to make sure that the people committing those appalling crimes are held to account—not just in Ukraine, but more widely around the world. That is one of the key aims of the conference we are hosting in November. We are also increasing our budget for women and girls development aid, specifically to tackle sexual violence.
I place on the record my deepest respect for and thanks to our wonderful development and diplomatic staff, who do a fantastic job in very difficult circumstances. I visited Afghanistan this month, which was truly heart-rending. It appears that my right hon. Friend the Member for Tottenham (Mr Lammy) and I are the only British MPs to have visited. I wonder why the Foreign Secretary has failed to visit, one year since the fall of Kabul. She knows that protecting development gains for women in Afghanistan is fundamental, given that millions are facing starvation, new restrictions and the loss of livelihoods.
Rather than hosting a summit, maybe the Foreign Secretary can explain what she meant when she said that
“we are restoring the aid budget for women and girls back to its previous levels and we are also restoring the humanitarian aid budget.”—[Official Report, 8 March 2022; Vol. 710, c. 191.]
Given that she failed to give an oral statement to the House on her 10-year international development strategy, will she make a statement to the House on when she plans to reverse the £1.9 billion in aid cuts to women’s programming that have proven so damaging to women and girls and to our reputation abroad—or is she following the Prime Minister’s lead of chasing headlines and not delivering?
I utterly condemn the appalling actions of the Taliban in reversing women’s and girls’ rights. We are doing all we can together with our international counterparts, including hosting a pledging conference to secure more support for the people of Afghanistan. As I have said, we are restoring the women’s and girls’ budget back to £745 million a year, and we are also ensuring that the humanitarian budget is greater so that we can tackle these issues around the world.
This Thursday I will be heading to Kigali for the Commonwealth Heads of Government meeting. In a world where freedom and sovereignty are being threatened by aggressors, the Commonwealth is more important than ever. It represents a third of the world’s population and about 30% of the votes at the United Nations. The British Government will be backing Kamina Johnson Smith, the Jamaican Foreign Minister, as the new Secretary-General to ensure that the Commonwealth delivers for all its members in areas such as trade, investment and defending democracy.
In answer to an earlier question about Sri Lanka, the Under-Secretary, the hon. Member for Chelmsford (Vicky Ford), said that she would continue to lobby the Sri Lankan Government, but that Government, and their military, are populated in part by people who are credibly accused of war crimes in a civil war that ended more than 10 years ago. The Americans thought that there was enough evidence to impose economic sanctions on some of those individuals. Is lobbying really the best that she can do?
On Sri Lanka, let me start by absolutely emphasising again that violence against peaceful protesters is unacceptable. We absolutely condemn the violence we see happening at the moment and we are urging everybody towards calm. We will continue to work to make sure that we support the country through funding from our conflict, stability and security fund, which has supported peacebuilding, and we continue to respect the independence of the prosecutor when it comes to investigating war crimes of the past.
We were disappointed that last week’s flight was unable to depart, but we are not deterred from doing the right thing in delivering on our plans to control our nation’s borders. We are providing further information to the Court. It would not be appropriate to comment on individual cases at this time. However, we strongly believe that this project meets our obligations under both national and international law, and the Home Secretary has made it very clear that we will do what it takes to deliver this new partnership.
As the Secretary of State knows, 10 days ago I visited Afghanistan. Millions face starvation. One widow whose husband was murdered during the Taliban takeover explained that she was so desperate for money that she had considered selling her kidneys so that she could eat. Meanwhile, conflict continues to rage across the world in Yemen, Lebanon, Ethiopia, Mali and of course Ukraine. Given the scale of the conflicts across the world and the hunger crisis being driven across the world, why is humanitarian aid down by 35% on pre-cut levels? Why are we the only member of the G7 cutting foreign aid, and what impact will this have on our national interests and reputation abroad?
Prior to Russia’s terrible invasion, 68 Ukrainian candidates were shortlisted for interviews for those really special Chevening scholarships. Obviously, those interviews could not take place, but I am absolutely delighted to give those brilliant, talented and often young people some good news: they will all be offered scholarships. That will treble the number of Chevening scholarships offered to Ukraine. For those who are unable to take up their scholarships, if, for example, they are defending their country, they will be able to defer.
I assure the hon. Lady that we are working hard to secure Alaa Abdel Fattah’s release. Lord Ahmad has met the family and I am seeking a meeting with the Egyptian Foreign Minister who is due to visit the United Kingdom shortly, where I will raise this case.
My hon. Friend is absolutely right; that is a vital issue. We are seeing attempts by Russia to destabilise the western Balkans. I recently visited Sarajevo, as has the Minister for Europe and North America, to do what we can to support the country through greater investment, so that there are alternatives to malign investment, and to make clear our support for security in the nation.
As it happens, after this session I will be travelling to Israel and the Occupied Palestinian Territories, which will obviously be a good opportunity to explore a number of different issues and our bilateral relationship with Israel.
This is a terrible tragedy. So far this year, we have provided more than £72 million of additional support to countries in the region, which is helping about 8 million people. We played a vital role in convening a roundtable in Geneva that raised about $400 million. Last week, I wrote to the president of the World Bank to urge it to mobilise further funding urgently. I will meet representatives of the Disasters Emergency Committee later this week to discuss further steps.
My constituent Godwin Suh from Bafut in Cameroon, who now lives in Nottingham, came to see me. He described the political violence that, as anglophones, he and his family have suffered. His brother is missing, his nieces and nephews have been hospitalised, and lately his house there has been badly damaged by Government forces. Will the Minister for Africa meet me and Godwin to hear more about the human rights challenges that many face in north-west and south-west Cameroon?
I welcome the statement last week that we are talking to our international partners about a Marshall fund for Ukraine. I previously suggested that we should consider not only seizing the assets of sanctioned Russians, but monetising them, either by putting a lien on them or by outright sale. Clearly, that would need to be done in conjunction with partners. Has my right hon. Friend considered that?
We are working with our allies and Ukraine on a new Marshall plan to help reconstruct Ukraine after the appalling war. There will be a Ukraine recovery conference in Lugano in the coming weeks, at which the United Kingdom will put forward our offer. We are looking at how we can seize Russian assets to help fund the rebuilding of Ukraine, which is something we are working on across Government and with our G7 partners.
A recent report by the Hong Kong Watch non-governmental organisation found that five Hong Kong officials and six lawmakers complicit in the ongoing human rights crackdown currently own property in the UK, so will the Government now commit to using the Economic Crime (Transparency and Enforcement) Act 2022 to sanction these Hong Kong and Chinese officials?
We remain deeply concerned about the appalling human rights violations in China and about the deterioration of rights and freedoms in Hong Kong. We keep all evidence on potential designations under close review, guided by the objectives of the relevant sanctions regime, but it is not appropriate to speculate about future sanctions and designations as to do so would reduce their impact.
It is vital that we do not forget the painful lessons we learned in the wake of Hurricane Irma in 2017, a key component of which is always to have a naval presence in the region ahead of hurricane season. Will the Minister please assure me those preparations are already being made?
The Department co-ordinated a cross-Government hurricane exercise earlier this month as part of its review of plans to ensure the UK provides a rapid and effective response this year. Officials also hosted a pre-hurricane season conference in May. Having visited Anguilla, the British Virgin Islands and the Cayman Islands, I totally understand the importance of hurricane preparedness. I reassure my hon. Friend that I met the Minister for the Armed Forces last week to discuss how our Departments can work together on an effective and appropriate response in the event of a major disaster.
Is the Foreign Secretary aware that the FCDO has set an annual budget limit for the Independent Commission for Aid Impact that will prevent it from carrying out the workplan to scrutinise UK aid that it previously agreed with my Select Committee? Will she look into this, please?
I recently took over as chair of the all-party parliamentary group for Latvia, and it was a pleasure to meet my opposite number from the Latvian Parliament, Rihards Kols, last week to discuss the importance of our future work together. Does the Minister agree that, now more than ever, it is important that we strengthen even further our long-standing relationship with countries such as Latvia that share a common set of values and principles with the UK?
I congratulate my hon. Friend on taking up his position. The UK enjoys close diplomatic, security and economic relations with Estonia, Latvia and Lithuania. I recently went to Estonia, and my right hon. Friend the Foreign Secretary has also been to the region and taken part in the three seas initiative that co-ordinates a number of workstreams in the Baltic and other parts of eastern Europe.
Since the illegal revocation of articles 370 and 35a, it has become absolutely clear that the right-wing Modi Government are bolder than ever before in their persecution of Kashmiris and minority groups in India. Most worrying, however, is the acceleration in their use of arbitrary arrest and detention of political and human rights activists, including Yasin Malik and hundreds of others, under the illegal Public Safety Act, which takes away any right to due process, yet the UK Government remain silent once more. Does the Foreign Secretary think it is right to continue negotiating a trade deal with the right-wing Modi Government, even at the expense of the blood of innocent men, women and children?
Canada is a key partner, and this morning I met the Speaker of the Legislative Assembly of Alberta, Nathan Cooper, who is keen to emphasise the potential for Alberta to help the UK through its present energy crisis. What is the Foreign Secretary doing to further deepen our relationship with Canada?
Canada is one of our closest allies. It is a fellow member of the G7, NATO and the Commonwealth, and we will shortly be joining it in the comprehensive and progressive agreement for trans-Pacific partnership. I speak regularly to my Canadian counterpart, and we are looking together at how we can bolster our energy security, in areas such as the one that my hon. Friend mentioned but also in the area of nuclear co-operation.
On Sunday, Francia Márquez, an internationally recognised environmental and human rights campaigner, made history by becoming the first black woman to be elected Vice-President of Colombia. Colombia is the most dangerous place in the world to be an environmental activist. Will the Minister commit herself to working with Francia Márquez and her new colleagues to ensure that the social and environmental rights of Colombia’s indigenous population are protected, and that UK aid for environmental programmes prioritises the protection of activists?
The solution to the inflationary crisis that we face, driven by high energy prices and a lack of supply, is primarily international. What is my right hon. Friend the Foreign Secretary doing to challenge OPEC’s position of not intending to take action to increase supply? That strikes me as the single most important thing that the British Government could do to tackle the crisis internationally.
As my right hon. Friend says, we need to tackle energy supply. In the long term, that means more renewables and more use of nuclear energy, but in the short term, it does involve looking at oil and gas. My colleague the Energy Secretary is working closely with his counterparts, particularly in the Gulf region, and I also have frequent conversations with them. We do need to see supply increase in order to lower global process.
I can assure the House that the UK Government remain completely committed to securing the full release of British dual nationals held in Iran. That passion has not been diminished. I assure the right hon. Lady and the House that we will continue to work on this with as much alacrity and passion as ever we have.
On the issue of the Northern Ireland protocol, can the Foreign Secretary give an assurance to businesses in Northern Ireland that are adversely affected by the east-west trade to which she has alluded that that problem will be solved as a result of her Bill, along with other political problems that will also be resolved as long as she proceeds with the Bill?
I can assure the hon. Gentleman that we are proceeding with the Bill. We are also proceeding with close consultations with business on the precise design of the red and green lanes to ensure that it works for companies in Northern Ireland and Great Britain, and also in the Republic of Ireland and the European Union, so that we can deliver the Bill as intended, freeing up east-west trade but also protecting that very important north-south relationship.
Bangladesh and northern India are facing some of the worst floods for 100 years. Many of my constituents are extremely worried about family and friends, especially in the Sylhet area. Can the Minister assure us that the Government will take action in respect of humanitarian aid, particularly when it comes to food, water and sanitation?
When I led the Joint Committee on Human Rights delegation to Strasbourg last week, we were repeatedly told that threats made by the United Kingdom to withdraw, or even just disengage, from the European convention on human rights risked giving succour to eastern European states, including Russia, which do not have the same respect for human rights and the rule of law that the United Kingdom has historically had. Will the Foreign Secretary tell the Prime Minister to tone down his veiled threats to leave the convention, and tell her more excitable Back Benchers to back off?
I honestly thought that the hon. and learned Lady would welcome the fact that the UK led in kicking Russia out of the Council of Europe and holding it to account.
War Pension Scheme and Armed Forces Compensation Scheme (Public Inquiry) Bill
Presentation and First Reading (Standing Order No. 57)
Owen Thompson presented a Bill to establish an independent public inquiry into the administration of the War Pension Scheme and of the Armed Forces Compensation Scheme by Veterans UK; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 16 September, and to be printed (Bill 51).
Ministerial Code (Enforcement) Bill
Presentation and First Reading (Standing Order No. 57)
Owen Thompson presented a Bill to make provision about the enforcement of the Ministerial Code; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 16 September, and to be printed (Bill 112).
Ministerial Interests (Public Appointments) Bill
Presentation and First Reading (Standing Order No. 57)
Owen Thompson presented a Bill to require a Minister to make an oral statement to Parliament if a person is appointed to a paid post by them, in whom, or a company in which, that Minister has a personal, political or financial interest.
Bill read the First time; to be read a Second time on Friday 16 September, and to be printed (Bill 113).
[3rd Allotted Day]
Access to GP Services and NHS Dentistry
I beg to move,
That this House notes that primary care is in crisis, with people across the country struggling to access GP services and dental treatment; believes that everyone should be able to get an appointment to see a doctor when they need to and has the right to receive dental treatment when they need it; is concerned by the Government’s failure to remain on track to deliver 6,000 additional GPs by 2024-25; and therefore calls on the Secretary of State for Health and Social Care to urgently bring forward a plan to fix the crisis in primary care, meet the Government’s GP target and ensure everyone who needs an NHS dentist can access one.
Mr Speaker, thank you for the opportunity to open this debate on the future of primary care, access to GPs and access to dentists. It is a particular delight to see the Secretary of State here. I so enjoyed our exchange of letters last week that I cannot wait to repeat the exchange in real life.
Primary care is the front door to our NHS—for most of us, the general practitioner is the first port of call when we are worried about our health—but after 12 years of Conservative mismanagement and underfunding of our health service, the front door is jammed. Patients are finding it impossible to book GP appointments, serious conditions are going undiagnosed, patients are waiting longer than is safe for treatment, with backlogs building up and greater pressure placed on the rest of the health service, and millions of people are waiting more than a month to be seen, often in pain and discomfort.
My hon. Friend has made an excellent beginning to his speech. What is his view of my local hospital, where, instead of 350 people daily, we have 710 people coming into accident and emergency at the North Middlesex Hospital? What response does he have to that kind of demand? Where is it going to lead if people cannot see a GP? They are going to end up in A&E.
My hon. Friend is absolutely right to highlight that problem. If the front door of the NHS in primary care is jammed, people end up presenting in A&E. As I shall outline in my speech, this is not only a great inconvenience and burden to patients; it comes at an additional cost to the NHS and we all pay the price for that in every respect.
At the GP practice in Norton in my constituency, it is almost impossible to get an appointment on the phone. I have dozens of cases of individuals unable to access vital care. One tried 196 times. The Care Quality Commission has not inspected this practice since 2015. Does my hon. Friend agree that it ought to be doing so now?
Even in the context of the pressures that we see right across primary care—I think every GP practice would acknowledge they face challenges—the case my hon. Friend has just described sounds extreme. We cannot allow the decade or more of mismanagement we have seen from this Government to excuse that kind of care, or indeed absence of care, for patients, and that brings me on to the next point I want to make.
We know why patients are forced to wait: Conservative Governments have cut 4,500 GPs over the last decade, they have closed 300 practices since the last election and they have failed to provide any meaningful reform of the system. The public are sick and tired of waiting. Public satisfaction with GP services stands at the lowest level on record as patients become ever more frustrated with not getting an appointment when they need one, or in a manner to suit them.
It says so much about the NHS at the moment that, while we have the lowest level of patient satisfaction since 1997, when we ask the public whom they trust, nurses and doctors are right up at the top of the list. The public understand that the staff who work in the NHS are trying to grapple with the biggest crisis in its history. Of course, the Government will want to pin that simply on the pandemic, but that does not explain why we went into the pandemic with NHS waiting lists already at record levels, with 100,000 staff vacancies in the NHS and with a decade or more of under-investment, leaving us ill-prepared for the pandemic—or, in the words of the Culture Secretary, “found wanting and inadequate”—but also now struggling to get the recovery from the pandemic that we need to build the health and care service we need for the future.
I am grateful to the right hon. Gentleman for that intervention. I will conclude my speech by talking about what a Labour Government will do, but let me answer his direct point about the range of options through which people should be able to access their GP. I value patient choice. Thinking back to my experience of accessing NHS services last year—as many people know, I did quite a lot of mystery shopping on the NHS—I had a range of interactions with GPs. Some were face-to-face. Some interactions at my GP surgery were not with my GP but with a nurse, which was entirely appropriate and much appreciated. Some of my engagements with my GP were over the telephone. I also had a video consultation with a dermatologist. I really valued that flexibility and range of approaches.
I think that the future for primary care has to be different courses for different horses. Of course, people should have a right to see their GP when they want to see their GP—I am clear about that—but there is also a range of ways in which we can offer more flexible access to GPs, particularly for working people who do not necessarily want to traipse down to the GP surgery in the middle of the afternoon if it is something that could be dealt with over the phone or on a video call.
The shadow Secretary of State is making a powerful speech. I commend in particular the point he made that people still trust their doctors. They are desperate to see them, even if it is online. A 74-year-old constituent of mine contacted me and said that he asked for an online appointment but it would take him 30 days to get there. He appreciates that the issue is not with GPs but with the Government’s lack of planning for the number of GPs who can provide that service in Oxfordshire.
The hon. Lady makes a powerful point. How is it that the NHS can be one of the largest employers in the world—it employs 1.2 million people—but does not have a workforce plan and strategy that says, “This is the workforce need that we have today, this is what the workforce need will be in the foreseeable future and, in the longer term, this is how we need to change the shape of the workforce to take into account advances in medicine and modern technology, and the changing demographics of our society”?
We gave the Government the opportunity to commission such a report when we debated the Health and Care Bill. It was supported on a cross-party basis, including by the Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt)—sadly, he is not able to be with us at the moment—yet the Government voted against it. What is it about the ostrich mentality of the Secretary of State and his ministerial team—or, I suspect even more, that of the Treasury—that they would rather bury their heads in the sand, pretend there is no problem with workforce and not even count the numbers of doctors and nurses needed because they worry that the Treasury might face up to the reality of what they need to provide?
Is it not the case that, in the pandemic, the Government fundamentally misunderstood the connection between the health of the nation and its economic success? All the argument the shadow Secretary of State makes about the NHS workforce and what they can achieve for our country shows that the Government are still making the very same mistake.
I wholeheartedly agree with my hon. Friend, who understands well the link between the health of the nation and the health of the economy. Given the labour market challenges in this country, it is simply not acceptable that we are losing so many people who could be in the labour market to ill health. We are also losing so many people from the labour market who are caring for relatives, because there is a disproportionate burden on families. Who disproportionately bears the burden of that care? It tends to be women, so we are losing a whole tranche of women from the labour market who could be contributing to the growth of the nation and the economy.
It is not just about GPs and surgeries; it is about dental access as well. In my constituency and across the whole of the United Kingdom of Great Britain and Northern Ireland, dentists are prepared to take private care and monthly care, but they will not take NHS patients. As poverty levels and prices rise, dentistry is at the end of the queue. Does the hon. Gentleman agree that dentistry is at crisis point and that Government intervention is absolutely critical?
The hon. Gentleman is right to describe the state of dentistry and I will be getting my teeth into that issue very shortly.
[Hon. Members: “Groan!”] It had to happen at some point. I had to get it in at some point. Let me touch on the other issue he mentions, which is about inequality and inequality of access.
The system in primary care is entirely unequal. Some areas have twice as many doctors as other parts of the country, with as many as 2,800 patients fighting over one family doctor. Patient safety is being put at risk. Last week, the BBC revealed the scale of the crisis in GP surgeries with its investigation into Operose Health. Patients who can get an appointment are seen by less qualified staff, standing in for GPs without supervision. Patient referrals and test results were left unread for up to six months: private profit placed above patient safety. When the Health Secretary was asked about that last week, he said:
“we expect local commissioners to take action.”—[Official Report, 14 June 2022; Vol. 716, c. 140.]
Well, it is not good enough to sit back and wait for others to act. Is an investigation happening? Can he tell us? If not, why on earth has he not launched one? [Interruption.] The Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield), from a sedentary position, talks about the last Labour Government. When are the Conservatives going to wake up to the fact that they have been in government for 12 years? Twelve years! It is remarkable. Twelve years they have been in government.
I thank the hon. Gentleman for giving way. He makes grand statements in support of the NHS, but I am afraid his actions do not support the NHS. He has backed these train and tube strikes today, which have meant that in my constituency patients cannot get to hospital, and nurses and doctors cannot get to their places of work. Can we have better action, rather than words?
I am very, very grateful to the hon. Lady for that intervention. Our party has been clear: we did not want to see the strikes go ahead. We believe the strikes could have been averted if the Government had shown responsible action. The absolute brass neck of the Secretary of State! It is one thing pretending they have not been in government for the last 12 years; now they are pretending they are not in government today and that, somehow, it is down to me, the shadow Health Secretary. Somehow, if I had uttered the magic words, “Don’t go ahead,” the RMT would have said, “Oh no, the shadow Secretary of State for Health has spoken now. We better put a stop to it.” [Interruption.]
Order. I want to help a little bit. We do not want to open up a debate that is not down for today. We have got a little bit carried away. The hon. Member for Kensington (Felicity Buchan) got in, and I was quite right to allow a response, but I think we have heard enough now.
Thank you, Mr Speaker.
I was about to quote the great political philosopher, Jonn Elledge, who, in response to what the Secretary of State said, commented on Twitter that we are
“all as ants before the might of the all powerful shadow health secretary”.
When is the Health Secretary going to wake up to the fact that he is in government, he has responsibilities, he is discharging the greatest crisis in the history of the NHS and he is doing nothing about it? Instead of lecturing the Opposition, when is he going to show some leadership and get on with governing?
The “Panorama” programme also exposed the fact that GP practices are being hoovered up by the private sector. Operose Health now owns 70 practices, with more than 600,000 patients. That exposes the fact that there is now a value to GP patients lists and that they are being sold on. They are collected by GPs, free of charge and then, as they are amassed in great number, they are sold to the private sector. Is my hon. Friend, like me, concerned about that practice?
I wholeheartedly agree with the point my hon. Friend makes. It is simply not good enough for the Minister to keep on talking about what the last Labour Government did. If she does not agree with the situation described by my hon. Friend, which is happening on her watch, why does she not legislate? If she is incapable of governing, she should make way for people who can govern.
I commend my hon. Friend for the tone of the speech that he is making, because it is vital that we stand up for our NHS, which the Government are failing to do. They seem happy to let everybody be angry with their GPs and about their inability to seek the medical help they need, but very unwilling to do something about it. Is this argument not really one to be had with the Government entirely? They should be making sure that we have sufficient GPs to treat the people in this country.
I wholeheartedly agree with my hon. Friend; it is the trend with this Government to seek division, sow division, pass the buck, devolve the blame and not take responsibility for anything. What Opposition Members would not give for just one day of being able to govern in the interests of the people in this country! This Government want to give the appearance of being in office but not governing at all. That is what is happening on their watch. If that is not bad enough, against a difficult economic backdrop, with scarce resources, not only is the way in which they manage and govern bad for patients, but it is squandering taxpayers’ money.
I will give way in just a moment. The problems in general practice are storing up problems for the rest of the NHS; as we have heard, people are presenting in accident and emergency because they cannot see a GP. That failure is costing the taxpayer dearly. A GP appointment costs the NHS £39, but a visit to an urgent care centre costs it £77 and a visit to the emergency department costs it £359. The Government’s failure to invest in new GPs may be penny-wise but it is pound-foolish. It is wasting money and inconveniencing patients, and it is not the way to manage the NHS. One of my constituents wrote to me yesterday to say that if she wants a same-day appointment for her baby, her GP sends her to A&E. She wrote:
“I was sent to A&E to check a newborn baby’s suspected ingrown toenail that had no sign of infection. How is going to A&E for a non-urgent matter a good thing for anyone.”
Yet that is what our constituents are forced to do, because they cannot get a GP appointment. I hope the hon. Member for Sleaford and North Hykeham can give us some insight as to why.
As part of that, I suggest that the hon. Gentleman remembers that GPs take 10 years to train. He is right to say that we have been in government for 12 years, but most of the current GP shortage is because the previous Labour Government did not train those GPs at the time. One of the first things the Conservative Government did was to set in train the opening of five medical schools to increase the number of medical students. We had enough doctors but they do take 10 years to train. The reason I stood up to intervene on the hon. Gentleman was to say that one of the challenges that doctors—I refer to my entry in the Register of Members’ Financial Interests, as a doctor—and members of staff face is being abused in a surgery. I wonder whether he would like to apologise for some of the comments he has made on social media—
Let me first say in response to the final point the hon. Lady made that there is absolutely no excuse for abusing NHS staff whatsoever. Most people in this country do not blame NHS staff for the state of the NHS; they place the blame squarely where it belongs, with the Government who have been in power for the past 12 years. Her first point would be more powerful if we did not have 1,500 fewer full-time equivalent GPs now than we did when her party came to power. Her point would have been more powerful if her party had not whipped its MPs to vote against having a workforce plan for the NHS, but I am afraid that that is what it did. Conservative Members cannot run way from their choices and decisions, and from the fact that they have now been in government for 12 years and there is no one else to blame but themselves. In communities right across the country, we now see the consequences of their mismanagement.
I regret to inform the hon. Gentleman that the situation in Wales is not much better, but I do not want to make a party political point. Will he commend the potential role that pharmacists can play in alleviating pressure on GPs? I have an excellent pharmacist in my home village of Pen-y-Groes, which provides an invaluable service for the communities in my area.
I wholeheartedly agree with the hon. Gentleman’s point about the importance of looking at primary care as a whole and the really powerful and valuable contribution that community pharmacies can make, alleviating pressures on other parts of the primary care system, particularly general practice.
Communities across the country are experiencing those problems; let me take one place at random to illustrate the scale of the challenge. Today, after a decade of Conservative mismanagement, the city of Wakefield has 16 fewer GPs than in 2013. In fact, Wakefield has not seen a single additional GP since the Prime Minister promised 6,000 more at the last election, and since Wakefield has been served by a Conservative MP—albeit, thankfully, no longer—it has seen three GP practices close, with some surgeries so short-staffed that 2,600 patients are left to fight over one family doctor. Last month, patients in Wakefield were able to book 25,000 fewer GP appointments than in November 2019, the last month in which they were served by a Labour MP. The only good news for general practice in Wakefield in recent years has been that Simon Lightwood, an NHS worker and brilliant candidate in Thursday’s by-election, has successfully campaigned to save the King Street walk-in centre. [Interruption.] They don’t like it. Conservative Members shout in protest and point the finger at us, but they have been in government for 12 years.
The hon. Gentleman is talking about problems, but his motion does not include one solution. He has now been speaking for 20 minutes, and he has not outlined one solution. If he wishes to be taken seriously as a politician, will he now turn to some solutions to the problems he has outlined?
It is certainly true that I am saving the best until last in my speech, but the hon. Gentleman may have missed the point I have made repeatedly, which is that the NHS—an organisation that employs more than 1.2 million people—needs a workforce strategy. It needs a proper analysis of what its workforce needs are today, the workforce needs of tomorrow, and the future shape of the workforce. We gave Government Members the opportunity to vote for that; the hon. Gentleman voted against it, and he wants to lecture me about being taken seriously as a politician. Who is he trying to kid? I do not know how the hon. Gentleman voted, because it was a secret ballot, but the fact that a majority of Government Members voted to keep the current Prime Minister in office means that they are not in any position at all to lecture anyone else on who is and is not a serious politician.
I am very grateful to the shadow Secretary of State for giving way. I have in front of me figures from the House of Commons Library on the increase in GPs per 100,000 population between September 2015 and April 2022, which show an 8% increase for Wakefield.
I notice that the hon. Gentleman has played the old trick of selecting figures from a specific set of years, but nothing he has said contradicts the facts that I have outlined. In any case, the people of Wakefield will draw their own conclusions on Thursday when they go to vote. The fact is that the Government have had more than enough time to reform general practice in this country, and they have no one other than themselves to blame for the crisis we are in.
Since the Conservative party has been in government for the past 12 years, I thought I would take a trip down memory lane to remind us, the House and the British people exactly what they have been promising since they were first elected in 2010. The 2010 Conservative party manifesto promised that GP surgeries would be open 12 hours a day, seven days a week. The Government failed to deliver that—maybe they blame their coalition partners, although I do not think the Liberal Democrats would have disagreed with GP surgeries being open for that long—so they promised the same again in 2015. That time, they set themselves a deadline of 2020, and guess what? They missed that, too.
In 2015, they promised that everyone over the age of 75 would get a same-day appointment—another promise broken. They said they would hire 5,000 more GPs by 2020—another promise broken. In 2019, they promised 6,000 more GPs, but the Health Secretary has already admitted that he is on course to break that promise, too. They promised 50 million more GP appointments a year, but as the British people know from their experience, appointments are down. That is today’s Conservative party: over-promise and under-deliver, never take responsibility, and leave patients paying the price.
This morning, one of my constituents contacted me to say she was standing outside her GP practice at 7.15 am in order to secure an appointment. She said that she was successful in securing an appointment, but a number of people who were also standing outside did not. Does my hon. Friend remember the Health Secretary promising that people would have to do that in order to secure a GP appointment?
I wholeheartedly agree with my hon. Friend. This is the problem: they overpromise and underdeliver. If they will not hear it from me, Mr Speaker, let us remind ourselves of what some of the Secretary of State’s colleagues have said. The hon. Member for South West Bedfordshire (Andrew Selous), who is in the Chamber, said in Prime Minister’s questions only last week:
“At one of my surgeries, which has double the recommended number of patients per GP, the bowel cancer diagnosis of a 51-year-old father of four was missed and is now terminal.”—[Official Report, 15 June 2022; Vol. 716, c. 283-4.]
Earlier this month, the hon. Member for Telford (Lucy Allan) read a letter from a constituent to the Health Secretary. It said:
“Trying to get basic healthcare is a joke in Telford. Maybe I would be better off in…a third-world country”.
If the Secretary of State is not going to listen to us, he should at least listen to his own side. Before Conservative Members leap to the defence of their Government’s record, they should probably go back and check the record to make sure that they had not agreed with us in the first place.
As for dentistry, 2,000 dentists quit the NHS last year, around 10% of all dentists employed in England. It is an exodus under the Government’s watch. Four million people cannot access NHS dental care and cannot afford to go private either.
My hon. Friend is making an excellent speech. My constituent, Ellie Cokeley, wrote to me. She works as a receptionist in a local dental practice and gets hundreds of calls a week from upset members of the public who are unable to find an NHS dentist. She said that it feels greatly unjust that the poorest in our society are being forced to pay huge amounts for vital dental care or, worse still, having to continue without any at all. Are the Government not failing people in this country when it comes to the care of their teeth? It is vital that we get more dentists in the system.
I will give way first to my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), then to my hon. Friend the Member for Hackney South and Shoreditch (Dame Meg Hillier) and then to the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone).
My hon. Friend mentioned Somerset, but can I also mention Sunderland, to keep up the alliteration? In Sunderland, we cannot find an NHS dentist and the few good ones we have are now turning to private practice to make it work. It is an existential crisis in dentistry—it really is at breaking point. Does my hon. Friend agree that the blame lies squarely with the Conservative Government, with backlog Britain, and that this is the effect on our constituents?
A constituent of mine told me that she had a terrible toothache, rang 111 and was assigned to an emergency dentist. The system worked, but does my hon. Friend agree that that that costs the taxpayer so much more money? My hon. Friend talks about overpromising and underdelivering, but with dentistry the Government have not even promised anything and they are underdelivering.
My hon. Friend knows exactly what she is talking about. Of course, there is no one better in this House to make the point about the waste of public money. That is the outrageous thing about all of this. People are paying more and getting less. Their taxes have been put up, justified in the name of the NHS, but the money is not being directed in the right way to deliver better care. In fact, the Government admit that even with the investment they are putting in, people will be waiting longer for care and that is a disgrace.
I thank the shadow Secretary of State for giving way. He is very civil. Can I also go down memory lane? We have had a Government of a rather different colour in Scotland since 2007, and today I have constituents coming to me and saying, “I cannot get on an NHS dentist’s list”. That echoes the point made by the hon. Member for Strangford (Jim Shannon). Does the shadow Secretary of State agree that in the event of the present Government sorting this situation out, they would do well to share what they did with the Scottish Government? And in the event of a change of Government after the next general election, will the shadow Secretary of State commit to giving advice to the Scottish Government?
This is the thing that the First Minister of Scotland does not want to acknowledge, but for all her noise, bluff and bluster she knows full well that a Labour Government here in Westminster would be good for the people of Scotland. The investment and reform that we would put into the NHS to deliver the same kind of results as the previous Labour Government did would be good for the people of Scotland. I look forward to the day when I can phone the Scottish Government to give them some advice and I look forward to the day when the Governments in Westminster and Edinburgh are Labour Governments delivering for people across the United Kingdom.
The hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) mentioned the trip down memory lane. The Under-Secretary of State for Health and Social Care, the hon. Member for Lewes, regularly blames Labour for what is happening in dentistry. That is because of something that happened 16 years ago: it was a contract that was put in place by the last Labour Government, which we committed to reform in our 2010 manifesto. Unfortunately, that manifesto was never implemented. The tragedy is that the Conservative manifesto that promised reform of the dentistry contract was not implemented either.
In 2010, the Conservatives promised to introduce a new dentistry contract. In 2017, they also promised to introduce a new dentistry contract. What is the Minister’s policy today? She promises to introduce a new dentistry contract. She must make up her mind: either, the current contract is so good that every time she tries to change it, she cannot find a way of improving it, or, the Minister’s Department, her Secretary of State and her Government are so incompetent, so distracted, or so indifferent, that they simply cannot get the job done. It is no good their blaming the Labour party for the problems in NHS dentistry. They have been asleep at the wheel for 12 years. They have failed to do anything to improve the service, and now 4 million people cannot access a dentist. The consequences are severe.
Let me tell the Health Secretary about a constituent of my right hon. Friend the Member for Normanton, Pontefract and Castleford (Yvette Cooper). She tells me that this constituent cannot get a dentist appointment anywhere for an unbearable toothache, and that they are in too much pain to sleep through the night. When they contacted a dentist, they were told that they would have to wait two years for an appointment. They wrote in an email:
“I am in such agony that I took Ibuprofen, drank whisky and tried to pull it out myself with plyers, but they kept slipping off and it was agony.”
What kind of country have we become when the most common reason for children to go to hospital is to have their teeth extracted? We have 78 children going to hospital every day to have their teeth extracted. [Interruption.] There is no point Members arguing from a sedentary position that it is because of fizzy drinks. That is their approach all the time. The system is broken, so let us blame the patients. It is absolutely outrageous. DIY dentistry in one of the richest countries on the planet, and their answer is to blame the patients. They should get real. This is so far from that original promise of the NHS, where care is provided to all who need it, when they need it.
To be fair to the Health Secretary, he has been in the role for just under a year, and, on that note, I would like to wish him a happy anniversary this Sunday for one year in the job. But I am afraid that that is where the niceties end, because I will now run through what he has said and done in his year in charge. He had a big media splash on “league tables for practices” to pressure them into doing more face-to-face appointments and then he backed down. He achieved great headlines on “nationalising GPs” in January—imagine the excitement—but there has been no action since. He talks about bringing the NHS into the Netflix age. Has he ever actually used the NHS app? I cannot even book a GP appointment through the app because my GP is not on it. Why is it still not available to every patient as a way to book appointments? I visited Israel recently—I refer to my entry in the Register of Members’ Financial Interests—where it has embraced the technological advances in medicine over recent years to massively improve access to healthcare for patients.
I was talking to a start-up, which is developing an app that tracks the recovery of stroke victims, and notifies them when they need to see a physio. I then showed the staff what the NHS app can do and what it cannot do and they laughed. In some senses, the Health Secretary had a point: the NHS is not as modernised as it needs to be to deliver for patients, and nowhere is that more true than in primary care. It is an analogue service in a digital age. Patients should not have to wake up at 8 in the morning and wait on the phone for an hour for an appointment. They should not be told to expect a call back, but given no indication as to what time that will be, and then be considered a missed appointment if they do not pick up because they are at work, or are busy, or are picking up the kids and doing everything else that people do between nine and five.
People have never been so well-informed about their own health. We carry around with us devices that can measure our exercise, our heart rate, how well we sleep, and so much more. Yet our healthcare system puts none of this to use and keeps all the pressure on GPs.
Let me conclude by outlining some of what a Labour Government would do to address this crisis—[Interruption.] I am not surprised that Conservative Members are excited; they must be as fed up as we are. First, we would take immediate practical steps to boost the number of GPs available. Why have the Government sat idly by while doctors are forced to retire early, for no other reason than that the cap on their pension contributions means they pay a financial penalty for staying on? Let us change the rules to keep the good doctors we have. Why is it that, at the last count, 800 medicine graduates had not been able to find junior doctor posts? Let us get them to work immediately—
It is rubbish, but it is his record.
Why is it that so many people are accessing NHS services because of a failure to invest in social care, where staff can be recruited and deployed a lot faster? On the dentistry contract, the last Labour Government acknowledged that the 2006 contract was not good enough, which is why we put the reform of that contract in our 2010 manifesto. The difference is that we will not wait 12 years to deliver the promise after the election of the next Labour Government. Those are just some of the practical steps that we would take immediately and that the Government could take immediately.
Let me tell the House about some of the fundamental issues we would fix. First, mental health services in this country are in such a state that GPs are seeing more and more of their own cases present with mental ill-health. A Labour Government would recognise that there has been a surge in mental ill-health following the pandemic and we would not leave it to overwhelmed GPs to see them. That is why we have committed to recruiting 8,500 new mental health professionals, including specialist support in every school and mental health hubs in every community. We would pay for that by ending the charitable status of private schools and closing the tax loopholes enjoyed by private equity fund managers—and do not tell me the Health Secretary does not know where they are; he was using them before he became a Member of Parliament.
That policy—[Interruption.] Conservative Members are funny. They ask for our policies but they do not like it when we provide the answers, because we have them and they do not. That policy, which would put mental health hubs in every community and support in every school and speed up access to treatment for everyone in our country, would help to reduce pressure on GPs and to deliver better mental health treatment in every community and faster access to a GP for everyone else who needs to see them. It also tells you something about the choices we would make and the priorities we would have as a Labour Government: better public services enjoyed by the many, paid for by closing tax perks for the few.
I know that there is lots of cynicism about politics. We have a Prime Minister who wants people to believe that we are all the same, that things cannot change and that his shambles of a Government are the best that Britain can do. All I would say to the people of Britain is this: judge them on their record and judge Labour on ours. They have been in power now for 12 years. They delivered the highest NHS waiting lists in history, before the pandemic. They delivered record staffing shortages in the NHS with 100,000 vacancies, before the pandemic. They delivered cancer care that worsened in every year since they came to office, before the pandemic. Now they tell us that patients will be paying more and waiting longer.
The last Labour Government were in power for 13 years, and we delivered the highest patient satisfaction in the history of the NHS, the lowest waiting times on record and more doctors, nurses and new hospitals. There were no threats of strikes in the NHS when we were in government because staff could see the difference we were making and so could the patients. We did not get everything right—nobody is perfect—but Labour’s record on the NHS is one that this Government could not even begin to touch. The longer we give the Conservatives in power, the longer patients will wait. Well, people are sick, and they are tired of waiting. This Government’s time is up.
I welcome this chance to come to the House to discuss primary care and dentistry, but I have to say that the audition by the hon. Member for Ilford North (Wes Streeting) did not go very well. I hope that he can see the irony—some might even say the hypocrisy—of his sudden interest in access to public services, today of all days. It is thanks to the strikes that he has been so vocal in supporting the fact that people right across the country cannot make their appointments, that GPs and dentists cannot get to work and that patients do not have access to the treatments they desperately need.
I will take some interventions in a moment.
The hon. Gentleman has had every opportunity to do the right thing, to put patients first and to condemn these unjustified and reckless transport strikes, yet at every turn he has chosen to back his union paymasters.
We are seeing record investment in the workforce, and we are seeing record increases. For the first time ever, the NHS is also coming up with a 15-year long-term workforce strategy, which I hope the hon. Lady welcomes.
The Government have always been on the side of patients and the people who care for them. I pay tribute to everyone working in primary care and dentistry for the difference they make day in, day out to their patients’ lives. I know that the pandemic has brought some unimaginable pressures, and equally I know that many of those pressures have not gone away now we are living with covid.
The hon. Member for Ilford North talks as though he does not know where the pressures have come from—as though he has had his head under a rock for two years. The NHS has said it believes that between 11 million and 13 million people stayed away from the NHS, including their GPs and dentists. Rightly, many of those people are now coming forward for the treatment they need—and I want them to come forward.
When the Secretary of State does the much-needed manpower review, will he ensure that a fast-growing area such as Wokingham with lots of new houses gets proper provision for that growth? Will the manpower plan also address how we recruit the doctors we have authority to get?
Last month, a constituent contacted me who had developed severe dental pain. He phoned 40 dentists and not one of them could take him on as an NHS patient. It got so bad that he phoned 111 but was told that he was not eligible to see an emergency dentist. What advice would the Secretary of State give to someone in those circumstances? Many other hon. Members on both sides of the House will be able to tell similar stories. In the end, my constituent had to pay to go private, but that should not have happened. Why are our constituents being placed in that position?
I am sorry to hear about the right hon. Gentleman’s constituent. If he will allow me, in a moment, I will come on to the pressures that dentistry is facing and, most importantly, what we are doing about them.
Those pressures have come about for two reasons. First, there was a fear of infection, which was understandable in a context where 10 minutes in a dentist’s chair during the pandemic could have meant 10 days in self-isolation or, perhaps, worse. Dental practices were almost uniquely at risk of spreading covid, so their activity was rightly severely constrained across the world—not just here in England and across the UK—by the infection prevention rules that were necessary at the time. Despite all the innovations in dentistry over the last few years, dental surgeries do not have a Zoom option.
Secondly, the British people stayed away because of their innate sense of responsibility during the pandemic. As all hon. Members saw in their constituencies, people understood our critical national mission. Our GPs were doing their duty vaccinating people in care homes and in thousands of vaccination centres up and down the country, protecting the most vulnerable and working hard to keep us all healthy and safe.
When omicron struck—we all remember that period, which was not that long ago—I stood before this House and asked GPs to stop all non-emergency work once again. I did not take that decision lightly, but we were faced with a stark choice of having more lockdowns or accelerating our vaccine programme. We chose to accelerate, with help from all corners of the NHS and with the backing, at that time, of the hon. Member for Ilford North. I remember him standing at the Dispatch Box pledging his full support for that effort and rightly stating that the Government were acting
“in the best interests of our NHS, our public health, and our nation.”—[Official Report, 13 December 2021; Vol. 705, c. 795.]
He recognised that it was the right thing to do then; he has now conveniently changed his mind. I wonder why.
But people like Mark in my constituency cannot find an NHS dentist. This is not about covid; it was happening before covid. The investment just is not there. He is in pain; he is in agony. The Secretary of State needs to step up, step in and get things right.
Covid is just a pathetic excuse, because even if it was the sole reason, the Secretary of State should have been planning for when we came out of it, but nothing he has said explains why we had record numbers of patients on waiting lists even before covid started.
Excuse me for raising this issue, but I want to draw attention to the fact that there has been news released that the Secretary of State’s Government have declined to introduce mandatory reporting of complications resulting from mesh. In the context of problems with waiting lists, and wider issues, if we do not introduce a mandatory reporting scheme to identify problems with a medical product, more people will end up requiring medical intervention and medical treatment, so I urge the Government to look again at their declining to introduce mandatory reporting.
The hon. Lady raises an important issue. That is why the Government commissioned an independent report. We have responded to that report. We are still listening to what hon. Members such as herself and others are saying on this important issue, and then we will do a follow-up of the report within a year, so that will be later this year. I know that she will take an interest in that.
Does my right hon. Friend agree that a lot of the issues with primary care services are about leadership? In my constituency, we have the brilliant Thistlemoor surgery with Dr Neil Modha and Dr Azhar Chaudhry, who serve 29,500 patients, 80% of whom do not have English as a first language. Same-day, face-to-face GP appointments are the norm in that practice. In contrast, a Thorney surgery has just temporarily closed a surgery in my constituency due to a lack of admin staff, which is not the fault of the admin staff themselves. Will he back my campaign to make sure that that GP surgery is open again serving local people as soon as possible?
My hon. Friend is campaigning passionately for primary care services in his constituency, and he points to some fantastic practices. I congratulate all the people involved in delivering that and support him in his work with his local commissioners to make sure that they are getting even better local primary care.
Does my right hon. Friend recognise that the crisis in NHS dentistry, which affects my constituency as it does his, well predates the pandemic, and indeed goes back to at least 2006 when the then Labour Government changed the way in which dentists are paid? Will he undertake to look at the units of dental activity system, which disincentivises dentists from providing dental work particularly in the most disadvantaged communities?
My right hon. Friend is absolutely right in his analysis, and I can give that undertaking. I will say a bit more about that in a moment.
If the hon. Member for Ilford North wants to talk about funding for the NHS, I am happy to oblige. Under the last NHS long-term plan, before the pandemic, we made a historic commitment of an extra £34 billion a year. Because of the pandemic, we then necessarily put in £92 billion of extra funding. At the last spending review, we increased funding still further so that the NHS budget will reach £162.6 billion by 2024-25, supported in part by the new health and social care levy.
We have made sure the NHS has the right level of resourcing to face the future with confidence, but we must also be alive to the consequences. The British people expect every pound spent to be spent well, and they expect us to be honest with them that every extra pound the hon. Gentleman calls for will be a pound less spent on education, infrastructure, housing and perhaps defence. I believe in a fair deal for the British people, and especially for our young people. We will be making plenty of changes alongside this funding.
One of the major problems we face in Wales and across the UK is the need to replace retiring GPs and dentists. There has been a welcome increase in the number of international medical graduates training in Wales, but the British Medical Association informs me that very few GP practices and dental practices in Wales are registered as skilled worker visa sponsors. Will the Secretary of State raise this with the Home Office to see what can be done to help GPs and primary care practitioners retain those international graduates to work in Wales and across the UK, if they so decide?
We are working with our colleagues in the Home Office on this and other skills and healthcare issues, so I can give the hon. Gentleman that assurance. He talks about the major problem he is facing in Wales, and that major problem is a Labour Government. I hope he agrees—[Interruption.] He is nodding.
Look at the performance of Labour in Wales, whether on health or education: the median waiting time for outpatients in Wales is almost double the median waiting time in England. People in Wales are waiting more than three years, whereas the longest wait in England is more than two years. Thanks to the covid recovery plan we set out in this House a few months ago, the number waiting more than two years has been slashed by more than two thirds in just four months, and it will be almost zero next month.
Thousands of people in Wales are waiting two or three years. In fact, one in four patients in Labour-run Wales are waiting longer than a year. In England it is one in 20, which is far too high and will be lowered, but in Wales it is one in four. It is not surprising the hon. Member for Ilford North had nothing to say about his colleagues in power in Wales.
There is much better performance from the Welsh Government than from the UK Government. The Prime Minister promised 6,000 more GPs, which has not happened.
I wrote to the Secretary of State about Blackburn having only 33 GPs per 100,000 people, whereas the south-west has 73. I wrote to him about a young man whose cancer was misdiagnosed, but I have not had a response. I would say Wales is doing much better than the Secretary of State.
That is a very strange comment about the hon. Lady’s colleagues in Wales. Either she does not know or she is deliberately saying something she does not quite believe. Perhaps I can make her aware of the facts in Wales, where the number of people waiting more than two years for treatment currently stands at more than 70,000. That is more than three times the figure in England. That is more than three times the figure in England. It is at 70,000, and the hon. Lady seems to be very comfortable with that. I am surprised—it tells us all we need to know about Labour’s ambitions for government if she thinks that is acceptable.
The Secretary of State knows we are having a debate about the whole UK, but I am asking him specifically about England and his responsibility. Can he answer the original question from my hon. Friend the Member for Blackburn (Kate Hollern), which was about the Prime Minister’s 2019 commitment to 6,000 extra GPs? We know there are 1,000 newly qualified foreign GPs who are about to be deported by his Government, plus students who are unable to complete their studies because this Government are not providing them with the money for the final years. Under the management of the Secretary of State’s Government in the last decade, we have lost 4,500 GPs. Can he talk about what he plans to do to replace them?
I am happy to talk about that. Because of the record funding this Government have put in, both pre and post pandemic, we are seeing record increases in the workforce across the NHS. When it comes to GPs, since March 2019 we have seen an increase of some 2,389. On top of that, we have seen a further increase of more than 18,000 full-time equivalent staff working in other important primary care roles. That is in England—I am talking about England numbers.
Of course, we are working hard towards the targets we have set. We are also seeing more GPs in training in our medical schools than ever before, with more medical schools operating than ever before. I hope the hon. Lady will welcome that result and that investment.